BNP helps the body compensate for heart failure (HF); measurements of BNP help doctors diagnose and treat this serious condition. Heart failure results when the heart becomes too weak or too stiff to pump normally. The most common causes are coronary artery disease and hypertension.
Full Answer
What is BNP and how is it used to diagnose heart failure?
BNP helps the body compensate for congestive heart failure (CHF); measurements of BNP help doctors diagnose and treat this serious condition. Congestive heart failure results when the heart muscle is weakened. The most common causes are coronary artery disease and hypertension. In other cases, heart valve disease is to blame.
Can a BNP test replace an echocardiogram for congestive heart failure?
So, when doctors suspect CHF, they usually order an echocardiogram to confirm the diagnosis and assess its severity. While the BNP test will never replace echocardiography, it has already helped doctors reserve the test for patients who really need it. In congestive heart failure, the heart chambers are dilated, or enlarged.
What is the historical BNP of cardiac filling pressure?
Historical BNP values. If historical BNP values are available, studies of biological variation have shown that an increase to 123% from 66% from baseline is representative of a clinically meaningful increase in cardiac filling pressures. Less significant changes could merely represent biological variation and should be cautiously interpreted. 7
How do you lower BNP levels in heart failure?
Nesiritide use, a synthetic form of BNP used to treat heart failure How to Bring BNP Levels Back to Normal When levels are above the normal range, doctors usually lower them with medication. Your doctor may prescribe ACE inhibitors, beta blockers, or diuretics to help.
How does BNP diagnosis heart failure?
The best way to diagnose and treat these patients is unclear. BNP increases when cardiac myocytes are strained; therefore, BNP is an effective method for detecting heart failure with or without systolic dysfunction.
Can BNP be used to monitor heart failure?
The 2010 NICE guideline on the management of chronic heart failure recommends that BNP (or its derivative N-terminal pro-Btype natriuretic peptide, NTproBNP) is measured in people with suspected heart failure who have no history of heart attack.
What BNP level indicates heart failure?
BNP levels go up when the heart cannot pump the way it should. A result greater than 100 pg/mL is abnormal. The higher the number, the more likely heart failure is present and the more severe it is.
What is a BNP used to diagnose?
A BNP test or an NT-proBNP test is most often used to diagnose or rule out heart failure. If you've already been diagnosed with heart failure, the test may be used to: Find out the severity of the condition. Plan treatment.
How accurate is BNP in diagnosing heart failure?
In general, the diagnostic accuracy is approximately 90% at the cut-off value of BNP (100 pg/mL) or NT-proBNP (162 pmol/L).
What does a BNP of 3000 mean?
Conclusion. These data suggest that the extreme elevation of NT pro-BNP levels (≥3000 pg/ml) is mainly determined by impaired renal function in elderly patients above 80 years. Extreme NT pro-BNP levels may be useful for assessing the severity of impaired renal function.
What does a BNP of 10000 mean?
A level of NT pro-BNP greater than 10,000 pg/mL has confirmed the diagnosis of heart failure in more than 99% of newly diagnosed cases and in 94% of heart failure cases. Additionally, age-stratified cutoff points have been included to increase diagnostic accuracy of heart failure (Table 1) (15).
What is a high BNP number?
BNP levels go up when the heart cannot pump the way it should. A result greater than 100 pg/mL is abnormal. The higher the number, the more likely heart failure is present and the more severe it is. Sometimes other conditions can cause high BNP levels.
How is BNP measured?
A BNP test is done by drawing blood from a vein in your arm using a hypodermic needle. This process is known as venipuncture. A machine then measures levels of BNP or another heart hormone, called N-terminal-pro BNP (NT-pro-BNP), in the blood sample.
When do you use BNP?
A simple, accurate, inexpensive tests can measure BNP in blood samples. BNP is very helpful in diagnosing HF. A normal BNP level makes HF less likely, freeing doctors to hunt for other conditions that may be causing shortness of breath or fluid retention.
What is the significance of BNP in cardiac patients?
BNP helps to regulate the body's salt and fluid content, and reduces blood pressure. In patients who have heart failure, BNP levels tend to become greatly elevated during episodes of worsening shortness of breath.
What Does a High BNP Mean? - eMedicineHealth
Causes of Elevated BNP and Information About BNP Test
What is BNP in cardiac?
BNP: An important new cardiac test. B-type natriuretic peptide (BNP) belongs to a family of protein hormones called natriuretic peptides. Each member of the group is produced by a different part of the circulatory system. ANP is produced by the muscle cells in the upper pumping chambers of the heart (the atria );
How does BNP therapy help the heart?
Effective therapy reduces the backup of blood in the heart. The heart chambers get smaller, and as the muscle cells recover from being stretched, they produce less BNP. When doctors see falling BNP levels, they breathe a sigh of relief; more important, their patients breathe better. Image: jarun011/Getty Images.
What is BNP in medical terms?
BNP helps the body compensate for congestive heart failure (CHF); measurements of BNP help doctors diagnose and treat this serious condition. Congestive heart failure results when the heart muscle is weakened. The most common causes are coronary artery disease and hypertension.
How accurate is BNP?
BNP is very helpful in diagnosing CHF. A normal BNP level is about 98% accurate in ruling out the diagnosis, freeing doctors to hunt for other conditions that may be causing shortness of breath or fluid retention. In general, levels below 100 picograms per milliliter (pg/ml) rule out CHF (the cutoff is 200 pg/ml for patients with kidney failure). High BNP levels are less conclusive, but in patients with suspected CHF, levels of about 900 pg/ml in 50- to 75-year-olds or above 1,200 pg/ml in older patients support the diagnosis up to 90% of the time; most of the patients who do not have true CHF have elevated BNPs due to severe lung or kidney disease. The table below lists some of the conditions that can raise or lower BNP levels.
Why is BNP important?
Also, BNP is very helpful in guiding the treatment of CHF. Effective therapy reduces the backup of blood in the heart. The heart chambers get smaller, and as the muscle cells recover from being stretched, they produce less BNP. When doctors see falling BNP levels, they breathe a sigh of relief; more important, their patients breathe better.
What are the effects of natriuretic peptides?
The net effect of natriuretic peptides is to promote urine excretion, relax blood vessels, lower blood pressure, and reduce the heart's workload. They are part of the body's natural defense mechanisms designed to protect the heart from stress. And they surge into action when they are needed most, when the heart itself is under siege.
Where is ANP produced?
ANP is produced by the muscle cells in the upper pumping chambers of the heart (the atria ); BNP is produced in the larger and more powerful lower chambers (the ventricles ); CNP is produced mainly in blood vessels; and DNP is found in the blood plasma but probably originates in the heart itself. These natriuretic peptides have an important role in ...
What is BNP in medical terms?
Brain natriuretic peptide (BNP) levels are simple and objective measures of cardiac function. These measurements can be used to diagnose heart failure, including diastolic dysfunction, and using them has been shown to save money in the emergency department setting. The high negative predictive value ….
Why does BNP increase?
Increases in BNP levels may be caused by intrinsic cardiac dysfunction or may be secondary to other causes such as pulmonary or renal diseases (e.g., chronic hypoxia). BNP tests are correlated with other measures of cardiac status such as New York Heart Association classification.
Does BNP testing help with heart failure?
Treatment with angiotensin-converting enzyme inhibitors, angiotensin-II receptor blockers, spironolactone, and diuretics reduces BNP levels, suggesting that BNP testing may have a role in monitoring patients with heart failure.
Can BNP be used to diagnose heart failure?
These measurements can be used to diagnose heart failure, including diastolic dysfunction, and using them has been shown to save money in the emergency department setting. The high negative predictive value of BNP tests is particularly helpful for ruling out heart failure.
What does BNP mean in heart failure?
Your results will indicate if your BNP levels are high enough to suspect a diagnosis of heart failure. If you already have a diagnosis of heart failure, the results can help your doctor find out whether heart failure treatments are helping treat it. Generally, BNP levels below 100 picograms per milliliter (pg/mL) are considered normal.
Why does BNP help with congestive heart failure?
When you have congestive heart failure, your heart can’t pump blood properly throughout your body because the walls of your heart chambers, known as the ventricles, become too weak.
What is a BNP test?
A B-type natriuretic peptide (BNP) blood test measures the levels of the BNP hormone in your blood.
How does BNP affect blood pressure?
When this happens, your heart cells produce extra BNP to help maintain the balance of fluids in your body cells and regulate your blood pressure.
How long does it take to get a BNP test?
A machine then measures levels of BNP or another heart hormone, called N-terminal-pro BNP (NT-pro-BNP), in the blood sample. The results from the test are usually ready in 15 to 20 minutes.
What causes a BNP test to be elevated?
nausea or having no appetite. A BNP test can also help rule out heart failure. Other conditions can cause elevated BNP levels, including lung or kidney conditions and obesity.
Why do doctors use BNP?
Your doctor may use BNP tests alongside other diagnostic tests to confirm if you have heart failure, or if other conditions are responsible for the increase in your BNP levels.
What is BNP in a lab?
BNP is a neurohormone released from the ventricular cells in response to increased cardiac filling pressures . Plasma measurements of BNP have been shown to reflect volume status, to predict risk at admission and discharge, and to serve as a treatment guide in a variety of clinical settings. 4 This simple laboratory test increasingly has been used to diagnose and manage ADHF; its utility and limitations deserve critical review.
What is the cutoff point for BNP?
For the entire cohort, the use of BNP (with a cutoff point of 100 pg/mL) would have improved the ED physician’s assessment from 74% diagnostic accuracy to 81%, which is statistically significant. Most important, in those patients initially given an intermediate likelihood of CHF, BNP results correctly classified 75% of these patients and rarely missed ADHF cases (<10%).
What is the blood pressure of a 76 year old woman?
A 76-year-old woman with a history of chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), and atrial fibrillation presents with shortness of breath. She is tachypneic, her pulse is 105 beats per minute, and her blood pressure is 105/60 mm/Hg. She is obese and has an immeasurable venous pressure with decreased breath sounds in both lung bases, and irregular and distant heart sounds. What is the role of brain (or B-type) natriuretic peptide (BNP) in the diagnosis and management of this patient?
What is the mortality rate of heart failure?
Mortality prediction. Nearly 3.5% of admitted heart failure patients will die during their hospitalization. For perspective, the rate of hospital mortality with acute myocardial infarction is 7%. BNP serves as a powerful and independent predictor of inpatient mortality. The ADHERE (Acute Decompensated Heart Failure National Registry) study showed that when divided into BNP quartiles of <430 pg/mL, 430 pg/mL to 839 pg/mL, 840 pg/mL to 1,729 pg/mL, and >1,730 pg/mL, patients’ risk of inpatient death was accurately predicted as 1.9%, 2.8%, 3.8%, and 6.0%, respectively. 10 Even when adjusted for other risk factors, BNP remained a powerful predictor; the mortality rate more than doubled from the lowest to highest quartile.
What is the goal of ADHF?
Once ADHF is diagnosed, ongoing bedside assessment of volume status is a difficult and inexact science. The physiologic goal is achievement of normal left ventricular end diastolic volume; however, surrogate measures of this status, including weight change, venous pressure, and pulmonary and cardiac auscultatory findings, have significant limitations. After discharge, patients have high and heterogeneous risks of readmission, death, and other adverse events. Identifying patients with the highest risk might allow for intensive strategies to improve outcomes.
How many patients are admitted with acutely decompensated heart failure?
Each year, more than 1 million patients are admitted to hospitals with acutely decompensated heart failure (ADHF). Although many of these patients carry a pre-admission diagnosis of CHF, their common presenting symptoms are not specific for ADHF, which leads to delays in diagnosis and therapy initiation, and increased diagnostic costs and potentially worse outcomes. Clinical risk scores from NHANES and the Framingham heart study have limited sensitivity, missing nearly 20% of patients. 1,2 Moreover, these scores are underused by clinicians who depend heavily on clinical gestalt. 3
Is ADHF a CHF diagnosis?
CHF diagnosis. Since introduction of the rapid BNP assay, several trials have evaluated its clinical utility in determining whether ADHF is the cause of a patient’s dyspnea. The largest of these trials, the Breathing Not Properly Multinational Study, conducted by McCullough et al, enrolled nearly 1,600 patients who presented with the primary complaint of dyspnea. 5 After reviewing conventional clinical information, ED physicians were asked to determine the likelihood that ADHF was the etiology of a patient’s dyspnea. These likelihoods were classified as low (<20%), intermediate (20%-80%), or high (>80%). The admission BNP was recorded but was not available for the ED physician decisions.
How does BNP help in therapy?
The use of BNP or NT-proBNP to assist in therapy decision making requires knowledge of a concentration at which the biomarker identifies a clear increase in risk. Although there is a relatively continuous relationship between NP levels and risk of adverse outcome, values for BNP of 125 pg/mL and for NT-proBNP of 1000 pg/mL have been shown to clearly dichotomize between low and high risk. 11 Whereas a single measurement for BNP or NT-proBNP provides prognostic value, the serial measurement of either provides incremental risk stratification. For example, Masson and colleagues 12 measured BNP and NT-proBNP in the Valsartan Heart Failure Therapy trial and showed that information from temporal trends in either peptide superseded the prognostic value of a single assessment ( Figure 1 ). 12 This dynamic nature of BNP or NT-proBNP thus unlocks their use for sequential monitoring, allowing therapy guidance, identifying a changing risk, and tending to identify those patients undergoing deleterious myocardial remodeling. 13, 14
What biomarkers are used for HF?
Although numerous biomarker candidates now exist, we focus our discussion on BNP and NT-proBNP, which are by far the best-characterized biomarkers for use in guiding HF management. The biology of BNP and NT-proBNP has been widely studied and forms the foundation for the clinical trials that have tested the utility of BNP and NT-proBNP in guiding HF therapy.
Why is biomarker guided management important?
Thus, when correctly applied, biomarker-guided management appears to improve both the thoroughness of care and the choice of agents used. Additionally, given that an elevated BNP or NT-proBNP identifies those at highest risk for adverse outcomes, including ventricular remodeling, HF progression, hospitalization, and death, use of the biomarker as a target also allows closure of the well-recognized gap in management that exists in these highest-risk patients.
Why is HF management inadequate?
The reasons for inadequate HF management are numerous and extend beyond this discussion but in part include the way HF therapy is delivered. The standard therapeutic approach to chronic HF, as articulated in clinical practice guidelines, 5 is predicated on the strategies used in well-designed RCTs to uptitrate therapies to target doses or, short of that, to maximally tolerated doses. Compounding the issue is the fact the pharmacopeia for patients with chronic HF has become very complex. Even in patients with left ventricular systolic dysfunction, for whom these therapies have proven benefit, the sequence of addition and uptitration is largely left to clinician judgment. Furthermore, to achieve goals of therapy as outlined in guidelines, frequent office visits for evaluation and management are often necessary. Considerable skill is required to recognize opportunities to titrate therapies, and acumen is needed to implement such changes.
How long after a therapy change can you get NT-proBNP?
Although biological data are limited with regard to the time at which steady state is reached for the salutary effects of chronic HF therapies on BNP or NT-proBNP release, data from studies of serial NP monitoring suggest that concentrations of NT-proBNP 2 to 4 weeks after a therapy change are most prognostic, identifying this time window as the appropriate time for NP resampling and consideration of retitration of medication. 16
What are the RCTs for HF?
Landmark randomized, controlled trials (RCTs) have identified a wide range of pharmacological- and device-based therapies that improve HF symptoms, reduce the risk for HF progression, prevent HF hospitalization, and lower mortality rates related to the diagnosis. Unfortunately, however, contemporary studies consistently demonstrate inadequacies not only in the uptake and achieved dosing of proven pharmacological therapies (such as angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, β-adrenergic blockers, and mineralocorticoid receptor antagonists) but also in the use of cardiac resynchronization therapy and implantable cardioverter-defibrillators. These gaps in care leave the real-world HF patient at high risk for adverse outcomes.
How many cases of HF are there in the US?
HF is reaching epidemic proportions, with millions of affected patients in the United States alone and more than half a million new cases yearly. 1 With a lifetime risk for HF of >20% beyond middle age, the crisis is only expected to worsen as the population grows and ages. 2 Furthermore, although prognosis in HF has improved over the past 50 years, it remains among the most lethal diagnoses in modern medicine, with a mortality rate that equals or exceeds many malignancies. Moreover, HF patients are frequently hospitalized, causing a financial burden on the healthcare system that will not abate soon. 3 For all these reasons, a substantial focus now exists on improving the care of patients affected by HF. 4
What is the mean BNP level?
Among patients with an LVEF >50% (n = 74), the mean BNP level was 256 pg/ml (112-598 pg/ml), compared to 534 pg/ml (275-1130 pg/ml) in those with an LVEF ≤20%.
Is HFPEF a medical problem?
Heart failure with preserved ejection fraction (HFPEF) is a large medical and epidemiological problem [1–5]. Mortality in HFPEF patients is roughly similar to that in HF patients with a reduced left ventricular ejection fraction (LVEF) [3,4]. Although survival has improved over the last 10 to 20 years in HF patients with reduced LVEF, this was not observed in HFPEF patients. Although a recent meta-analysis showed that medical treatment may improve exercise capacity [6], none of the treatments was convincingly shown to improve outcome, and therefore none of these drugs has received a
Is BNP lower in HFPEF?
BNP levels in patients with HFPEF are lower than in those with reduced LVEF, but are still predictive of prognosis. These findings may have important implications in the management of HFPEF patients in everyday clinical practice and in the design of trials in HFPEF.
Does brain natriuretic peptide-guided treatment improve morbidity and mortality in extensively treated?
Brain natriuretic peptide-guided treatment does not improve morbidity and mortality in extensively treated patients with chronic heart failure: responders to treatment have a significantly better outcome.
Is natriuretic peptides a good measure of heart failure?
Although natriuretic peptides (NPs) are powerful markers of cardiovascular risk in heart failure patients, there is little evidence that heart failure therapy should vary according to measured NP levels. Titration of neurohormonal antagonists to effective or maximally tolerated doses is recommended for all patients regardless of background risk, including the vast majority without markedly elevated NP levels. Although it is intuitively appealing to view NP levels as an objective measure of the adequacy of heart failure therapy, “optimal” NP targets are frequently unachievable in practice. When levels are persistently high, the “guidance” provided by serial NP measurements amounts to little more than a simple prompt to routinely intensify treatment, even when clinical judgment might direct caution. The low rate of serious adverse events with this approach in carefully selected clinical trial populations of younger patients with reduced ejection fraction does not guarantee safety during broader application in real-world practice, in which heart failure patients are often older with complex medical comorbidities and preserved ejection fraction. Drs Januzzi and Troughton correctly highlight the substantial opportunity for improvement in the quality of heart failure care through more consistent application and adjustment of guideline-recommended therapies; however, performance gaps are perhaps better addressed by educating clinicians to make evidence-based decisions rather than by encouraging them to substitute judgment with laboratory testing that has little bearing on the selection of appropriate treatment.
What is a Class 1 BNP?
Both are Class 1 (highest strength) recommendations based on evidence judged to be of highest quality (Level A). The task force also state that for all hospitalized HF patients predischarge BNP or NT-proBNP value can be useful to establish postdischarge prognosis. This is a Class IIa (moderate strength) recommendation based on evidence judged to be of moderate quality (Level B-NR).
Where does BNP come from?
Brain or B-type natriuretic peptide (BNP) was first isolated from pig brain in 1988 [3]. Three years later it was demonstrated that human BNP is derived principally from heart muscle cells (myocytes) that comprise the walls of the ventricles of the heart.
What is HF in heart failure?
HF due to impaired ventricle filling is associated with preserved EF (i.e. >55 %) and is referred to as HFpEF or diastolic heart failure. Heart imaging allows detection of left ventricular dysfunction (either systolic or diastolic) before symptoms of heart failure occur.
What is HF in cardiac?
HF is a complex syndrome with many possible causes that result from impaired ability of the left ventricle to either fill with blood during the diastolic phase of the cardiac cycle or eject blood during the systolic phase of the cardiac cycle. The affected heart is consequently increasingly less able to pump a sufficient blood volume to meet the oxygen demands of the body. Heart imaging (echocardiography) allows measurement of the left ventricular ejection fraction (LVEF).
What is the term for a patient with chronic HF?
Typically, patients have periods of chronic stable HF, punctuated by acute exacerbation, called acute (decompensated) heart failure (AHF) when symptoms and hemodynamic condition worsen significantly, requiring emergency admission to hospital.
What is HF in physical therapy?
HF is a progressively debilitating condition. The New York Heart Association (NYHA) Functional Classification [9] is widely used to classify the severity of HF to one of four classes based on the extent to which physical activity is limited.
How common is heart failure in the US?
Heart failure (HF) is a common chronic condition, which predominantly affects the elderly. Prevalence is 0.8-2 % in the general population but 10-20 % among those aged >70 years [7]. With an ever-aging population, prevalence is increasing. In the US, HF currently affects 5.8 million; one estimate predicts that this will rise to more than 8 million by 2030 [8].
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- BNP is very helpful in determining the outlook for patients with CHF. In general, the higher the level, the worse it is. Finally, BNP is very helpful in guiding the treatment of CHF. Effective therapy reduces the backup of blood in the heart. The heart chambers get smaller, and as the muscle cells recover from being stretched, they produce less BNP...
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