BNP/NT-proBNP in pulmonary arterial hypertension: time for point-of-care testing?

Abstract

Despite the advent of new therapies and improved outcomes in patients with pulmonary arterial hypertension (PAH), it remains a life-shortening disease and the time to diagnosis remains unchanged. Strategies to improve outcomes are therefore currently focused on earlier diagnosis and a treatment approach aimed at moving patients with PAH into a category of low-risk of 1-year mortality. B-type natriuretic peptide (BNP; or brain natriuretic peptide) and N-terminal prohormone of BNP (NT-proBNP) are released from cardiac myocytes in response to mechanical load and wall stress. Elevated levels of BNP and NT-proBNP are incorporated into several PAH risk stratification tools and screening algorithms to aid diagnosis of systemic sclerosis. We have undertaken a systematic review of the literature with respect to the use of BNP and NT-proBNP in PAH and the use of these biomarkers in the diagnosis and risk stratification of PAH, their relation to pulmonary haemodynamics and the potential for point-of-care testing to improve diagnosis and prognosis.

Prevalence, Incidence and Associates of Pulmonary Hypertension Complicating Type 2 Diabetes: Insights from the Fremantle Diabetes Study Phase 2 and National Echocardiographic Database of Australia

“…An increase in plasma NT-proBNP was independently associated with PH in all multivariable analyses. Its strong predictive value in incident PH in the present study support its suggested use as a screening tool [ 31 ]. Since attenuation of the relationship with incident PH was observed only in the competing risk model, people with higher NT-proBNP may be dying before developing PH, thus weakening the prognostic relationship with incident PH.…”

Pulmonary hypertension in the child with bronchopulmonary dysplasia

“…Serum brain natriuretic peptide (BNP) and N ‐terminal pro‐BNP (NT‐pro‐BNP) are helpful biomarkers for monitoring right ventricular strain, as they are released from the cardiac myocardium during wall stress, either from pressure or volume overload states 34,40 . Studies have associated BNP and NT‐pro‐BNP with pulmonary vascular resistance, mPAP, and disease outcomes 47–50 . There is limited data on the use of these markers in patients with BPD‐PH 51–53 .…”

Where are we in 2021 with heart failure with reduced ejection fraction?—current outlook and expectations from new promising clinical trials

“…The VICTORIA trial (Vericiguat Global Study in Subjects with Heart Failure with Reduced Ejection Fraction) was designed to investigate the efficacy and safety of Fig. 2 Pathways of synthesis and release of B-type natriuretic peptide and a pivotal role of cyclic guanosine monophosphate pathway modulation with sacubitril and vericiguat in heart failure outcome [9][10][11]. BNP B-type natriuretic peptide, cGMP cyclic guanosine monophosphate, GC guanyl cyclase, GTP guanosine triphosphate, NPPB natriuretic peptide B, NPRA natriuretic peptide receptor A, NT-proBNP N-terminal prohormone of BNP, pGC particulate guanylate cyclase, sGC soluble guanylate cyclase ◂ vericiguat in patients with chronic HFrEF with EF 45% or less (85.8% of individuals with EF < 40%), with recent worsening HF requiring a hospitalization or an intravenous diuretic therapy [32,33].…”