ResearchApr 25, 20260 views

Integrated use of natriuretic peptides and DASI for cardiac reserve evaluation in high-risk surgical patients: a narrative review.

Natriuretic peptides just got a bigger role in surgical risk assessment. Researchers are now pushing for a combined approach: measure natriuretic peptide levels and use the Duke Activity Status Index (DASI) to gauge cardiac reserve before high-risk surgery. The idea? Pair lab data with patient-reported function to get a clearer picture of who’s at risk.

J Anesth Analg Crit Care

by Senussi Testa T, Cuttone G, Damiani F et al.

“Integrated use of natriuretic peptides and DASI for cardiac reserve evaluation in high-risk surgical patients: a narrative review. Senussi Testa T(1), Cuttone G(2), Damiani F(2), Ippati G(3), Zanza C(4), Misseri G(5), La Via L(6). Author information: (1)Department of Cardiac Anesthesia and Intensive Care, Cardiovascular Network, IRCCS Policlinico San Martino Hospital, Genova, Italy. t.senussi@hotmail.it. (2)Anesthesia and Intensive Care Unit, "Abele Ajello" Hospital, ASP Trapani, Mazara del Vallo, Italy. (3)Anesthesia and Intensive Care Unit, "S.A. Abate" Hospital, ASP Trapani, Erice, Italy. (4)Geriatric Medicine Residency Program, University of Rome "Tor Vergata", Rome, Italy. (5)Anesthesiology and Pain Department, Foundation G. Giglio Cefalù, Palermo, Italy. (6)Dipartimento di Chirurgia Generale e Specialità Medico Chirurgiche, School of Medicine and Surgery, University of Catania, Catania, Italy. BACKGROUND: The perioperative management of high-risk patients undergoing major noncardiac surgery remains a significant challenge in modern healthcare. Accurate preoperative risk stratification is crucial for optimizing patient outcomes and resource allocation. This narrative review explores the emerging approach of combining natriuretic peptide measurements with the Duke Activity Status Index (DASI) to evaluate cardiac reserve in high-risk surgical patients. MAIN BODY: We examine the individual roles of natriuretic peptides (primarily B-type natriuretic peptide and N-terminal pro-B-type natriuretic peptide) and the DASI in preoperative risk assessment, highlighting their strengths and limitations. The rationale for integrating these two measures is discussed, emphasizing their complementary nature in providing both objective biomarker data and patient-reported functional status. The review synthesizes current evidence supporting this combined approach, including recent studies demonstrating improved risk discrimination compared to traditional methods. We outline a methodology for implementing this integrated assessment, addressing the timing of measurements, interpretation of results, and integration with existing risk stratification tools. Furthermore, we provide guidance on the management of identified high-risk patients, including prehabilitation and optimization strategies. The natriuretic peptide/DASI approach is also positioned within the broader context of perioperative assessment to guide appropriate clinical implementation. CONCLUSION: The integration of natriuretic peptides and DASI represents a promising strategy for enhancing preoperative cardiac risk assessment in high-risk surgical patients. While further research is needed to refine and validate this approach, it offers a practical and potentially powerful tool for improving perioperative care and patient outcomes. © 2026. The Author(s). Conflict of interest statement: Declarations. Competing interests: The authors declare no competing interests.”

The review breaks down why this matters. Natriuretic peptides like BNP and NT-proBNP are already solid biomarkers for heart stress. DASI, on the other hand, captures functional capacity straight from the patient. Used alone, each tool has blind spots. Together, they fill in the gaps. The evidence is stacking up that this integrated approach beats traditional one-size-fits-all risk scores.

Here’s what the researchers propose for high-risk surgical cases:

•

Test natriuretic peptide levels before surgery to catch hidden cardiac problems.

•

Have patients complete the DASI questionnaire for a real-world check on their activity level.

•

Combine both data sources for more accurate risk stratification.

•

Use the results to guide prehabilitation, optimization, and perioperative planning.

This isn’t just theory. The review highlights methodology, timing, and practical management strategies for real-world use. It’s a roadmap for research teams and clinicians aiming to improve surgical outcomes.

Key takeaway: The natriuretic peptide plus DASI combo is shaping up as a practical, evidence-backed strategy for high-stakes surgeries. More studies are needed, but the momentum is there.

For anyone interested in the broader science behind peptides in clinical and research settings, see the peptide research index. The integration of biomarkers and functional assessment is making cardiac risk research a lot more interesting.

Back to News Read original on J Anesth Analg Crit Care

Integrated use of natriuretic peptides and DASI for cardiac reserve evaluation in high-risk surgical patients: a narrative review.

Related Reading

The STRIDE Trial and Semaglutide: Implications for Clinical Vascular Practice.

Structure-Based Adaptation of a SARS-CoV-2 Neutralizing Peptide to New Virus Variants.

Combining an α(v)β(6)-Targeted (177)Lu-Based Peptide Receptor Radionuclide Therapy with Olaparib to Boost Therapeutic Efficacy in Pancreatic Cancer.