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      B-type natriuretic peptides. A diagnostic breakthrough in heart failure.

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      Minerva cardioangiologica

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          Abstract

          B-type natriuretic peptide (BNP) is a neurohormone synthesized in the cardiac ventricles, which is released as N-terminal pro-brain natriuretic peptide (NT-proBNP) and then enzymatically cleaved in to the NT fragment and the immunoreactive BNP. Both tests have been used to identify patients with congestive heart failure (CHF). Important considerations for these tests include their half-lives in plasma, dependence on renal function for clearance, and the interpretation of their units of measure. In general, a BNP level below 100 pg/mL has strong negative predictive value in the assessment of patients with dyspnea caused by a disorder other than CHF. In addition, BNP levels can be used to gauge the effect of short-term treatment of acutely decompensated heart failure, and the peptide has been shown to be a reliable independent predictor of sudden cardiac death. In the absence of renal dysfunction NT-proBNP has also been shown to be an independent predictor of sudden death in CHF patients. Because both a large area of myonecrosis or concomitant left ventricular failure are related to prognosis in acute coronary syndromes, B-type natriuretic peptides have also been linked to outcomes in this condition. This article describes the physiology and timing of release of B-type natriuretic peptides and the rationale for their use in the following settings: 1) evaluation of decompensated CHF, 2) screening for chronic CHF, 3) prognosis of CHF and sudden death, and 4) prognosis in acute coronary syndromes with inferred left ventricular dysfunction.

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          Author and article information

          Journal
          Minerva Cardioangiol
          Minerva cardioangiologica
          0026-4725
          0026-4725
          Apr 2003
          : 51
          : 2
          Affiliations
          [1 ] Divisions of Cardiology, Nutrition and Preventive Medicine, William Beaumont Hospital, Royal Oak MI 48073, USA. pmc975@yahoo.com
          Article
          12783068
          823c9f56-ecd3-40bd-8313-d9aac04f04d0
          History

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