Natriuretic peptides (NPs) are entered in current guidelines for heart failure
(HF) diagnosis and management because of their high specificity and sensibility
in screening patients with acute dyspnea. Due to their availability and
relatively low cost, they became the first step examinations in HF patients
evaluation at hospital admission together with clinical and chest radiography
examination. NPs are released following any cardiac haemodynamic stress due to
volume or pressure overload and should be considered as a mirror of cardiac
condition helping in recognizing patients with poor outcome. Moreover, the exact
role of NPs in early HF stages, in isolated diastolic dysfunction, and in general
population is questioned. Several promising reports described their potential
role; however, the wide cut-off definition, inclusion criteria, and intrinsic
measurement biases do not actually consent to their clinical application in these
settings. A multimodality strategy including both NPs and imaging studies appears
to be the best strategy to define the cardiac dysfunction etiology and its
severity as well as to identify patients with higher risk. In this review, we
describe the current and potential role of NPs in patients with asymptomatic
cardiac insufficiency, evaluating the requirement to obtain a better
standardization for imaging as for laboratory criteria
