B-Type Natriuretic Peptide (BNP) and ProBNP: Role of Emerging Markers to Guide Therapy and Determine Prognosis in Cardiovascular Disorders

Abstract

Over the last decade, one group of neurohormonal markers, including atrial natriuretic peptide (ANP), N-terminal pro-ANP, B-type natriuretic peptide (BNP), and N-terminal proBNP, has generated much interest in the evaluation and management of heart failure and acute coronary syndrome. There has been so much literature on the subject, especially concerning BNP and proBNP, that it leaves us confused at times about what the literature has to say about these markers. In this article, we have made an honest attempt to examine all the available literature in relation to the impact of BNP and proBNP on cardiovascular disease and present it to the reader in an assimilated fashion.

The relationship of systemic right ventricular function to ECG parameters and NT-proBNP levels in adults with transposition of the great arteries late after Senning or Mustard surgery

“…Elevated circulating N-terminal pro-brain natriuretic peptide (NT-proBNP) levels help identify patients with impaired systemic ventricular function8 and relate to outcome in those with acquired heart disease 9. In mixed cohorts of patients with congenital cardiac disease, brain natriuretic peptide (BNP) has been shown to relate to systemic ventricular function as determined by echocardiography10 and to function of the pressure overloaded systemic and subpulmonary right ventricle as determined by CMR 11.…”

The Role of Cardiokines in Heart Diseases: Beneficial or Detrimental?

“…ProBNP, which is initially stored in cardiomyocytes, is released and instantly decomposes into BNP and inactive NT-proBNP in equimolar quantities when the ventricular walls experience stretching forces or ventricular pressure is increased [ 3 ]. It therefore appears that BNP and its precursor play a clinically significant role in response to various CVDs such as HF, hypertension, and arrhythmias [ 14 , 15 ]. In addition, BNP contributes to better diagnosis of acute HF, and in particular HF classification [ 16 ].…”

Searching for ‘omic’ biomarkers

“…The negative predictive value of this biomarker is 98% (34), and its applicability is appropriate given the clinical context of heart failure; the ability to exclude heart failure in a patient is indispensable. As a result, the implementation of BNP as a tool in clinical practice has resulted in reduced time from patient diagnosis to discharge; prevented unnecessary admission to hospital; reduced costs of conventional management; and reduced adverse events, mortality and patient hospital days (35).…”