Cardiology Department and Cardiac Catheterization Laboratory, Athens General Hospital G.Gennimatas, Athens, Greece.
Curr Top Med Chem. 2013;13(2):82-94. doi: 10.2174/1568026611313020002.
Natriuretic neuropeptides (ANP, BNP, CNP) are produced primarily in the cardiac atria under normal conditions. The main stimulus for ANP and BNP peptide synthesis and secretion is cardiac wall stress. Cardiac ventricular myocytes constitute the major source of BNP-related peptides. Ventricular NT-proBNP production is upregulated in cardiac failure and locally in the area surrounding a myocardial infarct. NT-proBNP is cleared passively by organs with high rate of blood flow (muscle, liver, kidney). It has a longer half life than BNP and higher plasma concentration. BNP and NTproBNP tend to be higher in women and lower in obese individuals. They are also higher in elderly, in left ventricular tachycardia, right ventricular overload, myocardial ischemia, hypoxaemia, renal dysfunction, liver cirrhosis, sepsis and infection. NT-proBNP is useful both in the diagnosis and prognosis of heart failure and is considered to be a gold standard biomarker in heart failure similar to BNP. A cut-off point 300 pg/ml has 99% sensitivity, 60%specificity and NPV 98%for exclusion of acute heart failure. NT proBNP has also a strong prognostic value of death in acute and chronic heart failure and also predicts short and long term mortality in patient with suspected or confirmed unstable CVD. Natriuretic peptides are also prognostic markers for the RV (Right Ventricular) Dysfunction. Their release is due to myocardial stretch from right ventricular pressure overload.Finally, there are data supporting that NT-proBNP might be useful to put a time frame on atrial fibrillation of unknown onset.
利钠肽（ANP、BNP、CNP）主要在正常情况下由心房产生。ANP 和 BNP 肽合成和分泌的主要刺激因素是心脏壁张力。心室心肌细胞构成 BNP 相关肽的主要来源。心力衰竭和心肌梗死周围区域局部会导致心室 NT-proBNP 产生增加。NT-proBNP 可被血流速度高的器官（肌肉、肝脏、肾脏）被动清除。它的半衰期比 BNP 长，血浆浓度更高。BNP 和 NT-proBNP 在女性中较高，在肥胖个体中较低。在老年人、左室性心动过速、右室超负荷、心肌缺血、低氧血症、肾功能不全、肝硬化、败血症和感染中也更高。NT-proBNP 在心衰的诊断和预后中都很有用，被认为是心衰的金标准生物标志物，与 BNP 相似。截断值 300 pg/ml 对急性心衰的排除具有 99%的敏感性、60%的特异性和 98%的阴性预测值。NT proBNP 在急性和慢性心衰中也具有很强的死亡预后价值，并且还可以预测疑似或确诊不稳定 CVD 患者的短期和长期死亡率。利钠肽也是右心室（RV）功能障碍的预后标志物。它们的释放是由于右心室压力超负荷导致的心肌拉伸。最后，有数据支持 NT-proBNP 可能有助于确定不明原因心房颤动的时间框架。
