Natriuretic peptides in acute coronary syndromes: A new role to predict recurrent ischemic event-related mortality?

Risk stratification in acute coronary syndromes (ACS) has been previously based on the severity of acute clinical presentation, presence of cardiovascular comorbidities, and abnormalities of ischemia-specific biomarkers, most importantly troponins. Natriuretic peptides (NPs), which become elevated upon increased myocardial wall stress, are established diagnostic and prognostic biomarkers in patients with heart failure. Recently, their prognostic potential in ACS has been reported, specifically as predictors of future new-onset heart failure or left ventricular (LV) systolic dysfunction. In the current issue of the Hellenic Journal of Cardiology, a new role of NPs is suggested in ACS as predictors of long-term mortality associated with recurrent cardiac ischemic events, specifically in patients with preserved or mid-range LV ejection fraction upon index ACS. Potential pathophysiological mechanisms that explain the association between augmented NP levels with recurrent myocardial ischemia are hypothesized including the potential of NPs to reflect augmented local and/or systemic inflammation, prothrombotic state, and vascular dysregulation.