New issues on measurement of B-type natriuretic peptides

Clerico, Aldo; Zaninotto, Martina; Passino, Claudio; Plebani, Mario

doi:10.1515/cclm-2017-0433

Cited by 21 publications

(17 citation statements)

References 58 publications

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“…Cardiac troponins, measured with high-sensitivity methods, actually show a significant different analytical and biological profile compared to other cardiovascular risk markers, especially the other cardio-specific biomarkers, namely the natriuretic peptides (in particular, BNP and NT-proBNP) [15,16,44,[84][85][86][87][88][89]. Indeed, the BNP and NT-proBNP have intra-individual and inter-individual variations (on average about 40-60%) and also Index of Individuality (about 0.64-1.0) higher than that of cTn [63,84,85,[87][88][89][90][91].…”

Section: Comparison Of Analytical and Biological Profiles Among The Cmentioning

confidence: 99%

Clinical relevance of biological variation of cardiac troponins

Clerico

Padoan

Zaninotto

et al. 2020

Clinical Chemistry and Laboratory Medicine (CCLM)

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The high-sensitivity immunoassays for cardiac troponin I (hs-cTnI) and cardiac troponin T (hs-cTnT) are recommended by all the most recent international guidelines as gold standard laboratory methods for the detection of myocardial injury and diagnosis of acute myocardial infarction (AMI). In this review article, the Authors aimed at discussing the relevant biochemical, physiological, and clinical issues related to biological variability of cTnI and cTnT. Cardiac troponins, measured with hs-cTn methods, show a better clinical profile than the other cardio-specific biomarkers (such as the natriuretic peptides, BNP and NT-proBNP). In particular, the hs-cTn methods are characterized by a low intra-individual index of variation (<0.6) and reduced analytical imprecision (about 5% CV) at the clinical cut-off value (i.e., the 99th percentile URL value). Moreover, recent studies have reported that differences between two hs-cTn measured values (RCV) >30% can be considered statistically significant. These favourable biological characteristics and analytical performance of hs-cTn methods significantly improved the accuracy in the diagnostic process of acute coronary syndromes (ACS) in patients admitted to emergence department. In addition, several studies have demonstrated the clinical usefulness of cardiovascular risk evaluation with hs-cTn methods in some groups of patients with clinical conditions at high cardiovascular risk (such as systemic hypertension, severe obesity, diabetes mellitus, renal insufficiency, and chronic obstructive pulmonary disease). However, screening programs in the general population with hs-cTn methods for cardiovascular risk stratification require further investigation to define the optimal target populations, timing of measurement, and preventive interventions.

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Section: Comparison Of Analytical and Biological Profiles Among The Cmentioning

confidence: 99%

Clinical relevance of biological variation of cardiac troponins

Clerico

Padoan

Zaninotto

et al. 2020

Clinical Chemistry and Laboratory Medicine (CCLM)

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“…The observation that NT-pro BNP and BNP demonstrate different trends is unsurprising. Although they are produced concurrently at equimolar concentrations, their pathophysiological characteristics and analysis are distinctly different [ 29 ]. For example, although the half-life of the biologically inactive NT-pro BNP is over 60 minutes, the active hormone BNP is between 15 and 20 minutes.…”

Section: Discussionmentioning

confidence: 99%

Pregnancy-specific Reference Intervals for BNP and NT-pro BNP—Changes in Natriuretic Peptides Related to Pregnancy

Dockree

Brook

Shine

et al. 2021

Journal of the Endocrine Society

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Background Cardiac disease is the leading cause of maternal mortality in the UK, so accurate cardiovascular diagnoses in pregnancy are essential. BNP (B-type natriuretic peptide) and NT-pro BNP (N-terminal-pro BNP) are useful clinical tools for investigating suspected peripartum cardiomyopathy but, as the pregnancy-specific reference intervals are undefined, it is uncertain how they should be interpreted in pregnant women. Methods Longitudinal study of 260 healthy pregnant women, with sampling in each trimester to define 95% reference intervals. Results The upper reference limit for NT-pro BNP was 200 pg/mL in the first and second trimesters, and 150 pg/mL in the third. Levels were significantly reduced in overweight women in the third trimester (p=0.0001), which supports the partitioning of reference intervals by BMI. The upper limit for BNP was 50 pg/mL, with no detectable trimester-related differences. Whilst other biomarkers (haemoglobin and platelets) fell throughout pregnancy, both natriuretic peptides were initially elevated before falling by the third trimester, suggesting that the observed changes in natriuretic peptides are driven by dynamic interplay between cardiac strain and progressive haemodilution. NT-pro BNP in the first trimester was inversely associated with neonatal birthweight at term (p=0.011). Conclusions Cardiac biomarkers have an important role for investigating suspected disease in high-risk pregnant women, but a robust assessment of the levels expected in healthy pregnant women is an essential prerequisite to their application in clinical practice. This study has defined trimester- and BMI-specific reference intervals for NT-pro BNP and BNP, which may improve how women with suspected cardiovascular disease are investigated in pregnancy.

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“…In addition, there are increasing number of inducements of heart failure, so the morbidity of heart failure is getting higher and higher, seriously threatening the life and health of humans ( 11 ). Patients with early heart failure only have complaints such as fatigue, decreased exercise tolerance and increased heart rate, which can easily be ignored ( 12 ), but with the prolonged course of disease and the aggravation of disease, patients may show manifestations including dyspnea on exertion, orthopnea, lung rale and even pink frothy sputum, which can reduce cardiac function and increase difficulties in treatment ( 13 ). Therefore, how to realize rapid and effective early diagnosis of heart failure in clinical practices and evaluate the prognosis of patients at the same time is the focus and hotspot of current studies ( 14 ).…”

Section: Discussionmentioning

confidence: 99%

Influencing factors of NT‑proBNP level inheart failure patients with different cardiacfunctions and correlation with prognosis

Chen

et al. 2018

Exp Ther Med

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Factors influencing N-terminal pro-brain natriuretic peptide (NT-proBNP) level in heart failure patients with different cardiac functions were identified to explore the correlations with prognosis. Eighty heart failure patients with different cardiac functions treated in Yixing People's Hospital from January 2016 to June 2017 were selected, and divided into two groups (group with cardiac function in class II and below and group with cardiac function in class III and above), according to the cardiac function classification established by New York Heart Association (NYHA). Blood biochemical test and outcome analysis were conducted to measure serum NT-proBNP and matrix metalloproteinase-9 (MMP-9) levels in patients with different cardiac functions, and correlations between levels of NT-proBNP and MMP-9 and left ventricular ejection fraction (LVEF) level were analyzed in patients with different cardiac functions at the same time. In addition, risk factors for heart failure in patients with different cardiac functions were analyzed. Compared with the group with cardiac function in class III and above, the group with cardiac function in class II and below had significantly lower serum NT-proBNP and MMP-9 levels (p<0.05). For echocardiogram indexes, left ventricular end-diastolic diameter (LVEDD) and left ventricular end-systolic diameter (LVESD) in the group with cardiac function in class II and below were obviously lower than those in the group with cardiac function in class III and above (p<0.05), while LVEF was higher in group with cardiac function in class II and below than that in group with cardiac function in class III and above (p<0.05). NT-proBNP and MMP-9 levels were negatively correlated with LVEF level [r=−0.8517 and −0.8517, respectively, p<0.001 (<0.05)]. Cardiac function in class III and above, increased NT-proBNP, increased MMP-9 and decreased LVEF were relevant risk factors and independent risk factors for heart failure in patients with different cardiac functions. NT-proBNP and MMP-9 levels are negatively correlated with LVEF in patients regardless of the cardiac function class. Therefore, attention should be paid to patients who have cardiac function in class III and above, increased NT-proBNP and MMP-9 levels and decreased LVEF in clinical practices, so as to actively prevent and treat heart failure.

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New issues on measurement of B-type natriuretic peptides

Cited by 21 publications

References 58 publications

Clinical relevance of biological variation of cardiac troponins

Clinical relevance of biological variation of cardiac troponins

Pregnancy-specific Reference Intervals for BNP and NT-pro BNP—Changes in Natriuretic Peptides Related to Pregnancy

Influencing factors of NT‑proBNP level inheart failure patients with different cardiacfunctions and correlation with prognosis

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