Circulating B-type natriuretic peptides in patients with acute coronary syndromes

Rudolf Jarai; Johann Wojta; Kurt Huber

doi:10.1160/TH05-06-0395

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2005; 94(05): 926-932
DOI: 10.1160/TH05-06-0395

Review Article

Schattauer GmbH

Circulating B-type natriuretic peptides in patients with acute coronary syndromes

Pathophysiological, prognostical and therapeutical considerations

Rudolf Jarai

¹Wilhelminenhospital, 3^rd Department of Medicine, Cardiology and Emergency Medicine, Vienna, Austria

,

Johann Wojta

²University of Vienna, Department of Cardiology, General Hospital, Vienna, Austria

,

Kurt Huber

¹Wilhelminenhospital, 3^rd Department of Medicine, Cardiology and Emergency Medicine, Vienna, Austria

› Author Affiliations

Abstract

Summary

Fifty percent of patients who experience death or develop heart failure after acute coronary syndromes (ACS) have extremely elevated concentrations of plasma B-type natriuretic peptides. These elevations, however, seem not to reflect permanent ventricular dysfunction or heart failure and are assumed to exist already at the onset of ischemic symptoms. The underlying mechanisms of BNP/Nt-proBNP elevations in patients withACS are still not known at present. Furthermore, the relationship of elevated BNP/Nt-proBNP with mortality but not with atherothrombotic complications of underlying disease makes it difficult to choose optimal therapeutic strategies based on plasma levels of these peptides. The remarkably high short- and long-term mortality rate associated with increases of BNP/Nt-proBNP elevations clearly show the need of further investigation to focus on this high-risk group of patients in order to clarify underlying pathomechanisms and to find optimal therapeutic approaches.

Keywords

B-type natriuretic peptides - acute coronary syndromes

Full Text

References

References
1 Sudoh T, Kangawa K, Minamino N. et al. A new natriuretic peptide in porcine brain. Nature 1988; 332: 78-81.
2 Mukoyama M, Nakao K, Obata K. et al. Augmented secretion of brain natriuretic peptide in acute myocardial infarction. Biochem Biophys Res Commun 1991; 180: 431-6.
3 Yoshimura M, Yasue H, Morita E. et al. Hemodynamic, renal, and hormonal responses to brain natriuretic peptide infusion in patients with congestive heart failure. Circulation 1991; 84: 1581-8.
4 Nakagawa O, Ogawa Y, Itoh H. et al. Rapid transcriptional activation and early mRNA turnover of brain natriuretic peptide in cardiocyte hypertrophy. Evidence for brain natriuretic peptide as an “emergency” cardiac hormone against ventricular overload. J Clin Invest 1995; 96: 1280-7.
5 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: 161-7.
6 Kruger S, Graf J, Kunz D. et al. brain natriuretic peptide levels predict functional capacity in patients with chronic heart failure. J Am Coll Cardiol 2002; 40: 718-22.
7 Harrison A, Morrison LK, Krishnaswamy P. et al. B-type natriuretic peptide predicts future cardiac events in patients presenting to the emergency department with dyspnea. Ann Emerg Med 2002; 39: 131-8.
8 Maisel AS, McCord J, Nowak RM. et al. Bedside B-Type natriuretic peptide in the emergency diagnosis of heart failure with reduced or preserved ejection fraction. Results from the Breathing Not Properly Multinational Study. J Am Coll Cardiol 2003; 41: 2010-7.
9 McCullough PA, Nowak RM, McCord J. et al. B-type natriuretic peptide and clinical judgment in emergency diagnosis of heart failure: analysis from Breathing Not Properly (BNP) Multinational Study. Circulation 2002; 106: 416-22.
10 Maisel A. B-type natriuretic peptide levels: a potential novel „white count” for congestive heart failure. J Card Fail 2001; 7: 183-93.
11 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: 647-54.
12 Januzzi J, Camargo C, Anwaruddin S. et al. The N-terminal Pro-BNP investigation of dyspnoe in the emergency department (PRIDE) study. Am J Cardiol 2005; 95: 948-54.
13 Richards M, Troughton RW. NT-proBNP in heart failure: therapy decisions and monitoring. Eur J Heart Fail 2004; 6: 351-4.
14 Kawai K, Hata K, Takaoka H. et al. Plasma brain natriuretic peptide as a novel therapeutic indicator in idiopathic dilated cardiomyopathy during beta-blocker therapy: a potential of hormone-guided treatment. Am Heart J 2001; 141: 925-32.
15 Richards AM, Lainchbury JG, Nicholls MG. et al. BNP in hormone-guided treatment of heart failure. Trends Endocrinol Metab 2002; 13: 151-5.
16 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: 1126-30.
17 Hall C. Essential biochemistry and physiology of (NT-pro)BNP. Eur J Heart Fail 2004; 6: 257-60.
18 Cowie MR. B type natriuretic peptide testing: where are we now?. Heart 2004; 90: 725-6.
19 McCullough PA. B-type natriuretic peptides. A diagnostic breakthrough in heart failure. Minerva Cardioangiol 2003; 51: 121-9.
20 de Lemos JA, McGuire DK, Drazner MH. B-type natriuretic peptide in cardiovascular disease. Lancet 2003; 362: 316-22.
21 Tabbibizar R, Maisel A. The impact of B-type natriuretic peptide levels on the diagnoses and management of congestive heart failure. Curr Opin Cardiol 2002; 17: 340-5.
22 Maisel A. B-type natriuretic peptide measurements in diagnosing congestive heart failure in the dyspneic emergency department patient. Rev Cardiovasc Med 2002; 3 (Suppl. 04) S10-7.
23 Arakawa N, Nakamura M, Aoki H. et al. Plasma Brain Natriuretic Peptide Concentrations Predict Survival After Acute Myocardial Infarction. J Am Coll Cardiol 1996; 27: 1656-61.
24 Omland T, Aakvaag A, Bonarjee VV. et al. Plasma brain natriuretic peptide as an indicator of left ventricular systolic function and long-term survival after acute myocardial infarction. Comparison with plasma atrial natriuretic peptide and N-terminal proatrial natriuretic peptide. Circulation 1996; 93: 1963-9.
25 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: 1921-9.
26 Lindahl B, Lindback J, Jernberg T. et al. Serial analyses of N-terminal pro-B-type natriuretic peptide in patients with non-ST-segment elevation acute coronary syndromes: a Fragmin and fast Revascularisation during In Stability in Coronary artery disease (FRISC)-II substudy. J Am Coll Cardiol 2005; 45: 533-41.
27 Jernberg T, James S, Lindahl B. et al. NT-proBNP in unstable coronary artery disease–experiences from the FAST, GUSTO IV and FRISC II trials. Eur J Heart Fail 2004; 6: 319-25.
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: 1909-16.
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: 275-81.
30 Jernberg T, Stridsberg M, Venge P. et al. N-Terminal Pro Brain Natriuretic Peptide on Admission for Early Risk Stratification of Patients With Chest Pain and No ST-Segment Elevation. J Am Coll Cardiol 2002; 40: 437-45.
31 Omland T, Persson A, Ng L. et al. N-terminal pro-B-type natriuretic peptide and long-term mortality in acute coronary syndromes. Circulation 2002; 106: 2913-8.
32 Richards AM, Nicholls MG, Espiner EA. et al. B-type natriuretic peptides and ejection fraction for prognosis after myocardial infarction. Circulation 2003; 107: 2786-92.
33 Richards AM, Nicholls MG, Yandle TG. et al. Neuroendocrine prediction of left ventricular function and heart failure after acute myocardial infarction. The Christchurch Cardioendocrine Research Group. Heart 1999; 81: 114-20.
34 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: 1014-21.
35 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: 1264-72.
36 Tapanainen JM, Lindgren KS, Makikallio TH. et al. Natriuretic peptides as predictors of non-sudden and sudden cardiac death after acute myocardial infarction in the beta-blocking era. J Am Coll Cardiol 2004; 43: 757-63.
37 Galvani M, Ottani F, Oltrona L. et al. N-terminal pro-brain natriuretic peptide on admission has prognostic value across the whole spectrum of acute coronary syndromes. Circulation 2004; 110: 128-34.
38 Suzuki S, Yoshimura M, Nakayama M. et al. Plasma level of B-type natriuretic peptide as a prognostic marker after acute myocardial infarction: a long-term follow-up analysis. Circulation 2004; 110: 1387-91.
39 Heeschen C, Hamm CW, Mitrovic V. et al. N-terminal pro-B-type natriuretic peptide levels for dynamic risk stratification of patients with acute coronary syndromes. Circulation 2004; 110: 3206-12.
40 Jarai R, Iordanova N, Raffetseder A. et al. Risk assessment in patients with unstable angina/non- ST-elevation myocardial infarction and normal N-terminal pro-brain natriuretic peptide levels by N-terminal pro-atrial natriuretic peptide. Eur Heart J 2005; 26: 250-6.
41 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: 1760-3.
42 Jarai R, Jarai R, Huber K. N-terminal pro-brain natriuretic peptide in relation to inflammation, myocardial necrosis, and the effect of invasive strategy in unstable coronary artery disease. J Am Coll Cardiol 2004; 44: 1932.
43 Mega JL, Morrow DA, De Lemos JA. et al. B-type natriuretic peptide at presentation and prognosis in patients with ST-segment elevation myocardial infarction: an ENTIRE-TIMI-23 substudy. J Am Coll Cardiol 2004; 44: 335-9.
44 Bazzino O, Fuselli JJ, Botto F. et al. Relative value of N-terminal probrain natriuretic peptide, TIMI risk score, ACC/AHA prognostic classification and other risk markers in patients with non-ST-elevation acute coronary syndromes. Eur Heart J 2004; 25: 859-66.
45 Jarai R, Jordanova N, Gyongyosi M. et al. N-terminal pro-brain natriuretic peptide levels add significant prognostic information to the Braunwald classification of unstable angina and the Canadian Cardiac Society Angina classification. Eur Heart J. 2004
46 Jarai R, Jarai R, Jarai F. et al. Prediction of Two-Year Survival and Composite Endpoints Using the TIMI-7 Risk Score Extended by N-terminal Pro-Brain Natriuretic Peptide Levels. J Am Coll Cardiol 2003; 41: 367A.
47 Squire IB, O’Brien RJ, Demme B. et al. N-terminal pro-atrial natriuretic peptide (N-ANP) and N-terminal pro-B-type natriuretic peptide (N-BNP) in the prediction of death and heart failure in unselected patients following acute myocardial infarction. Clin Sci (Lond) 2004; 107: 309-16.
48 Latini R, Masson S, Anand I. et al. Effects of valsartan on circulating brain natriuretic peptide and norepinephrine in symptomatic chronic heart failure: the Valsartan Heart Failure Trial (Val-HeFT). Circulation 2002; 106: 2454-8.
49 Latini R, Masson S, Anand I. et al. The comparative prognostic value of plasma neurohormones at baseline in patients with heart failure enrolled in Val-HeFT. Eur Heart J 2004; 25: 292-9.
50 Hartmann F, Packer M, Coats AJ. et al. Prognostic impact of plasma N-terminal pro-brain natriuretic peptide in severe chronic congestive heart failure: a substudy of the Carvedilol Prospective Randomized Cumulative Survival (COPERNICUS) trial. Circulation 2004; 110: 1780-6.
51 Hartmann F, Packer M, Coats AJ. et al. NT-proBNP in severe chronic heart failure: rationale, design and preliminary results of the COPERNICUS NT-proBNP substudy. Eur J Heart Fail 2004; 6: 343-50.
52 Cleland JG, Daubert JC, Erdmann E. et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med 2005; 352: 1539-49.
53 Potapov EV, Hennig F, Wagner FD. et al. Natriuretic peptides and E-selectin as predictors of acute deterioration in patients with inotrop-dependent heart failure. Eur J Cardiothorac Surg 2005; 27: 899-905.
54 Galvani M, Ferrini D, Ottani F. Natriuretic peptides for risk stratification of patients with acute coronary syndromes. Eur J Heart Fail 2004; 6: 327-33.
55 de Lemos JA, Morrow DA. Brain Natriuretic Peptide Measurement in Acute Coronary Syndromes: Ready for Clinical Application?. Circulation 2002; 106: 2868-70.
56 Jernberg T, James S, Lindahl B. et al. Natriuretic peptides in unstable coronary artery disease. Eur Heart J 2004; 25: 1486-93.
57 Ruck A, Gustafsson T, Norrbom J. et al. ANP and BNP but not VEGF are regionally overexpressed in ischemic human myocardium. Biochem Biophys Res Commun 2004; 322: 287-91.
58 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: 1558-64.
59 Morita E, Yasue H, Yoshimura M. et al. Increased plasma levels of brain natriuretic peptide in patients with acute myocardial infarction. Circulation 1993; 88: 82-91.
60 Gill D, Seidler T, Troughton RW. et al. Vigorous response in plasma N-terminal pro-brain natriuretic peptide (NT-BNP) to acute myocardial infarction. Clin Sci (Lond) 2004; 106: 135-9.
61 Sadanandan S, Cannon CP, Chekuri K. et al. Association of elevated B-type natriuretic peptide levels with angiographic findings among patients with unstable angina and non-ST-segment elevation myocardial infarction. J Am Coll Cardiol 2004; 44: 564-8.
62 de Lemos JA, Morrow DA. Combining natriuretic peptides and necrosis markers in the assessment of acute coronary syndromes. Rev Cardiovasc Med 2003; 4 (Suppl. 04) S37-46.
63 Tateishi J, Masutani M, Ohyanagi M. et al. Transient increase in plasma brain (B-type) natriuretic peptide after percutaneous transluminal coronary angioplasty. Clin Cardiol 2000; 23: 776-80.
64 Kyriakides ZS, Markianos M, Michalis L. et al. Brain natriuretic peptide increases acutely and much more prominently than atrial natriuretic peptide during coronary angioplasty. Clin Cardiol 2000; 23: 285-8.
65 Sabatine MS, Morrow DA, de Lemos JA. et al. Acute changes in circulating natriuretic peptide levels in relation to myocardial ischemia. J Am Coll Cardiol 2004; 44: 1988-95.
66 Foote RS, Pearlman JD, Siegel AH. et al. Detection of exercise-induced ischemia by changes in B-type natriuretic peptides. J Am Coll Cardiol 2004; 44: 1980-7.
67 Marumoto K, Hamada M, Aburaya M. et al. Augmented secretion of atrial and brain natriuretic peptides during dynamic exercise in patients with old myocardial infarction. Jpn Circ J 1995; 59: 715-24.
68 Magga J, Marttila M, Mantymaa P. et al. Brain natriuretic peptide in plasma, atria, and ventricles of vasopressin- and phenylephrine-infused conscious rats. Endocrinology 1994; 134: 2505-15.
69 Bruneau BG, Piazza LA, de Bold AJ. BNP gene expression is specifically modulated by stretch and ET-1 in a new model of isolated rat atria. Am J Physiol 1997; 273: H2678-86.
70 Ogawa T, Vatta M, Bruneau BG. et al. Characterization of natriuretic peptide production by adult heart atria. Am J Physiol 1999; 276: H1977-86.
71 Bruneau BG, Piazza LA, de Bold AJ. Alpha 1-adrenergic stimulation of isolated rat atria results in discoordinate increases in natriuretic peptide secretion and gene expression and enhances Egr-1 and c-Myc expression. Endocrinology 1996; 137: 137-43.
72 Jesse RL. Neurohormonal regulation and the overlapping pathology between heart failure and acute coronary syndromes. Rev Cardiovasc Med 2003; 4 (Suppl. 04) S29-36.
73 Levin ER, Gardner DG, Samson WK. Natriuretic peptides. N Engl J Med 1998; 339: 321-8.
74 Goetze JP, Christoffersen C, Perko M. et al. Increased cardiac BNP expression associated with myocardial ischemia. Faseb J 2003; 17: 1105-7.
75 Goetze JP, Gore A, Moller CH. et al. Acute myocardial hypoxia increases BNP gene expression. Faseb J 2004; 18: 1928-30.
76 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.
77 Sumida H, Yasue H, Yoshimura M. et al. Comparison of secretion pattern between A-type and B-type natriuretic peptides in patients with old myocardial infarction. J Am Coll Cardiol 1995; 25: 1105-10.
78 Nagaya N, Nishikimi T, Goto Y. et al. Plasma brain natriuretic peptide is a biochemical marker for the prediction of progressive ventricular remodeling after acute myocardial infarction. Am Heart J 1998; 135: 21-8.
79 Nagaya N, Goto Y, Nishikimi T. et al. Sustained elevation of plasma brain natriuretic peptide levels associated with progressive ventricular remodelling after acute myocardial infarction. Clin Sci (Lond) 1999; 96: 129-36.
80 McDonagh TA, Robb SD, Murdoch DR. et al. Biochemical detection of left-ventricular systolic dysfunction. Lancet 1998; 351: 9-13.
81 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.
82 Hammerer-Lercher A, Ludwig W, Falkensammer G. et al. Natriuretic peptides as markers of mild forms of left ventricular dysfunction: effects of assays on diagnostic performance of markers. Clin Chem 2004; 50: 1174-83.
83 Heidenreich PA, Gubens MA, Fonarow GC. et al. Cost-effectiveness of screening with B-type natriuretic peptide to identify patients with reduced left ventricular ejection fraction. J Am Coll Cardiol 2004; 43: 1019-26.
84 Troughton RW, Prior DL, Pereira JJ. et al. Plasma B-type natriuretic peptide levels in systolic heart failure: importance of left ventricular diastolic function and right ventricular systolic function. J Am Coll Cardiol 2004; 43: 416-22.
85 Hobbs FD, Davis RC, Roalfe AK. et al. Reliability of N-terminal proBNP assay in diagnosis of left ventricular systolic dysfunction within representative and high risk populations. Heart 2004; 90: 866-70.
86 Kazanegra R, Cheng V, Garcia A. et al. A rapid test for B-type natriuretic peptide correlates with falling wedge pressures in patients treated for decompensated heart failure: a pilot study. J Card Fail 2001; 7: 21-9.
87 Gegenhuber A, Mueller T, Firlinger F. et al. Time course of B-type natriuretic peptide (BNP) and N-terminal proBNP changes in patients with decompensated heart failure. Clin Chem 2004; 50: 454-6.
88 Yu CM, Sanderson JE, Shum IO. et al. Diastolic dysfunction and natriuretic peptides in systolic heart failure. Higher ANP and BNP levels are associated with the restrictive filling pattern. Eur Heart J 1996; 17: 1694-702.
89 Fruhwald FM, Fahrleitner A, Watzinger N. et al. N-terminal proatrial natriuretic peptide correlates with systolic dysfunction and left ventricular filling pattern in patients with idiopathic dilated cardiomyopathy. Heart 1999; 82: 630-3.
90 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: 274-9.
91 Mabuchi N, Tsutamoto T, Maeda K. et al. Plasma cardiac natriuretic peptides as biochemical markers of recurrence of atrial fibrillation in patients with mild congestive heart failure. Jpn Circ J 2000; 64: 765-71.
92 Ohta Y, Shimada T, Yoshitomi H. et al. Drop in plasma brain natriuretic peptide levels after successful direct current cardioversion in chronic atrial fibrillation. Can J Cardiol 2001; 17: 415-20.
93 Silvet H, Young-Xu Y, Walleigh D, Ravid S. Brain natriuretic peptide is elevated in outpatients with atrial fibrillation. Am J Cardiol 2003; 92: 1124-7.
94 Jourdain P, Bellorini M, Funck F. et al. Short-term effects of sinus rhythm restoration in patients with lone atrial fibrillation: a hormonal study. Eur J Heart Fail 2002; 4: 263-7.
95 Albage A, Kenneback G, van der Linden J. et al. Improved neurohormonal markers of ventricular function after restoring sinus rhythm by the Maze procedure. Ann Thorac Surg 2003; 75: 790-5.
96 Vinch CS, Rashkin J, Logsetty G. et al. Brain natriuretic peptide levels fall rapidly after cardioversion of atrial fibrillation to sinus rhythm. Cardiology 2004; 102: 188-93.
97 Wang TJ, Larson MG, Levy D. et al. Heritability and genetic linkage of plasma natriuretic peptide levels. Circulation 2003; 108: 13-6.
98 Nakamura T, Sakamoto K, Yamano T. et al. Increased plasma brain natriuretic peptide level as a guide for silent myocardial ischemia in patients with non-obstructive hypertrophic cardiomyopathy. J Am Coll Cardiol 2002; 39: 1657-63.
99 Bibbins-Domingo K, Ansari M, Schiller NB. et al. Is B-type natriuretic peptide a useful screening test for systolic or diastolic dysfunction in patients with coronary disease? Data from the Heart and Soul Study. Am J Med 2004; 116: 509-16.
100 Bibbins-Domingo K, Ansari M, Schiller NB. et al. B-type natriuretic peptide and ischemia in patients with stable coronary disease: data from the Heart and Soul study. Circulation 2003; 108: 2987-92.
101 Maisel AS, Clopton P, Krishnaswamy P. et al. Impact of age, race, and sex on the ability of B-type natriuretic peptide to aid in the emergency diagnosis of heart failure: results from the Breathing Not Properly (BNP) multinational study. Am Heart J 2004; 147: 1078-84.
102 Wang TJ, Larson MG, Levy D. et al. Impact of age and sex on plasma levels in healthy adults. Am J Cardiol 2002; 90: 254-8.
103 Weber M, Dill T, Arnold R. et al. N-terminal B-type natriuretic peptide predicts extent of coronary artery disease and ischemia in patients with stable angina pectoris. Am Heart J 2004; 148: 612-20.
104 Bassan R, Potsch A, Maisel A. et al. B-type natriuretic peptide: a novel early blood marker of acute myocardial infarction in patients with chest pain and no STsegment elevation. Eur Heart J 2005; 26: 234-40.