Mid-Region Pro-Hormone Markers for Diagnosis and Prognosis in Acute Dyspnea

Maisel, Alan S.; Müeller, Christian; Nowak, Richard M.; Peacock, W. Frank; Landsberg, Judd W.; Ponikowski, Piotr; Möckel, Martin; Hogan, Christopher; Wu, Alan H.B.; Richards, Mark; Clopton, Paul; Filippatos, Gerasimos; Somma, Salvatore Di; Anand, Inder S.; Ng, Leong L.; Daniels, Lori B.; Neath, Sean‐Xavier; Christenson, Robert H.; Potocki, Mihael; McCord, James; Terracciano, Garret; Kremastinos, Dimitrios Th.; Hartmann, Oliver; Haehling, Stephan von; Bergmann, Andreas; Morgenthaler, Nils G.; Anker, Stefan D.

doi:10.1016/j.jacc.2010.02.025

Cited by 462 publications

(144 citation statements)

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“…The use of NPs in the ED for diagnostic purposes has been studied extensively with concordant results 2, 12, 13, 14. Nevertheless, no studies were able to provide strong evidence that this has a beneficial impact on outcome.…”

Section: Discussionmentioning

confidence: 99%

“…The present study is a post hoc analysis of the BACH study 2. We focused our analysis on the European cohort as the US cohort had a lower mortality and the New Zealand patient group was very small 8.…”

Section: Methodsmentioning

confidence: 99%

“…In the acute phase, B‐type NP (BNP), N‐terminal proBNP (NT‐proBNP), or mid‐regional pro‐atrial NP (MR‐proANP) have equal diagnostic value 2. Besides their diagnostic capabilities, NPs are strong prognostic markers predictive of short‐term and long‐term cardiovascular events independent of the underlying main diagnosis.…”

Section: Introductionmentioning

confidence: 99%

“…The prospective, international BACH (Biomarkers in Acute Heart Failure) diagnostic biomarker study in patients admitted with dyspnea forms the largest available database about NPs in the acute setting 2. Patients were characterized in detail, and gold standard diagnoses were made.…”

Section: Introductionmentioning

confidence: 99%

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Early identification of acute heart failure at the time of presentation: do natriuretic peptides make the difference?

et al. 2018

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BackgroundThe early identification of patients with acute heart failure (AHF) is challenging as many other diseases lead to a clinical presentation with dyspnea.AimThe aim of the study was to evaluate the impact of natriuretic peptides at common HF study cut‐offs on the diagnosis of patients with dyspnea at admission.Methods and resultsFor this post hoc analysis, we analysed n = 726 European Union (EU) patients from the prospective BACH (Biomarkers in Acute Heart Failure) study. Cut‐offs were 350 ng/L (BNP), 300 pmol/L [pro‐atrial natriuretic peptide (proANP)], and 1800 ng/L (NT‐proBNP). These cut‐offs had equivalent 90 days' mortality in the EU cohort of BACH. We analysed the effect of selection using these cut‐offs on the prevalence of the gold standard diagnoses made in the BACH study and the respective mortality. The prevalence of AHF is increased from 47.5 to 75.6% (NT‐proBNP criteria) up to 79.7% (BNP criteria). With the use of the proANP criteria, 90 days' mortality of patients with AHF rose from 14 to 17% (P = 0.029). In the group with no‐AHF diagnoses, mortality rose from 10 to 25% (P < 0.001).ConclusionsThe prevalence of patients with the gold standard diagnoses of AHF among those presenting with dyspnea to the emergency department is significantly increased by the use of natriuretic peptides with common cut‐offs used in prospective HF studies. Nevertheless, in the selected groups, patients with no AHF diagnosis have the highest mortality, and therefore, the addition of a natriuretic peptide alone is insufficient to start specific therapies.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Early identification of acute heart failure at the time of presentation: do natriuretic peptides make the difference?

et al. 2018

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“…N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) is the best‐validated biomarker in risk stratification and management of HF 8, 9, 10. B‐type cardiac natriuretic peptide (BNP) and NT‐proBNP have proven their prognostic power in patients with HF across the entire spectrum of ejection fraction 11.…”

Section: Introductionmentioning

confidence: 99%

N‐terminal pro‐B‐type natriuretic peptide and prognosis in Caucasian vs. Asian patients with heart failure

et al. 2018

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AimsN‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) is the most frequently used biomarker in heart failure (HF), but its prognostic utility across ethnicities is unclear.Methods and resultsThis study included 546 Caucasians with HF from the Coordinating Study Evaluating Outcomes of Advising and Counseling in Heart Failure and 578 Asians with HF from the Singapore Heart Failure Outcomes and Phenotypes study. NT‐proBNP was measured at discharge after HF hospitalization. The studied outcome was a composite of all‐cause mortality and HF hospitalization at 18 months. Compared with Caucasian patients, Asian patients were younger (63 ± 12 vs. 71 ± 11 years); less often female (26% vs. 39%); and had lower body mass index (26 vs. 27 kg/m2), better renal function (61 ± 37 vs. 54 ± 20 mL/min/1.73 m2), lower rates of atrial fibrillation (25% vs. 46%), strikingly higher rates of diabetes (59% vs. 30%), and higher rates of hypertension (76% vs. 44%). Despite these clear inter‐group differences in individual drivers of NT‐proBNP, average levels were similar in Asians [2709 (1350, 6302) pg/mL] and Caucasians [2545 (1308, 5484) pg/mL] (P = 0.514). NT‐proBNP was strongly associated with outcome [hazard ratio 1.28 (per doubling), 95% confidence interval 1.18–1.39, P < 0.001], regardless of ethnicity (P interaction = 0.719). NT‐proBNP was similarly associated with outcome in HF with reduced and preserved ejection fraction in Asian (P interaction = 0.776) and Caucasian patients (P interaction = 0.558).ConclusionsNT‐proBNP has similar prognostic performance in Asians and Caucasians with HF despite ethnic differences in known clinical determinants of plasma NT‐proBNP.

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Molecular and Digital Biomarker Supported Decision Making in Clinical Studies in Cardiovascular Indications

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2016

Archiv der Pharmazie

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Although a large number of pharmaceutical therapies are available to treat cardiovascular diseases like heart failure, in many medical conditions treatment is still not optimal and, therefore, the need for innovative, safe and efficacious drugs is still very high in this indication. Biomarkers are an important tool in the preclinical and clinical drug development process; they allow patient selection for clinical studies as well as therapy monitoring during studies. Biomarker concepts in cardiovascular indications differ very much from those in oncology and are very diverse. The present article gives an overview of the pathomechanisms of heart failure and describes the socioeconomic impact of the disease and the biomarker strategies being applied in the development of new heart failure drugs. The focus lies on protein biomarkers that can be measured in the blood and on functional biomarkers that can be derived from implanted and wearable medical devices.

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Mid-Region Pro-Hormone Markers for Diagnosis and Prognosis in Acute Dyspnea

Cited by 462 publications

References 30 publications

Early identification of acute heart failure at the time of presentation: do natriuretic peptides make the difference?

Early identification of acute heart failure at the time of presentation: do natriuretic peptides make the difference?

N‐terminal pro‐B‐type natriuretic peptide and prognosis in Caucasian vs. Asian patients with heart failure

Molecular and Digital Biomarker Supported Decision Making in Clinical Studies in Cardiovascular Indications

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