Brain natriuretic peptide-guided therapy in the inpatient management of decompensated heart failure

Abstract

Heart failure is extremely prevalent and is associated with significant mortality, morbidity and cost. Studies have already established mortality benefit with the use of neurohormonal blockade therapy in systolic failure. Unfortunately, physical signs and symptoms of heart failure lack diagnostic sensitivity and specificity, and medication doses proven to improve mortality in clinical trials are often not achieved. Brain natriuretic peptide (BNP) has proven to be of clinical use in the diagnosis and prognosis of heart failure, and recent efforts have been taken to further elucidate its role in guiding heart failure management. Multiple studies have been conducted on outpatient guided management, and although still controversial, there is a trend towards improved outcomes. Inpatient studies are lacking, but preliminary data suggest various BNP cut-off values, as well as percentage changes in BNP, that could be useful in predicting outcomes and improving mortality. In the future, heart failure management will probably involve an algorithm using clinical assessment and a multibiomarker-guided approach.

Cardiac fibroblasts, fibrosis and extracellular matrix remodeling in heart disease

“…Elevated levels of MMP2, MMP9 and TNFα in these mice were linked to increased production of collagen types I and III by CFBs in a TGFβ-dependent manner, leading to myocardial fibrosis [130]. Atrial natriuretic peptide and BNP levels are consistently elevated in heart disease in patients [131,132] as well as in experimental models of heart disease [133,134], and are consistently linked to severity and progression of disease [135]. Taken together, these elevated atrial natriuretic peptide and BNP levels in heart disease could be a protective attempt by the myocardial tissue to limit excess fibrotic deposition, tissue injury and adverse remodeling.…”

Bedside Evaluation of Critical Dyspnea. Proposal of a Diagnostic Score for Acute Heart Failure in Emergency Setting

“…Moreover, its diagnostic accuracy (AUC=75.5%) was considerably lower than LUS examination [36,37]. Higher values of NT pro-BNP have been associated with a wide variety of cardiac and non-cardiac causes with low diagnostic accuracy [38].…”

Molecular markers for diagnostics of cardiac failure

“…После высвобождения BNP связывается с NP-рецептором А, вызывая сигнальный каскад, который инициирует натрийурез, диурез, артериальную вазодилатацию, ингибирование роста сердечных и сосудистых миоцитов. BNP имеет период полураспада 20 мин [12] и выводится из кровообращения посредством эндоцитоза, почечной фильтрации или пассивной экскреции. Диагностическая значимость BNP была продемонстрирована в нескольких исследованиях, в связи с чем данный биомаркер является наиболее широко используемым при диагностике острой СН [13].…”