De natriuretiske hjertehormoner. Klinisk anvendelse ved hjertesvigt
Sammanfattning
The heart synthesizes and releases peptide hormones, the natriuretic peptides that primarily augment natriuresis and diuresis. Furthermore they have a vasodilatory effect. The fact that plasma concentration of the natriuretic peptides and their precursors increase significantly in heart failure patients has given rise to many investigations concerning the diagnostic, prognostic and therapeutic value of the peptides. A high plasma-brain natriuretic peptide (BNP) cannot in itself make the diagnosis of systolic left ventricular dysfunction (LVSD) but a normal plasma-BNP contains a high negative predictive value. In addition, BNP is a strong predictor of mortality and morbidity and it seems independent of and stronger than other known clinical, neurohumoral and hemodynamic variables associated with a bad prognosis. Conventional treatment titrated after plasma-N-proBNP as well as treatment with the socalled vasopeptidase inhibitors may prove to have a potential in the future treatment of chronic heart failure.