Use of B-Type Natriuretic Peptide for the Diagnosis of Congestive Heart Failure in the Emergency Department

Abstract

Background: B-type natriuretic peptide (BNP) is released from cardiac ventricles in response to increased wall tension. It is helpful in differentiating dyspnea resulting from congestive heart failure (CHF) and noncardiac causes. Methods: One hundred consecutive patients who came to the emergency department of a community hospital with dyspnea in a 2-month period were enrolled in the study. Each patient had a rapid bedside assay of BNP by BIOSITE at the time of arrival to the emergency department. Patient hospitalizations were reviewed and primary discharge diagnoses of pneumonia and heart failure were used as the basis for the analysis. Results: Of 100 patients, 53 patients had BNP >150 pg/mL. Forty-five patients had BNP >150 pg/mL and clinical and echocardiographic evidence of CHF. Six patients had BNP >150 pg/mL and no clinical but echocardiographic evidence of CHF. Two patients had BNP >150 pg/mL without any clinical or echocardiographic evidence of CHF. Two patients had BNP <150 pg/mL with a diagnosis of pneumonia and no clinical evidence of CHF. Conclusions: Our results showed that rapid diagnosis of heart failure can be made by using bedside marker BNP on arrival to the emergency department. We have found BNP levels of 150 pg/mL and above are highly consistent with a discharge diagnosis of congestive heart failure.