Using Natriuretic Peptides to ‘Guide’ Therapy in Heart Failure

2012 ◽  
Vol 8 (1) ◽  
pp. 36 ◽  
Author(s):  
Roland RJ van Kimmenade ◽  
James L Januzzi Jr ◽  
◽  
Keyword(s):  
Heart Failure ◽  
Clinical Practice ◽  
Natriuretic Peptide ◽  
Natriuretic Peptides ◽  
Optimal Strategy ◽  
Therapy Response ◽  
Diagnostic Tools ◽  
Heart Failure Management ◽  
Amino Terminal ◽  
Guided Therapy

Assays for B-type natriuretic peptide (BNP) and its cleavage equivalent amino terminal proB-type natriuretic peptide (NT-proBNP) have quickly progressed from being biochemical novelties to representing valuable diagnostic tools for the physician confronted with patients suffering from suspected or proven heart failure. Besides being useful adjuncts for the diagnostic evaluation of heart failure, these biomarkers have shown to be superior predictors of prognosis in patients so affected. An intriguing synergy between BNP and NT-proBNP with respect to therapy response has been observed, which has led to the intriguing concept of their use to unlock a personalised, optimal strategy for heart failure management. In this paper, we aim to review the current available data on natriuretic peptide guided therapy and provide some insights on the implementation of this approach in clinical practice.

scholarly journals Natriuretic Peptides and Analytical Barriers

2017 ◽  
Vol 63 (1) ◽  
pp. 50-58 ◽  
Author(s):  
Vlad C Vasile ◽  
Allan S Jaffe
Keyword(s):  
Heart Failure ◽  
Clinical Practice ◽  
Natriuretic Peptide ◽  
Natriuretic Peptides ◽  
Myocardial Function ◽  
Specific Assay ◽  
Peptide System ◽  
Cardiovascular Homeostasis ◽  
Natriuretic Peptide System

Abstract BACKGROUND The natriuretic peptide system is an endocrine, autocrine and paracrine system that plays an important role in the maintenance of cardiovascular homeostasis. Biomarkers based on these peptides are important diagnostic and prognostic tools for myocardial function. CONTENT Although natriuretic peptides were discovered more than 2 decades ago, their intricate and complex biology is associated with important questions not yet elucidated. The diversity of circulating forms of natriuretic peptides, the distinct expression of these forms in particular patients, and the heterogeneity of heart failure forms, along with specific assay-related and preanalytic issues, cause assays to be poorly harmonized. SUMMARY This review presents the relevant issues related to the biology of natriuretic peptides and differences between assays with immediate implications for clinical practice.

scholarly journals Measurement of Cardiac Natriuretic Hormones (Atrial Natriuretic Peptide, Brain Natriuretic Peptide, and Related Peptides) in Clinical Practice: The Need for a New Generation of Immunoassay Methods

2000 ◽  
Vol 46 (10) ◽  
pp. 1529-1534 ◽  
Author(s):  
Aldo Clerico ◽  
Silvia Del Ry ◽  
Daniela Giannessi
Keyword(s):  
Heart Failure ◽  
Clinical Practice ◽  
Atrial Natriuretic Peptide ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Sensitivity And Specificity ◽  
Natriuretic Peptides ◽  
Healthy Subjects ◽  
Cardiac Natriuretic Peptides ◽  
New Generation

Abstract Background: Cardiac natriuretic hormones (CNHs) are a family of related peptides, including atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), and other peptides derived from the N-terminal portion of the proANP and proBNP peptide chains. Assays for cardiac natriuretic peptides have been proposed to help assess clinical conditions associated with expanded fluid volume. In particular, the assays can be useful for distinguishing healthy subjects from patients in different stages of heart failure. Measurements of these hormones have also been considered for prognostic indicators of long-term survival in patients with heart failure and/or after acute myocardial infarction. The different CNHs differ in their production/secretion patterns and have different clearance rates. Furthermore, there are numerous proposed assay configurations for each of these hormones, and it is not clear which assay provides the best pathophysiological and/or clinical information. Approach: Here we review recent studies concerning the competitive (such as RIA, enzyme immunoassay, or luminescence immunoassay) and noncompetitive immunoassays (such as two-site IRMA, ELISA, or immunoluminometric assay) for the different cardiac natriuretic peptides to compare the analytical characteristics and clinical relevance of assays for the different CNHs and the different assay formats. Content: Developing sensitive, precise, and accurate immunoassays for cardiac natriuretic peptides has been difficult because of their low concentrations (on average, ∼3–6 pmol/L) in healthy subjects and because of their structural, metabolic, and physiological characteristics. Competitive assays have historically suffered from lack of sensitivity and specificity for the biologically active peptides. These usually require tedious extraction procedures prior to analysis. Recently, immunometric assays have been developed that have improved sensitivity and specificity; it appears these will be the methods of choice. Summary: To date, there is no consensus on the best assay procedure of cardiac natriuretic peptides. To facilitate widespread propagation of determination of these hormones in routine clinical practice, it will be necessary to study the new generation of noncompetitive immunometric methods that are less time-consuming and more sensitive and specific. Although several studies suggest that BNP exhibits better clinical utility than the other CNHs, more studies examining multiple CNHs in the same cohorts of patients will be necessary.

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.

scholarly journals Amino-Terminal Pro–Brain Natriuretic Peptide, Brain Natriuretic Peptide, and Troponin T for Prediction of Mortality in Acute Heart Failure

2007 ◽  
Vol 53 (3) ◽  
pp. 412-420 ◽  
Author(s):  
Rahul Sakhuja ◽  
Sandy Green ◽  
Eveline M Oestreicher ◽  
Patrick M Sluss ◽  
Elizabeth Lee-Lewandrowski ◽  
...  
Keyword(s):  
Heart Failure ◽  
Brain Natriuretic Peptide ◽  
Acute Heart Failure ◽  
Natriuretic Peptide ◽  
Natriuretic Peptides ◽  
Troponin T ◽  
Roc Curves ◽  
Amino Terminal ◽  
Prediction Of Mortality ◽  
Academic Center

Abstract Background: Combining testing for natriuretic peptides [amino-terminal pro–brain natriuretic peptide (NT-proBNP) and brain natriuretic peptide (BNP)] and cardiac troponin T (cTnT) may help predict mortality in patients with acute heart failure (HF). Methods: We studied 209 patients with acute HF at an urban academic center and used ROC curves and multivariate analyses to examine the relationship of outcome to natriuretic peptide and cTnT concentrations at presentation. Results: Higher concentrations of natriuretic peptides and cTnT at presentation were predictors of death at 60 days and 1 year (P <0.001 and P <0.01, respectively, at both time points). Optimal cutoff points for NT-proBNP, BNP, and cTnT for predicting death by 60 days or 1 year were 5562 and 3174 ng/L, 428 and 352 ng/L, and 0.01 and 0.01 μg/L, respectively. Most decedents demonstrated increased concentrations of both natriuretic peptides and cTnT and had a 25% mortality rate at the 60-day time point (P <0.001). Mortality rates were low (<4%) among patients with either no increase or an increase in only 1 marker. Decedents with increases in both a natriuretic peptide and cTnT at presentation had the highest death rate at 1 year (45%, P <0.001). This combination was strongly predictive of death [NT-proBNP plus cTnT: hazard ratio (HR), 7.66; 95% confidence interval (CI), 3.06–17.8; BNP plus cTnT: HR, 6.82; 95% CI, 2.99–16.5]. Conclusions: A dual-marker strategy incorporating a natriuretic peptide and cTnT is superior to either marker alone for estimating short- and longer-term risk in patients with acute HF.

597 Can we use BNP and NTproBNP to rule out heart failure in clinical practice? Results of the UK natriuretic peptide study

2003 ◽  
Vol 2 (1) ◽  
pp. 131
Author(s):  
A ZAPHIRIOU ◽  
S ROBB ◽  
G MENDEZ ◽  
T MURRAYTHOMAS ◽  
S HARDMAN ◽  
...  
Keyword(s):  
Heart Failure ◽  
Clinical Practice ◽  
Natriuretic Peptide ◽  
The Uk ◽  
Rule Out

Natriuretic Peptides – Addressing the Dilemma of Heart Failure Management

2011 ◽  
Vol 7 (2) ◽  
pp. 104
Author(s):  
Kenneth McDonald ◽  
Ulf Dahlström ◽  
◽  
Keyword(s):  
Heart Failure ◽  
Physical Examination ◽  
Natriuretic Peptides ◽  
Normal Values ◽  
Outpatient Setting ◽  
Heart Failure Management ◽  
Effective Screening ◽  
Specific Symptoms ◽  
Objective Marker

Heart failure (HF) is characterised by non-specific symptoms and unremarkable physical examination; therefore, the need exists for an available objective marker of HF status. Natriuretic peptides (NPs) are a marker that can aid the dilemmas in present-day HF management. More effective screening for clinical deterioration would include changes in brain natriuretic peptide (BNP) levels. Normal values for BNP, <50–100 pg/ml, have excellent negative predictive value (NPV) in excluding HF as a diagnosis. BNP values that are significantly elevated, e.g. >500 pg/ml, make the diagnosis of HF more likely. There are now established and emerging uses for NPs in managing HF in the community. These include the role of NPs at the time of possible new presentation of HF, its role in prognostication and, finally, the increasing interest in using NPs to guide therapy in the outpatient setting.

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