Objective: To assess the long-term prognostic value of plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) after major vascular surgery.. Design: A single-centre prospective cohort study.. Patients: 335 patients who underwent abdominal aortic aneurysm repair or lower extremity bypass surgery.. Interventions: Prior to surgery, baseline NT-proBNP level was measured. Patients were also evaluated for cardiac risk factors according to the Revised Cardiac Risk Index. Dobutamine stress echocardiography (DSE) was performed to detect stress-induced myocardial ischaemia.. Main outcome measures: The prognostic value of NT-proBNP was evaluated for the endpoints all-cause mortality and major adverse cardiac events (MACE) during long-term follow-up.. Results: In this patient cohort (mean age: 62 years, 76% male), median NT-proBNP level was 186 ng/l (interquartile range: 65-444 ng/l). During a mean follow-up of 14 (SD 6) months, 49 patients (15%) died and 50 (15%) experienced a MACE. Using receiver ...
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BACKGROUND: The natriuretic peptides are counterregulatory hormones involved in volume homeostasis and cardiovascular remodeling. The prognostic significance of plasma natriuretic peptide levels in apparently asymptomatic persons has not been established.. METHODS: We prospectively studied 3346 persons without heart failure. Using proportional-hazards regression, we examined the relations of plasma B-type natriuretic peptide and N-terminal pro-atrial natriuretic peptide to the risk of death from any cause, a first major cardiovascular event, heart failure, atrial fibrillation, stroke or transient ischemic attack, and coronary heart disease.. RESULTS: During a mean follow-up of 5.2 years, 119 participants died and 79 had a first cardiovascular event. After adjustment for cardiovascular risk factors, each increment of 1 SD in log B-type natriuretic peptide levels was associated with a 27 percent increase in the risk of death (P=0.009), a 28 percent increase in the risk of a first cardiovascular ...
Background Patients with rheumatoid arthritis (RA) are at increased risk of heart failure and vascular events. Small increases in circulating N-terminal pro-brain natriuretic peptide (NT-proBNP) are associated with an increased risk of a cardiovascular event, and high levels signal left ventricular dysfunction. Data on the effects of tumour necrosis factor α(TNFα) blocking agents on circulating NT-proBNP levels in patients with active RA are lacking but may be informative.. Methods 171 consecutive patients with RA (28-joint disease activity score ,3.2) without congestive heart failure (NYHA class III or IV) were scheduled to receive adalimumab once every 2 weeks. Serum NT-proBNP concentrations were measured simultaneously on stored baseline and 16-week samples. Paired sample t tests were used to observe differences in biomarkers before and after adalimumab administration. Correlations between the biomarkers and changes in circulating log NT-proBNP levels were evaluated with the Pearson test ...
article{f11d08e8-ad91-4917-ae93-8e3b89b2c1b0, abstract = {BACKGROUND:,br/,,br, Serum N-terminal pro-brain natriuretic peptide (NT-proBNP) is regarded as a sensitive marker of cardiovascular disease. Vascular disease plays an important role in cognitive impairment.,br/,,br, ,br/,,br, METHOD:,br/,,br, In 447 elderly patients with mental illness, serum NT-proBNP level and the presence or absence of vascular disease according to the medical record were used to categorize patients in different subgroups of vascular disease.,br/,,br, ,br/,,br, RESULTS AND CONCLUSION:,br/,,br, Patients with vascular disease and elevated serum NT-proBNP level had a lower cognition level, shorter survival time, lower renal function and a higher percentage of pathological brain imaging than patients with vascular disease and normal NT-proBNP level. Thus, elevated serum NT-proBNP level might be helpful to detect patients who have a more severe cardiovascular disease.}, author = {Nilsson, Karin and Gustafson, Lars and ...
The primary finding in this cross-sectional study is that more than 1 in 5 patients with systolic HF and chronic symptoms seen at our outpatient HF clinic had plasma BNP ,100 pg/mL-levels that are often considered "normal" in the contemporary diagnostic use of BNP testing. Therefore, it is prudent to recognize that the usefulness of BNP is specific to the clinical context and the patient population being tested. It is equally important to recognize that our findings in no way contradict the reliable diagnostic role for plasma BNP testing in the setting of acute exacerbation of HF, because mean plasma BNP levels have been shown to be invariably elevated in such patients.1. What are the potential mechanisms for relatively low BNP levels in a cohort of patients with symptomatic chronic stable systolic HF? Plasma BNP is considered a direct counterregulatory response to myocardial stress and increased left ventricular filling pressures in the failing myocardium.6 Significant reduction in plasma BNP ...
INTRODUCTION: N-terminal pro brain natriuretic peptide (NT-proBNP) is a cardiac biomarker that has recently shown to be of diagnostic value in a diagnosis of decompensated heart failure, acute coronary syndromes and other conditions resulting in myocardial stretch. We sought to study whether sepsis-induced myocardial dilation would result in an elevation of NT-proBNP. METHOD: Serum NT-proBNP measurements were made in six consecutive patients with septic shock within 6 hours of admission to the intensive care unit. RESULTS: Markedly elevated levels of NT-proBNP were found in all six patients. CONCLUSIONS: NT-proBNP levels can be markedly elevated in critically ill patients presenting with septic shock. An elevated NT-proBNP level in a critically ill patient is not specific for decompensated heart failure ...
Introduction: Increased plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) concentration reflects cardiac overload and is used to diagnose and stage congestive heart failure. While NT-proBNP exhibits beneficial effects on the cardiovascular system via vasodilatation and diuresis, increased amounts of circulating NT-proBNP also promote release of norepinephrine, which is known to affect blood pressure. Cross-sectional studies report positive associations of NT-pro-BNP with blood pressure, but the prospective association of increased NT-proBNP with risk of hypertension is not well characterized. Thus, the study aim was to evaluate the association of NT-proBNP with incident hypertension in the community-based ARIC Study.. Methods: We conducted a prospective cohort analysis of 3,849 participants aged 53-75 years with measured NT-proBNP at ARIC Visit 4 (1996-98) and normal blood pressure; participants with a history of hypertension (medication use or measured BP ≥140/90 mmHg), ...
TY - JOUR. T1 - Usefulness of N-Terminal Pro-B-Type natriuretic peptide increase as a marker for cardiac arrhythmia in patients with syncope. AU - Costantino, Giorgio. AU - Solbiati, Monica. AU - Casazza, Giovanni. AU - Bonzi, Mattia. AU - Vago, Tarcisio. AU - Montano, Nicola. AU - McDermott, Daniel. AU - Quinn, James. AU - Furlan, Raffaello. PY - 2014/1/1. Y1 - 2014/1/1. N2 - B-type natriuretic peptides (BNPs) have been investigated as biomarkers for risk stratification of patients with syncope. Their concentration can be influenced by age and co-morbidities. In the present study, we compared the change in N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels within 6 hours in patients with vasovagal and arrhythmic syncope to determine whether this change can predict arrhythmic syncope. Using a case-control design, 33 patients were enrolled. Of the 33 patients, 18 with arrhythmic syncope, as they underwent controlled ventricular tachycardia or ventricular fibrillation (VF) during device ...
Background: Cardiac dysfunction is a well-known complication of sepsis, but its characteristics and consequences, especially on a longer term, remain unclear. The aim of this thesis was to study the characteristics and the implications of cardiac dysfunction for outcome in intensive care unit (ICU) patients with septic shock.. Purpose: First, to assess the ability of a cardiac biomarker to predict outcome in ICU patients. Second, to characterise cardiac dysfunction in septic shock using speckle tracking echocardiography. Third, to investigate the reliability of echocardiographic methods used to describe cardiac dysfunction in septic shock. Fourth, to study long-term cardiac outcome in severe sepsis and septic shock patients.. Materials and methods: The cardiac biomarker amino-terminal pro-brain natriuretic peptide (NTproBNP) was collected in 481 patients on ICU admission and its ability to predict death was assessed. In 50 patients with septic shock, echocardiography was performed on ICU ...
714 Relationship between serial measurements of N-terminal pro brain natriuretic peptide and ambulatory cardiac filling pressures in outpatients with chronic heart failure. Braunschweig, F.; Fahrleitner, A.; Mangiavacchi, M.; Ghio, S.; Fotuhi, P.; Hoppe, U.C.; Harrison, M.; Linde, C. // European Journal of Heart Failure. Supplements;Jun2004, Vol. 2 Issue 1, p149 An abstract of the study "Relationship Between Serial Measurements of N-Terminal Pro Brain Natriuretic Peptide and Ambulatory Cardiac Filling Pressures in Outpatients With Chronic Heart Failure," by F. Braunschweig and colleagues is presented. ...
Aims. The levels of plasma brain natriuretic peptide (BNP) are known to be elevated in patients with primary pulmonary hypertension (PH). We sought to verify the sensitivity and specificity of plasma BNP levels for the diagnosis of PH in HIV infected patients.. Methods and Results. Plasma N-terminal proBNP levels were measured in 16 patients with HIV disease and a confirmed diagnosis of PH and in 77 control HIV patients with no cardiac or pulmonary disease. All patients underwent an echocardiographic and Doppler examination focused on the evaluation of right ventricular (RV) geometry and function. An abnormal value of N-terminal proBNP (,153 pg/ml in males and ,88 pg/ml in females) yielded a 91% specificity and a 81% sensitivity for the diagnosis of PH. Three PH patients with normal N-terminal but similar transtricuspidal and transpulmonary gradients in comparison to those with abnormal N-terminal pro-BNP had normal indices of RV function.. Conclusions. Abnormal plasma N-terminal proBNP levels ...
Correlation of serum brain natriuretic peptide with hyponatremia and delayed ischemic neurological deficits after subarachnoid hemorrhage.
OBJECTIVES Due to different release mechanisms, mid-regional pro-atrial natriuretic peptide (MR proANP) may be superior to N-terminal pro-B-type natriuretic peptide (NT proBNP) in the diagnosis of acute heart failure (AHF) in patients with atrial fibrillation (AF). We compared MR proANP and NT proBNP for their diagnostic value in patients with AF and sinus rhythm (SR). DESIGN Prospective cohort study. SETTING University hospital, emergency department. PATIENTS 632 consecutive patients presenting with acute dyspnoea. MAIN OUTCOME MEASURES MR proANP and NT proBNP plasma levels were determined. The diagnosis of AHF was adjudicated by two independent cardiologists using all available data. Patients received long-term follow-up. RESULTS AF was present in 151 patients (24%). MR proANP and NT proBNP levels were significantly higher in the AF group compared with the SR group (385 (258-598) versus 201 (89-375) pmol/l for MR proANP, p|0.001 and 4916 (2169-10285) versus 1177 (258-5166) pg/ml, p|0.001 for
The measurement of natriuretic peptides for the diagnosis of heart failure has been a major breakthrough in cardiology (1)(2). B-Type natriuretic peptide (BNP) is synthesized as preproBNP mainly in the ventricular myocardium. On ventricular myocyte stretch, preproBNP is enzymatically cleaved to proBNP and released in the form of the hormonally active BNP and the inactive N-terminal proBNP (NT-proBNP). Both BNP and NT-proBNP have been shown to reflect heart failure severity (1), but studies on their sensitivity and specificity for different degrees of heart failure produced conflicting results (3)(4)(5)(6). Both BNP and NT-proBNP can be used for the diagnosis of heart failure, but there are important differences between the two tests, particularly regarding influence of age and renal function (1). In addition to glomerular filtration, BNP is eliminated from plasma mainly through natriuretic peptide receptors and degraded by neutral endopeptidases (7)(8)(9). In contrast, NT-proBNP possibly is ...
Methods Between 1997 and 2001, serum NT-proBNP was measured in 6040 participants (mean age 69 years, 57% women) free of heart-failure and dementia from the Rotterdam Study. Participants were continuously followed-up for incident dementia until 2012, for 56 616 person-years. Cognition was assessed at baseline and reassessed between 2002 and 2006 by Letter-Digit-Substitution-task, Stroop test and Word-Fluency test. Associations of NT-proBNP with dementia (555 cases), Alzheimers disease (357 cases) and vascular dementia (32 cases) were assessed linearly, and in quartiles using Cox regression. Associations of NT-proBNP with cognitive-decline were assessed using multiple linear regression. All analyses were repeated after excluding patients with CVD. ...
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 Cardiol. 2002;40:1794-800. 12446063 (All 2003 articles were reviewed for relevancy, and abstracts were last revised in 2009 ...
1. Edema BE. In: Fauci AS, et al, eds. Harrisons principles of Internal Medicine, 14th ed. McGraw-Hill: New York. 1998:210-214 2. Strunk A, Bhalla V, Clopton P. et al. Impact of the history of congestive heart failure on the utlity of B-Type natriuretic peptide in the emergency diagnosis of heart failure: results from the Breathing Not Properly Multinational Study. Am J Med. 2006;119:69e1-69e11 3. Kragelund C, Gronning B, Kober L, Hildebrandt P, Steffensen R. N-terminal pro-B-Type Natriuretic Peptide and long-term mortality in stable coronary heart disease. N Engl J Med. 2005;352:666-675 4. Kistorp C, Raymond I, Pedersen F, Gustafsson F, Faber J, Hildebrandt P. N-terminal pro-brain natriuretic peptide, C-reactive protein, and urinary albumin levels as predictors of mortality and cardiovascular events in older adults. JAMA. 2005;293:1609-1616 5. Berger R, Huelsman M, Strecker K. et al. B-type natriuretic peptide predicts sudden death in patients with chronic heart failure. Circulation. ...
In this prospective study of asymptomatic patients with type 2 diabetes and microalbuminuria, without known CAD, risk stratification with NT-proBNP and CAC, alone and in combination, predicted CVD and all-cause mortality on top of established risk factors. According to our previously defined risk criteria based on NT-proBNP and CAC, 24 of 26 deaths occurred in the high risk group during 6.1 years of follow-up and in these patients the adjusted HR for fatal or nonfatal CVD was 10.6 (95 % CI 2.4-46.3). Both risk markers added independent predictive value in the assessment of risk for future events. Identifying diabetic subjects at risk of CVD and death at an early stage and initiating more aggressive therapy in these individuals could improve outcome.. We demonstrated that patients stratified into a high-risk group (NT-proBNP ≥45.2 ng/L and/or CAC ≥ 400) had a significantly higher risk of CVD events and mortality compared to low-risk patients. Findings were similar when comparing each of the ...
TY - JOUR. T1 - Association between chronic hepatitis C virus infection and high levels of circulating N-terminal pro-brain natriuretic peptide. AU - Okada, Kyoko. AU - Furusyo, Norihiro. AU - Ogawa, Eiichi. AU - Ikezaki, Hiroaki. AU - Ihara, Tsuyoshi. AU - Hayashi, Takeo. AU - Kainuma, Mosaburo. AU - Masayuki, Murata. AU - Hayashi, Jun. PY - 2013/2/1. Y1 - 2013/2/1. N2 - The association between HCV infection and myocardial disorders remains unclear. This study aimed to assess whether or not HCV infection influences myocardial dysfunction by the use of NT-proBNP, a sensitive marker of myocardial dysfunction. A total of 198 participants [99 patients with chronic HCV infection (aged 46-68 years) and 99 anti-HCV-negative sex and age matched controls] were examined. Serum HCV-RNA level and HCV genotype were tested and liver biopsy was done only for the patient group. The NT-proBNP concentration of the HCV patients (mean 71.6 ± 79.1 pg/ml; median 46.0 pg/ml, range 5.0-400.0) was significantly higher ...
The role of preoperative transthoracic echocardiography (TTE) for the risk stratification has not been well investigated yet. We compared the predictive power of TTE with N-terminal pro-brain natriuretic peptide (NT-proBNP), a representative biomarke
Baseline and post-endoscopy human brain natriuretic peptide (hBNP) levels in patients aged |65 years and patients ≥65 years with and without cardiovascular
With the exception of IL-6, all biomarkers were higher in TIA patients than in controls. NT-proBNP was significantly related to the presence or new diagnosis of AF at all time points analyzed. Furthermore, the baseline NT-proBNP level was significantly higher than values at the 7-day and 90-day follow-up. For this reason, different cut-off values were obtained at different times: 313 pg/ml at baseline [odds ratio (OR) = 18.99, P , 0.001], 181 pg/ml at 7 days (OR = 11.4, P = 0.001) and 174 pg/ml (OR = 8.46, P , 0.001) at 90 days. ...
We show that BNP and NT-proBNP plasma concentrations are associated with the progression of renal failure in patients with primary, nondiabetic CKD. BNP and NT-proBNP are both released from the heart in response to wall stretch induced by volume or pressure overload and have been introduced into the clinical routine as valuable diagnostic and prognostic markers of CHF and LVD (4)(5)(6)(7)(8)(16). In addition, BNP and NT-proBNP plasma concentrations have been found to be increased in patients with impaired renal function (10)(17). In our study, in accordance with published data (9)(10)(11)(16), median BNP and NT-proBNP concentrations increased in parallel with decreasing renal function. Hence, even a moderate restriction of GFR was associated with a significant increase of NT-proBNP values.. To date, the increase of BNP and NT-proBNP concentrations in patients with impaired renal function has been considered an unwanted confounder in the diagnostics of CHF. Moreover, the reason for increased BNP ...
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TY - JOUR. T1 - Risk stratification for heart failure and death in an acute coronary syndrome population using inflammatory cytokines and N-terminal pro-brain natriuretic peptide. AU - Kavsak, Peter A.. AU - Ko, Dennis. AU - Newman, Alice M.. AU - Palomaki, Glenn E.. AU - Lustig, Viliam. AU - MacRae, Andrew R.. AU - Jaffe, Allan S. PY - 2007/12. Y1 - 2007/12. N2 - Background: Inflammation in acute coronary syndrome (ACS) can identify those at greater long-term risks for heart failure (HF) and death. The present study assessed the performance of interleukin (IL)-6, IL-8, and monocyte chemoattractant protein-1 (MCP-1) (cytokines involved in the activation and recruitment of leukocytes) in addition to known biomarkers [e.g., N-terminal probrain natriuretic peptide (NT-proBNP)] for predicting HF and death in an ACS population. Methods: In a cohort of 216 ACS patients, NT-proBNP (Elecsys®; Roche) and IL-6, IL-8, and MCP-1 (evidence investigator™; Randox) were measured in serial specimens collected ...
Brain natriuretic peptide (BNP) was originally identified in extracts of porcine brain. However, in humans, it is produced mainly in the cardiac ventricles in response to excessive stretching of heart muscle cells (cardiomyocytes); high concentrations of BNP in the blood are a marker of heart failure. BNP is also known as natriuretic peptide B, gamma-brain natriuretic peptide, and GC-B. The release of BNP is controlled by calcium ions. BNP binds to and activates the atrial natriuretic factor receptors NPRA and NPRB, similar to atrial natriuretic peptide (ANP) but with much lower affinity. Both BNP and ANP cause a net decrease in blood volume, which lowers the bodys blood pressure. Recombinant BNP is used to treat decompensated heart failure.. ...
Brain natriuretic peptide (BNP) was originally identified in extracts of porcine brain. However, in humans, it is produced mainly in the cardiac ventricles in response to excessive stretching of heart muscle cells (cardiomyocytes); high concentrations of BNP in the blood are a marker of heart failure. BNP is also known as natriuretic peptide B, gamma-brain natriuretic peptide, and GC-B. The release of BNP is controlled by calcium ions. BNP binds to and activates the atrial natriuretic factor receptors NPRA and NPRB, similar to atrial natriuretic peptide (ANP) but with much lower affinity. Both BNP and ANP cause a net decrease in blood volume, which lowers the bodys blood pressure. Recombinant BNP is used to treat decompensated heart failure.. ...
Both atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) are involved in sodium and water homoeostasis in healthy humans. The plasma concentrations of the natriuretic peptides can be used to differentiate between dyspnoea of cardiac and pulmonary origin, and the degree of elevation of the peptide levels in the plasma in heart failure is a measure of the severity of the disease. However, the patterns of secretion of ANP and BNP are not clear either in healthy humans or in patients. The purpose of the present study was to test the hypotheses that both ANP and BNP are secreted in pulses in healthy humans, and that this phenomenon can be revealed by determination of ANP and BNP in peripheral venous blood samples. In 12 healthy subjects, blood samples were drawn every 2 min through an intravenously inserted plastic needle over a period of 2 h. Plasma concentrations of ANP and BNP were determined by RIAs, and the results were analysed for pulsatile behaviour by Fourier transformation. ...
BACKGROUND: Patients undergoing acute left main (LM) coronary artery revascularization have a high mortality and natriuretic peptides such as N-terminal pro-B-type (NT-proBNP) have been shown to have prognostic value in patients with acute coronary syndromes. The present study looked at the prognostic value of NT-proBNP in these patients. METHODS AND RESULTS: We studied all consecutive patients undergoing acute LM coronary artery percutaneous coronary intervention between January 2005 and December 2008 in whom NT-proBNP was measured (n=71). We analyzed the clinical characteristics and the short- and long-term outcomes in relation to NT-proBNP level at admission. Median NT-proBNP was 1,364 ng/L, ranging from 46 to 70,000 ng/L. NT-proBNP was elevated in 63 (89%) patients and was ≥1,000ng/L in 42 (59%). Log NT-proBNP (hazard ratio [HR] 3.51, 95% confidence interval [CI] 1.55-7.97, P=0.003) and left ventricular ejection fraction (HR 0.95, 95%CI 0.91-0.99, P=0.007) were predictors for all-cause ...
Early diagnosis and treatment can help people who have heart failure live longer, more active lives.. A test for B-type natriuretic peptide (BNP) or N-terminal pro b-type natriuretic peptide (NT-proBNP) is primarily used to help detect, diagnose, and evaluate the severity of heart failure. It can be used, along with other cardiac biomarker tests, to detect heart stress and damage and/or along with lung function tests to distinguish between causes of shortness of breath. Chest X-rays and an ultrasound test called echocardiography(also available in the 4th Practice) may also be performed.. BNP and NT-proBNP are substances that are produced in the heart and released when the heart is stretched and working hard to pump blood. (For more on this, see the "What is being tested?" section.). Heart failure can be confused with other conditions, and it may co-exist with them. BNP and NT-proBNP levels can help doctors differentiate between heart failure and other problems, such as lung disease. An accurate ...
Brain natriuretic peptide (BNP), also known as B-type natriuretic peptide, is a hormone secreted by cardiomyocytes in the heart ventricles in response to stretching caused by increased ventricular blood volume. BNP is named as such because it was originally identified in extracts of pig brain. The 32-amino acid polypeptide BNP is secreted attached to a 76-amino acid N-terminal fragment in the prohormone called NT-proBNP (BNPT), which is biologically inactive. Once released, BNP binds to and activates the atrial natriuretic factor receptor NPRA, and to a lesser extent NPRB, in a fashion similar to atrial natriuretic peptide (ANP) but with 10-fold lower affinity. The biological half-life of BNP, however, is twice as long as that of ANP, and that of NT-proBNP is even longer, making these peptides better targets than ANP for diagnostic blood testing. The physiologic actions of BNP are similar to those of ANP and include decrease in systemic vascular resistance and central venous pressure as well as ...
Patients with idiopathic pulmonary arterial hypertension usually undergo acute vasodilator tests with nitric oxide (NO) for haemodynamic evaluation and therapeutical planning. The aim of this study was to evaluate the link between the variation of N-
Objective: As the veteran population ages, the incidence of clinically significant aortic stenosis (AS) is increasing and aortic stenosis has become a veterans health issue. This analysis focused on using serum Brain Natriuretic Peptide (BNP) levels as an adjunct to aid decision making for early aortic valve replacement (AVR) in veterans with severe AS to reduce hospital admission rates. Methods: We retrospectively reviewed the charts of patients referred to the heart valve clinic at the Washington DC, Veterans Affairs Medical Center (VAMC) Heart Center between 2004 and 2015 who were diagnosed with severe AS. We identified veterans who had a BNP drawn in addition to traditional echocardiography during their diagnostic workup. This cohort was then stratified based on their serum BNP levels and whether they received medical therapy or aortic valve replacement. The primary endpoint of interest was admission to a VAMC for valvular heart failure. Results: Univariate analysis of BNP quartile and operative
Previous studies have shown that natriuretic peptide levels correlate inversely with GFR in chronic kidney disease (16,17). Investigators have postulated that higher filling pressures and wall stress play an important role in this cardiorenal link. However, in our patients with renal failure (75% acute), natriuretic peptide levels were massively elevated and could not be explained on the basis of higher filling pressures, wall stress, or depressed cardiac function. Moreover, natriuretic peptide levels ,1,000 pg/ml (BNP) and 10,000 pg/ml (NT-proBNP) were more specific for a GFR ,60 (BNP, 92%; NT-proBNP, 100%) than for a PCWP ,18 mm Hg (BNP, 42%; NT-proBNP, 60%).. To our knowledge, this study is the first to document such natriuretic peptide-hemodynamic dissociations in the setting of renal failure and suggests that renal function has a more direct effect on circulating natriuretic peptide levels than previously recognized. Moreover, the present study highlights the important limitations of these ...
Although patients can present with non-specific symptoms and minimal clinical signs, generally, in the community, patients with heart failure present with symptoms of dyspnoea or fluid retention. In order to confirm (or refute) the diagnosis, NICE recommends natriuretic peptide testing (ideally N-terminal pro B-type natriuretic peptide; NT-proBNP) in all patients with suspected heart failure. An NT-proBNP level , 2,000 ng/L is highly suggestive of heart failure and NICE recommends echocardiography and specialist review within 2 weeks. Conversely, an NT-proBNP level , 400 ng/L suggests that a diagnosis of heart failure is unlikely. Patients with an NT-proBNP of 400-2,000 ng/L should have echocardiography and specialist assessment within 6 weeks. ...
Background Measurement of plasma concentration of natriuretic peptides (NPs) is suggested to be of value in diagnosis of cardiac disease in dogs, but many factors other than cardiac status may influence their concentrations. Dog breed potentially is 1 such factor. Objective To investigate breed variation in plasma concentrations of pro-atrial natriuretic peptide 31-67 (proANP 31-67) and N-terminal B-type natriuretic peptide (NT-proBNP) in healthy dogs. Animals 535 healthy, privately owned dogs of 9 breeds were examined at 5 centers as part of the European Union (EU) LUPA project. Methods Absence of cardiovascular disease or other clinically relevant organ-related or systemic disease was ensured by thorough clinical investigation. Plasma concentrations of proANP 31-67 and NT-proBNP were measured by commercially available ELISA assays. Results Overall significant breed differences were found in proANP 31-67 (P,.0001) and NT-proBNP (P,.0001) concentrations. Pair-wise comparisons between breeds ...
B type natriuretic peptide (BNP) is mainly synthesized in the ventricles of the heart and released in response to volume and pressure loading and ventricular stress and, therefore, plays an important role in regulation of extracellular fluid volume. BNP causes diuresis, natriuresis, arterial and venous vasodilation and antagonizes the renin-angiotensin system resulting in a reduction in intravascular volume and decreased ventricular preload and afterload.. In adults, BNP levels have been routinely used to diagnose and measure the degree of congestive heart failure. In healthy term infants, BNP levels are initially elevated in the first few days of life but then decline over the ensuing week after birth to near adult levels by 3 months of age. However, in premature newborn infants there are still no normative values for BNP and, therefore, no agreed-upon cut off points to diagnose ventricular overload without confirmatory echocardiography. Patent ductus arteriosus (PDA) is the most common cause ...
B type natriuretic peptide (BNP) is mainly synthesized in the ventricles of the heart and released in response to volume and pressure loading and ventricular stress and, therefore, plays an important role in regulation of extracellular fluid volume. BNP causes diuresis, natriuresis, arterial and venous vasodilation and antagonizes the renin-angiotensin system resulting in a reduction in intravascular volume and decreased ventricular preload and afterload.. In adults, BNP levels have been routinely used to diagnose and measure the degree of congestive heart failure. In healthy term infants, BNP levels are initially elevated in the first few days of life but then decline over the ensuing week after birth to near adult levels by 3 months of age. However, in premature newborn infants there are still no normative values for BNP and, therefore, no agreed-upon cut off points to diagnose ventricular overload without confirmatory echocardiography. Patent ductus arteriosus (PDA) is the most common cause ...
Background:N-terminal fragment B-type natriuretic peptide (NT-proBNP) prognostic utility is commonly determined post hoc by identifying a single optimal discrimination threshold tailored to the individual study population. The authors aimed to determine how using these study-specific post hoc thresholds impacts meta-analysis results. Methods: The authors conducted a systematic review of studies reporting the ability of preoperative NT-proBNP measurements to predict the composite outcome of all-cause mortality and nonfatal myocardial infarction at 30 days after noncardiac surgery. Individual patient-level data NT-proBNP thresholds were determined using two different methodologies. First, a single combined NT-proBNP threshold was determined for the entire cohort of patients, and a meta-analysis conducted using this single threshold. Second, study-specific thresholds were determined for each individual study, with meta-analysis being conducted using these study-specific thresholds. Results: The ...
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Brain natriuretic peptide, also called B-type natriuretic peptide or BNP, is a protein released by the lower chambers of the heart in response to higher pressure levels that occur during heart...
12. A method for discriminating between placenta-associated cardiac dysfunction and cardiac dysfunction related to heart disease in a pregnant female, the method comprising the steps ofmeasuring a level of a brain natriuretic peptide in a sample from the female,measuring a level of placental growth factor (PlGF) in a sample from the female,measuring a level of soluble fms-like tyrosine kinase 1 (sFlt-1) in a sample from the female,comparing the measured level of the brain natriuretic peptide to a reference level of brain natriuretic peptide, andcomparing the measured level of placental growth factor to a reference level of placental growth factor,comparing the measured level of sFlt-1 to a reference level of sFlt-1,wherein an increased level of the brain natriuretic peptide in the sample relative to the reference level of the brain natriuretic peptide, a decreased level of PlGF in the sample relative to the reference level of PlGF, and an increased level of sFlt-1 in the sample relative to the ...
In the ASCOT study, we report that amlodipine-based treatment decreased NT-proBNP ,6 months, whereas atenolol-based treatment increased it. Among the amlodipine-based treatment group, an achieved NT-proBNP below the median was associated with a lower risk of subsequent CVD events. These observations are notable given that the amlodipine-based treatment randomized arm had fewer total cardiovascular events than the atenolol-based treatment randomized arm (hazard ratio, 0.84; 95% confidence interval, 0.78-0.90; P,0.0001).15. In line with a growing body of evidence,4-6 baseline NT-proBNP enhanced prediction of CVD events among hypertensive men and women without prior CVD. Thus, NT-proBNP may be a useful biomarker in the context of risk prediction in people with hypertension. Data from a small cohort study of patients with hypertension (median NT-proBNP of 82 pg/mL; highly comparable with our cohort) previously reported that NT-proBNP is associated with mortality (n=40 outcomes) independent of a ...
We assessed the predictive ability of selected biomarkers using N-terminal pro-brain natriuretic peptide (NT-proBNP) as the benchmark and tried to establish a multi-biomarker approach to heart failure (HF) in hypertensive patients. In 120 hypertensive patients with or without overt heart failure, the incremental predictive value of the following biomarkers was investigated: Collagen III N-terminal propeptide (PIIINP), cystatin C (CysC), lipocalin-2/NGAL, syndecan-4, tumor necrosis factor-α (TNF-α), interleukin 1 receptor type I (IL1R1), galectin-3, cardiotrophin-1 (CT-1), transforming growth factor β (TGF-β) and N-terminal pro-brain natriuretic peptide (NT-proBNP). The highest discriminative value for HF was observed for NT-proBNP (area under the receiver operating characteristic curve (AUC) = 0.873) and TGF-β (AUC = 0.878). On the basis of ROC curve analysis we found that CT-1 | 152 pg/mL, TGF-β | 7.7 ng/mL, syndecan | 2.3 ng/mL, NT-proBNP | 332.5 pg/mL, CysC | 1 mg/L and NGAL | 39.9 ng/mL were
Our results suggest that the previous study may have overestimated the relation between NT-proBNP and the subsequent risk of hospitalisation for worsening heart failure.3 This discrepancy may have arisen because our study is of a population based cohort of acutely ill patients with heart failure arising from a number of different aetiologies and a wide range of disease severity. Perhaps there is a stronger association in patients with specific aetiologies, such as CAD.3 Alternatively, the timing of NT-proBNP measurement may be an important factor in maximising its predictive value for subsequent hospitalisation. While in our study NT-proBNP was measured shortly after first diagnosis, in the study by Richards and colleagues, patients were enrolled, and their NT-proBNP measured when they were in a stable state.3 A recent study has addressed this issue directly, comparing measurements of NT-proBNP made on arrival at, and on discharge from, a coronary care unit.5 Both measurements were available for ...
Case Report: Clinicians asked us to consult on a 61-year-old man admitted to our hospital with suspected diastolic heart failure and persistently elevated serum BNP levels. The patient had previously been treated for dyspnea and chest discomfort and had a history of hypertension. Our laboratory measured a serum BNP level of 3234 ng/L (normal range, 0 to 80 ng/L; Abbott AxSYM assay, Abbott Diagnostics, Abbott Park, Illinois). Prior serum BNP levels were greater than 4000 ng/L and 3798 ng/L at 6 months and 3 months before admission, respectively. Hepatic and renal function, lipid levels, and chest radiography were normal. Echocardiography showed normal ejection fraction with a lower peak velocity for mitral E-wave than for mitral A-wave. Cardiac catheterization showed normal pressures in the right atrium, right ventricle, pulmonary artery, and pulmonary capillary wedge. Angiography showed no stenosis in the coronary arteries. The results of other diagnostic tests, including serum levels of ...
Methods and Results-A total of 16 492 patients with type 2 diabetes mellitus and a history of, or at risk of, cardiovascular events were randomized to saxagliptin or placebo (mean follow-up, 2.1 years). The primary end point was the composite of cardiovascular death, myocardial infarction, or ischemic stroke. Hospitalization for heart failure was a predefined component of the secondary end point. Baseline N-terminal pro B-type natriuretic peptide was measured in 12 301 patients. More patients treated with saxagliptin (289, 3.5%) were hospitalized for heart failure compared with placebo (228, 2.8%; hazard ratio, 1.27; 95% confidence intercal, 1.07-1.51; P=0.007). Corresponding rates at 12 months were 1.9% versus 1.3% (hazard ratio, 1.46; 95% confidence interval, 1.15-1.88; P=0.002), with no significant difference thereafter (time-varying interaction, P=0.017). Subjects at greatest risk of hospitalization for heart failure had previous heart failure, an estimated glomerular filtration rate ≤60 ...
Mark A. Oyama, Adrian Boswood, David J. Connolly, Stephen J. Ettinger, Philip R. Fox, Sonya G. Gordon, John E. Rush, D. David Sisson, Rebecca L. Stepien, Gerhard Wess, Faiez Zannad, Clinical usefulness of an assay for measurement of circulating N-terminal pro-B-type natriuretic peptide concentration in dogs and cats with heart disease, Journal of the American Veterinary Medical Association, 2013, 243, 1, ...
B-type natriuretic peptide (NT-proBNP) is a cardiac neurohormone that is secreted from the left ventricle in response to volume and pressure overload as occurs in patients with congestive heart failure. NT-proBNP has now become a useful tool in the diagnosis of congestive heart failure and in the management of patients with acute dyspnea. In recent years, several studies showed that NT-proBNP levels may be influenced by thyroid diseases. However, there arent data on the elderly population, a group of patients in whom the incidence of both thyroid diseases and heart failure is frequent ,. The aim of this study was to assess the levels of NT-proBNP in a group of elderly patients with dyspnea and thyroid disease and without congestive heart failure. ...