Cardiopulmonary laboratory biomarkers in the evaluation of acute dyspnea

Stokes, Natalie; Dietz, Brett W.; Liang, Jackson J.

doi:10.2147/oaem.s71446

Cited by 15 publications

(22 citation statements)

References 112 publications

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“…Although applying BNP and NT-proBNP as diagnostic biomarkers of HF has brought significant improvement in treating HF, several confounding factors, such as aging, obesity, anemia, sepsis, hypertension, MI, cardiac hypertrophy, pulmonary hypertension, atrial fibrillation, diabetes mellitus, renal failure, liver cirrhosis, severe burn and cancer chemotherapy, limit their accuracy [ 165 ]. Plasma NP levels have been inversely related to body mass index in epidemiological investigations [ 166 , 167 ].…”

Section: Diagnostic Valuesmentioning

confidence: 99%

Synthesis, secretion, function, metabolism and application of natriuretic peptides in heart failure

et al. 2018

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As a family of hormones with pleiotropic effects, natriuretic peptide (NP) system includes atrial NP (ANP), B-type NP (BNP), C-type NP (CNP), dendroaspis NP and urodilatin, with NP receptor-A (guanylate cyclase-A), NP receptor-B (guanylate cyclase-B) and NP receptor-C (clearance receptor). These peptides are genetically distinct, but structurally and functionally related for regulating circulatory homeostasis in vertebrates. In humans, ANP and BNP are encoded by NP precursor A (NPPA) and NPPB genes on chromosome 1, whereas CNP is encoded by NPPC on chromosome 2. NPs are synthesized and secreted through certain mechanisms by cardiomyocytes, fibroblasts, endotheliocytes, immune cells (neutrophils, T-cells and macrophages) and immature cells (embryonic stem cells, muscle satellite cells and cardiac precursor cells). They are mainly produced by cardiovascular, brain and renal tissues in response to wall stretch and other causes. NPs provide natriuresis, diuresis, vasodilation, antiproliferation, antihypertrophy, antifibrosis and other cardiometabolic protection. NPs represent body's own antihypertensive system, and provide compensatory protection to counterbalance vasoconstrictor-mitogenic-sodium retaining hormones, released by renin-angiotensin-aldosterone system (RAAS) and sympathetic nervous system (SNS). NPs play central roles in regulation of heart failure (HF), and are inactivated through not only NP receptor-C, but also neutral endopeptidase (NEP), dipeptidyl peptidase-4 and insulin degrading enzyme. Both BNP and N-terminal proBNP are useful biomarkers to not only make the diagnosis and assess the severity of HF, but also guide the therapy and predict the prognosis in patients with HF. Current NP-augmenting strategies include the synthesis of NPs or agonists to increase NP bioactivity and inhibition of NEP to reduce NP breakdown. Nesiritide has been established as an available therapy, and angiotensin receptor blocker NEP inhibitor (ARNI, LCZ696) has obtained extremely encouraging results with decreased morbidity and mortality. Novel pharmacological approaches based on NPs may promote a therapeutic shift from suppressing the RAAS and SNS to re-balancing neuroendocrine dysregulation in patients with HF. The current review discussed the synthesis, secretion, function and metabolism of NPs, and their diagnostic, therapeutic and prognostic values in HF.

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Section: Diagnostic Valuesmentioning

confidence: 99%

Synthesis, secretion, function, metabolism and application of natriuretic peptides in heart failure

et al. 2018

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“…Furthermore, conclusions on causality cannot be drawn based on our observational data. It would also have been of value to have data on natriuretic peptide markers in the present study, to show if TNFR1 and TNFR2 are adding clinically important information, as natriuretic peptides are clinically used biomarkers in the ED for different conditions [ 16 – 20 ]. Among strengths of the study are the longitudinal study design and the characterization of study participants.…”

Section: Discussionmentioning

confidence: 99%

TNFR1 is associated with short-term mortality in patients with diabetes and acute dyspnea seeking care at the emergency department

et al. 2020

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Background Circulating levels of TNF alpha receptor 1 (TNFR1) and 2 (TNFR2) are associated with increased long-term mortality and impaired kidney function. Aim To study association between circulating levels of TNFR1 and TNFR2 and short-term mortality in patients with diabetes and dyspnea. Population and methods Patients aged ≥ 18 years seeking at emergency department (ED) during daytime on weekdays between December 2013 and July 2018, with diabetes and acute dyspnea, identified at the triage process, were included. Participants (n = 291) were triaged according to Medical Emergency Triage and Treatment System-Adult score, and blood samples were collected. Association between TNFR1 and TNFR2, respectively, and 90-day mortality were estimated by Cox regression models adjusted for age, sex, BMI, creatinine and CRP. Results Univariate models showed significant associations between TNFR1 and TNFR2, respectively, and CRP, age and creatinine. TNFR1 and TNFR2 tended to be elevated in patients with the highest triage level, compared to patients with lower triage levels (ns). In longitudinal analyses, TNFR1 but not TNFR2 was associated with increased short-term mortality, HR adjusted for age, BMI and creatinine 1.43 (95% CI 1.07–1.91), but not in the model also adjusted for CRP, HR 1.29 (95% CI 0.94–1.77). In secondary analysis for quartile 4 versus quartiles 1–3 of TNFR1, corresponding HRs were 2.46 (95% CI 1.27–5.15) and 2.21 (95% CI 1.07–2.56). Conclusions We found a trend for the association between circulating TNFR1 levels and short-term mortality in patients with diabetes and acute dyspnea at the ED, possibly suggesting an inflammatory pathway for the association.

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“…Currently, it is recommended that an NT-proBNP level Ͼ1,800 pg/ml is indicative of CHF in patients Ͼ75 yr of age. In patients with chronic kidney disease, an NT-proBNP level Ͼ1,200 pg/ml suggests CHF for those Ͻ50 yr of age and Ͼ4,502 pg/ml for those between 50 and 75 yr old (53).…”

Section: The Role Of Natriuretic Peptides In Chfmentioning

confidence: 99%

“…Other causes for elevated levels of BNP and NT-proBNP include anemia, pulmonary hypertension, sepsis, severe burns, and cancer chemotherapy. Some patients with advanced CHF may have normal BNP or NT-proBNP levels or have falsely low BNP levels because of obesity (53,59,64).…”

Section: The Role Of Natriuretic Peptides In Chfmentioning

confidence: 99%

The renal and cardiovascular effects of natriuretic peptides

Wong

Guo

Zhang

2017

Advances in Physiology Education

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The landmark report by de Bold et al. in 1981 signified the heart as one of the endocrine organs involved in fluid and salt balance (de Bold AJ, Borenstein HB, Veress AT, Sonnenberg H. 28: 89-94, 1981). Atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) are secreted from cardiomyocytes in response to cardiac stretch as in the case of heart failure, whereas C-type natriuretic peptide (CNP) is secreted from endothelial and renal cells in response to cytokines and endothelium-dependent agonists, such as acetylcholine. Binding ANP or BNP to natriuretic peptide receptor A induces cyclic guanylyl monophosphate as second messenger in the target cells to mediate the following: natriuresis; water diuresis; increasing glomerular filtration rate; decreasing systemic sympathetic activities; plasma volume; cardiac output and blood pressure; and curbing mitoses of heart fibroblasts and hypertrophy of cardiovascular muscle cells. ANP, BNP, and CNP are cleared from the bloodstream by natriuretic peptide receptor C and degraded by an ectoenzyme called neprilysin (NEP). The plasma levels of BNP are typically>100 pg/ml in patients with congestive heart failure. Sacubitril/valsartan is an angiotensin receptor NEP inhibitor that prevents the clinical progression of surviving patients with heart failure more effectively than enalapril, an angiotensin-converting enzyme inhibitor. A thorough understanding of the renal and cardiovascular effects of natriuretic peptides is of major importance for first-year medical students to gain insight into the significance of plasma levels of BNP in patients with heart failure.

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Cardiopulmonary laboratory biomarkers in the evaluation of acute dyspnea

Cited by 15 publications

References 112 publications

Synthesis, secretion, function, metabolism and application of natriuretic peptides in heart failure

Synthesis, secretion, function, metabolism and application of natriuretic peptides in heart failure

TNFR1 is associated with short-term mortality in patients with diabetes and acute dyspnea seeking care at the emergency department

The renal and cardiovascular effects of natriuretic peptides

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