scholarly journals What Is High Enough? Elevated NT-pro-BNP in Decompensated Paroxysmal Supraventricular Tachycardia

2017 ◽  
Vol 07 (01) ◽  
pp. 049-053
Author(s):  
Clayton Womack ◽  
L. Lutherer ◽  
Christopher Todd ◽  
Kerrie Pinkney ◽  
Thivakorn Kasemsri ◽  
...  
Keyword(s):  
Heart Failure ◽  
Supraventricular Tachycardia ◽  
Natriuretic Peptide ◽  
Clinical Signs ◽  
Case Series ◽  
Signs And Symptoms ◽  
Decompensated Heart Failure ◽  
Adult Patients ◽  
Cardiac Monitoring ◽  
Paroxysmal Supraventricular Tachycardia

AbstractSince the late 1980s, elevated atrial natriuretic peptide (ANP) was considered the cause of brisk diuresis in adult patients with paroxysmal supraventricular tachycardia (PSVT). Pro-brain natriuretic peptide (pro-BNP) and related molecules, e.g., N-terminal pro b-type natriuretic peptide (NT-pro-BNP) are known biomarkers of heart failure in adult patients from many causes with probable relevance in children. Perhaps, pro-BNP or related molecules such as NT-pro-BNP are useful in the management of PSVT in infants, thus hastening treatment in children who may otherwise significantly decompensate. Case series of one infant and two neonates presenting with cardiogenic shock and evidence of heart failure are presented. Cardiac monitoring or electrocardiogram (ECG) confirmed the presence of PSVT. Adenosine was administered resulting in successful chemical cardioversion with each case. Significantly elevated NT-pro-BNP levels correlated with heart failure prior to cardioversion. In each case, patients were discharged home with lower NT-pro-BNP levels and maintenance with a β-blocker. Due to documented relationships between elevated pro-BNP level and heart failure in adults, the authors measured the related biomarker NT-pro-BNP in each case, as the relationship could be similar in pediatric PSVT. Based on our experience with children in acute heart failure from other causes, NT-pro-BNP can increase to potentially extreme levels in infants. It appears to correlate with clinical signs of insufficient cardiac output, such as tachycardia, respiratory distress, and moribund appearance. Indeed, in the case series, extremely high NT-pro-BNP values were obtained when the patients appeared moribund from decompensated PSVT. The question arising from these observations is: At what level of elevated NT-pro-BNP, would patients be identified for cardioversion prior to appearance of other signs and symptoms? For each patient within the case series, NT-pro-BNP levels of approximately 20,000 pg/mL were indicative of decompensated heart failure, which was subsequently confirmed by examination of the patient. Further investigation is needed to determine the clinical significance of NT-pro-BNP and related peptides in pediatric patients with PSVT and intermittent PSVT. However, the possibility exists that an increase in NT-pro-BNP and related peptides could be a biomarker for cardiac decompensation after prolonged or intermittent PSVT, thereby shortening the time of diagnosis and intervention, and hence, potentially preventing morbidity, mortality, and extended hospitalization. Additional evidence-based research would help provide biomarker information during PSVT allowing practitioners to more objectively analyze risks.

Nesiritide for Acute Decompensated Heart Failure

2002 ◽  
Vol 18 (6) ◽  
pp. 295-304
Author(s):  
Teresa S Barclay ◽  
Joanne J Kim ◽  
Audrey J Lee
Keyword(s):  
Heart Failure ◽  
Natriuretic Peptide ◽  
Acute Decompensated Heart Failure ◽  
Safety Information ◽  
Signs And Symptoms ◽  
Decompensated Heart Failure ◽  
Dependent Manner ◽  
Medline Search ◽  
Pulmonary Capillary ◽  
Study Selection

Objective: To evaluate nesiritide for the treatment of acute decompensated heart failure (HF) with respect to its pharmacology, pharmacokinetics, clinical efficacy, adverse effect profile, and outcomes. Data Source: Primary and review articles were identified by MEDLINE search (1966–March 2001). Data from the PRECEDENT trial and additional dosing/administration and safety information were obtained from Scios, Inc. Study Selection: All of the articles identified from the data sources were evaluated and all information deemed relevant was included in this review. Data Synthesis: Research into the cardiac natriuretic peptides has revealed that brain natriuretic peptide (BNP) is elevated in patients with HF and may counterregulate the pathophysiologic mechanisms involved in progression of the disease. Nesiritide (Natrecor), recombinant human BNP, is the first natriuretic peptide to be approved by the FDA for treatment of acute decompensated HF. Nesiritide is a potent venous and arterial vasodilator that reduces pulmonary capillary wedge pressure and systemic vascular resistance in a dose-dependent manner with minimal effect on heart rate. It improves signs and symptoms of HF; however, its effect on patient outcomes is unclear because of limited data. The most commonly reported adverse effects in clinical trials were dose-related hypotension and nausea. Conclusions: Nesiritide is an intravenous arterial and venous vasodilator that may be particularly useful in patients who may not tolerate the arrhythmogenic effects of dobutamine and milrinone or who cannot tolerate nitroglycerin and nitroprusside. Further well-designed comparative studies are needed to define nesiritide's place in management of acute decompensated HF.

scholarly journals Comparison between admission natriuretic peptides, NGAL and sST2 testing for the prediction of worsening renal function in patients with acutely decompensated heart failure

2015 ◽  
Vol 53 (4) ◽  
Author(s):  
Benedetta De Berardinis ◽  
Hanna K. Gaggin ◽  
Laura Magrini ◽  
Arianna Belcher ◽  
Benedetta Zancla ◽  
...  
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Natriuretic Peptide ◽  
Acute Decompensated Heart Failure ◽  
International Study ◽  
Decompensated Heart Failure ◽  
Hospital Length Of Stay ◽  
Hospital Death ◽  
Amino Terminal ◽  
Worsening Renal Function

AbstractIn order to predict the occurrence of worsening renal function (WRF) and of WRF plus in-hospital death, 101 emergency department (ED) patients with acute decompensated heart failure (ADHF) were evaluated with testing for amino-terminal pro-B-type natriuretic peptide (NT-proBNP), BNP, sST2, and neutrophil gelatinase associated lipocalin (NGAL).In a prospective international study, biomarkers were collected at the time of admission; the occurrence of subsequent in hospital WRF was evaluated.In total 26% of patients developed WRF. Compared to patients without WRF, those with WRF had a longer in-hospital length of stay (LOS) (mean LOS 13.1±13.4 days vs. 4.8±3.7 days, p<0.001) and higher in-hospital mortality [6/26 (23%) vs. 2/75 (2.6%), p<0.001]. Among the biomarkers assessed, baseline NT-proBNP (4846 vs. 3024 pg/mL; p=0.04), BNP (609 vs. 435 pg/mL; p=0.05) and NGAL (234 vs. 174 pg/mL; p=0.05) were each higher in those who developed WRF. In logistic regression, the combination of elevated natriuretic peptide and NGAL were additively predictive for WRF (OR: In ED patients with ADHF, the combination of NT-proBNP or BNP plus NGAL at presentation may be useful to predict impending WRF (Clinicaltrials.gov NCT#0150153).

scholarly journals Impact of Renal Disease on Natriuretic Peptide Testing for Diagnosing Decompensated Heart Failure and Predicting Mortality

2007 ◽  
Vol 53 (8) ◽  
pp. 1511-1519 ◽  
Author(s):  
Christopher R deFilippi ◽  
Stephen L Seliger ◽  
Susan Maynard ◽  
Robert H Christenson
Keyword(s):  
Heart Failure ◽  
Renal Function ◽  
Natriuretic Peptide ◽  
Estimated Glomerular Filtration Rate ◽  
Area Under The Curve ◽  
Decompensated Heart Failure ◽  
Multivariate Regression Analysis ◽  
Poor Outcomes ◽  
One Year ◽  
Roc Area

Abstract Background: Concomitant occurrence of kidney disease (KD) and heart failure (HF) is common and associated with poor outcomes. Natriuretic peptide studies have typically excluded many individuals with KD. We compared the accuracy of B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) for diagnosing decompensated HF and predicting mortality across the spectrum of renal function. Methods: BNP and NT-proBNP were prospectively measured in a cohort of 831 dyspnea patients. KD was defined as an estimated glomerular filtration rate &lt;60 mL · min−1 · (1.73 m2)−1. The accuracy and predictive value of each test for diagnosing decompensated HF and predicting all-cause 1-year mortality were assessed by ROC area under the curve (AUC) and multivariate regression analysis. Results: Among the 831 dyspnea patients, 393 (47%) had KD. The diagnostic accuracies of BNP and NT-proBNP in detecting decompensated HF were similar to each other in patients without KD (AUC 0.75 vs 0.74, respectively; P = 0.60) and in patients with KD (AUC 0.68 vs 0.66; P = 0.10). One-year mortality rates were 36.3% and 19.0% in those with and without KD, respectively (P &lt;0.001). Progressively higher BNP and NT-proBNP concentrations remained predictive of increased mortality in KD patients. Compared with the lowest quartile, quartile 4 of BNP had an adjusted hazards ratio (HR) of 2.6 (95% CI 1.4–4.8; P = 0.004 for trend) and NT-proBNP quartile 4 had an HR of 4.5 (95% CI 2.0–10.2; P &lt;0.001 for trend). Only NT-proBNP remained a predictor of death after adjustment for clinical confounders and the other natriuretic peptide marker. Conclusions: NT-proBNP and BNP are equivalent predictors of decompensated HF across a spectrum of renal function, but NT-proBNP is a superior predictor of mortality.

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