Natriuretic peptides: molecular biology, pathophysiology and clinical implications for the cardiologist (original) (raw)
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Review on the Correlation between Natriuretic Peptide Levels and Heart Failure
Many studies have evaluated the diagnostic characteristics of BNP and NT-proBNP. Study populations have included patients with acute decompensated HF who present to the emergency room or patients with symptoms and signs of HF who are evaluated by primary care physicians. These studies have examined the performance of BNP and NT-proBNP in patients with various comorbidities and at different cut points. However, questions about issues such as optimal cut points still persist regarding the diagnostic capability of BNP and NT-proBNP. Consequently, a systematic review is needed to better understand the diagnostic capability of BNP and NT-proBNP.Clinically, HF is a syndrome with typical symptoms (e.g., breathlessness and fatigue) and signs (e.g., elevated jugular venous pressure and pulmonary crackles). Patients with HF may have either reduced or preserved left ventricular ejection fraction (LVEF). The diagnosis of HF can be difficult since the clinical features of the condition are not always sensitive or specific. No gold standard investigation exists to diagnose HF. The use of BNP or NT-proBNP in the diagnosis, prognosis, or treatment for HF requires knowledge of the variation in peptide levels over serial measurements. Currently, the evidence is uncertain concerning how much of a difference in BNP or NT-proBNP concentration is clinically important.The challenge of diagnosing HF emphasizes the importance of evaluating whether other investigations may help diagnose the condition. Furthermore, the characteristics of these other investigations should be examined for their prognostic utility and their usefulness in guiding HF therapy. The natriuretic peptides, i.e., B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP), may be useful to help with diagnosis, prognosis, and management of HF. BNP and NTproBNP are secreted into the bloodstream by cardiac myocytes in response to increased ventricular wall stress, hypertrophy, and volume overload. BNP and NT-proBNP levels are increased in persons with HF, and low levels rule out HF. Thus, these peptides have emerged as promising markers for HF 1. Assessment of prognosis is important to promote better counseling of HF patients with regard to future therapies, including cardiac transplantation. Research suggests that BNP and NT-proBNP may provide incremental prognostic information beyond what is available from the clinical data such as New York Heart Association (NYHA) class, LVEF, and comorbidities 2. A systematic review is required to better understand whether BNP and NT-proB-NP provide prognostic information for patients with acute decompensated HF and chronic stable HF. The management of HF is essentially directed by an algorithm for medical therapy. Many times, patients are not fully optimized on therapy because clinicians believe, based on the clinical findings, that further optimization is unnecessary. This could result in under treatment for HF patients. Since BNP and NT-proBNP concentrations have been found to decrease with the escalation of therapy, sequential measurement of these markers may be a useful means of guiding HF treatment. To date, individual studies have not definitively demonstrated whether BNP or NT-proBNP test values can guide HF therapy. A systematic review of this issue would provide information to assess strategies to better optimize the management of HF patients. The use of BNP or NT-proBNP in the diagnosis, prognosis, or treatment for HF requires knowledge of the variation in peptide levels over serial measurements. Currently, the evidence is uncertain concerning how much of a difference in BNP or NT-proBNP concentration is clinically important. Given the many outstanding issues involved in using BNP and NT-proBNP for diagnosing, prognosticating, and treating HF, the following questions are to be addressed 3 : • Question 1: In patients presenting to the emergency department or urgent care facilities with signs or symptoms suggestive of heart failure (HF):
Biomarkers of HFpEF: Natriuretic Peptides, High-Sensitivity Troponins and Beyond
Journal of Cardiovascular Development and Disease
Heart failure (HF) is a significant cause of morbidity and mortality worldwide. HF with preserved ejection fraction (HFpEF) is a complex syndrome, often participated by several cardiac and extracardiac conditions, including chronic kidney disease, pulmonary disease, anaemia and advanced age. Circulating biomarkers reflecting pathophysiological pathways involved in HFpEF development and progression may assist clinicians in early diagnosis and management of this condition. Natriuretic peptides (NPs) are cardioprotective hormones released by cardiomyocytes in response to pressure or volume overload and in response to activation of neuro-endocrine-immune system. The relevance of B-type NP (BNP) and N-terminal pro-B-type NP (NT-proBNP) for diagnosis and risk stratification has been extensively demonstrated, and these biomarkers are emerging tools for population screening and as guides to the start of treatment in subclinical HF. On the contrary, conflicting evidence exists on the value o...
Congestive Heart Failure, 2004
Among the most exciting developments in the field of heart failure in recent times has been the rediscovery of the natriuretic peptide system and its pleuripotent effects on cardiac structure and function. This is particularly true of its natriuretic and hemodynamic effects. There has been an explosion of the knowledge base seeking to understand the wide range of homeostatic, regulatory, and counter-regulatory functions in which the natriuretic peptide system participates. Additional interest has been stimulated by advances in technology such as point-of-care and core laboratory BNP assays and the use of the recombinant B-type natriuretic peptide nesiritide as a treatment option. Despite this recent interest, the available literature lacks a comprehensive expert review of the current science and roles of natriuretic peptides for diagnostic, prognostic, screening, treatment monitoring, and therapeutic purposes. More importantly, a summary updating and guiding the clinician on most of these advances was lacking. An expert Consensus Panel with basic, methodological, and clinical expertise was convened to summarize current knowledge in these areas and the findings and consensus statements are contained herein.
Natriuretic Peptides in the Diagnosis and Management of Chronic Heart Failure
Heart Failure Clinics, 2009
Circulating levels of the BNP system can help in the diagnosis of cardiovascular disease and provide prognostic information not only in patients with HF but also the general population and other patient groups. Changes over time also carry prognostic information and studies are assessing BNP-guided treatment strategies. New insights regarding the biology of the BNP system are emerging with identification of circulating molecular forms of BNP, which may improve the diagnostic and prognostic value of BNP. Likewise, accounting for rs198389, a common single nucleotide polymorphism that increases BNP levels, may help to further refine our use of components of the BNP system as biomarkers.
Journal of geriatric cardiology : JGC, 2018
B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP), the key members of natriuretic peptide family have been recommended as the gold standard biomarkers for the diagnosis and prognosis of heart failure (HF) according to the current clinical guidelines. However, recent studies have revealed many previously unrecognized features about the natriuretic peptide family, including more accurate utilization of BNP and NT-proBNP in diagnosing HF. The pathophysiological mechanisms behind natriuretic peptide release, breakdown, and clearance are very complex and the diverse nature of circulating natriuretic peptides and fragments makes analytical detection particularly challenging. In addition, a new class of drug therapy, which works via natriuretic peptide family, has also been considered promising for cardiology application. Under this context, our present mini-review aims at providing a critical analysis on these new progresses on BNP and NT-proBNP with a special emphasis on...
Urinary B-type natriuretic peptide levels in the diagnosis and prognosis of heart failure
Journal of cardiac …, 2007
Background: Plasma B-type natriuretic peptide (BNP) is a useful biomarker for diagnosis and prognosis of heart failure (HF); however, urine BNP has never been calculated. We sought to compare urinary and plasma BNP levels and to investigate the potential diagnostic and prognostic value of this peptide in HF. Methods and Results: Urine and plasma BNP levels were measured in 92 HF patients and 30 control subjects. Urinary BNP levels were higher in HF patients than in control subjects (P ! .0001), correlating with plasma BNP levels (r 5 0.64, P ! .0001). Urine BNP was a good tool for the diagnosis of HF, the area under the curve (AUC) being 0.91 6 0.06 (P ! .0001). Urinary BNP levels had prognostic power for cardiac events (cardiac admissions þ mortality) with an odds ratio of 6.6 (P ! .05). To determine the prognostic power of urinary BNP in detecting 12-month cardiac mortality, we obtained an AUC of 0.76 6 0.6 (P 5 .014). Conclusions: The data suggest that urine BNP is a new candidate marker for diagnosis and prognosis of HF mortality and cardiac events. This raises the possibility of using this relatively simple noninvasive test in primary care settings or in specific conditions where the collection of blood samples could be difficult. (J Cardiac Fail 2007;13:549e555)
Pharmacology & Therapeutics, 2004
The natriuretic peptide family consists of at least 3 structurally similar peptides: atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), and C-type natriuretic peptide (CNP). Under normal conditions, ANP is synthesized by the atrium and released in response to atrial stretch. This peptide plays an important role in sodium and water homeostasis and is involved in cardiovascular function. In contrast, BNP is synthesized primarily by the ventricles, and its circulatory concentrations are significantly elevated in profound congestive heart failure (CHF). While both plasma levels of ANP and BNP have been found to be increased in patients with various heart diseases, the elevation in circulatory BNP correlates better than ANP with the severity of CHF. Therefore, plasma BNP has been suggested (and lately used) to aid in the accurate diagnosis of heart failure in patients admitted to the emergency room with symptoms of decompensated heart failure. Furthermore, circulatory BNP has been utilized as a prognostic marker in CHF as well as a hormone guide in the evaluation of the efficacy of the conventional treatment of this disease state. In light of the cardiovascular and renal effects of BNP, which most likely exceed those of ANP, the former has been used as a therapeutic agent for the treatment of patients with acute severe CHF. Intravenous infusion of BNP into patients with sustained ventricular dysfunction causes a balanced arterial and venous vasodilatation that has been shown to result in rapid reduction in ventricular filling pressure and reversal of heart failure symptoms, such as dyspnea and acute hemodynamic abnormalities. Thus, the goal of this article is to review the physiology and pathophysiology of natriuretic peptides and the potential use of their circulating levels for diagnosis and treatment of heart failure. D 2004 Elsevier Inc. All rights reserved.
Natriuretic Peptides in the Diagnosis and Management of Acute Heart Failure
Heart Failure Clinics, 2009
Heart failure (HF) is one of the major health problems in modern medicine. It is the most common cause of hospitalization in people older than 65 years. Despite advances in pharmacotherapy for treating HF, the incidence and the morbidity and mortality associated with HF continue to rise. This rise in incidence is in part because of the aging of the population and age-related prevalence of risk factors such as hypertension, and the improved survival of patients who have acute coronary syndromes, a group at especially high risk for developing HF. A recent study, which showed that in the last 25 years, the incidence of HF has tripled, 1 confirmed the magnitude of economic burden faced by the modern health system.