Abstract
Currently, brain natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) are widely used as diagnostic biomarkers for heart failure (HF) and cardiac dysfunction in clinical medicine. They are also used as postmortem biomarkers reflecting cardiac function of the deceased before death in forensic medicine. Several previous studies have reviewed BNP and NT-proBNP in clinical medicine, however, few articles have reviewed their application in forensic medicine. The present article reviews the biological features, the research and application status, and the future research prospects of BNP and NT-proBNP in both clinical medicine and forensic medicine, thereby providing valuable assistance for clinicians and forensic pathologists.
Highlights
More than 26 million people all over the world are suffering from heart failure (HF) and cardiac dysfunction, which are currently serious global public health problems
In addition to natriuretic peptide receptors (NPR)-C receptors involved in the degradation of brain natriuretic peptide (BNP), neutral endopeptidase (NEP), dipeptidyl peptidase-IV (DPPIV), and insulin degrading enzyme (IDE) are associated with the clearance of BNP under physiological conditions, which leads to an approximate half-life of 20 min for BNP and 90–120 min for NT-proBNP [12,34,39,40]
In 2015, the first of a new class of drugs was approved by the Food and Drug Administration (FDA) of America; it was a sodium supramolecular complex with an equal ratio of the angiotensin receptor blocker valsartan and the neprilysin inhibitor prodrug sacubitril, and it has been proven to be able to successfully cut down mortality in patients suffering from heart failure with reduced ejection fraction (HFrEF) [33,41,42]
Summary
More than 26 million people all over the world are suffering from heart failure (HF) and cardiac dysfunction, which are currently serious global public health problems. Due to high morbidity and mortality, the diagnosis of HF and cardiac dysfunction is extremely important in both clinical and forensic medicine [7,8,9,10]. For the deceased examined by forensic pathologists, the diagnosis of HF or the evaluation of cardiac function after death is very difficult due to the lack of clinical medical records of the deceased and unavailability of assisted examinations. Many forensic studies have demonstrated that BNP and NT-proBNP could be used to reflect the cardiac function of the deceased before their death through extensive animal experiments and postmortem specimens, and they could be used as postmortem biomarkers for the diagnosis of HF or cardiac dysfunction in forensic medicine [9,10,18,19,20]. This article reviews the biological features, the clinical and forensic research, and the application status of BNP and NT-proBNP, as well as their future research prospects in order to provide valuable assistance for clinicians and forensic pathologists
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