Natriuretic Peptide assays revisited do we need pro-B-type natriuretic Peptide?

Discovery of the endocrine function of the heart, which exerts a fundamental role in regulating cardiovascular homeostasis through atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP), has opened up a new field of research that has resulted in multiple clinical applications

Diagnostic accuracy and prognostic relevance of the measurement of the cardiac natriuretic peptides: a review

Summary Background Pathophysiological and clinical relevance of cardiac natriuretic hormone (CNH) assay has been investigated by a great deal of experimental and clinical studies. Authors sought to evaluate the diagnostic accuracy and prognostic relevance of the measurement of CNHs according to the evidence-laboratory medicine principles. Methods In June 2003, a computerized literature search on National Library of Medicine using keyword "ANP" and "BNP" found more than 12.300 and 1200 articles, respectively. A more refined search with keywords "ANP or BNP assay" extracted about 7000 and 800 articles, respectively. Only studies specifically designed to evaluate the diagnostic accuracy and prognostic relevance of CNH measurement were selected from this huge mass of articles to be discussed in this review. Content Several studies suggested that CNH assay may be clinically useful: for the screening and classification of patients with heart failure, as a prognostic marker in cardiovascular disease, in the follow-up of patients with heart failure, and also because it may reduce the need for further cardiac investigation. However, it is difficult to compare, even the best well-designed studies, because not only they evaluated different populations, but they also used different gold standards. Conclusions CNH assay and conventional diagnostic work-up provide complementary information for the evaluation of presence and severity of cardiac dysfunction and clinical disease. Several aspects of CNH assay are still to be delucidated, and further work is still needed to carefully assess its diagnostic accuracy and prognostic value in cardiac disease

Cardiac endocrine function is an essential component of the homeostatic regulation network: physiological and clinical implications

The discovery of cardiac natriuretic hormones required a profound revision of the concept of heart function. The heart should no longer be considered only as a pump, but rather as a multi-functional and interactive organ, part of a complex network and active component of the integrated systems of the body. In the present review, we will first consider the cross-talk between endocrine and contractile function of the heart. Then, based on the existing literature, we will propose the hypothesis that cardiac endocrine function is an essential component of the integrated systems of the body and thus plays a pivotal role in fluid, electrolyte and hemodynamic homeostasis. We will highlight those studies indicating how alterations in cardiac endocrine function can better explain the pathophysiology of cardiovascular diseases and in particular of heart failure, in which several target organs develop a resistance to the biological action of cardiac natriuretic peptides. Finally, we will emphasize the concept that a complete knowledge of the cardiac endocrine function and of its relation with other neurohormonal regulatory systems of the body is crucial to correctly interpret changes in circulating natriuretic hormones, especially the brain natriuretic peptide

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

Abstract Study aim The current study compares the diagnostic accuracy of BNP and NT-proBNP assays for the diagnosis of heart failure, according to evidence based laboratory medicine (EBLM) principles. Methods In May 2006, studies specifically designed to compare the diagnostic accuracy of BNP and NT-proBNP assays were selected by means of a computerized literature search performed on National Library of Medicine. The comparison took into account the area under the curve (AUC) and diagnostic odds ratio (DOR) derived from ROC analysis of original studies. Results Both BNP and NT-proBNP assays were found to be clinically useful for the diagnosis of heart failure. A meta-analysis of these data was made difficult by the heterogeneity of data, regarding patient population, diagnostic criteria, end-points and immunoassay methods for both BNP and NT-proBNP. Separate meta-analyses were performed for acute and chronic heart failure. In chronic heart failure, the diagnostic odds ratio (DOR) for BNP assay (DOR 8.44, 95% CI 4.66 – 15.30) was not significantly different from NT-proBNP one (23.36, 95% CI 9.38 – 58.19). In patients with acute heart failure, the mean DOR for BNP assay was 16.46 (95% CI 10.65 – 25.43) and for NT-proBNP assay 18.61 (95% CI 12.99 – 26.65), without a significant difference. Conclusion Our results indicate that both BNP and NT-proBNP assays have a high degree of diagnostic accuracy and clinical relevance in both acute and chronic heart failure

Cardiac biomarker testing in the clinical laboratory: Where do we stand? General overview of the methodology with special emphasis on natriuretic peptides

Diagnosis of heart failure (HF) is not based on a single test, but on a combination of history, physical examination and appropriate investigations. For these reasons, the accuracy of diagnosis by clinical means alone is often inadequate, especially in the early, asymptomatic stages of the HF. Thus, there is an increasing interest in the development of new cardiovascular biomarkers and, consequently, a great number of laboratory tests have recently been proposed for their assay. The aim of this article is to provide a general overview on the biomarkers, recommended by international guidelines, for the diagnosis, risk stratification, and follow-up of patients with HF. Cardiac natriuretic peptides and in particular the B-type related peptides, which are considered to be the first line biomarker for HF by international guidelines, will be discussed with special emphasis