A systematic review of BNP and NT-proBNP in the management of heart failure: overview and methods

Abstract

B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) levels are increased in persons with heart failure (HF); low levels of these peptides rule out HF. We systematically reviewed the literature to assess the use of BNP and NT-proBNP in the diagnosis, prognosis, and treatment for HF. We also examined the biological variation of these peptides in persons with and without HF. We searched Medline, Embase, AMED, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and CINAHL for English-language studies published between January 1989 and June 2012. Supplemental searches involved the gray literature and the reference lists of included studies. Trained reviewers used standardized forms to screen articles for inclusion in the review and to extract data from included papers. We examined the risk of bias with QUADAS-2 for diagnosis studies, the Hayden criteria for prognosis studies, and the Jadad scale for treatment studies. We assessed the strength of evidence in four domains (risk of bias, consistency, directness, and precision) for the diagnosis and treatment studies. Results were reported as narrative syntheses. Additional meta-analyses were conducted for the diagnosis studies. Three hundred ten articles passed through screening and were included in the review. One hundred four articles applied to diagnostic accuracy, 190 papers pertained to prognosis, and nine articles addressed BNP- or NT-proBNP-guided treatment. Each individual paper in this series reports, summarizes, and discusses the evidence regarding diagnosis, prognosis, or treatment.

Cardio-Pulmonary-Renal Interactions

“…However, most hospitalizations for acute decompensated HF occur because of symptoms (85). BNP is also prognostic for PH, probably due to increased right ventricular wall tension and up-regulation of the pre-proBNP gene (86).…”

“…BNP is also prognostic for PH, probably due to increased right ventricular wall tension and up-regulation of the pre-proBNP gene (86). Elevations in BNP in the setting of acutely decompensated HF and acute coronary syndromes is associated with an increased risk of AKI (38,85).…”

Myocardial injury in fetal aortic stenosis: Insights from amniotic fluid analysis

“…In this study, we describe cardiac markers in amniotic fluid of mid‐gestation fetuses with severe AS and find elevated NT‐BNP and normal troponin. NT‐BNP is a well‐established and validated marker of heart failure in adults that is released in response to ventricular stretch . This is the first study to report elevated NT‐BNP in response to LV pressure load in the human fetus.…”

Biomarker Guided Therapy in Chronic Heart Failure

“…Natriuretic peptides may be very useful in this as they are strong prognostic markers across the whole spectrum of HF, particularly in the chronic stage 15 and seem to change relatively little if patients are clinically stable. 16 More importantly, natriuretic peptides change over time in parallel with change in prognosis 17,18 and treatment of chronic HF influences plasma levels of natriuretic peptides. Thus, loop diuretics, angiotensin-converting enzyme (ACE)-inhibitors, angiotensin-II receptor blockers (ARB) and mineralocorticoid receptor antagonists (MRA), as well as cardiac resynchronisation therapy (CRT), may cause a fall in natriuretic peptide levels.…”