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Definitions and Clinical Diagnosis of Heart Failure
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Katerina K. Naka, Aris Bechlioulis
The upper limit of normal in non-acute settings is 35 pg/mL for BNP and 125 pg/mL for NT-proBNP, although higher cut-offs have been suggested for the acute setting. Cut-offs do not differ for HFrEF and HFpEF, although values are lower for HFpEF vs HFrEF patients.13 The negative predictive value of levels below the cut-offs is high (0.94–0.98) in both acute and chronic settings. However, the positive predictive value is lower, both in the chronic setting (0.44–0.57) and in the acute setting (0.66–0.67).2 These data suggest that BNP and NT-proBNP are powerful, not only in ruling out HF, but also in confirming a diagnosis of HF, supplementing (but not replacing) clinical judgment. Patients with very high levels (NT-proBNP >2,000 pg/mL) should be referred to a cardiologist (preferably a HF specialist) within two weeks and those with levels between 400 and 2000 pg/mL within six weeks.14 Several point-of-care devices have been developed to measure natriuretic peptides levels in clinical practice; in addition to blood, the use of saliva is also currently being investigated.15
Cardiac Hypertrophy, Heart Failure and Cardiomyopathy
Published in Mary N. Sheppard, Practical Cardiovascular Pathology, 2022
ANP and BNP are endogenously generated peptides activated in response to atrial and ventricular volume/pressure expansion. ANP and BNP are released from the atria and ventricles respectively, and both promote vasodilation and natriuresis. Their haemodynamic effects are mediated by decreases in ventricular filling pressures, owing to reductions in cardiac preload and afterload. BNP, in particular, produces selective afferent arteriolar vasodilation and inhibits sodium reabsorption in the proximal convoluted tubule. BNP inhibits renin and aldosterone release and, therefore, adrenergic activation as well. Both ANP and BNP are elevated in chronic HF. BNP in particular, has important diagnostic, therapeutic and prognostic implications.
Respiratory, endocrine, cardiac, and renal topics
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
The atrial natriuretic peptide (ANP) and the B-type natriuretic peptide (BNP) are two peptides with natriuretic and diuretic properties [29]. Enhancing the activity of the NPs could help patients presenting with inappropriate salt and water retention. Recent studies with BNP have produced promising results in situations of heart failure [30].
Plasma thrombomodulin levels are associated with acute kidney injury in patients with acute heart failure
Published in Annals of Medicine, 2022
Shu-Min Lin, Chih-Hsiang Chang, Ting-Yu Lin, Allen Chung-Cheng Huang, Chiung-Hung Lin, Yung-Chang Chen, Pao-Hsien Chu
The estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation [20]. Cases of baseline eGFR <60 were defined as chronic kidney disease (CKD). High-sensitivity C-reactive protein (hsCRP), hemoglobin (Hb), platelet, and white blood cell (WBC) counts were measured upon admission. The blood samples were collected into EDTA vacutainers and placed on ice immediately. Within 30 min of collection, samples were centrifuged at 3000 rpm (1000 g) and 4 °C for 15 min. Plasma was kept frozen in aliquots. Complete blood cell count and all biochemical analyses were performed in the Department of Laboratory Medicine, Chang Gung Memorial Hospital. Our hospital authority has permitted the checking of serum BNP levels in all patients with heart failure since January 2006. Serum BNP levels were measured using the microparticle enzyme immunoassay test (Abbott, Chicago, IL, USA). In this study, all BNP levels were obtained within one hour after presentation at the emergency department or ICU. The low osmolar iodine contrast was used when imaging examination was needed.
Subarachnoidal hemorrhage related cardiomyopathy: an overview of Tako-Tsubo cardiomyopathy and related cardiac syndromes
Published in Expert Review of Cardiovascular Therapy, 2022
Susan Deenen, Dharmanand Ramnarain, Sjaak Pouwels
In SAH patients, it is found that BNP or N-terminal pro-brain natriuretic peptide (NT-proBNP) can be elevated [78,81,87–90]. Higher BNP levels are seen in cases with more severe neurological deficit [89]. BNP is a vasoactive peptide with natriuretic, diuretic, and vasodilator activity. It is synthesized and released by cardiomyocytes as a reaction to increased transmural wall stress and is used to detect LV dysfunction and heart failure [3,91]. Due to wall motion abnormalities or LV dysfunction leading to wall stress in SAH patients, BNP levels can be elevated [3]. It is also mentioned that focal brain edema has a role in the pathogenesis of an excessive secretion of BNP during the subacute phase of SAH [61]. Higher age, female sex, high plasma troponin levels at admission, and worse clinical condition at admission are also known to increase BNP levels [3,91]. Yokobori et al. [90] found that elevated BNP levels were associated with the increase in both cardiac preload and afterload. They also found that patients with lower BNP levels had a significantly better outcome than patients with higher BNP levels [90]. High BNP levels are associated with LV dysfunction, increased cardiopulmonary complications, neurologic deficits, and death [91]. Therefore, it is mentioned that BNP can be used in the diagnosis and prognosis of heart failure after SAH and could be used as a screening tool for cardiac failure after SAH and could serve as a good biomarker for severity of cardiac failure [3,90].
The use of cardiac troponins and B-type natriuretic peptide in COVID-19
Published in Acta Cardiologica, 2022
Bert Zwaenepoel, Sebastiaan Dhont, Hannah Schaubroeck, Sofie Gevaert
Brain natriuretic peptide (BNP) is a natriuretic hormone that was first identified in the brain, though is primarily released in the cardiac ventricles in response to high ventricle filling pressures and ventricular wall stress [30]. BNP and its N-terminal portion (NT-proBNP) are usual markers for congestive heart failure (CHF), though maybe elevated in several other (non-)cardiovascular conditions, with age and renal impairment being the most important ones. On the other hand, values may be disproportionately low in obese patients [31]. Therefore, the diagnosis of CHF cannot be made solely upon the measurement of (NT-pro)BNP and remains mainly clinical, based upon typical symptoms and signs (e.g. fatigue, dyspnoea, peripheral oedema, elevated jugular pressure), mostly added with cardiac imaging [31]. These symptoms may however be subtle and/or evoked by other cardiopulmonary comorbidities, such as COVID-19, which makes a definitive diagnosis often hard to establish. Therefore, (NT-pro)BNP does play a growing role in defining and standardising CHF [32]. The typical cut-off values are subdivided between acute and chronic CHF. The URL in the non-acute setting for BNP is 35 pg/mL and for NT-proBNP 125 pg/mL, whereas higher values should be used in the acute setting (BNP > 100 pg/mL and NT-proBNP > 300 pg/mL) [31].