Use of B-type natriuretic peptide outside of the emergency department

Maeder, Micha T.; Müeller, Christian; Pfisterer, Matthias; Buser, Peter; Rocca, Hans Peter Brunner–La

doi:10.1016/j.ijcard.2007.10.018

Cited by 31 publications

(30 citation statements)

References 135 publications

(202 reference statements)

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“…Most importantly, in our study we measured ⌬ A-CS BNP rather than peripheral BNP. Similar to many cross-sectional studies revealing an association between higher plasma BNP and lower LVEF, 18 we found a strong association between lower LVEF and higher ⌬ A-CS BNP. Physiologically, however, LVEF does not reflect a specific mechanical load that would contribute to the regulation of BNP gene expression or release by cardiomyocytes.…”

Section: Discussionsupporting

confidence: 91%

Hemodynamic Determinants of Myocardial B-Type Natriuretic Peptide Release

2010

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Abstract-Although B-type natriuretic peptide (BNP) is widely used as a biomarker for heart failure, the in vivo mechanical stimulus for its cardiac release remains poorly defined. We aimed to characterize the hemodynamic determinants of the transcardiac BNP gradient as a measure of myocardial BNP release by performing a detailed hemodynamic assessment in subjects with a broad spectrum of systolic and diastolic left ventricular dysfunction. Forty-two subjects underwent a detailed transthoracic echocardiographic study, right heart catheterization, and simultaneous BNP measurement in arterial and coronary sinus plasma. The transcardiac BNP gradient was lowest in subjects with normal left ventricular ejection fraction/high peak early diastolic annular velocity (nϭ11), intermediate in those with normal left ventricular ejection fraction/low peak early diastolic annular velocity (nϭ13), and highest in those with low left ventricular ejection fraction/low peak early diastolic annular velocity (nϭ18; 29 ng/L (range: 15 to 78 ng/L) versus 88 ng/L (range: 34 to 172 ng/L) versus 1566 ng/L (range: 624 to 2349 ng/L; PϽ0.001). Across the range of patients, left ventricular end-systolic wall stress (r 2 ϭ0.51) and peak systolic mitral annular velocity (r 2 ϭ0.47) showed the strongest correlation with higher transcardiac BNP gradient. In contrast, the transcardiac BNP gradient was weakly related to indices of diastolic load, including pulmonary capillary wedge pressure (r 2 ϭ0.27) and left ventricular end-diastolic wall stress (r 2 ϭ0.21). Across this spectrum of pathophysiology, left ventricular end-systolic wall stress appears to be the key mechanical stimulus influencing cardiac BNP release. (Hypertension. 2010;56:682-689.)

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Section: Discussionsupporting

confidence: 91%

Hemodynamic Determinants of Myocardial B-Type Natriuretic Peptide Release

2010

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“…Thus, isolated increase in wall stress of the right-sided cardiac cavities, for example in patients with pulmonary hypertension, may result in significant increase in BNP and NT-proBNP levels. Although BNP and NT-proBNP levels are usually lower in isolated right compared to left heart failure, very high levels may also be seen in advanced pulmonary hypertension [3]. In addition, non-cardiac mechanisms, like reduced creatinine clearance may also contribute to BNP release [3].…”

Section: Discussionmentioning

confidence: 99%

“…Although BNP and NT-proBNP levels are usually lower in isolated right compared to left heart failure, very high levels may also be seen in advanced pulmonary hypertension [3]. In addition, non-cardiac mechanisms, like reduced creatinine clearance may also contribute to BNP release [3]. In this regard, advanced age and reduced renal function are important.…”

Section: Discussionmentioning

confidence: 99%

“…Accordingly, in acute heart failure, BNP and NT-proBNP levels correlate positively with left ventricular (LV) dimensions, LV volumes, LV mass and left atrial volume and are inversely related to LV ejection fraction [2]. In subjects with normal LV ejection fraction, elevated NT-proBNP (>600 pg/ml) or BNP (>100 pg/ml) are the strongest independent predictors of severe diastolic dysfunction [3]. It is generally believed that elevation of left-sided filling pressures and BNP or NT-proBNP levels are unidirectional, that is, elevation of filling pressures result in an elevation in BNP and NT-proBNP and vice versa.…”

Section: Introductionmentioning

confidence: 99%

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Dehydration with High Natriuretic Peptide Levels! A Word of Caution

2011

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B-type natriuretic peptide is secreted primarily by cardiomyocytes in response to increased ventricular or atrial wall stress reflecting volume or pressure overload. The relationship between natriuretic peptides and the severity of heart failure is well established. We present here a case where natriuretic peptide levels were increased due to dehydration in the abscence of renal impairment. Normalization of natriuretic peptide level was achieved by stopping the diuretics and the administration of normal saline.

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“…BNP has been shown to be helpful for the differentiation of patients with HF from those with dyspnoea due to other causes [30], although the correlation between BNP and single haemodynamic or echocardiographic measures is only moderate [9,10,31], and BNP is influenced by noncardiac factors such as renal failure, BMI and anaemia [31]. BNP seems, however to reflect the burden of cardiac dysfunction and might thus be a composite marker of cardiovascular function.…”

Section: Discussionmentioning

confidence: 99%

B‐type natriuretic peptide and C‐terminal‐pro‐endothelin‐1 for the prediction of severely impaired peak oxygen consumption

Maeder

Brutsche

Staub

et al. 2009

Journal of Internal Medicine

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Objective. To assess the utility of B-type natriuretic peptide (BNP) and C-terminal-pro-endothelin-1 (CTproET-1) to predict a severely impaired peak oxygen consumption (peak VO 2 , < 14 mL kg )1 min )1 ) in patients referred for cardiopulmonary exercise testing.Design. Cross-sectional study.Setting. Tertiary care center.Methods. Peak VO 2 , BNP and CT-proET-1 were assessed in 141 consecutive patients referred for cardiopulmonary exercise testing.Results. B-type natriuretic peptide [median (interquartile range) 48 (38-319) vs. 33 (15-86) pg mL )1 ; P = 0.002] and vs. 60 (52-74) pmol L )1 ; P < 0.001] were higher in patients with a peak VO 2 < 14 mL kg )1 min )1 (n = 30) than in those with a peak VO 2 ‡ 14 mL kg )1 min )1 (n = 111). CT-pro-ET-1 had a higher area under the receiver-operator-characteristics curve (AUC) to predict a peak VO 2 < 14 mL kg )1 min )1 than BNP (0.79 vs. 0.68; P = 0.04). The optimal BNP cut-off of 37.2 pg mL )1 had a sensitivity of 80% and a specificity of 56%. The optimal CT-proET-1 cut-off of 74.4 pmol L )1 had a sensitivity of 80% and specificity of 76%. A five-item score composed of body mass index, diabetes, forced expiratory volume within the first second, alveolo-arterial oxygen pressure difference, and BNP had an AUC of 0.88 to predict a peak VO 2 < 14 mL kg )1 min )1 . Adding CT-proET-1 to the score resulted in an AUC of 0.92.Conclusions. C-terminal-pro-endothelin-1 is superior to BNP for the prediction of a peak VO 2 < 14 mL kg )1 min )1 in patients referred for CPET. A score incorporating body mass index, diabetes status, spirometry, blood gases, BNP and CT-proET-1 improves the prediction of a peak VO 2 < 14 mL kg )1 min )1 based on single biomarkers.

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Use of B-type natriuretic peptide outside of the emergency department

Cited by 31 publications

References 135 publications

Hemodynamic Determinants of Myocardial B-Type Natriuretic Peptide Release

Hemodynamic Determinants of Myocardial B-Type Natriuretic Peptide Release

Dehydration with High Natriuretic Peptide Levels! A Word of Caution

B‐type natriuretic peptide and C‐terminal‐pro‐endothelin‐1 for the prediction of severely impaired peak oxygen consumption

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