Prevention of Congestive Heart Failure (CHF) (see Congestive Heart Failure, [[Congestive Heart Failure]])
Recommendations (2017 Focused Update of 2013 ACCF/AHA Guideline for the Management of Heart Failure) (Circulation, 2017) [MEDLINE]
For Patients at Risk of Developing Heart Failure, BNP-Based Screening Followed by Team-Based Care, Including a Cardiovascular Specialist Optimizing Guideline-Directed Management and Therapy, Can Be Useful to Prevent the Development of Left Ventricular Dysfunction (Systolic or Diastolic) or New-Onset Heart Failure (Class of Recommendation II1, Level of Evidence B-R
Data Suggest that BNP Screening and Early Intervention May Prevent Heart Failure
Diagnosis of Congestive Heart Failure (CHF) (see Congestive Heart Failure, [[Congestive Heart Failure]])
Clinical Efficacy-Systolic Dysfunction
xxx
Clinical Efficacy-Diastolic Dysfunction
Severity of Diastolic Dysfunction is Correlated with Both BNP and NT Pro-BNP Levels (J Amer Coll Cardiol, 2003) [MEDLINE] and (NEJM, 2007) [MEDLINE]
Recommendations (2017 Focused Update of 2013 ACCF/AHA Guideline for the Management of Heart Failure) (Circulation, 2017) [MEDLINE]
Acute Heart Failure
In Patients Presenting with Dyspnea, Measurement of BNP (or NT-ProBNP) is Useful to Support or Exclude a Diagnosis of Heart Failure (Class of Recommendation I, Level of Evidence A)
Measurement of Baseline BNP/NT-ProBNP and/or Cardiac Troponin on Admission to the Hospital is Useful to Establish a Prognosis in Acutely Decompensated Heart Failure (Class of Recommendation I, Level of Evidence A)
During a Heart Failure Hospitalization, a Predischarge BNP/NT-ProBNP Can Be Useful to Establish a Post-Discharge Prognosis (Class of Recommendation IIa, Level of Evidence B-NR)
Chronic Heart Failure
Measurement of BNP/NT-ProBNP is Useful for Establishing Prognosis or Disease Severity in Chronic Heart Failure (Class of Recommendation I, Level of Evidence A)
In Patients with Chronic Heart Failure, Measurement of Other Clinically Available Tests, Such as Biomarkers of Myocardial Injury or Fibrosis (Soluble ST2 Receptor, Galectin-3, High-Sensitivity Cardiac Troponin, etc) in Addition to BNP/NT-ProBNP May Be Considered for Additive Risk Stratification (Class of Recommendation II1, Level of Evidence B-NR)
A Combination of Biomarkers May Prove to Be More Useful than Single Biomarkers
Prediction of Perioperative Complications Rates
Clinical Efficacy
Preoperative BNP >385 pg/mL Predicted the Postoperative Complication Rate and 1-Year Mortality Rate After Cardiac Surgery ( J Am Coll Cardiol, 2004) [MEDLINE]
Postperatively, Elevated BNP Levels and Elevated Change to Peak BNP Level were Associated with Prolonged Hospital Stay and 1-Year Mortality Rate
Prediction of Ventilator Weaning
Clinical Efficacy
Baseline Plasma BNP Level Before the First Weaning Attempt is Higher in Patients with Subsequent Weaning Failure and Correlates with Weaning Duration (Intensive Care Med, 2006) [MEDLINE]
Risk Stratification of Patients with Acute Pulmonary Embolism (PE) (see xxxx, [[xxxx]])
Clinical Efficacy
xxxx
Technique
Leuchte 2006 Paper: BNP >33 has a 87% sens for dx of pulmonary hypertension in idiopathic pulmonary fibrosis
Effect of Age
BNP Increases with Age (Eur J Heart Fail, 2008)[MEDLINE]: unclear why
Age <50 y/o: NT Pro BNP cutoff point = 450 pg/mL
Age 50-75 y/o: NT Pro BNP cutoff point = 900 pg/mL
Age >75 y/o: NT Pro BNP cutoff point = 1800 pg/mL
Effect of Sex
Males Have Lower BNP Levels than Females: unclear why
Effect of Renal Function
Values are Highly Variable with CrCl <60 mL/min and Cutpoints May Need to Be Adjusted: for this reason, BNP testing is not recommended in patients on hemodialysis
Mechanisms of BNP Elevation in the Setting of Renal Disease
Decreased Renal Clearance
Abnormal Counter-Regulatory Response Between the Heart and Kidney
Obese Patients Have Lower BNP Levels than Non-Obese Patients (with a Linear Inverse Relationship Between BMI and BNP): unclear why
Effect of Disease States
Cardiogenic Shock Increases BNP Levels
Sepsis Increases BNP Levels (see Sepsis, [[Sepsis]])
BNP Does Not Appear to Reliably Predict the Pulmonary Capillary Wedge Pressure (PCWP) in ICU Patients (Especially in Patients with Shock) (Crit Care Med 2004) [MEDLINE] and (J Am Coll Cardiol, 2005) [MEDLINE]
References
Bedside B-type natriuretic peptide in the emergency diagnosis of heart failure with reduced or preserved ejection fraction. Results from the Breathing Not Properly Multinational Study. J Amer Coll Cardiol Jun 4 2003;41(11):2010–7 [MEDLINE]
Brain natriuretic peptide: a marker of myocardial dysfunction and prognosis during severe sepsis. Crit Care Med 2004;32:660–5 [MEDLINE]
Utility of B-type natriuretic peptide in predicting postoperative complications and outcomes in patients undergoing heart surgery. J Am Coll Cardiol 2004;43:1873–9 [MEDLINE]
Utility of B-type natriuretic peptide for the evaluation of intensive care unit shock. Crit Care Med 2004;32:1643–7 [MEDLINE]
Relationship between B-type natriuretic peptides and pulmonary capillary wedge pressure in the intensive care unit. J Am Coll Cardiol 2005;45:1667–71 [MEDLINE]
B-type natriuretic peptide and weaning from mechanical ventilation. Intensive Care Med 2006;32:1529–36 [MEDLINE]
Prognosis in heart failure with a normal ejection fraction. N Engl J Med Aug 23 2007;357(8):829–30 [MEDLINE]
State of the art: using natriuretic peptide levels in clinical practice. Eur J Heart Fail. 2008 Sep;10(9):824-39. doi: 10.1016/j.ejheart.2008.07.014. Epub 2008 Aug 29 [MEDLINE]
2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013 Oct 15;128(16):e240-327. doi: 10.1161/CIR.0b013e31829e8776. Epub 2013 Jun 5 [MEDLINE]
The Registry of the International Society for Heart and Lung Transplantation: Thirty-second Official Adult Heart Transplantation Report–2015; Focus Theme: Early Graft Failure. J Heart Lung Transplant. 2015 Oct;34(10):1244-54. doi: 10.1016/j.healun.2015.08.003. Epub 2015 Aug 28 [MEDLINE]
2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation. 2017 Aug 8;136(6):e137-e161. doi: 10.1161/CIR.0000000000000509. Epub 2017 Apr 28 [MEDLINE]
