Use of B-Type Natriuretic Peptide in the Evaluation and Management of Acute Dyspnea

Müeller, Christian; Scholer, André; Laule-Kilian, Kirsten; Martina, Benedict; Schindler, Christian; Buser, Peter; Pfisterer, Matthias; Perruchoud, André P.

doi:10.1056/nejmoa031681

Cited by 897 publications

(461 citation statements)

References 27 publications

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“…A commonly used biochemical marker for severity of HF is pro-BNP, which has been shown to correlate with the severity of HF [24,25]. In the present study, the VO 2 peak/THV ratio was shown to correlate with pro-BNP, indicating that the ratio can potentially serve as a measure for severity of HF.…”

Section: Discussionsupporting

confidence: 61%

Peak oxygen uptake in relation to total heart volume discriminates heart failure patients from healthy volunteers and athletes

Engblom

Steding

Carlsson

et al. 2010

Journal of Cardiovascular Magnetic Resonance

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BackgroundAn early sign of heart failure (HF) is a decreased cardiac reserve or inability to adequately increase cardiac output during exercise. Under normal circumstances maximal cardiac output is closely related to peak oxygen uptake (VO2peak) which has previously been shown to be closely related to total heart volume (THV). Thus, the aim of this study was to derive a VO2peak/THV ratio and to test the hypothesis that this ratio can be used to distinguish patients with HF from healthy volunteers and endurance athletes. Thirty-one patients with HF of different etiologies were retrospectively included and 131 control subjects (60 healthy volunteers and 71 athletes) were prospectively enrolled. Peak oxygen uptake was determined by maximal exercise test and THV was determined by cardiovascular magnetic resonance. The VO2peak/THV ratio was then derived and tested.ResultsPeak oxygen uptake was strongly correlated to THV (r2 = 0.74, p < 0.001) in the control subjects, but not for the patients (r2 = 0.0002, p = 0.95). The VO2peak/THV ratio differed significantly between control subjects and patients, even in patients with normal ejection fraction and after normalizing for hemoglobin levels (p < 0.001). In a multivariate analysis the VO2peak/THV ratio was the only independent predictor of presence of HF (p < 0.001).ConclusionsThe VO2peak/THV ratio can be used to distinguish patients with clinically diagnosed HF from healthy volunteers and athletes, even in patients with preserved systolic left ventricular function and after normalizing for hemoglobin levels.

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Section: Discussionsupporting

confidence: 61%

Peak oxygen uptake in relation to total heart volume discriminates heart failure patients from healthy volunteers and athletes

Engblom

Steding

Carlsson

et al. 2010

Journal of Cardiovascular Magnetic Resonance

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“…Furthermore, NT-proBNP measurements might prove valuable for enrichment of diabetic patient populations in future intervention trials, including studies of cardioprotective treatment aiming to demonstrate that specific modification of this marker will translate into improved outcome, as suggested in patients with heart failure [31] and emergency patients with dyspnoea [32]. In addition, determination of plasma NT-proBNP concentration will enable the identification of type 1 diabetic patients with nephropathy with a relatively low 10-year mortality rate, a rate approaching the risk in diabetic patients with persistent normoalbuminuria.…”

Section: Discussionmentioning

confidence: 99%

Plasma N-terminal pro-brain natriuretic peptide as an independent predictor of mortality in diabetic nephropathy

et al. 2004

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Aims/hypothesis: Raised N-terminal pro-brain natriuretic peptide (NT-proBNP) is independently associated with an increased risk of death in chronic heart failure and acute coronary syndromes in nondiabetic populations. Diabetic nephropathy is characterised by an increased risk of cardiovascular morbidity and mortality. This study investigated the prognostic value of NT-proBNP in a large cohort of type 1 diabetic patients with and without diabetic nephropathy. Methods: In a prospective observational follow-up study, 198 type 1 diabetic patients with overt diabetic nephropathy (122 men, age [mean±SD] 41±10 years, duration of diabetes 28±8 years, GFR 74±33 ml min −1 ) and a matched control group of 188 patients with longstanding type 1 diabetes and persistent normoalbuminuria (114 men, age 43±10 years, duration of diabetes 27±9 years) were followed for 9.3 (0.0-9.5) years. Plasma NTproBNP concentration was determined by immunoassay at baseline. Results: In patients with diabetic nephropathy, plasma NT-proBNP concentration was elevated to (median [range]) 110 (5-79640) ng l −1 vs. 27 (5-455) ng l −1 in normoalbuminuric patients (p<0.0001). Among patients with nephropathy, 39 (39%) patients with plasma NTproBNP concentrations above the median and 12 (12%) with values below the median died from any cause (unadjusted hazard ratio 3.86 [95% CI 2.02-7.37], p<0.0001; covariate-adjusted hazard ratio 2.28 [1.04-4.99], p=0.04). This lower mortality rate was attributable to fewer cardiovascular deaths: 31 (31%) and 7 (7%) above and below the median NT-proBNP level respectively (unadjusted hazard ratio 5.25 [2.31-11.92], p<0.0001; covariate-adjusted hazard ratio 3.81 [1.46-9.94], p=0.006). Conclusions/interpretation: Elevated circulating NT-proBNP is a new independent predictor of the excess overall and cardiovascular mortality in diabetic nephropathy patients without symptoms of heart failure.

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“…Circulating levels of the cardiac natriuretic peptides, particularly brain natriuretic peptide (BNP) and the 1-76 amino-acid N-terminal pro-BNP (NT-proBNP), have been identified as robust biochemical markers of heart failure in patients presenting with acute shortness of breath, [1][2][3][4] as prognostic indices for mortality and the development of heart failure following acute myocardial infarction, 5,6 and as potentially useful guides to the intensity of pharmacotherapy in patients with chronic heart failure. 7 Natriuretic peptide levels have been reported also to be higher in patients with hypertension, especially those with left ventricular hypertrophy or dysfunction, than in normotensive subjects.…”

Section: Introductionmentioning

confidence: 99%

Plasma N terminal pro-brain natriuretic peptide levels and its determinants in a multi-ethnic population

et al. 2007

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This study documents the determinants and plasma levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) among hypertensive and normotensive subjects in a multi-ethnic population in the United Arab Emirates (UAE). We obtained demographic, anthropometric and clinical data, together with fasting NT-proBNP and biochemical indices from 128 hypertensive patients and 138 normotensive subjects matched for age, gender and ethnicity. Plasma NT-proBNP levels were significantly (Po0.001), and several-fold higher among hypertensives (median 5.92, inter quartile range (IQR): 1.79-18.48 pmol/l) than normotensives (median 1.78, IQR: 0.59-4.32 pmol/l) in the total study population, and the same was true for the ethnic groups separately. Similarly, plasma levels of glucose, blood urea nitrogen (BUN) and creatinine, but not insulin, were significantly (Po0.05) higher among hypertensives than normotensives. For all subjects combined, log NT-proBNP correlated positively and significantly with age (Po0.01), log glucose (Po0.05), systolic blood pressure (SBP, Po0.001), log BUN (Po0.001) and log creatinine (Po0.001). Multivariate regression analysis showed that NT-proBNP levels were independently and positively correlated with SBP, age, gender, log BUN, Emirati and South East Asian ethnic groups and inversely associated with current exercise. In conclusion, we found circulating levels of NT-proBNP to be significantly increased in hypertensive versus normotensive subjects in the UAE and independently related to SBP, age, gender, indices of renal function and possibly exercise. Our results further suggest a possible modulating effect of ethnicity on NT-proBNP levels.

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Use of B-Type Natriuretic Peptide in the Evaluation and Management of Acute Dyspnea

Abstract: Used in conjunction with other clinical information, rapid measurement of B-type natriuretic peptide in the emergency department improved the evaluation and treatment of patients with acute dyspnea and thereby reduced the time to discharge and the total cost of treatment.

Cited by 897 publications

References 27 publications

Peak oxygen uptake in relation to total heart volume discriminates heart failure patients from healthy volunteers and athletes

Peak oxygen uptake in relation to total heart volume discriminates heart failure patients from healthy volunteers and athletes

Plasma N-terminal pro-brain natriuretic peptide as an independent predictor of mortality in diabetic nephropathy

Plasma N terminal pro-brain natriuretic peptide levels and its determinants in a multi-ethnic population

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