Natriuretic Peptides in the Diagnosis and Management of Chronic Heart Failure
Section snippets
B-type natriuretic peptide: a cardiac hormone activated in heart failure
Within the heart, the BNP gene (NPPB) produces a 134–amino acid pre-proBNP precursor peptide, which after removal of a 26–amino acid signal peptide, results in the 108–amino acid prohormone, proBNP (Fig. 1). Subsequently, the enzyme corin cleaves ProBNP into the biologically active mature 32–amino acid, BNP (BNP 1–32), containing the critical 17–amino acid disulfide ring. A second cleavage product is the linear 76–amino acid N-terminal peptide, NTproBNP 1–76. All studies suggest that mature BNP
Diagnostic and prognostic significance of B-type natriuretic peptide
Given its association with cardiac load, it is not surprising that BNP has been found to convey diagnostic and prognostic information in acute HF and in other settings. Of note, BNP levels are affected not only by cardiac overload but also by factors such as age, sex, renal function, obesity, and genetic factors.16, 17, 18, 19, 20, 21 In the setting of acute HF, the contribution of these factors is small compared with the impact of cardiac overload so that even single, unadjusted BNP values can
Changes of B-type natriuretic peptide over time
If cardiac overload negatively impacts prognosis and if BNP reflects cardiac overload, then reductions in BNP would be expected to indicate an improved prognosis. If this were so, BNP could be used to help assess the efficacy of a therapeutic intervention in normal clinical practice and in clinical trials. Elevated levels could indicate impending clinical deterioration not yet apparent from symptoms and signs and trigger an earlier intervention, which could result in improved outcomes. With
B-type natriuretic peptide–guided therapy
As discussed earlier, higher BNP levels are related to cardiac overload and have been associated with worse outcomes. This association provides the rationale for the hypothesis that intensifying treatment so as to reduce BNP levels below a certain threshold could improve outcomes. Important study characteristics to consider are the treatment goal (ie, target BNP value) and the treatment algorithm to be followed. Some of the study characteristics discussed in the following paragraphs are shown
What Exactly Are We Measuring?
As mentioned previously, most current assay systems use antibodies directed against epitopes of BNP 1–32 or NTproBNP. This approach can have only limited specificity, and indeed, several conventional assays also detect circulating proBNP.5, 6 Because proBNP has reduced biologic activity compared with BNP 1–32, nonspecific assays may not accurately reflect biologic activity.5, 6 Recently, a proBNP assay was developed that uses an antibody directed against the hinge region of proBNP so that
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Revealing the synergistic mechanism of Shenfu Decoction for anti-heart failure through network pharmacology strategy
2020, Chinese Journal of Natural MedicinesShenfu Formula reduces cardiomyocyte apoptosis in heart failure rats by regulating microRNAs
2018, Journal of EthnopharmacologyCitation Excerpt :Myocardial infarction has become the major cause of morbidity and mortality in all heart diseases. The onset of myocardial ischemia and ensuing necrosis greatly impact the pumping of blood from the heart to the body, which may eventually lead to heart failure (Boerrigter et al., 2009). After heart failure, ventricular function is severely impaired and the renin-angiotensin system and apoptosis cascade are activated.
Divergent effects of a designer natriuretic peptide CD-NP in the regulation of adipose tissue and metabolism
2017, Molecular MetabolismCitation Excerpt :Besides cold exposure and the β3-adrenergic pathway, the cyclic GMP (cGMP) signaling pathway is also capable of inducing WAT browning [12,13]. The natriuretic peptide (NP) family consists of atrial NP (ANP), the B-type NP (BNP), and C-type NP (CNP) [14–17]. NPs bind to natriuretic peptide receptors (NPR), thereby inducing the production of second messenger cGMP [15,18,19].
Electrophysiological effects of natriuretic peptides in the heart are mediated by multiple receptor subtypes
2016, Progress in Biophysics and Molecular BiologyB-type Natriuretic Peptide circulating forms: Analytical and bioactivity issues
2015, Clinica Chimica ActaCitation Excerpt :BNP has qualitatively similar physiological actions to those of ANP in promoting natriuresis and diuresis through its action on the kidney and its antagonism of the salt and fluid retaining renin–angiotensin–aldosterone system. These actions of BNP to eliminate salt and water, together with its direct action on the vascular system to induce vasodilatation, culminate in a reduction of blood pressure [7–9]. Further beneficial effects accrue from its local action within the heart where it exerts antifibrotic and antihypertrophic actions [10,11].
This research was supported by PO1 HL76611 and RO1 HL36634 (JCB), and by T32 HL07111 (GB). JCB also has research support from BioRad.