Brain type natriuretic peptide (BNP)-A marker of new millennium in diagnosis of congestive heart failure (original) (raw)

Review on the Correlation between Natriuretic Peptide Levels and Heart Failure

Many studies have evaluated the diagnostic characteristics of BNP and NT-proBNP. Study populations have included patients with acute decompensated HF who present to the emergency room or patients with symptoms and signs of HF who are evaluated by primary care physicians. These studies have examined the performance of BNP and NT-proBNP in patients with various comorbidities and at different cut points. However, questions about issues such as optimal cut points still persist regarding the diagnostic capability of BNP and NT-proBNP. Consequently, a systematic review is needed to better understand the diagnostic capability of BNP and NT-proBNP.Clinically, HF is a syndrome with typical symptoms (e.g., breathlessness and fatigue) and signs (e.g., elevated jugular venous pressure and pulmonary crackles). Patients with HF may have either reduced or preserved left ventricular ejection fraction (LVEF). The diagnosis of HF can be difficult since the clinical features of the condition are not always sensitive or specific. No gold standard investigation exists to diagnose HF. The use of BNP or NT-proBNP in the diagnosis, prognosis, or treatment for HF requires knowledge of the variation in peptide levels over serial measurements. Currently, the evidence is uncertain concerning how much of a difference in BNP or NT-proBNP concentration is clinically important.The challenge of diagnosing HF emphasizes the importance of evaluating whether other investigations may help diagnose the condition. Furthermore, the characteristics of these other investigations should be examined for their prognostic utility and their usefulness in guiding HF therapy. The natriuretic peptides, i.e., B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP), may be useful to help with diagnosis, prognosis, and management of HF. BNP and NTproBNP are secreted into the bloodstream by cardiac myocytes in response to increased ventricular wall stress, hypertrophy, and volume overload. BNP and NT-proBNP levels are increased in persons with HF, and low levels rule out HF. Thus, these peptides have emerged as promising markers for HF 1. Assessment of prognosis is important to promote better counseling of HF patients with regard to future therapies, including cardiac transplantation. Research suggests that BNP and NT-proBNP may provide incremental prognostic information beyond what is available from the clinical data such as New York Heart Association (NYHA) class, LVEF, and comorbidities 2. A systematic review is required to better understand whether BNP and NT-proB-NP provide prognostic information for patients with acute decompensated HF and chronic stable HF. The management of HF is essentially directed by an algorithm for medical therapy. Many times, patients are not fully optimized on therapy because clinicians believe, based on the clinical findings, that further optimization is unnecessary. This could result in under treatment for HF patients. Since BNP and NT-proBNP concentrations have been found to decrease with the escalation of therapy, sequential measurement of these markers may be a useful means of guiding HF treatment. To date, individual studies have not definitively demonstrated whether BNP or NT-proBNP test values can guide HF therapy. A systematic review of this issue would provide information to assess strategies to better optimize the management of HF patients. The use of BNP or NT-proBNP in the diagnosis, prognosis, or treatment for HF requires knowledge of the variation in peptide levels over serial measurements. Currently, the evidence is uncertain concerning how much of a difference in BNP or NT-proBNP concentration is clinically important. Given the many outstanding issues involved in using BNP and NT-proBNP for diagnosing, prognosticating, and treating HF, the following questions are to be addressed 3 : • Question 1: In patients presenting to the emergency department or urgent care facilities with signs or symptoms suggestive of heart failure (HF):