Challenges of using natriuretic peptides to screen for the risk of developing heart failure in patients with diabetes: a report from the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) Committee on Clinical Applications of Cardiac Bio-Markers (C-CB).

BACKGROUND

Several guidelines groups have made recommendations about how to use natriuretic peptides (NPs) to screen patients with diabetes for incipient heart failure. This group is at risk for undetected and stage B heart failure, where structural heart disease is present despite the absence of clinical signs and symptoms. These recommendations are based on trial data that suggest there are therapeutic options to benefit these patients.

CONTENT: These guidelines do not adequately account for the marked analytic differences between NP assays nor their high degree of biological and analytical variability. Thus, without additional data and guidance, these recommendations could lead to excessive testing for some groups but might disadvantage others. In addition, these issues could lead to difficulties in the interpretation of values. Accordingly, the Committee on Clinical Applications of Cardiac Bio Markers of the International Federation of Clinical Chemistry has developed a consensus educational document to describe these difficulties and define areas where additional data are needed. Clinicians should be cognizant of differences in the assays for NPs, the high degree of variability of values, differences in sex and ethnicity and the need to factor in a variety of clinical and treatment variables in interpreting NP values.

SUMMARY: These suggestions for diabetes eventually will include others at high risk. They will require close attention to the issues involved in measuring and interpreting NP values.