Clinical and echocardiographic characteristics of elderly hospitalized patients with high levels of NT-proBNP without clinical diagnosis of heart failure

Natriuretic peptide family as diagnostic/prognostic biomarker and treatment modality in management of adult and geriatric patients with heart failure: remaining issues and challenges

B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP), the key members of natriuretic peptide family have been recommended as the gold standard biomarkers for the diagnosis and prognosis of heart failure (HF) according to the current clinical guidelines. However, recent studies have revealed many previously unrecognized features about the natriuretic peptide family, including more accurate utilization of BNP and NT-proBNP in diagnosing HF. The pathophysiological mechanisms behind natriuretic peptide release, breakdown, and clearance are very complex and the diverse nature of circulating natriuretic peptides and fragments makes analytical detection particularly challenging. In addition, a new class of drug therapy, which works via natriuretic peptide family, has also been considered promising for cardiology application. Under this context, our present mini-review aims at providing a critical analysis on these new progresses on BNP and NT-proBNP with a special emphasis on their use in geriatric cardiology settings. We have focused on several remaining issues and challenges regarding the clinical utilization of BNP and NT-proBNP, which include: (1) Different prevalence and diagnostic/prognostic values of BNP isoforms; (2) methodological issues on detection of BNP; (3) glycosylation of proBNP and its effect on biomarker testing; (4) specificity and comparability of BNP/NT-proBNP resulted from different testing platforms; (5) new development of natriuretic peptides as HF treatment modality; (6) BNP paradox in HF; and (7) special considerations of using BNP/NT-proBNP in elderly HF patients. These practical discussions on BNP/NT-proBNP may be instrumental for the healthcare providers in critically interpreting laboratory results and effective management of the HF patients.

Role of circulating factors in cardiac aging

Worldwide increase in life expectancy is a major contributor to the epidemic of chronic degenerative diseases. Aging, indeed, simultaneously affects multiple organ systems, and it has been hypothesized that systemic alterations in regulators of tissue physiology may regulate this process. Cardiac aging itself is a major risk factor for cardiovascular diseases and, because of the intimate relationship with the brain, may contribute to increase the risk of neurodegenerative disorders. Blood-borne factors may play a major role in this complex and still elusive process. A number of studies, mainly based on the revival of parabiosis, a surgical technique very popular during the 70s of the 20th century to study the effect of a shared circulation in two animals, have indeed shown the potential that humoral factors can control the aging process in different tissues. In this article we review the role of circulating factors in cardiovascular aging. A better understanding of these mechanisms may provide new insights in the aging process and provide novel therapeutic opportunities for chronic age-related disorders.