Skip to main content

Advertisement

SpringerLink
Log in

B-type natriuretic peptide in ischemic heart disease

  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

B-type natriuretic peptide (BNP) and the N-terminal fragment of its prohormone (N-proBNP) are released from the heart in response to increased wall stress. Assays for these peptides are now commercially available, and measurement of BNP and N-proBNP is becoming commonplace in patients with suspected heart failure. BNP and N-proBNP facilitate diagnosis and risk stratification in patients with heart failure, and may help guide response to therapy. This review focuses on the emerging role of BNP and NproBNP measurement in patients with acute coronary syndromes (ACS). Although experimental studies demonstrate rapid BNP release in response to cardiac ischemia, it is unlikely that BNP will be used to diagnose cardiac ischemia, because many other conditions are also associated with modest BNP elevation. In contrast, BNP holds tremendous promise as a prognostic marker in patients with ACS. Studies to date have shown consistently that higher BNP levels are associated with worse clinical outcomes, and that BNP provides unique information to clinical variables, other biomarkers, and left ventricular ejection fraction. Future studies are needed to identify the therapeutic implications of BNP elevation in patients with ACS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Edwards BS, Zimmerman RS, Schwab TR, et al.: Atrial stretch, not pressure, is the principal determinant controlling the acute release of atrial natriuretic factor. Circ Res 1988, 62:191–195.

    PubMed  CAS  Google Scholar 

  2. Yan W, Sheng N, Seto M, et al.: Corin, a mosaic transmembrane serine protease encoded by a novel cDNA from human heart. J Biol Chem 1999, 274:14926–14935.

    Article  PubMed  CAS  Google Scholar 

  3. Hooper JD, Scarman AL, Clarke BE, et al.: Localization of the mosaic transmembrane serine protease corin to heart myocytes. Eur J Biochem 2000, 267:6931–6937.

    Article  PubMed  CAS  Google Scholar 

  4. Potter LR, Hunter T: Guanylyl cyclase-linked natriuretic peptide receptors: structure and regulation. J Biol Chem 2001, 276:6057–6060.

    Article  PubMed  CAS  Google Scholar 

  5. Rademaker MT, Charles CJ, Kosoglou T, et al.: Clearance receptors and endopeptidase: equal role in natriuretic peptide metabolism in heart failure. Am J Physiol 1997, 273:H2372-H2379.

    PubMed  CAS  Google Scholar 

  6. Maisel AS, Koon J, Krishnaswamy P, et al.: Utility of B-natriuretic peptide as a rapid, point-of-care test for screening patients undergoing echocardiography to determine left ventricular dysfunction. Am Heart J 2001, 141:367–374.

    Article  PubMed  CAS  Google Scholar 

  7. Lubien E, DeMaria A, Krishnaswamy P, et al.: Utility of B-natriuretic peptide in detecting diastolic dysfunction: comparison with Doppler velocity recordings. Circulation 2002, 105:595–601.

    Article  PubMed  CAS  Google Scholar 

  8. Yu CM, Sanderson JE, Shum IO, et al.: Diastolic dysfunction and natriuretic peptides in systolic heart failure. Higher ANP and BNP levels are associated with the restrictive filling pattern. Eur Heart J 1996, 17:1694–1702.

    PubMed  CAS  Google Scholar 

  9. Dao Q, Krishnaswamy P, Kazanegra R, et al.: Utility of B-type natriuretic peptide in the diagnosis of congestive heart failure in an urgent-care setting. J Am Coll Cardiol 2001, 37:379–385.

    Article  PubMed  CAS  Google Scholar 

  10. Davis M, Espiner E, Richards G, et al.: Plasma brain natriuretic peptide in assessment of acute dyspnoea. Lancet 1994, 343:440–444.

    Article  PubMed  CAS  Google Scholar 

  11. Cowie MR, Struthers AD, Wood DA, et al.: Value of natriuretic peptides in assessment of patients with possible new heart failure in primary care. Lancet 1997, 350:1349–1353.

    Article  PubMed  CAS  Google Scholar 

  12. Maisel AS, Krishnaswamy P, Nowak RM, et al.: Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med 2002, 347:161–167.

    Article  PubMed  CAS  Google Scholar 

  13. McCullough PA, Nowak RM, McCord J, et al.: B-type natriuretic peptide and clinical judgment in emergency diagnosis of heart failure: analysis from Breathing Not Properly (BNP) Multinational Study. Circulation 2002, 106:416–422.

    Article  PubMed  Google Scholar 

  14. Richards AM, Doughty R, Nicholls MG, et al.: Neurohumoral prediction of benefit from carvedilol in ischemic left ventricular dysfunction. Australia-New Zealand Heart Failure Group. Circulation 1999, 99:786–792.

    PubMed  CAS  Google Scholar 

  15. Maeda K, Tsutamoto T, Wada A, et al.: High levels of plasma brain natriuretic peptide and interleukin-6 after optimized treatment for heart failure are independent risk factors for morbidity and mortality in patients with congestive heart failure. J Am Coll Cardiol 2000, 36:1587–1593.

    Article  PubMed  CAS  Google Scholar 

  16. Stanek B, Frey B, Hulsmann M, et al.: Prognostic evaluation of neurohumoral plasma levels before and during beta-blocker therapy in advanced left ventricular dysfunction. J Am Coll Cardiol 2001, 38:436–442.

    Article  PubMed  CAS  Google Scholar 

  17. Berger R, Huelsman M, Strecker K, et al.: B-type natriuretic peptide predicts sudden death in patients with chronic heart failure. Circulation 2002, 105:2392–2397.

    Article  PubMed  Google Scholar 

  18. Isnard R, Pousset F, Trochu J, et al.: Prognostic value of neurohormonal activation and cardiopulmonary exercise testing in patients with chronic heart failure. Am J Cardiol 2000, 86:417–421.

    Article  PubMed  CAS  Google Scholar 

  19. Richards AM, Doughty R, Nicholls MG, et al.: Plasma N-terminal pro-brain natriuretic peptide and adrenomedullin: prognostic utility and prediction of benefit from carvedilol in chronic ischemic left ventricular dysfunction. Australia-New Zealand Heart Failure Group. J Am Coll Cardiol 2001, 37:1781–1787.

    Article  PubMed  CAS  Google Scholar 

  20. Harrison A, Morrison LK, Krishnaswamy P, et al.: B-type natriuretic peptide predicts future cardiac events in patients presenting to the emergency department with dyspnea. Ann Emerg Med 2002, 39:131–138.

    Article  PubMed  Google Scholar 

  21. Intravenous nesiritide vs nitroglycerin for treatment of decompensated congestive heart failure: a randomized controlled trial. JAMA 2002, 287:1531–1540.

  22. Hobbs RE, Mills RM, Young JB: An update on nesiritide for treatment of decompensated heart failure. Expert Opin Investig Drugs 2001, 10:935–942.

    Article  PubMed  CAS  Google Scholar 

  23. Colucci WS: Nesiritide for the treatment of decompensated heart failure. J Cardiac Fail 2001, 7:92–100.

    Article  CAS  Google Scholar 

  24. Colucci WS, Elkayam U, Horton DP, et al.: Intravenous nesiritide, a natriuretic peptide, in the treatment of decompensated congestive heart failure. Nesiritide Study Group. N Engl J Med 2000, 343:246–253.

    Article  PubMed  CAS  Google Scholar 

  25. Hama N, Itoh H, Shirakami G, et al.: Rapid ventricular induction of brain natriuretic peptide gene expression in experimental acute myocardial infarction. Circulation 1995, 92:1558–1564.

    PubMed  CAS  Google Scholar 

  26. Toth M, Vuorinen KH, Vuolteenaho O, et al.: Hypoxia stimulates release of ANP and BNP from perfused rat ventricular myocardium. Am J Physiol 1994, 266:H1572-H1580.

    PubMed  CAS  Google Scholar 

  27. Marumoto K, Hamada M, Hiwada K: Increased secretion of atrial and brain natriuretic peptides during acute myocardial ischaemia induced by dynamic exercise in patients with angina pectoris. Clin Sci 1995, 88:551–556.

    PubMed  CAS  Google Scholar 

  28. Tateishi J, Masutani M, Ohyanagi M, Iwasaki T: Transient increase in plasma brain (B-type) natriuretic peptide after percutaneous transluminal coronary angioplasty. Clin Cardiol 2000, 23:776–780.

    PubMed  CAS  Google Scholar 

  29. Morita E, Yasue H, Yoshimura M, et al.: Increased plasma levels of brain natriuretic peptide in patients with acute myocardial infarction. Circulation 1993, 88:82–91.

    PubMed  CAS  Google Scholar 

  30. Arakawa N, Nakamura M, Aoki H, Hiramori K: Relationship between plasma level of brain natriuretic peptide and myocardial infarct size. Cardiology 1994, 85:334–340.

    Article  PubMed  CAS  Google Scholar 

  31. Talwar S, Squire IB, Downie PF, et al.: Profile of plasma N-terminal proBNP following acute myocardial infarction. Correlation with left ventricular systolic dysfunction. Eur Heart J 2000, 21:1514–1521.

    Article  PubMed  CAS  Google Scholar 

  32. Nagaya N, Nishikimi T, Goto Y, et al.: Plasma brain natriuretic peptide is a biochemical marker for the prediction of progressive ventricular remodeling after acute myocardial infarction. Am Heart J 1998, 135:21–28.

    Article  PubMed  CAS  Google Scholar 

  33. Omland T, Aakvaag A, Bonarjee VV, et al.: Plasma brain natriuretic peptide as an indicator of left ventricular systolic function and long-term survival after acute myocardial infarction. Comparison with plasma atrial natriuretic peptide and N-terminal proatrial natriuretic peptide. Circulation 1996, 93:1963–1969.

    PubMed  CAS  Google Scholar 

  34. de Lemos JA, Morrow DA, Bentley JH, et al.: The prognostic value of B-type natriuretic peptide in patients with acute coronary syndromes. N Engl J Med 2001, 345:1014–1021. In 2525 patients with ST elevation MI, NSTEMI, and unstable angina, a single measurement of BNP obtained in the first few days after the onset of ischemic symptoms provided prognostic information that was greater than, and independent of, other commonly measured variables.

    Article  PubMed  Google Scholar 

  35. Omland T, de Lemos JA, Morrow DA, et al.: Prognostic value of N-terminal pro-atrial and pro-brain natriuretic peptide in patients with acute coronary syndromes. Am J Cardiol 2002, 89:463–465. In patients admitted with non-ST-elevation ACS, N-proBNP levels were associated with early death but not with nonfatal recurrent AMI. This case-control study suggest that N-proBNP levels provide additional prognostic information to conventional biomarkers, including troponin I.

    Article  PubMed  CAS  Google Scholar 

  36. Omland T, Persson A, Ng L, et al.: N-terminal pro-B-type natriuretic peptide and long-term mortality in acute coronary syndromes. Circulation 2002, 106:2913–2918. In this study, N-proBNP levels were associated with increased mortality after accounting for LVEF, addressing a limitation of prior studies.

    Article  PubMed  CAS  Google Scholar 

  37. Jernberg T, Stridsberg M, Venge P, Lindahl B: N-terminal pro brain natriuretic peptide on admission for early risk stratification of patients with chest pain and no ST-segment elevation. J Am Coll Cardiol 2002, 40:437–445. Measurement of N-proBNP at the time of admission in patients with chest pain and a nondiagnostic ECG provides useful information for early risk stratification, extending the population of patients who may benefit from N-proBNP testing.

    Article  PubMed  CAS  Google Scholar 

  38. Morrow DA, de Lemos JA, Sabatine MS: Evaluation of B-type natriuretic peptide for risk assessment in UA/NSTEMI: BNP and prognosis in TACTICS-TIMI 18. J Am Coll Cardiol 2003, 41:1264–1272. Among 1676 patients with non-ST-elevation ACS, elevated BNP levels at the time of admission were associated with a higher risk of death and heart failure, but not with recurrent acute MI. However, early invasive treatment was not of greater benefit among patients with elevated BNP.

    Article  PubMed  CAS  Google Scholar 

  39. Cannon CP, Weintraub WS, Demopoulos LA, et al.: Comparison of early invasive and conservative strategies in patients with unstable coronary syndromes treated with the glycoprotein IIb/IIIa inhibitor tirofiban. N Engl Med 2001, 344:1879–1887.

    Article  CAS  Google Scholar 

  40. Morrow DA, Cannon CP, Rifai N, et al.: Ability of minor elevations of troponins I and T to predict benefit from an early invasive strategy in patients with unstable angina and non-ST elevation myocardial infarction: results from a randomized trial. JAMA 2001, 286:2405–2412.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Cardiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, HA 9.133, 75390-9047, Dallas, TX, USA

    Rajat Deo MD & James A. de Lemos MD

Authors
  1. Rajat Deo MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. James A. de Lemos MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Deo, R., de Lemos, J.A. B-type natriuretic peptide in ischemic heart disease. Curr Cardiol Rep 5, 271–277 (2003). https://doi.org/10.1007/s11886-003-0062-8

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11886-003-0062-8

Keywords

Search

Navigation