National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: Clinical Utilization of Cardiac Biomarker Testing in Heart Failure

Christenson, Robert H.; Apple, Fred S.; Cannon, Christopher P.; Francis, Gary S.; Jesse, Robert L.; Morrow, David A.; Newby, L. Kristin; Ravkilde, Jan; Storrow, Alan B.; Tang, W.H. Wilson; Wu, Alan H.B.

doi:10.1161/circulationaha.107.185267

Cited by 206 publications

(35 citation statements)

References 158 publications

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“…The precursor protein pro-BNP is cleaved to form BNP and an amino terminal fragment called N-terminal pro-BNP (NT pro-BNP). Both these molecules circulate in the plasma and are measured by a number of commercially available assays [35]. …”

Section: Biomarkers In Atrial Fibrillationmentioning

confidence: 99%

Biomarkers in electrophysiology: role in arrhythmias and resynchronization therapy

Bose

Truong

Singh

2015

J Interv Card Electrophysiol

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Circulating biomarkers related to inflammation, neurohormones, myocardial stress, and necrosis have been associated with commonly encountered arrhythmic disorders such as atrial fibrillation (AF) and more malignant processes including ventricular arrhythmias (VA) and sudden cardiac death (SCD). Both direct and indirect biomarkers implicated in the heart failure cascade have potential prognostic value in patients undergoing cardiac resynchronization therapy (CRT). This review will focus on the role of biomarkers in AF, history of SCD, and CRT with an emphasis to improve clinical risk assessment for arrhythmias and patient selection for device therapy. Notably, information obtained from biomarkers may supplement traditional diagnostic and imaging techniques, thus providing an additional benefit in the management of patients.

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Section: Biomarkers In Atrial Fibrillationmentioning

confidence: 99%

Biomarkers in electrophysiology: role in arrhythmias and resynchronization therapy

Bose

Truong

Singh

2015

J Interv Card Electrophysiol

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“…In viewing results from published studies, the European Society of Cardiology, 1 the National Institute for Health and Clinical Excellence (NICE), 16 the American College of Cardiology/American Heart Association, 17 the National Academy of Clinical Biochemistry, 18 and the National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand 19 opined that the evidence is insufficient to support routine NP-guided treatment over conventional care.…”

Section: Introductionmentioning

confidence: 99%

Effect of B-type natriuretic peptide-guided treatment of chronic heart failure on total mortality and hospitalization: an individual patient meta-analysis

Troughton

Frampton

Rocca

et al. 2014

European Heart Journal

237

152

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AimsNatriuretic peptide-guided (NP-guided) treatment of heart failure has been tested against standard clinically guided care in multiple studies, but findings have been limited by study size. We sought to perform an individual patient data meta-analysis to evaluate the effect of NP-guided treatment of heart failure on all-cause mortality.Methods and resultsEligible randomized clinical trials were identified from searches of Medline and EMBASE databases and the Cochrane Clinical Trials Register. The primary pre-specified outcome, all-cause mortality was tested using a Cox proportional hazards regression model that included study of origin, age (<75 or ≥75 years), and left ventricular ejection fraction (LVEF, ≤45 or >45%) as covariates. Secondary endpoints included heart failure or cardiovascular hospitalization. Of 11 eligible studies, 9 provided individual patient data and 2 aggregate data. For the primary endpoint individual data from 2000 patients were included, 994 randomized to clinically guided care and 1006 to NP-guided care. All-cause mortality was significantly reduced by NP-guided treatment [hazard ratio = 0.62 (0.45–0.86); P = 0.004] with no heterogeneity between studies or interaction with LVEF. The survival benefit from NP-guided therapy was seen in younger (<75 years) patients [0.62 (0.45–0.85); P = 0.004] but not older (≥75 years) patients [0.98 (0.75–1.27); P = 0.96]. Hospitalization due to heart failure [0.80 (0.67–0.94); P = 0.009] or cardiovascular disease [0.82 (0.67–0.99); P = 0.048] was significantly lower in NP-guided patients with no heterogeneity between studies and no interaction with age or LVEF.ConclusionNatriuretic peptide-guided treatment of heart failure reduces all-cause mortality in patients aged <75 years and overall reduces heart failure and cardiovascular hospitalization.

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“…Thus, pro-BNP levels are elevated in renal failure patients and further increased in the presence of hypervolemia and hypertension [39,40]. Pro-BNP levels also increase with age and are inversely related to BMI, malnourishment and systolic function [41,42]. Interestingly and unexpectedly, considering that pro-BNP is a biomarker of myocardial parietal stress, pro-BNP levels were not associated with a higher intradialytic ultrafiltration rate (table 5).…”

Section: Discussionmentioning

confidence: 99%

Elevated Pro-Brain Natriuretic Peptide, Troponin T and Malnutrition Inflammatory Score in Chronic Hemodialysis Patients with Overt Cardiovascular Disease

Trimarchi

Muryan²,

Campolo-Girard

et al. 2010

Nephron Clin Pract

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Background: We assessed the relationship between pro-brain natriuretic peptide (pro-BNP), troponin T (TropT) and nutritional status. Methods: A total of 48 chronic hemodialysis patients were grouped according to the presence [group A (GA); n = 24] or not [group B (GB)] of cardiovascular disease. Results: Compared to GB subjects, GA subjects were older, had been on hemodialysis for a longer period and had higher prevalences of vascular grafts, hypertension and elevated C-reactive protein (CRP) [GA vs. GB: 1.1 (range 0.1–32.9) vs. 0.4 (0–28.1) mg/dl; p = 0.028], malnutrition inflammatory score (MIS) (GA vs. GB: 7.50 vs. 4.00; p = 0.001), pro-BNP [GA vs. GB: 6,760 (601–103,200) vs. 686 (75–83,700) pg/ml; p < 0.001] and TropT [GA vs. GB: 0.3650 (0.011–0.199) vs. 0.010 (0.0–0.290) ng/ml; p = 0.002]. Pro-BNP correlated with TropT (rho 0.539; p < 0.001), MIS (rho 0.502; p < 0.0001), homocysteine (rho 0.321; p = 0.13) and CRP (rho 0.511; p < 0.0001). Pro-BNP levels were lower in GB patients as the body mass index increased; the opposite occurred in GA. Conclusions: Patients with cardiovascular disease had elevated pro-BNP and TropT levels. In patients without cardiovascular disease, malnutrition and inflammation were associated with vascular prostheses, while pro-BNP was lower in obese patients.

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National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: Clinical Utilization of Cardiac Biomarker Testing in Heart Failure

Cited by 206 publications

References 158 publications

Biomarkers in electrophysiology: role in arrhythmias and resynchronization therapy

Biomarkers in electrophysiology: role in arrhythmias and resynchronization therapy

Effect of B-type natriuretic peptide-guided treatment of chronic heart failure on total mortality and hospitalization: an individual patient meta-analysis

Elevated Pro-Brain Natriuretic Peptide, Troponin T and Malnutrition Inflammatory Score in Chronic Hemodialysis Patients with Overt Cardiovascular Disease

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