Clinical significance of natriuretic peptides in the differential diagnosis of dyspnea


Authors: Jiří Špác
Authors‘ workplace: II. interní klinika LF MU a FN U sv. Anny v Brně
Published in: Vnitř Lék 2016; 62(7-8): 640-645
Category: Reviews

Motto
Biomarkers make bad doctors worse and good doctors better | Biomarkery dělají ze špatných lékařů horší a z dobrých lékařů lepší.
Maisel A, přednáška ESC 2011

Overview

Acute dyspnea is one of the most common emergency department symptoms. But early diagnosis and treatment could be e challenging because of multiple potential causes. The gold standard biomarkers in cardiac dyspnea are B-type natriuretic peptide (BNP) and N-terminal pro-B-type (natriuretic peptide NT-pro BNP), which play an important role in the diagnosis, prognosis, and management of acute decompensated heart failure. The purpose of this review is to analyze diagnostic potential of BNP and NT-pro BNP biomarkers use in patients with acute dyspnea. BNP and NT-proBNP are markers of cardiac stress but are not cardiac-specific. They have comparable clinical utility, and both help in excluding acute cardiac dyspnea but they cannot reliably discriminate systolic from diastolic HF.

Key word:
acute dyspnea – natriuretic peptide – heart failure


Sources

1. Parshall MB, Schwartzstein RM, Adams L et al. [American Thoracic Society Committee on Dyspnea]. An official American Thoracic Society statement: update on the mechanisms, assessment, and management of dyspnea. Am J Respir Crit Care Med 2012; 185(4): 435–452.

2. Maisel AS, Peacock WF, McMullin N et al. Timing of immunoreactive B-type natriuretic peptide levels and treatment delay in acute decompensated heart failure: an ADHERE (Acute Decompensated Heart Failure National Registry) analysis. J Am Coll Cardiol 2008; 52(7): 534–540.

3. Singer AJ, Emerman C, Char DM et al. Bronchodilator therapy in acute decompensated heart failure patients without a history of chronic obstructive pulmonary disease. Ann Emerg Med 2008; 51(1): 25–34.

4. 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(7): 647–654.

5. Ray P, Birolleau S, Lefort Y et al. Acute respiratory failure in the elderly: etiology, emergency diagnosis and prognosis. Crit Care 2006; 10(3): R82.

6. Jorge S, Becquemin MH, Delerme S et al. Cardiac asthma in elderly patients: incidence, clinical presentation and outcome. BMC Cardiovasc Disord 2007; 7:16. Dostupné z DOI: <http://doi10.1186/1471–2261–7-16>.

7. Lien CT, Gillespie ND, Struthers AD et al. Heart failure in frail elderly patients: diagnostic difficulties, co-morbidities, polypharmacy and treatment dilemmas. Eur J Heart Fail 2002; 4(1): 91–98.

8. Papadimitriu L,Georgiopoulou VV, Kort S et al. Echocardiography in Acute Heart Failure: Current Perspectives. J Cardiac Fail 2016; 22(1): 82–94.

9. McMurray JJ, Adamopoulos S, Anker SD et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J 2012; 33(14): 1787–1847. Erratum in Eur Heart J 2013; 34(2): 158.

10. Liang F, O’Rear J, Schellenberger U et al. Evidence for functional heterogeneity of circulating B-type natriuretic peptide. J Am Coll Cardiol 2007; 49(10): 1071–1078.

11. Semenov AG, Tamm NN, Seferian KR et al. Processing of Pro-B-Type Natriuretic Peptide Furin and Corin as Candidate Convertases. Clin Chem 2010; 56(7): 1166–1176.

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(3): 161–167.

13. Januzzi JL, Camargo CA, Anwaruddin S et al. The N-terminal Pro-BNP investigation of dyspnea in the emergency department (PRIDE) study. Am J Cardiol 2005; 95(8): 948–954.

14. Januzzi JL, Van Kimmenade R, Lainchbury J et al. 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 2006; 27(3): 330–337.

15. van der Burg-de Graauw N, Cobbaert CM, Middelhoff CJ et al. The additive value of N-terminal pro-B-type natriuretic peptide testing at the ED in patients with acute dyspnea. Eur J Intern Med 2009; 20(3): 301–306.

16. Moe GW, Howlett J, Januzzi JL et al. Canadian Multicenter Improved Management of Patients With Congestive Heart Failure (IMPROVE-CHF) Study Investigators]. 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 2007; 115(24): 3103–3110.

17. Mueller C, Laule-Kilian K, Schindler C et al. Cost-effectiveness of B-type natriuretic peptide testing in patients with acute dyspnea. Arch Intern Med 2006; 166(10): 1081–1087.

18. Ondráčková B. Farmakoekonomická analýza nákladů na hospitalizaci pacientů s akutním srdečním selháním. Disertační práce. LF MU: Brno 2011.

19. Schneider HG, Lam L, Lokuge A et al. B-type natriuretic peptide testing, clinical outcomes, and health services use in emergency department patients with dyspnea: a randomized trial. Ann Intern Med 2009; 150(6): 365.

20. Januzzi JL, Van Kimmenade R, Lainchbury J et al. 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 2006; 27(3): 330–337.

21. Van Kimmenade RR, Pinto YM, Januzzi JL Importance and interpretation of intermediate (gray zone) amino-terminal pro-B-type natriuretic peptide concentrations. Am J Cardiol2008; 101(3A): 39–42.

22. Maisel A, Mueller C, Nowak R et al. Mid-region pro-hormone markers for diagnosis and prognosis in acute dyspnea: results from the BACH (Biomarkers in Acute Heart Failure) trial. J Am Coll Cardiol 2010; 55(19): 2062–2076.

23. Baggish AL, Siebert U, Lainchbury JG et al. 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 2006; 151(1): 48–54.

24. Van Kimmenade RR, Januzzi JL, Bakker JA et al. Renal clearance of B-type natriuretic peptide and amino terminal pro-B-type natriuretic peptide a mechanistic study in hypertensive subjects. J Am Coll Cardiol 2009; 53(10): 884–890.

25. Packer M, McMurray JJ, Desai AS et al. Angiotensin receptor neprilysin inhibition compared with enalapril on the risk of clinical progression in surviving patients with heart failure. Circulation 2015; 131(1): 54–61.

26. Krishnaswamy P, Lubien E, Clopton P et al. Utility of B-natriuretic peptide levels in identifying patients with left ventricular systolic or diastolic dysfunction. Am J Med 2001; 111(4): 274–279.

27. Krauser DG, Lloyd-Jones DM, Chae CUet al. 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 2005; 149(4): 744–750.

28. Maisel A, Muller C, Adams K Jr et al. State of the art: Using natriuretic peptide levels in clinical practice. Eur J Heart Fail 2008; 10(9): 824–839.

29. Maisel A, Barnard D, Jaski B et al. Primary Results of the HABIT Trial (Heart Failure Assessment with BNP in the Home). J Am Coll Cardiol 2013; 61(16): 1726–1735.

Labels
Diabetology Endocrinology Internal medicine

Article was published in

Internal Medicine

Issue 7-8

2016 Issue 7-8

Most read in this issue

This topic is also in:


Login
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account