B-type natriuretic peptide
NPPBproteinBNP reflects post-infarction cardiac insufficiency and hemodynamic strain, operating off the atherothrombotic axis.
Pathway placement
Cascade stepOff-pathway / systemic markers
Confidencehigh
RationaleAnchor molecule s0; cardiac remodeling and hemodynamic stress marker, not atherothrombotic cascade.
Druggability
DruggableYes
Known drugs / candidates0
Small-molecule tractableNo
Antibody tractableYes
EnsemblENSG00000120937
Type I vs non-Type I discrimination
ScoresShared / rises in both
R — rupture / Type-I67
C — non-Type-I53
A — assay feasibility96
E — evidence strength67
T1DI (composite)33
Specificity differential (R−C)+1.4
Direct evidence: higher in non-Type I (D=-1)
NT-proBNP: 10,327 +/- 12,923 ng/L in T2-MI vs 4675 +/- 11,740 ng/L in T1-MI (P=0.006); a second cohort found no T1/T2 discrimination
Non-Type-I axis panel
Does this marker also move in each non-Type-I setting? mag 0–3; higher means less Type-I-specific. n/a = no evidence retrieved, which is not the same as no change.
2sepsis / systemic inflammationmag 2
2anemia / acute blood lossn/a
2hypovolemia / dehydrationmag 2
2tachyarrhythmiamag 1
2hypoxemia / respiratory failuremag 1
2hypertensive emergencymag 2
2high-demand / peri-operative stressmag 1
3sudden cardiac deathmag 1
4aPCI-related periproceduralmag 2
4bstent thrombosisn/a
4cin-stent restenosismag 2
5CABG-relatedmag 2
Coverage: 10/12 axes with evidence
Tier: deep-scored (abstract-extracted) · 18 supporting references. See the discrimination table for all markers.
Assay & specimen
Validated clinical assay
Specimen
Plasma (BNP: EDTA required); serum/plasma (NT-proBNP)
Collection tube
K2-EDTA, chilled plastic (lavender-top) · Serum separator (gold/red-top, SST)
Method / principle
Chemiluminescent sandwich immunoassay
Reagent / substrate
Anti-BNP or anti-NT-proBNP antibody pair
Platform
Automated analyzer; POC (Alere Triage)
Turnaround · availability
STAT (~15–30 min) · FDA-cleared
Human genetic evidence
0.026
Open Targets association (STEMI)
Literature evidence(60)
- Associations Between Psychological Constructs and Cardiac Biomarkers After Acute Coronary Syndrome.Psychosomatic medicine · 2017 · PMID 27749683 · doi
- Endothelial function after ST-elevation myocardial infarction in patients with high levels of high-sensitivity CRP and Lp-PLA: A substudy of the RESPONSE randomized trial.Cardiovascular revascularization medicine : including molecular interventions · 2017 · PMID 28110894 · doi
- Erectile dysfunction as a predictor of two-year prognosis in acute myocardial infarction.Cardiology journal · 2017 · PMID 28150293 · doi
- Plasma Levels of Soluble CD146 Reflect the Severity of Pulmonary Congestion Better Than Brain Natriuretic Peptide in Acute Coronary Syndrome.Annals of laboratory medicine · 2016 · PMID 27139601 · doi
- Cathepsin A inhibition attenuates myocardial infarction-induced heart failure on the functional and proteomic levels.Journal of translational medicine · 2016 · PMID 27246731 · doi
- Biomarkers in lone atrial fibrillation - an additional 'fine tuning' of risk?Current pharmaceutical design · 2015 · PMID 25175091 · doi
- Relation of baseline plasma MMP-1 levels to long-term all-cause mortality in patients with known or suspected coronary artery disease referred for coronary angiography.Atherosclerosis · 2015 · PMID 25635325 · doi
- Novel methodologies for biomarker discovery in atherosclerosis.European heart journal · 2015 · PMID 26049157 · doi
- Changes in fractalkine in patients with ST-elevation myocardial infarction.Coronary artery disease · 2015 · PMID 26049921 · doi
- Cardiovascular biomarkers and sex: the case for women.Nature reviews. Cardiology · 2015 · PMID 26149486 · doi
- Biomarker changes after strenuous exercise can mimic pulmonary embolism and cardiac injury--a metaanalysis of 45 studies.Clinical chemistry · 2015 · PMID 26240298 · doi
- Biomarkers in stable coronary heart disease, their modulation and cardiovascular risk: The LIPID biomarker study.International journal of cardiology · 2015 · PMID 26318511 · doi
- Regional right ventricular dysfunction in acute pulmonary embolism: relationship with clot burden and biomarker profile.The international journal of cardiovascular imaging · 2015 · PMID 26428674 · doi
- Long-term prognostic utility of pentraxin 3 and D-dimer as compared to high-sensitivity C-reactive protein and B-type natriuretic peptide in suspected acute coronary syndrome.European journal of preventive cardiology · 2015 · PMID 26635361 · doi
- Overview of cardiac markers in heart disease.Clinics in laboratory medicine · 2014 · PMID 24507783 · doi
- Clinical correlation between N-terminal pro-B-type natriuretic peptide and angiographic coronary atherosclerosis.Clinics (Sao Paulo, Brazil) · 2014 · PMID 24964305 · doi
- [Essential cardiac biomarkers in myocardial infarction and heart failure].Herz · 2014 · PMID 25091086 · doi
- Analysis of biomarkers for risk of acute kidney injury after primary angioplasty for acute ST-segment elevation myocardial infarction: results of the HORIZONS-AMI trial.Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions · 2014 · PMID 25130788 · doi
- Novel risk factors related to stable angina.Current pharmaceutical design · 2013 · PMID 23016718
- MicroRNA-150: a novel marker of left ventricular remodeling after acute myocardial infarction.Circulation. Cardiovascular genetics · 2013 · PMID 23547171 · doi
- Serum adiponectin and cardiometabolic risk in patients with acute coronary syndromes.Arquivos brasileiros de cardiologia · 2013 · PMID 24029961 · doi
- Potential clinical application of novel cardiac biomarkers for acute myocardial infarction.Acta medica Indonesiana · 2013 · PMID 24045397
- Peripheral endothelial function and cardiovascular events in high-risk patients.Journal of the American Heart Association · 2013 · PMID 24275629 · doi
- Betaine and secondary events in an acute coronary syndrome cohort.PloS one · 2012 · PMID 22649561 · doi
- Prognostic utility of neopterin and risk of heart failure hospitalization after an acute coronary syndrome.European heart journal · 2011 · PMID 21345849 · doi
- Novel biomarkers in diagnosing cardiac ischemia in the emergency department: a systematic review.Resuscitation · 2011 · PMID 22200578 · doi
- Biomarkers in acute myocardial infarction.BMC medicine · 2010 · PMID 20529285 · doi
- Utility of placental growth factor for prediction of 30-day adverse event in emergency department population with non-ST elevation acute coronary syndrome.Clinical laboratory · 2010 · PMID 20575469
- Perspective on the clinical application of troponin in heart failure and states of cardiac injury.Heart failure reviews · 2009 · PMID 19347578 · doi
- [Redefinition of myocardial infarction--relevance of biomarkers].Herz · 2008 · PMID 18344030 · doi
- Thrombus precursor protein and clinical outcomes in patients with acute coronary syndromes.Journal of the American College of Cardiology · 2008 · PMID 18565400 · doi
- Potential mechanisms of stroke benefit favoring losartan in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study.Current medical research and opinion · 2007 · PMID 17288698 · doi
- Biomarkers of cardiovascular damage and dysfunction--an overview.Heart, lung & circulation · 2007 · PMID 17618829 · doi
- Endothelial activation, dysfunction, and damage in congestive heart failure and the relation to brain natriuretic peptide and outcomes.The American journal of cardiology · 2006 · PMID 16490435 · doi
- [Multi-biomarker approach to acute coronary syndrome].Nihon rinsho. Japanese journal of clinical medicine · 2006 · PMID 16613186
- Difference in elevation of N-terminal pro-BNP and conventional cardiac markers between patients with ST elevation vs non-ST elevation acute coronary syndrome.Circulation journal : official journal of the Japanese Circulation Society · 2006 · PMID 17062956 · doi
- Incremental prognostic value of C-reactive protein and N-terminal proB-type natriuretic peptide in acute coronary syndrome.Circulation journal : official journal of the Japanese Circulation Society · 2006 · PMID 17062957 · doi
- Evaluation and management of the acutely dyspneic patient: the role of biomarkers.The American journal of emergency medicine · 2005 · PMID 15915417 · doi
- [New perspectives in the diagnostic approach to acute coronary syndrome].Recenti progressi in medicina · 2005 · PMID 15932030
- Individualizing therapy in acute coronary syndromes: using a multiple biomarker approach for diagnosis, risk stratification, and guidance of therapy.Current cardiology reports · 2004 · PMID 15182604 · doi
Showing 40 of 60 linked references.
Clinical trials(1)
- Biomarkers, Hemodynamic and Echocardiographic Predictors of Ischemic Strokes and Their Influence on the Course and PrognosisNCT03377465 · NA · COMPLETED · ADMA (asymmetric dimethylarginine) , NTproBNP (N-terminal pro b-type natriuretic peptide), IL-6 (Interleukin 6), Adiponectina, Leptine, Syndecan, Resistin