Heart Failure and B-Type Natriuretic Protein

Abstract

1. Jonathan Hoyne, PhD[⇑][1] 1. is Director of Chemistry, Mayo Clinic, Jacksonville, FL 1. Address for correspondence: Jonathan Hoyne PhD, Director of Chemistry, Mayo Clinic, 4500 San Pablo Rd. Stabile N-225 Jacksonville, Fl 32224, hoyne.jonathan{at}mayo.edu. Upon completion of this activity, participants should be able to: 1. Define heart failure and discuss its signs and symptoms. 2. Describe how heart failure is classified and explain NYHA functional criteria. 3. Explain the role biomarkers can play in heart failure. 4. Discuss the physiologic role of BNP and its origin in healthy individuals versus HF patients. 5. Describe the synthesis and release of BNP noting proteolytic cleavage products. 6. State the current recommendations for BNP use. 7. Interpret BNP values in the context of heart failure. Heart Failure: Pathology Heart failure (HF) is a syndrome of varying but progressive severity in which the ability of the heart to pump blood is compromised. It has been said that, “…heart failure is a primary complication of virtually every form of heart disease”1. In general, prior to developing HF, a disease or condition exists that stresses the cardiovascular system. The body possesses several feedback mechanisms that adapt to stress and maintain acute cardiovascular function. However, many of these adaptations are themselves toxic and degrade cardiac function over the long term2. Several common chronic progressive conditions such as hypertension, acute coronary syndrome, a previous myocardial infarction or diabetes mellitus are precursors to HF3. At diagnosis, one-year mortality is nearly 10% and five-year mortality is about 50%4. The clinical presentation of HF is variable. Patients may present without symptoms but with evidence of left ventricular structural or functional changes. Classic signs and symptoms include breathing difficulty, fatigue after modest physical exertion and fluid retention resulting in peripheral edema and pulmonary congestion. Heart Failure: Clinical Summary In addition to the individual toll, heart failure (HF) is a public health problem whose morbidity and mortality are significant burdens on the health care system. According to the American Heart Association (AHA)4, in 2006 the prevalence of HF in the US was 5.7 million people, or 2.5% of the population. In 2005, HF was the primary cause of 58,933 deaths and a contributing factor in an additional 233,281 deaths. That same year, the total direct… Upon completion of this activity, participants should be able to: 1. Define heart failure and discuss its signs and symptoms. 2. Describe how heart failure is classified and explain NYHA functional criteria. 3. Explain the role biomarkers can play in heart failure. 4. Discuss the physiologic role of BNP and its origin in healthy individuals versus HF patients. 5. Describe the synthesis and release of BNP noting proteolytic cleavage products. 6. State the current recommendations for BNP use. 7. Interpret BNP values in the context of heart failure. [1]: #corresp-1