Plasma BNP Concentration Research Articles

Clinical characteristics of patients with acute heart failure associated with elevated systolic blood pressure on admission.

Objectives: Systolic blood pressure (sBP) is often elevated in acute heart failure (AHF) that may precipitate the increase in left ventricular end-diastolic pressure especially in the presence of diastolic dysfunction. To elucidate whether elevated sBP is the cause or the result of AHF, we studied the clinical characteristics of patients with AHF who showed elevated sBP on admission. Methods: Consecutive 60 patients with AHF were enrolled. LV fractional shortening (LVFS) and plasma BNP concentration were measured on admission and at recovery phase.

Brain natriuretic peptide secretion in adult rat heart muscle cells: The role of calcium channels

The cellular mechanisms that regulate B-type natriuretic secretion are not well elicited. Intracellular fluctuation of calcium ions rate seems to be implicated. In this study, we evaluate the role of ventricular transmembrane calcium channels in the secretion of BNP in normal adult rats (group N) and pressure overload hypertrophied ones (group H). We measured plasma BNP concentration and BNP concentration in culture media of cardiomyocytes from N and H group in the presence and absence of calcium channels antagonists. Plasma BNP concentration was increased in H group in comparison to N group (0.630+/-0.008 ng/ml versus 0.106+/-0.004 ng/ml; p<0.01). This increase in BNP level was also obtained in culture media of H group in comparison to N group (3.45+/-0.7 ng/ml versus 0.53+/-0.22 ng/ml). However, the presence of calcium channels antagonists in the culture media of cardiomyocytes had decreased BNP concentration in both N (nifedipine: 0.22+/-0.04 ng/ml; verapamil: 0.19+/-0.05 ng/ml; diltiazem: 0.17+/-0.03 ng/ml; p<0.05) and H group (nifedipine: 0.18+/-0.05 ng/ml; verapamil: 0.23+/-0.04 ng/ml; diltiazem: 0.28+/-0.1 ng/ml; p<0.05). These results suggest that transmembrane calcium channels may have an important role in the regulation of BNP secretion.

Distribution, but not Volume, of Late Enhancement Associated with Plasma BNP Concentration in Patients with Old Myocardial Infarction: Contrast-enhanced MRI Study

Distribution, but not Volume, of Late Enhancement Associated with Plasma BNP Concentration in Patients with Old Myocardial Infarction: Contrast-enhanced MRI Study

Natriuretic Peptides in Cetaceans: Identification, Molecular Characterization and Changes in Plasma Concentration After Landing

Dolphins are aquatic animals free from gravity, and this may have imposed significant changes in their cardiovascular status and its hormonal regulation compared with terrestrial animals. This study molecularly characterized two major cardiovascular hormones, atrial and B-type natriuretic peptides (ANP and BNP) and measured their changes in dolphin plasma concentrations in relation to the cardiovascular status of the animal. We initially identified ANP and BNP in three species of dolphins (Lagenorhynchus obliquidens, Phocoenoides dalli and Tursiops truncatus). ANP precursors are highly conserved in most mammals, but dolphin BNP precursors were more variable. In molecular phylogenetic analyses, dolphin ANP and BNP precursors grouped with those of artiodactyls, particularly to the camel peptides. The chromatographic characterization of tissue and plasma molecular forms using specific radioimmunoassays showed that the predominant ANP and BNP in the atrium are prohormone and mature peptide, respectively, whereas mature ANP and BNP are circulating in the dolphin blood. A mass spectrometric analysis showed that atrial BNP consists of 26 amino acids, rather than the 32-amino-acid form detected in other mammals. Finally, changes in plasma ANP and BNP concentrations were examined in captive bottlenose dolphins (Tursiops truncatus) after their pool was drained. Plasma ANP and BNP concentrations did not change after landing, unlike terrestrial mammals. Plasma angiotensin II and cortisol concentrations did not change either, showing minor stress after landing. Since landed dolphins show a different cardiovascular status on land than terrestrial mammals, plasma ANP and BNP concentrations seem to reflect the cardiovascular status characteristic of dolphins.

ANP is cleared much faster than BNP in patients with congestive heart failure

To obtain a better understanding of the pharmacokinetics of atrial and brain natriuretic peptides (ANP and BNP, respectively), two peptide mediators used in the treatment of congestive heart failure (CHF). Although both peptides exert their effects by binding to a common receptor (natriuretic peptide receptor A) with about the same affinity, their respective loading and maintenance doses differ. Sixteen CHF patients were randomized to be infused for 2 h with alpha-human ANP (0.05 microg/kg per minute) or BNP (0.01 microg/kg per minute). Plasma concentrations of both peptides were measured 0, 2, 5, 15, 30, 60 and 120 min post-infusion. The pharmacokinetic parameters were then calculated using a 1-compartment model. The plasma BNP concentrations in the ANP and BNP groups before infusion were 464.7 +/- 339.8 and 506.8 +/- 332.5 pg/ml, respectively. Following infusion, ANP disappeared from the circulation more rapidly than BNP: their plasma half-lives were 2.4 +/- 0.7 and 12.1 +/- 3.0 min, and their total body clearance volumes were 48.2 +/- 24.1 and 10.1 +/- 2.7 ml/min per kilogram, respectively. ANP has a shorter half-life in the plasma of CHF patients than BNP, which suggests that it controls hemodynamics more readily than BNP.

Association between the T-381C polymorphism of the brain natriuretic peptide gene and risk of type 2 diabetes in human populations

Brain natriuretic peptide (BNP/NPPB) is a member of the natriuretic family involved in the regulation of blood pressure and blood volume as well as lipolysis control in human fat cells. Thus BNP may play a role in energy metabolism and metabolic diseases. We therefore assessed the association between the BNP promoter T-381C polymorphism and risk of type 2 diabetes and metabolic and BNP expression traits in several population samples. In French population-based samples (n = 3216), we found that individuals bearing the -381CC genotype had lower (P = 0.005) fasting glucose levels than -381TC or -381TT individuals. Moreover, the -381CC genotype was less frequent in individuals with type 2 diabetes (n = 280, 13.6%) or with impaired fasting glucose (n = 248, 12.9%) compared with normoglycaemic individuals (n = 2485, 17.8%). The adjusted odds ratio (OR) (95% CI) of type 2 diabetes for -381CC individuals was 0.69 (0.47-1.00), P = 0.05, when compared with -381T allele bearers. We replicated this association in four additional case-control studies for type 2 diabetes. The overall OR (95% CI) of type 2 diabetes was 0.85 (0.76-0.96), P = 0.008, (under a recessive model) (3593 cases and 6646 controls in total). We also found that the -381C allele was associated with higher plasma BNP concentrations (P = 0.015, n = 634) and higher BNP promoter activity in reporter gene assays. Collectively, these data suggest that relatively high BNP expression may protect against type 2 diabetes in humans.

Plasma Natriuretic Peptide Concentrations as a Predictor for Successful Catheter Ablation in Patients With Drug-Refractory Atrial Fibrillation

The concentrations of atrial and brain natriuretic peptides (ANP and BNP) are elevated in patients with atrial fibrillation (AF), but the usefulness of their measurement before and after AF ablation has not been reported. The concentrations of the natriuretic peptides were evaluated in 54 patients undergoing catheter ablation for drug-resistant paroxysmal and persistent AF without heart failure. Based on the outcome, the patients were divided into 2 groups: successful (n=42) or failure (n=12). All patients were asked to keep a log of the duration and frequency of their symptoms and underwent 24-h ECG monitoring at least once after the ablation. The plasma BNP and ANP concentrations, most of which were well below the heart failure range, exceeded the normal range in 69% and 26% of the patients, respectively. The BNP concentration decreased after ablation in the success group (49+/-43 to 27+/-28 pg/ml; p<0.05), however, it was unchanged in the failure group (46+/-35 to 70+/-37 pg/ml; p=0.46). A value of the DeltaBNP (BNP after ablation - BNP before ablation) of </=0 pg/ml identified a successful ablation with a sensitivity of 83% and specificity of 83%. The plasma ANP concentration did not differ statistically between the 2 groups before and after the ablation. A moderate elevation in the BNP concentration is often found in patients with symptomatic paroxysmal and persistent AF, and a reduction in the plasma BNP concentration shortly after the ablation may indicate a successful outcome.

Assessment of plasma brain natriuretic peptide concentration in Boxers with arrhythmogenic right ventricular cardiomyopathy

To determine whether Boxers with a clinical diagnosis of arrhythmogenic right ventricular cardiomyopathy (ARVC) have increased plasma concentrations of brain natriuretic peptide (BNP), compared with concentrations in clinically normal dogs. 13 Boxers with ARVC, 9 clinically normal Boxers, 10 clinically normal non-Boxer dogs, and 5 hound dogs with systolic dysfunction. All Boxers were evaluated via 24-hour ambulatory electrocardiography and echocardiography; the number of ventricular premature contractions (VPCs) per 24 hours was assessed. Hound dogs with cardiac pacing-induced systolic dysfunction (positive control dogs) and clinically normal non-Boxer dogs (negative control dogs) were evaluated echocardiographically. Three milliliters of blood was collected from each dog for measurement of plasma BNP concentration by use of a radioimmunoassay. Mean +/- SD plasma BNP concentration for the ARVC-affected Boxers, clinically normal Boxers, negative control dogs, and positive control dogs was 11.0 +/- 4.6 pg/mL, 7.9 +/- 3.2 pg/mL, 11.5 +/- 4.9 pg/mL, and 100.8 +/- 56.8 pg/mL, respectively. Compared with findings in the positive control group, plasma BNP concentration in each of the other 3 groups was significantly different. There was no significant difference in BNP concentration between the 2 groups of Boxers. A significant correlation between plasma BNP concentration and number of VPCs per 24 hours in the ARVC-affected Boxers was not identified. A significant difference in BNP concentration between Boxers with ARVC and clinically normal Boxers was not identified. Results suggest that BNP concentration may not be an indicator of ARVC in Boxers.

Elevated plasma concentrations of atrial and brain natriuretic peptide in type 1 diabetic subjects

The intravenous infusion of atrial (ANP) and brain (BNP) natriuretic peptides have been shown to increase urinary albumin excretion in type 1 diabetes. To measure plasma ANP and BNP concentrations in patients with type 1 diabetes and to examine the parameters associated with elevated plasma concentrations. Methods We measured plasma ANP and BNP concentrations, UAER, HbA1C systolic blood pressure, and left ventricular mass index. Plasma ANP and BNP were also measured in non-diabetic control subjects for comparison. Using multivariate regression analysis plasma ANP correlated positively with HbA1C (1.9 + 0.47, p = 0.0002), UAER (0.37 + 0.05, p = 0.00001), SBP (1.26 + 0.5, p = 0.01) and LVMI (00.46 + 0.25, p = 0.07). BNP was positively related with LVMI (0.95 + 0.4, p = 0.02), and UAER (0.56 + 0.08, p = 0.001). Plasma concentrations of ANP and BNP are elevated in some patients with type 1 diabetes. Plasma ANP concentrations are closely related to UAER and elevated plasma concentrations are associated with poor glycaemic control and systemic hypertension. Plasma BNP concentration is related to LVMI.

Plasma B-type Natriuretic Peptide Levels and Risk Factors for Congestive Heart Failure in a Japanese General Population

This cross-sectional study was performed to establish the rationale for BNP testing for identifying subjects at high risk of congestive heart failure (CHF) in a screening setting. Plasma BNP concentrations were measured in 8,178 community-dwelling residents (mean age, 62 +/- 12 years; 3,194 males). First, in order to determine age- and sex-related reference values for plasma BNP levels, subjects having factors known to influence plasma BNP levels were excluded. The remaining 3,410 subjects were eligible for the reference study. Second, to verify BNP testing for screening for subjects at high risk of CHF, the clinical characteristics of subjects showing abnormally high plasma BNP levels (> or = 97.5 percentile for each age- and sex-specific value of the reference cohort) were examined. In the reference subjects, plasma BNP levels increased with age in both genders, and were higher in women than in men. In the original cohort, age- and sex-specific reference values for high plasma BNP levels were related to the presence of major ECG abnormalities, hypertension, mildly elevated serum creatinine levels, and a history of coronary heart disease. The results of the present study indicate that individuals with high plasma BNP levels in the community have accumulating risk factors for CHF. This suggests that plasma BNP measurement may be a useful screening test for identification of individuals at high risk of CHF within a Japanese general population.

Endocrine Paradox in Heart Failure: Resistance to Biological Effects of Cardiac Natriuretic Hormones

We read the interesting minireview by Goetze (1) concerning the biochemistry of pro-B-type natriuretic peptide (proBNP)-derived peptides: the main message is the potential clinical relevance of the proBNP-derived peptides, which should be considered for current clinical interpretation of plasma BNP concentrations and be the focus of ongoing research. Accordingly, the lack of accurate studies on in vivo production/secretion mechanisms and metabolism of BNP- and proBNP-related peptides explains the incomplete knowledge of the pathophysiologic significance of this hormone system. Thus, we agree with Goetze that deeper insight into the biochemistry of these peptides could pave the way for more sensitive and disease-specific assays in the clinical setting. We have some observations concerning the presence of an “endocrine paradox in heart failure” (1). The lack of encoding and processing of the precursor peptides to the mature hormones, atrial natriuretic peptide (ANP) and BNP, which have a potent diuretic and natriuretic effect, could explain the disturbed electrolyte and fluid homeostasis occurring in chronic heart failure (2)(3). However, the hypothesis of heart failure as a syndrome of cardiac natriuretic hormone (CNH) deficiency was challenged when this system was investigated in experimental animals and in humans. In fact, patients with congestive heart failure [New York Heart Association (NYHA) classes III–IV] have greatly increased plasma concentrations of CNHs compared with healthy individuals (up to 500-fold or more for plasma BNP concentration) (1)(2)(3). Goetze (1) tries to explain this paradox of heart failure (i.e., highly increased CNH concentrations in patients with sodium retention) by suggesting that a part of circulating CNH-related peptides (especially proBNP-related peptides) is not biologically active. We agree that increased concentrations of immunoreactive, but biologically inactive, proBNP-related peptides (as well as proANP-related peptides) are present in patients with heart failure. As also correctly pointed out in the … [↵][1]aAddress correspondence to this author at: Department of Clinical Biochemistry, Rigshospitalet, University of Copenhagen, 9 Blegdamsvej, DK-2100 Copenhagen, Denmark. Fax 45-35454640; e-mail jpg{at}dadlnet.dk. [1]: #xref-corresp-2-1

Effects of Assisted Ventilation on Brain Natriuretic Peptide Levels in Elderly Heart Failure Patients with Cheyne-Stokes Respiration

PURPOSE: Cheyne-Stokes respiration with central sleep apnea (CSR-CSA) has been detected in as many as 50% of patients with chronic congestive heart failure(CHF). The presence of CSR-CSA in a patient with CHF confers a worse prognosis. Unfortunately, there are few data on treating CSR-CSA in patients with CHF. The plasma concentration of several neurohormones has been shown to be independent markers of left ventricular ejection fraction(LVEF) and mortality in patients with heart failure. Our study was to compare the effects of assisted ventilation(Autoset CS, ResMed, Australia) on clinical outcomes and plasma BNP concentrations in elderly patients with heart failure and CSR-CSA.

Consequences of a dropout from carvedilol therapy: do the effects of beta-adrenergic blockers on cardiac function alters after long-term administration?

Purpose: Beta-adrenergic blockers including carvedilol improve systolic function in patients with heart failure. Moreover, several investigations including SWEDIC study demonstrated that carvedilol improves diastolic function as well. However, little has been known about the duration of these effects. This investigation was carried out to study whether the effects of beta-adrenergic blockers on cardiac function alters after long-term administration. Methods: Reviewing our database of follow-up clinic for patients sent to a local physician after successful treatment using carvedilol for more than 1 year, we found 20 patients having dropped out from carvedilol therapy. We examined them using plasma BNP concentration and echocardiography. Results: The duration of dropout was 8.7 ± 2.0 months. Left ventricular EF was signifincantly decreased from 51.8 ± 11.9% to 45.9 ± 13.6% (p < 0.04). However, the plasma BNP concentration was decreased from 136.9 ± 90.0 to 107.9 ± 94.5 pg/ml (p < 0.01). Deceleration time of transmitral flow E has not altered significantly. Conclusions: The effects of carvedilol on systolic function continues more than 1 year. However, the effects on diastolic function may be reduced in long-term therapy.

Reverse remodeling of the left ventricle in diastolic heart failure by low-dose Carvedilol therapy

Purpose: We previously reported that low-dose carvedilol decreases plasma BNP concentration and alleviates symptom in patients with diastolic heart failure especially due to ischemic heart disease. The purpose of this investigation is to examine the influence of this therapy on LV mass. Methods: We reviewed the records of the participants of the previous investigation enrolling 40 patients with diastolic heart failure (NYHA II/II and EF > 45%) and 5-10 mg/day of carvedilol was randomly adminstered to 19 patients; we found 24 patients (15 on carvedilol, 9 on control therapy) whose echocardiograms were available for LV mass measurement. Results: LV mass index was significantly decreased in patients on carvedilol from 174.7 ± 66.7kg/m2 to 157.9 kg/m2 ± 64.4 (p < 0.02) although not in the other patients (155.0 kg/m2 ± 55.4 kg/m2 to 142.8 ± 25.6 kg/m2). Among 15 patients on carvedilol, 10 people (67%) underwent ishcemic heart disease. Conclusion: This investigation demonstrated that carvedilol potentially reverse LV hypertrophic remodeling in patients with diastolic heart failure. The mojority of ischemic heart disease may effect the present results.

Effects of carvedilol on plasma B-type natriuretic peptide concentration and symptoms in patients with heart failure and preserved ejection fraction

Although the benefits of carvedilol in patients with heart failure and depressed ejection fraction (EF) have been elucidated, those in patients with preserved EF are not understood. We enrolled 40 patients with mild or moderate heart failure and EF ≥45%. They were randomly assigned to carvedilol (n = 19) or conventional therapy (n = 21). After 12 months of treatment, carvedilol significantly improved all end points (plasma concentration of B-type natriuretic peptide [BNP] from 175 (35 to 209) to 106 (52 to 160) pg/ml, mean (95% confidence interval) p <0.01; New York Heart Association functional class from 2.37 (2.13 to 2.61) to 1.56 (1.21 to 1.91), p <0.01; exercise capacity estimated with the Specific Activity Scale from 4.75 (4.50 to 5.00) to 5.68 (5.22 to 6.14) METs, p <0.02), whereas conventional therapy did not (plasma BNP concentration from 150 (114 to 186) to 174 (100 to 248) pg/ml; New York Heart Association functional class from 2.29 (2.08 to 2.50) to 2.11 (1.73 to 2.49); exercise capacity from 4.57 (4.34 to 4.80) to 4.72 (4.41 to 5.03) METs). Univariate regression analyses showed that only the use of carvedilol was correlated with the decrease in plasma BNP concentration (p <0.03). Multivariate analyses demonstrated that an ischemic cause of heart failure (p <0.02), high plasma concentration of BNP (p <0.02), left ventricular dilation (p <0.03), and use of carvedilol (p <0.04) at baseline were predictive of a decrease in plasma concentration of BNP. In conclusion, carvedilol potentially decreased neurohumoral activation, decreased symptoms, and increased exercise capacity in patients with heart failure and preserved EF.

Correlation of plasma concentrations of B-type natriuretic peptide with infarct size quantified by tomographic thallium-201 myocardial scintigraphy in asymptomatic patients with previous myocardial infarction.

Secretion of A-type (atrial) and B-type (brain) natriuretic peptides (ANP and BNP) increases in relation to left ventricular (LV) dysfunction in patients with myocardial infarction (MI). However, it is unknown what determines the concentrations of ANP and BNP in asymptomatic MI patients with preserved LV function, so the aim of the present study was to examine if they are associated with MI size. Plasma concentrations of ANP and BNP in the peripheral blood were measured in 88 asymptomatic (New York Heart Association class I) patients with previous MI. The infarct size was quantitatively calculated from rest thallium-201 myocardial single photon emission computed tomography. In multivariate linear regression analysis that included MI size, hemodynamic parameters, and age as covariables, only BNP concentrations had a significant association with MI size (p=0.0001). In contrast, ANP concentrations were not significantly correlated with MI size in either the univariate or multivariate analysis. BNP but not ANP concentrations increased in proportion to the scintigraphic MI size despite the lack of heart failure in asymptomatic patients with previous MI. Thus, the increase in plasma BNP concentrations reflects the MI size, an important determinant of prognosis, in asymptomatic patients with MI.

Effect of an ACE inhibitor and an AT1 receptor antagonist on cardiac hypertrophy.

The effect of long-term administration of delapril, an angiotensin converting enzyme inhibitor, and candesartan, an angiotensin II receptor blocker, on cardiac hypertrophy was investigated in spontaneously hypertensive rats (SHR). Delapril (2 mg/kg/ day) and candesartan (2 mg/kg/day) were administered for 5 weeks to 15-week-old male SHR. Echocardiographic estimation of cardiac morphology and function revealed cardiac hypertrophy in SHR compared with Wistar-Kyoto rats (WKY) which were used as normal controls. Both treated groups revealed regression of cardiac hypertrophy estimated by echocardiography. Heart to body weight ratio of treated SHR was also smaller than that of untreated SHR. Plasma BNP and ANP concentrations were increased in untreated SHR and decreased in the treated groups. Histological examination was performed using light microscopy and the area of fibrosis was estimated by computer. Reduction of the fibrotic area was observed in SHR treated with delapril and candesartan, although the latter was not statistically significant. Immunohistochemical examination using anti-collagen monoclonal antibody showed a decrease of type I collagen in treated SHR as compared with untreated SHR. It is concluded that both angiotensin converting enzyme inhibitor and angiotensin II receptor blocker sufficiently reduce blood pressure in SHR associated with regression of cardiac remodeling.

The role of brain natriuretic peptide in population screening.

While measurement of plasma BNP concentration has been shown to be useful in the diagnosis of heart failure, its role as a screening test for detection of pre-clinical ventricular remodeling or dysfunction in the general population has not been established. Here we review available population-based studies assessing the predictive characteristics of BNP for the detection of pre-clinical structural heart disease (Stage B Heart Failure).

Corrélation entre les valeurs du BNP plasmatique et les mesures isotopiques de la fraction d’éjection ventriculaire gauche

Brain Natriuretic Peptide is a biological marker used for the diagnosis of the left ventricular dysfunction. The aim of our study is to find correlation between BNP and Left Ventricular Ejection Fraction (LVEF) measured by radionuclide ventriculography. Patients from the cardiology department for measurement of the LVEF, had at the same times a measurement of BNP plasma levels. 89 patients had been included (75 men and 15 women) in study. 4 groups of patients have been made according to their pathology (ischaemic heart desease, non ischaemic dilated cardiomyopathy, hypertrophic cardiomyopathy and valvular heart deseases). Also, we have distinguished 2 sub-groups according to the result of LVEF: patients having LVEF ≥ 52% with median plasma concentration = 34pg/ml (18–91.5), and patients having LEVF < 52% with median plasma concentration = 111pg/ml (49–457). Significant difference was found between those 2 sub-groups by Mann Withney Wilcoxon test ( p = 0.0005). Among patients with LVEF < 52%, a significant negative correlation between plasma BNP concentration and LVEF was found (Spearmann r = –0.576). In conclusion, the plasma BNP concentration is a reliable parameter to explore the left ventricular dysfunction.

Measurement of plasma brain natriuretic peptide level as a guide for cardiac overload.

We examined whether measurement of the plasma BNP concentrations might be useful for the early diagnosis of the existence and severity of disease in patients with heart disease in daily clinical practice. The plasma BNP and ANP concentrations in 415 patients with heart disease and hypertension and 65 control subjects were measured. Patients with heart disease had higher plasma BNP and ANP concentrations than did those with hypertension or control subjects. Among the etiology of cardiac diseases, specifically dilated cardiomyopathy and hypertrophic cardiomyopathy, was associated with the highest plasma BNP concentrations, whereas dilated cardiomyopathy was associated with the highest plasma ANP concentrations. Plasma BNP concentrations showed an increase as the severity of the heart disease, as graded according to the NYHA classification of cardiac function, increased. In both patients with heart disease and hypertension, the plasma BNP values were higher in those who had abnormalities in their echocardiogram and electrocardiogram as compared to those without any abnormalities. The plasma BNP levels also showed a significant correlation with left ventricular wall thickness and left ventricular mass. On the other hand, the plasma ANP levels showed significant correlations with left ventricular dimension. Receiver operative characteristic analysis revealed that plasma BNP levels showed substantially high sensitivity and specificity to detect the existence of heart diseases. Measurements of the plasma BNP concentrations is useful to detect the existence of the diseases, and abnormalities of left ventricular function and hypertrophy in patients with heart disease in daily clinical practice.