Heart Failure Reviews

, Volume 15, Issue 4, pp 275–291

Utility of natriuretic peptide testing in the evaluation and management of acute decompensated heart failure

  • Jun R. Chiong
  • Geoffrey T. Jao
  • Kirkwood F. AdamsJr.


The B-type natriuretic peptide (BNP) and the amino-terminal fragment of proBNP (NT-proBNP) are increased in heart failure in proportion to severity of symptoms, degree of left ventricular dysfunction, and elevation of cardiac filling pressures. These natriuretic peptides (NPs) are increasingly used for diagnostic and prognostic purposes in acute heart failure. While NP levels on admission provide independent prognostic information, serial determinations during hospitalization and at discharge better reflect adequacy of treatment and prognosis. The addition of BNP and NT-proBNP to usual clinical decision making enhances detection of high-risk patients who need aggressive follow-up and adjustment of treatment.


Natriuretic peptides Acute heart failure Prognosis 


  1. 1.
    Adams KF, Lindenfeld J, Arnold JMO, Baker DW, Barnard DH, Baughman KL, Boehmer JP, Deedwania P, Dunbar SB, Elkayam U, Gheorghiade M, Howlett JG, Konstam MA, Kronenberg MW, Massie BM, Mehra MR, Miller AB, Moser DK, Patterson JH, Rodeheffer RJ, Sackner-Bernstein J, Silver MA, Starling RC, Stevenson LW, Wagoner LE (2006) Executive summary: HFSA 2006 comprehensive heart failure practice guideline. J Card Fail 12:10–38. doi:10.1016/j.cardfail.2005.12.001 CrossRefGoogle Scholar
  2. 2.
    Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B (2005) ACC/AHA 2005 Guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American college of cardiology/American heart association task force on practice guidelines. Circulation 112:e154–e235. doi:10.1161/CIRCULATIONAHA.105.167586 CrossRefPubMedGoogle Scholar
  3. 3.
    Centers for Medicare and Medicaid Services (2008) www.cms.hhs.gov/chartseries/. Accessed 14 Nov 2008
  4. 4.
    Curtis LH, Whellan DJ, Hammill BG, Hernandez AF, Anstrom KJ, Shea AM, Schulman KA (2008) Incidence and prevalence of HF in elderly persons, 1994–2003. Arch Intern Med 168:418–424. doi:10.1001/archinternmed.2007.80 CrossRefPubMedGoogle Scholar
  5. 5.
    Adams KF, Fonarow GC, Emerman CL, LeJemtel TH, Costanzo MR, Abraham WT, Berkowitz RL, Galvao M, Horton DP (2005) Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design, and preliminary observations from the first 100, 000 cases in the acute decompensated heart failure national registry (ADHERE). Am Heart J 149:209–216. doi:10.1016/j.ahj.2004.08.005 CrossRefPubMedGoogle Scholar
  6. 6.
    Rosamond W, Flegal K, Friday G, Furie K, Go A, Greenlund K, Haase N, Ho M, Howard V, Kissela B, Kittner S, Lloyd-Jones D, McDermott M, Meigs J, Moy C, Nichol G, O’Donnell CJ, Roger V, Rumsfeld J, Sorlie P, Steinberger J, Thom T, Wasserthiel-Smoller S, Hong Y, American Heart Association Statistics Committee Stroke Statistics Subcommittee (2007) Heart disease and stroke statistics–2007 update: a report from the American heart association statistics committee and stroke statistics subcommittee. Circulation 115:e69–e171. doi:10.1161/CIRCULATIONAHA.106.179918 CrossRefPubMedGoogle Scholar
  7. 7.
    Lee DS, Austin PC, Rouleau JL, Liu PP, Naimark D, Tu JV (2003) Predicting mortality among patients hospitalized for heart failure: derivation and validation of a clinical model. J Am Med Assoc 290:2581–2587. doi:10.1001/jama.290.19.2581 CrossRefGoogle Scholar
  8. 8.
    Gheorghiade M, Zannad F, Sopko G, Klein L, Piña IL, Konstam MA, Massie BM, Roland E, Targum S, Collins SP, Filippatos G, Tavazzi L, International Working Group on Acute Heart Failure Syndromes (2005) Acute heart failure syndromes: current state and framework for future research. Circulation 112:3958–3968. doi:10.1161/CIRCULATIONAHA.105.590091 CrossRefPubMedGoogle Scholar
  9. 9.
    McKee PA, Castelli WP, McNamara PM, Kannel WB (1971) The natural history of congestive heart failure: the Framingham study. N Engl J Med 285:1441–1446PubMedGoogle Scholar
  10. 10.
    Schellenbaum GD, Rea TD, Heckbert SR, Smith NL, Lumley T, Roger VL, Kitzman DW, Taylor HA, Levy D, Psaty BM (2004) Survival associated with two sets of diagnostic criteria for congestive heart failure. Am J Epidemiol 160:628–635. doi:10.1093/aje/kwh268 CrossRefPubMedGoogle Scholar
  11. 11.
    Gackowski A, Isnard R, Golmard JL, Pousset F, Carayon A, Montalescot G, Hulot JS, Thomas D, Piwowarska W, Komajda M (2004) Comparison of echocardiography and plasma B-type natriuretic peptide for monitoring the response to treatment in acute heart failure. Eur Heart J 25:1788–1796. doi:10.1016/j.ehj.2004.07.038 CrossRefPubMedGoogle Scholar
  12. 12.
    Morrison LK, Harrison A, Krishnaswamy P, Kazanegra R, Clopton P, Maisel A (2002) Utility of a rapid B-natriuretic peptide assay in differentiating congestive heart failure from lung disease in patients presenting with dyspnea. J Am Coll Cardiol 39:202–209. doi:10.1016/S0735-1097(01)01744-2 CrossRefPubMedGoogle Scholar
  13. 13.
    Maisel A, Hollander J, Guss D, McCullough P, Nowak R, Green G, Saltzberg M, Ellison SR, Bhalla MA, Bhalla V, Clopton P, Jesse R, Rapid Emergency Department Heart Failure Outpatient Trial investigators (2004) Primary results of the rapid emergency department heart failure outpatient trial (REDHOT). A multicenter study of B-type natriuretic peptide levels, emergency department decision making, and outcomes in patients presenting with shortness of breath. J Am Coll Cardiol 44:1328–1333. doi:10.1016/j.jacc.2004.06.015 CrossRefPubMedGoogle Scholar
  14. 14.
    Mueller C, Laule-Kilian K, Frana B, Rodriguez D, Scholer A, Schindler C, Perruchoud AP (2006) Use of B-type natriuretic peptide in the management of acute dyspnea in patients with pulmonary disease. Am Heart J 151:471–477. doi:10.1016/j.ahj.2005.03.036 CrossRefPubMedGoogle Scholar
  15. 15.
    Kosowsky JM, Weiner C, Aronson AA, Morrissey JH (2006) Impact of point-of-care B-type natriuretic peptide (BNP) measurement on medical decision-making for older emergency department patients with dyspnea. J Emerg Med 31:147–150. doi:10.1016/j.jemermed.2005.10.001 CrossRefPubMedGoogle Scholar
  16. 16.
    McCullough PA, Nowak RM, McCord J, Hollander JE, Herrmann HC, Steg PG, Duc P, Westheim A, Omland T, Knudsen CW, Storrow AB, Abraham WT, Lamba S, Wu AH, Perez A, Clopton P, Krishnaswamy P, Kazanegra R, Maisel AS (2002) B-type natriuretic peptide and clinical judgment in emergency diagnosis of heart failure: analysis of breathing not properly (BNP) multinational study. Circulation 106:416–422. doi:10.1161/01.CIR.0000025242.79963.4C CrossRefPubMedGoogle Scholar
  17. 17.
    Maisel AS, Krishnaswamy P, Nowak RM, McCord J, Hollander JE, Duc P, Omland T, Storrow AB, Abraham WT, Wu AH, Clopton P, Steg PG, Westheim A, Knudsen CW, Perez A, Kazanegra R, Herrmann HC, McCullough PA, Breathing Not Properly Multinational Study Investigators (2002) Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med 347:161–167. doi:10.1056/NEJMoa020233 CrossRefPubMedGoogle Scholar
  18. 18.
    Mueller C, Scholer A, Laule-Kilian K, Martina B, Schindler C, Buser P, Pfisterer M, Perruchoud AP (2004) Use of B-type natriuretic peptide in the evaluation and management of acute dyspnea. N Engl J Med 350:647–654. doi:10.1056/NEJMoa031681 CrossRefPubMedGoogle Scholar
  19. 19.
    Januzzi JL Jr, Camargo CA, Anwaruddin S, Baggish AL, Chen AA, Krauser DG, Tung R, Cameron R, Nagurney JT, Chae CU, Lloyd-Jones DM, Brown DF, Foran-Melanson S, Sluss PM, Lee-Lewandrowski E, Lewandrowski KB (2005) The N-terminal Pro-BNP investigation of dyspnea in the emergency department (PRIDE) study. Am J Cardiol 95:948–954. doi:10.1016/j.amjcard.2004.12.032 CrossRefPubMedGoogle Scholar
  20. 20.
    Januzzi JL, van Kimmenade R, Lainchbury J, Bayes-Genis A, Ordonez-Llanos J, Santalo-Bel M, Pinto YM, Richards M (2006) 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. Eur Heart J 27:330–337. doi:10.1093/eurheartj/ehi631 CrossRefPubMedGoogle Scholar
  21. 21.
    Moe GW, Howlett J, Januzzi JL, Zowall H, Canadian Multicenter Improved Management of Patients with Congestive Heart Failure (IMPROVE-CHF) Study Investigators (2007) N-terminal pro-B-type natriuretic peptide testing improves the management of patients with suspected acute heart failure: primary results of the Canadian prospective randomized multicenter IMPROVE-CHF study. Circulation 115:3103–3110. doi:10.1161/CIRCULATIONAHA.106.666255 CrossRefPubMedGoogle Scholar
  22. 22.
    Clerico A, Iervasi G, Del Chicca MG, Emdin M, Maffei S, Nannipieri M, Sabatino L, Forini F, Manfredi C, Donato L (1998) Circulating levels of cardiac natriuretic peptides (ANP and BNP) measured by highly sensitive and specific immunoradiometric assays in normal subjects and in patients with different degrees of heart failure. J Endocrinol Invest 21:170–179PubMedGoogle Scholar
  23. 23.
    Dao Q, Krishnaswamy P, Kazanegra R, Harrison A, Amirnovin R, Lenert L, Clopton P, Alberto J, Hlavin P, Maisel AS (2001) Utility of B-type natriuretic peptide in the diagnosis of congestive heart failure in an urgent-care setting. J Am Coll Cardiol 37:379–385. doi:10.1016/S0735-1097(00)01156-6 CrossRefPubMedGoogle Scholar
  24. 24.
    Cheng V, Kazanagra R, Garcia A, Lenert L, Krishnaswamy P, Gardetto N, Clopton P, Maisel A (2001) A rapid bedside test for B-type peptide predicts treatment outcomes in patients admitted for decompensated heart failure: a pilot study. J Am Coll Cardiol 37:386–391. doi:10.1016/S0735-1097(00)01157-8 CrossRefPubMedGoogle Scholar
  25. 25.
    Harrison A, Morrison LK, Krishnaswamy P, Kazanegra R, Clopton P, Dao Q, Hlavin P, Maisel AS (2002) B-type natriuretic peptide predicts future cardiac events in patients presenting to the emergency department with dyspnea. Ann Emerg Med 39:131–138. doi:10.1067/mem.2002.121483 CrossRefPubMedGoogle Scholar
  26. 26.
    Maisel AS, McCord J, Nowak RM, Hollander JE, Wu AH, Duc P, Omland T, Storrow AB, Krishnaswamy P, Abraham WT, Clopton P, Steg G, Aumont MC, Westheim A, Knudsen CW, Perez A, Kamin R, Kazanegra R, Herrmann HC, McCullough PA, Breathing Not Properly Multinational Study Investigators (2003) Bedside B-type natriuretic peptide in the emergency diagnosis of heart failure with reduced or preserved ejection fraction. Results from the breathing not properly multinational study. J Am Coll Cardiol 41:2010i–2017i. doi:10.1016/S0735-1097(03)00405-4 CrossRefGoogle Scholar
  27. 27.
    Baggish AL, Siebert U, Lainchbury JG, Cameron R, Anwaruddin S, Chen A, Krauser DG, Tung R, Brown DF, Richards AM, Januzzi JL Jr (2006) A validated clinical and biochemical score for the diagnosis of acute heart failure: the ProBNP Investigation of dyspnea in the emergency department (PRIDE) acute heart failure score. Am Heart J 151:48–54. doi:10.1016/j.ahj.2005.02.031 CrossRefPubMedGoogle Scholar
  28. 28.
    Baggish AL, Cameron R, Anwaruddin S, Chen AA, Krauser DG, Tung R, Januzzi JL (2004) A clinical and biochemical critical pathway for the evaluation of patients with suspected acute congestive heart failure: the ProBNP investigation of dyspnea in the emergency department (PRIDE) algorithm. Crit Pathw Cardiol 3:171–176PubMedGoogle Scholar
  29. 29.
    Pieralli F, Olivotto I, Vanni S, Conti A, Camaiti A, Targioni G, Grifoni S, Berni G (2006) Usefulness of bedside testing for brain natriuretic peptide to identify right ventricular dysfunction and outcome in normotensive patients with acute pulmonary embolism. Am J Cardiol 97:1386–1390. doi:10.1016/j.amjcard.2005.11.075 CrossRefPubMedGoogle Scholar
  30. 30.
    Cavallazzi R, Nair A, Vasu T, Marik PE (2008) Natriuretic peptides in acute pulmonary embolism: a systematic review. Intensive Care Med 34:2147–2156. doi:10.1007/s00134-008-1214-5 CrossRefPubMedGoogle Scholar
  31. 31.
    Bruch C, Fischer C, Sindermann J, Stypmann J, Breithardt G, Gradaus R (2008) Comparison of the prognostic usefulness of N-terminal pro-brain natriuretic peptide in patients with heart failure with versus without chronic kidney disease. Am J Cardiol 102:469–474. doi:10.1016/j.amjcard.2008.03.082 CrossRefPubMedGoogle Scholar
  32. 32.
    DeFilippi C, van Kimmenade RR, Pinto YM (2008) Amino-terminal pro-B-type natriuretic peptide testing in renal disease. Am J Cardiol 101:82–88. doi:10.1016/j.amjcard.2007.11.029 CrossRefPubMedGoogle Scholar
  33. 33.
    Bayes-Genis A, Lloyd-Jones DM, Van Kimmenade R, Lainchbury JG, Richards AM, Ordoñez-Llanos AM, Santaló M, Pinto YM, Januzzi JL (2007) The effect of body-mass index on the diagnostic and prognostic utility of plasma NT-proBNP in patients with acute dyspnea: results from the international collaborative of NT-proBNP (ICON) study. Arch Intern Med 167:400–407. doi:10.1001/archinte.167.4.400 CrossRefPubMedGoogle Scholar
  34. 34.
    Pirracchio R, Deye N, Lukaszewicz AC, Mebazaa A, Cholley B, Matéo J, Mégarbane B, Launay JM, Peynet J, Baud F, Payen D (2008) Impaired plasma B-type natriuretic peptide clearance in human septic shock. Crit Care Med 36:2542–2546. doi:10.1097/CCM.0b013e318183f067 CrossRefPubMedGoogle Scholar
  35. 35.
    Redfield MM, Rodeheffer RJ, Jacobsen SJ, Mahoney DW, Bailey KR, Burnett JC Jr (2002) Plasma brain natriuretic peptide concentration: impact of age and gender. J Am Coll Cardiol 40:976–982. doi:10.1016/S0735-1097(02)02059-4 CrossRefPubMedGoogle Scholar
  36. 36.
    Costello-Boerrigter LC, Boerrigter G, Redfield MM, Rodeheffer RJ, Urban LH, Mahoney DW, Jacobsen SJ, Heublein DM, Burnett JC Jr (2006) Amino-terminal pro-B-type natriuretic peptide and B-type natriuretic peptide in the general community: determinants and detection of left ventricular dysfunction. J Am Coll Cardiol 47:345–353. doi:10.1016/j.jacc.2005.09.025 CrossRefPubMedGoogle Scholar
  37. 37.
    Redfield MM, Jacobsen SJ, Borlaug BA, Rodeheffer RJ, Kass DA (2005) Age- and gender-related ventricular-vascular stiffening: a community-based study. Circulation 112:2254–2262. doi:10.1161/CIRCULATIONAHA.105.541078 CrossRefPubMedGoogle Scholar
  38. 38.
    McCullough PA, Duc P, Omland T, McCord J, Nowak RM, Hollander JE, Herrmann HC, Steg PG, Westheim A, Knudsen CW, Storrow AB, Abraham WT, Lamba S, Wu AH, Perez A, Clopton P, Krishnaswamy P, Kazanegra R, Maisel AS (2003) B-type natriuretic peptide and renal function in the diagnosis of heart failure: an analysis from the breathing not properly multinational study. Am J Kidney Dis 41:571–579. doi:10.1053/ajkd.2003.50118 CrossRefPubMedGoogle Scholar
  39. 39.
    Frankenstein L, Remppis A, Nelles M, Schaelling B, Schellberg D, Katus H, Zugck C (2008) Relation of N-terminal pro-brain natriuretic peptide levels and their prognostic power in chronic stable heart failure to obesity status. Eur Heart J 29:2634–2640. doi:10.1093/eurheartj/ehn388 CrossRefPubMedGoogle Scholar
  40. 40.
    Maisel AS, Clopton P, Krishnaswamy P, Nowak RM, McCord J, Hollander JE, Duc P, Omland T, Storrow AB, Abraham WT, Wu AH, Steg G, Westheim A, Knudsen CW, Perez A, Kazanegra R, Bhalla V, Herrmann HC, Aumont MC, McCullough PA, BNP Multinational Study Investigators (2004) Impact of age, race, and sex on the ability of B-type natriuretic peptide to aid in the emergency diagnosis of heart failure: results from the breathing not properly (BNP) multinational study. Am Heart J 147:1078–1084. doi:10.1016/j.ahj.2004.01.013 CrossRefPubMedGoogle Scholar
  41. 41.
    Raymond I, Groenning BA, Hildebrandt PR, Nilsson JC, Baumann M, Trawinski J, Pedersen F (2003) The influence of age, sex and other variables on the plasma level of N-terminal pro brain natriuretic peptide in a large sample of the general population. Heart 89:745–751. doi:10.1136/heart.89.7.745 CrossRefPubMedGoogle Scholar
  42. 42.
    Ray P, Arthaud M, Lefort Y, Birolleau S, Beigelman C, Riou B (2004) Usefulness of B-type natriuretic peptide in elderly patients with acute dyspnea. Intensive Care Med 30:2230–2236. doi:10.1007/s00134-004-2469-0 CrossRefPubMedGoogle Scholar
  43. 43.
    Chenevier-Gobeaux C, Delerme S, Allo JC, Arthaud M, Claessens YE, Ekindjian OG, Riou B, Ray P (2008) B-type natriuretic peptides for the diagnosis of congestive heart failure in dyspneic oldest-old patients. Clin Biochem 41:1049–1054. doi:10.1016/j.clinbiochem.2008.05.012 CrossRefPubMedGoogle Scholar
  44. 44.
    Christ M, Laule-Kilian K, Hochholzer W, Klima T, Breidthardt T, Perruchoud AP, Mueller C (2006) Gender-specific risk stratification with B-type natriuretic peptide levels in patients with acute dyspnea: insights from the B-type natriuretic peptide for acute shortness of breath evaluation study. J Am Coll Cardiol 48:1808–1812. doi:10.1016/j.jacc.2006.07.037 CrossRefPubMedGoogle Scholar
  45. 45.
    Daniels LB, Clopton P, Bhalla V, Krishnaswamy P, Nowak RM, McCord J, Hollander JE, Duc P, Omland T, Storrow AB, Abraham WT, Wu AH, Steg PG, Westheim A, Knudsen CW, Perez A, Kazanegra R, Herrmann HC, McCullough PA, Maisel AS (2006) How obesity affects the cut-points for B-type natriuretic peptide in the diagnosis of acute heart failure. Results from the breathing not properly multinational study. Am Heart J 151:999–1005. doi:10.1016/j.ahj.2005.10.011 CrossRefPubMedGoogle Scholar
  46. 46.
    Taylor JA, Christenson RH, Rao K, Jorge M, Gottlieb SS (2006) B-type natriuretic peptide and N-terminal pro B-type natriuretic peptide are depressed in obesity despite higher left ventricular end diastolic pressures. Am Heart J 152:1071–1076. doi:10.1016/j.ahj.2006.07.010 CrossRefPubMedGoogle Scholar
  47. 47.
    Krauser DG, Lloyd-Jones DM, Chae CU, Cameron R, Anwaruddin S, Baggish AL, Chen A, Tung R, Januzzi JL Jr (2005) Effect of body mass index on natriuretic peptide levels in patients with acute congestive heart failure: a ProBNP investigation of dyspnea in the emergency department (PRIDE) substudy. Am Heart J 149:744–750. doi:10.1016/j.ahj.2004.07.010 CrossRefPubMedGoogle Scholar
  48. 48.
    Bayes-Genis A, DeFilippi C, Januzzi JL Jr (2008) Understanding amino-terminal pro-B-type natriuretic peptide in obesity. Am J Cardiol 101:89–94. doi:10.1016/j.amjcard.2007.11.030 CrossRefPubMedGoogle Scholar
  49. 49.
    Hermann-Arnhof KM, Hanusch-Enserer U, Kaestenbauer T, Publig T, Dunky A, Rosen HR, Prager R, Köller U (2005) N-terminal pro-B-type natriuretic peptide as an indicator of possible cardiovascular disease in severely obese individuals: comparison with patients in different stages of heart failure. Clin Chem 51:138–143. doi:10.1373/clinchem.2004.035923 CrossRefPubMedGoogle Scholar
  50. 50.
    Magnusson M, Melander O, Israelsson B, Grubb A, Groop L, Jovinge S (2004) Elevated plasma levels of Nt-proBNP in patients with type 2 diabetes without overt cardiovascular disease. Diabetes Care 27:1929–1935. doi:10.2337/diacare.27.8.1929 CrossRefPubMedGoogle Scholar
  51. 51.
    O’Donoghue M, Kenney P, Oestreicher E, Anwaruddin S, Baggish AL, Krauser DG, Chen A, Tung R, Cameron R, Januzzi JL Jr (2007) Usefulness of aminoterminal pro-brain natriuretic peptide testing for the diagnostic and prognostic evaluation of dyspneic patients with diabetes mellitus seen in the emergency department (from the PRIDE Study). Am J Cardiol 100:1336–1340. doi:10.1016/j.amjcard.2007.06.020 CrossRefPubMedGoogle Scholar
  52. 52.
    Wu AH, Omland T, Duc P, McCord J, Nowak RM, Hollander JE, Herrmann HC, Steg PG, Wold Knudsen C, Storrow AB, Abraham WT, Perez A, Kamin R, Clopton P, Maisel AS, McCullough PA, Breathing Not Properly Multinational Study Investigators (2004) The effect of diabetes on B-type natriuretic peptide concentrations in patients with acute dyspnea: an analysis from the breathing not properly multinational study. Diabetes Care 27:2398–2404. doi:10.2337/diacare.27.10.2398 CrossRefPubMedGoogle Scholar
  53. 53.
    Bargnoux AS, Klouche K, Fareh J, Barazer I, Villard-Saussine S, Dupuy AM, Leray-Moragues H, Giuliani I, Canaud B, Cristol JP (2008) Prohormone brain natriuretic peptide (proBNP), BNP and N-terminal-proBNP circulating levels in chronic hemodialysis patients. Correlation with ventricular function, fluid removal and effect of hemodiafiltration. Clin Chem Lab Med 46:1019–1024. doi:10.1515/CCLM.2008.192 CrossRefPubMedGoogle Scholar
  54. 54.
    McCullough PA, Sandberg KR (2003) B-type natriuretic peptide and renal disease. Heart Fail Rev 8:355–358. doi:10.1023/A:1026195332025 CrossRefPubMedGoogle Scholar
  55. 55.
    Kroll MH, Srisawasdi P (2007) The clearance of BNP modeled using the NT-proBNP-BNP relationship. Biosystems 88:147–155. doi:10.1016/j.biosystems.2006.05.004 CrossRefPubMedGoogle Scholar
  56. 56.
    Racek J, Králová H, Trefil L, Rajdl D, Eiselt J (2006) Brain natriuretic peptide and N-terminal proBNP in chronic haemodialysis patients. Nephron Clin Pract 103:c162–c172. doi:10.1159/000092914 CrossRefPubMedGoogle Scholar
  57. 57.
    Stewart GA, Gansevoort RT, Mark PB, Rooney E, McDonagh TA, Dargie HJ, Stuart R, Rodger C, Jardine AG (2005) Electrocardiographic abnormalities and uremic cardiomyopathy. Kidney Int 67:217–226. doi:10.1111/j.1523-1755.2005.00072.x CrossRefPubMedGoogle Scholar
  58. 58.
    Mark PB, Stewart GA, Gansevoort RT, Petrie CJ, McDonagh TA, Dargie HJ, Rodger RS, Jardine AG (2005) Diagnostic potential of circulating natriuretic peptides in chronic kidney disease. Nephrol Dial Transplant 21:402–410. doi:10.1093/ndt/gfi187 CrossRefPubMedGoogle Scholar
  59. 59.
    Sun L, Sun Y, Zhao X, Xu C, Chen D, Li L, Ma Y, Rong S, Mei C (2008) Predictive role of BNP and NT-proBNP in hemodialysis patients. Nephron Clin Pract 110:c178–c184. doi:10.1159/000167270 CrossRefPubMedGoogle Scholar
  60. 60.
    deFilippi CR, Seliger SL, Maynard S, Christenson RH (2007) Impact of renal disease on natriuretic peptide testing for diagnosing decompensated heart failure and predicting mortality. Clin Chem 53:1511–1519. doi:10.1373/clinchem.2006.084533 CrossRefPubMedGoogle Scholar
  61. 61.
    van Kimmenade RR, Januzzi JL Jr, Baggish AL, Lainchbury JG, Bayes-Genis A, Richards AM, Pinto YM (2006) Amino-terminal pro-brain natriuretic peptide, renal function, and outcomes in acute heart failure: redefining the cardiorenal interaction? J Am Coll Cardiol 48:1621–1627. doi:10.1016/j.jacc.2006.06.056 CrossRefPubMedGoogle Scholar
  62. 62.
    Suntharalingam J, Goldsmith K, Toshner M, Doughty N, Sheares KK, Hughes R, Jenkins D, Pepke-Zaba J (2007) Role of NT-proBNP and 6MWD in chronic thromboembolic pulmonary hypertension. Respir Med 101:2254–2262. doi:10.1016/j.rmed.2007.06.027 CrossRefPubMedGoogle Scholar
  63. 63.
    Reesink HJ, Tulevski II, Marcus JT, Boomsma F, Kloek JJ, Vonk Noordegraaf A, Bresser P (2007) Brain natriuretic peptide as noninvasive marker of the severity of right ventricular dysfunction in chronic thromboembolic pulmonary hypertension. Ann Thorac Surg 84:537–543. doi:10.1016/j.athoracsur.2007.04.006 CrossRefPubMedGoogle Scholar
  64. 64.
    Ueda S, Nishio K, Akai Y, Fukushima H, Ueyama T, Kawai Y, Masui K, Yoshioka A, Okuchi K (2006) Prognostic value of increased plasma levels of brain natriuretic peptide in patients with septic shock. Shock 26:134–139. doi:10.1097/01.shk.0000226266.99960.d0 CrossRefPubMedGoogle Scholar
  65. 65.
    Rudiger A, Gasser S, Fischler M, Hornemann T, von Eckardstein A, Maggiorini M (2006) Comparable increase of B-type natriuretic peptide and amino-terminal pro-B-type natriuretic peptide levels in patients with severe sepsis, septic shock, and acute heart failure. Crit Care Med 34:2140–2144. doi:10.1097/01.CCM.0000229144.97624.90 CrossRefPubMedGoogle Scholar
  66. 66.
    Kandil E, Burack J, Sawas A, Bibawy H, Schwartzman A, Zenilman ME, Bluth MH (2008) B-type natriuretic peptide: a biomarker for the diagnosis and risk stratification of patients with septic shock. Arch Surg 143:242–246. doi:10.1001/archsurg.2007.69 CrossRefPubMedGoogle Scholar
  67. 67.
    Vila G, Resl M, Stelzeneder D, Struck J, Maier C, Riedl M, Hülsmann M, Pacher R, Luger A, Clodi M (2008) Plasma NT-proBNP increases in response to LPS administration in healthy men. J Appl Physiol 105:1741–1745. doi:10.1152/japplphysiol.90442.2008 CrossRefPubMedGoogle Scholar
  68. 68.
    Januzzi JL Jr, Sakhuja R, O’donoghue M, Baggish AL, Anwaruddin S, Chae CU, Cameron R, Krauser DG, Tung R, Camargo CA Jr, Lloyd-Jones DM (2006) Utility of amino-terminal pro-brain natriuretic peptide testing for prediction of 1-year mortality in patients with dyspnea treated in the emergency department. Arch Intern Med 166:315–320. doi:10.1001/archinte.166.3.315 CrossRefPubMedGoogle Scholar
  69. 69.
    Omland T (2008) Advances in congestive heart failure management in the intensive care unit: B-type natriuretic peptides in evaluation of acute heart failure. Crit Care Med 36:S17–S27CrossRefPubMedGoogle Scholar
  70. 70.
    Meyer B, Huelsmann M, Wexberg P, Delle Karth G, Berger R, Moertl D, Szekeres T, Pacher R, Heinz G (2007) N-terminal pro-B-type natriuretic peptide is an independent predictor of outcome in an unselected cohort of critically ill patients. Crit Care Med 35:2268–2273. doi:10.1097/01.CCM.0000269405.18646.52 CrossRefPubMedGoogle Scholar
  71. 71.
    Fonarow GC, Abraham WT, Albert NM, Stough WG, Gheorghiade M, Greenberg BH, O’Connor CM, Pieper K, Sun JL, Yancy C, Young JB, OPTIMIZE-HF Investigators Hospitals (2007) Association between performance measures and clinical outcomes for patients hospitalized with heart failure. J Am Med Assoc 297:61–70. doi:10.1001/jama.297.1.61 CrossRefGoogle Scholar
  72. 72.
    Yancy CW, Fonarow GC, ADHERE Scientific Advisory Committee (2004) Quality of care and outcomes in acute decompensated heart failure: the ADHERE registry. Curr Heart Fail Rep 1:121–128. doi:10.1007/s11897-004-0021-8 CrossRefPubMedGoogle Scholar
  73. 73.
    Fonarow GC, Peacock WF, Phillips CO, Givertz MM, Lopatin M, ADHERE Scientific Advisory Committee Investigators (2007) Admission B-type natriuretic peptide levels and in-hospital mortality in acute decompensated heart failure. J Am Coll Cardiol 49:1943–1950. doi:10.1016/j.jacc.2007.02.037 CrossRefPubMedGoogle Scholar
  74. 74.
    Johnson W, Omland T, Hall C, Lucas C, Myking OL, Collins C, Pfeffer M, Rouleau JL, Stevenson LW (2002) Neurohormonal activation rapidly decreases after intravenous therapy with diuretics and vasodilators for class IV heart failure. J Am Coll Cardiol 39:1623–1629. doi:10.1016/S0735-1097(02)01814-4 CrossRefPubMedGoogle Scholar
  75. 75.
    Shah MR, Hasselblad V, Tasissa G, Christenson RH, Binanay C, O’Connor CM, Ohman EM, Stevenson LW, Califf RM (2007) Rapid assay brain natriuretic peptide and troponin I in patients hospitalized with decompensated heart failure (from the evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness trial). Am J Cardiol 100:1427–1433. doi:10.1016/j.amjcard.2007.06.035 CrossRefPubMedGoogle Scholar
  76. 76.
    Valle R, Aspromonte N, Giovinazzo P (2008) B-Type natriuretic peptide-guided treatment for predicting outcome in patients hospitalized in sub-intensive care unit with acute HF. J Card Fail 14:219–224. doi:10.1016/j.cardfail.2007.10.009 CrossRefPubMedGoogle Scholar
  77. 77.
    Hogenhuis J, Voors AA, Jaarsma T, Hillege HL, Hoes AW, van Veldhuisen DJ (2006) Low prevalence of B-type natriuretic peptide levels <100 pg/mL in patients with heart failure at hospital discharge. Am Heart J 151:1012.e1-5Google Scholar
  78. 78.
    Bettencourt P, Azevedo A, Pimenta J, Friões F, Ferreira S, Ferreira A (2004) N-terminal-pro-brain natriuretic peptide predicts outcome after hospital discharge in heart failure patients. Circulation 110:2168–2174. doi:10.1161/01.CIR.0000144310.04433.BE CrossRefPubMedGoogle Scholar
  79. 79.
    Verdiani V, Ognibene A, Rutili MS, Lombardo C, Bacci F, Terreni A, Nozzoli C (2008) NT-proBNP reduction percentage during hospital stay predicts long-term mortality and readmission in heart failure patients. J Cardiovasc Med 9:694–699Google Scholar
  80. 80.
    Cournot M, Mourre F, Castel F, Ferrières J, Destrac S (2008) Optimization of the use of B-type natriuretic peptide levels for risk stratification at discharge in elderly patients with decompensated heart failure. Am Heart J 155:986–991. doi:10.1016/j.ahj.2008.01.011 CrossRefPubMedGoogle Scholar
  81. 81.
    Troughton RW, Frampton CM, Yandle TG, Espiner EA, Nicholls MG, Richards AM (2000) Treatment of heart failure guided by plasma aminoterminal brain natriuretic peptide (N-BNP) concentrations. Lancet 355:1126–1130. doi:10.1016/S0140-6736(00)02060-2 CrossRefPubMedGoogle Scholar
  82. 82.
    O’Hanlon R, O’Shea P, Ledwidge M, O’Loughlin C, Lange S, Conlon C, Phelan D, Cunningham S, McDonald K (2007) The biologic variability of B-type natriuretic peptide and N-terminal pro-B-type natriuretic peptide in stable HF patients. J Card Fail 13:50–55. doi:10.1016/j.cardfail.2006.09.003 CrossRefPubMedGoogle Scholar
  83. 83.
    Wasywich CA, Whalley GA, Walsh HA, Gamble GD, Doughty RN (2008) The relationship between BNP and E/Ea in patients hospitalized with acute heart failure. Int J Cardiol 125:280–282. doi:10.1016/j.ijcard.2007.07.146 CrossRefPubMedGoogle Scholar
  84. 84.
    Verdiani V, Nozzoli C, Bacci F, Cecchin A, Rutili MS, Paladini S, Olivotto I (2005) Pre-discharge B-type natriuretic peptide predicts early recurrence of decompensated heart failure in patients admitted to a general medical unit. Eur J Heart Fail 7:566–571. doi:10.1016/j.ejheart.2004.12.006 CrossRefPubMedGoogle Scholar
  85. 85.
    Feola M, Aspromonte N, Milani L, Bobbio M, Bardellotto S, Barro S, Giovinazzo P, Noventa F, Valle R (2008) Plasma brain natriuretic peptide predicts short-term clinical outcome in heart failure patients with restrictive filling pattern. J Card Fail 14:420–425. doi:10.1016/j.cardfail.2008.01.013 CrossRefPubMedGoogle Scholar
  86. 86.
    O’Brien RJ, Squire IB, Demme B, Davies JE, Ng LL (2003) Pre-discharge, but not admission, levels of NT-proBNP predict adverse prognosis following acute LVF. Eur J Heart Fail 5:499–506. doi:10.1016/S1388-9842(03)00098-9 CrossRefPubMedGoogle Scholar
  87. 87.
    Lindenauer PK, Remus D, Roman S, Rothberg MB, Benjamin EM, Ma A, Bratzler DW (2007) Public reporting and pay for performance in hospital quality improvement. N Engl J Med 356:486–496. doi:10.1056/NEJMsa064964 CrossRefPubMedGoogle Scholar
  88. 88.
    Boyd CM, Darer J, Boult C, Fried LP, Boult L, Wu AW (2005) Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. J Am Med Assoc 294:716–724. doi:10.1001/jama.294.6.716 CrossRefGoogle Scholar
  89. 89.
    Siebert U, Januzzi JL Jr, Beinfeld MT, Cameron R, Gazelle GS (2006) Cost-effectiveness of using N-terminal pro-brain natriuretic peptide to guide the diagnostic assessment and management of dyspneic patients in the emergency department. Am J Cardiol 98:800–805. doi:10.1016/j.amjcard.2006.06.005 CrossRefPubMedGoogle Scholar
  90. 90.
    Breidthardt T, Laule K, Strohmeyer AH, Schindler C, Meier S, Fischer M, Scholer A, Noveanu M, Christ M, Perruchoud AP, Mueller C (2007) Medical and economic long-term effects of B-type natriuretic peptide testing in patients with acute dyspnea. Clin Chem 53:1415–1422. doi:10.1373/clinchem.2006.081448 CrossRefPubMedGoogle Scholar
  91. 91.
    Vanderheyden M, Bartunek, Claeys G, Manoharan G, Beckers JF, Ide L (2006) Head to head comparison of N-terminal pro-B-type natriuretic peptide and B-type natriuretic peptide in patients with/without left ventricular systolic dysfunction. Clin Biochem 39:640–645. doi:10.1016/j.clinbiochem.2006.01.021 CrossRefPubMedGoogle Scholar
  92. 92.
    Mueller C, Laule-Kilian K, Schindler C, Klima T, Frana B, Rodriguez D, Scholer A, Christ M, Perruchoud AP (2006) Cost-effectiveness of B-type natriuretic peptide testing in patients with acute dyspnea. Arch Intern Med 166:1081–1087. doi:10.1001/archinte.166.10.1081 CrossRefPubMedGoogle Scholar
  93. 93.
    Mark DB, Felker GM (2004) B-type natriuretic peptide—a biomarker for all seasons? N Engl J Med 350:718–720. doi:10.1056/NEJMe038233 CrossRefPubMedGoogle Scholar
  94. 94.
    Ewald B, Ewald D, Thakkinstian A, Attia J (2008) Meta-analysis of B type natriuretic peptide and N-terminal pro B natriuretic peptide in the diagnosis of clinical heart failure and population screening for left ventricular systolic dysfunction. Intern Med J 38:101–113. doi:10.1111/j.1445-5994.2007.01454.x CrossRefPubMedGoogle Scholar
  95. 95.
    Doust JA, Pietrzak E, Dobson A, Glasziou P (2005) How well does B-type natriuretic peptide predict death and cardiac events in patients with heart failure: systematic review. BMJ 330:625. doi:10.1136/bmj.330.7492.625 CrossRefPubMedGoogle Scholar
  96. 96.
    Richards AM (2008) Serial measurements of plasma B-type natriuretic peptides: what do they tell us? J Am Coll Cardiol 52:1004–1005. doi:10.1016/j.jacc.2008.06.026 CrossRefPubMedGoogle Scholar
  97. 97.
    Maisel A (2001) B-type natriuretic peptide levels: a potential novel “white count” for congestive heart failure. J Card Fail 7:183–193. doi:10.1054/jcaf.2001.24609 CrossRefPubMedGoogle Scholar
  98. 98.
    Mueller C, Buser P (2002) B-type natriuretic peptide (BNP): can it improve our management of patients with congestive heart failure? Swiss Med Wkly 132:618–622PubMedGoogle Scholar
  99. 99.
    Rehman SU, Januzzi JL (2008) Natriuretic peptide testing in clinical medicine. Cardiol Rev 16:240–249. doi:10.1097/CRD.0b013e3181815333 CrossRefPubMedGoogle Scholar
  100. 100.
    Maisel A (2006) The coming of age of natriuretic peptides: the emperor does have clothes! J Am Coll Cardiol 47:61–64. doi:10.1016/j.jacc.2005.10.011 CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Jun R. Chiong
    • 1
  • Geoffrey T. Jao
    • 2
  • Kirkwood F. AdamsJr.
    • 3
  1. 1.Cardiomyopathy ProgramLoma Linda University Medical CenterLoma LindaUSA
  2. 2.Section of General Internal MedicineWake Forest University Baptist Medical CenterWinston-SalemUSA
  3. 3.Departments of Medicine and RadiologyUniversity of North Carolina Chapel HillChapel HillUSA

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