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0.6% of the total health care costs of the country and 6.6% of the total costs because of heart disease in general [9]. Brain natriuretic peptide (BNP) is one member of the family of natriuretic peptides that were initially discovered by de Bold et al. [10]. BNP is synthesized and released into the blood in response to volume overload or conditions that cause ventricular stretch, in order to control fluid and electrolyte homeostasis by interaction with the renin-angiotensin-aldosterone system [11, 12]. Plasma concentrations of BNP are consistently elevated in

Clin Chem Lab Med 2009;47(6):762–768 2009 by Walter de Gruyter • Berlin • New York. DOI 10.1515/CCLM.2009.153 2007/617 Article in press - uncorrected proof Proficiency testing project for brain natriuretic peptide (BNP) and the N-terminal part of the propeptide of BNP (NT-proBNP) immunoassays: the CardioOrmocheck study Concetta Prontera1, Martina Zaninotto3, Stefania Giovannini1, Gian Carlo Zucchelli1, Alessandro Pilo1, Laura Sciacovelli4, Mario Plebani3 and Aldo Clerico1,2,* 1 Fondazione Toscana Gabriele Monasterio and CNR Institute of Clinical Physiology, Pisa

Abstract

The clinical relevance of brain natriuretic peptide (BNP) and N-terminal (NT)-proBNP assays as a diagnostic tool and prognostic marker in patients with cardiovascular diseases has recently been confirmed. However, several studies demonstrated variation of intra-individual BNP concentrations of >30% (ranging from 30% to 50%) with reference change values at the 95% confidence interval (i.e., the estimated critical difference) ranging from 99% to 130% in healthy subjects and heart failure patients. According to this estimated confidence interval, only a great variation in plasma BNP levels should be considered significant in an individual patient (for example, a decrease of >50% or an increase of more than two-fold). Many recent clinical studies have demonstrated that BNP variations below this estimated critical difference could also have clinical relevance. Like the concentration of other neuro-hormones, levels of plasma BNP fluctuate widely and rapidly along with heart rhythm and blood pressure variations in response to physiological stimuli. However, biological variation of BNP should not be interpreted strictly as random fluctuation around a homeostatic set point, as assumed by the common model used in all studies on biological variation of BNP reported in the literature. These results cannot be directly transferred to clinical practice. While awaiting more accurate studies, we suggest that variations of plasma BNP three-fold greater than the analytical imprecision should be considered as potentially relevant from a physiological and clinical point of view.

Clin Chem Lab Med 2004;42(2):159–163 2004 by Walter de Gruyter • Berlin • New York 2003191 Biochemical diagnosis of impaired left ventricular ejection fraction – comparison of the diagnostic accuracy of brain natriuretic peptide (BNP) and amino terminal proBNP (NT-proBNP) Thomas Mueller1, Alfons Gegenhuber2, Werner Poelz3 and Meinhard Haltmayer1,* 1 Department of Laboratory Medicine, Konventhospital Barmherzige Brueder, Linz, Austria 2 Department of Internal Medicine, Konventhospital Barmherzige Brueder, Linz, Austria 3 Department of Applied System Sciences and

Stability of Brain Natriuretic Peptide (BNP) in Human Whole Blood and Plasma Clin Chem Lab Med 2000; 38(6):519–523 © 2000 by Walter de Gruyter · Berlin · New York Agnès Gobinet-Georges1, Nathalie Valli1, Hélène Filliatre1, Marie-France Dubernet1, Olivier Dedeystere2 and Laurence Bordenave1 1 Service de Médecine Nucléaire, Hôpital du Haut-Lévêque CHU de Bordeaux, Pessac, France 2 CIS bio international, Gif-sur-Yvette, France Brain natriuretic peptide is proposed as a biochemical marker which could provide a useful screening test to select patients for further

Introduction B-type natriuretic peptides are considered the first-line biomarkers for adult patients with acute or chronic heart failure according to the most recent international guidelines [1]. The interest in brain natriuretic peptide (BNP) has also progressively increased for pediatric patients undergoing cardiac surgery [2–17]. Several studies have indicated that in children undergoing surgery for congenital heart disease (CHD), BNP levels (especially those measured pre-operatively) are independently associated with markers of outcome including the duration

, Clerico A. Old and new biomarkers of heart failure. Eur J Heart Fail 2009;11:331–5. 17. Emdin M, Passino C, Prontera C, Fontana M, Poletti R, Gabutti A, et al. Comparison of brain natriuretic peptide (BNP) and amino-terminal ProBNP for early diagnosis of heart failure. Clin Chem 2007;53:1289–97. 18. Clerico A, Giannoni A, Vittorini S, Passino C. Thirty years of the heart as an endocrine organ: physiological role and clinical utility of cardiac natriuretic hormones. Am J Physiol Heart Circ Physiol 2011;301:H12–20. 19. Dickstein K, Cohen-Solal A, Filippatos G, McMurray JJ

than slow and right. The evolution of point-of-care testing (POCT) systems has provided the opportunity to reach the standard of “fast and right” for the evaluation of cardiac biomarkers, such as troponin (cTn), brain natriuretic peptide (BNP) and neutrophil gelatinase-associated lipocalin (NGAL). A US study has shown that adopting POCT to evaluate cTn and CK-MB provided a sensitivity of 96.9% and a negative predictive value (NPV) of 99.6% for the diagnosis of MI within 90 min, thereby dismissing acute MI and reducing the median turnaround time from the blood

-Paul Cristol1,* 1 Laboratoire de Biochimie, CHU Lapeyronie, Université Montpellier 1, Montpellier, France 2 Service de réanimation métabolique, CHU Lapeyronie, Université Montpellier 1, Montpellier, France 3 FRE CNRS 3009, Montpellier, France 4 Laboratoire de Biochimie, CH, Béziers, France 5 Service de Néphrologie-Hémodialyse et Soins Intensifs, CHU Lapeyronie, Université Montpellier 1, Montpellier, France 6 Laboratoires Bio-Rad, Marnes-La-Coquette, France Abstract Background: Brain natriuretic peptide (BNP), N-ter- minal proBNP (NT-proBNP) and to a lesser extent pro

Physiology , Pisa , Italy 3 Scuola Superiore Sant ’ Anna , Pisa , Italy Abstract Background : The aim of this study is to test the hypothesis whether the combined use of a cardio-specifi c biomarker, the brain natriuretic peptide (BNP) and a marker of early renal damage, the assay of urinary neutrophil gelatinase-associated lipocalin (uNGAL), may improve risk stratifi cation in pediat- ric cardiac surgery. Methods: We prospectively enrolled 135 children [median age 7 (interquartile range 1 – 49) months] undergoing to car- diac surgery for congenital heart