The Impact of Cardiac Natriuretic Peptide Determination on the Diagnosis and Management of Heart Failure

Abstract

The long-predicted endocrine function of the heart has been proven by the discovery of atrial natriuretic peptide (atrial natriuretic factor, A-type natriuretic peptide; ANP) 20 years ago. This subsequently led to the description of a whole family of structurally similar but genetically distinct peptides, the natriuretic peptide family, which contributes to cardiovascular homeostasis. These looped peptides promote natriuresis and diuresis, act as vasodilators, and exert antimitogenic effects on cardiovascular tissues. Two members, ANP and brain natriuretic peptide (B-type natriuretic peptide; BNP) are secreted by the heart mainly in response to myocardial stretch induced by volume load. The natriuretic peptides are synthesized as preprohormones. The C-terminal endocrinological active peptides (ANP, BNP) and their N-terminal prohormone fragments are found in plasma. The natriuretic peptide system is activated to its highest degree in ventricular dysfunction. However, natriuretic peptides are increased in all patients with edematous disorders which lead to an increase in atrial tension or central blood volume, such as renal failure or ascitic liver cirrhosis. It could be demonstrated that in chronic heart failure patients and during the subacute phase of myocardial infarction, of all tested neurohormones, the cardiac natriuretic peptides were best markers to identify heart failure and the most powerful predictors of morbidity and mortality. Natriuretic peptides are independent markers for risk assessment. In comparative studies BNP was superior to ANP and its N-terminal prohormone fragments in myocardial infarction as well as in chronic heart failure patients. Less data on N-terminal proBNP (NT-proBNP) is available, but BNP and NT-proBNP appear to be equivalent markers. For primary care physicians natriuretic peptide measurement is useful to decide which patient with suspected heart failure warrants further investigation, particularly when assessment of left ventricular function is not readily available. Natriuretic peptides have an excellent negative predictive value, particularly in high risk patients. An increase in BNP is serious enough to warrant follow-up examinations. For the cardiologists the natriuretic peptides are helpful for guidance of therapy and monitoring disease course in heart failure patients and for risk stratification in heart failure and myocardial infarction.

Improved LFIAs for highly sensitive detection of BNP at point-of-care

“…[59][60][61] Although these methods have achieved quantitative detection with high sensitivity (2-10 pg/mL), 60 they are either timeconsuming (~12-36 h), complicated (need tedious procedures), inconvenient (require cumbersome instruments and professional operators) or need large blood volume (~5 mL), which significantly limit their accessibility in resourcelimited settings. 61 Our proposed test strip is simple, low cost and equipment free, which can be performed by untrained users in resource-limited settings in 10-15 min using only a drop of blood, eliminating the need for large and expensive equipment or laboratory infrastructure.…”

Diagnostic Accuracy and Prognostic Relevance of the Measurement of Cardiac Natriuretic Peptides: A Review

“…Contrary to other recent reviews (1)(2)(3)(4)(5)(6)(7), we will analyze in detail and critically compare the relevance of interrelationships among the analytical performances of CNH immunoassays, the population selection protocol, and the "gold standard" used in the different studies. Moreover, the diagnostic accuracy and prognostic relevance of assays of different CNHs in the entire spectrum of cardiovascular disease will be evaluated, whereas other reviews have focused the discussion on one peptide only (mainly BNP) and/or on one clinical condition only (mainly HF) (2,3,5,6 ).…”

Biomarcadores cardiacos como ayuda diagnóstica en las cardiopatías

“…El bnp es sintetizado como una prohormona, probnp, y es descompuesto por una furina en las moléculas activas (bnp) e inactivas (nt-probnp); ambas pueden estar en el miocardio y el plasma [41].…”