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

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.

Cardiovascular manifestations of Takayasu arteritis and their relationship to the disease activity: Analysis of 204 Korean patients at a single center

“…Therefore, it is highly speculative that the main mechanism of the elevated NTproBNP level in the active TA group is the elevated RV filling pressure due to pulmonary arterial involvement, and it is possibly due to the higher incidence of AR and severe LV dysfunction in the active TA group. However, in patients with sepsis, BNP levels are positively correlated with CRP levels and it could be mediated by cytokines such as tumor necrosis factor alpha (TNF-a) and certain interleukins [31,32]. Therefore, there is a chance that NT-proBNP is elevated as an acute phase response in patients with active TA.…”

Semiología y diagnóstico diferencial de la insuficiencia cardíaca crónica

“…Este último presenta una relación inversa con la función renal, lo que lleva a errores en el diagnóstico de IC cuando hay presencia de disfunción de este organo [30]. Otras causas de elevación de péptidos natriureticos incluyen cirrosis, hipertiroidismo, infecciones, isquemia cerebral, tromboembolismo pulmonar [31,32], sexo femenino y envejecimiento [33]. Condiciones como la obesidad pueden producir niveles bajos de BNP [34].…”

Baseline NT-proBNP correlates with change in 6-minute walk distance in patients with pulmonary arterial hypertension in the pivotal inhaled treprostinil study TRIUMPH-1

“…7 The use of these peptides as biomarkers is best established in congestive heart failure. 9 There is a linear correlation between plasma concentrations of BNP and NTproBNP. 10 Being more stable with a much higher plasma concentration than BNP, NT-proBNP is more suitable for use as a biomarker from a practical perspective.…”