Brain Natriuretic Peptide: Diagnostic and Therapeutic Implications in Pulmonary Arterial Hypertension

ABSTRACT

Brain or B-type natriuretic peptide (BNP) is one of the new biomarkers employed within the last decade to help clarify difficult cardiovascular problems. Plasma BNP is elevated in cardiac ventricular dysfunction and plays a key role in protecting the body from volume overload by maintaining renal function and sodium balance. Studies in patients with pulmonary arterial hypertension (PAH) have demonstrated that plasma BNP levels are raised proportionally to the extent of right ventricular (RV) dysfunction. There is growing evidence that BNP may be a potential biomarker for PAH in screening for occult disease, diagnostic evaluation, prognosis, and estimating a response to therapy. Additionally, augmentation of the natriuretic peptide system through exogenous administration of BNP or by preventing its degradation may be a promising option for the management of decompensated RV failure. Because plasma BNP levels rise in a variety of cardiopulmonary conditions and are affected by several physiological factors, BNP interpretation must not occur in isolation but rather within the context of good clinical judgment.

KEYWORDS

Brain natriuretic peptide - biological markers - pulmonary hypertension - pulmonary heart disease

REFERENCES

• 1 Hatano S, Strasser T Primary pulmonary hypertension: report on a WHO meeting. Geneva; World Health Organization 1975
• 2 Simonneau G, Galie N, Rubin L J et al.. Clinical classification of pulmonary hypertension.  J Am Coll Cardiol. 2004;  43(suppl 12) 5S-12S
• 3 Maisel A S, Krishnaswamy P, Nowak R M et al.. Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure.  N Engl J Med. 2002;  347 161-167
• 4 Yasue H, Yoshimura M, Sumida H et al.. Localization and mechanism of secretion of B-type natriuretic peptide in comparison with those of A-type natriuretic peptide in normal subjects and patients with heart failure.  Circulation. 1994;  90 195-203
• 5 Luchner A, Stevens T L, Borgeson D D et al.. Differential atrial and ventricular expression of myocardial BNP during evolution of heart failure.  Am J Physiol. 1998;  274 H1684-H1689
• 6 Hama N, Itoh H, Shirakami G et al.. Rapid ventricular induction of brain natriuretic peptide gene expression in experimental acute myocardial infarction.  Circulation. 1995;  92 1558-1564
• 7 Goetze J P. Biochemistry of pro-B-type natriuretic peptide-derived peptides: the endocrine heart revisited.  Clin Chem. 2004;  50 1503-1510
• 8 Burnett Jr J C, Kao P C, Hu D C et al.. Atrial natriuretic peptide elevation in congestive heart failure in the human.  Science. 1986;  231 1145-1147
• 9 Levin E R, Gardner D G, Samson W K. Natriuretic peptides.  N Engl J Med. 1998;  339 321-328
• 10 Nagaya N, Nishikimi T, Okano Y et al.. Plasma brain natriuretic peptide levels increase in proportion to the extent of right ventricular dysfunction in pulmonary hypertension.  J Am Coll Cardiol. 1998;  31 202-208
• 11 Leuchte H H, Holzapfel M, Baumgartner R A et al.. Clinical significance of brain natriuretic peptide in primary pulmonary hypertension.  J Am Coll Cardiol. 2004;  43 764-770
• 12 Leuchte H H, Neurohr C, Baumgartner R et al.. Brain natriuretic peptide and exercise capacity in lung fibrosis and pulmonary hypertension.  Am J Respir Crit Care Med. 2004;  170 360-365
• 13 Ishii J, Nomura M, Ito M et al.. Plasma concentration of brain natriuretic peptide as a biochemical marker for the evaluation of right ventricular overload and mortality in chronic respiratory disease.  Clin Chim Acta. 2000;  301 19-30
• 14 Lubien E, DeMaria A, Krishnaswamy P et al.. Utility of B-natriuretic peptide in detecting diastolic dysfunction: comparison with Doppler velocity recordings.  Circulation. 2002;  105 595-601
• 15 Yamamoto K, Burnett Jr J C, Jougasaki M et al.. Superiority of brain natriuretic peptide as a hormonal marker of ventricular systolic and diastolic dysfunction and ventricular hypertrophy.  Hypertension. 1996;  28 988-994
• 16 Fujii T, Otsuka T, Tanaka S et al.. Plasma endothelin-1 level in chronic obstructive pulmonary disease: relationship with natriuretic peptide.  Respiration . 1999;  66 212-219
• 17 de Lemos J A, Morrow D A, Bentley J H et al.. The prognostic value of B-type natriuretic peptide in patients with acute coronary syndromes.  N Engl J Med. 2001;  345 1014-1021
• 18 Sabatine M S, Morrow D A, de Lemos J A et al.. Acute changes in circulating natriuretic peptide levels in relation to myocardial ischemia.  J Am Coll Cardiol. 2004;  44 1988-1995
• 19 Tulevski I I, Hirsch A, Sanson B J et al.. Increased brain natriuretic peptide as a marker for right ventricular dysfunction in acute pulmonary embolism.  Thromb Haemost. 2001;  86 1193-1196
• 20 Hasegawa K, Fujiwara H, Doyama K et al.. Ventricular expression of brain natriuretic peptide in hypertrophic cardiomyopathy.  Circulation. 1993;  88 372-380
• 21 Ikeda T, Matsuda K, Itoh H et al.. Plasma levels of brain and atrial natriuretic peptides elevate in proportion to left ventricular end-systolic wall stress in patients with aortic stenosis.  Am Heart J. 1997;  133 307-314
• 22 Masters R G, Davies R A, Veinot J P et al.. Discoordinate modulation of natriuretic peptides during acute cardiac allograft rejection in humans.  Circulation. 1999;  100 287-291
• 23 Charpentier J, Luyt C E, Fulla Y et al.. Brain natriuretic peptide: a marker of myocardial dysfunction and prognosis during severe sepsis.  Crit Care Med. 2004;  32 660-665
• 24 Borghi C, Esposti D D, Immordino V et al.. Relationship of systemic hemodynamics, left ventricular structure and function, and plasma natriuretic peptide concentrations during pregnancy complicated by preeclampsia.  Am J Obstet Gynecol. 2000;  183 140-147
• 25 Berendes E, Walter M, Cullen P et al.. Secretion of brain natriuretic peptide in patients with aneurysmal subarachnoid haemorrhage.  Lancet. 1997;  349 245-249
• 26 McCullough P A, 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;  41 571-579
• 27 Akiba T, Tachibana K, Togashi K et al.. Plasma human brain natriuretic peptide in chronic renal failure.  Clin Nephrol. 1995;  44(Suppl 1) S61-S64
• 28 Totsune K, Takahashi K, Satoh F et al.. Urinary immunoreactive brain natriuretic peptide in patients with renal disease.  Regul Pept. 1996;  63 141-147
• 29 Haug C, Metzele A, Steffgen J et al.. Changes in brain natriuretic peptide and atrial natriuretic peptide plasma concentrations during hemodialysis in patients with chronic renal failure.  Horm Metab Res. 1994;  26 246-249
• 30 Cataliotti A, Malatino L S, Jougasaki M et al.. Circulating natriuretic peptide concentrations in patients with end-stage renal disease: role of brain natriuretic peptide as a biomarker for ventricular remodeling.  Mayo Clin Proc. 2001;  76 1111-1119
• 31 Redfield M M, Rodeheffer R J, Jacobsen S J et al.. Plasma brain natriuretic peptide concentration: impact of age and gender.  J Am Coll Cardiol. 2002;  40 976-982
• 32 Wang T J, Larson M G, Levy D et al.. Impact of age and sex on plasma natriuretic peptide levels in healthy adults.  Am J Cardiol. 2002;  90 254-258
• 33 Wang T J, Larson M G, Levy D et al.. Impact of obesity on plasma natriuretic peptide levels.  Circulation. 2004;  109 594-600
• 34 Mehra M R, Uber P A, Park M H et al.. Obesity and suppressed B-type natriuretic peptide levels in heart failure.  J Am Coll Cardiol. 2004;  43 1590-1595
• 35 McCord J, Mundy B J, Hudson M P et al.. Relationship between obesity and B-type natriuretic peptide levels.  Arch Intern Med. 2004;  164 2247-2252
• 36 Sarzani R, Dessi-Fulgheri P, Paci V M et al.. Expression of natriuretic peptide receptors in human adipose and other tissues.  J Endocrinol Invest. 1996;  19 581-585
• 37 Pemberton C J, Johnson M L, Yandle T G et al.. Deconvolution analysis of cardiac natriuretic peptides during acute volume overload.  Hypertension. 2000;  36 355-359
• 38 Lainchbury J G, Campbell E, Frampton C M et al.. Brain natriuretic peptide and n-terminal brain natriuretic peptide in the diagnosis of heart failure in patients with acute shortness of breath.  J Am Coll Cardiol. 2003;  42 728-735
• 39 Battle R W, Davitt M A, Cooper S M et al.. Prevalence of pulmonary hypertension in limited and diffuse scleroderma.  Chest. 1996;  110 1515-1519
• 40 MacGregor A J, Canavan R, Knight C et al.. Pulmonary hypertension in systemic sclerosis: risk factors for progression and consequences for survival.  Rheumatology (Oxford). 2001;  40 453-459
• 41 Mukerjee D, St George D, Coleiro B et al.. Prevalence and outcome in systemic sclerosis associated pulmonary arterial hypertension: application of a registry approach.  Ann Rheum Dis. 2003;  62 1088-1093
• 42 Badesch D B, Tapson V F, McGoon M D et al.. Continuous intravenous epoprostenol for pulmonary hypertension due to the scleroderma spectrum of disease: a randomized, controlled trial.  Ann Intern Med. 2000;  132 425-434
• 43 Channick R N, Simonneau G, Sitbon O et al.. Effects of the dual endothelin-receptor antagonist bosentan in patients with pulmonary hypertension: a randomised placebo-controlled study.  Lancet. 2001;  358 1119-1123
• 44 Oudiz R J, Schilz R J, Barst R J et al.. Treprostinil, a prostacyclin analogue, in pulmonary arterial hypertension associated with connective tissue disease.  Chest. 2004;  126 420-427
• 45 Allanore Y, Borderie D, Meune C et al.. N-terminal pro-brain natriuretic peptide as a diagnostic marker of early pulmonary artery hypertension in patients with systemic sclerosis and effects of calcium-channel blockers.  Arthritis Rheum. 2003;  48 3503-3508
• 46 McQuillan B M, Picard M H, Leavitt M et al.. Clinical correlates and reference intervals for pulmonary artery systolic pressure among echocardiographically normal subjects.  Circulation. 2001;  104 2797-2802
• 47 Denton C P, Cailes J B, Phillips G D et al.. Comparison of Doppler echocardiography and right heart catheterization to assess pulmonary hypertension in systemic sclerosis.  Br J Rheumatol. 1997;  36 239-243
• 48 Rubin L J. Diagnosis and management of pulmonary arterial hypertension: ACCP evidence-based clinical practice guidelines.  Chest. 2004;  126 4S-6S
• 49 Galie N, Torbicki A, Barst R et al.. Guidelines on diagnosis and treatment of pulmonary arterial hypertension. The Task Force on Diagnosis and Treatment of Pulmonary Arterial Hypertension of the European Society of Cardiology.  Eur Heart J. 2004;  25 2243-2278
• 50 Barst R J, McGoon M, Torbicki A et al.. Diagnosis and differential assessment of pulmonary arterial hypertension.  J Am Coll Cardiol. 2004;  43 40S-47S
• 51 Reynolds E W. Brain-type natriuretic Peptide in the diagnosis and management of persistent pulmonary hypertension of the newborn: in reply.  Pediatrics. 2005;  115 1112
• 52 Reynolds E W, Ellington J G, Vranicar M et al.. Brain-type natriuretic peptide in the diagnosis and management of persistent pulmonary hypertension of the newborn.  Pediatrics. 2004;  114 1297-1304
• 53 Nagaya N, Nishikimi T, Uematsu M et al.. Plasma brain natriuretic peptide as a prognostic indicator in patients with primary pulmonary hypertension.  Circulation. 2000;  102 865-870
• 54 Park M H, Scott R L, Uber P A et al.. Usefulness of B-type natriuretic peptide as a predictor of treatment outcome in pulmonary arterial hypertension.  Congest Heart Fail. 2004;  10 221-225
• 55 Wilkins M R, Paul G A, Strange J W et al.. Sildenafil versus Endothelin Receptor Antagonist for Pulmonary Hypertension (SERAPH) Study.  Am J Respir Crit Care Med. 2005;  171 1292-1297
• 56 Francis G S, Goldsmith S R, Levine T B et al.. The neurohumoral axis in congestive heart failure.  Ann Intern Med. 1984;  101 370-377
• 57 Colucci W S, Elkayam U, Horton D P et al.. Intravenous nesiritide, a natriuretic peptide, in the treatment of decompensated congestive heart failure. Nesiritide Study Group.  N Engl J Med. 2000;  343 246-253
• 58 Publication Committee for the VMAC Investigators . Intravenous nesiritide vs nitroglycerin for treatment of decompensated congestive heart failure: a randomized controlled trial.  JAMA. 2002;  287 1531-1540
• 59 Yancy C W, Saltzberg M T, Berkowitz R L et al.. Safety and feasibility of using serial infusions of nesiritide for heart failure in an outpatient setting (from the FUSION I trial).  Am J Cardiol. 2004;  94 595-601
• 60 Michaels A D, Chatterjee K, Madden J et al.. Hemodynamic effects of intravenous nesiritide in patients with pulmonary hypertension [abstract].  J Am Coll Cardiol. 2004;  43(Suppl 5A) 192A
• 61 Kurian D C, Wagner I J, Klapholz M. Nesiritide in pulmonary hypertension.  Chest. 2004;  126 302-305
• 62 Corti R, Burnett Jr J C, Rouleau J L et al.. Vasopeptidase inhibitors: a new therapeutic concept in cardiovascular disease?.  Circulation. 2001;  104 1856-1862
• 63 Packer M, Califf R M, Konstam M A et al.. Comparison of omapatrilat and enalapril in patients with chronic heart failure: the Omapatrilat Versus Enalapril Randomized Trial of Utility in Reducing Events (OVERTURE).  Circulation. 2002;  106 920-926
• 64 Hoeper M M, Oudiz R J, Peacock A et al.. End points and clinical trial designs in pulmonary arterial hypertension: clinical and regulatory perspectives.  J Am Coll Cardiol. 2004;  43 48S-55S