Cardiovascular Medicine Book

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Brain Natriuretic Peptide

Aka: Brain Natriuretic Peptide, B-Type Natriuretic Peptide, BNP
  1. Mechanism
    1. Heart secretes natriuretic peptides
      1. Maintains Blood Pressure and blood volume
      2. Prevents excessive salt and water retention
    2. Specific activity of natriuretic peptides
      1. Suppresses sympathetic nervous system
      2. Suppresses renin-Angiotensin-aldosterone system
      3. Stimulates diuresis
      4. Decreases peripheral vascular resistance
      5. Increases smooth muscle relaxation
    3. Pathway for heart BNP release
      1. Left ventricular wall stretched by volume overload
      2. Cardiac muscle cells secrete BNP precursor
      3. Precursor converted to proBNP
      4. ProBNP cleaved into 2 parts
        1. C-terminal BNP (biologically active)
        2. N-terminal BNP or NT-proBNP (biologically inactive)
  2. Indication
    1. Congestive Heart Failure Marker
    2. Dyspnea Evaluation
      1. Most useful for Negative Predictive Value
      2. Level <50 pg/ml suggests other Dyspnea cause
      3. Level >150 pg/ml suggests Congestive Heart Failure
  3. Intrepetation of BNP Levels
    1. No Congestive Heart Failure: BNP <50 pg/ml
      1. Median BNP: 9 pg/ml
    2. Congestive Heart Failure
      1. CHF Diagnosis: >150 pg/ml (standard cutoff)
      2. NYHA Class I CHF: Median BNP 83 pg/ml (49-137)
      3. NYHA Class II CHF: Median BNP 235 pg/ml (137-391)
      4. NYHA Class III CHF: Median BNP 459 pg/ml (200-871)
      5. NYHA Class IV CHF: Median BNP 1119 pg/ml (>728)
  4. Interpretation of NT-proBNP
    1. Cutoffs in studies: NT-proBNP>300 suggests CHF
  5. Causes of increased BNP level
    1. Congestive Heart Failure
      1. BNP released from left ventricle
      2. Response to volume overload
      3. Response to pressure overload
    2. Left Ventricular Hypertrophy
    3. Cardiac inflammation
      1. Myocarditis
      2. Cardiac allograft rejection
    4. Kawasaki disease
    5. Primary Pulmonary Hypertension
    6. Renal Failure
    7. Ascitic Cirrhosis
    8. Endocrine disease
      1. Primary Hyperaldosteronism
      2. Cushing Syndrome
    9. Advanced age
    10. Medications that raise BNP
      1. Digoxin
      2. Beta Blockers (some)
  6. Causes of artificially lowered BNP levels
    1. Diuretics (e.g. Spironolactone)
    2. ACE Inhibitors
    3. Angiotensin Receptor Blockers (ARBs)
  7. Efficacy
    1. Most effective for Negative Predictive Value
      1. See above under indications
      2. CHF very unlikely if BNP<50 pg/ml
    2. BNP cutoff for CHF diagnosis at 150 pg/ml
      1. Test Sensitivity: 82%
      2. Test Specificity: 83%
  8. References
    1. Cheng (2001) J Am Coll Cardiol 37:386-91
    2. Collins (2003) Ann Emerg Med 41:532-45
    3. Dao (2001) J Am Coll Cardiol 37:379-85
    4. Doust (2004) Arch Intern Med 164:1978-84
    5. Mueller (2004) N Engl J Med 350:647-54
    6. Wieczorek (2002) Am Heart J 144:834-9

Nesiritide (C0054015)

Definition (NCI) Brain natriuretic peptide 32 (32 aa, ~3 kDa) is encoded by the human NPPB gene. This protein plays a role in the modulation of diuresis, vasorelaxation and secretion of renin and aldosterone.
Definition (MSH) A PEPTIDE that is secreted by the BRAIN and the HEART ATRIA, stored mainly in cardiac ventricular MYOCARDIUM. It can cause NATRIURESIS; DIURESIS; VASODILATION; and inhibits secretion of RENIN and ALDOSTERONE. It improves heart function. It contains 32 AMINO ACIDS.
Definition (NCI) A recombinant version of the cardiac neurohormone, human B-type natriuretic peptide (hBNP) produced by the ventricular myocardium. Nesiritide binds to natriuretic peptide receptors on vascular smooth muscle and endothelial cells, through which it triggers guanylate cyclase dependent signal transduction resulting in increase of intracellular concentrations of cGMP. This leads to smooth muscle cell relaxation causing arterial and venous dilatation.
Definition (PDQ) A recombinant version of the cardiac neurohormone, human B-type natriuretic peptide (hBNP) produced by the ventricular myocardium. Nesiritide binds to natriuretic peptide receptors on vascular smooth muscle and endothelial cells, through which it triggers guanylate cyclase dependent signal transduction resulting in increase of intracellular concentrations of cGMP. This leads to smooth muscle cell relaxation causing arterial and venous dilatation. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=434520&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=434520&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C47636" NCI Thesaurus)
Concepts Amino Acid, Peptide, or Protein (T116) , Pharmacologic Substance (T121) , Hormone (T125)
MSH D020097
SnomedCT 385677001, 385678006, 385680000, 385679003, 407059007
English Nesiritide (HBNP), 1,2-Dithia-5,8,11,14,17,20,23,26,29,32,35,38,41,44,47,50-hexadecaazacyclotripentacontane, Cyclic Peptide Derivative, L-Histidine, L-seryl-L-prolyl-L-lysyl-L-methionyl-L-valyl-L-glutaminylglycyl-L-serylglycyl-L-cysteinyl-L-phenylalanylglycyl-L-arginyl-L-lysyl-L-methionyl-L-alpha-aspartyl-L-arginyl-L-isoleucyl-L-seryl-L-seryl-L-seryl-L-serylglycyl-L-leucylglycyl-L-cysteinyl-L-lysyl-L-valyl-L-leucyl-L-arginyl-L-arginyl-, Cyclic (10-26)-disulfide, Human Brain Natriuretic Factor-32, Natriuretic factor-32, Human B-type natriuretic peptide (substance), Natriuretic factor, brain, Brain Natriuretic Peptide, Natriuretic Peptide, Brain, Peptide, Brain Natriuretic, nesiritide (medication), nesiritide, Nesiritide, NESIRITIDE, Natriuretic Peptide, Brain [Chemical/Ingredient], b-type natriuretic peptide, brain natriuretic peptides, brain natriuretic peptide, b type natriuretic peptide, b type natriuretic peptides, brain natriuretic factor, type b natriuretic peptide, Brain Natriuretic Peptide 32, BNP(1-32), BNP-32, B-Type Natriuretic Peptide, BNP 32, BNP Gene Product, Brain Natriuretic Peptide-32, Natriuretic Factor 32, Natriuretic Factor-32, Natriuretic Peptide Type B, Natriuretic Peptide Type-B, Natriuretic Peptide, B-Type, Natriuretic Peptide, Type-B, Natriuretic Peptide-32, Brain, Peptide-32, Brain Natriuretic, Type-B Natriuretic Peptide, Type B Natriuretic Peptide, Human B-type natriuretic peptide (product), Human B-type natriuretic peptide, Nesiritide (product), Nesiritide (substance), Brain natriuretic peptide (substance), Natriuretic Peptide B Type, B-type natriuretic peptide, Brain natriuretic peptide
Portuguese Peptídeo Encefálico Natriurético, Peptídeo Natriurético Encefálico, Peptídeo Natriurético Cerebral, Peptídeo Cerebral Natriurético, Nesiritida
Spanish Péptido Natriurético Encefálico, Peptido Natriuretico Encefalico, Peptido Encefalico Natriuretico, Péptido Encefálico Natriurético, Péptido Cerebral Natriurético, Péptido Natriurético Cerebral, Peptido Natriuretico Cerebral, Peptido Cerebral Natriuretico, péptido natriurético cerebral humano de tipo B, péptido natriurético humano tipo B (sustancia), nesiritide (sustancia), nesiritide, nesiritida (sustancia), nesiritida (producto), nesiritida, péptido natriurético humano tipo B (producto), péptido natriurético humano tipo B, péptido natriurético cerebral (sustancia), péptido natriurético cerebral, péptido natriurético tipo B, Nesiritida
Swedish Natriuretisk peptid, hjärna
Czech natriuretický peptid typu B
Finnish B-tyypin natriureettinen peptidi
French Facteur natriurétique de type B, BNP-32, Peptide cérébral natriurétique, Peptide natriurétique de type B, Nésiritide, BNP32, BNP (Brain Natriuretic Peptide), Peptide natriurétique cérébral, Produit du gène BNP
Russian NATRIIURETICHESKII PEPTID MOZGA, MOZGA GOLOVNOGO NATRIIURETICHESKII PEPTID, NATRIIURETICHESKII PEPTID MOZGOVOI, НАТРИЙУРЕТИЧЕСКИЙ ПЕПТИД МОЗГОВОЙ, НАТРИЙУРЕТИЧЕСКИЙ ПЕПТИД МОЗГА, МОЗГА ГОЛОВНОГО НАТРИЙУРЕТИЧЕСКИЙ ПЕПТИД
Japanese 脳性ナトリウム利尿ペプタイド, 脳性利尿ペプチド, ナトリウム利尿ペプチド-脳性, 脳ナトリウム利尿ペプチド, 脳内ナトリウム利尿ペプチド, ナトリウム利尿ペプチド-B型, クエン酸ネシリチド, 脳性ナトリウム利尿ペプチド, ネシリチド, ネシリチドクエン酸塩, B型ナトリウム利尿ペプチド
Polish Peptyd natriuretyczny mózgowy
Croatian MOŽDANI NATRIJURETSKI PEPTID, NATRIURETSKI PEPTID, MOŽDANI, NATRIJURETSKI PEPTID, MOŽDANI
German Gehirn, natriuretisches Peptid, Natriuretisches Peptid, Gehirn
Italian Peptide natriuretico del cervello
Sources
Derived from the NIH UMLS (Unified Medical Language System)


NPPB gene (C1417808)

Definition (NCI) This gene is involved in cardiac homeostasis.
Concepts Gene or Genome (T028)
English BNP, NPPB, NATRIURETIC PEPTIDE, BRAIN TYPE, NATRIURETIC PEPTIDE PRECURSOR B, NPPB Gene, Natriuretic Peptide Precursor B Gene, natriuretic peptide B, NPPB gene
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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