The effects of medications on circulating levels of cardiac natriuretic peptides

Troughton, Richard W.; Richards, A. Mark; Yandle, Tim G.; Frampton, Chris; Nicholls, M. Gary

doi:10.1080/07853890701232057

Cited by 53 publications

(37 citation statements)

References 151 publications

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“…Furthermore, the diagnostic performance of BNP/NT-proBNP for acute HF shows excellent sensitivity, specificity, negative predictive values, and overall accuracy (1,2 ). Response to anti-HF therapy is reflected in rapidly apparent parallel changes in plasma BNP/NT-proBNP with the use of diuretics and vasodilators, reflecting the rapid cardiac "decompression" achieved by volume depletion and vasodilation (6 ). In a proof-of-principle study Murdoch et al demonstrated the ability to drive plasma peptide concentrations down during escalation of vasodilator therapy (7 ).…”

confidence: 99%

Use of Natriuretic Peptides to Guide and Monitor Heart Failure Therapy

Richards

Troughton

2012

Clinical Chemistry

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BACKGROUND Plasma B-type cardiac natriuretic peptides reflect cardiac structure and function and have proven roles in assisting in the diagnosis of acute heart failure. They are independent prognostic indicators across the full spectrum of cardiovascular disease. Serial changes in plasma B-type cardiac natriuretic peptides parallel prognosis in chronic heart failure. Beneficial responses to medications and devices used in the treatment of heart failure are associated with decreases in plasma B-type peptide concentrations. This effect has led to the hypothesis that intensified treatment directed at reducing B-peptide concentrations may improve outcomes in heart failure. CONTENT The efficacy of serial measurements of plasma B-type peptides in guiding titration of therapy for chronic heart failure has been the subject of several randomized controlled trials reported in the peer-reviewed literature since 2000. These reports are summarized in this review. Trial design, characteristics of the heart-failure population studied, duration of follow-up, exact end points recorded, and target peptide concentrations pursued all differ somewhat between trials. In addition, in studies in which benefits were seen, the exact mechanisms mediating the improvements in outcome were unclear. However, an overall consistency is emerging that is supported by 2 metaanalyses. SUMMARY In aggregate the existing trial data suggest that adjustment of treatment in chronic heart failure according to serial B-type peptide measurements, used in conjunction with established clinical methods, is likely to reduce cardiac mortality and hospital admissions with heart failure, at least in patients with systolic heart failure who are younger than 75 years and relatively free of comorbidities.

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confidence: 99%

Use of Natriuretic Peptides to Guide and Monitor Heart Failure Therapy

Richards

Troughton

2012

Clinical Chemistry

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“…Of note is the fact that renin-angiotensin system blockers were usually interrupted, whereas they have been shown to decrease natriuretic peptide levels. 35 Further studies on standard therapy are thus needed to refine prognostic cutoffs.…”

Section: Limitationsmentioning

confidence: 99%

N-Terminal Pro-Brain Natriuretic Peptide

et al. 2011

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Abstract-Natriuretic peptides are controregulatory hormones associated with cardiac remodeling, namely, left ventricular hypertrophy and systolic/diastolic dysfunction. We intended to address the prognostic value of N-terminal pro-brain natriuretic peptide (NT-proBNP) in hypertension. We prospectively studied the relationship between plasma NTproBNP and all-cause mortality in 684 hypertensive patients with no history or symptoms of heart failure referred for hypertension workup in our institution from 1998 to 2008. After a mean duration of 5.7 years, we observed 40 deaths (1.04 deaths per 100 patients per year). After adjustment for traditional cardiovascular risk factors, including ambulatory blood pressure and serum creatinine, the risk for all-cause mortality more than doubled with each increment of 1 log NT-proBNP (hazard ratio: 2.33 [95% CI: 1.36 to 3.96]). The risk of death of patients with plasma NT-proBNP Ն133 pg/mL (third tertile of the distribution) was 3.3 times that of patients with values Ͻ50.8 pg/mL (first tertile; hazard ratio: 3.30 [95% CI: 0.90 to 12.29]). This predictive value was independent of, and superior to, that of 2 ECG indexes of left ventricular hypertrophy, the Sokolov-Lyon index and the amplitude of the R wave in lead aVL. In addition, it persisted in patients without ECG left ventricular hypertrophy, which allowed refining risk stratification in this relatively low-risk patient category. In this large sample of hypertensive patients, plasma NT-proBNP appeared as a strong prognostic marker. This performance, together with the ease of measurement, low cost, and widespread availability of NT-proBNP test kits, should prompt a wide use of this marker for risk stratification in hypertension. (Hypertension. 2011;57:702-709.)Key Words: hypertension Ⅲ NT-proBNP Ⅲ survival Ⅲ risk stratification Ⅲ left ventricular hypertrophy I n hypertension, detection of cardiac damages is critical for risk stratification. 1 This is usually done by searching for left ventricular hypertrophy (LVH), a major predictor of cardiovascular events. 2,3 However, in clinical practice, LVH detection is subject to various limitations. ECG is recommended by most guidelines but has a poor sensitivity and is rarely performed in clinical practice. 4 Echocardiography is extensively used but is time consuming, expensive, and not always feasible for technical reasons. The cost-effectiveness of its systematic use in hypertensive patients is still widely debated. 5 Thus, there is still room for new cardiac markers to be used for risk stratification.In response to volume expansion and pressure load, ventricular myocytes release a cardiac hormone, the B-type natriuretic peptide (BNP), together with its amino-terminal fragment, the N-terminal proBNP (NT-proBNP). 6 BNP and NT-proBNP are strong prognostic markers in advanced stages of cardiac diseases like heart failure 7 or coronary disease. 8 They are also closely related to cardiac geometry and mass, 9 and we have recently demonstrated the good performance of plasma NTproBNP for t...

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“…Ayrıca renal yetmezlik, diabetes mellitus, anemi, beta bloker, ACE inhibitörü ve anjiotensin reseptör blokerleri gibi bir çok faktör NT-proBNP düzeyini etkileyebilir (31,32).…”

Section: Discussionunclassified

Tiroid Fonksiyon Bozukluğu Bulunan Hastalarda Erken Dönem Kardiyak Disfonksiyonu Belirlemede N-Terminal Pro-B-Tip Natriüretik Peptid

Ulusoy¹,

Gerek²,

Yiğit³

et al. 2013

haseki

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ÖzetAmaç:Bu çalışmanın amacı hipotiroidi ve hipertiroidi tanısı almış, ekokardiyografik ve klinik olarak herhangi bir kardiyak problemi bulunmayan hastalarda NT-proBNP düzeyinin erken dönem kardiyak disfonksiyonunun belirteci olarak kullanımını araştırmaktır. Yöntem: Hastanemizin İç Hastalıkları polikliniklerine başvuran tiroid hastalığı konmuş 13'ü erkek, 40'ı kadın toplam 53 hasta ile 40 sağlıklı kontrol çalışmaya dahil edildi. Çalışmaya alınan hastaların daha öncesine ait bilinen bir hastalık öyküsü yoktu ve yeni tanı almış aşikar hipotiroidi ve hipertiroidi hastalarıydı. Hasta ve kontrol gruplarının kan örneklerinde rutin biyokimyasal parametrelere, tiroid fonksiyon testlerine ve NT-proBNP düzeylerine bakıldı, elektrokardiyogram çekildi ve ekokardiyografi yapıldı. Bulgular: Çalışmaya alınan hastaların 28'inde hipotiroidi, 25'inde hipertiroidi mevcuttu. Hipotiroid grubun yaş ortalaması daha yüksekti. Hipertiroidi ve hipotiroidili hasta grubunda NTproBNP ortalaması kontrol grubuna göre anlamlı derecede yüksekti (p=0.019). Bu iki hasta grubu ayrı ayrı kontrol grubu ile karşılaştırıldığında NT-proBNP düzeyi hipotiroidili (p=0.0096) ve hipertiroidili (p=0.0415) hastalarda kontrol grubuna göre anlamlı olarak yüksek bulundu. Sonuç:Artmış NT-proBNP düzeyi kalp yetersizliği ve koroner arter hastalığında kötü prognozu gösteren önemli bir belirteçtir. Bu nedenle artmış NT-proBNP düzeyi aşikar hipotiroidi ve hipertiroidisi olan hastalarda erken dönem kardiyak disfonksiyonu belirlemede değerli bir belirteç olabilir. Abs tractAim: The aim of this study was to investigate N-terminal probrain natriuretic peptide (NT-proBNP) as a marker of early cardiac dysfunction in patients with hypothyroidism or hyperthyroidism without any clinical and echocardiographic cardiac problem. Methods:A total of 53 patients (13 male and 40 female), who were newly diagnosed with thyroid disease and 40 healthy controls who attended our internal medicine outpatient clinic, were included in the study. The patients had no history of any disease and, all of them were with newly diagnosed overt hypothyroidism or hyperthyroidism. Routine biochemical tests, and thyroid function tests were done and NT-proBNP levels were measured. Electrocardiograms and echocardiograms were performed. Results: There were 28 patients with hypothyroidsm and 25 patients with hyperthyroidism in the study group. The mean age of hypothyroidism group was higher than that of hyperthyroidism group. The mean NT-proBNP levels were significantly higher in the patient group when compared to the control group (p=0.019). When the two groups of patients were compared with the control group separately, the level of NT-proBNP was significantly higher in hypothyroidism group (p=0.0096) and hyperthyroidism group (p=0.0415). Conclusion: Elevated NT-proBNP levels are an important marker that suggests worse prognosis in heart failure and coronary artery disease. Elevated serum NT-proBNP levels might be a valuable marker to detect early cardiac dysfunction in patients with overt hypothyroidism ...

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The effects of medications on circulating levels of cardiac natriuretic peptides

Cited by 53 publications

References 151 publications

Use of Natriuretic Peptides to Guide and Monitor Heart Failure Therapy

Use of Natriuretic Peptides to Guide and Monitor Heart Failure Therapy

N-Terminal Pro-Brain Natriuretic Peptide

Tiroid Fonksiyon Bozukluğu Bulunan Hastalarda Erken Dönem Kardiyak Disfonksiyonu Belirlemede N-Terminal Pro-B-Tip Natriüretik Peptid

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