Brain natriuretic peptide--the biological marker in the diagnosis of overt congestive heart failure and myocardial ischemia (original) (raw)
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Hospital chronicles, 2015
Brain natriuretic peptide (BNP) is a peptide hormone secreted by cardiomyocytes in response to atrial or ventricular wall stretch. It promotes a number of systemic effects, including vasodilatation, increase in urinary output and sodium excretion as well as inhibition of the sympathetic nervous system and the renin–angiotensin–aldosterone system. Plasma BNP levels have been reported to be elevated in patients with left ventricular hypertrophy, congestive heart failure, acute coronary syndromes, atrial fibrillation and impaired renal function. Moreover, elevated BNP levels have been shown to be a strong predictor of morbidity and mortality in patients with heart failure. Interestingly, it has also been found that the N-terminal peptide of BNP is slightly superior to BNP for predicting death or re-hospitalization for heart failure. Presumably, it is the longer half-life of NT-pro-BNP that may promote it as a more accurate index of ventricular stress and therefore a better predictor of...
The American Journal of Cardiology, 2005
The usefulness of B-type natriuretic peptide (BNP) levels to assess ventricular dysfunction in children and the congenital heart disease population remains largely unknown. We retrospectively analyzed 62 patients with or without known heart disease who had plasma BNP measured for the investigation of new or severity grading of known ventricular dysfunction. BNP levels were significantly higher in patients with ventricular dysfunction (mean 623 ؎ 146 pg/ml, range 5 to 5,000) than in patients without ventricular dysfunction (mean 22 ؎ 5 pg/ml, range 5 to 63; p <0.01). Using a cutoff of 40 pg/ml, BNP levels detected heart disease associated with ventricular dysfunction at a sensitivity of 85%, specificity of 81%, positive predictive value of 92%, and negative predictive value of 68%. The degree of BNP elevation was also associated with the severity of heart failure and high ventricular filling pressures. Plasma BNP elevation can be a reliable test in children and young adults with various kinds of congenital heart disease resulting in ventricular dysfunction. ᮊ2005 by Excerpta Medica Inc.
Natriuretic Peptides and Heart Disease in Infants and Children
The Journal of Pediatrics, 2005
The natriuretic peptides are a family of circulating peptides that play an important role in the regulation of extracellular fluid volume and blood pressure. These peptides induce natriuresis, diuresis, and vasodilatation and specifically act to counter the effects of the renin-angiotensin-aldosterone system. 1-3 The cardiac members of this family are the atrial or A-type natriuretic peptide (ANP) and the B-type natriuretic peptide (BNP). ANP is secreted primarily from the cardiac atria in response to increased left and right atrial pressure as well as volume loads, whereas BNP is secreted primarily from the ventricles in response to increased left and right ventricular pressure and volume loads. The stimulus for natriuretic peptide release is myocyte stretch. 1-4 The natriuretic peptides are synthesized as pre-prohormones, are cleaved to prohormones, and then are cleaved to the C-terminal active peptides and the N-terminal prohormones that have no known biological actions, and are found in the plasma. Binding of the natriuretic peptides to specific receptors on the surface of target cells leads to generation of cyclic guanosine monophosphate, which mediates most of the biological effects. 5 The physiological properties of the natriuretic peptides made them attractive candidates for heart failure therapy. Indeed, BNP (nesiritide) was found to be beneficial, and it was approved for treatment of acute decompensated congestive heart failure in the United States in 2001. Preliminary reports suggest that subcutaneous administration of the peptide may be well tolerated and beneficial for patients with heart failure. 6 Another therapeutic approach is blockade of the degradation of the natriuretic peptides. New drugs that block natriuretic peptide degradation and angiotensinconverting enzyme production have been developed and tested for therapy of congestive heart failure and hypertension. Soon after the discovery of the physiological role of these peptides, it was realized that the natriuretic peptides may serve as biochemical markers for heart disease. In comparative studies, BNP and its terminal prohormone fragment, N-terminal pro-B-type natriuretic peptide (NT-proBNP), were found to be superior to ANP as markers in myocardial infarction as well as chronic heart failure. 7 NT-proBNP has a longer halflife and its plasma levels are higher than those of BNP. 8 Thus BNP may be more appropriate for measuring acute changes and NT-proBNP for the management of patients with chronic heart failure and for monitoring the response to therapy. 9 In recent years, commercial kits for the measurement of BNP and NT-proBNP have appeared. These kits do not require extraction and are easy to use and are available for commercial laboratory systems. Available commercial kits for BNP are automated platforms developed by Bayer Diagnostics (Tarrytown, NJ), and Abbott Laboratories (Abbott Park, Ill), and a point-of-care assay, that can perform bedside BNP measurements within minutes, manufactured by Biosite (San Diego, Calif). An assay for NT-proBNP has been introduced by Roche Diagnostics (Mannheim, Germany). Standardization of these assays is lacking, and different cutoff values have been reported. 10 The availability of these tests makes BNP and NT-proBNP candidate markers for heart disease in everyday practice. The clinical value of these peptides and their potential benefit for the practicing cardiologist have been subject to intense clinical research in recent years. A wealth of data has accumulated in adults. In pediatrics, however, knowledge about the clinical role of BNP and NT-proBNP is limited but has expanded rapidly in recent years. The purpose of this article is to review the available data and the potential use of these markers in infants and children. CLINICAL VALUE OF BNP IN ADULT CARDIOLOGY The natriuretic peptide system is activated in heart failure. In adult patients with left ventricular dysfunction, plasma levels of BNP, and NT-proBNP, are elevated. 1,4,11 Data on NT-proBNP show that this marker is comparable to BNP for detection of left ventricular ANP A-type natriuretic peptide BNP B-type natriuretic peptide NT-proANP N-terminal pro-A-type natriuretic peptide NT-proBNP N-terminal pro-B-type natriuretic peptide Qp/Qs Pulmonary-to-systemic flow ratio
Indian journal of clinical biochemistry : IJCB, 2007
The burden of disease in patients with congestive heart failure is high. The future of BNP looks promising as it may be a better diagnostic tool for the diagnosis of CHF in developing countries in new millennium. Natriuretic peptide hormones, a family of vasoactive peptides with many favourable physiological properties, have emerged as important contenders for development of diagnostic tools and therapeutic agents in cardiovascular disease. Measurement of B-type natriuretic peptide has become as an easy-to-perform bedside test. The clinical and diagnostic significance of the measurement of plasma Nt-proBNP in the diseases of the cardiovascular system with particular emphasis on the assessment of patients with heart failure and their effects on predicting survival rate. The plasma levels of Nt-proBrain Natriuretic peptide responds more vigorously after myocardial infarction than those of other natriuretic peptides. This article is an attempt to give a short overview on the utility of...
Clinical Chemistry and Laboratory Medicine, 2000
The aim of this article is to review the diagnostic and prognostic relevance of measurement of brain natriuretic peptide (BNP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) in pediatric patients with congenital cardiac diseases (CHD). A computerized literature search in the National Library of Medicine using the keywords ''BNP assay'' and ''NT-proBNP assay''qneonate/s and newborn/s was performed. Next, we refined the analysis to include only the studies specifically designed to evaluate the clinical usefulness of BNP and NT-proBNP measurements in children with CHD. Several authors suggested that BNP/NT-proBNP is clinically helpful as a diagnostic and prognostic marker for children with suspected CHD. BNP values are age dependent, even in paediatric populations. Unfortunately, accurate reference values for BNP and NT-proBNP for neonatal ages have only recently become available. As a result, the lack of homogenous and accurate decisional levels in the neonatal period greatly limits the clinical impact of the BNP assay, and also contributed to the production of conflicting results. Regardless of age, there is great variability in BNP/ NT-proBNP values among CHD characterized by different hemodynamic and clinical conditions. In particular, cardiac defects characterized by left ventricular volume and pressure overload usually show a higher BNP response than CHD which is characterized by right ventricular volume or pressure overload. BNP and NT-proBNP may be considered helpful markers in the integral clinical approach for patients with CHD. Measurement of BNP cannot replace cardiac imaging (including echocardiography, angiography and magnetic resonance), but provide independent, low cost and com-
Role of brain natriuretic peptide in the diagnosis and management of heart failure: Current concepts
Journal of Cardiac Failure, 2002
Background: Progression of heart failure is related to ventricular remodeling, a process associated to neurohormonal activation. Brain natriuretic peptide (BNP), a member of the natriuretic peptide family, has recently emerged as an important neurohormone in the pathophysiology of heart failure. Methods: In this update, some of the recent advances on the role of BNP in heart failure are summarized. In particular, the role of BNP in diagnosis of heart disease, as a prognostic marker of cardiovascular events and as a possible guide to optimize heart failure therapy is discussed. Results: Recent results from 4,300 patients enrolled in the Valsartan Heart Failure Trial (Val-HeFT) confirmed that BNP is the strongest predictor of outcome in heart failure, when compared to other neurohormones and clinical markers. The current use of BNP in the screening and diagnosis of heart failure and its possible future roles are presented. Conclusion: In recent years, there has been an impressive accumulation of data supporting an important role of BNP as a diagnostic and prognostic marker of heart failure. Development of rapid, accurate and affordable diagnostic methods will allow the routine monitoring of BNP in a wide spectrum of settings, from general practice to controlled clinical trials.
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.
Scandinavian Journal of Clinical & Laboratory Investigation, 1998
The use of cardiac peptide measurements as possible diagnostic tools in congestive heart failure has been extensively discussed in the recent literature. Therefore, the aim of this study was to establish a model of experimental chronic heart failure, and thereby perform a comparative study of secretion and circulating levels of the cardiac peptides atrial natriuretic peptide (ANP), N-terminal proatrial natriuretic peptide (N-terminal proANP) and brain natriuretic peptide (BNP) during evolving heart failure. Chronic heart failure was induced in seven pigs by rapid left atrial pacing for three weeks. The e¡ects of failure induction were documented 24 h after pacemaker deactivation. Hemodynamic indices of cardiac preload, like pulmonary capillary wedge pressure (PCWP) and right atrial pressure (RAP), were all considerably increased compared to sham operated controls. Likewise, plasma endothelin-1, noradrenaline, renin activity, aldosterone and angiotensin II were all markedly increased. Heart failure was accompanied by signi¢cant increases in both estimated cardiac secretory rate and plasma concentrations of all three cardiac peptides, signi¢cantly correlated to the PCWP. The directional changes during evolving heart failure were similar, although the percentage increase in plasma BNP was much larger than for ANP and N-terminal proANP. In absolute molar terms, however, the BNP concentration changes were minor compared to those of the other two peptides. The larger percentage increase of BNP might indicate its superiority as a marker of heart failure development, provided a functional assay suitable for clinical use can be designed for a peptide circulating in this low concentration range.