BNP as a Predictor of Cardiovascular Disease and All Cause Mortality. Dr. Thierry Le Jemtel

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1 BNP as a Predictor of Cardiovascular Disease and All Cause Mortality Dr. Thierry Le Jemtel

2 Outline Role of BNP and probnp as relevant biomarkers in cardiac conditions Role of BNP and probnp as relevant biomarkers in the general population Natriuretic Peptide and Metabolic Regulation

3 Brain Natriuretic Peptide Natriuretic peptides (NP) are hormones involved in the regulation of blood volume and blood pressure. ProBNP is secreted from the cardiac ventricles in response to increased myocardial wall stress due to volume overload and increased pressure. When probnp is released in the circulation it is cleaved in two equal parts: BNP and probnp

4 Differences between BNP and probnp: BNP is active probnp is not In whole blood BNP is stable for 24 hours and probnp for 72 hours. Amino acids: 32 for BNP and 76 for probnp. Half life is 20 min for BNP and 120 min for probnp. BNP is cleared by NPR C and neural endopeptidases, probnp by the kidney. BNP normal level is <100 pg/l, probnp normal level is <300 pg/l

5 Circulation 2004;109:

6 Int J Cardiol 2017; 228:

7 Hamada M et al Int J Cardiol 2017; 228:

8 Hamada M et al Int J Cardiol 2017; 228:

10 Forest plot of percent difference in log NTproBNP levels in African Americans, compared to Caucasians, overall and across subgroups of ARIC participants. Deepak K. Gupta et al. J Am Heart Assoc 2015;4:e001831

11 Cardiac Conditions

12 Base-Line Characteristics of 1586 Patients with Dyspnea Maisel, A. et al. N Engl J Med 2002;347:

13 Box Plots Showing Median Levels of B-Type Natriuretic Peptide Measured in the Emergency Department in Three Groups of Patients Maisel, A. et al. N Engl J Med 2002;347:

14 Multiple Logistic-Regression Analysis of Factors Used for Differentiating between Patients with and Those without Congestive Heart Failure Maisel, A. et al. N Engl J Med 2002;347:

15 Relationship between NT-proBNP and BNP quartiles and the primary outcome evaluated by Coxregression models and incremental value of natriuretic peptides for the primary outcome according to body mass index categories. Wilson Nadruz, Jr et al. Circulation. 2016;134:

16 From: Natriuretic Peptide Based Screening and Collaborative Care for Heart FailureThe STOP-HF Randomized Trial Figure Legend: Participant FlowBNP indicates brain-type natriuretic peptide. Ledwidge et al JAMA. 2013;310(1):66-74.

Randomized Trial Table Title: Baseline Participant

17 From: Natriuretic Peptide Based Screening and Collaborative Care for Heart FailureThe STOP-HF Randomized Trial Table Title: Baseline Participant Characteristics Ledwidge M et al JAMA. 2013;310(1):66-74.

18 Natriuretic Peptide Based Screening and Collaborative Care for Heart FailureThe STOP-HF Randomized Trial Figure Legend: Kaplan-Meier Analysis of Major Adverse Cardiovascular Events in the Full Study Sample and in Participants With BNP 50 pg/mlbnp indicates brain-type natriuretic peptide. Major adverse cardiovascular events included arrhythmia, transient ischemic attack, stroke, myocardial infarction, peripheral or pulmonary thrombosis/embolus, or heart failure. In the full sample, 51 (7.3%) of 697 patients were admitted for major adverse cardiovascular events in the intervention group and 71 (10.5%) of 677 were admitted in the control group. In participants with BNP 50 pg/ml, 35 (13.3%) of 263 were admitted for major adverse cardiovascular events in the intervention group and 45 (19.1%) of 235 were admitted in the control group. Ledwidge et al JAMA.2013;310(1):66-74

19 Lemos JA et al N Engl J Med :

20 Lemos JA et al N Engl J Med :

21 Caselli C et al Arterioscler Thromb Vasc Biol 2016;36:

22 Caselli C et al Arterioscler Thromb Vasc Biol 2016;36:

23 B type Natriuretic Peptide Predicts Morbidity and Long Term Mortality in Coronary Artery Bypass Grafting and Valve Surgery. Endicott KM 1, Amdur RL, Greenberg MD, Trachiotis GD Endicott KM et al Innovations 2016; 11:

24 Clavel MA J Am Coll Cardiol 2016;68:

25 Mentias A et al Am J Cardiol 2016; 117:

26 Pavasini R et al Chronic Respiratory Disease

27 General population

28 Wang, T. et al. N Engl J Med 2004;350:

29 Cumulative Incidence of Death (Panel A) and Heart Failure (Panel B), According to the Plasma B- Type Natriuretic Peptide Level at Base Line Wang, T. et al. N Engl J Med 2004;350:

30 Multivariate Analysis of the Association of Plasma B-Type Natriuretic Peptide (BNP) Levels and Outcomes Wang, T. et al. N Engl J Med 2004;350: Wang, T. et al. N Engl J Med 2004;350:

31 Huelsmann M et al J Am Coll Cardiol. 2013; 62:

32 Huelsmann M et al J Am Coll Cardiol. 2013; 62:

33 Huelsmann et al J Am Coll Cardiol. 2013; 62:

34 McKie PM Mayo Clin Proc 2011; 86:

35 McKie P et al Mayo Clin Proc 2011; 86:

adjusted hazard ratios on the risk of cardiovascular events and

36 Frequency distribution of plasma levels of N-terminal fragment of pro-b-type natriuretic peptide (NT-proBNP) and multivariable adjusted hazard ratios on the risk of cardiovascular events and all-cause mortality. Gerard C.M. Linssen et al. Eur Heart J 2010;31:

37 Kaplan Meier plot for cardiovascular events by quintiles (Q) of N-terminal fragment of pro-btype natriuretic peptide (NT-proBNP). Gerard C.M. Linssen et al. Eur Heart J 2010;31:

38 Dietl A et al PlOS ONE 2016 October 6

39 Dietl A et al PlOS ONE 2016 October 6

40 Dietl A et alplos ONE 2016 October 6

41 Abdullah SM et al Am J Cardiol 2005; 96:

42 Cardiometabolic Regulation

43 Wang T N Engl J Med 2012; 367:

44 Zois NE et al Nat Rev Cardiol 2014; 11:

Natriuretic Peptides The Cardiologists View. Christopher defilippi, MD University of Maryland Baltimore, MD, USA

Natriuretic Peptides The Cardiologists View Christopher defilippi, MD University of Maryland Baltimore, MD, USA Disclosures Research support: Alere, BG Medicine, Critical Diagnostics, Roche Diagnostics,