Natriuretic peptides in heart failure: where we are, where we are going

Abstract

Tremendous advances have been made in understanding the pathophysiology and treatment of congestive heart failure (CHF). However, diagnosis still remains difficult, even with a comprehensive physical examination. Symptoms such as dyspnea are non-specific and poorly sensitive indicators for early CHF that can be largely undetected. The discovery of natriuretic peptides (BNP) as diagnostic biomarkers has been one of the most critical advances for heart failure diagnosis. Therefore, both B-type and N-terminal pro-B-type have potential role in the diagnosis of heart failure, as well as in prognostic risk assessment. A single determination of BNP at any time during the progression of chronic HF provides a clinically useful tool for risk stratification. The hypothesis that repeated measurements might carry prognostic information beyond a single measure was confirmed in different settings. One of the main interests is given to the values of repeated determinations for monitoring progression of disease, and for the evaluation of the clinical effects of medical therapy. Nevertheless, despite thousands of papers describing their potential utility, current guidelines have not endorsed the highest level of recommendation for their use, in part, because the application in clinical practice is often limited for the absence of well codified cut off. Recently, European guidelines emphasized the role of natriuretic peptides as potential laboratory markers. In the near future, algorithm building will take into consideration clinical and echocardiographic parameters as well as NP measurements, and this may lead to a correct diagnosis and identification of patients at high risk. The purpose of this review is to discuss the clinical approaches and future applications of natriuretic peptides in heart failure and coronary disease.

Usefulness of amino terminal pro-B-type natriuretic peptide in evaluating children with cardiac failure

“…The difference did not reach statistical significance probably because of the small number of mortality. There was no statistically significant relationship between the plasma NT-proBNP and the duration of admission in this study in contrast to previous studies on adult subjects with heart failure (8,9). This could be due to the faster recovery from illnesses in children compared to adults who tend to have co-morbidities.…”

“…It contributes significantly to childhood morbidity and mortality globally (2,3). The prevalence of heart failure from various studies done within Nigeria has ranged from 5.8-15.5% (4-6), symptoms or signs are also seen in other conditions such as upper respiratory tract infections (URTIs), urinary tract infections (UTIs) and other acute febrile illnesses (7,8).…”

“…The natriuretic peptides have been identified as cardiac biomarkers that can more objectively diagnose heart failure and are also useful in the management of the condition (8)(9)(10). The plasma levels of these peptides, especially the B-type natriuretic peptide (BNP) and its inactive metabolite, amino-terminal pro B type natriuretic peptide (NT-proBNP) are elevated in subjects with heart failure and increase with worsening degree of heart failure (11,12).…”

Predictors of Mortality in Paediatric Myocarditis

“…Many literature reveal BNP to be elevated in serum of patients with myocarditis or DCM and in animal models of myocarditis [24][25][26][27][28]. Several studies have proclaimed an association of higher levels of circulating BNP with the diagnosis of heart failure and fatal outcome [25,29]. As a predictor of death BNP levels are better than endothelin-1 or norepinephrine [22].…”

Natriuretic peptides in heart failure: where we are, where we are going

“…We read with great interest the article by Palazzuoli et al [1], which briefly gives a clinical update on natriuretic peptides (NP). The authors describe the role of NP both in heart failure diagnosis and prognosis and in the acute coronary syndrome.…”