Skip to main content
SpringerLink
Log in

Clinical Use of Natriuretic Peptides for the Diagnosis and Management of Heart Failure

  • Chapter
Cardiovascular Biomarkers

Part of the book series: Contemporary Cardiology ((CONCARD))

  • 1383 Accesses

Abstract

Since the approval of B-type natriuretic peptide (BNP) as an aid to the diagnosis of heart failure by the US Food and Drug Administration in November 2000, this novel biomarker has generated intense interest for both clinical and research applications in patients with or at risk of heart failure. Initially focused on the urgent, bedside diagnosis of heart failure, BNP testing in settings outside of the emergency department has been supported by subsequent research. Not only is BNP a useful adjunct for diagnosing and monitoring patients with heart failure (stages C and D), but studies now suggest that BNP provides independent prognostic information with respect to the risk of death or rehospitalization. In addition, BNP may have a role in screening high-risk patients for the presence of underlying cardiac dysfunction (stages A and B). BNP is established as a useful tool for aiding the diagnosis and risk stratification of patients with heart failure. In addition, the potential for using BNP in screening, in monitoring, and as a target for therapy continues to be explored.

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

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 299.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Mark DB, Felker GM. B-type natriuetic peptide: a biomarker for all seasons. N Engl J Med 2004;350: 718–720.

    Article  PubMed  CAS  Google Scholar 

  2. Wang TJ, Larson MG, Levy D, et al. Plasma natriuretic peptide levels and the risk of cardiovascular events and death. N Engl J Med 2004;350:655–663.

    Article  PubMed  CAS  Google Scholar 

  3. Hunt SA, Baker DW, Chin MH, et al. ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult: executive summary: a report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Committee to revise the 1995 Guidelines for the Evaluation and Management of Heart Failure). J Am Coll Cardiol 2001;38:2101–2113.

    Article  PubMed  CAS  Google Scholar 

  4. Rich M. Epidemiology, pathophysiology, and etiology of congestive heart failure in older adults. J Am Geriatr Soc 1997;45:968–974.

    PubMed  CAS  Google Scholar 

  5. Krumholz HM, Wang Y, Parent EM, et al. Quality of care for elderly patients hospitalized with heart failure. Arch Intern Med 1997;157(19):2242–2247.

    Article  PubMed  CAS  Google Scholar 

  6. Cohn JN, Levine TB, Olivari MT, et al. Plasma norepinephrine as a guide to prognosis in patients with chronic congestive heart failure. N Engl J Med 1984;311:819–823.

    Article  PubMed  CAS  Google Scholar 

  7. Clerico A, Iervasi G, Mariani G. Clinical relevance of the measurement of cardiac natriuretic peptide hormones in humans. Horm Metab Res 1999;31:487–498.

    Article  PubMed  CAS  Google Scholar 

  8. Maisel A. B-type natriuretic peptide levels: a potential novel “white coun” for congestive heart failure. J Card Fail 2001;7:183–193.

    Article  PubMed  CAS  Google Scholar 

  9. Boomama F, Van der Meiracker AH. Plasma A-and B-type natriuretic peptides: physiology, methodology and clinical use. Cardiovasc Res 2001;51:442–449.

    Article  Google Scholar 

  10. The SOLVD Investigators. Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced ventricular ejection fractions and congestive heart failure. N Engl J Med 1991;325:293–302.

    Google Scholar 

  11. Stevenson LW. The limited availability of physical signs for estimating hemodynamics in chronic heart failure. JAMA 1989;261:884–888.

    Article  PubMed  CAS  Google Scholar 

  12. Devereux RB, Lieberson PR, Haran MJ. Recommendations concerning use of electrocardiography in hypertension and general population research. Hypertension 1987;9(2 Pt 2):II97–II104.

    PubMed  CAS  Google Scholar 

  13. Wuerz RC, Meador SA. Effects of prehospital medications on mortality and length of stay in HF. Ann Emerg Med 1992;21(6):669–674.

    Article  PubMed  CAS  Google Scholar 

  14. Deveraux RB, Liebson PR, Horan MJ. Recommendations concerning use of echocardiography in hypertension and general population research. Hypertension 1987;9(2 Pt 2):II97–II104.

    Google Scholar 

  15. Davie AP, Francis CM, Love MP, et al. Value of the electrocardiogram in identifying heart failure due to left ventricular systolic dysfunction. BMJ 1996;312:222.

    PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  17. Dao Q, Krishnaswamy P, Kazanegra R, et al. Utility of B-type natriuretic peptide (BNP) in the diagnosis of HF in an urgent care setting. J Am Coll Cardiol 2001;37:379–385.

    Article  PubMed  CAS  Google Scholar 

  18. Maisel A, 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(3):161–167.

    Article  PubMed  CAS  Google Scholar 

  19. Maisel A, Hollander JE, Guss D, et al. 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 2004;44:1328–1333.

    Article  PubMed  Google Scholar 

  20. Mueller C, Scholer A, Laule-Kilian K, et al. Use of B-type natriuretic peptide in the evaluation and management of acute dyspnea. N Engl J Med 2004;350:647–654.

    Article  PubMed  CAS  Google Scholar 

  21. McCullough PA, Duc P, Omland T, et al. 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 2003;41(3):571–579.

    Article  PubMed  CAS  Google Scholar 

  22. Dries DL, Exner DV, Domanski MJ, et al. The prognostic implications of renal insufficiency in asymptomatic and symptomatic patients with left ventricular systolic dysfunction. J Am Coll Cardiol 2000;35: 681–689.

    Article  PubMed  CAS  Google Scholar 

  23. Morrison KL, Harrison A, Krishnaswamy P, et al. Utility of a rapid B-natriuretic peptide (BNP) assay in differentiating HF from lung disease in patients presenting with dyspnea. J Am Coll Cardiol 2002;39: 202–209.

    Article  PubMed  CAS  Google Scholar 

  24. McCullough PA, Hollander JE, Nowak RM, et al. Uncovering heart failure in patients with a history of pulmonary disease: rationale for the early use of B-type natriuretic peptide in the emergency department. Acad Emerg Med 2003;10(3):198–204.

    Article  PubMed  Google Scholar 

  25. Knudsen CW, Omland T, Clopton P, et al. Diagnostic value of B-type natriuretic peptide and chest radiographic findings in patints with acute dyspnea. Am J Med 2004;116:1–6.

    Article  CAS  Google Scholar 

  26. Berman B, Spragg R, Maisel A. B-type natriuretic peptide (BNP) levels in differentiating congestive heart failure from acute respiratory distress syndrome (ARDS): abstracts from the 75th Annual Scientific Meeting of the American Heart Association. Circulation 2002;106:S3191.

    Google Scholar 

  27. Kucher N, Printzen G, Goldhaber S. Prognostic role of brain natriuretic peptide in acute pulmonary embolism. Circulation 2003;107:2545–2547.

    Article  PubMed  CAS  Google Scholar 

  28. Leuchte HH, Holzapfel M, Baumgartner RA, et al. Clinical significance of brain natriuretic peptide in primary pulmonary hypertension. J Am Coll Cardiol 2004;43(5):764–770.

    Article  PubMed  CAS  Google Scholar 

  29. Lubien E, DeMaria A, Krishnaswamy P, et al. Utility of B-natriuretic Peptide (BNP) in diagnosing diastolic dysfunction. Circulation 2002;105(5):595–601.

    Article  PubMed  CAS  Google Scholar 

  30. Krishnaswamy P, Lubien E, Clopton P, et al. Utility of B-natriuretic peptide (BNP in elucidating left ventricular dysfunction (systolic and diastolic) in patients with and without symptoms of congestive heart failure at a veterans hospital. Am J Med 2001;111:274–279.

    Article  PubMed  CAS  Google Scholar 

  31. Maisel AS, McCord JM, Nowak RM, et al. Bedside B-type natriuretic peptide in the emergency diagnosis of heart failure: with reduced or preserved ejection fraction: results from the Breathing Not Properly (BNP) multinational study. J Am Coll Cardiol 2003;410(11):2010–2017.

    Article  Google Scholar 

  32. Kenchaiah S, Eveans JC, Levy D, et al. Obesity and the risk of heart failure. N Engl J Med 2002;347:358

    Article  Google Scholar 

  33. Eckel RH, Barouch WW, Ershow AG. Report of the National Heart, Lung, and Blood Institute-National Institute of Diabetes and Digestive and Kidney Diseases Working Group on the Pathophysiology of Obesity-Associated Cardiovascular Disease. Circulation 2002;105:2923–2928.

    Article  PubMed  Google Scholar 

  34. Banerjee P, Banerjee T, Khand A, et al. Diastolic heart failure: neglected or misdiagnosed? J Am Coll Cardiol 2002;39:138–141.

    Article  PubMed  Google Scholar 

  35. Mehra MR, Uber PA, Park M, et al. Obesity and suppressed B-type natriuretic peptide levels in heart failure. J Am Coll Cardiol 2004;43(9):1590–1595.

    Article  PubMed  CAS  Google Scholar 

  36. McCord J, Mudny BJ, Hudson MP, et al. The relationship between obesity and B-type natriuretic peptide levels. Arch Intern Med 2004;164:2247–2252.

    Article  PubMed  CAS  Google Scholar 

  37. Koglin J, Pehlivanli S, Schwaiblamir M, et al. Role of brain natriuretic peptide in risk stratification of patients with congestive heart failure. J Am Coll Cardiol 2001;38:1934–1941.

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  39. Cheng VL, Krishnaswamy P, Kazanegra R, et al. A rapid bedside test for B-type natriuretic peptide predicts treatment outcomes in patients admitted with decompensated heart failure. J Am Coll Cardiol 2001; 37:386–391.

    Article  PubMed  CAS  Google Scholar 

  40. Bettencourt P, Ferreira S, Azevedo A, et al. Preliminary data on the potential usefulness of B-type natriuretic peptide levels in predicting outcomes after hospital discharge in patients with heart failure. Am J Med 2002;113(3):215–219.

    Article  PubMed  CAS  Google Scholar 

  41. 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 

  42. Bradley DJ, Bradley EA, Baughman KL, et al. Cardiac resynchronization and death from progressive heart failure: a meta-analysis of randomized controlled trials. JAMA 2003;289:730.

    Article  PubMed  Google Scholar 

  43. Sinha A-M, Filzmaier K, Breithardt O-A, et al. Usefulness of brain natriuretic peptide release as a surrogate marker of the efficacy of long-term cardiac resynchronization therapy in patients with heart failure. Am J Cardiol 2003;91:755–758.

    Article  PubMed  CAS  Google Scholar 

  44. Olivetti G, Abbi R, Quaini F, et al. Apoptosis in the failing human heart. N Engl J Med 1997;336:1131–1141.

    Article  PubMed  CAS  Google Scholar 

  45. Sato Y, Yamada T, Taniguchi R, et al. Persistently increased serum concentrations of cardiac troponin T in patients with idiopathic dilated cardiomyopathy are predictive of adverse outcomes. Circulation 2001;103:369–374.

    PubMed  CAS  Google Scholar 

  46. Horwich T, Patel J, MacLellan W, Fonarow G. Cardiac troponin I is associated with impaired hemodynamics, progressive left ventricular dysfunction, and increased mortality rates in advanced heart failure. Circulation 2003;108:833–838.

    Article  PubMed  CAS  Google Scholar 

  47. Freitag MH, Vasan RS. Screening for left ventricular systolic dsyfucntion: the use of BNP. Heart Fail Monitor 2003;4(2):1–7.

    Google Scholar 

  48. Vasan RS, Benjamin EJ, Larson MG, et al. Monitoring Cardiovascular Disease investigation. Plasma natriuretic peptides for community screening for left ventricular hypertrophy and systolic dysfunction: the Framingham heart study. JAMA 2002;288:194–202.

    Article  Google Scholar 

  49. Silver MA, Pisano C. High incidence of elevation B-type natriuretic peptide levels and risk factors for heart failure in an unselected at-risk population (stage A):implications for heart failure screening programs. Congest Heart Fail 2003;9:194–200.

    Google Scholar 

  50. 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 

  51. Epshteyn V, Morrison K, Krishnaswamy P, et al. Utility of B-type natriuretic peptide (BNP) as a screen for left ventricular dysfunction in patients with diabetes. Diabetes Care 2003;26(7):2081–2087.

    Article  PubMed  CAS  Google Scholar 

  52. Atisha D, Bhalla MA, Morrison LK, et al. A prospective study in search of an optimal BNP level to screen patients for cardiac dysfunction. Am Heart J 2004;148:518–523.

    Article  PubMed  CAS  Google Scholar 

  53. Heidenreich PA, Gubens MA, Fonarow GC, et al. Cost-effectiveness of screening with B-type natriuretic peptide to identify patients with reduced left ventricular ejection fraction. J Am Coll Cardiol 2004; 43:1019–1026.

    Article  PubMed  CAS  Google Scholar 

  54. Maisel A. Updated algorithms for using B-type natriuretic peptide (BNP) levels in the diagnosis and management of congestive heart failure. Crit Pathways Cardiol, in press.

    Google Scholar 

  55. Krumholz HM, Parent EM, Tu N, et al. Readmission after hospitalization for congestive heart failure among Medicare beneficiaries. Arch Intern Med 1997;157:99–104.

    Article  PubMed  CAS  Google Scholar 

  56. Konstam MA, Kimmelstiel CD. Economics of heart failure. In: Balady GJ, Pina IL, eds. Exercise and Heart Failure. Futura, Armonk, NY, 1997, pp. 19–281.

    Google Scholar 

  57. Kazanegra R, Cheng V, Garcia A, et al. A rapid test for B-type natriuretic peptide correlates with falling wedge pressures in patients treated for decompensated heart failure: a pilot study. J Cardiac Fail 2001;7: 21–29.

    Article  CAS  Google Scholar 

  58. Stevenson LW. Tailored therapy to hemodynamic goals for advanced heart failure. Eur J Heart Fail 1999; 1:252–257.

    Article  Google Scholar 

  59. Maisel A. Algorithm for using b-type natriuretic peptide levels in the diagnosis and management of congestive heart failure. Crit Pathways Cardiol 2000;I(2):68–73.

    Google Scholar 

  60. Sodian R, Loebe M, Schmitt C, et al. Decreased plasma concentrations of brain natriuretic peptide as a potential indicator of cardiac recovery in patients supported by mechanical circulatory assist systems. J Am Coll Cardiol 2001;38:1942–1949.

    Article  PubMed  CAS  Google Scholar 

  61. Richardson AM, Doughty R, Nicholls MG, et al. Neurohumoral predictors of benefit from Carvedilol in ischemic left ventricular dysfunction. Circulation 1999;99:786–797.

    Google Scholar 

  62. Troughton RW, Frampton CM, Yandle TG, et al. Treatment of heart failure guided by plasma amino terminal brain natriuretic peptide (N-BNP) concentrations. Lancet 2000;355:1126–1130.

    Article  PubMed  CAS  Google Scholar 

  63. Anand IS, Fisher LD, Chiang Y-T, et al., for the Val-HeFT Investigators. Changes in brain natriuretic peptide and norepinephrine over time and mortality and morbidity in the Valsartan Heart Failure Trial (Val-HeFT). Circulation 2003;107:1278–1283.

    Article  PubMed  CAS  Google Scholar 

  64. Silver MA, Maisel A, Yancy CW, et al. BNP Consensus Panel 2004: A clinical approach for the diagnostic, prognostic, screening, treatment monitoring, and therapeutic roles of natriuretic peptides in cardiovascular diseases. Congest Heart Fail 2004;10(5 Suppl 3):1–30.

    Article  CAS  Google Scholar 

  65. Wieczorek SJ, Wu AH, Christenson R, et al. A rapid B-type natriuretic peptide assay accurately diagnoses left ventricular dysfunction and heart failure: a multicenter evaluation. Am Heart J 2002;144:834–839.

    PubMed  CAS  Google Scholar 

  66. Anand IS, Fisher LD, Chiang YT, et al. Changes in brain natriuretic peptide and norepinephrine over time and mortality and morbidity in the Valsartan Heart Failure Trial (Val-HeFT). Circulation 2003;107: 1278–1283.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. San Diego VA Healthcare System, University of California at San Diego, San Diego, CA

    Alan Maisel MD (Professor of Medicine, Director of the Coronary Care and Heart Failure Program)

Authors
  1. Alan Maisel MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA

    David A. Morrow MD, MPH

Rights and permissions

Reprints and permissions

Copyright information

© 2006 Humana Press Inc., Totowa, NJ

About this chapter

Cite this chapter

Maisel, A. (2006). Clinical Use of Natriuretic Peptides for the Diagnosis and Management of Heart Failure. In: Morrow, D.A. (eds) Cardiovascular Biomarkers. Contemporary Cardiology. Humana Press. https://doi.org/10.1007/978-1-59745-051-5_23

Download citation

  • DOI: https://doi.org/10.1007/978-1-59745-051-5_23

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-58829-526-2

  • Online ISBN: 978-1-59745-051-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation