ProBNP-derived peptides in cardiac disease

The natriuretic peptides constitute a family of structurally related peptides that regulate fluid homeostasis, vascular tonus and growth. After the discovery of an endocrine component of the heart almost 25 years ago, the cardiac natriuretic peptides have now been fully accepted as useful markers in diverse aspects of cardiology including as diagnostic, therapeutic and prognostic markers of cardiac disease. In humans, atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP) are mainly synthesized and secreted by the failing heart, whereas the related C-type natriuretic peptide (CNP) appears to be a local regulatory peptide secreted by the vascular endothelium. Accordingly, CNP is not a cardiac peptide. With the recent implementation of sensitive and specific immunoassays, increased plasma concentrations of proBNP-derived peptides have now been associated with several cardiac conditions, where the major application today seems related to ventricular dysfunction. Recently, focus has also turned to ischemic heart disease, since myocardial hypoxia increases the local BNP gene expression. This review recapitulates the established clinical applications of measuring proBNP-derived peptides in plasma. Furthermore, the evidence of increased cardiac BNP expression in ischemic heart disease will be emphasized. In turn, plasma measurement of proBNP-derived peptides may still hold new possibilities in screening for coronary artery disease.