How are B-type natriuretic peptide (BNP) cardiac markers characterized and what do they indicate?

Updated: Nov 20, 2018
  • Author: Donald Schreiber, MD, CM; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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B-type natriuretic peptide (BNP) is secreted primarily by the ventricular myocardium in response to wall stress, including volume expansion and pressure overload. Multiple studies have demonstrated that BNP may also be a useful prognostic indicator in ACS. The TIMI study group performed several investigations showing that the BNP level predicted cardiac mortality and other adverse cardiac events across the entire spectrum of ACS. The mortality rate nearly doubled when both TnI and BNP levels were elevated.

In the TACTICS-TIMI 18 trial, an elevated BNP level was associated with tighter culprit stenosis, higher corrected TIMI frame count, and left anterior descending artery involvement. [44] These data suggest that increased BNP levels may correlate with greater severity of myocardial ischemia and could partially explain the association between increased BNP levels and adverse outcomes.

Data from OPUS-TIMI 16 and TACTICS-TIMI 18 demonstrated that baseline elevations of TnI, C-reactive protein (CRP), and BNP levels in patients with NSTEMI were independent predictors of the composite endpoint of death, MI, or CHF. [54] The PROMPT-TIMI 35 trial demonstrated that transient myocardial ischemia during exercise testing was associated with an immediate rise in BNP levels. [55] In addition, the severity of ischemia was directly proportional to the elevation in BNP.

The presence of acute CHF in patients with ACS is a well-known predictor of adverse cardiac events and higher risk. Therefore, it is not surprising that an elevated BNP level, as a marker of CHF, is also predictive of adverse cardiac events in patients with ACS. Although BNP has been validated as a diagnostic marker for CHF, insufficient data are available to evaluate the use of BNP as a diagnostic cardiac marker for ACS in the ED.

Preinterventional levels of mid-regional (MR) pro-adrenomedullin (MR-proADM), MR-pro-A-type natriuretic peptide (MR-proANP), and N-terminal pro-natriuretic peptide (NT-proBNP) also appear to have potential prognostic utility for adverse events within 1 year of patients with severe aortic valve stenosis who undergo transcatheter aortic valve implantation (TAVI). [56] In a prospective study of 100 consecutive patients with aortic stenosis who were treated with TAVI, preintervention levels of these markers as well as highly sensitive troponin T (hs-TnT) were not predictive of 30-day outcome but were associated with cardiovascular events and all-cause mortality at 1 year.

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