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BNP
Kinds of BNP Terms modified by BNP Selected AbstractsDownregulation of oxytocin receptors in right ventricle of rats with monocrotaline-induced pulmonary hypertensionACTA PHYSIOLOGICA, Issue 2 2010T. L. Broderick Abstract Aim:, Pulmonary hypertension (PH) in the rat leads to right ventricular (RV) hypertrophy, inflammation and increased natriuretic peptide (NP) levels in plasma and RV. Because the release of nitric oxide (NO) and atrial natriuretic peptide (ANP) is a function of the oxytocin receptor (OTR), we examined the effect of PH on gene and protein expression of OTR, NP (A, atrial; B, brain) and receptors (NPRs), nitric oxide synthases (NOS), interleukin (IL)-1,, IL-6 and tumour necrosis factor-, in the hypertrophied RV in a model of PH. Methods:, RV hypertrophy was induced in male Sprague,Dawley rats with monocrotaline (MCT; 60 mg kg,1) and was confirmed by the presence of an increased RV weight and RV-to-[left ventricle (LV) and septum] ratio. Results:, In the RV of MCT-treated rats, a ,40% reduction in OTR mRNA and protein was observed compared with the RV of control rats. This reduction was associated with increased transcripts of ANP and BNP in both ventricles and a corresponding increase in NP receptor mRNA expression for receptors A, B and C. Protein expression of inducible NOS was increased in the RV, whereas endothelial NOS transcripts were increased only in the LV of MCT-treated rats. In the RV of MCT-treated rats, downregulation of OTR was also associated with increased mRNA expression of IL-1, and IL-6. Conclusion:, Our results show that downregulation of the OTR in the RV of MCT-treated rats is associated with increased expression of NP and their receptors as well as IL-1, and IL-6. This reduction in OTR in RV myocardium may have an impact on cardiac function in the MCT-induced model of PH. [source] Usefulness of Serial Assessment of Natriuretic Peptides in the Emergency Department for Patients With Acute Decompensated Heart FailureCONGESTIVE HEART FAILURE, Issue 4 2008Salvatore DiSomma MD The value of natriuretic peptides, both B-type natriuretic peptide (BNP) and N-terminal prohormone brain natriuretic peptide (NTproBNP), for determining diagnosis, severity, and prognosis of emergency department (ED) patients with acute decompensated heart failure (ADHF) has been well documented. Emerging data support the hypothesis that repeated natriuretic peptide determinations in the acute phase of ADHF may assist in confirming the diagnosis, monitoring drug therapy, and evaluating the adequacy of patient stabilization. Data from the authors' group demonstrate that in patients admitted to the ED for acute dyspnea, serial NTproBNP measurement at admission and 4, 12, and 24 hours later was useful in confirming the diagnosis of ADHF compared with patients with chronic obstructive pulmonary disease. Moreover, in the same patients receiving intensive intravenous diuretic therapy, there was a progressive reduction of NTproBNP blood levels from hospitalization to discharge (P<.001), accompanied by clinical improvement and stabilization of heart failure. More recently, the authors also demonstrated that in ADHF patients improving with diuretics, a progressive reduction in BNP levels was observed, starting 24 hours after ED admission and continuing until discharge. Comparing BNP and NTproBNP, there was a significant correlation between NTproBNP and BNP levels but not between NTproBNP's and BNP's percent variation compared with baseline. In ADHF, serial ED measurements of BNP are useful for monitoring the effects of treatment. A reduction in BNP from admission to discharge is indicative of clinical improvement. [source] Screening for Asymptomatic Left Ventricular Dysfunction Using B-Type Natriuretic PeptideCONGESTIVE HEART FAILURE, Issue 2008Theresa A. McDonagh MD Asymptomatic left ventricular dysfunction (ASLVD), a known precursor phase of heart failure, fulfills the essential criteria that should be met before screening for a disease. It is common and associated with reduced longevity and quality of life. Left untreated, it progresses to heart failure, which incurs a mortality greater than most cancers as well as significant morbidity rates. In addition, we now have several population-based studies that demonstrate that both B-type natriuretic peptide (BNP) and N-terminal prohormone brain natriuretic peptide (NTproBNP) can accurately exclude left ventricular systolic dysfunction. More recent work shows that this can be done cost-effectively. There is also a wealth of evidence from randomized controlled trials indicating that the treatment of ASLVD can reduce both morbidity and mortality and slow progression to the heart failure state. The main stumbling block to implementation of screening, in addition to the perceived cost, may well be the lack of a randomized study showing that screening the population for ASLVD really does alter the natural history of the condition, something that other screening strategies have so far failed to do. Congest Heart Fail. 2008;14(4 suppl 1):5,8. ©2008 Le Jacq [source] Invasive and Noninvasive Correlations of B-Type Natriuretic Peptide in Patients With Heart Failure Due to Chagas CardiomyopathyCONGESTIVE HEART FAILURE, Issue 3 2008Fábio Vilas-Boas MD Heart failure due to Chagas cardiomyopathy (HFCC) differs from failure with other etiologies because of the occurrence of intense inflammatory infiltrate and right ventricle compromise. This article investigates correlations of B-type natriuretic peptide (BNP) levels with parameters of severity in HFCC. Twenty-eight patients and 8 normal controls underwent heart catheterization and clinical and laboratory analyses. BNP levels were higher in patients with HFCC (P<.0001) and correlated with New York Heart Association (NYHA) class; right atrial pressure; wedge pressure; cardiac output; levels of serum sodium, hemoglobin, urea, and tumor necrosis factor-,; and ejection fraction. Interferon-, and transforming growth factor-, did not correlate with BNP level. The authors conclude that BNP levels are elevated in patients experiencing HFCC, irrespective of NYHA class, and that the occurrence of HFCC correlates with severity of disease. [source] Brain Natriuretic Peptide Levels and Response to Cardiac Resynchronization Therapy in Heart Failure PatientsCONGESTIVE HEART FAILURE, Issue 5 2006Reynolds M. Delgado MD The authors used brain natriuretic peptide (BNP) as a reliable marker to identify nonresponders to cardiac resynchronization therapy (CRT) in patients with advanced heart failure. The study included 70 patients with left ventricular dysfunction (mean ejection fraction, 21±4%) and left bundle branch block (QRS duration, 164±25 milliseconds) treated with CRT. The authors reviewed data on New York Heart Association functional class, baseline ejection fraction, sodium, creatinine, QRS duration, and BNP levels 3 months before and after CRT therapy. The authors compared results of 42 patients who survived (973+192 days) after CRT implantation (responders) to those of 28 patients (nonresponders) who either expired (n=21) or underwent heart transplantation (n=5) or left ventricular assist device implantation (n=2) after an average of 371+220 days. Mean BNP levels after 3 months of CRT decreased in responders from 758±611 pg/mLto 479±451 pg/mL (P=.044), while in nonresponders there was increase in BNP levels from 1191 ±466 pg/mL to 1611 ±1583; P=.046. A rise in BNP levels was associated with poor response (death or need for transplantation or left ventricular assist device and impaired long-term outcome), which makes it a good predictor to identify such patients. [source] Usefulness of B-Type Natriuretic Peptide as a Predictor of Treatment Outcome in Pulmonary Arterial HypertensionCONGESTIVE HEART FAILURE, Issue 5 2004Myung H. Park MD We examined the utility of early modulation B-type natriuretic peptide (BNP) levels in 20 pulmonary arterial hypertension patients as a marker of response to epoprostenol therapy. The baseline BNP level was 828±217 pg/mL. A total of 19 hospitalizations and one death occurred in nine patients during 11.0±1.8 months. At baseline, a trend toward higher BNP level was observed among the event-free (Group A) as compared with clinical event patients (Group B) (1090±372 vs. 510±235 pg/mL, respectively; p=0.08). After 3 months on epoprostenol, a significant reduction among Group A occurred while Group B demonstrated an increase (288±92 vs. 610±121 pg/mL, p=0.04). A comparison of percent reduction in BNP level demonstrated a ,70±7% change among Group A and an 11±19% increase in Group B (p=0.005). A decrease in BNP level of ,50% during the first 3 months on epoprostenol was strongly predictive of event-free survival (p=0.003). This investigation establishes the utility of BNP for predicting response to epoprostenol therapy in pulmonary arterial hypertension. [source] BNP Consensus Panel 2004: A Clinical Approach for the Diagnostic, Prognostic, Screening, Treatment Monitoring, and Therapeutic Roles of Natriuretic Peptides in Cardiovascular DiseasesCONGESTIVE HEART FAILURE, Issue 2004Marc A. Silver MD Among the most exciting developments in the field of heart failure in recent times has been the rediscovery of the natriuretic peptide system and its pleuripotent effects on cardiac structure and function. This is particularly true of its natriuretic and hemodynamic effects. There has been an explosion of the knowledge base seeking to understand the wide range of homeostatic, regulatory, and counter-regulatory functions in which the natriuretic peptide system participates. Additional interest has been stimulated by advances in technology such as point-of-care and core laboratory BNP assays and the use of the recombinant B-type natriuretic peptide nesiritide as a treatment option. Despite this recent interest, the available literature lacks a comprehensive expert review of the current science and roles of natriuretic peptides for diagnostic, prognostic, screening, treatment monitoring, and therapeutic purposes. More importantly, a summary updating and guiding the clinician on most of these advances was lacking. An expert Consensus Panel with basic, methodological, and clinical expertise was convened to summarize current knowledge in these areas and the findings and consensus statements are contained herein. [source] Combination of B-Type Natriuretic Peptide Levels and Non-Invasive Hemodynamic Parameters in Diagnosing Congestive Heart Failure in the Emergency DepartmentCONGESTIVE HEART FAILURE, Issue 4 2004Erin Barcarse BS This study aimed to assess whether the combination of a B-type natriuretic peptide (BNP) level with various noninvasive hemodynamic parameters can help physicians more quickly and accurately diagnose congestive heart failure and determine the type of left ventricular dysfunction present in patients presenting to the emergency department with dyspnea. Subjects were 98 men (aged 64.57±1.23 years) that presented to the VA San Diego Healthcare System. Hemodynamic parameters were measured using impedance cardiography, and BNP levels were quantified using a rapid immunoassay. All patients with a BNP <100 pg/mL (n=37) had no evidence of congestive heart failure 97% of the time. In those with a BNP >100 pg/mL (601 ±55 pg/mL; n=61), a cardiac index of 2.6 L/min/m2 is 65% sensitive and 88% specific in determining systolic dysfunction. In patients with a BNP >100 pg/mL, a multivariate model consisting of noninvasive hemodynamic measurements was able to predict cardiac deaths, readmissions, and emergency department visits within 90 days with 83% accuracy. The authors conclude that, in patients presenting to an emergency department with dyspnea, the addition of impedance cardiography measurements to BNP level measurements will more effectively diagnose congestive heart failure and determine both the type of heart dysfunction and the severity of illness. [source] Cardiac natriuretic peptides and continuously monitored atrial pressures during chronic rapid pacing in pigsACTA PHYSIOLOGICA, Issue 2 2000Changes in atrial natriuretic peptide (ANP), N-terminal proatrial natriuretic peptide and brain natriuretic peptide (BNP) were evaluated in relation to continuously monitored atrial pressures in a pacing model of heart failure. Pigs were subjected to rapid atrial pacing (225 beats min,1) for 3 weeks with adjustments of pacing frequencies if the pigs showed overt signs of cardiac decompensation. Atrial pressures were monitored by a telemetry system with the animals unsedated and freely moving. Left atrial pressure responded stronger and more rapidly to the initiation of pacing and to alterations in the rate of pacing than right atrial pressure. Plasma natriuretic peptide levels were measured by radioimmunoassay and all increased during pacing with BNP exhibiting the largest relative increase (2.9-fold increase relative to sham pigs). Multiple regression analysis with dummy variables was used to evaluate the relative changes in natriuretic peptides and atrial pressures and the strongest correlation was found between BNP and left atrial pressure with R,2=0.81. Termination of pacing resulted in rapid normalization of ANP values in spite of persistent elevations in atrial pressures. This may reflect an increased metabolism or an attenuated secretory response of ANP to atrial stretch with established heart failure. In conclusion, 3 weeks of rapid pacing induced significant increases in atrial pressures and natriuretic peptide levels. All the natriuretic peptides correlated with atrial pressures with BNP appearing as a more sensitive marker of cardiac filling pressures than ANP and N-terminal proatrial natriuretic peptide. [source] Diagnostic utility of brain-natriuretic peptide for left ventricular diastolic dysfunction in asymptomatic type 2 diabetic patientsDIABETES OBESITY & METABOLISM, Issue 3 2007M. Shimabukuro Aim:, Left ventricular (LV) diastolic dysfunction has been reported to be prevalent in diabetic subjects, but this recognition could often be missed. We evaluated prevalence of LV diastolic dysfunction and diagnostic utility of brain-natriuretic peptide (BNP) in asymptomatic patients with type 2 diabetes mellitus. Research design and methods:, Plasma BNP levels and LV geometry and diastolic filling indices, including the ratio of peak early transmitral Doppler flow (E) over flow propagation velocity (Vp) measured by colour M-mode Doppler echocardiography, were analysed in 98 consecutive asymptomatic patients with type 2 diabetes mellitus and 51 age-matched controls. Results:, The LV mass index and relative wall thickness were higher in diabetic groups than controls without any differences in LV systolic function. The frequency of diastolic dysfunction defined as E/Vp , 1.5 were 31% in diabetic groups and 15% in controls (,2 = 4.364, p = 0.037). By receiver-operating characteristic (ROC) curve analysis, a BNP cutoff value of 19.2 pg/ml in controls had a 53.1% positive predictive value (53.1%) and a high negative predictive value (94.4%) for E/Vp , 1.5, whereas a BNP cutoff value of 18.1 pg/ml in diabetic groups had a 61.8% positive and 97.3% negative predictive values. Conclusions:, The frequency of E/Vp , 1.5 was higher in asymptomatic diabetic patients, suggesting that LV diastolic dysfunction was prevalent. The plasma concentration of BNP could be used to depict LV diastolic dysfunction in such population. [source] miR133a regulates cardiomyocyte hypertrophy in diabetesDIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue 1 2010Biao Feng Abstract Background Diabetic cardiomyopathy, characterized by cardiac hypertrophy and contractile dysfunction, eventually leads to heart failure. We have previously shown that alterations of a number of key molecules are involved in producing cardiomyocyte hypertrophy in diabetes. The aim of the present study was to determine whether microRNAs (miRNA) play a role in mediating altered gene expression and structural/functional deficits in the heart in diabetes. Methods STZ-induced diabetic mice were haemodynamically investigated after 2 months of diabetes to establish the development of cardiomyopathy. The tissues were then examined for gene expression and microRNA analysis. We further investigated neonatal rat cardiomyocytes to identify the mechanisms of glucose-induced hypertrophy and the potential role of miR133a. Results Diabetic mice showed myocardial contractile dysfunction and augmented mRNA expression of atrial and brain natriuretic peptides (ANP, BNP), MEF2A and MEF2C, SGK1 and IGF1R compared to age- and sex-matched controls. Cardiac tissues from these mice showed alteration of multiple miRNAs by array analysis including miR133a, which was confirmed by RT-PCR. In vitro exposure of cardiomyocytes to high levels of glucose produced hypertrophic changes and reduced expression of miRNA133a. Finally, transfection of miR133a mimics prevented altered gene expression and hypertrophic changes. Conclusion Data from these studies demonstrate a novel glucose-induced mechanism regulating gene expression and cardiomyocyte hypertrophy in diabetes which is mediated through miR133a. Copyright © 2009 John Wiley & Sons, Ltd. [source] Evaluation of Right Ventricular Function by Using Tissue Doppler Imaging in Patients after Repair of Tetralogy of FallotECHOCARDIOGRAPHY, Issue 8 2009lker Çetin M.D. Background: The aim of this study was to assess the relation between plasma B-type natriuretic peptide (BNP) levels and right ventricular function evaluated by tissue Doppler imaging (TDI) in patients after repair of tetralogy of Fallot (ToF). Methods: Twenty-five patients with a mean age of 14.1 ± 4.4 years who underwent repair of ToF at a mean age of 4.9 ± 5.1 years enrolled in this study. The control group consisted of 29 healthy children at a mean age of 13.1 ± 2.8 years. The right ventricle and pulmonary regurgitation (PR) were assessed by two-dimensional echocardiography and color Doppler. Blood samples for BNP levels were taken and TDI was performed at rest. Results: Plasma BNP levels were significantly higher in patients than in controls (28.3 ± 24.1 vs. 7.4 ± 2.3 pg/mL, P = 0.0001). The myocardial performance index (MPI) (1.08 ± 0.35 vs. 0.58 ± 0.11, P = 0.0001) was higher and isovolumic acceleration (IVA) (3.1 ± 0.7 vs. 5.4 ± 1.0 m/s2, P = 0.0001) was lower in patients. The correlations were also significant between the degree of PR and MPI (r = 0.7, P = 0.0001) and also IVA (r =,0.7, P = 0.0001). The correlations were also significant between the BNP level and MPI (r = 0.6, P = 0.0001), IVA (r =,0.4, P = 0.002) and the degree of PR (r = 0.6, P = 0.0001). Conclusion: As a result, plasma BNP level increases in patients with ToF and both MPI and IVA from the right ventricular basal segments might be used to assess the right ventricular function. [source] Correlation between NT-pro BNP Levels and Early Mitral Annulus Velocity (E,) in Patients with Non,ST-Segment Elevation Acute Coronary SyndromeECHOCARDIOGRAPHY, Issue 4 2008Marcia M. Barbosa M.D., Ph.D. Acute coronary syndromes in the absence of ST-segment elevation (NSTE-ACS) are a heterogeneous entity in which early risk stratification is essential. Diastolic dysfunction is precocious and associated with poor prognosis. BNP has been recognized as a biochemical marker of ventricular dysfunction and ischemia. Objective: To investigate if there is correlation of NT pro-BNP levels with diastolic dysfunction in patients with NSTE-ACS. Methods: Fifty-two patients with NSTE-ACS admitted to the coronary unit were included. NT-pro brain natriuretic hormone (BNP) levels and a Doppler echocardiogram were obtained in all and systolic and diastolic functions were analyzed. Their Doppler indexes were compared with those of 53 age- and sex-matched controls, without heart failure symptoms and with normal ejection fraction (EF) and normal NT-pro BNP levels. Results: Twenty-four patients (46%) with unstable angina and 28 patients (54%) with acute myocardial infarction (AMI) were included. Mean EF was 55.9 ± 10.7% and mean NT-pro BNP level was 835 ± 989 pg/ml. No mitral or pulmonary venous flow parameters of diastolic function correlated with NT-pro BNP levels. E,/A, correlated with NT-pro BNP level in univariate analysis but, in a multivariate analysis, only the EF and the E, showed negative correlation with the peptide level (r =,0.33, P = 0.024 and r =,0.29, P = 0.045, respectively). Thirteen patients presented with stage II diastolic dysfunction but the NT-pro BNP level in these patients did not differ from the level in stage I patients. Conclusion: NT-pro BNP levels are elevated in acute coronary syndromes, even in the absence of significant necrosis. Of all echocardiographic parameters investigated, only E, and the EF correlated with the levels of NT-pro BNP in this group of patients. [source] Accuracy of Tissue Doppler Echocardiography in the Diagnosis of New-Onset Congestive Heart Failure in Patients with Levels of B-Type Natriuretic Peptide in the Midrange and Normal Left Ventricular Ejection FractionECHOCARDIOGRAPHY, Issue 8 2006Stephane Arques M.D. Background: Based on the hypothesis that it reflects left ventricular (LV) diastolic pressures, B-type natriuretic peptide (BNP) is largely utilized as first-line diagnostic complement in the emergency diagnosis of congestive heart failure (HF). The incremental diagnostic value of tissue Doppler echocardiography, a reliable noninvasive estimate of LV filling pressures, has been reported in patients with preserved LV ejection fraction and discrepancy between BNP levels and the clinical judgment, however, its clinical validity in such patients in the presence of BNP concentrations in the midrange, which may reflect intermediate, nondiagnostic levels of LV filling pressures, is unknown. Methods: 34 patients without history of HF, presenting with acute dyspnea at rest, BNP levels of 100,400 pg/ml and normal LV ejection fraction were prospectively enrolled (17 with congestive HF and 17 with noncardiac cause). Tissue Doppler echocardiography was performed within 3 hours after admission. Results: unlike BNP (P = 0.78), Boston criteria (P = 0.0129), radiographic pulmonary edema (P = 0.0036) and average E/Ea ratio (P = 0.0032) were predictive of congestive HF by logistic regression analysis. In this clinical setting, radiographic pulmonary edema had a positive predictive value of 80% in the diagnosis of congestive HF. In patients without evidence of radiographic pulmonary edema, average E/Ea > 10 was a powerful predictor of congestive HF (area under the ROC curve of 0.886, P < 0.001, sensitivity 100% and specificity 78.6%). Conclusion: by better reflecting LV filling pressures, bedside tissue Doppler echocardiography accurately differentiates congestive HF from noncardiac cause in dyspneic patients with intermediate, nondiagnostic BNP levels and normal LV ejection fraction. [source] Enantioselectivity of alcohol-modified polymeric surfactants in micellar electrokinetic chromatographyELECTROPHORESIS, Issue 15 2003Jepkoech Tarus Abstract A novel method of modifying sodium undecanoyl- L -leucinate (SUL) micelles employed in chiral separation of analytes in micellar electrokinetic chromatography (MEKC) to enhance selectivity toward specific analytes is discussed. The current study aimed at modifying the SUL micelles by introducing different alcohols into the mono-SUL micelles. The micellar solutions were then polymerized in the presence of alcohols followed by postpolymerization extraction of the alcohols to yield alcohol-free polymeric surfactants (poly- L -SUL). The effects of hexanol (C6OH) and undecylenyl alcohol (C11OH) on micellar properties of this surfactant were investigated by use of surface tensiometry, fluorescence spectroscopy, pulsed field gradient-nuclear magnetic resonance (PFG-NMR), and MEKC. The surface tension and PFG-NMR studies indicated an increase in the critical micelle concentration (cmc) and micellar size upon increasing the alcohol concentration. Fluorescence measurements suggested that alcohols induce closely packed micellar structures. Coumarinic and benzoin derivatives, as well as (±)-1, 1'-binaphthyl-2,2'-dihydrogen phosphate (BNP) were used as test analytes for MEKC experiments. Examination of MEKC data showed remarkable resolutions and capacity factors of coumarinic derivatives obtained with modified poly- L -SUL as compared to the unmodified poly- L -SUL. Evaluation of fluorescence, PFG-NMR, and MEKC data suggest a strong correlation between the polarity and hydrodynamic radii of alcohol-modified micelles and the resolution of the test analytes. [source] B-type natriuretic peptide in the diagnosis of heart failure in the emergency departmentEMERGENCY MEDICINE AUSTRALASIA, Issue 2 2006Robert Chircop Abstract B-type natriuretic peptide (BNP) is increasingly being used as a diagnostic marker in the diagnosis of heart failure. Here we evaluate the evidence base for its utility in the ED. Clinical trials suggest that it is more accurate than clinical acumen especially when emergency physicians have diagnostic problems. BNP appears more accurate than any clinical findings or radiological signs. In conjunction with considered clinical judgement, knowledge of its limitations and variable cut-off points, BNP can be of considerable utility to the emergency physician. [source] Long-term prognostic value of B-type natriuretic peptide in cardiac and non-cardiac causes of acute dyspnoeaEUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 11 2007M. Christ Abstract Background, B-type natriuretic peptide (BNP) levels significantly predict increased risk of death in heart failure. The predictive role of BNP levels in patients with non-cardiac causes of acute dyspnoea presenting to the emergency department is not well characterized. Materials and methods, The B-type natriuretic peptide for Acute Shortness of Breath EvaLuation (BASEL) study enrolled consecutive patients with acute dyspnoea. Results, Cumulative mortality was 14·8%, 33·1% and 51·9% in 452 patients (age: 19,97 years; 58% male) within low (< 100 pg mL,1), intermediate (100,500 pg mL,1) and high (> 500 pg mL,1) BNP plasma levels at 18 months of follow-up. BNP classes (point estimate: 1·55, 95%CI: 1·19,2·03, P = 0·001) in addition to age, increased heart rate and diuretic use emerged as significant predictors for long-term mortality in multivariable Cox regression analyses. The BNP concentration alone had an area under the receiver operating characteristic curve of 0·71 (95%CI: 0·66,0·76; P < 0·001) for predicting 18 months mortality. BNP plasma levels independently predicted long-term risk of death in patients with non-cardiac (point estimate: 1·72, 95%CI: 1·16,2·56; P = 0·007) and with cardiac causes of acute dyspnoea (point estimate: 2·21, 95%CI: 1·34,3·64; P = 0·002). Conclusions, BNP levels are strong and independent predictors for long-term mortality in unselected dyspnoeic patients presenting to the emergency department independent from the cause of dyspnoea. [source] Heart specific up-regulation of genes for B-type and C-type natriuretic peptide receptors in diabetic miceEUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 2 2006C. Christoffersen Abstract Background, Diabetes may cause cardiomyopathy characterized by cardiac fibrosis. Recent studies of genetically modified mice have elucidated a role of the natriuretic peptides (NP), type-A and type-B (ANP and BNP), and their common receptor [natriuretic peptide receptor (NPR), type-A] in development of cardiac fibrosis. The role of NP type-C (CNP) and NPR type-B (NPR-B) in the heart is less well established. In this study we examined if diabetes alters heart expression of the genes encoding the NP and its receptors. Materials and methods, Cardiac mRNA was quantified by real-time PCR in diabetic streptozotocin (STZ)-treated and ob/ob- mice and nondiabetic control mice. Results, The ob/ob -mice with type-II diabetes displayed highly significant increases of the cardiac mRNA expression of NPR-B and NPR-C while the expression levels of NPR-A, ANP, BNP, and CNP mRNA were similar in ob/ob -mice and controls. Mice with STZ-induced type-I diabetes also showed an increase of heart NPR-B mRNA expression at 12 weeks, but not at 3, 6 or 9 weeks after STZ-treatment. The ANP and NPR-C mRNA expressions were only altered after 3 weeks, whereas BNP, CNP and NPR-A mRNA expressions were not altered in STZ-treated-mouse hearts at any of the time points. Conclusions, The results show that diabetes in mice confers increased NPR-B gene expression in the heart, suggesting that increased NPR-B signalling may affect development of diabetic cardiomyopathy. [source] BNP and N-terminal proBNP are both extracted in the normal kidneyEUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 1 2006J. P. Goetze Abstract Background, Increased plasma concentrations of cardiac-derived B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (proBNP) are both associated with left ventricular dysfunction. Information on the regional elimination of the peptides is, however, still scarce. We therefore examined the renal and peripheral extraction of N-terminal proBNP and BNP. Materials and methods, The study comprised 18 patients with essential arterial hypertension, 51 with cirrhosis, and 18 control patients without kidney or liver disease. All patients underwent a haemodynamic investigation with catheterization of the femoral artery and femoral and renal veins. Blood sampling from the catheters allowed determination of the arteriovenous extraction ratio of N-terminal proBNP and BNP. Results, Neither the peripheral N-terminal proBNP (13, 11, 19 pmol L,1, NS) nor the BNP plasma concentrations (4, 12, 9 pmol L,1, NS) differed between the patient groups. In addition, similar renal extractions were observed in the groups. The renal extraction of N-terminal proBNP (0·16) was not different from that of BNP (0·16). In contrast, the N-terminal proBNP extraction in the lower extremity was markedly lower compared with BNP (0·00 vs. 0·125, P = 0·007). Conclusions, A comparable renal elimination of N-terminal proBNP and BNP is contrasted by a selective extraction of BNP in the lower extremity. Our results suggest a different elimination mechanism in the renal and peripheral circulation, which partly may explain the higher N-terminal proBNP compared with BNP concentrations in normal plasma. [source] Brain natriuretic peptide in the prediction of recurrence of angina pectorisEUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 2 2004H. Takase Abstract Background, Circulating levels of brain natriuretic peptide (BNP) provide prognostic information for patients with heart failure, but little is known about its prognostic usefulness in patients with stable angina pectoris. We investigated whether BNP could be used as a marker for the prediction of anginal recurrence after successful treatment. Design, Brain natriuretic peptide levels of 77 patients with stable angina pectoris were measured at enrolment and after confirmation of successful treatment (i.e. no anginal attack for at least 6 months: chronic phase) with percutaneous transluminal coronary angioplasty and/or conventional medication. Then, we prospectively followed them up for 25·9 ± 1·4 months, with the endpoint being a recurrence of anginal attacks. Results, An anginal attack recurred in seven patients. In patients without recurrence, BNP levels in the chronic phase (21 ± 12 [median ± median absolute deviation] pg mL,1) were lower than those measured at enrolment (46 ± 25 pg mL,1, P < 0·0001), whereas the levels in patients with recurrence increased during the same period (from 36 ± 16 to 72 ± 42 pg mL,1, P < 0·05). A univariate analysis revealed that the BNP level measured in the chronic phase was the significant predictor of future anginal recurrence. Analysis of the receiver operating characteristic curve indicated that the cutoff level of BNP in the chronic phase was 68 pg mL,1. The Kaplan-Meier method revealed that the incidence of anginal recurrence was higher in patients with higher (71·4%) than lower levels of BNP (2·9%; P < 0·0001). Conclusions, Measurement of BNP levels after successful therapy is clinically useful for the prediction of recurrence of anginal attacks in patients with angina pectoris. [source] Remote myocardium gene expression after 30 and 120 min of ischaemia in the ratEXPERIMENTAL PHYSIOLOGY, Issue 2 2006Miguel S. Guerra The aim of the present study was to investigate how early the onset of ischaemia-induced changes in gene expression is in remote myocardium, and whether these changes would be different for left and right ventricles. Wistar rats (n= 27) were randomly assigned to left coronary artery (LCA) ligation for 30 or 120 min and sham groups. Evans Blue infusion revealed antero-apical left ventricle (LV) and left intraventricular (IV) septal ischaemia (35.5 ± 0.6% of LV mass). LCA ligation induced transient LV systolic dysfunction and sustained biventricular slowing of relaxation. Regarding mRNA levels, type B natriuretic peptide (BNP) was upregulated in the LV at 30 (+370 ± 191%) and 120 min (+221 ± 112%), whilst in the right ventricle (RV) this was only significant at 120 min (+128 ± 39%). Hipoxia-inducible factor 1, and interleukin 6 overexpression positively correlated with BNP. Inducible NO synthase upregulation was present in both ventricles at 120 min (LV, +327 ± 195%; RV, +311 ± 122%), but only in the RV at 30 min (+256 ± 88%). Insulin-like growth factor 1 increased in both ventricles at 30 (RV, +59 ± 18%; LV, +567 ± 192%) and 120 min (RV, +69 ± 33%; LV, +120 ± 24%). Prepro-endothelin-1 was upregulated in the RV at 120 min (+77 ± 25%). Ca2+ -handling proteins were selectively changed in the LV at 120 min (sarcoplasmic reticulum Ca2+ ATPase, 53 ± 7%; phospholamban, +31 ± 4%; Na+,Ca2+ exchanger, 31 ± 6%), while Na+,H+ exchanger was altered only in the RV (,79 ± 5%, 30 min; +155 ± 70%, 120 min). Tumour necrosis factor-, and angiotensin converting enzyme were not significantly altered. A very rapid modulation of remote myocardium gene expression takes place during myocardial ischaemia, involving not only the LV but also the RV. These changes are different in the two ventricles and in the same direction as those observed in heart failure. [source] Vascular and renal actions of brain natriuretic peptide in man: physiology and pharmacologyFUNDAMENTAL & CLINICAL PHARMACOLOGY, Issue 4 2005Alphons J.H.M. Houben Abstract During the last decade brain natriuretic peptide (BNP) has received increasing attention as a potential marker of cardiovascular disease. BNP may act as a compensating mechanism in cardiovascular diseases in order to reduce preload. However, the increase in endogenous BNP is often not sufficient to compensate for volume overload in diseases like established hypertension and heart failure. The reported hemodynamic and renal effects of BNP in man differ largely between studies, because of differences in design and doses of BNP employed. In the pharmacological range, BNP has clear blood pressure and afterload lowering effects, and in the kidney blood flow and filtration is increased with concomitant natriuresis and diuresis. While in the physiological range BNP does not affect blood pressure and reduces preload only, and induces natriuresis/diuresis without changes in renal blood flow and filtration. There is increasing evidence from vascular studies that BNP preferentially acts on the venous system resulting in preload reduction, in contrast to atrial natriuretic peptide which acts preferentially on the arterial system to reduce afterload. This review summarizes our current understanding of BNP, and discuss its regulation and mechanisms of action on the vasculature and the kidneys. [source] An evaluation of blood volume changes during ultrafiltration pulses and natriuretic peptides in the assessment of dry weight in hemodialysis patientsHEMODIALYSIS INTERNATIONAL, Issue 1 2007Anouk C. M. VAN DE POL Abstract Changes in blood volume (BV) during dialysis as well as plasma levels of brain natriuretic peptide (BNP) and N-terminal (NT) pro-BNP levels are possible tools to assess dry weight in hemodialysis (HD) patients. The aim of the study was to compare these parameters with other non-invasive techniques used to assess dry weight in HD patients, and to study their relation with intradialytic hypotension (IDH) and the presence of cardiovascular disease BV changes during HD, both during regular dialysis and during an ultrafiltration pulse, plasma levels of NT pro-BNP and BNP, and vena cava diameter index (VCDI) were assessed in a cohort of 66 HD patients, which was subdivided according to tertiles of total body water (TBW) corrected for body weight, assessed by bioimpedance analysis. Parameters were also related to the presence of IDH and history of cardiovascular disease. The decline in BV during regular dialysis and during an ultrafiltration pulse, as well as VCDI and BNP were significantly different between the tertiles of normalized TBW, but refill after the ultrafiltration pulse and NT pro-BNP were not. Only VCDI and the decline in BV during regular dialysis were significantly different between patients with or without IDH. Vena cava diameter index, BNP, and NT pro-BNP were significantly higher in patients with cardiovascular disease. Using bioimpedance as the reference method, changes in BV, either during regular dialysis or during an ultrafiltration pulse, as well as VCDI and BNP are all indicative of hydration state in dialysis patients, but refill after an ultrafiltration pulse is not. Only VCDI and BV changes were related to IDH. The presence of cardiovascular disease appears to influence both VCDI as well as BNP. [source] Brain natriuretic peptide and the athlete's heart: a pilot studyINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 4 2010E. D. Pagourelias Background:, The role of brain natriuretic peptide (BNP) in differentiating the athlete's heart from maladaptive cardiac hypertrophy is unclear. Methods:, To address this issue, an integrated M mode, two-dimensional B mode and Doppler echocardiographical study were performed and plasma BNP levels were measured in 25 strength athletes, 25 patients with established hypertrophic cardiomyopathy (HCM) and 25 healthy volunteers. Results:, Among athletes, BNP levels correlated negatively with the total training time (r = ,0.79, p = 0.002) and positively with ejection fraction (r = 0.58, p = 0.049) and fractional shortening (r = 0.57, p = 0.049). A BNP cut-off value of 11.8 pg/ml had 88% specificity and 74% negative predictive value for the exclusion of HCM. Conclusions:, Brain natriuretic peptide might be useful as a preparticipation screening test in athletes. [source] An obesity drug sibutramine reduces brain natriuretic peptide (BNP) levels in severely obese patientsINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 4 2010D. Taner Ertugrul Summary Objectives:, Sibutramine is a selective inhibitor of the reuptake of monoamines. Plasma levels of brain natriuretic peptide (BNP) appear to be inversely associated with body mass index (BMI) in subjects with and without heart failure for reasons that remain unexplained. The aim of this study was to investigate the possible influence of sibutramine treatment on BNP levels in severely obese patients. Methods:, Fifty-two severely obese female patients with BMI > 40 kg/m2 were included to this study. The women were recommended to follow a weight-reducing daily diet of 25 kcal/kg of ideal body weight. During the treatment period, all patients were to receive 15 mg of sibutramine once a day. Blood chemistry tests were performed before the onset of the medication and after 12 weeks of treatment. Results:, None of the subjects was withdrawn from the study because of the adverse effects of sibutramine. Body weight (108.8 ± 13.3 kg vs. 101.7 ± 15.6 kg, p < 0.001), BMI (44.6 ± 4.6 kg/m2 vs. 41.8 ± 5.7 kg/m2, p < 0.001) and BNP [8.6 (0.5,49.5) ng/l vs. 3.1 (0.2,28.6) ng/l, p = 0.018] levels were significantly decreased after 12 weeks of sibutramine treatment. Total cholesterol (5.19 ± 0.90 mmol/l vs. 4.82 ± 1.05 mmol/l respectively; p < 0.001), low-density lipoprotein-cholesterol (3.26 ± 0.86 mmol/l vs. 2.99 ± 0.40 mmol/l respectively; p = 0.008), levels were significantly decreased; however, there was no significant alteration in high-density lipoprotein-cholesterol and triglyceride levels. Conclusion:, This study has shown a decrease in BNP levels which may lead to improvement in cardiac outcome after sibutramine treatment. Further randomised studies are needed to be conducted to clarify the relationship between sibutramine and BNP. [source] B-type natriuretic peptide as an indicator of right ventricular dysfunction in acute pulmonary embolism,INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 8 2008T. Yardan Summary Objective:, B-type natriuretic peptide (BNP) is a neurohormone secreted from cardiac ventricles in response to ventricular strain. The aim of present study was to evaluate the role of BNP in the diagnosis of the right ventricular (RV) dysfunction in acute pulmonary embolism (PE). Methods:, BNP levels were measured in patients with acute PE as diagnosed by high probability lung scan or positive spiral computed tomography. All patients underwent standard echocardiography and blood tests during the second hour of the diagnosis. Results:, Forty patients diagnosed as acute PE (mean age, 60.4 ± 13.2 years; 62.5% women) were enrolled in this study. Patients with RV dysfunction had significantly higher BNP levels than patients without RV dysfunction (426 ± 299.42 pg/ml vs. 39.09 ± 25.22 pg/ml, p < 0.001). BNP-discriminated patients with or without RV dysfunction (area under the receiver operating characteristic curve, 0.943; 95% CI, 0.863,1.022). BNP > 90 pg/ml was associated with a risk ratio of 165 (95% CI, 13.7,1987.2) for the diagnosis of RV dysfunction. There was a significant correlation between RV end-diastolic diameter and BNP (r = 0.89, p < 0.001). Sixteen patients (40%) were diagnosed as having low-risk PE, 19 patients (47.5%) with submassive PE and five patients (12.5%) with massive PE. The mean BNP was 39.09 ± 25.2, 378.4 ± 288.4 and 609.2 ± 279.2 pg/ml in each group respectively. Conclusion:, Measurement of BNP levels may be a useful approach in diagnosis of RV dysfunction in patients with acute PE. The possibility of RV dysfunction in patients with plasma BNP levels > 90 pg/ml should be strongly considered. [source] The clinical value of rapid assay for plasma B-type natriuretic peptide in differentiating congestive heart failure from pulmonary causes of dyspnoeaINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 2 2008S.-Q. Zhao Summary Background:, B-type natriuretic peptide (BNP) is a cardiac neurohormone secreted from the cardiac ventricles in response to pressure overload. Objective:, To evaluate the optimal cutoff point of plasma BNP in diagnosing congestive heart failure (CHF). Methods:, We conducted a prospective study of 195 patients who were hospitalised with dyspnoea. Pulmonary capillary wedge pressure (PCWP) was measured with a Swan-Ganz catheterisation and plasma BNP level was obtained by a rapid immunofluorescence assay in all patients. PCWP > 12 mmHg was chosen as the golden standard for left ventricular dysfunction in this study. The subjects were divided into two groups by the criteria, one group with dyspnoea caused by CHF (n = 134) and the other caused by lung diseases (n = 61). Results:, (1) BNP cutoff point of 100 pg/ml had a sensitivity of 94.34%, a specificity of 92.13% and an accuracy of 93.33% for differentiating CHF from pulmonary dyspnoea. (2) By multiple logistic-regression analysis, measurements of BNP added significantly independent predictive power to other clinical variables in models predicting which patients had CHF. Conclusion:, A value of 100 pg/ml or more for a rapid BNP assay may be the most accurate independent predictor of the presence or absence of CHF. [source] Xenon and isoflurane improved biventricular function during right ventricular ischemia and reperfusionACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2010M. HEIN Background: Although anesthetics have some cardioprotective properties, these benefits are often counterbalanced by their negative inotropic effects. Xenon, on the other hand, does not influence myocardial contractility. Thus, xenon may be a superior treatment for the maintenance of global hemodynamics, especially during right ventricular ischemia, which is generally characterized by a high acute complication rate. Methods: The effects of 70 vol% xenon and 0.9 vol% isoflurane on biventricular function were assessed in a porcine model (n=36) using the conductance catheter technique, and the expression of the type B natriuretic peptide (BNP) gene was measured. The animals underwent 90 min of right ventricular ischemia followed by 120 min of reperfusion. A barbiturate-anesthetized group was included as a control. Results: Cardiac output was compromised in unprotected animals during ischemia by 33±18% and during reperfusion by 53±17%. This was mainly due to impaired contractility in the left ventricle (LV) and increased stiffness. Isoflurane attenuated the increase in stiffness and resulted in a higher preload. In contrast, xenon increased the right ventricular afterload, which was compensated by an increase in contractility. Its effects on diastolic function were less pronounced. Upregulation of BNP mRNA expression was impeded in the remote area of the LV by both isoflurane and xenon. Conclusions: Xenon and isoflurane demonstrated equipotent effects in preventing the hemodynamic compromise that is induced by right ventricular ischemia and reperfusion, although they acted through somewhat differential inotropic and vasodilatory effects. [source] B-Type Natriuretic Peptide Is Associated with Mortality in Older Functionally Impaired PatientsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 11 2005Miles D. Witham BM Objectives: To determine the predictive power of B-type natriuretic peptide (BNP) regarding death in older, functionally impaired patients with multiple comorbidity. Design: Prospective cohort study. Setting: Specialist geriatric assessment clinic and day hospital. Participants: Two hundred ninety-nine older, functionally impaired patients, mean age 79 at enrollment. Measurements: Full clinical history and examination, baseline BNP, and echocardiography. Date and cause of death were ascertained from Scottish death records. Kaplan-Meier survival curves were constructed for quartiles of log (BNP), and the contribution of BNP to prediction of death was investigated. Results: The follow-up period ranged from 3.9 to 5.2 years (mean 4.4 years). BNP was a powerful independent predictor of all-cause and cardiovascular mortality. BNP was a more powerful predictor than blood pressure, diabetes mellitus, smoking, echocardiographic left ventricular hypertrophy, left ventricular systolic dysfunction, or age. BNP predicted death in those with and without a previous cardiovascular event at baseline. Conclusion: BNP has significant predictive power for death in older, functionally impaired patients. [source] B-type natriuretic peptide and extracellular matrix protein interactions in human cardiac fibroblastsJOURNAL OF CELLULAR PHYSIOLOGY, Issue 1 2010Brenda K. Huntley Cardiac fibroblasts (CFs) regulate myocardial remodeling by proliferating, differentiating, and secreting extracellular matrix (ECM) proteins. B-type natriuretic peptide (BNP) is anti-fibrotic, inhibits collagen production, augments matrix metalloproteinases, and suppresses CF proliferation. Recently, we demonstrated that the ECM protein fibronectin (FN) augmented production of BNP's second messenger, 3,, 5, cyclic guanosine monophosphate (cGMP) in CFs, supporting crosstalk between FN, BNP, and its receptor, natriuretic peptide receptor A (NPR-A). Here, we address the specificity of FN to augment cGMP generation by investigating other matrix proteins, including collagen IV which contains RGD motifs and collagen I and poly- L -lysine, which have no RGD domain. Collagen IV showed increased cGMP generation to BNP similar to FN. Collagen I and poly- L -lysine had no effect. As FN also interacts with integrins, we then examined the effect of integrin receptor antibody blockade on BNP-mediated cGMP production. On FN plates, antibodies blocking RGD-binding domains of several integrin subtypes had little effect, while a non-RGD domain interfering integrin ,v,3 antibody augmented cGMP production. Further, on uncoated plates, integrin ,v,3 blockade continued to potentiate the BNP/cGMP response. These studies suggest that both RGD containing ECM proteins and integrins may interact with BNP/NPR-A to modulate cGMP generation. J. Cell. Physiol. 225: 251,255, 2010. © 2010 Wiley-Liss, Inc. [source] | |||||||||||||||||||||||||||||||||||||||||||