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

backgroundThe 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.

conclusionThe 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.