B-type Natriuretic Peptide Assay Research Articles

Distinguishable Optimal Levels of Plasma B-type Natriuretic Peptide in Heart Failure Management Based on Complicated Atrial Fibrillation

A B-type natriuretic peptide (BNP)-guided strategy is being widely used as a superior management technique for heart failure (HF). However, the optimal target level of BNP to improve the prognosis of HF in clinical practice remains unclear. Several studies have recently demonstrated that the existence of atrial fibrillation (AF) affects plasma BNP levels. We evaluated the prognostic value of BNP assay for HF management and found the optimal target level under the BNP-guided HF management according to the basal cardiac rhythms: AF or sinus rhythm (SR). Patients hospitalized for HF exacerbation between 1996 and 2002 were stratified into SR (n = 129) and chronic AF (CAF, n = 58) groups as basal cardiac rhythms during hospitalization. Cardiac events including death and re-admission for HF exacerbation after discharge were analyzed in relation to the plasma BNP levels at predischarge. Receiver-operating characteristic (ROC) analysis demonstrated that the cut-off values for predischarge BNP, which predict cardiac events at 36 months after discharge, were 125 pg/mL in the SR group and 165 pg/mL in the CAF group. The area under the ROC curve was 0.72 and 0.82, respectively. Stratified subgroup analysis using the Kaplan-Meier method demonstrated that the risk of a cardiac event decreased in a stepwise fashion across a decreasing predischarge BNP range above these cut-off levels, while the minimum decreased risk was recognized at a BNP range below these cut-off levels in each group. In conclusion, the optimal target levels of plasma BNP at predischarge to improve the prognosis of HF should be different and distinguishable depending on with or without AF.

The emerging role of natriuretic peptides in the diagnosis and treatment of decompensated heart failure

B-type natriuretic peptide (BNP) is a cardiac neurohormone and is released as prepro BNP and then enzymatically cleaved to the N-terminal proBNP (NT-proBNP) and BNP upon ventricular myocyte stretch. Blood measurements of BNP and NT-proBNP have been used to identify patients with heart failure (HF). Clinical considerations for these tests include their half-lives in plasma, dependence on renal function for clearance, interpretation of their units of measure, and the rapid availability of the test results. The BNP assay is currently used as a diagnostic and prognostic aid in HF. In general, a BNP level below 100 pg/mL excludes acutely decompensated HF. Recombinant, human BNP (nesiritide) is an approved intravenous treatment for acute, decompensated HF. This paper reviews the literature concerning the use of this peptide as a diagnostic test and as an intravenous therapy.

50 Utility of Rapid B-Type Natriuretic Peptide Assay for Diagnosis of Symptomatic Patent Ductus Arteriosus in Preterm Infants

Background/aims: In preterm infants, the rapid and accurate determination of the presence of a hemodynamically significant patent ductus arteriosus (hsPDA) is extremely important, but this is often difficult. Plasma B-type natriuretic peptide (BNP) measurement has been reported to be a helpful aid in the diagnosis of hsPDA in preterm infants. The aim of our study was to investigate the usefulness of rapid BNP assay as a diagnostic marker of symptomatic PDA (sPDA) in preterm infants. Methods: 66 preterm infants, ranging from 25 to 34 gestational weeks of age, underwent clinical and echocardiographic examinations for PDA every other day from the third day of life until the disappearance of ductal flow. Simultaneously, plasma BNP concentrations were measured using a commercial kit, Triage® BNP test kit (Biosite Diagnositics, San Diego, California, U.S.A.). When two or more clinical significant features of PDA were noted, and a large ductal flow was confirmed by color Doppler echocardiography, sPDA was diagnosed and treated with indomethacin. Results: On the third day of birth, the BNP concentration in the sPDA group (N=23) was significantly higher than in the control group (N=43) (P <0.001). 17 infants (74%) in the sPDA group became asymptomatic after a first course of indomethacin and their BNP levels concomitantly decreased. In the control group, only 14 infants (32.5%) had a ductal shunt but did not develop sPDA (asPDA infants). The BNP concentration of asPDA infants was significantly higher than that of closed PDA infants (P <0.001). Moreover, BNP concentrations were significantly correlated with the magnitudes of the ductal shunt, such as the ratio of left atrial to aortic root diameter and the diastolic flow velocity of the left pulmonary artery (r = 0.686 and r = 0.839, respectively, P <0.001). The area under the ROC curve using BNP to diagnose sPDA was 0.997 (95% CI, 0.991 to 1.004, P < 0.001). A cutoff BNP value of 1,110 pg/mL had a sensitivity of 92.0%, specificity of 100% and a positive predictive value of 100% for diagnosis of sPDA. Conclusion: Although not a stand-alone test, the rapid BNP assay clearly adds valuable information for the detection of preterm infants with sPDA that require treatment. Particularly, a cutoff BNP level of 1,110 pg/mL differentiated well between preterm infants with and without sPDA. Moreover, serial plasma BNP measurements may be of value in determining the clinical course of PDA in preterm infants.

B‐type Natriuretic Peptide for Diagnosis of Heart Failure in Emergency Department Patients: A Critical Appraisal

The diagnosis of heart failure in the outpatient setting can be difficult. A rapid assay for B-type natriuretic peptide (BNP) has been advocated for the diagnosis of heart failure, using a single cutoff of 100 pg/mL. BNP is produced by both the right and left cardiac ventricles and is elevated in a variety of conditions, including heart failure, pulmonary hypertension, cor pulmonale, pulmonary embolism, left ventricular hypertrophy, renal failure, circulatory overload, acute coronary syndromes, atrial fibrillation, lung cancer, and sepsis. This multitude of causes of BNP elevation imposes limits on its diagnostic use for heart failure. The literature on the use of BNP testing for diagnosis of heart failure is reviewed, and improved guidelines for its interpretation are suggested.

Analytical and clinical evaluation of the Bayer ADVIA Centaur automated B-type natriuretic peptide assay in patients with heart failure: a multisite study.

B-Type natriuretic peptide (BNP) is released from the left ventricle of the heart into the circulation in response to ventricular stretching and volume overload. Increased BNP concentrations are associated with heart failure (HF). We evaluated the analytical and clinical performance of the Bayer ADVIA Centaur BNP assay. Studies included precision, analytical correlation (against the Shionogi ShionoRIA and Biosite Triage BNP assays), BNP results for blood collected in plastic tubes containing EDTA vs other collection tubes, high-dose hook effect, detection limits, and interferences. The clinical performance was tested on 2243 blood samples collected from 983 apparently healthy individuals, 538 patients with chronic disease but without HF (renal insufficiency, chronic obstructive pulmonary disease, diabetes, and hypertension), and 722 patients with HF (New York Heart Association classes I-IV). The ADVIA Centaur assay had total imprecision (CV) of 3.4%, 2.9%, and 2.4% at BNP concentrations of 48, 461, and 1768 ng/L, respectively. The Passing-Bablok correlations to the ShionoRIA and Triage were as follows: ADVIA Centaur = 1.11(ShionoRIA) - 1.19 ng/L (r = 0.98); ADVIA Centaur = 0.78(Triage) + 5.89 ng/L (r = 0.92), respectively. Of the different blood collection tubes, only EDTA plastic tubes (with and without the barrier gel) were acceptable. The lower detection limit was 0.5 ng/L, and there were no interferences from common analytes, other neuropeptides, or unusual antibodies. BNP exhibited different reference intervals according to age and gender. BNP concentrations increased progressively as the severity of HF increased. The ADVIA Centaur is the first commercially available BNP assay for use on an automated immunochemistry platform. This assay has good analytical and clinical performance characteristics for diagnosing HF.

Predischarge B-type natriuretic peptide assay for identifying patients at high risk of re-admission after decompensated heart failure

Predischarge B-type natriuretic peptide assay for identifying patients at high risk of re-admission after decompensated heart failure

Biological variation of the natriuretic peptides and their role in monitoring patients with heart failure.

B-type natriuretic peptide (BNP) and the inactive metabolite NT-proBNP are proven tests for diagnosis and staging of severity for patients with heart failure. However, the utility of these biomarkers for monitoring the success of drug therapy remains to be determined. Results of longitudinal studies on serial blood testing must be linked to overall patient morbidity and mortality outcomes. We previously determined the 8-week biological variability (BV) of BNP and NT-proBNP assays in healthy subjects and the 1-day BV for BNP alone in patients with compensated and stable heart failure. From these studies, the percent statistical change in serial samples of approximately 100% difference was estimated (95% confidence). We applied the biological variability concepts to the serial results of BNP and NT-proBNP collected from patients with heart failure and compared the performance of these two markers. While there are minor differences in the results between the assays from one time period to another, the overall interpretation of results are essentially identical. Moreover, the majority of individual serial time points are not significantly different from the previous value. Frequent testing (e.g. daily) for BNP and NT-proBNP to monitor therapy for patients with CHF is not indicated, as overall changes require several days to become evident.

1032-121 Utility of B-type natriuretic peptide assay in the assessment of symptomatic state in hypertrophic cardiomyopathy

Background. Hypertrophic cardiomyopathy (HCM) is a common genetic cardiovascular disease with a diverse clinical spectrum which often includes functional disability due to progressive heart failure symptoms at any age. Assessment of symptom severity may be highly subjective and encumbered by the heterogenous clinical presentation of HCM. Plasma B-type natriuretic peptide (BNP) has been used widely as an objective marker for the severity of heart failure and clinical outcome predominantly in coronary heart disease with ventricular dilatation and systolic dysfunction. We considered the possibility that BNP would be an accurate and independent predictor of heart failure severity in HCM, a disease characterized by intact ventricular function in the absence of chamber dilatation. Methods. We prospectively assessed plasma BNP as a quantitative clinical marker of heart failure severity in 107 consecutive HCM patients. Results. BNP showed a statistically significant relationship to the magnitude of functional limitation assessed by New York Heart Association (NYHA) functional class: I: 136 ± 159 pg/ml; II: 338 ± 439 pg/ml; III/IV: 481 ± 334 pg/ml (p 200 pg/ml was the most reliable predictor of heart failure symptoms with positive and negative predictive values of 65% and 79%, respectively. Conclusions. Plasma BNP is independently related to the presence and magnitude of heart failure-related symptoms in patients with HCM. The clinical power of BNP as a marker for heart failure in HCM is, however, restricted by the overlap in BNP values between symptom-related subgroups, due largely to the important confounding variables of advancing age and substantial left ventricular wall thickness characteristic of this heterogeneous disease.

Predischarge B-type natriuretic peptide assay for identifying patients at high risk of re-admission after decompensated heart failure

ObjectivesThe aim of this study was to determine the value of serial B-type natriuretic peptide (BNP) assay for predicting post-discharge outcome of patients admitted for decompensated congestive heart failure (CHF). BackgroundPatients hospitalized for decompensated CHF are frequently re-admitted. Thus, identification of high-risk patients before their discharge is a major issue that remains challenging. B-type natriuretic peptide measurement could be useful. MethodsSerial BNP measurements were performed from admission to discharge in two samples of consecutive patients. Survivors were monitored for six months; the main end point combined death or first re-admission for CHF. ResultsAmong the 105 survivors of the derivation study, all serial BNP values, percentage change in BNP levels, and predischarge Doppler mitral pattern correlated with the outcome. In contrast, clinical variables and left ventricular ejection fraction were poorly predictive. The predischarge BNP assay had the best discriminative power (area under the receiver operating characteristic [ROC] curve = 0.80) and remained the lone significant variable in multivariate analysis (hazard ratio [HR] = 1.14 [95% confidence interval {CI}, 1.02 to 1.28], p = 0.027). Among the 97 survivors of the validation study, the predischarge BNP assay was also the most predictive parameter (area under the ROC curve = 0.83). The risk of death or re-admission increased in stepwise fashion across increasing predischarge BNP ranges (p < 0.0001). After adjustment for baseline covariables, the HRs were 5.1 [95% CI 2.8 to 9.1] for BNP levels between 350 and 700 ng/l and 15.2 [95% CI 8.5 to 27] for BNP levels >700 ng/l, compared with BNP <350 ng/l. ConclusionsHigh predischarge BNP assay is a strong, independent marker of death or re-admission after decompensated CHF, more relevant than common clinical or echocardiographic parameters and more relevant than changes in BNP levels during acute cares.

The effect of class-specific protease inhibitors on the stabilization of B-type natriuretic peptide in human plasma

Background: B-type natriuretic peptide (BNP) is a cardiac hormone that regulates hemodynamic equilibrium. In the circulation, its activity is controlled by proteolytic factors. Accurate measurement of BNP in a patient's plasma may be affected by degradation due to proteolysis. Objective: We report on the identification and performance of classes of protease inhibitors that stabilize BNP in plasma. Design and methods: Using the Bayer ADVIA Centaur® BNP assay, we measured the effect of arginine, serine and/or specific kallikrein protease inhibitors (PIs) on exogenous spiked or endogenous BNP in patient plasma. Results: Compared to controls without inhibitor, all PIs were capable, to varying degrees, of retarding the rate of proteolytic degradation. The kallikrein-specific inhibitor, d-Phe–Phe–Arg–chloromethylketone (PPACK II) was most effective as a single constituent and was able to eliminate BNP degradation in patient samples for up to 6–10 days when stored at 2–8 °C. Conclusions: The stability of BNP was markedly increased in the presence of kallikrein-specific PPACK II and a broad spectrum of serine PIs. Use of these compounds offers a simple method of extending sample handling and storage of plasma samples containing BNP.

B-Type Natriuretic Peptide and Its Clinical Implications in Heart Failure

B-type natriuretic peptide (BNP) is a cardiac neurohormone released as preproBNP and then enzymatically cleaved to N-terminal-proBNP and BNP upon ventricular myocyte stretch. Blood measurements of BNP have been used to identify patients with heart failure. Currently, BNP assay is used as a diagnostic and prognostic aid in congestive heart failure. In general, a BNP level <100 pg/mL excludes acutely decompensated heart failure. This article sorts out the literature concerning the practical use of BNP in a variety of clinical scenarios.

Reduction in length of stay of heart failure admissions using B-type natriuretic peptide assay in the emergency department to facilitate early identification

Reduction in length of stay of heart failure admissions using B-type natriuretic peptide assay in the emergency department to facilitate early identification

B-type natriuretic peptide: a new tool in the armamentarium used to accurately diagnose heart failure.

Nearly 5 million Americans have heart failure (HF). Making a correct diagnosis early is an important component in the multifaceted approach to detection and/or treatment of this disease. The US Food and Drug Administration recently approved a point-of-care B-type natriuretic peptide assay to be used in the diagnosis of HF. Nesiritide, a synthetic B-type natriuretic peptide, was also approved for use in decompensated HF. B-type natriuretic peptide is released from the cardiac ventricles in response to increased left ventricular volume and/or pressure. This article reviews the nature of this peptide and its potential as a screening tool for HF. It will also present evidence defining the role of B-type natriuretic peptide in the differential diagnosis of dyspnea, prognosis after cardiac events, and in monitoring HF drug therapy.

Doppler echocardiography was more accurate than B-type natriuretic peptide assay for detecting CHF in acute dyspnea

Source Citation Logeart D, Saudubray C, Beyne P, et al. Comparative value of Doppler echocardiography and B-type natriuretic peptide assay in the etiologic diagnosis of acute dyspnea. J Am Coll Car...

Comparative value of Doppler echocardiography and B-type natriuretic peptide assay in the etiologic diagnosis of acute dyspnea

Comparative value of Doppler echocardiography and B-type natriuretic peptide assay in the etiologic diagnosis of acute dyspnea

Using BNP to diagnose, manage, and treat heart failure.

A rapid assay for B-type natriuretic peptide (BNP) not only can be used to diagnose heart failure, it can help the clinician evaluate effectiveness of therapy, determine when discharge from the hospital is appropriate, and estimate prognosis. A synthetic formulation of BNP (nesiritide) is used to treat decompensated heart failure, resulting in improved hemodynamics and symptoms.

Correlation of B-type natriuretic peptide level to 6-min walk test performance in patients with left ventricular systolic dysfunction

Background: B-type natriuretic peptide (BNP) is a neurohormone that can be measured in blood and is useful in patients with congestive heart failure (CHF). We compared whole blood BNP concentrations to distance walked during a 6-min walk test in patients with CHF. Methods: Forty-four patients with CHF underwent a 6-min walk test. The distance walked was compared to the BNP concentration on blood collected prior to the walk test. Patients were followed for 16±2.8 months after testing. Results: A significant correlation was observed between the BNP concentration and the distance walked ( r=−0.47, p<0.001). One patient without congestion died suddenly. Two patients died of progressive heart failure, and two other patients underwent cardiac transplantation. Each of the latter four patients had high BNP concentrations (median 1080 ng/l) and walked short distances (median 183 m). This study indicates that the BNP concentration in blood correlates inversely with the degree of physical capability of patients with heart failure. Conclusions: The BNP concentration could be used as an alternative to the 6-min walk test to assess the severity of heart failure. The assay for BNP is non-invasive, inexpensive, and results are available at the bedside or in a heart failure clinic.

B-type natriuretic peptide in heart transplantation: an important marker of allograft performance.

The successful management of a cardiac allograft recipient centers around detection of allograft dysfunction early and preferably in a noninvasive manner. Up to this point, echocardiography or right heart catherization with endomyocardial biopsy are the only definitive methods available to diagnose allograft dysfunction. However, these methods do not reflect early structural changes and neurohormonal aberrations involved in allograft dysfunction. B-type natriuretic peptide (BNP) reflects ventricular wall stress and pressure and early studies have intimated potential usefulness of this marker in heart transplantation. Recent studies utilizing point-of-care BNP assay in heart transplant recipients have demonstrated elevated BNP levels at baseline compared with controls. Furthermore, the two most significant correlates of BNP levels are central hemodynamic perturbations despite preserved systolic function and presence of right sided cardiac dysfunction. Initial investigations have demonstrated BNP levels to serve as prognostic marker for cardiac related events and to track responses to therapeutic interventions. Further studies are needed to further assess the utility of BNP as surrogate marker for cardiac function and adaptation.

Temporal alteration in B-type natriuretic peptide expression predicts allograft failure in heart transplantation

Background: B-type natriuretic peptide (BNP), secreted in response to ventricular wall stress, has been shown to correlate with outcome in patients with chronic heart failure. The correlation between hemodynamics and BNP levels in stable heart transplant recipients has been demonstrated. However, the predictive utility of rapid bedside BNP assay as a prognostic marker for cardiac dysfunction requiring hospitalization among heart transplant recipients is unknown.

The Application of B-Type Natriuretic Peptide Level of the Dyspneic Patients: Differentiation Between Cor Pulmonale and Left Ventricular Dysfunction

Background : The serum B-type natriuretic peptide (BNP) is released from the ventricles as a response to volume or pressure overload of the ventricles. A few studies have reported that the BNP measurements are useful in differentiating between heart failure and pulmonary causes in patients who visited the emergency department with dyspnea as the chief complaint. It is difficult to differentiate a right heart failure from a left heart failure in the emergency room. However, there is no report on the application of a BNP assay to differentiate in right heart failure from left heart failure. In this study, the BNP levels were measured from dyspneic patients in the emergency department to determine whether or not the BNP level would be useful in differentiating the cause of the dyspnea from right ventricular failure and left ventricular failure. Method : 89 patients who visited emergency department of the Bundang Cha Hospital with dyspnea from June 2002 to March 2003 were selected. The 29 patients from the outpatient clinics and inpatients