Natriuretic peptides in patients with heart failure
Cleavage of the prohormone proBNP (B-type natriuretic peptide) produces biologically active 32 amino acid BNP and biologically inert 76 amino acid N-terminal pro-BNP (NT-proBNP). Atrial natriuretic peptide (ANP) is a hormone that is released from myocardial cells in the atria, and in some cases the ventricles in response to volume expansion. The circulating concentration of BNP is less than 20% of that of ANP in normal subjects but can equal or exceed that of ANP in patients with heart failure (HF). The wider range of concentrations makes BNP a more useful measurement than ANP in the evaluation of patients with HF, thus there is more clinical experience with BNP. Mid- regional pro-atrial natriuretic peptide (MR-proANP) is available at some specialised institutions.
- -proBNP is the most frequently measured peptide in commercial laboratories, including Lancet Laboratories, due to its analytical stability. It has also been used in many clinical trials, and so is useful to the physician to optimise patient management.