Either B-type natriuretic peptide (BNP) or NT-proBNP may be used as a diagnostic, screening, prognostic and therapeutic tool for CHF. The Food and Drug Administration (FDA) cleared the cut-off point for BNP at 100 pg/mL, and that of NT-proBNP at 125 pg/mL for patients <75 years and 450 pg/mL for those >75. A steadily rising titre even below the cut-off value should be raised as a concern as heart failure is progressive if left untreated and may result in cardiac death. Both biomarkers are also featured in lab investigations for patients with acute coronary syndrome (ACS).
SaitoY. Roles of atrial natriuretic peptide and its therapeutic use. J Cardiol2010; 56(3):262–70.
2.
SaengerAKJaffeAS. The use of biomarkers for the evaluation and treatment of patients with acute coronary synromes. Med Clin North Am2007; 91(4):657–681.
3.
GantzerML, Understanding the Natriuretic Peptides, Medical Laboratory Observer, Medical Laboratory Observer May 2005.
4.
O'DonoghueMBraunwaldE. Natriuretic peptides in heart failure: Should therapy be guided by BNP levels?Nat Rev Cardiol2010;7(1):13–20.
5.
WieshammerSDreyhauptJBeslerBMarsovskyE. NT-proBNP for pulmonologists: Not only a rule-out test for systolic heart failure but also a global marker of heart disease. Respiration2009; 77(4):370–380.
6.
McCulloughPANowakRMMcCordJHollanderJEHerrmannHCStegPG. B-type natriuretic peptide and clinical judgment in emergency diagnosis of heart failure: Analysis from Breathing Not Properly (BNP) Multinational Study. Circulation. 2002;106(4):416–22.
7.
DicksteinKCohen-SolalAFilippatosGMcMurrayJJPonikowskiPPoole-WilsonPA. ESC Committee for Practice Guidelines (CPG).ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur Heart J2008 Oct;29(19):2388–442.
8.
NACB Writing Group, WuAHJaffeASAppleFSJesseRLFrancisGL. National Academy of Clinical Biochemistry laboratory medicine practice guidelines: Use of cardiac troponin and B-type natriuretic peptide or N-terminal proB-type natriuretic peptide for etiologies other than acute coronary syndromes and heart failure. Clin Chem2007;53(12):2086–96.
9.
PalazzuoliAAntonelliGQuatriniINutiR. Natriuretic peptides in heart failure: Where we are, where we are going. Intern Emerg Med2011;6(1):63–8.
10.
PalazzuoliAGallottaMQuatriniINutiR. Natriuretic peptides (BNP and NTproBNP): Measurement and relevance in heart failure. Vasc Health Risk Manag2010;6: 411–8.
11.
DoustJLehmanRGlasziouP. The role of BNP testing in heart failure. Am Fam Physician. 2006;74(11):1893–8.
12.
JanuzziJLJrCamargoCAAnwaruddinSBaggishALChenAAKrauserDG. The N-terminal Pro-BNP investigation of dyspnea in the emergency department (PRIDE) study. Am J Cardiol2005; 95(8):948–54.
13.
COBAS® proBNP II STAT Test package insert, rev 2010–12, Roche Diagnostics GmbH, Mannheim Germany.
14.
JanuzziJLvan KimmenadeRLainchburyJBayes-GenisAOrdonez-LlanosJSantalo-BelM. NT-proBNP Testing for Diagnosis and Short-term Prognosis in Acute Destabilized Heart Failure: An International Pooled Analysis of 1256 Patients, The International Collaborative of NT-proBNP Study, Euro Heart J2006;27(3): 330–7.
15.
JaffeASBabuinLAppleFS. Biomarkers in acute cardiac disease: The present and the future. J Am Coll Cardiol2006; 4;48(1):1–11.
16.
ChengVKazanagraRGarciaALenertLKrishnaswamyPGardettoN. A rapid bedside test for B-type peptide predicts treatment outcomes in patients admitted for decompensated heart failure: A pilot study. J Am Coll Cardiol2001;37(2):386–91.
17.
LogeartDThabutGJourdainPChavelasCBeynePBeauvaisF. Predischarge B-type natriuretic peptide assay for identifying patients at high risk of re-admission after decompensated heart failure. J Am Coll Cardiol2004;18;43(4):635–41.
18.
MaiselA. B-type natriuretic peptide levels: Diagnostic and prognostic in congestive heart failure: What's next?Circulation2002;105(20):2328–31.
19.
ChristensonRH. What is the value of B-type natriuretic peptide testing for diagnosis, prognosis or monitoring of critically ill adult patients in intensive care?Clin Chem Lab Med2008;46(11):1524–32.
20.
OkkonenMVarpulaMLinkoRPerttiläJVarpulaTPettiläV. N-Terminal-Pro-BNP in critically ill patients with acute respiratory failure: A prospective cohort study. Acta Anaesthesiol Scand2011;55(6):749–57.
21.
Varpula M, Pulkki K, Karlsson S, Ruokonen E, Pettilä V, FINNSEPSIS Study Group. Predictive value of N-terminal pro-brain natriuretic peptide in severe sepsis and septic shock. Crit Care Med2007; 35(5):1277–83.
22.
MeyerBHuelsmannMWexbergPDelle KarthGBergerRMoertlD. N-terminal pro-B-type natriuretic peptide is an independent predictor of otcome in an unselected cohort of critically ill patients. Crit Care Med2007;35(10):2268–73.
23.
JourdainPJondeauGFunckFGueffetPLe HellocoADonalE. Plasma brain natriuretic peptide-guided therapy to improve outcome in heart failure. J Am Coll Cardiol2007;49(16):1733–9
24.
TroughtonRWFramptonCMYandleTGEspinerEANichollsMGRichardsAM. Treatment of heart failure guided by plasma aminoterminal brain natriuretic peptide (N-BNP) concentrations. Lancet2000;355(9210):1126–30.
25.
KazanegraRChengVGarciaAKrishnaswamyPGardettoNCloptonP. A. A rapid test for B-type natriuretic peptide correlates with falling wedge pressures in patients treated for decompensated heart failure: A pilot study. J Card Fail2001;7(1):21–9.
26.
MadridA HernándezDíazM MiguelañezCervantesC EscobarTiradosB BlancoMarínIBernalE. Usefulness of brain natriuretic peptide to evaluate patients with heart failure treated with cardiac resynchronization. Rev Esp Cardiol2004;57(4):299–305.
27.
WuAH. Serial testing of B-type natriuretic peptide and NTpro-BNP for monitoring therapy of heart failure: The role of biologic variation in the interpretation of results. Am Heart J2006;152(5):828–34.
28.
ShahMRCaliffRMNohriaABhapkarMBowersMManciniDM. The STARBRITE trial: A randomized, pilot study of B-type natriuretic peptide-guided therapy in patients with advanced heart failure. J Cardiac Fail2011;17:613–21.
29.
PfistererMBuserPRickliHGutmannMErnePRickenbacherP. BNP-guided vs symptom-guided heart failure therapy: The Trial of Intensified vs Standard Medical Therapy in Elderly Patients With Congestive Heart Failure (TIME-CHF) randomized trial. JAMA2009;301(4):383–92.
30.
ClericoAFontanaMZywLPassinoCEmdinM. Comparison of the Diagnostic Accuracy of Brain Natriuretic Peptide (BNP) and the N-Terminal Part of the Propeptide of BNP Immunoassays in Chronic and Acute Heart Failure: A Systematic Review. Clinical Chemistry2007; 53(5): 813–22.
31.
BluesteinBBelenkyA. NTproBNP: Improved standard in CHF diagnosis. MLO Med Lab Obs2008;40(12):20, 22, 24.
32.
PrahashALynchT. B-Type Natriuretic Peptide: A Diagnostic, Prognostic, and Therapeutic Tool in Heart Failure. Am J Crit Care2004;13: 46–53.
33.
Blonde-CynoberFMorineauGEstrugoBFillieEAusselCVincentJ-P. Diagnostic and prognostic value of brain natriuretic peptide (BNP) concentrations in very elderly heart disease patients: Specific geriatric cut-off and impacts of age, gender, renal dysfunction, and nutritional status. Arch Gerontol Geriat2011;52:106–10
34.
FradleyMGLarsonMGChengSMcCabeECoglianeseEShahRV. Reference limits for N-Terminalpro-B-Type natriuretic peptide in healthy individuals (from the Framingham Heart Study). Am J Cardiol2011;108(9):1341–5.
35.
HaafPReichlinTCorsonNTwerenboldRReiterMSteuerS. B-type natriuretic peptide in the early diagnosis and risk stratification of acute chest pain. Am J Med2011;124:444–452.
36.
NeyouAO'NeilBBermanADBouraJAMcCulloughPA. Determinants of markedly increased B-type natriuretic peptide in patients with ST-segment elevation myocardial infarction. Am J Emerg Med2011; 29:757–67.
37.
NadirMAWithamMDSzwejkowskiBRStruthersAD. Meta-analysis of B-type natriuretic peptide's ability to identify stress induced myocardial ischemia. Am J Cardiol2011;107:662–7.
38.
TurnerKLMooreLJToddSRSucherJFJonesSAMcKinleyBA. Identification of cardiac dysfunction in sepsis with B-type natriuretic peptide. J Am Coll Surg2011; 213:139–47.
39.
RodsethRNBuseGALBolligerDBurkhartCSCuthbertsonBHGibsonSC. The predictive ability of pre-operative B-type natriuretic peptide in vascular patients for major adverse cardiac events: An individual patient data meta-analysis. J Am Coll Cardiol2011;58:522–9.
40.
NozohoorSNilssonJAlgotssonLSjögrenJ. Postoperative increase in B-type natriuretic peptide levels predicts adverse outcome after cardiac surgery. J Cardiothoracic Vasc Anesth2011; 25(3):469–75.
41.
ThygesenKMairJMuellerCHuberKWeberMPlebaniM. Recommendations for the use of natriuretic peptides in acute cardiac care: A position statement from the study group on biomarkers in cardiology of the ESC working group on acute cardiac care. Eur Heart J (2011) doi: 10.1093/eurheartj/ehq509.