| Abstract: | Introduction: Heart failure is a complex clinical syndrome that affects patients both physically and
psychologically, requiring specialized care. Due to the increasingly aging population, the incidence of
this disease is also expected to rise. Heart failure is categorized into acute and chronic based on its
form. Regarding the left ventricular ejection fraction, it can be classified into heart failure with
preserved ejection fraction or HFpEF, heart failure with mildly reduced ejection fraction or HFmrEF,
and heart failure with reduced ejection fraction or HFrEF. The diagnostic approach to a patient with
heart failure includes biomarkers, such as natriuretic peptides, which are known for their reliability in
both diagnosis and prognosis. The aim of the research was to determine the prognostic value of
natriuretic peptides in various forms and phenotypes of heart failure.
Methods: A descriptive method was used, involving a review of professional and scientific literature
by Slovenian and international authors, whose research area is related to the prognostic value of
natriuretic peptides in patients with heart failure. We reviewed literature in databases such as PubMed,
Google Scholar, Springer Link, and COBISS.SI. For the purpose of the research, we used literature that
was fully accessible, content-appropriate, published in Slovenian and/or English language, and originating
from the period between January 2013 and July 2024.
Results: In our literature review, we initially retrieved 1,237 results based on our search strategy.
Based on the reviewed titles and abstracts, we excluded 1,137. We then conducted a full-content
review of the remaining 100 sources, excluding an additional 76. The remaining 24 sources were
thoroughly analyzed and included in the final analysis. Based on the research, we formed three
categories: the prognostic value of natriuretic peptides, competing prognostic biomarkers in heart
failure, and pre-analytical phase factors.
Discussion: Natriuretic peptides remain the most researched and reliable markers in the context of
prognostics and diagnostics of heart failure. The prognostic value of BNP or NT-proBNP is currently
considered somewhat more reliable than that of ANP or MR-proANP due to a lack of studies. The
phenotype of heart failure (HFpEF and HFrEF) and the form (acute and chronic heart failure) do not
significantly affect the prognostic value of BNP or NT-proBNP. ANP or its fragment MR-proANP is
more pronounced in acute heart failure with consequently higher concentrations compared to chronic
heart failure, where it is less researched and reliable as a prognostic tool. Most authors conclude that
the prognostic value, especially of NT-proBNP, is improved and enhanced when combined with other
biomarkers involved in the pathophysiology of heart failure, such as ST2, GDF-15, hs-cTnT, MRproADM.
Among these biomarkers, ST2, along with troponins, is the most researched. Among the
biological factors of the preanalytical phase (related to the patient) that influence the values of
natriuretic peptides are the patient’s age, sex, comorbidities (renal dysfunction, atrial fibrillation,
obesity etc.), and the phenotype of heart failure (HFpEF and HFrEF). Factors that may cause irrelevant
results or complications of the diagnostic procedure include the patient's physical activity before
sampling, the type of tube used, the storage of the tube and temperature, sample haemolysis, the
patient's position during sampling, sample contamination, incorrect identification, improper transport,
insufficient tube filling volume, and venous blood stasis. |
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