Vigorous response in plasma N-terminal pro-brain natriuretic peptide (NT-BNP) to acute myocardial infarction

Gill, Denzil; Seidler, Tim; Troughton, Richard W.; Yandle, Timothy G.; Frampton, Christopher M.; Richards, Mark; Lainchbury, John G.; Nicholls, Gary

doi:10.1042/cs20030131

Cited by 49 publications

(31 citation statements)

References 42 publications

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“…In parallel with this, biomarkers particularly B type natriuretic peptide (BNP) and its more stable counterpart N-terminal pro-B type natriuretic peptide (NT-proBNP) [9] have been shown to have a vigorous response following an acute myocardial infarction (AMI) [10] and plasma levels are related to short and long-term mortality [11][12][13][14][15]. BNP is able to provide additional prognostic information over and above that provided by left ventricular dysfunction following an acute myocardial infarction [12].…”

Section: Introductionmentioning

confidence: 99%

N-terminal pro-B-type natriuretic peptide complements the GRACE risk score in predicting early and late mortality following acute coronary syndrome

Khan

Narayan

et al. 2009

Clinical Science

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Background: The GRACE risk score has been shown to offer predictive power with regards to death and myocardial infarction (AMI) in patients with acute coronary syndromes (ACS). Nterminal pro-B type natriuretic peptide (NT-proBNP) has also been found to be useful in predicting mortality following ACS. Aim: We sought to investigate the utility of GRACE score and NT-proBNP levels at predicting risk of early and late deaths following ACS. Method: We studied 1033 patients (740 men, mean age 66.5 ± 12.7years) with AMI. Blood was drawn once within 24 hours following the onset of chest pain. The plasma concentration of NT-proBNP was determined using an in-house non-competitive immunoassay. Results: Patients were GRACE risk scored as described. 30-day mortality was 3.7%, 6-month mortality was 7.8%, all were related to higher GRACE risk scores (p=0.001 for trend). Higher NT-proBNP levels were also related to increased mortality (p<0.0001). In a Cox proportional hazards model, independent predictors of 30-day and 6-month mortality included NT-proBNP levels and GRACE risk score. The receiver-operating curve for GRACE risk score was complemented by NT-proBNP levels for prediction of 30-day mortality (AUC 0.85) and 6-month mortality (AUC 0.81). Conclusion: NT-proBNP gives complementary information to GRACE risk score for predicting early and late mortality. The inclusion of the NT-proBNP blood test is useful in risk stratifying patients after an acute coronary syndrome.

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Section: Introductionmentioning

confidence: 99%

N-terminal pro-B-type natriuretic peptide complements the GRACE risk score in predicting early and late mortality following acute coronary syndrome

Khan

Narayan

et al. 2009

Clinical Science

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“…CK-MB and myoglobin measurements were all determined by commercial assays (Abbott, Abbott Park, Ill) by the Clinical Biochemistry section of Canterbury Health Labs (Christchurch Hospital, New Zealand) according to our previously described protocols. 12,14,15 Troponin I was determined by a late-generation assay (Abbott Architect) with a 99th percentile cutoff of 0.03 g/L. …”

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confidence: 99%

B-Type Natriuretic Peptide Signal Peptide Circulates in Human Blood

et al. 2010

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Background-The diagnosis of cardiac necrosis such as myocardial infarction can be difficult and relies on the use of circulating protein markers like troponin. However, there is a clear need to identify circulating, specific biomarkers that can detect cardiac ischemia without necrosis. Methods and Results-Using specific immunoassay and tandem mass spectrometry, we show that a fragment derived from the signal peptide of B-type natriuretic peptide (BNPsp) not only is detectable in cytosolic extracts of explant human heart tissue but also is secreted from the heart into the circulation of healthy individuals. Furthermore, plasma levels of BNPsp in patients with documented acute ST-elevation myocardial infarction (nϭ25) rise to peak values (Ϸ3 times higher than the 99th percentile of the normal range) significantly earlier than the currently used biomarkers myoglobin, creatine kinase-MB, and troponin. Preliminary receiver-operating characteristic curve analysis comparing BNPsp concentrations in ST-elevation myocardial infarction patients and other patient groups was positive (area under the curveϭ0.97; PϽ0.001), suggesting that further, more rigorous studies in heterogeneous chest pain patient cohorts are warranted. Key Words: acute coronary syndrome Ⅲ biomarkers Ⅲ ischemia Ⅲ myocardial infarction Ⅲ signal peptide A cute coronary syndromes encompass a spectrum of cardiac ischemic events ranging from unstable angina to acute myocardial infarction. However, a significant proportion of patients who present with suspected acute coronary syndromes do not have a cardiac cause for their symptoms or have equivocal findings on history and ECG. This places a heavy emphasis on using circulating biomarker concentrations for accurate diagnosis. 1 A number of biomarkers have been proposed for this purpose, including creatine kinase-MB (CK-MB), troponin T, troponin I (TnI), and myoglobin. However, time to detectable or abnormal elevation of plasma cardiac biomarkers in acute myocardial infarction can be 6 to 12 hours, imposing a delay on a precise diagnosis and treatment. Furthermore, myoglobin, CK, and to a lesser degree CK-MB lack specificity and can be secreted from extracardiac sources, especially during trauma or surgery. Accurate early diagnosis of acute myocardial infarction facilitates prompt introduction of effective percutaneous or thrombolytic revascularization and adjunctive anticoagulant and antiplatelet therapy. Such treatments are progressively less effective at reducing mortality and morbidity with each hour of delay in diagnosis and management. 2 Given the need for accelerated decision making in this clinical situation, there is considerable interest in the identification of new circulating biomarkers that provide early and specific diagnosis of acute cardiac injury. Conclusion-Our Editorial see p 229 Clinical Perspective on p 264Signal peptides (SPs) perform the function of directing nascent preproproteins through the process of translation into the endoplasmic reticulum (ER) and eventual secretion from Received ...

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“…In previous studies, time intervals of serial NT-proBNP measurements were heterogenous (from admission to 96 h after admission and more) [27,30]. Serial measurements of NT-proBNP, measured on admission and 8 h later, were analyzed in one of these studies, but predictive values of NT-proBNP plasma levels on admission and 8 h later were almost identical [27].…”

Section: Incremental Value Of Serial B-type Natriuretic Peptide Testimentioning

confidence: 99%

Serial NT-proBNP measurements for risk stratification of patients with decompensated heart failure

Lüers

Schmidt

Wachter

et al. 2010

Herz

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NT-proBNP is a powerful marker of 30-day mortality in patients with decompensated heart failure of ischemic and non-ischemic origin. Compared with single baseline measurements, serial measurements of NT-proBNP plasma levels within 12 h after hospital admission may be used to increase the predictive value of NT-proBNP with regard to the early identification of patients who are at high risk of mortality.

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Vigorous response in plasma N-terminal pro-brain natriuretic peptide (NT-BNP) to acute myocardial infarction

Cited by 49 publications

References 42 publications

N-terminal pro-B-type natriuretic peptide complements the GRACE risk score in predicting early and late mortality following acute coronary syndrome

N-terminal pro-B-type natriuretic peptide complements the GRACE risk score in predicting early and late mortality following acute coronary syndrome

B-Type Natriuretic Peptide Signal Peptide Circulates in Human Blood

Serial NT-proBNP measurements for risk stratification of patients with decompensated heart failure

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