The Measurement of Brain Natriuretic Peptide in Heart Failure

Abstract

Although advances have been made in the management of heart failure (HF), hospital readmission rates remain high. Finding a simple blood test to identify HF would dramatically impact the diagnosis and treatment of this syndrome. A better understanding of the pathophysiology of HF may result in improved treatment measures. Current guidelines do not target any clinical or hemodynamic criteria to achieve before discharge. Most efforts to reduce readmissions have been focused on drugs, technology, and the use of specialty HF clinics. Brain natriuretic peptide (BNP) levels have the potential of providing diagnostic, prognostic, and therapeutic information. In addition, BNP levels appear to be associated with future cardiac events such as hospital readmission. The purpose of this article is to review the precision and accuracy of BNP measurement in those with HF, and to describe how measurement of BNP can be used in clinical practice. Ultimately, BNP testing may improve the accuracy of the diagnosis of HF and guide best treatment practices.

Comparison of the Diagnostic Characteristics of Two B-Type Natriuretic Peptide Point-of-Care Devices

“…Several prior studies have evaluated the precision and accuracy of various measurements of BNP (9). Del Ry et al compared the precision between an immunoradiometric and an immunofluorometric (Triage) method (10).…”

Cardiac risk scores in high‐risk Hispanics and the predictive value of BNP

“…2002). The Triage BNP test has been shown to have high sensitivity and specificity of ≥82% in several studies (Howie et al. 2003, Maisel 2003).…”

Trends in Laboratory Test Volumes for Medicare Part B Reimbursements, 2000–2010

“…Brain Natriuretic Peptide.-Published literature supporting the use of BNP began to appear in 2003, [58][59][60] and that was the first year this test was reimbursed under Medicare Part B. There was a rapid increase in the (Figure 3).…”

“…When BNP was first introduced, associated data indicated clinical utility comparable to other methods for evaluating patients with heart failure. [58][59][60] However, subsequent reports noted limited evidence supporting the use of the BNP test for diagnosis of cardiac dysfunction or heart failure in the elderly of 75 years and older. 7 Current findings justify neither use nor confident rejection of BNP levels to inform the prognosis or diagnosis of heart failure, 61 with recommendations for clinicians to cautiously interpret concentrations of BNP to predict the outcome of persons with coronary artery disease.…”

“…66 Levels of BNP may help assess heart failure in a patient with dyspnea as well as providing information for making both triage and management decisions. 58,60 Brain natriuretic peptide is a consistent, independent predictor of mortality in patient populations with risk of coronary artery disease, diagnosed coronary artery disease, and diagnosed heart failure. 67 However, there is insufficient evidence to determine the value of BNP in screening for preclinical ventricular remodeling or dysfunction in the general population.…”