Korean Circ J.  2007 Sep;37(9):393-398. 10.4070/kcj.2007.37.9.393.

Serial Monitoring of B-Type Natriuretic Peptide in Heart Failure Patients

• Ahn MS
• Yoo BS

• KMID: 2093974
• DOI: http://doi.org/10.4070/kcj.2007.37.9.393

Abstract

The measurements of B-type natriuretic peptide (BNP) or N-terminal proBNP (NT-proBNP), when taken together with conventional clinical assessment, may assist in making the prognosis and also for making serial adjustment of such treatment. But although such commercial assays are currently approved for the diagnosis of heart failure, the role of the natriuretic peptides for monitoring the success of congestive heart failure (CHF) therapy has not as yet been submitted for regulatory approval. Moreover, because of the intra-individual biologic variation of the BNP or because of multiple factors that affect the BNP levels, the magnitude of the change of BNP levels must be large to confidently interpret BNP changes within an individual, and just how large has not been determined. Yet the levels of plasma BNP and NT-pro BNP are well correlated with the concurrent haemodynamic measurements and indicators of left ventricular systolic function. Also, BNP and NT-pro BNP serve as significant prognostic information and it is possible that adjustment of anti-heart failure therapy according to serial measurements of BNP (in addition to the standard clinical assessment) may offer improved outcomes. Better understanding of the test characteristics is needed before we can effectively use this valuable test to guide therapeutic strategies.

Keyword

Heart failure; Natriuretic peptides; B-type natriuretic peptide

MeSH Terms

Diagnosis
Heart Failure*
Heart*
Humans
Natriuretic Peptide, Brain*
Natriuretic Peptides
Plasma
Prognosis
Natriuretic Peptide, Brain
Natriuretic Peptides

Figure

• 

  Fig. 1 Diagram of the potential roles of B-type natriuretic peptide (BNP) or N-terminal proBNP (NT-proBNP). Testing for either BNP or NT-proBNP has a number of possible uses for the treatment of heart failure: screening for asymptomatic left ventricular dysfunction, diagnosis, risk stratification, determining the prognosis and treatment monitoring.

• 

  Fig. 2 Neuro-hormone imbalance in heart failure. For patients with heart failure, the rennin-angiotensin-aldosterone system, the sympathetic nerve system and the endothelin systems are activated over the counter-regulatory natriuretic peptide (BNP, ANP) systems or other systems (A). Therefore, neurohormonal imbalance is a significant patho-physiologic mechanism in heart failure. After treatment, recovery of the neurohormonal balance means stabilization of the heart failure status (B). BNP: B-type natriuretic peptide, ANP: A-type natriuretic peptide, RAS: renin-angiotensin-aldosterone system, SNS: sympathetic nervous system.

• 

  Fig. 3 Relationship of the B-type natriuretic peptide (BNP) levels and the pulmonary wedge pressure (PAW) in patients with heart failure.14) During 24 hours of treatment for patient with decompensated congestive heart failure, the wedge pressure decreased below 20 mm Hg within 16 hours and then remained there. As the wedge pressure fell, so did the BNP level. It is interesting to note that even after the wedge pressures normalized in these patients, the BNP levels continued to decline. This reflects continual neuro-hormonal normalization and the BNP was a relatively good indicator for treatment monitoring.

• 

  Fig. 4 Percent reduction in the N-terminal proBNP (NT-proBNP) levels according to the clinical course during hospitalization.8) The NT-proBNP levels were significantly lower in patients with complete resolution than those in the patients with an insufficient response to therapy (p<0.05). BNP: B-type natriuretic peptide.

• 

  Fig. 5 Kaplan-Meier curves according to the predefined B-type natriuretic peptide (BNP) cut off (350 ng/L).9) Predischarge BNP levels >350 ng/L are strongly related to death or re-admission (HR=12.6 [5.7 to 28.1], p=0.0001), and the rate of events reached 23.5% at one month and 79.4% at six months.

• 

  Fig. 6 Outcomes and treatment of heart failure as guided by N-terminal proBNP (NT-proBNP).19) This figure shows a significant reduction in events in that group whose treatment was adjusted according to serial measurements of plasma NT-proBNP. BNP: B-type natriuretic peptide.

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