atrial-natriuretic-factor and Dyspnea

Natriuretic peptides (NPs) encompass a family of structurally related hormone/paracrine factors acting through the natriuretic peptide system regulating cell proliferation, vessel tone, inflammatory processes, neurohumoral pathways, fluids, and electrolyte balance. The three most studied peptides are atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), and C-Type natriuretic peptide (CNP). ANP and BNP are the most relevant NPs as biomarkers for the diagnosis and prognosis of heart failure and underlying cardiovascular diseases, such as cardiac valvular dysfunction, hypertension, coronary artery disease, myocardial infarction, persistent arrhythmias, and cardiomyopathies. Cardiac dysfunctions related to cardiomyocytes stretching in the atria and ventricles are primary elicitors of ANP and BNP release, respectively. ANP and BNP would serve as biomarkers for differentiating cardiac versus noncardiac causes of dyspnea and as a tool for measuring the prognosis of patients with heart failure; nevertheless, BNP has been shown with the highest predictive value, particularly related to pulmonary disorders. Plasma BNP has been reported to help differentiate cardiac from pulmonary etiologies of dyspnea in adults and neonates. Studies have shown that COVID-19 infection also increases serum levels of N-terminal pro b-type natriuretic peptide (NT-proBNP) and BNP. This narrative review assesses aspects of ANP and BNP on their physiology, and predictive values as biomarkers. We present an overview of the NPs' synthesis, structure, storage, and release, as well as receptors and physiological roles. Following, considerations focus on ANP versus BNP, comparing their relevance in settings and diseases associated with respiratory dysfunctions. Finally, we compiled data from guidelines for using BNP as a biomarker in dyspneic patients with cardiac dysfunction, including its considerations in COVID-19.

Topics: Adult; Atrial Natriuretic Factor; Biomarkers; COVID-19; Dyspnea; Heart Failure; Humans; Infant, Newborn; Natriuretic Peptide, Brain; Natriuretic Peptides

Topics: Atrial Natriuretic Factor; Biomarkers; Dyspnea; Heart Failure; Humans; Predictive Value of Tests; Prognosis; Reproducibility of Results

Biomarkers may help to rapidly differentiate heart failure from noncardiac causes of acute dyspnea. Natriuretic peptides are especially useful for this purpose and should be measured in all patients presenting with acute onset dyspnea. Due to their excellent negative predictive value, a normal serum concentration of natriuretic peptides makes acute heart failure unlikely. Assays exist for B‑type natriuretic peptide (BNP), N‑terminal pro-B-type natriuretic peptide (NT-proBNP) and midregional pro-atrial natriuretic peptide (MR-proANP) with established cut-offs in the acute setting. Importantly, in patients treated with an angiotensin receptor-neprilysin inhibitor (ARNI), NT-proBNP (or MR-proANP) should be used instead of BNP, since the latter is increased by ARNI treatment. Besides their established diagnostic value in heart failure patients, the measurement of natriuretic peptides provides prognostic information and may help in guiding therapy. Additionally, multiple other biomarkers reflect several pathophysiological processes involved in heart failure patients. Their diagnostic and prognostic impact in heart failure needs to be established.

Topics: Acute Disease; Atrial Natriuretic Factor; Biomarkers; Dyspnea; Heart Failure; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis

The rising incidence of and the cost associated with heart failure have made it increasingly imperative to accurately diagnose heart failure upon presentation. Correctly identifying heart failure in an Emergency Department is extremely challenging, and according to estimates, is only confirmatory in approximately 40-50% of patients. For an accurate diagnosis of heart failure and the consequent treatment, there needs to be more accurate test relying on biochemical factors as opposed to general symptoms that patients are experiencing. Natriuretic peptides are now utilized in routine tests for heart disease diagnosis in emergency departments as it is relatively low cost, easy to use and is a quick way to exclude heart failure as a reason for dyspnea. In this review, we detail the role and value of individual natriuretic peptides, particularly BNP, NT-proBNP, and MR-proANP, in diagnosing acute heart failure.

Topics: Atrial Natriuretic Factor; Biomarkers; Dyspnea; Emergency Service, Hospital; Female; Heart Failure; Humans; Male; Natriuretic Peptide, Brain; Natriuretic Peptides; Peptide Fragments

Acute decompensated heart failure (ADHF) is a complex clinical event associated with excess morbidity and mortality. Managing ADHF patients is challenging because of the lack of effective treatments that both reduce symptoms and improve clinical outcomes. Existing guideline recommendations are largely based on expert opinion, but several recently published trials have yielded important data to inform both current clinical practice and future research directions. New insight has been gained regarding volume management, including dosing strategies for intravenous loop diuretics and the role of ultrafiltration in patients with heart failure and renal dysfunction. Although the largest ADHF trial to date (ASCEND-HF, using nesiritide) was neutral, promising results with other investigational agents have been reported. If these findings are confirmed in phase III trials, novel compounds, such as relaxin, omecamtiv mecarbil, and ularitide, among others, may become therapeutic options. Translation of research findings into quality clinical care can not be overemphasized. Although many gaps in knowledge exist, ongoing studies will address issues around delivery of evidence-based care to achieve the goal of improving the health status and clinical outcomes of patients with ADHF.

Topics: Adrenomedullin; Atrial Natriuretic Factor; Biomarkers; Blood Pressure Monitoring, Ambulatory; Cardiotonic Agents; Clinical Trials as Topic; Diet, Sodium-Restricted; Diuretics; Dopamine; Dose-Response Relationship, Drug; Dyspnea; Glycopeptides; Heart Failure; Hemofiltration; Hospitalization; Humans; Natriuretic Agents; Natriuretic Peptide, Brain; Nitroglycerin; Peptide Fragments; Prognosis; Protein Precursors; Quality of Health Care; Relaxin; Risk Assessment; Saline Solution, Hypertonic; Urea; Vasodilator Agents; Xanthines

Topics: Acute Coronary Syndrome; Acute Disease; Atrial Natriuretic Factor; Biomarkers; Critical Care; Dyspnea; Heart Diseases; Heart Failure; Humans; Immunoassay; Natriuretic Peptide, Brain; Practice Guidelines as Topic; Pulmonary Embolism; Reference Values; Risk Assessment

To evaluate the diagnostic performance of the mid-regional portion of the pro-atrial natriuretic peptide (MR-proANP) for heart failure (HF) in dyspnea patients.. We performed a systematic review of English-language studies published during the past three decades. The performance characteristics (diagnostic sensitivity, specificity, and other measures of accuracy) were pooled and examined by random-effects models.. Five studies met the inclusion criteria, which included 1153 patients with HF and 1904 non-HF patients. The summary estimates for MR-proANP in HF diagnosis had a diagnostic sensitivity of 0.90 (95% confidence interval (CI), 0.88-0.92), a specificity of 0.68 (95% CI, 0.66-0.70), and a diagnostic odds ratio (DOR) of 22.89 (95% CI, 12.54-41.77). The area under the curve (AUC) and Q value for the summary receiver operating characteristic (sROC) curves were 0.88 and 0.81, respectively.. MR-proANP showed a high diagnostic accuracy for HF in dyspnea patients.

Topics: Atrial Natriuretic Factor; Dyspnea; Heart Failure; Humans; Research Report; ROC Curve; Sensitivity and Specificity

Whereas the role of the cardiac natriuretic peptides, ANP and BNP, in some aspects of physiology and pathophysiology is clear, their potential in diagnosis, prognosis, and therapeutics in many clinical disorders remains uncertain. We predict that circulating levels of these peptides will find increasing diagnostic utility in patients presenting with dyspnoea, in guiding the complex pharmacotherapy in heart failure, and may likewise be useful in guiding the management of patients on chronic maintenance renal dialysis. We predict also that levels of these peptides will be of practical use as prognostic indicators in 'at-risk' populations (such as those with diabetes, coronary heart disease, hypertension, thalassaemia, etc.) but probably not in the general population. It appears likely that administration of these peptides will find a place in the therapeutics of acute myocardial infarction, but this is less clear for heart failure. We describe the presence of a segment of the signal peptide for BNP within the circulation and discuss its potential clinical utility.

Topics: Animals; Atrial Natriuretic Factor; Dyspnea; Heart Failure; Humans; Myocardial Infarction; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis

The use of biomarkers has been demonstrated useful in many acute diseases both for diagnosis, prognosis and risk stratification.. The purpose of this review is to analyze several biomarkers of potential use in patients referring to Emergency Department with acute dyspnea.. The role of natriuretic peptides has a proven utility in the diagnosis, risk stratification, patient management and prediction of outcome in acute and chronic heart failure (HF). New immunoassays are available for the detection of mid-region prohormones in patients with acute dyspnea such as Mid-region pro-adrenomedullin (MR-proADM) and Mid-region pro-atrial natriuretic peptide (MR-proANP). Also procalcitonin, copeptin and D-dimer, which are markers of inflammation, bacterial infections and sepsis, seem to be useful in the differential diagnosis of dyspnea. Conventional and high-sensitivity troponins are fundamental, not only in the diagnosis of acute coronary syndromes, but also as indicators of mortality in patients with acute decompensated heart failure.. Further studies with randomized controlled clinical trials will be needed to prove the theoretical clinical advantages offered by a shortness of breath biomarkers in terms of diagnostic, prognostic, cost effective work-up and management of patients with acute dyspnea.. A multimarker pannel approach performed by rapid and accurate assays could be useful for emergency physicians to promptly identify different causes of dyspnea thus managing to improve diagnosis, treatment and risk stratification.

Topics: Acute Disease; Adrenomedullin; Atrial Natriuretic Factor; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Dyspnea; Fibrin Fibrinogen Degradation Products; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Protein Precursors; Troponin T

The natriuretic peptides are a family of related hormones that play a crucial role in cardiovascular homeostasis. They have recently emerged as potentially important clinical markers in heart failure. Recent data have suggested an important role for these markers in establishing the diagnosis of heart failure in patients with unexplained dyspnea in both acute care and ambulatory settings. Other clinical uses of the natriuretic peptides, such as screening for asymptomatic ventricular dysfunction, establishing prognosis or guiding titration of drug therapy, are under investigation but have not yet sufficiently been validated for widespread clinical use.

Topics: Atrial Natriuretic Factor; Bayes Theorem; Biomarkers; Dyspnea; Heart Failure; Humans; Likelihood Functions; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Reference Values; ROC Curve; Sensitivity and Specificity; Treatment Outcome; Ventricular Dysfunction, Left

More than 4.5 million Americans have congestive heart failure (CHF), close to 550,000 new cases are diagnosed each year, and one third of known patients with CHF are annually admitted to the hospital. Emergency department diagnosis of CHF is often based on history and physical examination findings along with results of ancillary tests, such as chest radiography and ECG. Although signs and symptoms of fluid overload, such as lower extremity edema and dyspnea, raise the suspicion of CHF, their lack of sensitivity makes them poor screening tools. The natriuretic peptides are promising markers of myocardial dysfunction and heart failure. Because of their relationship to myocardial pressure and stretching, natriuretic peptides have been investigated over the past 5 decades as both diagnostic and prognostic markers in acute coronary syndromes and CHF. This article discusses each of the natriuretic peptides and attempts to delineate their potential diagnostic and prognostic roles in the ED.

Topics: Acute Disease; Atrial Natriuretic Factor; Biomarkers; Diagnosis, Differential; Discriminant Analysis; Dyspnea; Emergency Treatment; Heart Failure; Humans; Mass Screening; Natriuretic Peptide, Brain; Natriuretic Peptide, C-Type; Nerve Tissue Proteins; Patient Admission; Peptide Fragments; Prognosis; Protein Precursors; Reproducibility of Results; Sensitivity and Specificity; Stroke Volume; United States

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.

Topics: Atrial Natriuretic Factor; Brain; Chronic Disease; Dyspnea; Heart Failure; Humans; Natriuretic Peptide, Brain; Predictive Value of Tests; Sensitivity and Specificity

Congestive heart failure poses significant challenges to physicians with both diagnosis and management. B-type natriuretic peptide (BNP) is synthesized in the cardiac ventricles. It correlates with ventricular function, NYHA classification, and prognosis. It is extremely useful in the emergency department in patients presenting with acute dyspnea. It has a particularly strong negative predictive value. In addition, it should be important in screening patients for heart diease, either for those who are at high risk (chemotherapy, diabetes) or as a possible screen before echocardiography. In the future, BNP may be used to modulate treatment of patients in the decompensated setting as well as in titrating outpatient therapy.

Topics: Atrial Natriuretic Factor; Biomarkers; Cardiotonic Agents; Dyspnea; Emergencies; Heart Failure; Humans; Natriuretic Peptide, Brain; Prognosis; Ventricular Dysfunction, Left

Fatigue and mainly dyspnea are symptoms the most often found in patients with diastolic heart failure. Flash pulmonary oedema is one of the most often found mode of clinical presentation. The heart has a normal size at chest X ray. Hemodynamic evaluation, the gold standard, shows increase in filling pressure but is not routinely performed. Doppler echocardiography has become the reference exam. It allows demonstrating: 1. the normal systolic function of the left ventricle (normal ejection fraction); 2. existence of a structural abnormality of the diastolic dysfunction; 3. calculating the level of pulmonary pressures. In the next years, it is likely that an increased plasma level of brain natriuretic peptide (BNP) becomes mandatory for a positive diagnosis.

Topics: Algorithms; Atrial Natriuretic Factor; Biomarkers; Diastole; Dyspnea; Fatigue; Heart Failure; Humans

For the acutely ill patient presenting to the emergency department with dyspnea, an incorrect diagnosis could place the patient at risk for both morbidity and mortality. The stimulus for B-type natriuretic peptide (BNP) release is a change in left-ventricular wall stretch and volume overload. A rapid, whole-blood BNP assay (Triage BNP Test, Biosite Inc, San Diego, CA) that allows quick evaluation of the dyspneic patient has recently been approved by the U.S. Food and Drug Administration. Preliminary research with this test set the stage for the recently completed "Breathing Not Properly" BNP Multinational Study, a seven-center, prospective study of 1586 patients who presented to the emergency department with acute dyspnea and had BNP measured with a point-of-care assay upon arrival. BNP was accurate in making the diagnosis of congestive heart failure (CHF), and levels correlated to severity of disease. Knowledge of BNP levels could have reduced clinical indecision by 74%. Algorithms are being developed for use in the emergency department that take into account other illnesses that might raise BNP levels. BNP levels should be extremely important in ruling out and diagnosing decompensated CHF, as long as baseline "euvolemic" BNP values are known. Finally, in addition to helping assess whether a dyspneic patient has heart failure, BNP levels may also be useful in making both triage and management decisions.

Topics: Atrial Natriuretic Factor; Dyspnea; Emergency Service, Hospital; Emergency Treatment; Heart Failure; Humans; Natriuretic Peptide, Brain

Our purpose was to assess the diagnostic utility of mid-regional pro-atrial natriuretic peptide (MR-proANP) for the diagnosis of acute heart failure (AHF) and the prognostic value of mid-regional pro-adrenomedullin (MR-proADM) in patients with AHF.. There are some caveats and limitations to natriuretic peptide testing in the acute dyspneic patient.. The BACH (Biomarkers in Acute Heart Failure) trial was a prospective, 15-center, international study of 1,641 patients presenting to the emergency department with dyspnea. A noninferiority test of MR-proANP versus B-type natriuretic peptide (BNP) for diagnosis of AHF and a superiority test of MR-proADM versus BNP for 90-day survival were conducted. Other end points were exploratory.. MR-proANP (> or =120 pmol/l) proved noninferior to BNP (> or =100 pg/ml) for the diagnosis of AHF (accuracy difference 0.9%). In tests of secondary diagnostic objectives, MR-proANP levels added to the utility of BNP levels in patients with intermediate BNP values and with obesity but not in renal insufficiency, the elderly, or patients with edema. Using cut-off values from receiver-operating characteristic analysis, the accuracy to predict 90-day survival of heart failure patients was 73% (95% confidence interval: 70% to 77%) for MR-proADM and 62% (95% confidence interval: 58% to 66%) for BNP (difference p < 0.001). In adjusted multivariable Cox regression, MR-proADM, but not BNP, carried independent prognostic value (p < 0.001). Results were consistent using NT-proBNP instead of BNP (p < 0.001). None of the biomarkers was able to predict rehospitalization or visits to the emergency department with clinical relevance.. MR-proANP is as useful as BNP for AHF diagnosis in dyspneic patients and may provide additional clinical utility when BNP is difficult to interpret. MR-proADM identifies patients with high 90-day mortality risk and adds prognostic value to BNP. (Biomarkers in Acute Heart Failure [BACH]; NCT00537628).

Topics: Adrenomedullin; Adult; Aged; Aged, 80 and over; Atrial Natriuretic Factor; Biomarkers; Dyspnea; Female; Heart Failure; Humans; Male; Middle Aged; Predictive Value of Tests; Prognosis; Prospective Studies; Reproducibility of Results

Recently, vasodilators have been increasingly being recognized as useful for the treatment of acute heart failure syndromes (AHFS). Although carperitide (alpha-human atrial natriuretic peptide) has vasodilatory, diuretic and organ-protective effects, its efficacy and safety for the first-line drug treatment of AHFS have not been reported.. A prospective observational study was performed in AHFS patients with preserved systolic blood pressure (SBP >or=120 mmHg), pulmonary congestion and dyspnea who were receiving carperitide monotherapy. The analysis was conducted in 1,832 patients (male: 52.7%; mean age: 75.1+/-12.7 years). The initial SBP was 151.1+/-25.7 mmHg; 62.0% were diagnosed as having acutely decompensated chronic heart failure and 78.8% were assessed as functional class III-IV according to New York Heart Association classification. Carperitide was administered at an initial dosage of 0.025-0.05 microg x kg(-1) x min(-1) in 50.4% of patients. In 1,524 patients (83.2%), carperitide monotherapy restored the acute phase and improved the degree of dyspnea as assessed using the modified Borg scale. The incidence of adverse drug reactions was 4.64%; the most frequently reported adverse reaction was hypotension (3.55%).. In the present study, following carperitide monotherapy, 83.2% of AHFS patients recovered from the acute phase. Based on these findings, carperitide seems useful for the first-line drug treatment of AHFS in patients with pulmonary congestion and preserved blood pressure.

Topics: Acute Coronary Syndrome; Adult; Aged; Aged, 80 and over; Atrial Natriuretic Factor; Blood Pressure; Dyspnea; Female; Heart Failure; Humans; Male; Middle Aged; Prospective Studies; Vasodilator Agents

The diagnostic utility of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in heart failure has been documented. However, most of the data were derived from countries with high healthcare resource use, and randomized evidence for utility of NT-proBNP was lacking.. We tested the hypothesis that NT-proBNP testing improves the management of patients presenting with dyspnea to emergency departments in Canada by prospectively comparing the clinical and economic impact of a randomized management strategy either guided by NT-proBNP results or without knowledge of NT-proBNP concentrations. Five hundred patients presenting with dyspnea to 7 emergency departments were studied. The median NT-proBNP level among the 230 subjects with a final diagnosis of heart failure was 3697 compared with 212 pg/mL in those without heart failure (P<0.00001). Knowledge of NT-proBNP results reduced the duration of ED visit by 21% (6.3 to 5.6 hours; P=0.031), the number of patients rehospitalized over 60 days by 35% (51 to 33; P=0.046), and direct medical costs of all ED visits, hospitalizations, and subsequent outpatient services (US $6129 to US $5180 per patient; P=0.023) over 60 days from enrollment. Adding NT-proBNP to clinical judgment enhanced the accuracy of a diagnosis; the area under the receiver-operating characteristic curve increased from 0.83 to 0.90 (P<0.00001).. In a universal health coverage system mandating judicious use of healthcare resources, inclusion of NT-proBNP testing improves the management of patients presenting to emergency departments with dyspnea through improved diagnosis, cost savings, and improvement in selected outcomes.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Ambulatory Care; Atrial Natriuretic Factor; Biomarkers; Canada; Cost Savings; Dyspnea; Emergency Medical Services; Female; Health Expenditures; Heart Failure; Humans; Male; Middle Aged; National Health Programs; Outcome Assessment, Health Care; Patient Readmission; Prospective Studies; Protein Precursors

In patients with pulmonary disease, it is often challenging to distinguish exacerbated pulmonary disease from congestive heart failure (CHF). The impact of B-type natriuretic peptide (BNP) measurements on the management of patients with pulmonary disease and acute dyspnea remains to be defined.. This study evaluated the subgroup of 226 patients with a history of pulmonary disease included in the BASEL Study. Patients were randomly assigned to a diagnostic strategy with (n = 119, BNP group) or without (n = 107, clinical group) the use of BNP levels provided by a rapid bedside assay. Time to discharge and total cost of treatment were recorded as the primary end points.. Baseline characteristics were similar in patients assigned to the BNP and control groups. Comorbidity was extensive, including coronary artery disease and hypertension in half of patients. The primary discharge diagnosis was CHF and exacerbated obstructive pulmonary disease in 39% and 33%, respectively. The use of BNP levels significantly reduced the need for hospital admission (81% vs 91%, P = .034). Median time to discharge was 9.0 days in the BNP group as compared with 12.0 days (P = .001) in the clinical group. Median total cost of treatment was $4841 in the BNP group as compared with $5671 in the clinical group (P = .008). Inhospital mortality was 8% in both groups.. CHF is a major cause of acute dyspnea in patients with a history of pulmonary disease. Used in conjunction with other clinical information, rapid measurement of BNP reduced time to discharge and total treatment cost of these patients.

Topics: Acute Disease; Aged; Asthma; Atrial Natriuretic Factor; Biomarkers; Confidence Intervals; Coronary Artery Disease; Dyspnea; Emergencies; Female; Heart Failure; Humans; Hypertension; Length of Stay; Male; Pneumonia; Pulmonary Disease, Chronic Obstructive; Pulmonary Embolism

B-type natriuretic peptide (BNP) is increased in left ventricular dysfunction and congestive heart failure e. The aim of the study was to determine the diagnostic accuracy of BNP and the degree to which BNP adds to clinical judgement in the diagnosis of heart failure.. The BNP Multinational Study was a seven-centre prospective study of 1586 patients presenting to emergency departments with acute dyspnoea who had BNP levels measured with a rapid, point-of-care device on arrival. 1538 (97%) had pre-test probability of congestive heart failure determined from 0-100% by the attending physician in the emergency department who was blinded to the BNP levels. The final diagnosis was adjudicated by two independent cardiologists, also blinded to BNP results, who reviewed all clinical data and standardised congestive heart failure scores.. The final diagnosis was congestive heart failure in 722 (47%) patients. Pre-test probability of this condition > or = 80% as determined by the attending physician had a sensitivity of 49% and specificity of 96 % for correct diagnosis. BNP > or = 100 pg/ml had a sensitivity of 90% and a specificity of 73% for correct diagnosis. In determining the correct diagnosis (congestive heart failure or not), adding BNP to clinical judgement would have enhanced diagnostic accuracy from 74% to 81%.. Measurement of BNP adds to the clinical information in the diagnosis of congestive heart failure in patients presenting with acute dyspnoea.

Topics: Acute Disease; Adult; Aged; Atrial Natriuretic Factor; Biomarkers; Diagnosis, Differential; Dyspnea; Emergency Service, Hospital; Female; Heart Failure; Humans; Male; Middle Aged; Patient Admission; Predictive Value of Tests; Prospective Studies; ROC Curve; Sensitivity and Specificity

We sought to determine the degree to which B-type natriuretic peptide (BNP) adds to clinical judgment in the diagnosis of congestive heart failure (CHF).. The Breathing Not Properly Multinational Study was a prospective diagnostic test evaluation study conducted in 7 centers. Of 1586 participants who presented with acute dyspnea, 1538 (97%) had clinical certainty of CHF determined by the attending physician in the emergency department. Participants underwent routine care and had BNP measured in a blinded fashion. The reference standard for CHF was adjudicated by 2 independent cardiologists, also blinded to BNP results. The final diagnosis was CHF in 722 (47%) participants. At an 80% cutoff level of certainty of CHF, clinical judgment had a sensitivity of 49% and specificity of 96%. At 100 pg/mL, BNP had a sensitivity of 90% and specificity of 73%. In determining the correct diagnosis (CHF versus no CHF), adding BNP to clinical judgment would have enhanced diagnostic accuracy from 74% to 81%. In those participants with an intermediate (21% to 79%) probability of CHF, BNP at a cutoff of 100 pg/mL correctly classified 74% of the cases. The areas under the receiver operating characteristic curve were 0.86 (95% CI 0.84 to 0.88), 0.90 (95% CI 0.88 to 0.91), and 0.93 (95% CI 0.92 to 0.94) for clinical judgment, for BNP at a cutoff of 100 pg/mL, and for the 2 in combination, respectively (P<0.0001 for all pairwise comparisons).. The evaluation of acute dyspnea would be improved with the addition of BNP testing to clinical judgment in the emergency department.

Topics: Adolescent; Adult; Aged; Atrial Natriuretic Factor; Dyspnea; Electrocardiography; Emergencies; Female; Heart Failure; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Radiography; Reference Standards; Reproducibility of Results; ROC Curve; Sensitivity and Specificity

B-Type natriuretic peptide (BNP) is a neurohormone secreted from the cardiac ventricles in response to volume expansion and pressure overload. We have recently demonstrated that BNP can differentiate congestive heart failure (CHF) from other causes of dyspnea in patients presenting to the emergency department. In this study, we assess whether BNP levels drawn in patients presenting with dyspnea to the ED were a predictor of future cardiac events.. In 325 patients presenting with dyspnea to the ED, BNP levels were determined. Patients were then followed up for 6 months to determine the following end points: death (cardiac and noncardiac), hospital admissions (cardiac), and repeat ED visits for CHF. Receiver operating characteristic (ROC) curves, relative risks (RRs), and Kaplan-Meier plots were used to assess the ability of BNP levels to predict future cardiac events.. The area under the ROC curve using BNP to detect a CHF end point-a CHF death, hospital admission, or repeat ED visit-was 0.870 (95% confidence interval [CI] 0.826 to 0.915). A BNP value of 480 pg/mL had a sensitivity of 68%, specificity of 88%, and an accuracy of 85% for predicting a subsequent CHF end point. The area under the ROC curve using BNP to detect death from CHF was 0.881 (95% CI 0.807 to 0.954) and for any cardiac death was 0.877 (95% CI 0.822 to 0.933). BNP was not associated with death from noncardiac causes. Using Kaplan-Meier plots for all CHF events, rising BNP levels were associated with a progressively worse prognosis. Patients with BNP levels more than 480 pg/mL had a 51% 6-month cumulative probability of a CHF event. Alternatively, patients with BNP levels less than 230 pg/mL had an excellent prognosis with only 2.5% incidence of CHF end points. The RR of 6-month CHF death in patients with BNP levels more than 230 pg/mL was 24.1. The RR of 6-month noncardiac death with BNP levels more than 230 pg/mL was 1.1. BNP levels were also predictive of CHF events in subsets of patients with positive CHF histories and ED diagnoses.. In this study population, BNP levels measured in patients presenting with dyspnea to the ED are highly predictive of cardiac events over the next 6 months.

Topics: Adult; Aged; Atrial Natriuretic Factor; California; Cardiotonic Agents; Dyspnea; Emergency Service, Hospital; Endpoint Determination; Female; Heart Failure; Hospitalization; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Predictive Value of Tests; ROC Curve

Decompensated congestive heart failure (CHF) is the leading hospital discharge diagnosis in patients older than 65 years.. To compare the efficacy and safety of intravenous nesiritide, intravenous nitroglycerin, and placebo.. Randomized, double-blind trial of 489 inpatients with dyspnea at rest from decompensated CHF, including 246 who received pulmonary artery catheterization, that was conducted at 55 community and academic hospitals between October 1999 and July 2000.. Intravenous nesiritide (n = 204), intravenous nitroglycerin (n = 143), or placebo (n = 142) added to standard medications for 3 hours, followed by nesiritide (n = 278) or nitroglycerin (n = 216) added to standard medication for 24 hours.. Change in pulmonary capillary wedge pressure (PCWP) among catheterized patients and patient self-evaluation of dyspnea at 3 hours after initiation of study drug among all patients. Secondary outcomes included comparisons of hemodynamic and clinical effects between nesiritide and nitroglycerin at 24 hours.. At 3 hours, the mean (SD) decrease in PCWP from baseline was -5.8 (6.5) mm Hg for nesiritide (vs placebo, P<.001; vs nitroglycerin, P =.03), -3.8 (5.3) mm Hg for nitroglycerin (vs placebo, P =.09), and -2 (4.2) mm Hg for placebo. At 3 hours, nesiritide resulted in improvement in dyspnea compared with placebo (P =.03), but there was no significant difference in dyspnea or global clinical status with nesiritide compared with nitroglycerin. At 24 hours, the reduction in PCWP was greater in the nesiritide group (-8.2 mm Hg) than the nitroglycerin group (-6.3 mm Hg), but patients reported no significant differences in dyspnea and only modest improvement in global clinical status.. When added to standard care in patients hospitalized with acutely decompensated CHF, nesiritide improves hemodynamic function and some self-reported symptoms more effectively than intravenous nitroglycerin or placebo.

Topics: Analysis of Variance; Atrial Natriuretic Factor; Cardiotonic Agents; Double-Blind Method; Drug Therapy, Combination; Dyspnea; Female; Heart Failure; Hemodynamics; Humans; Infusions, Intravenous; Male; Middle Aged; Natriuretic Peptide, Brain; Nitroglycerin; Prospective Studies; Pulmonary Wedge Pressure; Statistics, Nonparametric; Vasodilator Agents

Intravenous infusion of nesiritide, a brain (B-type) natriuretic peptide, has beneficial hemodynamic effects in patients with decompensated congestive heart failure. We investigated the clinical use of nesiritide in such patients.. Patients hospitalized because of symptomatic congestive heart failure were enrolled in either an efficacy trial or a comparative trial. In the efficacy trial, which required the placement of a Swan-Ganz catheter, 127 patients with a pulmonary-capillary wedge pressure of 18 mm Hg or higher and a cardiac index of 2.7 liters per minute per square meter of body-surface area or less were randomly assigned to double-blind treatment with placebo or nesiritide (infused at a rate of 0.015 or 0.030 microg per kilogram of body weight per minute) for six hours. In the comparative trial, which did not require hemodynamic monitoring, 305 patients were randomly assigned to open-label therapy with standard agents or nesiritide for up to seven days.. In the efficacy trial, at six hours, nesiritide infusion at rates of 0.015 and 0.030 microg per kilogram per minute decreased pulmonary-capillary wedge pressure by 6.0 and 9.6 mm Hg, respectively (as compared with an increase of 2.0 mm Hg with placebo, P<0.001), resulted in improvements in global clinical status in 60 percent and 67 percent of the patients (as compared with 14 percent of those receiving placebo, P<0.001), reduced dyspnea in 57 percent and 53 percent of the patients (as compared with 12 percent of those receiving placebo, P<0.001), and reduced fatigue in 32 percent and 38 percent of the patients (as compared with 5 percent of those receiving placebo, P<0.001). In the comparative trial, the improvements in global clinical status, dyspnea, and fatigue were sustained with nesiritide therapy for up to seven days and were similar to those observed with standard intravenous therapy for heart failure. The most common side effect was dose-related hypotension, which was usually asymptomatic.. In patients hospitalized with decompensated congestive heart failure, nesiritide improves hemodynamic function and clinical status. Nesiritide is useful for the treatment of decompensated congestive heart failure.

Topics: Atrial Natriuretic Factor; Cardiotonic Agents; Dose-Response Relationship, Drug; Double-Blind Method; Dyspnea; Fatigue; Female; Heart Failure; Humans; Hypotension; Male; Middle Aged; Natriuretic Peptide, Brain; Pulmonary Wedge Pressure; Vasodilator Agents

Recognition of heart failure (HF) may be difficult in patients presenting with acute dyspnoea, particularly in the presence of chronic airways obstruction. Since increased secretion of the cardiac hormones atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) occurs early in the course of HF, we have assessed the value of measuring these hormones in plasma in the diagnosis of suspected HF in 52 elderly patients presenting with acute dyspnoea, and compared values with left-ventricular ejection fraction (LVEF), a standard measure of left-ventricular function, by radionuclide angiography. Patients were enrolled prospectively. On the basis of clinical findings, conventional tests, and response to specific treatment, 20 of the 52 patients were classified as having primary lung disorder (PLD), 12 as HF alone, and 20 as HF with underlying PLD (HF/PLD). Compared with findings in PLD patients, LVEF was significantly depressed in HF and HF/PLD patients (p < 0.001), whereas both plasma ANP and BNP were significantly increased (p < 0.001). Admission plasma BNP concentration more accurately reflected the final diagnosis of HF (93% sensitivity and 90% specificity when BNP > or = 22 pmol/L) than LVEF or plasma ANP concentration. When all patients were considered together, there were strong negative correlations between LVEF and log BNP (r = -0.7, p < 0.001) and log ANP (r = -0.59, p < 0.001). Our finding that plasma BNP is raised in dyspnoeic patients with HF but not in acutely breathless patients with PLD, suggests that rapid BNP assays may assist in the diagnosis of patients with acute dyspnoea.

Topics: Acute Disease; Aged; Aged, 80 and over; Atrial Natriuretic Factor; Diagnosis, Differential; Dyspnea; Female; Heart Failure; Humans; Lung Diseases; Male; Middle Aged; Natriuretic Peptide, Brain; Nerve Tissue Proteins; Prospective Studies; Stroke Volume

The effects of intravenous human atrial natriuretic factor ANF(99-126) administration on anterior pituitary hormone secretion have not been extensively investigated in humans. We repeatedly studied 10 healthy volunteers (5 female, 5 male, aged 28 +/- 2 years) on 2 occasions, 3 days apart. In randomized, single blind order, subjects received pretreatment with either placebo or intravenous ANF(99-126) (bolus 100 micrograms/kg, 30-min infusion of 0.1 micrograms/kg.min). Subsequently on both occasions subjects received a combined intravenous bolus injection of pituitary releasing hormones (200 micrograms thyrotropin releasing hormone, 100 micrograms gonadotropin releasing hormone and 100 micrograms human adrenocorticotropin releasing hormone; Bissendorf, Hannover, FRG). Plasma concentrations of adrenocorticotropic hormone (ACTH), cortisol, luteinizing hormone (LH), follicle-stimulating hormone (FSH), growth hormone (GH), thyrotropin (TSH), prolactin, ANF and cyclic guanosine monophosphate (GMP) were determined by radioimmunoassay. ANF(99-126) treatment induced a significant reduction in basal ACTH plasma concentrations and tended to decrease basal plasma cortisol. The TSH response to combined releasing hormone administration was significantly diminished after ANF(99-126) pretreatment. In women, the releasing hormone induced prolactin increase was reduced after ANF(99-126) pretreatment. With the present study design, ANF(99-126) did not alter the basal or releasing hormone stimulated plasma concentrations of cortisol, LH, FSH and GH. Releasing hormone administration did not affect ANF and cyclic GMP plasma levels. In humans, effects of natriuretic peptides on anterior pituitary hormone secretion may have to be considered with investigational or therapeutic administration of ANF analogues or agents interfering with the ANF metabolism.

Topics: Adult; Atrial Natriuretic Factor; Blood Pressure; Dyspnea; Female; Flushing; Heart Rate; Humans; Infusions, Intravenous; Injections, Intravenous; Male; Nausea; Peptide Fragments; Pituitary Gland, Anterior; Pituitary Hormone-Releasing Hormones; Pituitary Hormones, Anterior; Secretory Rate; Taste Disorders

Human atrial natriuretic peptide, known as carperitide, is approved for early relief of dyspnea in patients with acute heart failure (AHF). However, the diuretic effect of carperitide is sometimes insufficient for controlling volume overload. We investigated predictors for the carperitide response in patients with AHF. Forty-seven patients (age: 74 ± 10 years; left ventricular ejection fraction: 42.0% ± 15.9%) with AHF were enrolled and treated with carperitide monotherapy at a dose of 0.0125 μg/kg/min. Patients without sufficient diuresis (< 60 ml/h) or improvement of symptoms by 4 h after carperitide administration, despite increasing to twice the dose of carperitide and adding another agent, were defined as non-responders. Twenty-four (51%) patients were defined as responders and treated with low-dose carperitide monotherapy on the first day. Multiple logistic regression analysis showed that the response to carperitide monotherapy was independently predicted by serum creatinine levels and systolic blood pressure (SBP) on admission. The area under the receiver-operating characteristic curve for predicting the response to carperitide by SBP was 0.808 (95% confidence interval [0.686-0.930], sensitivity: 83.3%, specificity: 65.2%, cutoff value: 135 mmHg). Four (8.5%) patients developed asymptomatic transient hypotension. Worsening renal function occurred within 3 days of admission in three (6.4%) patients who received low-dose carperitide therapy. SBP and serum creatinine levels on admission might be useful for predicting the diuretic response to low-dose carperitide monotherapy in patients with AHF. Initial use of low-dose carperitide therapy does not have adverse effects on renal function.

Topics: Acute Disease; Aged; Aged, 80 and over; Atrial Natriuretic Factor; Biomarkers; Blood Pressure; Creatinine; Diuresis; Diuretics; Dyspnea; Female; Heart Failure; Humans; Hypotension; Male; Middle Aged; Predictive Value of Tests; Recovery of Function; Retrospective Studies; Time Factors; Treatment Outcome

Interferon lambdas (IFNLs) have important anti-viral/bacterial and immunomodulatory functions in the respiratory tract. How do IFNLs impact COPD and its exacerbations?. Five hundred twenty eight patients were recruited in a prospective observational multicentre cohort (PROMISE) study. The genetic polymorphisms (rs8099917 and rs12979860) within the IFNL3/4 gene region and circulating levels of IFNL3 in COPD patients were determined and associated with disease activity and outcome during a median follow-up of 24 months.. The GG genotype significantly influenced severe exacerbation rate (42 vs. 23%; p = 0.032) and time to severe exacerbation (HR = 2.260; p = 0.012). Compared to the TT or TG genotypes, the GG genotype was associated with severe dyspnoea (modified medical research council score ≥ median 3; 22 vs 42%, p = 0.030). The CC genotype of the rs12979860 SNP was associated with a poorer prognosis (body mass index, airflow obstruction, dyspnea and exercise capacity index ≥ median 4; 46 vs. 36% TC vs. 20.5% TT; p = 0.031). Patients with stable COPD and at exacerbation had significantly lower circulating IFNL3 compared to healthy controls (p < 0.001 and p < 0.001, respectively). Circulating IFNL3 correlated to post-bronchodilator FEV. IFNL3/4 polymorphisms and circulating IFNL3 may be associated with disease activity and outcomes in COPD.. Clinical Trial registration http://www.isrctn.com/ identifier ISRCTN99586989 on 16 April 2008.

Topics: Adrenomedullin; Aged; Atrial Natriuretic Factor; Case-Control Studies; Cohort Studies; Disease Progression; Dyspnea; Female; Forced Expiratory Volume; Glycopeptides; Humans; Interferons; Interleukins; Male; Middle Aged; Polymorphism, Genetic; Polymorphism, Single Nucleotide; Procalcitonin; Prognosis; Proportional Hazards Models; Prospective Studies; Protein Precursors; Pulmonary Disease, Chronic Obstructive; Severity of Illness Index

To compare the diagnostic and prognostic value of mid-regional pro-ANP (MR-proANP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients with acute dyspnea.. MR-proANP and NT-proBNP were measured with commercial immunoassays at hospital admission (n = 313), on day 2 (n = 234), and before discharge (n = 91) and compared for diagnosing acute heart failure (HF; n = 143) and to predict mortality among patients with acute HF and acute exacerbation of chronic obstructive pulmonary disease (AECOPD; n = 84) separately.. The correlation coefficient between MR-proANP and NT-proBNP was 0.89 (p < 0.001) and the receiver-operating area under the curve (AUC) was 0.85 (95% CI 0.81-0.89) for MR-proANP and 0.86 (0.82-0.90) for NT-proBNP to diagnose acute HF. During a median follow-up of 816 days, mortality rates were 46% in acute HF patients and 42% in AECOPD patients. After adjustment for other risk variables by multivariate Cox regression analysis, MR-proANP and NT-proBNP concentrations were associated with mortality in patients with acute HF, but only MR-proANP were associated with mortality among patients with AECOPD: hazard ratio (. MR-proANP and NT-proBNP concentrations provide similar diagnostic and prognostic information in patients with acute HF. In contrast to NT-proBNP, MR-proANP measurements also provided independent prognostic information in AECOPD patients.

Topics: Aged; Atrial Natriuretic Factor; Dyspnea; Female; Heart Failure; Hospitalization; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Prognosis; Pulmonary Disease, Chronic Obstructive

Acute dyspnea is a frequent complaint in patients attending the emergency department (ED).. To evaluate the accuracy of PCT, MR-proANP, MR-proADM, copeptin and CT-proET1 for the risk-stratification of severe acute dyspnea patients presenting to the ED.. Multicenter prospective study in adult patients with a chief complaint of acute dyspnea. Pro-hormone type biomarkers concentrations were measured on arrival. Combined primary endpoint was a poor outcome.. Three hundred and ninety-four patients were included, 137 (35%) met the primary endpoint. MR-proADM was the only biomarker associated with the primary endpoint (odds ratio 1.43 [95%CI: 1.13-1.82], p = 0.003) as were the presence of paradoxical abdominal breathing (odds ratio 2.48 [95%CI: 1.31-4.68]) or cyanosis (odds ratio 3.18 [1.46-6.89]) Conclusions: In patients with severe acute dyspnea in the ED, pro-hormone type biomarkers measurements have a low added value to clinical signs for the prediction of poor outcome.

Topics: Acute Disease; Adrenomedullin; Atrial Natriuretic Factor; Biomarkers; Calcitonin; Dyspnea; Emergency Service, Hospital; Endothelin-1; Glycopeptides; Hormones; Humans; Peptide Fragments; Prognosis; Prospective Studies; Severity of Illness Index

Topics: Aged; Aged, 80 and over; Atrial Natriuretic Factor; Dyspnea; Heart Failure; Humans; Natriuretic Peptide, Brain; Respiration

The evaluation of the role of novel biomarkers in the management of cardiac and pulmonary conditions has received particular attention in recent years. A further particular perspective is the use of biomarker panels in the evaluation of patients presenting with acute dyspnea.. We prospectively evaluated three biomarkers (MR-proANP, PCT, and MR-proADM) in consecutive patients presenting with acute dyspnea in a medical emergency unit during a 4-week period. Patients received a final diagnosis. Biomarkers were tested for their potential to predict diagnoses and survival. No intervention was done.. Overall, n = 172 patients were included. Of these, 32.6 % had acute heart failure, 16.9 % pneumonia, and 5.8 % died. MR-proANP was the highest in patients with acute heart failure and lung embolism. Dyspnea scores and levels of MR-pro-ANP correlated positively. MR-proANP achieved an AUC of 0.83 for the diagnosis of acute heart failure. Using a cut-off of 120 pmol/l, sensitivity was 91.1 % and specificity 50 %. PPV was 46.8 % and NPV 92.1 %. In patients with MR-proANP >300 pmol/l, PPV raised to 67.3 %. MR-proADM had an AUC of 0.84 for the prediction of death. PPV was 16 % and NPV 98.4 %. The AUC of PCT was 0.74 for the diagnosis of pneumonia. Using a cut-off of 0.25 ng/ml, PCT had a sensitivity of 44.8 % and a specificity of 85.3 %. PPV was 38.2 and NPV 88.4 %. Using a lower cut-off of <0.1 ng/ml, NPV reached 92.9 %.. A panel of three biomarkers (MR-proANP, PCT, and MR-proADM) in patients presenting to the emergency unit with acute dyspnea provides information about the probability of acute heart failure, nonsurvival, and pneumonia. These biomarkers achieve low to moderate positive predictive values (PPV) and high negative predictive values (NPV).

Topics: Acute Disease; Adrenomedullin; Aged; Aged, 80 and over; Area Under Curve; Atrial Natriuretic Factor; Biomarkers; Calcitonin; Dyspnea; Emergency Service, Hospital; Female; Heart Failure; Humans; Male; Middle Aged; Pneumonia; Predictive Value of Tests; Prognosis; Prospective Studies; Protein Precursors; Reproducibility of Results; Risk Factors; ROC Curve; Time Factors

Topics: Acute Disease; Atrial Natriuretic Factor; Biomarkers; Dyspnea; Heart Failure; Humans; Natriuretic Peptide, Brain; Peptide Fragments

The purpose of this study was to assess the impact of atrial fibrillation (AF) on the performance of mid-region amino terminal pro-atrial natriuretic peptide (MR-proANP) in comparison with the B-type peptides (BNP and NT-proBNP) for diagnosis of acute heart failure (HF) in dyspneic patients.. The effects of AF on the diagnostic and prognostic performance of MR-proANP in comparison with the B type natriuretic peptides have not been previously reported.. A total of 1,445 patients attending the emergency department with acute dyspnea had measurements taken of MR-proANP, BNP, and NT-proBNP values on enrollment to the BACH trial and were grouped according to presence or absence of AF and HF.. AF was present in 242 patients. Plasma concentrations of all three peptides were lowest in those with neither AF nor HF and AF without HF was associated with markedly increased levels (p < 0.00001). HF with or without AF was associated with a significant further increment (p < 0.00001 for all three markers). Areas under receiver operator characteristic curves (AUCs) for discrimination of acute HF were similar and powerful for all peptides without AF (0.893 to 0.912; all p < 0.001) with substantial and similar reductions (0.701 to 0.757) in the presence of AF. All 3 peptides were independently prognostic but there was no interaction between any peptide and AF for prediction of all-cause mortality.. AF is associated with increased plasma natriuretic peptide (MR-proANP, BNP and NT-proBNP) levels in the absence of HF. The diagnostic performance of all three peptides is impaired by AF. This warrants consideration of adjusted peptide thresholds for diagnostic use in AF and mandates the continued search for markers free of confounding by AF.

Topics: Acute Disease; Atrial Fibrillation; Atrial Natriuretic Factor; Biomarkers; Dyspnea; Female; Heart Failure; Humans; Male; Middle Aged; Predictive Value of Tests; Prospective Studies

Midregional pro atrial natriuretic peptide (MR-proANP) is useful for diagnosing acute heart failure (HF) in patients presenting to the Emergency Department with dyspnoea. Optimal interpretation of MR-proANP requires understanding of how various demographic variables influence its levels and performance as a diagnostic marker. We sought to determine how age, race, sex, and body mass index (BMI) affect the levels and interpretation of MR-proANP for the diagnosis of acute HF.. The Biomarkers in Acute Heart Failure (BACH) study was an international 15-centre study of 1641 patients presenting to the Emergency Department with acute dyspnoea. Of these, 1352 had complete information on age, race, sex, and BMI. MR-proANP levels increased with age and were higher in men and in patients with lower BMI. MR-proANP performed better as a diagnostic marker in younger individuals and in blacks compared with whites. Despite this, MR-proANP at the recommended cut-off point of 120 pmol/L was >90 % sensitive in ruling out the diagnosis of acute HF in all subgroups of patients except white subjects <50 years old.. Age, race, sex, and BMI affect MR-proANP levels to various degrees. However, the diagnostic performance of the recommended cut-off point of 120 pmol/L to rule out acute HF was robust across most subgroups. Although both sex and BMI affected MR-proANP levels, they did not alter its overall diagnostic performance. Lower cut-off points for MR-proANP could be considered in younger patients and in patients with a higher BMI, to optimize diagnostic sensitivity.

Topics: Acute Disease; Age Factors; Aged; Aged, 80 and over; Atrial Natriuretic Factor; Biomarkers; Body Mass Index; Dyspnea; Female; Heart Failure; Humans; Male; Middle Aged; Predictive Value of Tests; Prospective Studies; Racial Groups; Sex Factors

Serum mid-regional pro-atrial natriuretic peptide (MR-proANP) and pro-adrenomedullin (MR-proADM) are novel biomarkers for acute heart failure (AHF). Like other AFH biomarkers, the performance of these tests are affected by the presence of clinical variables such as renal failure and obesity. In a substudy of the Biomarkers from Acute Heart Failure Study, we show that diabetes did not influence the performance of these markers with regards to AHF diagnosis or 90-day all cause death. However, in patients without AHF, increased MR-proADM alone was associated with the presence of diabetes.

Topics: Acute Disease; Adrenomedullin; Adult; Aged; Aged, 80 and over; Atrial Natriuretic Factor; Biomarkers; Clinical Trials as Topic; Diabetes Mellitus; Dyspnea; Female; Heart Failure; Humans; Kaplan-Meier Estimate; Linear Models; Male; Middle Aged; Multivariate Analysis; Peptide Fragments; Prognosis; Protein Precursors; ROC Curve

The aim of this study was to assess diagnostic and prognostic value of mid-regional pro-atrial natriuretic peptide (MR-proANP) and adrenomedullin (MR-proADM) for the evaluation of patients presenting to the emergency department with acute dyspnoea.. A total of 560 patients from the pro-B type natriuretic peptide Investigation of Dyspnoea in the Emergency Department were evaluated; 180 had acutely decompensated heart failure (ADHF). Concentrations of amino-terminal pro-B type natriuretic peptide (NT-proBNP), MR-proADM, and MR-proANP were measured, and patients were followed to 4 years for survival. Logistic regression evaluated utility of MR-proANP in ADHF diagnosis. Area under the curve (AUC), multivariate Cox regression, net reclassification improvement, and Kaplan-Meier survival analyses were used for mortality analyses. Mid-regional pro-atrial natriuretic peptide was higher in patients with ADHF (median 329 vs. 58 pmol/L; P < 0.001), and remained an independent predictor of HF diagnosis even when NT-proBNP was included as a covariate (odds ratio = 4.34, 95% CI = 2.11-8.92; P < 0.001). In time-dependent analyses, MR-proADM had the highest AUC for death during the first year; after 1 year, MR-proANP and NT-proBNP had a higher AUC. Both mid-regional peptides were independently prognostic and reclassified risk at 1 year [MR-proANP, hazard ratio (HR) = 2.99, MR-proADM, HR = 2.70; both P < 0.001] and at 4 years (MR-proANP, HR = 3.12, P < 0.001; MR-proADM, HR = 1.51, P = 0.03) and in Kaplan-Meier curves both mid-regional peptides were associated with death out to 4 years, individually or in a multimarker strategy.. Among patients with acute dyspnoea, MR-proANP is accurate for diagnosis of ADHF, while both MR-proANP and MR-proADM are independently prognostic to 4 years of the follow-up.

Topics: Acute Disease; Adrenomedullin; Area Under Curve; Atrial Natriuretic Factor; Dyspnea; Heart Failure; Humans; Kaplan-Meier Estimate; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prognosis; Protein Precursors

The aim of this study was to evaluate the diagnostic and the prognostic value of a laboratory panel consisting of mid-regional pro-atrial natriuretic peptide (MR-proANP), procalcitonin (PCT), and mid-regional pro-adrenomedullin (MR-proADM) for patients presenting to the emergency department (ED) with acute dyspnea.. We prospectively enrolled ED patients who presented with a chief complaint of dyspnea and who had an uncertain diagnosis after physician evaluation. Final primary diagnosis of the cause of shortness of breath was confirmed through additional testing per physician discretion. We recorded inpatient admission and 30-day mortality rates.. One hundred fifty-four patients were enrolled in the study. Congestive heart failure exacerbation was the final primary diagnosis in 42.2% of patients, while infectious etiology was diagnosed in 33.1% of patients. For the diagnosis of congestive heart failure exacerbation, MR-proANP had a sensitivity of 92.7% and specificity of 36.8%, with a negative likelihood ratio (LR-) of 0.16 and a positive likelihood ratio (LR+) of 1.44 (cut-off value: 120 pmol/L). For the diagnosis of an infectious etiology, PCT had a 96.5% specificity and 48.8% sensitivity (LR-: 0.58, LR+: 13.8, cutoff value: 0.25 ng/mL). As a prognostic indicator, MR-proADM demonstrated similar values: odds ratio for 30-day mortality was 8.5 (95% CI, 2.5-28.5, cutoff value: 1.5 nmol/L) and the area under the receiver operating characteristic curve in predicting mortality was 0.81 (95% CI, 0.71-0.91).. The good negative LR- of MR-proANP and the good positive LR+ of PCT may suggest a role for these markers in the early diagnosis of ED patients with dyspnea. Furthermore, MR-proADM may assist in risk stratification and prognosis in these patients..

Topics: Adrenomedullin; Aged; Atrial Natriuretic Factor; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Dyspnea; Emergency Service, Hospital; Female; Heart Failure; Humans; Male; Peptide Fragments; Prospective Studies; Protein Precursors; Risk Assessment; Sensitivity and Specificity

Topics: Adrenomedullin; Atrial Natriuretic Factor; Dyspnea; Heart Failure; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Protein Precursors

Due to different release mechanisms, mid-regional pro-atrial natriuretic peptide (MR proANP) may be superior to N-terminal pro-B-type natriuretic peptide (NT proBNP) in the diagnosis of acute heart failure (AHF) in patients with atrial fibrillation (AF). We compared MR proANP and NT proBNP for their diagnostic value in patients with AF and sinus rhythm (SR).. Prospective cohort study.. University hospital, emergency department.. 632 consecutive patients presenting with acute dyspnoea.. MR proANP and NT proBNP plasma levels were determined. The diagnosis of AHF was adjudicated by two independent cardiologists using all available data. Patients received long-term follow-up.. AF was present in 151 patients (24%). MR proANP and NT proBNP levels were significantly higher in the AF group compared with the SR group (385 (258-598) versus 201 (89-375) pmol/l for MR proANP, p<0.001 and 4916 (2169-10285) versus 1177 (258-5166) pg/ml, p<0.001 for NT proBNP). Diagnostic accuracy in AF patients was similar for MR proANP (0.90, 95% CI 0.84 to 0.95) and NT proBNP (0.89, 95% CI 0.81 to 0.96). Optimal cut-off levels in AF patients were significantly higher compared with the optimal cut-off levels for patients in SR (MR proANP 240 vs 200 pmol/l; NT proBNP 2670 vs 1500 pg/ml respectively). After adjustment in multivariable Cox proportional hazard analysis, MR proANP strongly predicted one-year all-cause mortality (HR=1.13 (1.09-1.17), per 100 pmol/l increase, p<0.001).. In AF patients, NT proBNP and MR proANP have similar diagnostic value for the diagnosis of AHF. The rhythm at presentation has to be taken into account because plasma levels of both peptides are significantly higher in patients with AF compared with SR.

Topics: Acute Disease; Aged; Atrial Fibrillation; Atrial Natriuretic Factor; Cohort Studies; Dyspnea; Heart Failure; Humans; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prospective Studies; Protein Precursors; Reproducibility of Results

Few tools exist that provide objective accurate prediction of short-term mortality risk in patients presenting with acute heart failure (AHF). The purpose was to describe the accuracy of several biomarkers for predicting short-term death rates in patients diagnosed with AHF in the emergency department (ED).. The Biomarkers in ACute Heart failure (BACH) trial was a prospective, 15-center, international study of patients presenting to the ED with nontraumatic dyspnea. Clinicians were blinded to all investigational markers, except troponin and natriuretic peptides, which used the local hospital reference range. For this secondary analysis, a core lab was used for all markers except troponin. This study evaluated patients diagnosed with AHF by the on-site emergency physician (EP).. In the 1,641 BACH patients, 466 (28.4%) had an ED diagnosis of AHF, of whom 411 (88.2%) had a final diagnosis of AHF. In the ED-diagnosed HF patients, 59% were male, 69% had a HF history, and 19 (4.1%) died within 14 days of their ED visit. The area under the curve (AUC) for the 14-day mortality receiver operating characteristic (ROC) curve was 0.484 for brain natriuretic peptide (BNP), 0.586 for N-terminal pro-B-type natriuretic peptide (NT-proBNP), 0.755 for troponin (I or T), 0.742 for adrenomedullin (MR-proADM), and 0.803 for copeptin. In combination, MR-proADM and copeptin had the best 14-day mortality prediction (AUC = 0.818), versus all other markers.. MR-proADM and copeptin, alone or in combination, may provide superior short-term mortality prediction compared to natriuretic peptides and troponin. Presented results are explorative due to the limited number of events, but validation in larger trials seems promising.

Topics: Acute Disease; Adrenomedullin; Aged; Aged, 80 and over; Atrial Natriuretic Factor; Biomarkers; Dyspnea; Emergency Service, Hospital; Female; Glycopeptides; Heart Failure; Humans; Length of Stay; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Prospective Studies; Reproducibility of Results; Risk; ROC Curve; Time Factors

Topics: Acute Coronary Syndrome; Americas; Atrial Natriuretic Factor; Biomarkers; Dyspnea; Early Diagnosis; Emergency Service, Hospital; Europe; Heart Diseases; Heart Failure; Humans; Hypertension, Pulmonary; Intensive Care Units; Japan; Myocardial Infarction; Natriuretic Peptide, Brain; Patient Discharge; Peptide Fragments; Practice Guidelines as Topic; Predictive Value of Tests; Prognosis; Survival Rate; Troponin; Ventricular Dysfunction, Left

The concentration of atrial natriuretic peptide (ANP) in the circulation is approximately 10- to 50- fold higher than B-type natriuretic peptide (BNP). We sought to compare the accuracy of midregional pro-atrial natriuretic peptide (MRproANP) measured with a novel sandwich immunoassay with N-terminal pro-B-type natriuretic peptide (NTproBNP) in the diagnosis of heart failure.. The diagnosis of heart failure was adjudicated by two independent cardiologists using all available clinical data (including BNP levels) in 287 consecutive patients presenting with dyspnoea to the emergency department (ED). MRproANP and NTproBNP levels were determined at presentation in a blinded fashion.. Heart failure was the adjudicated final diagnosis in 154 patients (54%). Median MRproANP was significantly higher in patients with heart failure as compared to patients with other causes of dyspnoea (400 vs. 92 pmol L(-1), P < 0.001). The diagnostic accuracy of MRproANP was very high with an area under the receiver operating characteristic curve of 0.92 and was comparable with that of NTproBNP (0.92, P = 0.791). Moreover, MRproANP provided incremental diagnostic information to BNP and NTproBNP in patients presenting with BNP levels in the grey zone between 100 and 500 pg mL(-1).. Midregional pro-atrial natriuretic peptide is as accurate in the diagnosis of heart failure as NTproBNP. MRproANP seems to provide incremental information on top of BNP or NT-proBNP in some subgroups and should be further investigated in other studies.

Topics: Aged; Atrial Natriuretic Factor; Biomarkers; Dyspnea; Female; Heart Failure; Humans; Male; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Prospective Studies; Risk Factors; ROC Curve; Survival Rate

Although renal dysfunction influences the threshold values of B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) in diagnosis of cardiac-related dyspnea (CRD), its effects on midregional pro-atrial natriuretic peptide (MR-proANP) threshold values are unknown. We evaluated the impact of renal function on MR-proANP concentrations and compared our results to those of BNP and NT-proBNP.. MR-proANP, BNP, and NT-proBNP concentrations were measured in blood samples collected routinely from dyspneic patients admitted to the emergency department. Patients were subdivided into tertiles based on their estimated glomerular filtration rate [eGFR, in mL · min(-1) · (1.73 m(2))(-1)]: tertiles 1 (<44.3), 2 (44.3-58.5), and 3 (≥58.6).. Of 378 patients studied, 69% (n = 260) had impaired renal function [<60 mL · min(-1) · (1.73 m(2))(-1)] and 30% (n = 114) had CRD. MR-proANP, BNP, and NT-proBNP concentrations were significantly increased in patients with impaired renal function. In each tertile, all peptides remained significantly increased in CRD patients by comparison with non-CRD patients. By ROC analysis, MR-proANP, BNP, and NT-proBNP threshold values for the diagnosis of CRD increased as eGFR decreased from tertile 3 to tertile 1. Areas under the ROC curve for all peptides were significantly lower in tertile 1. Using adapted thresholds, MR-proANP, BNP, and NT-proBNP remained independently predictive of CRD, even in tertile 1 patients.. Renal function influences optimum cutoff points of MR-proANP for the diagnosis of CRD. With use of an optimum threshold value adapted to the eGFR category, MR-proANP remains as effective as BNP and NT-proBNP in independently predicting a diagnosis of CRD in the emergency department.

Topics: Aged; Aged, 80 and over; Atrial Natriuretic Factor; Dyspnea; Emergency Service, Hospital; Female; Glomerular Filtration Rate; Heart Diseases; Humans; Kidney; Male; Multivariate Analysis; Natriuretic Peptide, Brain; Peptide Fragments; Protein Precursors

The aim of the present study was to assess the utility of amino-terminal pro-A-type natriuretic peptide (NT-proANP) measurements for the emergency diagnosis of acute destabilized heart failure (HF), using a novel sandwich immunoassay covering midregional epitopes (MR-proANP).. The retrospective analysis comprised 251 consecutive patients presenting to the emergency department of a tertiary care hospital with dyspnea as a chief complaint. The diagnosis of acute destabilized HF was based on the Framingham score for HF plus echocardiographic evidence of systolic or diastolic dysfunction. A commercially available immunoluminometric assay was used for measurement of MR-proANP plasma concentrations.. Median MR-proANP plasma concentrations were significantly higher in patients with dyspnea attributable to acute destabilized HF (338 pmol/L; n = 137) than in patients with dyspnea attributable to other reasons (98 pmol/L; n = 114; P <0.001). The area under the curve for MR-proANP was 0.876 (SE = 0.022; 95% confidence interval, 0.829-0.914), and the cutoff concentration with the highest diagnostic accuracy was 169 pmol/L (sensitivity, 89%; specificity, 76%; diagnostic accuracy, 83%). In the setting evaluated, diagnostic information obtained by MR-proANP measurements was similar to that obtained with B-type natriuretic peptide (BNP) and amino-terminal proBNP (NT-proBNP) measurements.. MR-proANP measurements may be useful as an aid in the diagnosis of acute destabilized HF in short-of-breath patients presenting to an emergency department. The diagnostic value of MR-proANP appears to be comparable to that of BNP and NT-proBNP.

Topics: Acute Disease; Atrial Natriuretic Factor; Dyspnea; Heart Failure; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Prospective Studies; Protein Precursors; ROC Curve

The prognostic value of natriuretic peptides in aortic stenosis (AS) remains unknown.. B-type natriuretic peptide (BNP), N-terminal BNP (NtBNP), and N-terminal atrial natriuretic peptide (NtANP) were determined in 130 patients with severe AS (mean age, 70+/-12 years; mean gradient, 64+/-21 mm Hg; valve area, 0.64+/-0.15 cm2) who were followed up for 377+/-150 days. Natriuretic peptides increased with NYHA class and with decreasing ejection fraction (EF). Even asymptomatic patients frequently had elevated neurohormones. Asymptomatic patients who developed symptoms during follow-up had higher BNP and NtBNP levels at entry compared with those remaining asymptomatic (median for NtBNP, 131 pmol/L [interquartile range, 50 to 202 pmol/L] versus 31 pmol/L [range, 19 to 56 pmol/L]; P<0.001). Symptom-free survival at 3, 6, 9, and 12 months for patients with NtBNP <80 versus > or =80 pmol/L was 100%, 88+/-7%, 88+/-7%, and 69+/-13% compared with 92+/-8%, 58+/-14%, 35+/-15%, and 18+/-15%, respectively (P<0.001). Seventy-nine patients eventually underwent surgery because of symptoms. Considering preoperative neurohormone levels, age, NYHA class, aortic valve area, EF, and presence of coronary artery disease, we found that neurohormones, EF, and NYHA class predicted survival; neurohormones predicted postoperative symptomatic status; and neurohormones and preoperative EF predicted postoperative EF. However, by multivariate analysis, NtBNP was the only independent predictor of outcome.. In severe AS, natriuretic peptides provide important prognostic information beyond clinical and echocardiographic evaluation. NtBNP independently predicts symptom-free survival, and preoperative NtBNP independently predicts postoperative outcome with regard to survival, symptomatic status, and left ventricular function. Thus, neurohormones may gain particular importance for timing of surgery in asymptomatic severe AS.

Topics: Aged; Aged, 80 and over; Aortic Valve Stenosis; Atrial Natriuretic Factor; Biomarkers; Disease Progression; Disease-Free Survival; Dyspnea; Female; Heart Failure; Heart Valve Prosthesis Implantation; Humans; Life Tables; Male; Middle Aged; Natriuretic Peptide, Brain; Nerve Tissue Proteins; Peptide Fragments; Prognosis; Prospective Studies; Protein Precursors; Severity of Illness Index; Single-Blind Method; Stroke Volume; Treatment Outcome; Ultrasonography

Both B-type natriuretic peptide (BNP) and renal function are prognostic indicators of survival in patients with congestive heart failure (CHF). However, relationships between BNP, renal function, and heart failure as an emergency diagnosis are unknown.. The Breathing Not Properly Multinational Study was a prospectively designed diagnostic test evaluation study conducted in seven centers. Of 1,586 participants who presented with acute dyspnea, 1,452 patients (91.6%) had both BNP level and baseline estimated glomerular filtration rate (eGFR) available. Patients with an eGFR less than 15 mL/min/1.73 m2 and those on dialysis therapy were excluded. The final diagnosis was adjudicated by two independent cardiologists who were blinded to BNP results.. The final diagnosis was CHF in 715 patients (49.2%). Raw and log-log transformed correlations between BNP and eGFR values were r = -0.19 and r = -0.17 for those with CHF and r = -0.20 and r = -0.31 for those without CHF (both P < 0.0001 for r not equal 0). Mean BNP levels were 561.6 pg/mL (162.3 fmol/mL), 647.5 pg/mL (187.1 fmol/mL), 745.6 pg/mL (215.5 fmol/mL), and 850.7 pg/mL (245.8 fmol/mL) for those with CHF and 85.4 pg/mL (24.7 fmol/mL), 131.7 pg/mL (38.1 fmol/mL), 297.2 pg/mL (85.9 fmol/mL), and 285.0 pg/mL (82.3 fmol/mL) for those without CHF in eGFR categories of 90 or greater, 89 to 60, 59 to 30, and less than 30 mL/min/1.73 m2, respectively. The area under the receiver operating characteristic curve and optimum cut points for BNP were 0.91 and 70.7 pg/mL (20.4 fmol/mL), 0.90 and 104.3 pg/mL (30.1 fmol/mL), 0.81 and 201.2 pg/mL (58.1 fmol/mL), and 0.86 and 225.0 pg/mL (65.0 fmol/mL) for the eGFR categories of 90 or greater, 89 to 60, 59 to 30, and less than 30 mL/min/1.73 m2, respectively.. Renal function correlates weakly with BNP and influences the optimal cut point for BNP, particularly in those with an eGFR less than 60 mL/min/1.73 m2.

Topics: Acute Disease; Aged; Atrial Natriuretic Factor; Cohort Studies; Dyspnea; Female; Glomerular Filtration Rate; Heart Failure; Humans; Kidney; Male; Middle Aged; Natriuretic Peptide, Brain; Predictive Value of Tests; Prognosis; Prospective Studies; Reference Standards; Survival

Topics: Atrial Natriuretic Factor; Biomarkers; Dyspnea; Heart Failure; Humans; Natriuretic Peptide, Brain; Predictive Value of Tests; Ventricular Dysfunction, Left

Topics: Atrial Natriuretic Factor; Diagnosis, Differential; Dyspnea; Heart Failure; Humans; Natriuretic Peptide, Brain; Prognosis; Sensitivity and Specificity

Topics: Acute Disease; Atrial Natriuretic Factor; Dyspnea; Heart Failure; Humans; Natriuretic Peptide, Brain; Prognosis

Topics: Aged; Aged, 80 and over; Atrial Natriuretic Factor; Biomarkers; Clinical Trials as Topic; Dyspnea; Female; Heart Failure; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Point-of-Care Systems; Sensitivity and Specificity

We compared the accuracy of B-type natriuretic peptide (BNP) assay with Doppler echocardiography for the diagnosis of decompensated congestive left-heart failure (CHF) in patients with acute dyspnea.. Both BNP and Doppler echocardiography have been described as relevant diagnostic tests for heart failure.. One hundred sixty-three consecutive patients with severe dyspnea underwent BNP assay and Doppler echocardiogram on admission. The accuracy of the two methods for etiologic diagnosis was compared on the basis of the final diagnoses established by physicians who were blinded to the BNP and Doppler findings.. The final etiologic diagnosis was CHF in 115 patients. Twenty-four patients (15%) were misdiagnosed at admission. The BNP concentration was 1,022 +/- 742 pg/ml in the CHF subgroup and 187 +/- 158 pg/ml in the other patients (p < 0.01). A BNP cutoff of 300 pg/ml correctly classified 88% of the patients (odds ratio [OR] 85 [19 to 376], p < 0.0001), but a high negative predictive value (90%) was only obtained when the cutoff was lowered to 80 pg/ml. The etiologic value of BNP was low in patients with values between 80 and 300 pg/ml (OR 1.85 [0.4 to 7.8], p = 0.4) and also in patients who were studied very soon after onset of acute dyspnea. Among the 138 patients with assessable Doppler findings, a "restrictive" mitral inflow pattern had a diagnostic accuracy for CHF of 91% (OR 482 [77 to 3,011], p < 0.0001), regardless of the BNP level.. Bedside BNP measurement and Doppler echocardiography are both useful for establishing the cause of acute dyspnea. However, Doppler analysis of the mitral inflow pattern was more accurate, particularly in patients with intermediate BNP levels or "flash" pulmonary edema.

Topics: Acute Disease; Aged; Aged, 80 and over; Atrial Natriuretic Factor; Biological Assay; Biomarkers; Dyspnea; Echocardiography, Doppler; Female; France; Heart Failure; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Predictive Value of Tests; Prospective Studies; ROC Curve; Stroke Volume

Topics: Atrial Natriuretic Factor; Diagnosis, Differential; Dyspnea; Heart Failure; Humans; Likelihood Functions; Natriuretic Peptide, Brain; Ventricular Dysfunction, Left

To determine the utility of B-type natriuretic peptide (BNP) in the diagnosis of congestive heart failure (CHF) in patients presenting with dyspnea to an emergency department (ED).. Seventy patients presenting with dyspnea to an ED from April to July 2001 were included in the study. Mean age was 72+/-16 years and 33 (47%) were male. BNP was measured in all patients at the moment of admission to the ED. Emergency-care physicians, blinded to BNP values, were required to assign a probable initial diagnosis. A cardiologist retrospectively reviewed the data (blinded to BNP measurements) and assigned a definite diagnosis, which was considered the gold standard for assessing the diagnostic performance of BNP.. The mean BNP concentration was higher in patients with CHF (n=36) than in those with other diagnoses (990+/-550 vs 80+/-67 pg/mL, p<0.0001). Patients with systolic dysfunction had higher BNP levels than those with preserved systolic function (1,180+/-641 vs 753+/-437 pg/mL, p=0.03). At a blood concentration of 200 pg/mL, BNP showed a sensitivity of 100%, specificity of 97.1%, positive predictive value of 97.3%, and negative predictive value of 100%. The application of BNP could have potentially corrected all 16 cases in which the diagnosis was missed by the emergency department physician.. BNP measurement is a useful tool in the diagnosis of CHF in patients presenting to the ED with dyspnea.

Topics: Aged; Atrial Natriuretic Factor; Biomarkers; Dyspnea; Emergencies; Female; Heart Failure; Humans; Male; Predictive Value of Tests; Sensitivity and Specificity

Topics: Atrial Natriuretic Factor; Cost Savings; Device Approval; Diagnosis, Differential; Diagnostic Techniques, Cardiovascular; Dyspnea; Emergency Service, Hospital; Heart Failure; Humans; Practice Guidelines as Topic; Reagent Kits, Diagnostic; Sensitivity and Specificity; Time Factors; United States; United States Food and Drug Administration

Topics: Acute Disease; Atrial Natriuretic Factor; Diagnosis, Differential; Dyspnea; Heart Failure; Humans; Natriuretic Peptide, Brain; Respiratory Distress Syndrome; Respiratory Insufficiency

Topics: Atrial Natriuretic Factor; Dyspnea; Heart Failure; Humans; Natriuretic Peptide, Brain; Predictive Value of Tests; Risk Assessment

Topics: Atrial Natriuretic Factor; Dyspnea; Heart Failure; Humans; Natriuretic Peptide, Brain; Predictive Value of Tests; Prognosis; Risk Assessment; Risk Factors; Sensitivity and Specificity

Natrecor (nesiritide) is targeted to acute decompensating CHF patients.

Topics: Atrial Natriuretic Factor; Cardiotonic Agents; Drug Costs; Dyspnea; Heart Failure; Hospitalization; Humans; Hypotension; Natriuretic Peptide, Brain; United States

Topics: Age Factors; Aged; Amyloidosis; Animals; Atrial Natriuretic Factor; Back Pain; Diagnosis, Differential; Doxorubicin; Dyspnea; Echocardiography; Electrocardiography; Fish Oils; Glomerulonephritis; Histocytochemistry; Humans; Kidney; Male; Microscopy, Electron; Nephrotic Syndrome; Rats

Topics: Acute Disease; Atrial Natriuretic Factor; Cardiac Output, Low; Cardiotonic Agents; Dyspnea; Humans; Multicenter Studies as Topic; Natriuretic Peptide, Brain; Pulmonary Wedge Pressure; Recombinant Proteins

A WELL-RECOGNIZED ENTITY: Diastolic heart failure is an increasingly common diagnosis. Signs may be misleading and positive etiological diagnosis remains difficult.. Fatigue, and most importantly dyspnea, are the cardinal signs of diastolic heart failure. Cor pulmonale is often the inaugural sign. The physical examination contributes little to diagnosis. The chest x-ray shows a small heart. Electrocardiographic anomalies are almost always found. A hemodynamic exploration of the right heart, the key diagnostic tool not always performed in routine work-ups, evidences increased filling pressure of the left ventricle. Doppler-echocardiography is used widely. It demonstrates preservation of the left ventricle function (normal ejection fraction) and visualizes the anatomic subtratum of the diastolic dysfunction, quantifying filling and relaxation disorders and allowing an indirect estimation of pulmonary pressures. In the future, it will be possible to assay atrial natriuretic peptide which will provide a most useful tool for the positive diagnosis of this type of heart failure.. The diagnosis of diastolic heart failure is complex, warranting rigorous, and critical, evaluation of left ventricular filling using noninvasive methods, particularly Doppler-echocardiography.

Topics: Adult; Age Factors; Atrial Natriuretic Factor; Cardiac Catheterization; Diagnosis, Differential; Diastole; Dyspnea; Echocardiography, Doppler; Electrocardiography; Heart Failure; Hemodynamics; Humans; Models, Theoretical; Natriuretic Peptide, Brain; Radiography, Thoracic; Radionuclide Ventriculography

1. From a screened cohort of 644 67-year-old men, drawn from the population of Gothenburg, 42 men with presumed cardiac dyspnoea were selected and compared with 45 random controls. 2. Cardiac function was evaluated by echocardiography and other non-invasive methods, and the potential of peripheral venous concentrations of immunoreactive atrial natriuretic peptide (IrANP), noradrenaline and adrenaline in revealing cardiac dysfunction was investigated. 3. Concentrations of venous IrANP and noradrenaline were both significantly, but weakly, related to the degree of dyspnoea and to pulmonary congestion. 4. IrANP, but not catecholamines, was also related to other indices of heart failure. The correlations were, however, due solely to increased immunoreactivity in men with severe dyspnoea; in most subjects with mild to moderate dyspnoea the level of IrANP was similar to that of the controls. 5. It is concluded that, in a population sample, the peripheral venous level of IrANP is more closely related to cardiac function than are catecholamines. Yet, the level of IrANP is not a very sensitive marker of cardiac dysfunction, suggesting that stimulation of alpha-human atrial natriuretic peptide release is a late phenomenon in the development of cardiac failure.

Topics: Aged; Atrial Natriuretic Factor; Cross-Sectional Studies; Dyspnea; Epinephrine; Heart Failure; Humans; Male; Norepinephrine