scholarly journals Natriuretic Peptide-based Screening and Prevention of Heart Failure

2017 ◽  
Vol 3 (2) ◽  
pp. 83 ◽  
Author(s):  
Joe Gallagher ◽  
Chris Watson ◽  
Patricia Campbell ◽  
Mark Ledwidge ◽  
Kenneth McDonald ◽  
...  
Keyword(s):  
Heart Failure ◽  
Natriuretic Peptide ◽  
Natriuretic Peptides ◽  
Cardiovascular Events ◽  
Personalised Medicine ◽  
Left Ventricular ◽  
Diabetic Patients ◽  
Targeted Prevention ◽  
Major Cardiovascular Events ◽  
Screening And Prevention

There is increasing interest in the concept of personalised medicine, whereby conditions with common pathophysiologies are targeted together, and also using biomarkers to identify patients who will most benefit from certain interventions. Several data sets indicate that natriuretic peptides are effective in refining risk prediction for heart failure and cardiovascular disease and add predictive power to conventional risk factors. To date two trials have tested the approach of using natriuretic peptides as part of a strategy to identify those at highest risk of cardiovascular events: St. Vincent’s Screening to Prevent Heart Failure (STOP-HF) and N-terminal Pro-brain Natriuretic Peptide Guided Primary Prevention of Cardiovascular Events in Diabetic Patients (PONTIAC). These have shown natriuretic peptide-based screening and targeted prevention can reduce heart failure and left ventricular dysfunction and other major cardiovascular events. This approach is now part of North American guidelines.

Abstract 2793: Comparison of Midregional Pro-atrial Natriuretic Peptide, B-type Natriuretic Peptide, and Amino-terminal Pro-B-type Natriuretic Peptide in Patients with Chronic Heart Failure: Influencing Factors, Detection of Left Ventricular Systolic Dysfunction, and Prediction of Death

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Deddo Moertl ◽  
Martin Huelsmann ◽  
Joachim Struck ◽  
Andreas Gleiss ◽  
Alexandra Hammer ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Atrial Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Influencing Factors ◽  
Natriuretic Peptides ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Ventricular Systolic Dysfunction

Background: Although natriuretic peptides are increasingly used for the management of chronic heart failure (CHF), there are sparse comparative data. Therefore, we compared the importance of influencing factors, the ability to detect left ventricular systolic dysfunction, and the prognostic power of midregional pro-atrial natriuretic peptide (MR-proANP), B-type natriuretic peptide (BNP), and aminoterminal pro-B-type natriuretic peptide (NT-proBNP) in patients with chronic heart failure. Methods and Results: MR-proANP, using a new assay directed at the midregion of aminoterminal-proANP, was compared with BNP and NT-proBNP, using conventional assays, in 797 patients with CHF. All three natriuretic peptides were independently influenced by left ventricular ejection fraction (LVEF), glomerular filtration rate (GFR), and the presence of ankle edema. Area under receiver-operator characteristic curves for detection of an LVEF <40% were similar between MR-proANP (0.799 [0.753– 0.844]) and BNP (0.803 [0.757– 0.849]), and NT-proBNP (0.730 [0.681– 0.778]. During a median observation time of 68 months, 492 patients died. In multiple Cox regression analysis each natriuretic peptide was the strongest prognostic parameter among various clinical variables, but proportion of explained variation showed that NT-proANP was a significantly stronger predictor of death than NT-proBNP and BNP (Figure ). Conclusions: Despite similarities in influencing factors and detection of reduced LVEF, MR-proANP outperformed BNP and NT-proBNP in the prediction of death. A new assay technology and the high biological stability of MR-proANP are potential explanations for these findings.

scholarly journals Monitoring of heart failure: comparison of left atrial pressure with intrathoracic impedance and natriuretic peptide measurements in an experimental model of ovine heart failure

2010 ◽  
Vol 120 (5) ◽  
pp. 207-217 ◽  
Author(s):  
Miriam T. Rademaker ◽  
Christopher J. Charles ◽  
Iain C. Melton ◽  
A. Mark Richards ◽  
Christopher M. Frampton ◽  
...  
Keyword(s):  
Heart Failure ◽  
Natriuretic Peptide ◽  
Natriuretic Peptides ◽  
Left Atrial ◽  
Left Ventricular ◽  
Atrial Pressure ◽  
Left Atrial Pressure ◽  
Cardiac Resynchronization ◽  
Delayed Response ◽  
Intrathoracic Impedance

Monitoring of HF (heart failure) with intracardiac pressure, intrathoracic impedance and/or natriuretic peptide levels has been advocated. We aimed to investigate possible differences in the response patterns of each of these monitoring modalities during HF decompensation that may have an impact on the potential for early therapeutic intervention. Six sheep were implanted with a LAP (left atrial pressure) sensor and a CRT-D (cardiac resynchronization therapy defibrillator) capable of monitoring impedance along six lead configuration vectors. An estimate of ALAP (LAP from admittance) was determined by linear regression. HF was induced by rapid ventricular pacing at 180 and 220 bpm (beats/min) for a week each, followed by a third week with daily pacing suspensions for increasing durations (1–5 h). Incremental pacing induced progressively severe HF reflected in increases in LAP (5.9 ± 0.4 to 24.5 ± 1.6 mmHg) and plasma atrial (20 ± 3 to 197 ± 36 pmol/l) and B-type natriuretic peptide (3.7 ± 0.7 to 32.7 ± 5.4 pmol/l) (all P<0.001) levels. All impedance vectors decreased in proportion to HF severity (all P<0.001), with the LVring (left ventricular)-case vector correlating best with LAP (r2=0.63, P<0.001). Natriuretic peptides closely paralleled rapid acute changes in LAP during alterations in pacing (P<0.001), whereas impedance changes were delayed relative to LAP. ALAP exhibited good agreement with LAP. In summary, impedance measured with an LV lead correlates significantly with changes in LAP, but exhibits a delayed response to acute alterations. Natriuretic peptides respond rapidly to acute LAP changes. Direct LAP, impedance and natriuretic peptide measurements all show promise as early indicators of worsening HF. ALAP provides an estimate of LAP that may be clinically useful.

scholarly journals Prognostic Factor of Soluble ST2 Serum on 90 Days-Major Cardiovascular Events in ST-Elevation Acute Myocardial Infarction Patients with Reperfusion Therapy

2017 ◽  
Vol 3 (1) ◽  
pp. 1
Author(s):  
Pamrayogi Hutomo ◽  
Anggoro Budi Hartopo ◽  
Indah Sukmasari ◽  
Ira Puspitawati ◽  
Putrika Prastuti Ratna Gharini ◽  
...  
Keyword(s):  
Heart Failure ◽  
Prognostic Factor ◽  
Cardiovascular Events ◽  
Venous Blood ◽  
Reperfusion Therapy ◽  
Cardiovascular Death ◽  
Left Ventricular ◽  
Bivariate Analysis ◽  
Soluble St2 ◽  
Major Cardiovascular Events

Background: Soluble ST2 (sST2) is released by strained myocardial. High baseline sST2 levels have been shown to be a predictor of mortality and heart failure in STEMI patients within 30 days and within 1 year, but its effect on medium-term events has not been widely investigated. Aims: To assess the prognostic factor of sST2 levels during admission with major cardiovascular events in the form of cardiovascular death and heart failure due to left ventricular dysfunction within 90 days of observation. Methods: A retrospective cohort study was conducted on STEMI patients with an onset of ≤ 24 hours undergoing reperfusion therapy from April 2014 - June 2015 in Dr. Sardjito General Hospital, Yogyakarta, Indonesia. The sST2 sample of venous blood was performed at admission. Primary outcomes for this analysis included cardiovascular death and congestive heart failure (CHF) through 90 days of follow-up. Assessment of major cardiovascular events was based on medical record data. Bivariate analysis were conducted on demographic and clinical factors related to sST2 and major cardiovascular events. A multivariate analysis was then conducted to determine the independent factors that influenced the emergence of major cardiovascular events. Results: Of the 107 patients who met the subject criteria, there were 33 (30.8%) subjects withmajor cardiovascular events and 74 subjects (69.2%) without major cardiovascular events in 90 days of observation. Of the 33 subjects with major cardiovascular events, there were 10 subjects (9.3%) died and 23 subjects (21.5%) with heart failure. The sST2 levels did not have a significant relationship with the incidence of mortality (p=0.617), heart failure (p=1.000), orboth combined (p = 1.000) in 90 days of observation. Conclusion: High serum sST2 levels during admission in STEMI patients who had undergonereperfusion therapy were not associated with increased incidence of major cardiovascular events (either the incidence of mortality or heart failure alone or both combined) in 90 days observation. 

scholarly journals Natriuretic peptides in cardiovascular diseases

2008 ◽  
Vol 13 (2) ◽  
Author(s):  
Mariusz Piechota ◽  
Maciej Banach ◽  
Anna Jacoń ◽  
Jacek Rysz
Keyword(s):  
Heart Failure ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Cardiovascular Diseases ◽  
Natriuretic Peptide ◽  
Natriuretic Peptides ◽  
Ventricular Dysfunction ◽  
Left Ventricular ◽  
Peptide Family ◽  
Artery Disease

AbstractThe natriuretic peptide family comprises atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), C-type natriuretic peptide (CNP), dendroaspis natriuretic peptide (DNP), and urodilatin. The activities of natriuretic peptides and endothelins are strictly associated with each other. ANP and BNP inhibit endothelin-1 (ET-1) production. ET-1 stimulates natriuretic peptide synthesis. All natriuretic peptides are synthesized from polypeptide precursors. Changes in natriuretic peptides and endothelin release were observed in many cardiovascular diseases: e.g. chronic heart failure, left ventricular dysfunction and coronary artery disease.

scholarly journals Relation of Natriuretic Peptides and Midregional Proadrenomedullin to Cardiac Chamber Volumes by Computed Tomography in Patients without Heart Failure: From the ROMICAT Trial

2010 ◽  
Vol 56 (4) ◽  
pp. 651-660 ◽  
Author(s):  
Quynh A Truong ◽  
Emily Siegel ◽  
Mahir Karakas ◽  
James L Januzzi ◽  
Fabian Bamberg ◽  
...  
Keyword(s):  
Heart Failure ◽  
Computed Tomography ◽  
Natriuretic Peptide ◽  
Natriuretic Peptides ◽  
Left Ventricular ◽  
Cardiac Chamber ◽  
Amino Terminal ◽  
Increased Risk ◽  
Lv Volumes ◽  
Incremental Increase

Abstract Background: Stress myocyte biomarkers are used prognostically in patients with cardiovascular disease. We examined associations between amino-terminal pro–B-type natriuretic peptide (NT-proBNP), midregional pro–A-type natriuretic peptide (MR-proANP), and midregional proadrenomedullin (MR-proADM) concentrations and cardiac chamber volumes in chest pain patients without heart failure by use of computed tomography (CT). Methods: At the time of 64-slice CT scan, we acquired plasma and serum samples for these biomarkers from 346 patients [mean (SD) age 53 (12) years, 65% men]. Left atrial volume (LAV) and left ventricular volumes at end-diastole (LVEDV) and end-systole (LVESV) were measured and indexed to body surface area (LAVI, LVEDI, LVESI). Results: Concentrations of both natriuretic peptides were correlated with LAV and LAVI (r = 0.19–0.32, all P ≤ 0.0005) and MR-proADM with LV volumes and indices (r = −0.14 to −0.21, all P ≤ 0.01). NT-proBNP and MR-proANP concentrations were higher in the top quartiles of patients than the lowest quartiles using LAV and LAVI, whereas MR-proADM concentrations were lower in the top quartiles of LV measures. In adjusted analyses, patients had 2- to 4-fold increased risk of LA enlargement for every incremental increase in log10NT-proBNP [LAV odds ratio (OR) 2.4, P = 0.03; LAVI OR 4.0, P = 0.003] and 10- to 13-fold increased risk of LA enlargement for every incremental increase in log10MR-proANP (LAV OR 10.7, P = 0.009; LAVI OR 13.1, P = 0.004). Conclusions: In patients without heart failure, both NT-proBNP and MR-proANP concentrations are independently associated with LA enlargement, whereas MR-proADM concentrations are correlated with LV volumes. This may partially explain the well-recognized value of natriuretic peptides for use in risk stratification.

Combined inhibition of angiotensin II and endothelin suppresses the brain natriuretic peptide response to developing heart failure

2004 ◽  
Vol 106 (6) ◽  
pp. 569-576 ◽  
Author(s):  
Miriam T. RADEMAKER ◽  
Chris J. CHARLES ◽  
Eric A. ESPINER ◽  
Chris M. FRAMPTON ◽  
M. Gary NICHOLLS ◽  
...  
Keyword(s):  
Heart Failure ◽  
Angiotensin Ii ◽  
Brain Natriuretic Peptide ◽  
Receptor Antagonist ◽  
Natriuretic Peptide ◽  
Natriuretic Peptides ◽  
Left Ventricular ◽  
Atrial Pressure ◽  
Developing Heart ◽  
Significant Difference

Blockade of AngII (angiotensin II) and ET (endothelin)-1, established and potential therapeutic strategies respectively, for heart failure, may have an adverse effect on the cardiac secretion of the natriuretic peptides, hormones with actions beneficial in this disease. The present study investigates the roles of AngII and ET-1 in regulating the stretch-induced release of the natriuretic peptides during the development of heart failure. On seven separate days, eight sheep underwent incremental left ventricular pacing (155, 190 and 225 beats/min for 90 min each) with concurrent infusions of a vehicle control, AngII, ET-1, AngII+ET-1, losartan [AT1 (AngII type 1) receptor antagonist], bosentan (ETA/ETB receptor antagonist) or losartan+bosentan. Pacing-induced rises in LAP (left atrial pressure) were amplified by the simultaneous administration of separate AngII and ET-1, and attenuated following blockade of the peptides, with maximum effects observed during combined treatments. Although these changes in atrial pressure were paralleled by concomitant alterations in circulating levels of both ANP (atrial natriuretic peptide) and BNP (brain natriuretic peptide), the plasma natriuretic peptide/atrial pressure relationship tended to be augmented by AngII and ET-1 and diminished by their blockade. A significant difference was demonstrated between the enhanced plasma BNP response to increasing LAP during combined AngII+ET-1 administration and decreased response during losartan+bosentan treatment (P<0.05). A similar, but non-significant, trend was evident for ANP. The present study indicates dual AngII/ET-1 blockade diminishes BNP (and to a lesser extent ANP) secretion in developing heart failure, suggesting that augmentation of the natriuretic peptide system during the combination of these therapies may be of benefit.

scholarly journals Natriuretic Peptide System Activation in Acute Heart Failure Patients with Diabetes

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Filipe M. Cunha ◽  
Joana Pereira ◽  
Pedro Marques ◽  
Helena Moreira ◽  
Pedro Rodrigues ◽  
...  
Keyword(s):  
Heart Failure ◽  
Natriuretic Peptide ◽  
Cox Regression ◽  
Left Ventricular ◽  
Diabetic Patients ◽  
Prognostic Impact ◽  
Convenience Sample ◽  
Cox Regression Analysis ◽  
Patients With Diabetes ◽  
One Year

Background. Elevated B-type natriuretic peptide (BNP) is a hallmark in heart failure (HF). Diabetic patients with chronic HF seem to have higher BNP than nondiabetics. We studied, in acute HF, if BNP levels are different between diabetics and nondiabetics. Methods. From a prospectively recruited population of acute HF patients, we selected a convenience sample. In pair-matched analysis, each diabetic patient was matched with a nondiabetic of the same age (±1 year), gender, and according to left ventricular systolic dysfunction. Diabetics and nondiabetics were compared. Cox-regression analysis was used to analyse the prognostic impact of diabetes. Results. We studied 328 patients, mean age: 78 years, 44.5% male. Diabetics were more often hypertensive and had ischemic HF; they had higher body mass index, lower haemoglobin, and worse renal function. Diabetics were more often discharged on ACE inhibitors/ARB, antiplatelet therapy, and statins. Neither admission nor discharge BNP values differed between diabetics and pair-matched nondiabetics. One-year mortality was also nondifferent between pairs of diabetics and nondiabetics: 44 (26.8%) and 46 (28.0%), respectively. HR for 1-year mortality in diabetics was 1.00 (95% CI: 0.82–1.24) compared with nondiabetics. Conclusions. HF patients with diabetes have similar neurohumoral activation when compared with nondiabetics. One-year mortality is also nondifferent after matching for age, gender, and systolic function.

Prognostic significance of natriuretic peptide levels in atrial fibrillation without heart failure

Heart ◽  
2020 ◽  
pp. heartjnl-2020-317735
Author(s):  
Yasuhiro Hamatani ◽  
Moritake Iguchi ◽  
Kentaro Ueno ◽  
Yuya Aono ◽  
Masahiro Esato ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Natriuretic Peptide ◽  
Prognostic Marker ◽  
Natriuretic Peptides ◽  
Prognostic Significance ◽  
Left Ventricular ◽  
Adverse Outcomes ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

ObjectivesNatriuretic peptides are an important prognostic marker in patients with heart failure (HF). However, little is known regarding their prognostic significance in patients with atrial fibrillation (AF) without HF and natriuretic peptides levels are underused in these patients in daily practice.MethodsThe Fushimi AF Registry is a community-based prospective survey of patients with AF in Fushimi-ku, Kyoto, Japan. We investigated patients with AF without HF (defined as prior HF hospitalisation, New York Heart Association functional class≥2 or left ventricular ejection fraction<40%) using the data of B-type natriuretic peptide (BNP, n=388) or N-terminal pro-B-type natriuretic peptide (NT-proBNP, n=771) at enrolment. BNPs were converted to NT-proBNP using a conversion formula. We divided the patients according to quartiles of NT-proBNP levels and compared the backgrounds and outcomes.ResultsOf 1159 patients (mean age: 72.1±10.2 years, median CHA2DS2-VASc score: 3 and oral anticoagulant (OAC) prescription: 671 (56%)), the median NT-proBNP level was 488 (IQR 169–1015) ng/L. Patients with high NT-proBNP levels were older, had higher CHA2DS2-VASc scores and had more OAC prescription (all p<0.001). Kaplan-Meier curves demonstrated that NT-proBNP levels were significantly associated with higher incidences of stroke/systemic embolism, all-cause death and HF hospitalisation during a median follow-up period of 5.0 years (log rank, all p<0.001). Multivariable Cox regression analyses revealed that NT-proBNP levels were an independent predictor of adverse outcomes even after adjustment by various confounders.ConclusionNT-proBNP levels are a significant prognostic marker for adverse outcomes in patients with AF without HF and may have clinical value.Trial registration numberUMIN000005834.

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