Biomarkers of Heart Failure (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):
Circulation, 2004
We read with interest the viewpoint of Dr Milton Packer in a recent editorial 1 accompanying a study examining the behavior of B-type natriuretic peptides in outpatients with congestive heart failure (CHF). 2 Dr Packer 1 suggested that B-type natriuretic peptides (BNPs) have not been shown to "improve upon the information derived from the patient-physician interaction" (p 2951). We disagree, citing data from the BNP (Breathing Not Properly) Multinational Study, 3 in which the results of the results of BNP testing were superior to clinical judgment for the detection of CHF among patients presenting in an urgent fashion. Similar results are now pending for NT-proBNP.
Clinical Chemistry, 2006
The B-type natriuretic peptides (BNP) and the amino-terminal probrain natriuretic peptide (NT-proBNP) are good markers of prognosis and diagnosis in chronic heart failure (HF). It is unclear, however, whether differences in their biological characteristics modify their clinical correlates and prognostic performance in HF. This work aimed to provide a direct comparison of the prognostic value of BNP and NT-proBNP in patients with chronic and stable HF. Methods: We measured BNP and NT-proBNP at baseline in 3916 patients enrolled in the Valsartan Heart Failure Trial. To identify the variables associated with both peptides, we conducted simple and multivariable linear regression analyses. We used Cox multivariable regression models to evaluate the independent prognostic value for all-cause mortality, mortality and morbidity, and hospitalization for HF. Prognostic performance was assessed by pairwise comparisons of the area under the curve of receiver-operator characteristic curves.
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...
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.