Interpretation and Use of Natriuretic Peptides in Non-congestive Heart Failure Settings

Overview

Journal Yonsei Med J

Specialty General Medicine

Date 2010 Mar 2

PMID 20191004

Citations 36

Authors

Shih-Hung Tsai

Yen-Yue Lin

Shi-Jye Chu

Ching-Wang Hsu

Shu-Meng Cheng

Affiliations

Soon will be listed here.

Abstract

Natriuretic peptides (NPs) have been found to be useful markers in differentiating acute dyspneic patients presenting to the emergency department (ED) and emerged as potent prognostic markers for patients with congestive heart failure (CHF). The best-established and widely used clinical application of BNP and NT-proBNP testing is for the emergent diagnosis of CHF in patients presenting with acute dyspnea. Nevertheless, elevated NPs levels can be found in many circumstances involving left ventricular (LV) dysfunction or hypertrophy; right ventricular (RV) dysfunction secondary to pulmonary diseases; cardiac inflammatory or infectious diseases; endocrinology diseases and high output status without decreased LV ejection fraction. Even in the absence of significant clinical evidence of volume overload or LV dysfunction, markedly elevated NP levels can be found in patients with multiple comorbidities with a certain degree of prognostic value. Potential clinical applications of NPs are expanded accompanied by emerging reports regarding screening the presence of secondary cardiac dysfunction; monitoring the therapeutic responses, risk stratifications and providing prognostic values in many settings. Clinicians need to have expanded knowledge regarding the interpretation of elevated NPs levels and potential clinical applications of NPs. Clinicians should recognize that currently the only reasonable application for routine practice is limited to differentiation of acute dyspnea, rule-out-diagnostic-tests, monitoring of therapeutic responses and prognosis of acute or decompensated CHF. The rationales as well the potential applications of NPs in these settings are discussed in this review article.

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References

Biasioli S, Zamperetti M, Borin D, Guidi G, De Fanti E, Schiavon R . Significance of plasma B-type natriuretic peptide in hemodialysis patients: blood sample timing and comorbidity burden. ASAIO J. 2007; 53(5):587-91. DOI: 10.1097/MAT.0b013e31814a57c3. View

Levitt J, Vinayak A, Gehlbach B, Pohlman A, Van Cleve W, Hall J . Diagnostic utility of B-type natriuretic peptide in critically ill patients with pulmonary edema: a prospective cohort study. Crit Care. 2008; 12(1):R3. PMC: 2374600. DOI: 10.1186/cc6764. View

Yamada T, Murakami Y, Okada T, Yoshida N, Toyama J, Yoshida Y . Plasma brain natriuretic peptide level after hybrid therapy with pulmonary vein isolation and antiarrhythmic drugs for atrial fibrillation. Int Heart J. 2008; 49(2):143-51. DOI: 10.1536/ihj.49.143. View

Sbarouni E, Georgiadou P, Marathias A, Geroulanos S, Kremastinos D . D-dimer and BNP levels in acute aortic dissection. Int J Cardiol. 2007; 122(2):170-2. DOI: 10.1016/j.ijcard.2006.11.056. View

Kahveci G, Bayrak F, Mutlu B, Bitigen A, Karaahmet T, Sonmez K . Prognostic value of N-terminal pro-B-type natriuretic peptide in patients with active infective endocarditis. Am J Cardiol. 2007; 99(10):1429-33. DOI: 10.1016/j.amjcard.2006.12.071. View

Schultz M, Faber J, Kistorp C, Jarlov A, Pedersen F, Wiinberg N . N-terminal-pro-B-type natriuretic peptide (NT-pro-BNP) in different thyroid function states. Clin Endocrinol (Oxf). 2003; 60(1):54-9. DOI: 10.1111/j.1365-2265.2004.01941.x. View

Iwanaga Y, Nishi I, Furuichi S, Noguchi T, Sase K, Kihara Y . B-type natriuretic peptide strongly reflects diastolic wall stress in patients with chronic heart failure: comparison between systolic and diastolic heart failure. J Am Coll Cardiol. 2006; 47(4):742-8. DOI: 10.1016/j.jacc.2005.11.030. View

Fonarow G, Peacock W, Horwich T, Phillips C, Givertz M, Lopatin M . Usefulness of B-type natriuretic peptide and cardiac troponin levels to predict in-hospital mortality from ADHERE. Am J Cardiol. 2008; 101(2):231-7. DOI: 10.1016/j.amjcard.2007.07.066. View

Kia M, Cooley A, Rimmer G, MacDonald T, Barber K, Manion P . The efficacy of B-type natriuretic peptide for early identification of blood loss in traumatic injury. Am J Surg. 2006; 191(3):353-7. DOI: 10.1016/j.amjsurg.2005.10.033. View

10.

Rauchenzauner M, Haberlandt E, Foerster S, Ulmer H, Laimer M, Ebenbichler C . Brain-type natriuretic peptide secretion following febrile and afebrile seizures - a new marker in childhood epilepsy?. Epilepsia. 2007; 48(1):101-6. DOI: 10.1111/j.1528-1167.2006.00837.x. View

11.

de Bold A . Heart atria granularity effects of changes in water-electrolyte balance. Proc Soc Exp Biol Med. 1979; 161(4):508-11. DOI: 10.3181/00379727-161-40584. View

12.

Lo Mauro R, Arcoleo F, Lo Giudice A, Picone A, Schirosa M, Raspanti G . B-type natriuretic peptide as a marker of asymptomatic re-stenosis after coronary implantation of a paclitaxel-eluting stent. J Cardiovasc Med (Hagerstown). 2007; 8(12):1020-3. DOI: 10.2459/JCM.0b013e3280bad8a5. View

13.

Giannakoulas G, Hatzitolios A, Karvounis H, Koliakos G, Charitandi A, Dimitroulas T . N-terminal pro-brain natriuretic peptide levels are elevated in patients with acute ischemic stroke. Angiology. 2005; 56(6):723-30. DOI: 10.1177/000331970505600610. View

14.

Kanat F, Vatansev H, Teke T . Diuretics, plasma brain natriuretic peptide and chronic obstructive pulmonary disease. Neth J Med. 2007; 65(8):296-300. View

15.

Nikolaou N, Goritsas C, Dede M, Paissios N, Papavasileiou M, Rombola A . Brain natriuretic peptide increases in septic patients without severe sepsis or shock. Eur J Intern Med. 2007; 18(7):535-41. DOI: 10.1016/j.ejim.2007.01.006. View

16.

Yano S, Kobayashi K, Kato K, Ikeda T . [The stady of pulmonary hypertension and plasma BNP values in respiratory diseases]. Nihon Kokyuki Gakkai Zasshi. 2007; 44(2):99-103. View

17.

Turk T, Ata Y, Ay D, Ozkan H, Vural H, Yavuz S . Plasma brain natriuretic Peptide after isolated on-pump coronary artery bypass grafting: prediction of postoperative adverse outcomes. Heart Surg Forum. 2008; 11(2):E84-9. DOI: 10.1532/HSF98.20071185. View

18.

Di Angelantonio E, De Castro S, Toni D, Sacchetti M, Biraschi F, Prencipe M . Determinants of plasma levels of brain natriuretic peptide after acute ischemic stroke or TIA. J Neurol Sci. 2007; 260(1-2):139-42. DOI: 10.1016/j.jns.2007.04.018. View

19.

Montaner J, Perea-Gainza M, Delgado P, Ribo M, Chacon P, Rosell A . Etiologic diagnosis of ischemic stroke subtypes with plasma biomarkers. Stroke. 2008; 39(8):2280-7. DOI: 10.1161/STROKEAHA.107.505354. View

20.

Kwan G, Isakson S, Beede J, Clopton P, Maisel A, Fitzgerald R . Short-term serial sampling of natriuretic peptides in patients presenting with chest pain. J Am Coll Cardiol. 2007; 49(11):1186-92. DOI: 10.1016/j.jacc.2006.11.031. View