Atrial natriuretic peptides in heart failure: pathophysiological significance, diagnostic and prognostic value

Neurohormonal activation in patients with heart failure is dominated by the deleterious long-term effects of activation of the sympathetic nervous system and the renin–angiotensin–aldosterone system. The natriuretic peptides, including brain natriuretic peptide (BNP) and atrial natriuretic peptide (ANP), are also upregulated in heart failure, and partially counteract these deleterious effects by promoting vasodilation, natriuresis, and diuresis. Although BNP has been established as an important biomarker in the diagnosis and prognosis of heart failure, growing evidence suggests that measurement of plasma ANP, specifically its metabolite mid-regional pro-ANP, has similar diagnostic and prognostic value. Furthermore, its measurement may provide incremental diagnostic value when BNP levels fall into “grey zone” levels and may be a more potent prognostic marker of mortality.

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Extrém magas B típusú natriureticus prohormon prognosztikai szerepe a szívelégtelenség miatt kezelt betegek kórházi halálozására

Orvosi Hetilap ◽

10.1556/650.2017.30761 ◽

2017 ◽

Vol 158 (20) ◽

pp. 779-782

Author(s):

Béla Bózsik ◽

Erzsébet Nagy ◽

Miklós Somlói ◽

János Tomcsányi

Keyword(s):

Heart Failure ◽

Hospital Mortality ◽

Hospital Stay ◽

Natriuretic Peptide ◽

Natriuretic Peptides ◽

Prognostic Value ◽

Response To Therapy ◽

Cardiology Department ◽

The Difference ◽

One Year

Abstract: Introduction: Patients hospitalized for heart failure have a very high in-hospital as well as one-year mortality. Natriuretic peptides play both a diagnostic and a prognostic role in this disease. Changes of natriuretic peptide levels in response to therapy are a well-known prognostic marker. Regarding in-hospital mortality, however, little is known about the prognostic value of extremely high levels of natriuretic peptides measured on admission. Aim: To decide whether extremely high levels of B-type natriuretic peptide have a prognostic value with regard to in-hospital mortality. Method: NT-proBNP levels on admission and in-hospital mortality were extracted retrospectively from the data of patients treated with heart failure in the cardiology department of the Hospital of St. John of God in Budapest. We separately analyzed the data of patients hospitalized for heart failure in 2015 with extremely high initial NT-proBNP levels. The cut-off value in this regard was 10 000 ng/l. We also analyzed the comorbidities of these patients. Results: The median NT-proBNP level of those patients who survived beyond the index hospital stay in the last 10 years was 4842 ng/l, whereas the median NT-proBNP level of those 182 patients who died during their hospital stay was 10 688 ng/l (p<0.001). In the year 2015, we treated 118 patients with an NT-proBNP level above 10 000 ng/l. Thirteen of these patients died, which means that their in-hospital mortality exceeded 10%. In comparison, the in-hospital mortality of all heart failure patients was 5.8%. The difference of median NT-proBNP levels of surviving versus deceased patients in this group with extremely high NT-proBNP levels was no longer significant (17 080 ng/l vs. 19 152 ng/l). Conclusions: Patients with an NT-proBNP level of >10 000 ng/l on admission have a significantly higher in-hospital mortality. The difference of NT-proBNP levels of surviving versus deceased patients in the group with admission NT-proBNP levels >10 000 ng/l is no longer significant. We could not identify any etiological factors that would explain these extremely high NT-proBNP levels or the excess in-hospital mortality. Orv Hetil. 2017; 158(20): 779–782.

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Opportunistic screening for heart failure with natriuretic peptides in patients with atrial fibrillation: a meta-analysis of individual participant data of four screening studies

Heart ◽

10.1136/heartjnl-2017-312781 ◽

2018 ◽

Vol 104 (15) ◽

pp. 1236.1-1237 ◽

Cited By ~ 4

Author(s):

Sander van Doorn ◽

Geert-Jan Geersing ◽

Rogier F Kievit ◽

Yvonne van Mourik ◽

Loes C Bertens ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Natriuretic Peptide ◽

Natriuretic Peptides ◽

Meta Analysis ◽

Diagnostic Value ◽

Community Dwelling ◽

Individual Participant Data ◽

Cut Point ◽

Individual Participant

ObjectiveHeart failure (HF) often coexists in atrial fibrillation (AF) but is frequently unrecognised due to overlapping symptomatology. Furthermore, AF can cause elevated natriuretic peptide levels, impairing its diagnostic value for HF detection. We aimed to assess the prevalence of previously unknown HF in community-dwelling patients with AF, and to determine the diagnostic value of the amino-terminal pro B-type natriuretic peptide (NTproBNP) for HF screening in patients with AF.MethodsIndividual participant data from four HF-screening studies in older community-dwelling persons were combined. Presence or absence of HF was in each study established by an expert panel following the criteria of the European Society of Cardiology. We performed a two-stage patient-level meta-analysis to calculate traditional diagnostic indices.ResultsOf the 1941 individuals included in the four studies, 196 (10.1%) had AF at baseline. HF was uncovered in 83 (43%) of these 196 patients with AF, versus 381 (19.7%) in those without AF at baseline. Median NTproBNP levels of patients with AF with and without HF were 744 pg/mL and 211 pg/mL, respectively. At the cut-point of 125 pg/mL, sensitivity was 93%, specificity 35%, and positive and negative predictive values 51% and 86%, respectively. Only 23% of all patients with AF had an NTproBNP level below the 125 pg/mL cut-point, with still a 13% prevalence of HF in this group.ConclusionsWith a prevalence of nearly 50%, unrecognised HF is common among community-dwelling patients with AF. Given the high prior change, natriuretic peptides are diagnostically not helpful, and straightforward echocardiography seems to be the preferred strategy for HF screening in patients with AF.

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DIFFERENTIAL REGULATION OF CIRCULATING CARDIAC NATRIURETIC PEPTIDES IN HUMAN ACUTE DECOMPENSATED HEART FAILURE: EVIDENCE FOR A SELECTIVE AND RELATIVE ATRIAL NATRIURETIC PEPTIDE DEFICIENCY

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(18)31302-0 ◽

2018 ◽

Vol 71 (11) ◽

pp. A761

Author(s):

Shawn Reginauld ◽

Valentina Cannone ◽

Denise Heublein ◽

Seethalakshmi Iyer ◽

Christopher Scott ◽

...

Keyword(s):

Heart Failure ◽

Atrial Natriuretic Peptide ◽

Natriuretic Peptide ◽

Natriuretic Peptides ◽

Acute Decompensated Heart Failure ◽

Decompensated Heart Failure ◽

Differential Regulation ◽

Cardiac Natriuretic Peptides ◽

Atrial Natriuretic

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Additive diagnostic and prognostic value of Bioelectrical Impedance Vector Analysis (BIVA) to brain natriuretic peptide ‘grey-zone’ in patients with acute heart failure in the emergency department

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872614521756 ◽

2014 ◽

Vol 3 (2) ◽

pp. 167-175 ◽

Cited By ~ 27

Author(s):

Salvatore Di Somma ◽

Irene Lalle ◽

Laura Magrini ◽

Veronica Russo ◽

Silvia Navarin ◽

...

Keyword(s):

Heart Failure ◽

Emergency Department ◽

Brain Natriuretic Peptide ◽

Acute Heart Failure ◽

Prognostic Value ◽

Bioelectrical Impedance ◽

Grey Zone ◽

Bioelectrical Impedance Vector Analysis ◽

Impedance Vector ◽

Diagnostic And Prognostic Value

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LINC01232 Sponges Multiple miRNAs and Its Clinical Significance in Pancreatic Adenocarcinoma Diagnosis and Prognosis

Technology in Cancer Research & Treatment ◽

10.1177/1533033820988525 ◽

2021 ◽

Vol 20 ◽

pp. 153303382098852

Author(s):

Wenyan Du ◽

Chengbin Lei ◽

Yanzhen Wang ◽

Yiwen Ding ◽

Peng Tian

Keyword(s):

Pancreatic Adenocarcinoma ◽

Clinical Significance ◽

Prognostic Value ◽

Prognostic Significance ◽

Diagnostic Value ◽

Characteristic Analysis ◽

Tissue Samples ◽

Real Time Quantitative Pcr ◽

Diagnosis And Prognosis ◽

Diagnostic And Prognostic Value

Background: Long noncoding RNAs have been demonstrated to play important roles in different kinds of human malignancy. The purpose of this study was to evaluate the diagnostic and prognostic value of long intergenic non-protein coding RNA 1232 (LINC01232) in patients with pancreatic adenocarcinoma (PAAD) and further explore the clinical significance of the potential miRNAs that might be sponged by LINC01232. Methods: The potential target miRNAs that might be sponged by LINC01232 were analyzed using bioinformatics analysis. The Real-Time quantitative PCR was adopted to measure the relative expression of LINC01232 and target miRNAs in PAAD serum and tissue samples. The diagnostic and prognostic value of LINC01232 was evaluated using the receiver operating characteristic analysis and Kaplan-Meier survival analysis, respectively. Results: LINC01232 expression was upregulated in PAAD serum and tissues and associated with patients’ TNM stage. Serum LINC01232 expression had diagnostic value, and the high levels of LINC01232 could predict unfavorable prognosis in PAAD patients. miR-204-5p, miR-370-5p and miR-654-3p were proposed as 3 targets of LINC01232 in PAAD, and their decreased expression levels in PAAD patients showed certain clinical significance in diagnosis and prognosis. Conclusion: The data of this study revealed that LINC01232 expression is upregulated in PAAD serum and tissue samples with considerable diagnostic and prognostic significance. In addition, miR-204-5p, miR-370-5p and miR-654-3p may be sponged by LINC01232 in PAAD, which also show potencies in PAAD diagnosis and prognosis.

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Amino Acid-Based Metabolic Panel Provides Robust Prognostic Value Additive to B-Natriuretic Peptide and Traditional Risk Factors in Heart Failure

Disease Markers ◽

10.1155/2018/3784589 ◽

2018 ◽

Vol 2018 ◽

pp. 1-11 ◽

Cited By ~ 6

Author(s):

Chao-Hung Wang ◽

Mei-Ling Cheng ◽

Min-Hui Liu

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Amino Acid ◽

Natriuretic Peptide ◽

Prognostic Value ◽

Validation Cohort ◽

Left Ventricular Ejection ◽

Composite Events ◽

Traditional Risk Factors ◽

Diagnostic And Prognostic Value

Metabolic disturbances represent functional perturbation in peripheral tissues and predict outcomes in patients with heart failure (HF). This study developed an amino acid-based metabolic panel and sought to see whether this panel could add diagnostic and prognostic value to currently used B-type natriuretic peptide (BNP) measurements. Mass spectrometry and ultra-performance liquid chromatography were performed on 1288 participants, including 129 normal controls and 712 patients at HF stages A to D in the initial cohort and 447 stage C patients in the validation cohort. Patients were followed up for composite events (death/HF-related rehospitalization). Histidine, ornithine, and phenylalanine were 3 metabolites found strongly significant to identify patients at stage C and were adopted to develop the HOP panel. Compared to BNP, HOP had better value in discriminating the patients at different stages, especially in elderly patients and those with atrial fibrillation, high body mass index, or kidney dysfunction. HOP was correlated with the distance of 6 min walking distance better than BNP. For prognosis, HOP predicted composite events in patients at stages C and D, independent of log (BNP), age, sex, left ventricular ejection fraction, New York Heart Association functional class, HF stage, diabetes mellitus, chronic kidney disease, hypertension, hemoglobin, and albumin. Higher BNP (≥750 pg/mL) along with higher HOP (≥14) robustly predicted lower event-free survival compared to all others [hazard ratio=3.15 (2.23–4.46), p<0.001]. The prognostic value of HOP was confirmed in the validation cohort. In conclusion, aiming for clinical applications, this study proved that the HOP panel provides diagnostic and prognostic value additive to BNP and traditional risk factors.

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