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

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

Comparison between BNP values measured in capillary blood samples with a POCT method and those measured in plasma venous samples with an automated platform

Letter to the Editor. Our data suggest that it is possible to measure BNP in fresh finger-stick samples of capillary whole blood with an acceptable reproducibility, and within 10 – 20 min to obtain results close correlated to those measured by the automated platform in plasma blood samples collected from a vein. The measurement of BNP in fresh finger-stick samples of capillary whole blood with this POCT method is in particular indicated for the management of HF patients at home and for the BNP assay in neonates and children

b-Gamma-glutamyltransferase activity in human vulnerable carotid plaques.

Objective: The atherosclerotic plaque that is vulnerable to rupture and to superimposed thrombosis is mainly represented by a thin-cap fibroatheroma with or without ulceration/thrombosis and inflammatory infiltrates. Total serum gamma-glutamyltransferase (GGT) activity is an independent predictor for cardiovascular events. Four GGT fractions have been identified in plasma and only one of them (b-GGT) in atherosclerotic plaques, but the possible role of GGT in plaque pathophysiology has not been assessed yet. We investigated the relationships between plaque b-GGT activity and the histological features of plaque vulnerability. Methods and results: Plaque GGT activity was investigated in 65 patients undergoing carotid endarterectomy; plaques were histologically characterized and immunostained for GGT. Intra-plaque total and fractional GGT activity was determined by a cost-effective test of molecular size exclusion chromatography, and compared with histological markers of plaque vulnerability. Plaque cholesterol content was also measured by chromatography. b-GGT was the only fraction detected within the atherosclerotic plaques and intra-plaque b-GGT activity correlated to plaque cholesterol content (r = 0.667, P < 0.0001), plasma b-GGT and f-GGT fractions (r = 0.249; r ¼ 0.298, both P < 0.05). Higher b- GGT activity was found in thin-cap fibroatheromas and it was associated to histological markers of vulnerable plaques, i.e., larger necrotic areas, greater macrophage infiltration and higher cholesterol content (P < 0.05). Conclusions: intra-plaque b-GGT activity correlates with the histological markers of vulnerable plaque and with plasma b-GGT in human carotid atherosclerosis; these data support the possible role of b-GGT in clinically significant atherosclerotic disease