Diagnostic accuracy and prognostic relevance of the measurement of the cardiac natriuretic peptides: a review

Summary Background Pathophysiological and clinical relevance of cardiac natriuretic hormone (CNH) assay has been investigated by a great deal of experimental and clinical studies. Authors sought to evaluate the diagnostic accuracy and prognostic relevance of the measurement of CNHs according to the evidence-laboratory medicine principles. Methods In June 2003, a computerized literature search on National Library of Medicine using keyword "ANP" and "BNP" found more than 12.300 and 1200 articles, respectively. A more refined search with keywords "ANP or BNP assay" extracted about 7000 and 800 articles, respectively. Only studies specifically designed to evaluate the diagnostic accuracy and prognostic relevance of CNH measurement were selected from this huge mass of articles to be discussed in this review. Content Several studies suggested that CNH assay may be clinically useful: for the screening and classification of patients with heart failure, as a prognostic marker in cardiovascular disease, in the follow-up of patients with heart failure, and also because it may reduce the need for further cardiac investigation. However, it is difficult to compare, even the best well-designed studies, because not only they evaluated different populations, but they also used different gold standards. Conclusions CNH assay and conventional diagnostic work-up provide complementary information for the evaluation of presence and severity of cardiac dysfunction and clinical disease. Several aspects of CNH assay are still to be delucidated, and further work is still needed to carefully assess its diagnostic accuracy and prognostic value in cardiac disease

A systematic review evaluating the impact of task shifting on access to antiretroviral therapy in sub-Saharan Africa

Background: Task shifting, defined for this review as the shifting of ART initiation and management from physicians to nurses, has been proposed as a possible method to increase access to HIV treatment in Sub-Saharan Africa.Objective: To critically evaluate the literature on task shifting, determining if there is evidence to support this view.Methods: A systematic search of the literature was undertaken, with both peer reviewed publications and conference abstracts presenting original data eligible for inclusion. Studies were evaluated according to methodology and discussion of confounding factors.Results: We identified 25 articles which evaluated the effect of task shifting on access to ART. The evidence was mixed. Although there is a significant body of field reports indicating that task shifting increases access, these studies were of low methodological quality. The only randomized controlled trial included in this review did not find that task shifting increased in access.Conclusion: Task shifting appears to be most effective at increasing access when combined with other interventions and financial support. There is a need for more research into the effects of task shifting policies, especially randomized controlled trials and high quality cohort studies.Key words: task shifting, antiretroviral therapy, nurse provided treatment, substitution of physicians, access to HIV treatmen

Natriuretic Peptide assays revisited do we need pro-B-type natriuretic Peptide?

Discovery of the endocrine function of the heart, which exerts a fundamental role in regulating cardiovascular homeostasis through atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP), has opened up a new field of research that has resulted in multiple clinical applications

Critical Comparison of Documents From Scientific Societies on Cardiac Amyloidosis: JACC State-of-the-Art Review.

Over the last year, 5 national or international scientific societies have issued documents regarding cardiac amyloidosis (CA) to highlight the emerging clinical science, raise awareness, and facilitate diagnosis and management of CA. These documents provide useful guidance for clinicians managing patients with CA, and all include: 1) an algorithm to establish a diagnosis; 2) an emphasis on noninvasive diagnosis with the combined use of bone scintigraphy and the exclusion of a monoclonal protein; and 3) indications for novel disease-modifying therapies for symptomatic CA, either with or without peripheral neuropathy. Nonetheless, the documents diverge on specific details of diagnosis, risk stratification, and treatment. Highlighting the similarities and differences of the documents by the 5 scientific societies with respect to diagnosis, risk stratification, and treatment offers useful insight into the knowledge gaps and unmet needs in the management of CA. An analysis of these documents, therefore, highlights “gray zones” requiring further investigation.post-print2330 K

Cardiac biomarker testing in the clinical laboratory: Where do we stand? General overview of the methodology with special emphasis on natriuretic peptides

Diagnosis of heart failure (HF) is not based on a single test, but on a combination of history, physical examination and appropriate investigations. For these reasons, the accuracy of diagnosis by clinical means alone is often inadequate, especially in the early, asymptomatic stages of the HF. Thus, there is an increasing interest in the development of new cardiovascular biomarkers and, consequently, a great number of laboratory tests have recently been proposed for their assay. The aim of this article is to provide a general overview on the biomarkers, recommended by international guidelines, for the diagnosis, risk stratification, and follow-up of patients with HF. Cardiac natriuretic peptides and in particular the B-type related peptides, which are considered to be the first line biomarker for HF by international guidelines, will be discussed with special emphasis