VOL. 3, No. 3/4, October 2006

A. Martinez and J. L. Januzzi [2006] Med Hypotheses Res 3: 785-801.

Extending the Utility of Natriuretic Peptide Testing:
Current Concepts and Future Realities

Abelardo Martinez and James L. Januzzi*

Departments of Medicine and Division of Cardiology, Massachusetts General Hospital,
Boston, MA 02114, USA

Abstract. Use of natriuretic peptide testing as a cornerstone in the diagnosis of heart
failure is now widespread. Important recent advances in the understanding of natriuretic
peptide testing have led to the recognition that these valuable assays for B-type natriuretic
peptide (BNP) or its amino-terminal fragment (NT-proBNP) may have applications well
outside the realm of heart failure. However, in order to refine these applications, a thorough
understanding of the finer physiologic and pathophysiologic mechanisms affecting BNP and
NT-proBNP is necessary. Such an understanding will not only enable clinicians to interpret
BNP or NT-proBNP levels more properly when evaluating patients with heart failure, but
also will lead to a more confident use of these markers in different clinical applications, such
as evaluation of other disease states, reviewed within. This paper will review the influence of
the common patient-specifiic physiologic and pathophysiologic factors known to affect BNP
and NT-proBNP other than heart failure, and will discuss opportunities for future, more
novel applications for natriuretic peptide testing.

*Address all correspondence to: Dr. James L. Januzzi, Division of Cardiology,
Massachusetts General Hospital, 55 Fruit Street, Yawkey 5984, Boston, MA, 02114. Phone:
617-726-3443; Fax: 617-643-1620; E-Mail:

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