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Dtsch Med Wochenschr 2017; 142(05): 346-355
DOI: 10.1055/s-0042-117368
Review
© Georg Thieme Verlag KG Stuttgart · New York

Einsatzgebiete und praktischer Nutzen der kardialen Marker BNP und NT-proBNP

Indications and Clinical Implications of the Use of the Cardiac Markers BNP and NT-proBNP
Andreas Luchner
1   Klinik für Innere Medizin I (Kardiologie, Angiologie, Nephrologie, Pneumologie, Internistische Intensivmedizin), Klinikum St. Marien, Amberg
,
Stephan von Haehling
2   Klinik für Kardiologie und Pneumologie, Universitätsmedizin Göttingen, Georg-August-Universität Göttingen, Göttingen
,
Christian Holubarsch
3   Park-Klinikum, Bad Krozingen
,
Till Keller
4   Goethe University Frankfurt, Department of Internal Medicine III, Division of Cardiology, Frankfurt am Main
5   German Centre for Cardiovascular Research (DZHK), Frankfurt am Main
,
Fabian Knebel
6   Medizinische Klinik mit Schwerpunkt Kardiologie und Angiologie, Campus Mitte, Charité – Universitätsmedizin Berlin
,
Christian Zugck
7   Internistische Gemeinschaftspraxis Steiner Thor, Straubing
,
Ulrich Laufs
8   Klinik für Innere Medizin III, Kardiologie, Angiologie und internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg
› Institutsangaben
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Publikationsverlauf

Publikationsdatum:
10. März 2017 (online)

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Zusammenfassung

Die B-Typ natriuretischen Peptide sind Marker der myokardialen Wandspannung. Sie werden in der Notfalldiagnostik zur Differenzialdiagnostik der Dyspnoe eingesetzt und ein normaler BNP- oder NT-proBNP-Wert schließt eine Herzinsuffizienz mit hoher Sicherheit aus. Neue Daten zeigen ihre Bedeutung für die Risikoprädiktion bei Patienten in verschiedenen Stadien der Herzinsuffizienz, aber auch in der Primärprävention. Eine durch natriuretische Peptide laborchemisch geführte Herzinsuffizienztherapie kann die Hochtitration der Herzinsuffizienztherapie verbessern. Dabei ist unter Therapie mit dem neuen Angiotensin-Rezeptor-Neprilysin-Inhibitor Sacubitril/Valsartan das NT-proBNP besser zur Verlaufskontrolle geeignet als BNP. Der folgende Artikel soll die aktuelle Studienlage zu den wichtigsten Anwendungsmöglichkeiten der B-Typ natriuretischen Peptide für das Schnittstellen-Management zwischen Klinik und Praxis zusammenfassen und erarbeitet klinische Empfehlungen zu ihrem Einsatz in der Patientenversorgung.

Abstract

B-type natriuretic peptides are markers of myocardial wall stress. BNP or NT-proBNP are used for the differential diagnosis of acute dyspnoe where normal serum concentrations make a cardiac cause unlikely. New data show their importance for risk prediction in different stages of heart failure and in primary prevention. Natriuretic peptide guided therapy improves titration of heart failure medications. Compared to BNP, NT-proBNP is better suited during therapy with the new angiotensin-rezeptor-neprilysin-inhibitor Sacubitril/Valsartan. This review article summarizes current data on the importance of B-type natriuretic peptides for the interface of ambulatory and hospital care and presents recommendations for their practical use in patient care.

Schlüsselwörter

BNP - NT-proBNP - natriuretische Peptide - Herzinsuffizienz - Übersichtsarbeit

Key words

BNP - NT-proBNP - natriuretic peptides - heart failure - review
 

  • Literatur

  • 1 Luchner A. Hengstenberg C. Lowel H. et al. Effect of compensated renal dysfunction on approved heart failure markers: direct comparison of brain natriuretic peptide (BNP) and N-terminal pro-BNP. Hypertension 2005; 46: 118-123
    CrossrefPubMedGoogle Scholar
  • 2 Luchner A. Behrens G. Stritzke J. et al. Long-term pattern of brain natriuretic peptide and N-terminal pro brain natriuretic peptide and its determinants in the general population: contribution of age, gender, and cardiac and extra-cardiac factors. Eur J Heart Fail 2013; 15: 859-867
    CrossrefPubMedGoogle Scholar
  • 3 Daniels LB. Clopton P. Bhalla V. et al. How obesity affects the cut-points for B-type natriuretic peptide in the diagnosis of acute heart failure. Results from the Breathing Not Properly Multinational Study. Am Heart J 2006; 151: 999-1005
    CrossrefPubMedGoogle Scholar
  • 4 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: 161-167
    CrossrefPubMedGoogle Scholar
  • 5 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
    CrossrefPubMedGoogle Scholar
  • 6 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: 2062-2076
    CrossrefPubMedGoogle Scholar
  • 7 Januzzi Jr JL. Camargo CA. Anwaruddin S. et al. The N-terminal Pro-BNP investigation of dyspnea in the emergency department (PRIDE) study. The Am J Cardiol 2005; 95: 948-954
    PubMedGoogle Scholar
  • 8 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: 330-337
    CrossrefPubMedGoogle Scholar
  • 9 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
    CrossrefPubMedGoogle Scholar
  • 10 Kelder JC. Cramer MJ. Verweij WM. et al. Clinical utility of three B-type natriuretic peptide assays for the initial diagnostic assessment of new slow-onset heart failure. J Card Fail 2011; 17: 729-734
    CrossrefPubMedGoogle Scholar
  • 11 Zaphiriou A. Robb S. Murray-Thomas T. et al. The diagnostic accuracy of plasma BNP and NTproBNP in patients referred from primary care with suspected heart failure: results of the UK natriuretic peptide study. Eur J Heart Fail 2005; 7: 537-541
    CrossrefPubMedGoogle Scholar
  • 12 Clerico A. Fontana M. Zyw L. et al. Comparison of the diagnostic accuracy of brain natriuretic peptide (BNP) and the N-terminal part of the propeptide of BNP immunoassays in chronic and acute heart failure: a systematic review. Clin Chem 2007; 53: 813-822
    CrossrefPubMedGoogle Scholar
  • 13 Authors/Task Force M, Document R. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2016; DOI: 10.1002/ejhf.592.
    CrossrefPubMedGoogle Scholar
  • 14 Lukowicz TV. Fischer M. Hense HW. et al. BNP as a marker of diastolic dysfunction in the general population: Importance of left ventricular hypertrophy. Eur J Heart Fail 2005; 7: 525-531
    CrossrefPubMedGoogle Scholar
  • 15 Kasner M. Gaub R. Westermann D. et al. Simultaneous estimation of NT-proBNP on top to mitral flow Doppler echocardiography as an accurate strategy to diagnose diastolic dysfunction in HFNEF. Int J Cardiol 2011; 149: 23-29
    CrossrefPubMedGoogle Scholar
  • 16 Logeart D. Thabut G. Jourdain P. et al. Predischarge B-type natriuretic peptide assay for identifying patients at high risk of re-admission after decompensated heart failure. J Am Coll Cardiol 2004; 43: 635-641
    CrossrefPubMedGoogle Scholar
  • 17 O'Brien RJ. Squire IB. Demme B. et al. Pre-discharge, but not admission, levels of NT-proBNP predict adverse prognosis following acute LVF. Eur J Heart Fail 2003; 5: 499-506
    CrossrefPubMedGoogle Scholar
  • 18 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
    CrossrefPubMedGoogle Scholar
  • 19 Gardner RS. Ozalp F. Murday AJ. et al. N-terminal pro-brain natriuretic peptide. A new gold standard in predicting mortality in patients with advanced heart failure. Eur Heart J 2003; 24: 1735-1743
    CrossrefPubMedGoogle Scholar
  • 20 Schou M. Gustafsson F. Corell P. et al. The relationship between N-terminal pro-brain natriuretic peptide and risk for hospitalization and mortality is curvilinear in patients with chronic heart failure. Am Heart J 2007; 154: 123-129
    CrossrefPubMedGoogle Scholar
  • 21 Masson S. Latini R. Anand IS. et al. Direct comparison of B-type natriuretic peptide (BNP) and amino-terminal proBNP in a large population of patients with chronic and symptomatic heart failure: the Valsartan Heart Failure (Val-HeFT) data. Clin Chem 2006; 52: 1528-1538
    CrossrefPubMedGoogle Scholar
  • 22 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
    CrossrefPubMedGoogle Scholar
  • 23 Richards AM. Nicholls MG. Yandle TG. et al. Plasma N-terminal pro-brain natriuretic peptide and adrenomedullin: new neurohormonal predictors of left ventricular function and prognosis after myocardial infarction. Circulation 1998; 97: 1921-1929
    CrossrefPubMedGoogle Scholar
  • 24 de Lemos JA. Morrow DA. Bentley JH. et al. The prognostic value of B-type natriuretic peptide in patients with acute coronary syndromes. N Engl J Med 2001; 345: 1014-1021
    CrossrefPubMedGoogle Scholar
  • 25 Sabatine MS. Morrow DA. de Lemos JA. et al. Multimarker Approach to Risk Stratification in Non-ST Elevation Acute Coronary Syndromes: Simultaneous Assessment of Troponin I, C-Reactive Protein, and B-Type Natriuretic Peptide. Circulation 2002; 105: 1760-1763
    CrossrefPubMedGoogle Scholar
  • 26 Richards AM. Nicholls MG. Espiner EA. et al. B-type natriuretic peptides and ejection fraction for prognosis after myocardial infarction. Circulation 2003; 107: 2786-2792
    CrossrefPubMedGoogle Scholar
  • 27 Morrow DA. de Lemos JA. Sabatine MS. et al. Evaluation of B-type natriuretic peptide for risk assessment in unstable angina/non-ST-elevation myocardial infarction: B-type natriuretic peptide and prognosis in TACTICS-TIMI 18. J Am Coll Cardiol 2003; 41: 1264-1272
    CrossrefPubMedGoogle Scholar
  • 28 Jernberg T. Lindahl B. Siegbahn A. et al. N-terminal pro-brain natriuretic peptide in relation to inflammation, myocardial necrosis, and the effect of an invasive strategy in unstable coronary artery disease. J Am Coll Cardiol 2003; 42: 1909-1916
    CrossrefPubMedGoogle Scholar
  • 29 James SK. Lindahl B. Siegbahn A. et al. N-terminal pro-brain natriuretic peptide and other risk markers for the separate prediction of mortality and subsequent myocardial infarction in patients with unstable coronary artery disease: a Global Utilization of Strategies To Open occluded arteries (GUSTO)-IV substudy. Circulation 2003; 108: 275-281
    CrossrefPubMedGoogle Scholar
  • 30 Buchner S. Debl K. Barlage S. et al. Dynamic changes in N-terminal pro-brain natriuretic peptide in acute coronary syndromes treated with percutaneous coronary intervention: a marker of ischemic burden, reperfusion and outcome. Clin Chem Lab Med 2010; 48: 875-881
    PubMedGoogle Scholar
  • 31 Omland T. Sabatine MS. Jablonski KA. et al. Prognostic value of B-Type natriuretic peptides in patients with stable coronary artery disease: the PEACE Trial. J Am Coll Cardiol 2007; 50: 205-214
    CrossrefPubMedGoogle Scholar
  • 32 Blankenberg S. McQueen MJ. Smieja M. et al. Comparative impact of multiple biomarkers and N-Terminal pro-brain natriuretic peptide in the context of conventional risk factors for the prediction of recurrent cardiovascular events in the Heart Outcomes Prevention Evaluation (HOPE) Study. Circulation 2006; 114: 201-208
    CrossrefPubMedGoogle Scholar
  • 33 Ledwidge M. Gallagher J. Conlon C. et al. Natriuretic peptide-based screening and collaborative care for heart failure: the STOP-HF randomized trial. JAMA 2013; 310: 66-74
    CrossrefPubMedGoogle Scholar
  • 34 Tarnow L. Hildebrandt P. Hansen BV. et al. Plasma N-terminal pro-brain natriuretic peptide as an independent predictor of mortality in diabetic nephropathy. Diabetologia 2005; 48: 149-155
    CrossrefPubMedGoogle Scholar
  • 35 Huelsmann M. Neuhold S. Resl M. et al. PONTIAC (NT-proBNP selected prevention of cardiac events in a population of diabetic patients without a history of cardiac disease): a prospective randomized controlled trial. J Am Coll Cardiol 2013; 62: 1365-1372
    CrossrefPubMedGoogle Scholar
  • 36 McKie PM. Rodeheffer RJ. Cataliotti A. et al. Amino-terminal pro-B-type natriuretic peptide and B-type natriuretic peptide: biomarkers for mortality in a large community-based cohort free of heart failure. Hypertension 2006; 47: 874-880
    CrossrefPubMedGoogle Scholar
  • 37 McKie PM. Cataliotti A. Lahr BD. et al. The prognostic value of N-terminal pro-B-type natriuretic peptide for death and cardiovascular events in healthy normal and stage A/B heart failure subjects. J Am Coll Cardiol 2010; 55: 2140-2147
    CrossrefPubMedGoogle Scholar
  • 38 Linssen GC. Bakker SJ. Voors AA. et al. N-terminal pro-B-type natriuretic peptide is an independent predictor of cardiovascular morbidity and mortality in the general population. Eur Heart J 2010; 31: 120-127
    CrossrefPubMedGoogle Scholar
  • 39 Kistorp C. Raymond I. Pedersen F. et al. N-terminal pro-brain natriuretic peptide, C-reactive protein, and urinary albumin levels as predictors of mortality and cardiovascular events in older adults. JAMA 2005; 293: 1609-1616
    CrossrefPubMedGoogle Scholar
  • 40 Laukkanen JA. Kurl S. Ala-Kopsala M. et al. Plasma N-terminal fragments of natriuretic propeptides predict the risk of cardiovascular events and mortality in middle-aged men. Eur Heart J 2006; 27: 1230-1237
    CrossrefPubMedGoogle Scholar
  • 41 Dietl A. Stark K. Zimmermann ME. et al. NT-proBNP predicts cardiovascular death in the general population independent of left ventricular mass and function: insights from a large population-based study with long-term follow-Up: PLoS One 2016; 11(10): e0164060
    PubMed
  • 42 Troughton RW. Frampton CM. Yandle TG. et al. Treatment of heart failure guided by plasma aminoterminal brain natriuretic peptide (N-BNP) concentrations. Lancet 2000; 355: 1126-1130
    CrossrefPubMedGoogle Scholar
  • 43 DeBeradinis B. Januzzi Jr JL. Use of biomarkers to guide outpatient therapy of heart failure. Curr Opin Cardiol 2012; 27: 661-668
    CrossrefPubMedGoogle Scholar
  • 44 Jourdain P. Jondeau G. Funck F. et al. Plasma brain natriuretic peptide-guided therapy to improve outcome in heart failure: the STARS-BNP Multicenter Study. J Am Coll Cardiol 2007; 49: 1733-1739
    CrossrefPubMedGoogle Scholar
  • 45 Pfisterer M. Buser P. Rickli H. et al. BNP-guided vs symptom-guided heart failure therapy: the Trial of Intensified vs Standard Medical Therapy in Elderly Patients With Congestive Heart Failure (TIME-CHF) randomized trial. JAMA 2009; 301: 383-392
    CrossrefPubMedGoogle Scholar
  • 46 Lainchbury JG. Troughton RW. Strangman KM. et al. N-terminal pro-B-type natriuretic peptide-guided treatment for chronic heart failure: results from the BATTLESCARRED (NT-proBNP-Assisted Treatment To Lessen Serial Cardiac Readmissions and Death) trial. J Am Coll Cardiol 2009; 55: 53-60
    CrossrefPubMedGoogle Scholar
  • 47 Berger R. Moertl D. Peter S. et al. N-terminal pro-B-type natriuretic peptide-guided, intensive patient management in addition to multidisciplinary care in chronic heart failure a 3-arm, prospective, randomized pilot study. J Am Coll Cardiol 2010; 55: 645-653
    CrossrefPubMedGoogle Scholar
  • 48 Januzzi Jr JL. Rehman SU. Mohammed AA. et al. Use of amino-terminal pro-B-type natriuretic peptide to guide outpatient therapy of patients with chronic left ventricular systolic dysfunction. J Am Coll Cardiol 2011; 58: 1881-1889
    CrossrefPubMedGoogle Scholar
  • 49 Luchner A. Burnett Jr JC. Jougasaki M. et al. Augmentation of the cardiac natriuretic peptides by beta-receptor antagonism: evidence from a population-based study. J Am Coll Cardiol 1998; 32: 1839-1844
    CrossrefPubMedGoogle Scholar
  • 50 Luchner A. Schunkert H. Interactions between the sympathetic nervous system and the cardiac natriuretic peptide system. Cardiovasc Res 2004; 63: 443-449
    CrossrefPubMedGoogle Scholar
  • 51 Sanders-van Wijk S. Muzzarelli S. Neuhaus M. et al. Safety and tolerability of intensified, N-terminal pro brain natriuretic peptide-guided compared with standard medical therapy in elderly patients with congestive heart failure: results from TIME-CHF. Eur J Heart Fail 2013; 15: 910-918
    CrossrefPubMedGoogle Scholar
  • 52 Troughton R. Michael Felker G. Januzzi JL. et al. Natriuretic peptide-guided heart failure management. Eur Heart J 2014; 35: 16-24
    CrossrefPubMedGoogle Scholar
  • 53 Maisel AS. Shah KS. Barnard D. et al. How B-Type Natriuretic Peptide (BNP) and Body Weight Changes Vary in Heart Failure With Preserved Ejection Fraction Compared With Reduced Ejection Fraction: Secondary Results of the HABIT (HF Assessment With BNP in the Home) Trial. J Card Fail 2016; 22: 283-293
    CrossrefPubMedGoogle Scholar
  • 54 Clerico A. Carlo Zucchelli G. Pilo A. et al. Clinical relevance of biological variation: the lesson of brain natriuretic peptide (BNP) and NT-proBNP assay. Clin Chem Lab Med 2006; 44: 366-378
    PubMedGoogle Scholar
  • 55 Bettencourt P. Azevedo A. Pimenta J. et al. N-terminal-pro-brain natriuretic peptide predicts outcome after hospital discharge in heart failure patients. Circulation 2004; 110: 2168-2174
    CrossrefPubMedGoogle Scholar
  • 56 Frankenstein L. Remppis A. Frankenstein J. et al. Variability of N-terminal probrain natriuretic peptide in stable chronic heart failure and its relation to changes in clinical variables. Clin Chem 2009; 55: 923-929
    CrossrefPubMedGoogle Scholar
  • 57 Maeder MT. Rickenbacher P. Rickli H. et al. N-terminal pro brain natriuretic peptide-guided management in patients with heart failure and preserved ejection fraction: findings from the Trial of Intensified versus standard medical therapy in elderly patients with congestive heart failure (TIME-CHF). Eur J Heart Fail 2013; 15: 1148-1156
    CrossrefPubMedGoogle Scholar
  • 58 Jaffe AS. Unwinding the interaction of natriuretic peptides and neprilysin. J Am Coll Cardiol 2015; 65: 666-667
    CrossrefPubMedGoogle Scholar
  • 59 Vodovar N. Seronde MF. Laribi S. et al. Elevated Plasma B-Type Natriuretic Peptide Concentrations Directly Inhibit Circulating Neprilysin Activity in Heart Failure. JACC Heart Fail 2015; 3: 629-636
    CrossrefPubMedGoogle Scholar
  • 60 Moe GW. Howlett J. Januzzi JL. et al. 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: 3103-3110
    CrossrefPubMedGoogle Scholar
  • 61 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: 365-371
    CrossrefPubMedGoogle Scholar
  • 62 Luchner A. Mockel M. Spanuth E. et al. N-terminal pro brain natriuretic peptide in the management of patients in the medical emergency department (PROMPT): correlation with disease severity, utilization of hospital resources, and prognosis in a large, prospective, randomized multicentre trial. Eur J Heart Fail 2012; 14: 259-267
    CrossrefPubMedGoogle Scholar
  • 63 Agvall B. Alehagen U. Dahlstrom U. The benefits of using a heart failure management programme in Swedish primary healthcare. Eur J Heart Fail 2013; 15: 228-236
    CrossrefPubMedGoogle Scholar
  • 64 Moertl D. Steiner S. Coyle D. et al. Cost-utility analysis of nt-probnp-guided multidisciplinary care in chronic heart failure. Int J Technol Assess Health Care 2013; 29: 3-11
    CrossrefPubMedGoogle Scholar
  • 65 Sanders-van Wijk S. van Asselt AD. Rickli H. et al. Cost-effectiveness of N-terminal pro-B-type natriuretic-guided therapy in elderly heart failure patients: results from TIME-CHF (Trial of Intensified versus Standard Medical Therapy in Elderly Patients with Congestive Heart Failure). JACC Heart Fail 2013; 1: 64-71
    CrossrefPubMedGoogle Scholar
  • 66 Bhardwaj A. Rehman SU. Mohammed AA. et al. Quality of life and chronic heart failure therapy guided by natriuretic peptides: results from the ProBNP Outpatient Tailored Chronic Heart Failure Therapy (PROTECT) study. Am Heart J 2012; 164: 793-799 e791
    CrossrefPubMedGoogle Scholar