Issue in cardiovascular nursing| Volume 37, ISSUE 4, P275-285, July 2008

Download started.


Diagnostic and prognostic impact of brain natriuretic peptide in cardiac and noncardiac diseases


      Cardiac secretion of brain natriuretic peptide (BNP) increases with the progression of congestive heart failure (CHF). The plasma measurement of BNP emerged recently as a useful, cost-effective biomarker for the diagnosis and prognosis of CHF.


      BNP assay is useful for evaluating patients with acute dyspnea, because a low level can help rule out CHF in primary care settings and reduce the demand for echocardiography. Equally, BNP level can be particularly useful in recognizing heart failure in a patient with acute dyspnea and a history of chronic obstructive pulmonary disease.


      However, although the clinical use of BNP as a biomarker in CHF is increasing, the specificity of BNP in CHF is not strong, suggesting that other mechanisms beyond simple ventricular stretch stimulate BNP release. Multiple disorders in the intensive care unit, apart from CHF, cause elevated BNP levels, including cardiovascular disease states such as ischemia, arrhythmias, cardiac hypertrophy, and coronary endothelial dysfunction, as well as disorders of no cardiac origin, such as sepsis, septic shock, and acute respiratory distress syndrome. Moreover, the impact of increased BNP in patients with sepsis is not clear. The relationship between BNP and both left ventricular ejection fraction and left-sided filling pressures is weak, and data on the prognostic impact of high BNP levels in patients with sepsis are conflicting.


      Nevertheless, this review highlights the potential benefits of BNP in the recognition and management of heart failure, and defines the gray zones of BNP levels; it also identifies conditions influencing BNP levels in relation to a certain heart failure and describes conditions of no cardiac origin with increased BNP.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Heart & Lung: The Journal of Cardiopulmonary and Acute Care
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • American Heart Association
        Stroke and statistical update 2002.
        American Heart Association, Dallas, TX2002
      1. Bukata R. B-natriuretic peptide and congestive heart failure. Emerg Med Acute Care Essays 2003;26.

        • Shamsham F.
        • Mitchell J.
        Essentials of the diagnosis of heart failure.
        Fam Physician. 2000; 61: 1319-1328
        • de Lemos J.A.
        • McGuire D.K.
        • Drazner M.H.
        B-type natriuretic peptide in cardiovascular disease.
        Lancet. 2003; 362: 316-322
        • Silver M.A.
        • Maisel A.
        • Yancy C.W.
        • et al.
        BNP Consensus Panel 2004: A clinical approach for the diagnostic, prognostic, screening, treatment monitoring, and therapeutic roles of natriuretic peptides in cardiovascular diseases.
        Congest Heart Fail. 2004; 10: S1-S30
        • Phua J.
        • Lim T.K.
        • Hoe Lee K.H.
        B-type natriuretic peptide: issues for the intensivist and pulmonologist.
        Crit Care Med. 2005; 33: 2094-2103
        • Lang C.C.
        • Choy A.J.
        • Struthers A.D.
        Atrial and brain natriuretic peptides: a dual natriuretic peptide system potentially involved in circulatory homeostasis.
        Clin Sci. 1992; 83: 519-527
        • White R.
        The role of brain natriuretic peptide in systolic heart failure.
        Dimens Crit Care Nurs. 2005; 24: 171-174
        • Hama N.
        • Itoh H.
        • Shirakami G.
        • Nakagawa O.
        • et al.
        Rapid ventricular induction of brain natriuretic peptide gene expression in experimental acute myocardial infarction.
        Circulation. 1995; 92: 1558-1564
        • Li N.
        • Wang J.
        Brain natriuretic peptide and optimal management of heart failure.
        J Zhejiang Univ Sci B. 2005; 6B: 877-884
        • Lee D.
        • Vasan R.
        Novel markers for heart failure diagnosis and prognosis.
        Curr Opin Cardiol. 2005; 20: 201-210
        • Grantham J.A.
        • Borgeson D.D.
        • Burnett Jr, J.C.
        BNP: pathophysiological and potential therapeutic roles in acute congestive heart failure.
        Am J Physiol. 1997; 272: R1077-R1083
        • Yamamoto K.
        • Burnett Jr, J.C.
        • Redfield M.M.
        Effect of endogenous natriuretic peptide system on ventricular and coronary function in failing heart.
        Am J Physiol. 1997; 273: H2406-H2414
        • Vanderheyden M.
        • Bartunek J.
        • Goethals M.
        Brain and other natriuretic peptides: molecular aspects.
        Eur J Heart Fail. 2004; 6: 261-268
        • Hunt P.J.
        • Richards A.M.
        • Nicholls M.G.
        • et al.
        Immunoreactive amino-terminal pro-brain natriuretic peptide (NT-PROBNP): a new marker of cardiac impairment.
        Clin Endocrinol (Oxf). 1997; 47: 287-296
        • Pemberton C.J.
        • Johnson M.L.
        • Yandle T.G.
        • Espiner E.A.
        Deconvolution analysis of cardiac natriuretic peptides during acute volume overload.
        Hypertension. 2000; 36: 355-359
        • Richards A.M.
        • Crozier I.G.
        • Holmes S.J.
        • Espiner E.A.
        • Yandle T.G.
        • Frampton C.
        Brain natriuretic peptide: natriuretic and endocrine effects in essential hypertension.
        J Hypertens. 1993; 11: 163-170
        • Jensen K.T.
        • Carstens J.
        • Pedersen E.B.
        Effect of BNP on renal hemodynamics tubular function and vasoactive hormones in humans.
        Am J Physiol. 1998; 274: F63-F72
        • Brunner-La Rocca H.P.
        • Kaye D.M.
        • Woods R.L.
        • Hastings J.
        • Esler M.D.
        Effects of intravenous brain natriuretic peptide on regional sympathetic activity in patients with chronic heart failure as compared with healthy control subjects.
        J Am Coll Cardiol. 2001; 37: 1221-1227
        • Clarkson P.B.
        • Wheeldon N.M.
        • MacFadyen R.J.
        • Pringle S.D.
        • MacDonald T.M.
        Effects of brain natriuretic peptide on exercise hemodynamics and neurohormones in isolated diastolic heart failure.
        Circulation. 1996; 93: 2037-2042
        • Cao L.
        • Gardner D.G.
        Natriuretic peptides inhibit DNA synthesis in cardiac fibroblasts.
        Hypertension. 1995; 25: 227-234
        • Fujisaki H.
        • Ito H.
        • Hirata Y.
        • et al.
        Natriuretic peptides inhibit angiotensin II-induced proliferation of rat cardiac fibroblasts by blocking endothelin-1 gene expression.
        J Clin Invest. 1995; 96: 1059-1065
        • van der Zander K.
        • Houben A.J.
        • Kroon A.A.
        • de Leeuw P.W.
        Effects of brain natriuretic peptide on forearm vasculature: comparison with atrial natriuretic peptide.
        Cardiovasc Res. 1999; 44: 595-600
        • van der Zander K.
        • Houben A.J.
        • Kroon A.A.
        • De Mey J.G.
        • Smits P.A.
        • de Leeuw P.W.
        Nitric oxide and potassium channels are involved in brain natriuretic peptide induced vasodilatation in man.
        J Hypertens. 2002; 20: 493-499
        • Maisel A.S.
        Nesiritide: a new therapy for the treatment of heart failure.
        Cardiovasc Toxicol. 2003; 3: 37-42
        • Packer M.P.
        The neurohormonal hypothesis: a theory to explain the mechanism of disease progression in heart failure.
        J Am Coll Cardiol. 1992; 20: 248-254
        • Stevenson L.W.
        Tailored therapy to hemodynamic goals for advanced heart failure.
        Eur J Heart Fail. 1999; 1: 251-257
        • Ferguson D.W.
        • Berg W.J.
        • Roach P.J.
        • Oren R.M.
        • Mark A.L.
        Effects of heart failure on baroreflex control of sympathetic neural activity.
        Am J Cardiol. 1992; 69: 523-531
        • Grassi G.
        • Seravalle G.
        • Cattaneo B.M.
        • et al.
        Sympathetic activation and loss of reflex sympathetic control in mild congestive heart failure.
        Circulation. 1995; 92: 3206-3211
        • Court O.
        • Kumar A.
        • Parrillo J.E.
        • et al.
        Clinical review: myocardial depression in sepsis and septic shock.
        Crit Care. 2002; 6: 500-508
        • Tomaru Ki K.
        • Arai M.
        • Yokoyama T.
        • et al.
        Transcriptional activation of the BNP gene by lipopolysaccharide is mediated through GATA elements in neonatal rat cardiac myocytes.
        J Mol Cell Cardiol. 2002; 34: 649-659
        • He Q.
        • LaPointe M.C.
        Interleukin-1beta regulation of the human brain natriuretic peptide promoter involves Ras-, Rac-, and p38 kinase-dependent pathways in cardiac myocytes.
        Hypertension. 1999; 33: 283-289
        • He Q.
        • LaPointe M.C.
        Interleukin-1beta regulates the human brain natriuretic peptide promoter via Ca(2_)-dependent protein kinase pathways.
        Hypertension. 2000; 35: 292-296
        • Kuwahara K.
        • Saito Y.
        • Harada M.
        • et al.
        Involvement of cardiotrophin-1 in cardiac myocyte-nonmyocyte interactions during hypertrophy of rat cardiac myocytes in vitro.
        Circulation. 1999; 100: 1116-1124
        • Heringlake M.
        • Heide C.
        • Bahlmann L.
        • et al.
        Effects of tilting and volume loading on plasma levels and urinary excretion of relaxin, NT-pro-ANP, and NT-pro-BNP in male volunteers.
        J Appl Physiol. 2004; 97: 173-179
        • Vieillard-Baron A.
        • Schmitt J.M.
        • Augarde R.
        • et al.
        Acute cor pulmonale in acute respiratory distress syndrome submitted to protective ventilation: incidence, clinical implications, and prognosis.
        Crit Care Med. 2001; 29: 1551-1555
        • Maeder M.
        • Fehr T.H.
        • Rickli H.
        • Ammann P.
        Sepsis-associated myocardial dysfunction. diagnostic and prognostic impact of cardiac troponins and natriuretic peptides.
        Chest. 2006; 129: 1349-1366
        • Jefic D.
        • Lee J.W.
        • Jefic D.
        • et al.
        Utility of B-type natriuretic peptide and N-terminal pro B-type natriuretic peptide in evaluation of respiratory failure in critically ill patients.
        Chest. 2005; 128: 288-295
        • Logeart D.
        • Thabut G.
        • Jourdain P.
        • et al.
        Predischarge B-type natriuretic peptide assay for identifying patients at high risk of re-admission after decompensated heart failure.
        J Am Coll Cardiol. 2004; 43: 635-641
        • Maisel A.
        • Krishnaswamy P.
        • Nowak R.
        • et al.
        Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure.
        N Engl J Med. 2002; 347: 161-167
        • Morrison L.
        • Harrison A.
        • Krishnaswamy P.
        • Kazanegra R.
        • Clopton P.
        • Maisel A.
        Utility of a rapid B-natriuretic peptide assay in differentiating congestive heart failure from lung disease in patients presenting with dyspnea.
        J Am Coll Cardiol. 2002; 39: 202-209
        • McCullough P.
        • Hollander J.
        • Nowak R.
        • et al.
        Uncovering heart failure in patients with a history of pulmonary disease: rationale for the early use of B-type natriuretic peptide in the emergency department.
        Acad Emerg Med. 2003; 10: 198-210
        • Mueller C.
        • Scholer A.
        • Laule-Kilian K.
        • et al.
        Use of B-type natriuretic peptide in the evaluation and management of acute dyspnea.
        N Engl J Med. 2004; 350: 647-654
        • Storrow A.
        Advances in the diagnosis of CHF: new markers.
        Mod Adv Emerg Cardiac Care. 2003; : 38-48
        • The Criteria Committee of the New York Heart Association
        Nomenclature and criteria for diagnosis of diseases of the heart and great vessels.
        Little, Brown, Boston1979
        • Januzzi Jr, J.L.
        • Camargo C.A.
        • Anwaruddin S.
        • et al.
        The N-terminal pro-BNP investigation of dyspnea in the emergency department (PRIDE) study.
        Am J Cardiol. 2005; 95: 48-54
        • Jaffe A.J.
        • Babuin L.
        • Apple F.S.
        Biomarkers in acute cardiac disease. the present and the future.
        J Am Coll Cardiol. 2006; 48: 1-11
        • Haug C.
        • Metzele A.
        • Kochs M.
        • Hombach V.
        • Grunert A.
        Plasma brain natriuretic peptide and atrial natriuretic peptide concentrations correlate with left ventricular end-diastolic pressure.
        Clin Cardiol. 1993; 16: 553-557
        • Kazanegra R.
        • Cheng V.
        • Garcia A.
        • et al.
        A rapid test for B-type natriuretic peptide correlates with falling wedge pressures in patients treated for decompensated heart failure: a pilot study.
        J Card Fail. 2001; 7: 21-29
        • Maeda K.
        • Tsutamoto T.
        • Wada A.
        • et al.
        Plasma brain natriuretic peptide as a biochemical marker of high left ventricular end-diastolic pressure in patients with symptomatic left ventricular dysfunction.
        Am Heart J. 1998; 35: 825-832
        • Davis M.
        • Espiner E.
        • Richards G.
        • et al.
        Plasma brain natriuretic peptide in assessment of acute dyspnoea.
        Lancet. 1994; 343: 440-444
        • Maisel A.S.
        • McCord J.
        • Nowak R.M.
        • et al.
        • Breathing Not Properly Multinational Study Investigators
        Bedside B-type natriuretic peptide in the emergency diagnosis of heart failure with reduced or preserved ejection fraction.
        Results from the Breathing Not Properly Multinational StudyJ Am Coll Cardiol. 2003; 41: 2010-2017
        • Teng Y.C.
        • Tang X.W.
        • Lin Q.D.
        • Wu Y.X.
        • Song X.L.
        Relationship between left ventricular diastolic function and plasma brain natriuretic peptide concentration during severe pregnancy induced hypertension syndrome.
        Chung Hua I Hsueh Tsa Chih. 2003; 83: 662-665
        • Lubien E.
        • DeMaria A.
        • Krishnaswamy P.
        • et al.
        Utility of B-natriuretic peptide in detecting diastolic dysfunction: comparison with Doppler velocity recordings.
        Circulation. 2002; 105: 595-601
        • Sullivan D.R.
        • West M.
        • Jeremy R.
        Utility of brain natriuretic peptide (BNP) measurement in cardiovascular disease.
        Heart Lung Circ. 2005; 14: 78-84
        • Yoshibayashi M.
        • Kamiya T.
        • Saito Y.
        • Matsuo H.
        Increased plasma levels of brain natriuretic peptide in hypertrophic cardiomyopathy.
        N Engl J Med. 1993; 329: 433-434
        • Takemura G.
        • Takatsu Y.
        • Doyama K.
        • et al.
        Expression of atrial and brain natriuretic peptides and their genes in hearts of patients with cardiac amyloidosis.
        J Am Coll Cardiol. 1998; 31: 754-765
        • Maisel A.
        • Hollander J.E.
        • Guss D.
        • et al.
        Primary results of the Rapid Emergency Department Heart Failure Outpatient Trial (REDHOT): a multicenter study of B-type natriuretic peptide levels, emergency department decision making, and outcomes in patients presenting with shortness of breath.
        J Am Coll Cardiol. 2004; 44: 1328-1333
        • Vasan R.S.
        • Benjamin E.J.
        • Larson M.G.
        • et al.
        Plasma natriuretic peptides for community screening for left ventricular hypertrophy and systolic dysfunction: the Framingham heart study.
        JAMA. 2002; 288: 1252-1259
        • Redfield M.M.
        • Rodeheffer R.J.
        • Jacobsen S.J.
        • et al.
        Plasma brain natriuretic peptide to detect preclinical ventricular systolic or diastolic dysfunction: a community-based study.
        Circulation. 2004; 109: 3176-3181
        • McDonagh T.A.
        • Robb S.D.
        • Murdoch D.R.
        • et al.
        Biochemical detection of left ventricular systolic dysfunction.
        Lancet. 1998; 351: 9-13
        • Tateishi J.
        • Masutani M.
        • Ohyanagi M.
        • Iwasaki T.
        Transient increase in plasma brain (B-type) natriuretic peptide after percutaneous transluminal coronary angioplasty.
        Clin Cardiol. 2000; 23: 776-780
        • Kyriakides Z.S.
        • Markianos M.
        • Michalis L.
        • Antoniadis A.
        • Nikolaou N.I.
        • Kremastinos D.T.
        Brain natriuretic peptide increases acutely and much more prominently than atrial natriuretic peptide during coronary angioplasty.
        Clin Cardiol. 2000; 23: 285-288
        • Kikuta K.
        • Yasue H.
        • Yoshimura M.
        • et al.
        Increased plasma levels of B-type natriuretic peptide in patients with unstable angina.
        Am Heart J. 1996; 132: 101-107
        • Nagaya N.
        • Nishikimi T.
        • Okano Y.
        • et al.
        Plasma brain natriuretic peptide levels increase in proportion to the extent of right ventricular dysfunction in pulmonary hypertension.
        J Am Coll Cardiol. 1998; 31: 202-208
        • Gan C.T.
        • McCann G.P.
        • Marcus J.T.
        • et al.
        Nt-proBNP reflects right ventricular structure and function in pulmonary hypertension.
        Eur Respir J. 2006; 28: 1190-1194
        • Kucher N.
        • Goldhaber S.Z.
        Cardiac biomarkers for risk stratification of patients with acute pulmonary embolism.
        Circulation. 2003; 108: 2191-2194
        • Kruger S.
        • Graf J.
        • Merx M.W.
        • et al.
        Brain natriuretic peptide predicts right heart failure in patients with acute pulmonary embolism.
        Am Heart J. 2004; 147: 60-65
        • Kucher N.
        • Printzen G.
        • Goldhaber S.Z.
        Prognostic role of brain natriuretic peptide in acute pulmonary embolism.
        Circulation. 2003; 107: 2545-2547
        • Kucher N.
        • Printzen G.
        • Doernhoefer T.
        • et al.
        Low pro-brain natriuretic peptide levels predict benign clinical outcome in acute pulmonary embolism.
        Circulation. 2003; 107: 1576-1578
        • Incalzi R.A.
        • Fuso L.
        • Serra M.
        • et al.
        Exacerbated chronic obstructive pulmonary disease: a frequently unrecognized condition.
        J Intern Med. 2002; 252: 48-55
        • Gan S.C.
        • Beaver S.K.
        • Houck P.M.
        • et al.
        Treatment of acute myocardial infarction and 30-day mortality among women and men.
        N Engl J Med. 2000; 343: 8-15
        • Cabanes L.
        • Richaud-Thiriez B.
        • Fulla Y.
        • et al.
        Brain natriuretic peptide blood levels in the differential diagnosis of dyspnea.
        Chest. 2001; 120: 2047-2050
        • Kita H.
        • Ohi M.
        • Chin K.
        • et al.
        The nocturnal secretion of cardiac natriuretic peptides during obstructive sleep apnoea and its response to therapy with nasal continuous positive airway pressure.
        J Sleep Res. 1998; 7: 199-207
        • Kaditis A.
        • Alexopoulos E.
        • Hatzi F.
        • et al.
        Overnight change in brain natriuretic peptide levels in children with sleep-disordered breathing.
        Chest. 2006; 130: 1377-1384
        • Brookes C.I.
        • Kemp M.W.
        • Hooper J.
        • Oldershaw P.J.
        • Moat N.E.
        Plasma brain natriuretic peptide concentrations in patients with chronic mitral regurgitation.
        J Heart Valve Dis. 1997; 6: 608-612
        • Tharaux P.L.
        • Dussaule J.C.
        • Hubert-Brierre J.
        • et al.
        Plasma atrial and brain natriuretic peptides in mitral stenosis treated by valvulotomy.
        Clin Sci (Colch). 1994; 87: 671-677
        • Gerber I.L.
        • Stewart R.A.
        • Legget M.E.
        • et al.
        Increased plasma natriuretic peptide levels reflect symptom onset in aortic stenosis.
        Circulation. 2003; 107: 1884-1890
        • Suda K.
        • Matsumura M.
        • Matsumoto M.
        Clinical implication of plasma natriuretic peptides in children with ventricular septal defect.
        Pediatr Int. 2003; 45: 249-254
        • Ribeiro A.L.
        • dos Reis A.M.
        • Barros M.V.
        • et al.
        Brain natriuretic peptide and left ventricular dysfunction in Chagas' disease.
        Lancet. 2002; 360: 461-462
        • Kawamura T.
        • Wago M.
        Brain natriuretic peptide can be a useful biochemical marker for myocarditis in patients with Kawasaki disease.
        Cardiol Young. 2002; 12: 153-158
        • Nakao K.
        Natriuretic peptide family.
        Nippon Naibunpi Gakkai Zasshi. 1992; 68 ([in Japanese]): 134-142
        • Adachi K.
        • Kawai H.
        • Saito M.
        • et al.
        Plasma levels of brain natriuretic peptide as an index for evaluation of cardiac function in female gene carriers of Duchenne muscular dystrophy.
        Intern Med. 1997; 36: 497-500
        • Hayakawa H.
        • Komada Y.
        • Hirayama M.
        • Hori H.
        • Ito M.
        • Sakurai M.
        Plasma levels of natriuretic peptides in relation to doxorubicin-induced cardiotoxicity and cardiac function in children with cancer.
        Med Pediatr Oncol. 2001; 37: 4-9
        • Niwa N.
        • Watanabe E.
        • Hamaguchi M.
        • et al.
        Early and late elevation of plasma atrial and brain natriuretic peptides in patients after bone marrow transplantation.
        Ann Hematol. 2001; 80: 460-465
        • Bordenave L.
        • Georges A.
        • Bareille R.
        • Conrad V.
        • Villars F.
        • Amedee J.
        Human bone marrow endothelial cells: a new identified source of B-type natriuretic peptide.
        Peptides. 2002; 23: 935-940
        • Wang T.J.
        • Larson M.G.
        • Levy D.
        • et al.
        Plasma natriuretic peptide levels and the risk of cardiovascular events and death.
        N Engl J Med. 2004; 350: 655-663
        • Nakamura M.
        • Endo H.
        • Nasu M.
        • et al.
        Value of plasma B type natriuretic peptide measurement for heart disease screening in a Japanese population.
        Heart. 2002; 87: 131-135
        • Bettencourt P.
        • Azevedo A.
        • Pimenta J.
        • Frioes F.
        • Ferreira S.
        • Ferreira A.
        N-terminal-pro-brain natriuretic peptide predicts outcome after hospital discharge in heart failure patients.
        Circulation. 2004; 110: 2168-2174
        • Peacock W.F.
        • Freda B.J.
        Heart failure part I.
        Emerg Med Rep. 2003; 3: 89-92
        • Conklin B.
        B-type natriuretic peptide: a new measurement to distinguish cardiac from pulmonary causes of acute dyspnea.
        J Emerg Nurs. 2005; 31: 73-75
        • Hartmann F.
        • Packer M.
        • Coats A.J.
        • et al.
        Prognostic impact of plasma N-terminal pro-brain natriuretic peptide in severe chronic congestive heart failure: a substudy of the Carvedilol Prospective Randomized Cumulative Survival (COPERNICUS) trial.
        Circulation. 2004; 110: 1780-1786
        • Gardner R.S.
        • Ozalp F.
        • Murday A.J.
        • et al.
        N-terminal pro-brain natriuretic peptide: a new gold standard in predicting mortality in patients with advanced heart failure.
        Eur Heart J. 2003; 24: 1735-1743
        • de Groote P.
        • Dagorn J.
        • Soudan B.
        • et al.
        B-type natriuretic peptide and peak exercise oxygen consumption provide independent information for risk stratification in patients with stable congestive heart failure.
        J Am Coll Cardiol. 2004; 43: 1584-1589
        • Hamada Y.
        • Tanaka N.
        • Murata K.
        • et al.
        Significance of predischarge BNP on one-year outcome in decompensated heart failure-comparative study with echo-Doppler indexes.
        J Card Fail. 2005; 11: 43-49
        • Miller W.L.
        • Hartman K.A.
        • Burritt M.F.
        • Borgeson D.D.
        • Burnett Jr, J.C.
        • Jaffe A.S.
        Biomarker responses during and after treatment with nesiritide infusion in patients with decompensated chronic heart failure.
        Clin Chem. 2005; 51: 569-577
        • Troughton R.W.
        • Frampton C.M.
        • Yandle T.G.
        • Espiner E.A.
        • Nicholls M.G.
        • Richards A.M.
        Treatment of heart failure guided by plasma aminoterminal brain natriuretic peptide (N-BNP) concentrations.
        Lancet. 2000; 355: 1126-1130
        • Abdulla J.
        • Kober L.
        • Torp-Pedersen C.
        Methods of assessing the functional status of patients with left ventricular systolic dysfunction in interventional studies: can brain natriuretic peptide measurement be used as surrogate for the traditional methods?.
        Cardiovasc Drugs Ther. 2004; 18: 219-224
        • Maeder M.
        • Ammann P.
        • Kiowski W.
        • et al.
        B-type natriuretic peptide in patients with sepsis and preserved left ventricular ejection fraction.
        Eur J Heart Fail. 2005; 7: 1164-1167
        • Chua G.
        • Kang-Hoe L.
        Marked elevations in N-terminal brain natriuretic peptide levels in septic shock.
        Crit Care. 2004; 8: R248-R250
        • Tung R.H.
        • Garcia C.
        • Morss A.M.
        • et al.
        Utility of B-type natriuretic peptide for the evaluation of intensive care unit shock.
        Crit Care Med. 2004; 32: 1643-1647
        • Forfia P.R.
        • Watkins S.P.
        • Rame J.E.
        • et al.
        Relationship between B-type natriuretic peptides and pulmonary capillary wedge pressure in the intensive care unit.
        J Am Coll Cardiol. 2005; 45: 1667-1671
        • Charpentier J.
        • Luyt C.E.
        • Fulla Y.
        • et al.
        Brain natriuretic peptide: a marker of myocardial dysfunction and prognosis during severe sepsis.
        Crit Care Med. 2004; 32: 660-665
        • Ueda S.
        • Nishio K.
        • Akai Y.
        • et al.
        Prognostic value of increased plasma levels of brain natriuretic peptide in patients with septic shock.
        Shock. 2006; 26: 134-139
        • Cuthbertson B.H.
        • Patel R.R.
        • Croal B.L.
        • et al.
        B-type natriuretic peptide and the prediction of outcome in patients admitted to intensive care.
        Anaesthesia. 2005; 60: 16-21
        • Henriksen J.H.
        • Gotze J.P.
        • Fuglsang S.
        • et al.
        Increased circulating pro-brain natriuretic peptide (proBNP) and brain natriuretic peptide (BNP) in patients with cirrhosis: relation to cardiovascular dysfunction and severity of disease.
        Gut. 2003; 52: 1511-1517
        • Iwao T.
        • Oho K.
        • Nakano R.
        • et al.
        High plasma cardiac natriuretic peptides associated with enhanced cyclic guanosine monophosphate production in preascitic cirrhosis.
        J Hepatol. 2000; 32: 426-433
        • Makikallio A.M.
        • Makikallio T.H.
        • Korpelainen J.T.
        • et al.
        Natriuretic peptides and mortality after stroke.
        Stroke. 2005; 36: 1016-1020
        • Berendes E.
        • Walter M.
        • Cullen P.
        • et al.
        Secretion of brain natriuretic peptide in patients with aneurysmal subarachnoid haemorrhage.
        Lancet. 1997; 349: 245-249
        • Espiner E.A.
        • Leikis R.
        • Ferch R.D.
        • et al.
        The neuro-cardio-endocrine response to acute subarachnoid haemorrhage.
        Clin Endocrinol. 2002; 56: 629-635
        • Fukui S.
        • Katoh H.
        • Tsuzuki N.
        • et al.
        Focal brain edema and natriuretic peptides in patients with subarachnoid hemorrhage.
        J Clin Neurosci. 2004; 11: 507-511
        • Sviri G.E.
        • Feinsod M.
        • Soustiel J.F.
        Brain natriuretic peptide and cerebral vasospasm in subarachnoid hemorrhage.
        Stroke. 2000; 31: 118-122
        • McGirt M.J.
        • Blessing R.
        • Nimjee S.M.
        • et al.
        Correlation of serum brain natriuretic peptide with hyponatremia and delayed ischemic neurological deficits after subarachnoid hemorrhage.
        Neurosurgery. 2004; 54: 1369-1373
        • Liang F.
        • Webb P.
        • Marimuthu A.
        • et al.
        Triiodothyronine increases brain natriuretic peptide (BNP) gene transcription and amplifies endothelin-dependent BNP gene transcription and hypertrophy in neonatal rat ventricular myocytes.
        J Biol Chem. 2003; 278: 15073-15083
        • Schultz M.
        • Faber J.
        • Kistorp C.
        • et al.
        Nterminal-pro-B-type natriuretic peptide (NT-pro-BNP) in different thyroid function states.
        Clin Endocrinol. 2004; 60: 54-59
      2. Knudsen CW, Vik-Mo H, Omland T. Blood haemoglobin is an independent predictor of B-type natriuretic peptide levels. Clin Sci (Lord) Epub 2005,109:69-74.

        • Redfield M.M.
        • Rodeheffer R.J.
        • Jacobsen S.J.
        • et al.
        Plasma brain natriuretic peptide concentration: impact of age and gender.
        J Am Coll Cardiol. 2002; 40: 976-982
        • McCullough P.A.
        • Duc P.
        • Omland T.
        • et al.
        B-type natriuretic peptide and renal function in the diagnosis of heart failure: an analysis from the Breathing Not Properly Multinational Study.
        Am J Kidney Dis. 2003; 41: 571-579
        • McLean A.S.
        • Huang S.J.
        • Nalos M.
        • Tang B.
        • Stewart D.E.
        The confounding effects of age, gender, serum creatinine, and electrolyte concentrations on plasma B-type natriuretic peptide concentrations in critically ill patients.
        Crit Care Med. 2003; 31: 2611-2618
        • Maffei S.
        • Del Ry S.
        • Prontera C.
        • Clerico A.
        Increase in circulating levels of cardiac natriuretic peptides after hormone replacement therapy in postmenopausal women.
        Clin Sci (Colch). 2001; 101: 447-453
        • Onuoha G.N.
        • Nicholls D.P.
        • Patterson A.
        • Beringer T.
        Neuropeptide secretion in exercise.
        Neuropeptides. 1998; 32: 319-325
        • Ohba H.
        • Takada H.
        • Musha H.
        • et al.
        Effects of prolonged strenuous exercise on plasma levels of atrial natriuretic peptide and brain natriuretic peptide in healthy men.
        Am Heart J. 2001; 141: 751-758
        • Almeida S.S.
        • Azevedo A.
        • Castro A.
        • et al.
        B-type natriuretic peptide is related to left ventricular mass in hypertensive patients but not in athletes.
        Cardiology. 2002; 98: 113-115
        • Lang C.C.
        • Choy A.M.
        • Henderson I.S.
        • Coutie W.J.
        • Struthers A.D.
        Effect of haemodialysis on plasma levels of brain natriuretic peptide in patients with chronic renal failure.
        Clin Sci (Colch). 1992; 82: 127-131
        • Mueller C.
        • Laule-Kilian K.
        • Scholer A.
        • et al.
        B-type natriuretic peptide for acute dyspnea in patients with kidney disease.
        Kidney Int. 2005; 67: 278-284
        • McCord J.
        • Mundy B.J.
        • Hudson M.P.
        • et al.
        Relationship between obesity and B-type natriuretic peptide levels.
        Arch Intern Med. 2004; 164: 2247-2252
        • Mehra M.R.
        • Uber P.A.
        • Park M.H.
        • et al.
        Obesity and suppressed B-type natriuretic peptide levels in heart failure.
        J Am Coll Cardiol. 2004; 43: 1590-1595
        • Silver M.A.
        • Maisel A.
        • Yancy C.W.
        • et al.
        BNP consensus panel 2004: a clinical approach for the diagnostic, prognostic, screening, treatment monitoring, and therapeutic roles of natriuretic peptides in cardiovascular diseases.
        Congest Heart Fail. 2004; 10: 1-30
        • Tabbibizar R.
        • Maisel A.
        The impact of B-type natriuretic peptide levels on the diagnosis and management of congestive heart failure.
        Curr Opin Cardiol. 2002; 17: 340-345