Natriuretic neuropeptides (ANP, BNP, CNP) are produced primarily in the cardiac atria under normal conditions.
The main stimulus for ANP and BNP peptide synthesis and secretion is cardiac wall stress. Cardiac ventricular myocytes
constitute the major source of BNP-related peptides. Ventricular NT-proBNP production is upregulated in cardiac
failure and locally in the area surrounding a myocardial infarct. NT-proBNP is cleared passively by organs with high rate
of blood flow (muscle, liver, kidney). It has a longer half life than BNP and higher plasma concentration. BNP and NTproBNP
tend to be higher in women and lower in obese individuals. They are also higher in elderly, in left ventricular
tachycardia, right ventricular overload, myocardial ischemia, hypoxaemia, renal dysfunction, liver cirrhosis, sepsis and infection.
NT-proBNP is useful both in the diagnosis and prognosis of heart failure and is considered to be a gold standard
biomarker in heart failure similar to BNP. A cut-off point 300 pg/ml has 99% sensitivity, 60%specificity and NPV 98%for
exclusion of acute heart failure. NT proBNP has also a strong prognostic value of death in acute and chronic heart failure
and also predicts short and long term mortality in patient with suspected or confirmed unstable CVD. Natriuretic peptides
are also prognostic markers for the RV (Right Ventricular) Dysfunction. Their release is due to myocardial stretch from
right ventricular pressure overload.Finally, there are data supporting that NT-proBNP might be useful to put a time frame
on atrial fibrillation of unknown onset.
Keywords: Biomarker, BNP, cardiac failure, diagnosis, natriuretic peptides, NT-proBNP, prognosis, right ventricular dysfunction
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