scholarly journals B-type natriuretic peptide and obesity in heart failure: a mysterious but important association in clinical practice

2020 ◽  
Author(s):  
Marie Reinmann ◽  
Philippe Meyer
Keyword(s):  
Heart Failure ◽  
Clinical Practice ◽  
Natriuretic Peptide

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

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.

Surrogate End Points in Heart Failure

2002 ◽  
Vol 36 (3) ◽  
pp. 479-488 ◽  
Author(s):  
Craig R Lee ◽  
Kirkwood F Adams ◽  
J Herbert Patterson
Keyword(s):  
Heart Failure ◽  
Clinical Practice ◽  
Drug Development ◽  
Disease Progression ◽  
Natriuretic Peptide ◽  
Cardiac Remodeling ◽  
Left Ventricular ◽  
Response To Therapy ◽  
End Points ◽  
End Diastolic Volume

OBJECTIVE: To describe the potential utility of a true surrogate marker of heart failure outcomes, historically investigate the validity of surrogates most commonly evaluated in heart failure, and identify specific end points offering the most potential for future use. DATA SOURCES: A MEDLINE search (1966–June 2001) was completed to identify relevant literature. Additional references were also retrieved from selected articles. Search terms included b-type natriuretic peptide, cardiac remodeling, end-diastolic volume, heart failure, and surrogate end points. DATA SYNTHESIS: By definition, true surrogate end points must predict outcomes associated with disease progression and response to therapy. A validated surrogate measure of mortality would render significant utility in both heart failure drug development and clinical practice. Improvements in traditional functional markers of heart failure, including ejection fraction and exercise capacity, have produced inconsistent results in regard to mortality in a number of clinical trials. Numerous measures of cardiac remodeling and neurohormonal activation, however, have proven to be reliable predictors of disease progression and therapeutic response. These findings have contributed significantly to the current understanding of heart failure pathophysiology and approach to treatment. Specifically, measures such as left-ventricular end-diastolic volume (LVEDV) and, potentially, b-type natriuretic peptide (BNP) concentrations may correlate with disease progression and parallel the mortality reductions observed with angiotensin-converting enzyme inhibitor and β-blocker therapy. CONCLUSIONS: Currently, LVEDV and plasma BNP offer the greatest potential as surrogate end points in heart failure. Further investigation of these measures is required before routine implementation in drug development and clinical practice can be justified.

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.

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 A Gray Zone Assigned to Inconclusive Results of Quantitative Diagnostic Tests: Application to the Use of Brain Natriuretic Peptide for Diagnosis of Heart Failure in Acute Dyspneic Patients

2006 ◽  
Vol 52 (12) ◽  
pp. 2229-2235 ◽  
Author(s):  
Joël Coste ◽  
Patrick Jourdain ◽  
Jacques Pouchot
Keyword(s):  
Heart Failure ◽  
Clinical Practice ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Diagnostic Tests ◽  
Acute Dyspnea ◽  
Gray Zone ◽  
Simple Method ◽  
History Of ◽  
Discriminatory Performance

Abstract Background: Most quantitative diagnostic tests do not perfectly differentiate between persons with and without a given disease. We present a simple method to construct a 3-zone partition for quantitative tests results, including positive and negative zones and a gray zone between, and we describe its use in the diagnosis of heart failure by brain natriuretic peptide (BNP) measurement in acute dyspneic patients. Methods: We conducted a prospective cohort study of 699 consecutive patients with acute dyspnea who were treated at the emergency department of 3 participating hospitals. Heart failure (acute or decompensated) was assessed independently at discharge by cardiologists blind to the results of BNP measurements. Results: The discriminatory performance of BNP was insufficient to provide a single cutoff value that could be used to correctly diagnose heart failure in clinical practice. Also, the discriminatory performance differed between patients with and without a history of chronic heart failure. The gray zone of inconclusive results was 167–472 ng/L for those without and 0–334 ng/L for those with such a history. Diagnosis of the current episode of heart failure by BNP results and history of heart failure was not enhanced by data from any other sources, including electrocardiography. Conclusions: The gray zone approach applied to the diagnosis of heart failure by BNP might allow sensible cutoff values to be determined for clinical practice according to relevant subgroups of patients. The gray zone approach might be usefully applied to many other quantitative tests and clinical diagnostic or screening problems.

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