BACKGROUNDSeveral small sample-size observational studies evaluated the association of plasma brain natriuretic peptide (BNP) or N-terminal pro-brain natriuretic peptide (NT-proBNP) with atrial fibrillation (AF), but the results were contradictory. We aimed to perform a meta-analysis of relevant studies to evaluate the availability of this association.

METHODSWe performed an extensive literature search on PubMed, Web of Science (WOS) and the Cochrane Library databases. Pooled standardized mean difference (SMD) and 95% confidence interval (CI) were calculated to assess the strength of association using random effects models. We performed sensitivity and subgroup analyses to explore the potential sources of heterogeneity. We also estimated publication biases. Statistical analyses were performed using the STATA 12.0 software.

RESULTSA total of 11 studies including 777 cases and 870 controls were finally analyzed. Overall, the brain natriuretic peptide/N-terminal pro-brain natriuretic peptide levels were higher in atrial fibrillation patients than controls without atrial fibrillation.

RESULTSshowed that the SMD in the natriuretic peptide levels between cases and controls was 2.68 units (95% CI 1.76 to 3.60); test for overall effect z-score = 5.7 (P < 0.001). There was significant heterogeneity between individual studies (I(2) = 97.8%; P < 0.001). Further analysis revealed that differences in the assay of natriuretic peptide possibly account for this heterogeneity.

CONCLUSIONSIncreased BNP/NT-proBNP levels were associated with the presence of atrial fibrillation. This finding indicates that BNP/NT-proBNP may prove to be a biomarker of an underlying predisposition to AF.

Atrial Fibrillation ; blood ; Biomarkers ; blood ; Humans ; Natriuretic Peptide, Brain ; blood ; Peptide Fragments ; blood

OBJECTIVETo determine the levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) and evaluate their relationships with cardiac structure and function and liver function in patients with cirrhosis.

METHODSFifty patients with cirrhosis underwent two-dimensional Doppler echocardiography. The cirrhotic patients were divided into groups according to Child-Pugh score:Child-Pugh class A, n=15; Child-Pugh class B, n=20; Child-Pugh class C, n=15. Cardiac dimensions and left and right ventricular functions were evaluated. In addition, the plasma NT-proBNP was detected in the 50 cirrhotic patients and 11 healthy controls.

RESULTSThe levels of plasma NT-proBNP was significantly higher in cirrhotic patients than in healthy controls (240.15+/-80.87 pg/mL vs.55.86+/-20.13 pg/mL, P=0.000).The Child-Pugh class A, B and C groups showed no differences for left ventricular diameter, right ventricular diameter, septal thickness, left ventricular wall thickness, E wave, A wave, aortic annulus diameter, and the value of E/A.However, the left atrial diameter was significantly lower in the A group than in the C group (29.83+/-3.76 mm vs.35.08+/-3.68 mm, P=0.015) and in the B group than in the C group (31.78+/-4.05 mm vs.35.08+/-3.68 mm, P=0.000); there was no significant difference between the A and B groups. The plasma NT-proBNP was significantly lower in the A group than the C group (189.20+/-20.25 pg/mL vs.300.13+/-34.96 pg/mL, P=0.000) and in the B group than in the C group (202.34+/-31.20 pg/mL vs.300.13+/-34.96 pg/mL, P=0.000); there was no significant difference between the A and B groups (P=0.302).The NT-proBNP level was positively correlated with the left atrial diameter and the left ventricular wall thickness (r=0.540, P=0.000 andr=0.309, P=0.029 respectively).In addition, the NT-proBNP showed correlation with Child-Turcotte-Pugh score (r=0.454, P=0.001), albumin level (r=-0.376, P=0.007) and total bilirubin level (r=0.283, P=0.047).

CONCLUSIONs Increased levels of plasma NT-proBNP are related to disease severity in patients with cirrhosis.Furthermore, cardiac dysfunction in patients with cirrhosis may be related to increased plasma levels of NT-proBNP.

Heart Diseases ; complications ; Humans ; Liver Cirrhosis ; complications ; physiopathology ; Natriuretic Peptide, Brain ; blood ; Peptide Fragments ; blood

Myocardial infarction (MI) is the leading cause of death in the developed world. Biomarkers have an essential role in diagnosis, risk stratification, guiding management and clinical decision making in the setting of patients presenting with signs and symptoms of MI. Cardiac troponin (cTn) rose to prominence during the 1990s and has evolved to be the cornerstone for diagnosis of MI. The current criteria for MI diagnosis include a rise and/or fall in cTn with at least one value above the 99th percentile of the upper reference limit. Along with cTn, the natriuretic peptides B-type natriuretic peptide (BNP) and amino-terminal proBNP (NT-proBNP) have an important role in determining prognosis and guiding management. As assays for cTn have been evolved that are capable of reliably detecting smaller and smaller quantities in the blood, a dilemma has emerged as to how to use this new information. Several studies have attempted to answer this question and have shown that these lower concentrations of cTn have important prognostic significance and, more importantly, that intervention in these patients leads to improved clinical outcomes. New algorithms incorporating BNP, NT-proBNP, and more sensitive cTn assays hold promise for more rapid diagnosis or rule-out of MI, allowing for appropriate management steps to be initiated and more efficient and effective utilization of healthcare resources.
Biological Markers/*blood ; Humans ; Myocardial Infarction/*diagnosis/metabolism ; Natriuretic Peptide, Brain/blood ; Peptide Fragments/blood ; Prognosis ; Troponin/blood

Biomarkers ; blood ; Child ; Heart Failure ; blood ; diagnosis ; physiopathology ; Humans ; Natriuretic Peptide, Brain ; blood

OBJECTIVENeonatal sepsis can cause multiple organ dysfunction syndrome, especially including myocardial injury and heart failure. In this study, the authors observed the changes and the levels of plasma brain natriuretic peptide and N-terminal pro-B-type natriuretic peptide in myocardial injury of neonatal sepsis at the different stages to search for the early diagnostic index of myocardial injury and heart failure in patients with neonatal septicemia.

METHODThe levels of plasma brain natriuretic peptide and N-terminal pro-B-type natriuretic peptide were determined in 96 newborns with neonatal septicemia according to the diagnosis and treatment program of neonatal septicemia in 2003. The 96 cases were divided into myocardial injury group and non-myocardial injury group. Every newborn was tested for the levels of plasma brain natriuretic peptide and N-terminal pro-B-type natriuretic peptide with enzyme-linked immunosorbent assay (ELISA) on the second day, fifth day and tenth day of septicemia and in the different gestational age infants. Meanwhile, the results were compared to creatine kinase isoenzyme and troponin I.

RESULTThe levels of plasma brain natriuretic peptide and N-terminal pro-B-type natriuretic peptide were significantly different between myocardial injury group and non-myocardial injury group at the fifth day (P<0.05), especially the levels of plasma N-terminal pro-B-type natriuretic peptide were significantly elevated at the early stage (on the second day) between the two groups (P<0.05). On the fifth day, the values of plasma N-terminal pro-B-type natriuretic peptide were (315.5 +/- 69.7) pmol/L in myocardial injury group, but the value of non-myocardial injury group was (179.3 +/- 27.5) pmol/L. On the fifth day, the results of plasma brain natriuretic peptide, N-terminal pro-B-type natriuretic peptide and troponin I were significantly different and had statistical significance between the myocardial injury group and non-myocardial injury group (P<0.05), while the results of creatine kinase isoenzyme had no statistically significant difference (P>0.05). The values of plasma brain natriuretic peptide were respectively (215.5 +/- 69.6) pmol/L and (119.3 +/- 37.4) pmol/L, While N-terminal pro-B-type natriuretic peptide were (315.5 +/- 69.7) pmol/L and (179.3 +/- 27.5) pmol/L in the two groups. The value of troponin I was (1.57 +/- 0.39) microg/L in the myocardial injury group and that in the non-myocardial injury group was (0.55 +/- 0.2) microg/L. The values of creatine kinase isoenzyme were (33.3 +/- 10.1) u/L in the myocardial injury group, but that of non-myocardial injury group was (17.4 +/- 8.5) u/L. In the different gestational age infants, the values of plasma brain natriuretic peptide and N-terminal pro-B-type natriuretic peptide of premature infants were the highest in the three groups. The values of plasma brain natriuretic peptide and N-terminal pro-B-type natriuretic peptide were (159.5 +/- 39.6) pmol/L and (238.5 +/- 49.7) pmol/L in premature infants.

CONCLUSIONThe levels of plasma brain natriuretic peptide and N-terminal pro-B-type natriuretic peptide evidently increased in myocardial injury of neonatal sepsis, especially in premature infants. The increase of plasma brain natriuretic peptide and N-terminal pro-B-type natriuretic peptide may be helpful in early diagnosis of the myocardial injury of neonatal sepsis associated with cTnI. N-terminal pro-B-type natriuretic peptide may become a useful index to diagnose the myocardial injury and should be widely used in the neonatal intensive care unit.

Female ; Heart Injuries ; blood ; diagnosis ; Humans ; Infant, Newborn ; Male ; Natriuretic Peptide, Brain ; blood ; Sepsis ; blood ; diagnosis

OBJECTIVETo elucidate whether the plasma concentration of NT-proBNP in patients with acute coronary syndrome (ACS) correlated with severity of the diseases and whether NT-proBNP is a reliable biochemical marker correctly indicates the severity of ACS.

METHODSEighty-nine subjects came from CCU of Cardiology Department of People's Hospital Beijing University from October 2003 to June 2004 and aged 34-85 y (66.89 +/- 11.12 y). In this study the spectrum of ACS only included unstable angina pectoris (UA) and acute myocardial infarction (AMI). Patients with UA were separated into 3 groups by Braunwald classes and those with AMI were separated into 4 groups by Killip classes when their venous blood samples were collected. Plasma concentration of NT-proBNP was measured by enzyme linked immunoabsorbent assay. Data was estimated by SPSS.

RESULTSThe concentration of NT-proBNP in patients with ACS was dramatically correlative with the severity of the diseases: with the upgrading of Braunwald classes, the concentration of NT-proBNP in patients with UA increased gradually; in patients with AMI it also raised gradually with the upgrading of killip classes; furthermore, the plasma concentration of NT-proBNP in patients with AIM increased much more than that in patients with UA when they are at the similar NYHA functional class.

CONCLUSIONPlasma concentration of NT-proBNP in patients with ACS might be a reliable biochemical marker which can objectively indicate the degree of this diseases.

Acute Coronary Syndrome ; blood ; physiopathology ; Adult ; Aged ; Aged, 80 and over ; Humans ; Middle Aged ; Natriuretic Peptide, Brain ; blood ; Peptide Fragments ; blood

OBJECTIVETo explore the relationship between serum N-terminal pro-brain natriuretic peptide (NT-proBNP) and metabolic syndrome (MS).

METHODSA total of 1323 Beijing residents (559 male) were investigated. MS was defined by the modified 2004 Chinese Diabetes Society criteria and 439 cases were diagnosed as MS according to this criteria. Multivariate logistic regression analysis was used to estimate the odds ratios (OR) of MS. Multiple linear regression analysis was performed to analyze the association between NT-proBNP and characteristic variables.

RESULTSNT-proBNP was significantly lower in MS group compared to non-MS group [32.51 (29.17, 36.14) ng/L vs.38.55 (35.73, 41.50) ng/L, P = 0.012] after adjusted for age and gender. NT-proBNP level decreased with the presence of MS components (from 0 to 4 or 5) (45.92, 37.24, 35.40, 31.55 and 33.65 ng/L respectively, P = 0.043 for linear trend). Among the components, groups with larger waist circumference, higher fasting glucose and triglycerides were associated with lower NT-proBNP level. After adjustment for potential confounders, compared with the lowest NT-proBNP quartile, the adjusted odds ratio of the second, third and fourth quartile for having MS were 0.782 (95%CI: 0.544 - 1.122, P > 0.05), 0.709 (95%CI: 0.489 - 1.028, P > 0.05), 0.604 (95%CI: 0.405 - 0.900, P < 0.05), respectively. Multiple linear regression analysis showed that female gender (β = 0.248, P < 0.001), age (β = 0.167, P < 0.001), systolic blood pressure (β = 0.154, P < 0.001) were positively related to NT-proBNP level while waist circumference (β = -0.082, P = 0.004), diastolic blood pressure (β = -0.085, P = 0.015), triglycerides (β = -0.101, P < 0.001), total cholesterol (β = -0.078, P = 0.004), eGFR (β = -0.150, P < 0.001) were negatively correlated to NT-proBNP level.

CONCLUSIONIn this cohort, higher serum NT-proBNP concentration is associated with lower incidence of metabolic syndrome.

Aged ; Aged, 80 and over ; Cross-Sectional Studies ; Female ; Humans ; Male ; Metabolic Syndrome ; blood ; Natriuretic Peptide, Brain ; blood ; Peptide Fragments ; blood

BACKGROUNDN-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) are excellent biomarkers for detecting heart failure and subclinical myocardial injury. However, it remains unclear whether subclinical myocardial injury is associated with NT-proBNP elevation in a community based population.

METHODSIn a community based study, levels of hs-cTnT and of NT-proBNP were determined in 1 497 participants older than 45 years. The lower detection limit of the hs-cTnT assay used in the present study was 0.003 ng/ml. The association of hs-cTnT levels and NT-proBNP levels was analyzed.

RESULTSWhen the subjects with undetectable (<0.003 ng/ml), intermediate (0.003-0.014 ng/ml), and elevated (≥0.014 ng/ml) levels of hs-cTnT were compared (r = 0.175, P < 0.001), a strong association between the hs-cTnT levels and NT-proBNP levels was observed (β = -0.206, P < 0.001; β = -0.118, P < 0.001, respectively). In multivariable analyses, older age and hs-cTnT were positively and independently associated with NT-proBNP levels (β = 0.341, P < 0.001; β = 0.143, P < 0.001, respectively), and male gender and the levels of eGFR were inversely and independently associated with NT-proBNP levels. When the subjects with normal or elevated NT-proBNP were analyzed separately, the hs-cTnT level was not an independent predictor for the NT-proBNP level in the normal NT-proBNP group, whereas the hs-cTnT level was the only independent predictor for NT-proBNP level in the elevated NT-proBNP group (β = 0.399, P < 0.01).

CONCLUSIONSIn this community based population, NT-proBNP elevation was common. In addition to female gender and older age, subclinical myocardial injury indicated by the hs-cTnT level was another important factor in NT-proBNP elevation.

Biomarkers ; analysis ; Female ; Humans ; Male ; Middle Aged ; Natriuretic Peptide, Brain ; blood ; Peptide Fragments ; blood ; Troponin T ; blood

Cardiac Pacing, Artificial ; methods ; Heart Failure ; blood ; therapy ; Humans ; Natriuretic Peptide, Brain ; blood ; Peptide Fragments ; blood ; Prognosis

OBJECTIVETo observe the prognostic value of admission B-type natriuretic peptide (BNP) on outcome for patients with congestive heart failure (CHF).

METHODSBlood BNP levels, routine echocardiography and tissue Doppler image were obtained in 162 CHF patients [95 male, mean age: (71.8±3.7) years] at admission. Patients were divided into high BNP (BNP>1500 ng/L, n=104) and low BNP (BNP≤1500 ng/L, n=58) groups. All patients were followed up for 2 years and clinical characteristics, echocardiography including Doppler image and cardiovascular events results were analyzed. Data were also compared between patients with (n=48) or without (n=107) cardiovascular events.

RESULTSLeft ventricular ejection fractions (LVEF) was significantly lower [(40.9±5.6)% vs. (44.0±5.9)%, P<0.01] while the total cardiovascular events rate (49.1% vs. 21.0%, P<0.01) and cardiac mortality rate (25.5% vs. 9.0%, P<0.01) were significantly higher in high BNP group than in low BNP group. BNP level at admission in event group was significantly higher than in event-free group [(2875.4±325.7) ng/L vs. (1136.9±298.6) ng/L, P<0.000]. BNP level was positively related to Tei-index (r=0.793, P<0.001) and negatively correlated with LVEF (r=-0.57, P<0.001). Multiple logistic regression analysis demonstrated that BNP, LVEF, Tei-index and β-blocker use were independent risk factors for cardiovascular events. The area under the ROC curve for predicting cardiovascular death within 2 years in event group by BNP was 0.795 (95%CI 0.693-0.935, sensitivity: 72.31% and specificity: 84.62%, cut-off BNP value: 1910 ng/L). The event risk was 2.17 times higher in CHF patients with admission BNP>1910 ng/L compared CHF patients with admission BNP≤1910 ng/L (95%CI: 1.852-2.954, P=0.000).

CONCLUSIONAdmission BNP level, LVEF, Tei-index and β-blocker use are independent risk factors for cardiovascular events in patients with CHF. Patients with higher admission BNP level (>1910 ng/L) is linked with worse prognosis in this patient cohort.

Aged ; Female ; Heart Failure ; blood ; diagnosis ; Humans ; Male ; Natriuretic Peptide, Brain ; blood ; Prognosis ; Survival Rate