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Reviews in Cardiovascular Medicine 2008Acute decompensated heart failure (ADHF) is a growing public health problem with high mortality and costs. ADHF often, if not usually, occurs in the setting of... (Review)
Review
Acute decompensated heart failure (ADHF) is a growing public health problem with high mortality and costs. ADHF often, if not usually, occurs in the setting of cardiovascular and noncardiovascular comorbidities as well as advanced age. New insights provide support for the concept of heart failure as a state of deficiency of and/or resistance to endogenous B-type natriuretic peptide. The primary goals of ADHF therapy are to relieve symptoms and optimize volume status with minimal side effects. Few therapies are proven to effectively do so. Nesiritide is a balanced vasodilator with favorable neurohumoral effects and is superior to placebo in providing rapid symptom relief and to nitroglycerin in reducing filling pressures. Recent trials confirm a lack of renal toxicity at recommended doses. An adequately powered multinational mortality trial is underway. Nesiritide represents a proven therapy for normotensive/hypertensive ADHF patients with severe symptoms at rest.
Topics: Acute Disease; Antihypertensive Agents; Clinical Trials as Topic; Cost-Benefit Analysis; Drug Costs; Heart Failure; Humans; Hypertension; Kidney; Natriuretic Peptide, Brain; Patient Selection; Risk Assessment; Treatment Outcome; Vasodilator Agents
PubMed: 18953274
DOI: No ID Found -
Journal of the American College of... Sep 2021
Topics: Heart Failure; Humans; Natriuretic Peptide, Brain; Peptide Fragments
PubMed: 34556319
DOI: 10.1016/j.jacc.2021.07.045 -
Journal of Cellular and Molecular... 2007The natriuretic peptides are a family of related hormones that play a crucial role in cardiovascular and renal homeostasis. They have recently emerged as potentially... (Review)
Review
The natriuretic peptides are a family of related hormones that play a crucial role in cardiovascular and renal homeostasis. They have recently emerged as potentially important clinical biomarkers in heart failure. Natriuretic peptides, particularly brain natriuretic peptide (BNP) and the inactive N-terminal fragment of BNP, NT-proBNP, that has an even greater half-life than BNP, are elevated in heart failure and therefore considered to be excellent predictors of disease outcome. Nesiritide, a recombinant human BNP, has been shown to provide symptomatic and haemodynamic improvement in acute decompensated heart failure, although recent reports have suggested an increased short-term risk of death with nesiritide use. This review article describes: the current use of BNP and its inactive precursor NT-proBNP in diagnosis, screening, prognosis and monitoring of therapy for congestive heart failure, the renoprotective actions of natriuretic peptides after renal failure and the controversy around the therapeutic use of the recombinant human BNP nesiritide.
Topics: Acute Kidney Injury; Animals; Biomarkers; Heart Failure; Humans; Natriuretic Peptide, Brain; Natriuretic Peptides
PubMed: 18205700
DOI: 10.1111/j.1582-4934.2007.00125.x -
Heart (British Cardiac Society) Sep 2006Synthesis and release of B-type natriuretic peptide (BNP) are increased in heart failure, and plasma concentrations provide important therapeutic and prognostic... (Review)
Review
Synthesis and release of B-type natriuretic peptide (BNP) are increased in heart failure, and plasma concentrations provide important therapeutic and prognostic information. Recent studies have shown that BNP concentrations are also increased with disease of the mitral and aortic valves. The extent of the increase is broadly related to the severity of the valve abnormality and the degree of consequent cardiac remodelling. BNP concentrations appear to relate to prognosis in these patients and might have a role in identifying suitable candidates for cardiac surgery. This paper reviews the current literature and identifies areas where further research is required if assessment of BNP is to be of practical use.
Topics: Atrial Natriuretic Factor; Biomarkers; Heart Valve Diseases; Humans; Natriuretic Peptide, Brain; Prognosis
PubMed: 16251227
DOI: 10.1136/hrt.2005.074161 -
Journal of Cardiology Mar 2011The mammalian natriuretic peptide family consists of atrial (ANP), brain [B-type; BNP] and C-type natriuretic peptide (CNP) and three receptors, natriuretic receptors-A... (Review)
Review
The mammalian natriuretic peptide family consists of atrial (ANP), brain [B-type; BNP] and C-type natriuretic peptide (CNP) and three receptors, natriuretic receptors-A (NPR-A), -B (NPR-B) and -C (NPR-C). Both ANP and BNP are abundantly expressed in the heart and are secreted mainly from the atria and ventricles, respectively. By contrast, CNP is mainly expressed in the central nervous system, bone and vasculature. Plasma concentrations of both ANP and BNP are elevated in patients with cardiovascular disease, though the magnitude of the increase in BNP is usually greater than the increase in ANP. This makes BNP is a clinically useful diagnostic marker for several pathophysiological conditions, including heart failure, ventricular remodeling and pulmonary hypertension, among others. Recent studies have shown that in addition to BNP-32, proBNP-108 also circulates in human plasma and that levels of both forms are increased in heart failure. Furthermore, proBNP-108 is O-glycosylated and circulates at higher levels in patients with severe heart failure. In this review we discuss recent progress in our understanding of the biochemistry, molecular biology and clinical relevance of the natriuretic peptide system.
Topics: Atrial Natriuretic Factor; Biomarkers; Cardiovascular Diseases; Gene Expression; Gene Expression Regulation; Heart Failure; Humans; Natriuretic Peptide, Brain; Natriuretic Peptide, C-Type; Peptide Fragments; Tissue Distribution; Transcription, Genetic
PubMed: 21296556
DOI: 10.1016/j.jjcc.2011.01.002 -
Sensors (Basel, Switzerland) Nov 2019Heart failure is a class of cardiovascular diseases that remains the number one cause of death worldwide with a substantial economic burden of around $18 billion... (Review)
Review
Heart failure is a class of cardiovascular diseases that remains the number one cause of death worldwide with a substantial economic burden of around $18 billion incurred by the healthcare sector in 2017 due to heart failure hospitalization and disease management. Although several laboratory tests have been used for early detection of heart failure, these traditional diagnostic methods still fail to effectively guide clinical decisions, prognosis, and therapy in a timely and cost-effective manner. Recent advances in the design and development of biosensors coupled with the discovery of new clinically relevant cardiac biomarkers are paving the way for breakthroughs in heart failure management. Natriuretic neurohormone peptides, B-type natriuretic peptide (BNP) and N-terminal prohormone of BNP (NT-proBNP), are among the most promising biomarkers for clinical use. Remarkably, they result in an increased diagnostic accuracy of around 80% owing to the strong correlation between their circulating concentrations and different heart failure events. The latter has encouraged research towards developing and optimizing BNP biosensors for rapid and highly sensitive detection in the scope of point-of-care testing. This review sheds light on the advances in BNP and NT-proBNP sensing technologies for point-of-care (POC) applications and highlights the challenges of potential integration of these technologies in the clinic. Optical and electrochemical immunosensors are currently used for BNP sensing. The performance metrics of these biosensors-expressed in terms of sensitivity, selectivity, reproducibility, and other criteria-are compared to those of traditional diagnostic techniques, and the clinical applicability of these biosensors is assessed for their potential integration in point-of-care diagnostic platforms.
Topics: Biomarkers; Biosensing Techniques; Heart Failure; Humans; Natriuretic Peptide, Brain; Natriuretic Peptides; Peptide Fragments; Point-of-Care Systems
PubMed: 31744130
DOI: 10.3390/s19225003 -
Congestive Heart Failure (Greenwich,... 2005Adverse neurohormonal activation is an essential component in the pathogenesis of acute decompensated congestive heart failure (CHF). Consequently, blunting this... (Review)
Review
Adverse neurohormonal activation is an essential component in the pathogenesis of acute decompensated congestive heart failure (CHF). Consequently, blunting this activation is an important therapeutic goal. B-type natriuretic peptide (BNP) is a counterregulatory hormone produced by the ventricles in response to pressure and volume load. Endogenous BNP levels are significantly elevated in patients with acute CHF, but these levels are frequently inadequate to overcome the excess neurohormonal activation present in this condition. Infusion of nesiritide, a recombinant form of endogenous human BNP, increases circulating BNP levels by several-fold, augmenting the counterregulatory effects of this hormone. Clinical trials demonstrate that in patients with acute decompensated CHF, nesiritide produces arterial and venous vasodilation, reducing both preload and afterload; blunts adverse neurohormones, including renin, aldosterone, norepinephrine, and endothelin-1; and improves renal hemodynamics and tubular function. As a result, nesiritide quickly reduces clinical symptoms and improves mortality in patients with acute CHF.
Topics: Heart Failure; Humans; Kidney; Natriuretic Peptide, Brain; Renin-Angiotensin System; Sympathetic Nervous System
PubMed: 15722668
DOI: 10.1111/j.1527-5299.2005.03794.x -
Current Cardiology Reviews 2019Natriuretic peptides, produced by cardiac myocytes, are regulators of the intravascular volume and blood pressure, and also exhibit neuroendocrine, metabolic and growth... (Review)
Review
Natriuretic peptides, produced by cardiac myocytes, are regulators of the intravascular volume and blood pressure, and also exhibit neuroendocrine, metabolic and growth controlling effects. In heart failure, their synthesis increases exponentially as part of the neuroendocrine activation, but their beneficial effects are diminished. The paper reviews relevant data about their role as diagnosis and prognosis markers in heart failure, the hemodynamic and clinical benefits of their use as therapy in heart failure, together with the main adverse effects. Peptides non-specifically increase in extracardiac pathology and the literature reveals the mechanisms of increase, significance and threshold values to exclude cardiac dysfunction.
Topics: Cardiovascular Diseases; Hemodynamics; Humans; Natriuretic Peptide, Brain; Natriuretic Peptides
PubMed: 30914031
DOI: 10.2174/1573403X15666190326150550 -
Journal of the American College of... Mar 2019
Topics: Circulating MicroRNA; Heart Failure; Humans; Natriuretic Peptide, Brain; Peptide Fragments
PubMed: 30898207
DOI: 10.1016/j.jacc.2018.10.091 -
Advances in Clinical Chemistry 2013The cardiac hormone, B-type natriuretic peptide (BNP), is one of human natriuretic peptides which possesses cardiorenal protective actions and is used as a therapeutic... (Review)
Review
The cardiac hormone, B-type natriuretic peptide (BNP), is one of human natriuretic peptides which possesses cardiorenal protective actions and is used as a therapeutic and a biomarker for heart failure (HF). Its prohormone, proBNP1_108, is processed by the proNPs convertases, corin or furin, to inactive NT-proBNP1_76 and active BNP1-32. Paradoxically, circulating NT-proBNP and BNP are elevated in HF leading to the use of BNP as a sensitive and predictive marker of HF. This paradox may be explained by the "nonspecific" nature of conventional assays and/or a relative deficiency state of "active BNP" as characterized by an increase in inactive proBNP_108 and a decrease in active BNP1-32. Therefore, understanding the regulation of proBNP1_108 processing and the role of the convertase corin may be important in understanding the physiology of HF. Corin is expressed in heart and kidney and may play an important role in regulating blood pressure and remodeling of the heart. The processing of proBNP1_108 by corin may be controlled by O-linked glycosylation of proBNP1-108. A potential impairment of proBNP1lo8 processing in HF may be linked to dysregulation of the convertase corin, which may offer therapeutic opportunities to control proBNPlo0s processing and its activation in HF.
Topics: Amino Acid Sequence; Animals; Biomarkers; Glycosylation; Heart; Heart Failure; Humans; Molecular Sequence Data; Natriuretic Peptide, Brain; Polymorphism, Single Nucleotide; Serine Endopeptidases
PubMed: 24015598
DOI: 10.1016/b978-0-12-407680-8.00001-4