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1
Laboratory of Cardiovascular Endocrinology, Consiglio Nazionale delle Ricerche Institute of Clinical Physiology, University of Pisa, 56100 Pisa, Italy.
a Address correspondence to this author at: Laboratory of Cardiovascular Endocrinology, Cell Biology, and Molecular Genetics, Consiglio Nazionale delle Ricerche, Institute of Clinical Physiology, via Savi 8, 56100 Pisa, Italy. Fax 39-050-553461; e-mail clerico{at}nsifc.ifc.pi.cnr.it
Background: Cardiac natriuretic hormones (CNHs) are a family of related peptides, including atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), and other peptides derived from the N-terminal portion of the proANP and proBNP peptide chains. Assays for cardiac natriuretic peptides have been proposed to help assess clinical conditions associated with expanded fluid volume. In particular, the assays can be useful for distinguishing healthy subjects from patients in different stages of heart failure. Measurements of these hormones have also been considered for prognostic indicators of long-term survival in patients with heart failure and/or after acute myocardial infarction. The different CNHs differ in their production/secretion patterns and have different clearance rates. Furthermore, there are numerous proposed assay configurations for each of these hormones, and it is not clear which assay provides the best pathophysiological and/or clinical information.
Approach: Here we review recent studies concerning the competitive (such as RIA, enzyme immunoassay, or luminescence immunoassay) and noncompetitive immunoassays (such as two-site IRMA, ELISA, or immunoluminometric assay) for the different cardiac natriuretic peptides to compare the analytical characteristics and clinical relevance of assays for the different CNHs and the different assay formats.
Content: Developing sensitive, precise, and accurate immunoassays
for cardiac natriuretic peptides has been difficult because of their
low concentrations (on average, 
3–6 pmol/L) in healthy subjects and
because of their structural, metabolic, and physiological
characteristics. Competitive assays have historically suffered from
lack of sensitivity and specificity for the biologically active
peptides. These usually require tedious extraction procedures prior to
analysis. Recently, immunometric assays have been developed that have
improved sensitivity and specificity; it appears these will be the
methods of choice.
Summary: To date, there is no consensus on the best assay procedure of cardiac natriuretic peptides. To facilitate widespread propagation of determination of these hormones in routine clinical practice, it will be necessary to study the new generation of noncompetitive immunometric methods that are less time-consuming and more sensitive and specific. Although several studies suggest that BNP exhibits better clinical utility than the other CNHs, more studies examining multiple CNHs in the same cohorts of patients will be necessary.
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