Updating the Role of Natriuretic Peptide Levels in Cardiovascular Disease

Abstract

Heart disease affects 1 in 3 individuals in the United States, and the prevalence of heart failure (HF) is increasing exponentially. Although our understanding of the disease progression of congestive HF (CHF) has advanced, refining the areas of diagnosis, risk stratification, prognosis, and treatment is still needed. The natriuretic peptides, specifically B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP), have shown promise in clinical practice. Brain natriuretic peptide is released from cardiac ventricular myocytes in response to volume or pressure overload. Rapid measurement of plasma BNP or NT-proBNP has been shown to increase the diagnostic accuracy of HF exacerbations. A cutoff value of 100 pg/mL has a sensitivity and specificity of 90% and 73%, respectively, according to the Breathing Not Properly Study. In addition, BNP and NT-proBNP have been considered independent predictors of adverse outcome. One study calculated a 35% increase in risk of death due to HF for every 100-pg/mL increase in BNP level. Lastly, natriuretic peptides have been known to decrease following medical therapy of HF, suggesting the role of their measurement in monitoring inpatient disease progression and outpatient medical programs. The future of natriuretic peptides lies in risk stratification in other cardiac diseases, such as acute coronary syndrome, and possibly determining severity of valvular disease. Although there is substantial work done in elucidating the power of natriuretic peptides in clinical practice, more research is necessary to reach a consensus regarding how to appropriately utilize them in treatment regimens.

Utilidad de los biomarcadores en insuficiencia cardiaca en la práctica clínica

“…El futuro de los PN se encuentra en la estratificación del riesgo en otras enfermedades cardiacas, como el síndrome coronario agudo y posiblemente, para determinar la gravedad de las enfermedades valvulares 10,11 .…”

Association of cardiac magnetic resonance‐detected myocardial abnormalities with disease characteristics and brain natriuretic peptide levels in systemic sclerosis without cardiac symptoms

“…Enhanced gene expression secondary to cardiac wall stress, especially LV wall stress, results in the production and secretion of brain natriuretic peptide (BNP) . Morphological changes may contribute to increased wall stress, possibly leading to elevated BNP levels.…”

Inverse relationship of bone mineral density and serum level of N-terminal pro-B-type natriuretic peptide in peritoneal dialysis patients

“…It is secreted by the heart along with biologically active BNP, and is one of the natriuretic peptides [1]. Recent studies have shown that elevated serum NT-pro-BNP is an independent predictor of adverse outcomes from congestive heart failure [2]. In hemodialysis patients, elevated serum NT-pro-BNP is associated with hypervolemia and mortality [34].…”