Brain natriuretic peptide: diagnostic and prognostic value in chronic heart failure (a literature review)

Authors

DOI:

https://doi.org/10.14739/2310-1210.2024.3.297277

Keywords:

brain natriuretic peptide, heart failure, diagnosis, prognosis

Abstract

The increase in the prevalence of cardiovascular disease has caused a rapid increase in the risk of developing heart failure. For many years, chronic heart failure (CHF) has occupied one of the leading positions in the structure of cardiac and all-cause mortality worldwide, resulting in not only negative social, but also economic effects. To optimize the timely detection of this pathological condition, laboratory biomarker-based diagnostics of heart dysfunction is widely used along with echocardiographic examination. Brain natriuretic peptide (BNP) is currently considered one of the most well-known and informative biochemical markers in heart failure.

The aim of the work was to cover the results of current scientific research according to the principles of evidence-based medicine regarding the use of BNP and its precursor NT-proBNP for the diagnosis of CHF, prognosis and monitoring of the treatment effectiveness. To achieve this goal, an analysis of literary sources published in scientometric databases such as ScienceDirect, Web of Science, Google Scholar, PubMed, Scopus for the period 2013–2024 was carried out.

Conclusions. BNP and NT-proBNP have been found to be informative markers for the early diagnosis of chronic heart failure and can also be recommended for dynamic assessment of patients’ condition and the effectiveness of their treatment. It is proposed to continue the research on clarifying the threshold diagnostic levels of the biomarkers in patients with chronic heart failure and comorbid conditions such as type 2 diabetes mellitus, obesity, as well as in consideration of their sex, age, racial and ethnic characteristics, which in the future would promote the optimization of timely diagnosis, selection of appropriate treatment and improvement of further prognosis.

Author Biographies

O. O. Sakovych, National Pirogov Memorial Medical University, Vinnytsia, Ukraine

MD, PhD, Associate Professor of the Department of Internal Medicine of Medical Faculty 2

Ya. O. Antoniuk, National Pirogov Memorial Medical University, Vinnytsia, Ukraine

MD, PhD, Assistant of the Department of Internal Medicine of Medical Faculty 2

A. F. Humeniuk, National Pirogov Memorial Medical University, Vinnytsia, Ukraine

MD, PhD, Associate Professor of the Department of Internal Medicine of Medical Faculty 2

V. M. Zhebel, National Pirogov Memorial Medical University, Vinnytsia, Ukraine

MD, PhD, DSc, Professor, Head of the Department of Internal Medicine of Medical Faculty 2

References

Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022;145(18):e895-e1032. doi: https://doi.org/10.1161/CIR.0000000000001063

McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021;42(36):3599-726. doi: https://doi.org/10.1093/eurheartj/ehab368

McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al. 2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2023;44(37):3627-39. doi: https://doi.org/10.1093/eurheartj/ehad195

Butler J, Yang M, Manzi MA, Hess GP, Patel MJ, Rhodes T, et al. Clinical Course of Patients With Worsening Heart Failure With Reduced Ejection Fraction. J Am Coll Cardiol. 2019;73(8):935-44. doi: https://doi.org/10.1016/j.jacc.2018.11.049

Ferrannini G, Benson L, Lautsch D, Dahlström U, Lund LH, Savarese G, et al. N-terminal pro-B-type natriuretic peptide concentrations, testing and associations with worsening heart failure events. ESC Heart Fail. 2023 Dec 19. doi: https://doi.org/10.1002/ehf2.14613

Voronkov LG, Berezin OE, Zharinova VY, Zebel VM, Koval OA, Rudik YS, et al. [Biological markers and their use in heart failure. Consensus of the All-Ukrainian Association of Cardiologists of Ukraine, All-Ukrainian Association of Specialists in Cardiac Failure, and the Ukrainian Association of Specialists in Emergency Cardiology]. Ukrainskyi kardiolohichnyi zhurnal. 2019;26(2):19-30. Ukrainian. doi: https://doi.org/10.31928/1608-635X-2019.2.1122

Koval OA. [Early laboratory diagnosis and monitoring of the course of heart failure: changing modern approaches is the key to effective treatment and improved prognosis]. Zdorovia Ukrainy. 2022;(3-4):6-7. Ukrainian. Available from: https://health-ua.com/multimedia/userfiles/files/2022/Cardio_3-4_2022/Cardio_3-4_2022_st6.pdf

Lippi G, Sanchis-Gomar F. Global epidemiology and future trends of heart failure. AME Med J. 2020;5:15. doi: https://doi.org/10.21037/amj.2020.03.03

Cleland JG, van Veldhuisen DJ, Ponikowski P. The year in cardiology 2018: heart failure. Eur Heart J. 2019;40(8):651-61. doi: https://doi.org/10.1093/eurheartj/ehz010

Conrad N, Judge A, Tran J, Mohseni H, Hedgecott D, Crespillo AP, et al. Temporal trends and patterns in heart failure incidence: a population-based study of 4 million individuals. Lancet. 2018;391(10120):572-80. doi: https://doi.org/10.1016/S0140-6736(17)32520-5

Krech R, Kickbusch I, Franz C, Wells N. Banking for health: the role of financial sector actors in investing in global health. BMJ Glob Health. 2018;3(Suppl 1):e000597. doi: https://doi.org/10.1136/bmjgh-2017-000597

Emdin CA, Conrad N, Kiran A, Salimi-Khorshidi G, Woodward M, Anderson SG, et al. Variation in hospital performance for heart failure management in the National Heart Failure Audit for England and Wales. Heart. 2017;103(1):55-62. doi: https://doi.org/10.1136/heartjnl-2016-309706

Díez J, Butler J. Growing Heart Failure Burden of Hypertensive Heart Disease: A Call to Action. Hypertension. 2023;80(1):13-21. doi: https://doi.org/10.1161/HYPERTENSIONAHA.122.19373

Lindman BR, Dávila-Román VG, Mann DL, McNulty S, Semigran MJ, Lewis GD, et al. Cardiovascular phenotype in HFpEF patients with or without diabetes: a RELAX trial ancillary study. J Am Coll Cardiol. 2014;64(6):541-9. doi: https://doi.org/10.1016/j.jacc.2014.05.030

Scirica BM, Braunwald E, Raz I, Cavender MA, Morrow DA, Jarolim P, et al. Heart failure, saxagliptin, and diabetes mellitus: observations from the SAVOR-TIMI 53 randomized trial. Circulation. 2014;130(18):1579-88. doi: https://doi.org/10.1161/CIRCULATIONAHA.114.010389

Marwick TH, Ritchie R, Shaw JE, Kaye D. Implications of Underlying Mechanisms for the Recognition and Management of Diabetic Cardiomyopathy. J Am Coll Cardiol. 2018;71(3):339-51. doi: https://doi.org/10.1016/j.jacc.2017.11.019

Grigorescu ED, Lacatusu CM, Floria M, Mihai BM, Cretu I, Sorodoc L. Left Ventricular Diastolic Dysfunction in Type 2 Diabetes—Progress and Perspectives. Diagnostics. 2019;9(3):121. doi: https://doi.org/https://doi.org/10.3390/diagnostics9030121

Antoniuk YO, Gumeniuk AF, Sakovych OO, Zhebel VM. The role of the brain natriuretic peptide gene polymorphism in the diagnostic use of the biomarker in myocardial dysfunction in men, residents of Podillya with comorbid essential hypertension and type 2 diabetes mellitus. Biomedical and Biosocial Anthropology. 2020;(38):54-60. doi: https://doi.org/10.31393/bba38-2020-08

Nakagawa Y, Nishikimi T, Kuwahara K. Atrial and brain natriuretic peptides: Hormones secreted from the heart. Peptides. 2019;111:18-25. doi: https://doi.org/10.1016/j.peptides.2018.05.012

Tan ES, Chan SP, Liew OW, Chong JP, Gerard Leong KT, Daniel Yeo PS, et al. Differential Associations of A-/B-Type Natriuretic Peptides With Cardiac Structure, Function, and Prognosis in Heart Failure. JACC Heart Fail. 2024;12(3):461-74. doi: https://doi.org/10.1016/j.jchf.2023.09.011

Tanase DM, Radu S, Al Shurbaji S, Baroi GL, Florida Costea C, Turliuc MD, et al. Natriuretic Peptides in Heart Failure with Preserved Left Ventricular Ejection Fraction: From Molecular Evidences to Clinical Implications. Int J Mol Sci. 2019;20(11):2629. doi: https://doi.org/10.3390/ijms20112629

Mueller C, McDonald K, de Boer RA, Maisel A, Cleland JG, Kozhuharov N, et al. Heart Failure Association of the European Society of Cardiology practical guidance on the use of natriuretic peptide concentrations. Eur J Heart Fail. 2019;21(6):715-31. doi: https://doi.org/10.1002/ejhf.1494

Taylor CJ, Ordóñez-Mena JM, Lay-Flurrie SL, Goyder CR, Taylor KS, Jones NR, et al. Natriuretic peptide testing and heart failure diagnosis in primary care: diagnostic accuracy study. Br J Gen Pract. 2022;73(726):e1-e8. doi: https://doi.org/10.3399/BJGP.2022.0278

Novack ML, Zevitz ME. Natriuretic Peptide B Type Test [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2020. Available from: https://www.ncbi.nlm.nih.gov/books/NBK556136/

Christopherson K, Kobeissi MM. Applying Evidence-Based Practice Guidelines in Primary Care: A Heart Failure Scenario. The Journal for Nurse Practitioners. 2024;20(1):104878. doi: https://doi.org/10.1016/j.nurpra.2023.104878

Rørth R, Jhund PS, Yilmaz MB, Kristensen SL, Welsh P, Desai AS, et al. Comparison of BNP and NT-proBNP in Patients With Heart Failure and Reduced Ejection Fraction. Circ Heart Fail. 2020;13(2):e006541. doi: https://doi.org/10.1161/CIRCHEARTFAILURE.119.006541

Roalfe AK, Lay-Flurrie SL, Ordóñez-Mena JM, Goyder CR, Jones NR, Hobbs FD, et al. Long term trends in natriuretic peptide testing for heart failure in UK primary care: a cohort study. Eur Heart J. 2021;43(9):881-91. doi: https://doi.org/10.1093/eurheartj/ehab781

Jehn S, Mahabadi AA, Pfohl C, Vogel L, Fadi Al-Rashid, Luedike P, et al. BNP and NT-proBNP Thresholds for the Assessment of Prognosis in Patients Without Heart Failure. JACC. 20231;2(10):100688. doi: https://doi.org/10.1016/j.jacadv.2023.100688

Kristensen SL, Mogensen UM, Jhund PS, Petrie MC, Preiss D, Win S, et al. Clinical and Echocardiographic Characteristics and Cardiovascular Outcomes According to Diabetes Status in Patients With Heart Failure and Preserved Ejection Fraction: A Report From the I-Preserve Trial (Irbesartan in Heart Failure With Preserved Ejection Fraction). Circulation. 2017;135(8):724-35. doi: https://doi.org/10.1161/CIRCULATIONAHA.116.024593

Savarese G, Trimarco B, Dellegrottaglie S, Prastaro M, Gambardella F, Rengo G, et al. Natriuretic peptide-guided therapy in chronic heart failure: a meta-analysis of 2,686 patients in 12 randomized trials. PLoS One. 2013;8(3):e58287. doi: https://doi.org/10.1371/journal.pone.0058287

Troughton RW, Frampton CM, Brunner-La Rocca HP, Pfisterer M, Eurlings LW, Erntell H, et al. Effect of B-type natriuretic peptide-guided treatment of chronic heart failure on total mortality and hospitalization: an individual patient meta-analysis. Eur Heart J. 2014;35(23):1559-67. doi: https://doi.org/10.1093/eurheartj/ehu090

Davarzani N, Sanders-van Wijk S, Karel J, Maeder MT, Leibundgut G, Gutmann M, et al. N-Terminal Pro-B-Type Natriuretic Peptide-Guided Therapy in Chronic Heart Failure Reduces Repeated Hospitalizations-Results From TIME-CHF. J Card Fail. 2017;23(5):382-9. doi: https://doi.org/10.1016/j.cardfail.2017.02.001

Senni M, Lopez-Sendon J, Cohen-Solal A, Ponikowski P, Nkulikiyinka R, Freitas C, et al. Vericiguat and NT-proBNP in patients with heart failure with reduced ejection fraction: analyses from the VICTORIA trial. ESC Heart Fail. 2022;9(6):3791-803. doi: https://doi.org/10.1002/ehf2.14050

Simioniuc A, Carluccio E, Ghio S, Rossi A, Biagioli P, Reboldi G, et al. Echo and natriuretic peptide guided therapy improves outcome and reduces worsening renal function in systolic heart failure: An observational study of 1137 outpatients. Int J Cardiol. 2016;224:416-23. doi: https://doi.org/10.1016/j.ijcard.2016.09.034

Ezekowitz JA, O'Connor CM, Troughton RW, Alemayehu WG, Westerhout CM, Voors AA, et al. N-Terminal Pro-B-Type Natriuretic Peptide and Clinical Outcomes: Vericiguat Heart Failure With Reduced Ejection Fraction Study. JACC Heart Fail. 2020;8(11):931-9. doi: https://doi.org/10.1016/j.jchf.2020.08.008

Karlström P, Johansson P, Dahlström U, Boman K, Alehagen U. Can BNP-guided therapy improve health-related quality of life, and do responders to BNP-guided heart failure treatment have improved health-related quality of life? Results from the UPSTEP study. BMC Cardiovasc Disord. 2016;16:39. doi: https://doi.org/10.1186/s12872-016-0221-7

Kuwahara K. The natriuretic peptide system in heart failure: Diagnostic and therapeutic implications. Pharmacol Ther. 2021;227:107863. doi: https://doi.org/10.1016/j.pharmthera.2021.107863

Werhahn SM, Becker C, Mende M, Haarmann H, Nolte K, Laufs U, et al. NT-proBNP as a marker for atrial fibrillation and heart failure in four observational outpatient trials. ESC Heart Fail. 2022;9(1):100-9. doi: https://doi.org/10.1002/ehf2.13703

Dhinakaran K, Selvarajan N. Correlation of NT-proBNP levels with clinical and echocardiographic features in evaluation of patients admitted with heart failure. Journal of Medical and Scientific Research. 2023;11(4):275-9. doi: https://doi.org/10.17727/jmsr.2023/11-51

Kajikawa Y, Ueda A, Ikeda M, Hirota M. Estimation of brain natriuretic peptide values from N-terminal pro brain natriuretic peptide levels and other factors. European Heart Journal. 2023;44(Suppl 1). doi: https://doi.org/10.1093/eurheartj/ehac779.044

Schupp T, Abumayyaleh M, Weidner K, Lau F, Schmitt A, Reinhardt M, et al. Diagnostic and Prognostic Value of Aminoterminal Prohormone of Brain Natriuretic Peptide in Heart Failure with Mildly Reduced Ejection Fraction Stratified by the Degree of Renal Dysfunction. J Clin Med. 2024;13(2):489. doi: https://doi.org/10.3390/jcm13020489

Shah SJ, Borlaug BA, Kitzman DW, McCulloch AD, Blaxall BC, Agarwal R, et al. Research Priorities for Heart Failure With Preserved Ejection Fraction: National Heart, Lung, and Blood Institute Working Group Summary. Circulation. 2020;141(12):1001-26. doi: https://doi.org/10.1161/CIRCULATIONAHA.119.041886

Shi K, Zhang G, Fu H, Li XM, Yu SQ, Shi R, et al. Reduced thoracic skeletal muscle size is associated with adverse outcomes in diabetes patients with heart failure and reduced ejection fraction: quantitative analysis of sarcopenia by using cardiac MRI. Cardiovasc Diabetol. 2024;23(1):28. doi: https://doi.org/10.1186/s12933-023-02109-7

Cosentino F, Grant PJ, Aboyans V, Bailey CJ, Ceriello A, Delgado V, et al. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J. 2020;41(2):255-323. doi: https://doi.org/10.1093/eurheartj/ehz486

Åkerblom A, Wojdyla D, Steg PG, Wallentin L, James SK, Budaj A, et al. Prevalence and relevance of abnormal glucose metabolism in acute coronary syndromes: insights from the PLATelet inhibition and patient Outcomes (PLATO) trial. J Thromb Thrombolysis. 2019;48(4):563-9. doi: https://doi.org/10.1007/s11239-019-01938-2

Berezin AE, Berezin AA. Circulating Cardiac Biomarkers in Diabetes Mellitus: A New Dawn for Risk Stratification-A Narrative Review. Diabetes Ther. 2020;11(6):1271-91. doi: https://doi.org/10.1007/s13300-020-00835-9

Palau P, Bertomeu-González V, Sanchis J, Soler M, de la Espriella R, Domínguez E, et al. Differential prognostic impact of type 2 diabetes mellitus in women and men with heart failure with preserved ejection fraction. Rev Esp Cardiol (Engl Ed). 2020;73(6):463-70. English, Spanish. doi: https://doi.org/10.1016/j.rec.2019.09.002

Belovol AN, Bobronnikova LR, Al’-Trawneh OV. [Pathogenetic features of the combined course of arterial hypertension and diabetes mellitus 2 type]. Shidnoevropejskij zurnal vnutrisnoi ta simejnoi medicini. 2017;(1):4-9. Russian. doi: https://doi.org/10.15407/internalmed2017.01.004

Brutsaert EF, Biggs ML, Delaney JA, Djoussé L, Gottdiener JS, Ix JH, et al. Longitudinal assessment of N-terminal pro-B-type natriuretic peptide and risk of diabetes in older adults: The cardiovascular health study. Metabolism. 2016;65(10):1489-97. doi: https://doi.org/10.1016/j.metabol.2016.06.002

Dunlay SM, Givertz MM, Aguilar D, Allen LA, Chan M, Desai AS, et al. Type 2 Diabetes Mellitus and Heart Failure: A Scientific Statement From the American Heart Association and the Heart Failure Society of America: This statement does not represent an update of the 2017 ACC/AHA/HFSA heart failure guideline update. Circulation. 2019;140(7):e294-e324. doi: https://doi.org/10.1161/CIR.0000000000000691

Vinnakota S, Chen HH. The Importance of Natriuretic Peptides in Cardiometabolic Diseases. J Endocr Soc. 2020;4(6):bvaa052. doi: https://doi.org/10.1210/jendso/bvaa052

Gupta DK, Walford GA, Ma Y, Jarolim P, Wang TJ; DPP Research Group. Racial/ethnic differences in circulating natriuretic peptide levels: The Diabetes Prevention Program. PLoS One. 2020;15(2):e0229280. doi: https://doi.org/10.1371/journal.pone.0229280

Birukov A, Eichelmann F, Kuxhaus O, Polemiti E, Fritsche A, Wirth J, et al. Opposing Associations of NT-proBNP With Risks of Diabetes and Diabetes-Related Complications. Diabetes Care. 2020;43(12):2930-7. doi: https://doi.org/10.2337/dc20-0553

Rørth R, Jhund PS, Kristensen SL, Desai AS, Køber L, Rouleau JL, et al. The prognostic value of troponin T and N-terminal pro B-type natriuretic peptide, alone and in combination, in heart failure patients with and without diabetes. Eur J Heart Fail. 2019;21(1):40-9. doi: https://doi.org/10.1002/ejhf.1359

Chong VH, Singh JS, Dow E, McCrimmon RJ, Lang CC, Struthers AD. Using biomarkers to identify diabetic patients with multiple silent cardiac abnormalities. European Heart Journal. 2020;41(Suppl 2): ehaa946.2942. doi: https://doi.org/10.1093/ehjci/ehaa946.2942

Antoniuk YO, Humeniuk AF, Pashkova YP, Sakovych OO, Zhebel VM. [The diagnostic value of brain natriuretic peptide in men with comorbid essential arterial hypertension and type 2 diabetes mellitus]. Zaporozhye medical journal. 2020;22(5):627-36. Ukrainian. doi: https://doi.org/10.14739/2310-1210.2020.5.214729

Clerico A, Masotti S, Musetti V, Passino C. Pathophysiological mechanisms determining sex differences in circulating levels of cardiac natriuretic peptides and cardiac troponins. J Lab Precis Med. 2019;4:8. doi: https://doi.org/10.21037/jlpm.2019.01.03

Kim HL, Kim MA, Choi DJ, Han S, Jeon ES, Cho MC, et al. Gender difference in the prognostic value of N-Terminal Pro-B type natriuretic peptide in patients with heart failure - a report from the korean heart failure registry (KorHF). Circulation Journal. 2017;81(9):1329-36. doi: https://doi.org/10.1253/circj.CJ-16-1345

Sursaieva LM, Zhebel VM, Pashkova YP, Kulchevich LV, Shevchuk OK. [BNP: phenotypic features of plasma concentration of biomarkers through the prism of sexual dimorphism]. Reports of Vinnytsia National Medical University. 2020;24(4):571-6. Ukrainian. doi: https://doi.org/10.31393/reports-vnmedical-2020-24(4)-02

Romiti GF, Recchia F, Zito A, Visioli G, Basili S, Raparelli V. Sex and Gender-Related Issues in Heart Failure. Heart Fail Clin. 2020;16(1):121-30. doi: https://doi.org/10.1016/j.hfc.2019.08.005

Sobhani K, Nieves Castro DK, Fu Q, Gottlieb RA, Van Eyk JE, Noel Bairey Merz C. Sex differences in ischemic heart disease and heart failure biomarkers. Biol Sex Differ. 2018;9(1):43. doi: https://doi.org/10.1186/s13293-018-0201-y

Gupta DK, Daniels LB, Cheng S, deFilippi CR, Criqui MH, Maisel AS, et al. Differences in Natriuretic Peptide Levels by Race/Ethnicity (From the Multi-Ethnic Study of Atherosclerosis). Am J Cardiol. 2017;120(6):1008-15. doi: https://doi.org/10.1016/j.amjcard.2017.06.030

Bajaj NS, Gutiérrez OM, Arora G, Judd SE, Patel N, Bennett A, et al. Racial Differences in Plasma Levels of N-Terminal Pro-B-Type Natriuretic Peptide and Outcomes: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study. JAMA Cardiol. 2018;3(1):11-7. doi: https://doi.org/10.1001/jamacardio.2017.4207

Published

2024-05-31

How to Cite

1.
Sakovych OO, Antoniuk YO, Humeniuk AF, Zhebel VM. Brain natriuretic peptide: diagnostic and prognostic value in chronic heart failure (a literature review). Zaporozhye Medical Journal [Internet]. 2024May31 [cited 2024Jun.30];26(3):234-41. Available from: http://zmj.zsmu.edu.ua/article/view/297277