Interpretation of B-type natriuretic peptide in cardiac disease and other comorbid conditions

Abstract

B-Type natriuretic peptide (BNP) is elevated in states of increased ventricular wall stress. BNP is most commonly used to rule out congestive heart failure (CHF) in dyspneic patients. BNP levels are influenced by age, gender and, to a surprisingly large extent, by body mass index (BMI). In addition, it can be elevated in a wide variety of clinical settings with or without CHF. BNP is elevated in other cardiac disease states such as the acute coronary syndromes, diastolic dysfunction, atrial fibrillation (AF), amyloidosis, restrictive cardiomyopathy (RCM), and valvular heart disease. BNP is elevated in non-cardiac diseases such as pulmonary hypertension, chronic obstructive pulmonary disease, pulmonary embolism, and renal failure. BNP is also elevated in the setting of critical illness such as in acute decompensated CHF (ADHF) and sepsis. This variation across clinical settings has significant implications given the increasing frequency with which BNP testing is being performed. It is important for clinicians to understand how to appropriately interpret BNP in light of the comorbidities of individual patients to maximize its clinical utility. We will review the molecular biology and physiology of natriuretic peptides as well as the relevant literature on the utilization of BNP in CHF as well as in other important clinical situations, conditions that are commonly associated with CHF and or dyspnea.

Plasma cBIN1 Score (CS) Identifies HFrEF and Can Predict Cardiac Hospitalization in Stable Ambulatory Patients

“…Natriuretic peptides (BNP and NT-proBNP) have the most robust data and reflect myocardial wall stress [35]. The BNP peptides are effective at diagnosing HF among patients with dyspnea [14], ruling out acute decompensated HF [15], and future adverse cardiovascular events and mortality among patients [36,37]. They are also used to guide HF therapy [8,38].…”

“…BNP and its more stable and non-active version N-terminal prohormone BNP (NT-proBNP) are secreted by cardiomyocytes in response to pressure and stretch, which (with active BNP) results in a downstream effect of increased natriuresis, diuresis, and vasodilatation [10][11][12][13]. As stretch-response molecules, BNP biomarkers assess fluid status and perform extremely well is situations of diagnostic dilemmas regarding patients' symptoms of acute dyspnea [14,15].…”

Role of B-type natriuretic peptide (BNP) in heart failure

“…It also inhibits the release of aldosterone and antidiuretic hormone (ADH), while reducing sympathetic nervous activity. By promoting vasodilatation, natriuresis, and diuresis, BNP reduces preload and afterload [13].…”

The effect of the Wingate Anaerobic Test on NTproBNP, lactate and blood pressure in wrestlers and untrained young healthy males

“…BNP (ng/mL) is released predominantly from the ventricular myocardium as a response to cardiac ventricular dilatation and pressure overload [7][8]. Increased circulating levels of BNP (ng/mL) and N-terminal pro-BNP (NTproBNP, ng/ mL), a cleaved fragment of BNP precursor (amino acids 1-76), have been shown to be of prognostic value in patients with heart failure or coronary artery disease [9][10][11][12]. Although predominantly produced by the heart, NTproBNP (ng/mL) has also been found in neurons of discrete brain regions where its expression was shown to be 13 times higher than that of Atrial Natriuretic Peptide (ANP) [13].…”

“…Moreover, it has been proposed that the cardiac endocrine response may be regulated differently by several types of stressors [24][25]. While NTproBNP (ng/mL) is commonly associated with cardiac patients and researched predominantly during aerobic exercise and since natriuretic peptides have powerful physiological effects on hemodynamic, body fluid, and electrolyte homeostasis and given the inhibitory action they share on neuro-hormonal and immunological systems [9][10][11][12], it is of interest to investigate the response of NTproBNP (ng/mL) to an acute all-out anaerobic performance test such as the WAnT and to correlate the peptide's levels to the mechanical outcomes (Watts) of the test, Lactate (mmol/L) and BP (mmHg). 20 (n total = 20) young, low risk, males, aged 18-25 years, all students at the University of Mary (Umary), Bismarck, ND, USA, have volunteered to participate in this study, receiving nothing in return.…”