Brain Natriuretic Peptide and Its Biochemical, Analytical, and Clinical Issues in Heart Failure: A Narrative Review

Abstract

Heart failure (HF) is a primary cause of morbidity and mortality worldwide. As the most widely studied and commonly applied natriuretic peptide (NP), B-type natriuretic peptide (BNP) has the effects of diuresis, natriuresis, vasodilation, anti-hypertrophy, and anti-fibrosis and it inhibits the renin-angiotensin-aldosterone and sympathetic nervous systems to maintain cardiorenal homeostasis and counteract the effects of HF. Both BNP and N-terminal pro B-type natriuretic peptide (NT-proBNP) are applied as diagnostic, managing, and prognostic tools for HF. However, due to the complexity of BNP system, the diversity of BNP forms and the heterogeneity of HF status, there are biochemical, analytical, and clinical issues on BNP not fully understood. Current immunoassays cross-react to varying degrees with pro B-type natriuretic peptide (proBNP), NT-proBNP and various BNP forms and cannot effectively differentiate between these forms. Moreover, current immunoassays have different results and may not accurately reflect cardiac function. It is essential to design assays that can recognize specific forms of BNP, NT-proBNP, and proBNP to obtain more clinical information. Not only the processing of proBNP (corin/furin) and BNP (neprilysin), but also the effects of glycosylation on proBNP processing and BNP assays, should be targeted in future studies to enhance their diagnostic, therapeutic, and prognostic values.

Heart Remodeling, Treatment of Myocardial Infarction With Diabetes Mellitus 2nd Type and Heart Failure

“…Biomarkers can be useful for diagnosing proceses, choice of the way of treatment, in monitoring treatment efficacy and predicting outcomes of the disease due to their high sensitivity and specificity in case of thorough laboratory controle. Within the patients with HF, the evolution of the disease and the response to therapy differ as well as the consequences that depends on the cause of the HF, pathophysiological characteristics (systolic or diastolic dysfunction), the severity of the HF, the rate of its progression [25,26,27].…”

The Dual Role of Echocardiography in the Diagnosis of Acute Cardiac Complications and Treatment Monitoring for Coronavirus Disease 2019 (COVID-19)

“…For NT-pro BNP values, a level greater that 300 pg/ml ( 32 ) should be considered as abnormal. Although, when taking age into consideration, a higher NTproBNP level >1,800 pg/ml should be used to suspect acute heart failure in patients older than >75 years, ( 33 , 34 ), anything lower than those NT pro-BNP values, at a cut-off level of 940 pg/ml, has been related to adverse outcomes in critically ill patients admitted to ICU ( 35 ). Elevated hs cardiac Troponin I is even more specific to myocardial injury than CTnT ( 36 ) and may be attributed to multiple and overlapping mechanisms.…”

Natriuretic Peptides in Clinical Practice

“…Moreover, as one of the mechanisms of action of recently introduced angiotensin receptor blocker/ neprilysin inhibitors is reducing the breakdown of BNP, BNP levels increase in patients who are using these drugs (27). It was suggested that even though it is not expected for NT-proBNP levels to be affected by neprilysin inhibition, increased BNP levels could decrease proBNP and thus NT-proBNP through negative feedback mechanisms, and therefore, NT-proBNP might not be correlated with the severity of HF (28). While using natriuretic peptides for diagnostic purposes, all demographic and clinical factors should be taken into consideration.…”

“…Although BNP and NT-proBNP are very significant diagnostic and prognostic tests in HF, several clinical presentations affect test values (age, gender, renal functions, acute coronary syndromes, left ventricular dysfunction, atrial fibrillation, etc.) (25,28,(71)(72)(73). Therefore, these clinical presentations should be well-known and diagnostic and prognostic processes should be carefully considered in a coherent history including physical examination, echocardiography and other well-known prognostic markers of HF.…”