B-type Natiuretic Peptide

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B-type Natiuretic Peptide
MaineHealth Cardiovascular Workgroup January 30,
2003
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Natriuretic Peptides
H
N-
Ser
2
?
Pro
Lys
Met
BNP
Met
Gly
Asp
Val
Gin
Arg
Lys
Arg
Gly
Met
Gly
S
Asp
IIe
Phe
Ser
S
Gly
Cys
Gly
Arg
Asn
Ala
IIe
S
Ser
S
Leu
Gin
Phe
Ser
Ser
Cys
Lys
COOH-
Tyr
Gly
Ser
Val
Leu
Ser
Leu
Gly
Ser
Arg
Arg
HOOC-
His
Arg
Ser
Urodilatin
Pro
Leu
Ala
Arg
Arg
Gly
H
N-
CNP
Gly
Thr
Met
2
Arg
Gly
Leu
Asp
Ser
Phe
NH
Lys
Leu
2
Leu
Gly
Ser
Ser
Arg
Cys
Asp
Lys
Phe
Gly
IIe
S
Arg
Cys
S
Cys
Gly
IIe
S
S
Asn
Gly
Ala
Ser
HOOC-
Gly
Cys
Leu
Phe
Gin
Ser
Gly
Gly
Ser
Arg
Leu
HOOC-
Met
Tyr
Gly
Ser
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B-type natiuretic peptide(brain natiuretic
peptide)

• B-type natriuretic peptide is a cardiac
  neurohormone secreted from the ventricles in
  response to volume expansion and pressure
  overload
• BNP levels correlate with LVEDP and volume.
• Plasma levels of BNP are elevated in patients
  with CHF and increase in proportion to the
  severity of symptoms of heart failure and degree
  of LV dysfunction.

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Release and Function of Natriuretic Peptides
ANP
Wall stress Endothelin Norepinephrine Vasopressin
BNP ANP
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Physiological Effects of BNP

• Vasodilation
• Sodium Excretion
• Decreased aldosterone levels
• Inhibition of RAAS
• Inhibition of sympathetic nervous system activity

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BNP Levels of 250 Patients Presenting with Dyspnea
P lt 0.001
1076 138
Mean BNP Concentration (pg/ml)
141 31
38 4
Asymptomatic LV Dysfunction No CHF (n14)
No CHF (n139)
CHF (n97)
Maisel A. et al. J Am Coll Cardiol
200137(2)379-85
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BNP Concentration for the Degree of CHF Severity
2013 266
BNP Concentration (pg/ml)
791 165
186 22
Moderate (n34)
Mild (n27)
Severe (n36)
Maisel A. et al. J Am Coll Cardiol
200137(2)379-85
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BNP Concentration for the Prediction of Clinical
Events
Death or Heart Failure Hospitalization
45
40
35
30
BNP gt 480 pg/ml
25
20
15
10
BNP 230-480 pg/ml
5
BNP lt 230 pg/ml
0
0
20
40
60
80
100
120
140
160
180
Days
Harrison, Maisel Ann Emerg Med 200239131-138
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Interpretation of the BNP Assay in the Dyspneic
Patient
Significant Decompensated Heart Failure
Mean BNP Concentration(pg/ml)
400
400
400
Mild Ventricle Stretch HF, PE, CM, ACS, Pulm HTN
100
100
100
No Heart Failure, No Ventricle Stretch
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BNP assay is now available at MMC