B-type Natriuretic Peptide Testing Research Articles

Does BNP testing aid diagnosis of heart failure?

Heart failure is common, causes major disability and often shortens life. Two UK guidelines advocate the measurement of plasma concentrations of B-type natriuretic peptide (BNP) in diagnosis of chronic heart...

Does B-Type Natriuretic Peptide Testing Affect Outcome and Management of Patients With Acute Dyspnea?

Letters18 August 2009Does B-Type Natriuretic Peptide Testing Affect Outcome and Management of Patients With Acute Dyspnea?Mihály Tapolyai, MDMihály Tapolyai, MDFrom Louisiana State University Health Sciences Center—Shreveport, Shreveport, LA 71103-4228.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-151-4-200908180-00019 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Schneider and colleagues (1) describe how a group of Australian emergency department physicians treat patients with severe shortness of breath. They evaluate their patients on the basis of their symptoms and promptly institute therapy based on their clinical impression.Their study examined whether advising physicians that “a BNP [B-type natriuretic peptide] level less than 100 ng/L made the diagnosis of heart failure unlikely, whereas a BNP level greater than 500 ng/L made heart failure likely,” would alter management of those patients (1). No other decision methodology, tree, or algorithm was instituted. The results show no difference between ...Reference1. Schneider HG, Lam L, Lokuge A, Krum H, Naughton MT, De Villiers Smit P, et al. B-type natriuretic peptide testing, clinical outcomes, and health services use in emergency department patients with dyspnea: a randomized trial. Ann Intern Med. 2009;150:365-71. [PMID: 19293069] LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Louisiana State University Health Sciences Center—Shreveport, Shreveport, LA 71103-4228.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoB-Type Natriuretic Peptide Testing, Clinical Outcomes, and Health Services Use in Emergency Department Patients With Dyspnea Hans-Gerhard Schneider , Louisa Lam , Amaali Lokuge , Henry Krum , Matthew T. Naughton , Pieter De Villiers Smit , Adam Bystrzycki , David Eccleston , Jacob Federman , Genevieve Flannery , and Peter Cameron Does B-Type Natriuretic Peptide Testing Affect Outcome and Management of Patients With Acute Dyspnea? Ajay Pachika , Malek Numeir , and Kiranmayi Adimoolam Does B-Type Natriuretic Peptide Testing Affect Outcome and Management of Patients With Acute Dyspnea? Franca Dipaola , Francesca Perego , Monica Solbiati , Giovanni Casazza , and Does B-Type Natriuretic Peptide Testing Affect Outcome and Management of Patients With Acute Dyspnea? Hans-Gerhard Schneider , Louisa Lam , and Peter Cameron Metrics 18 August 2009Volume 151, Issue 4Page: 288KeywordsBehaviorBrain natriuretic peptidesConflicts of interestDecision treesDyspneaHeart failureLongitudinal studiesNatriuretic peptidesPatients ePublished: 18 August 2009 Issue Published: 18 August 2009 CopyrightCopyright © 2009 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...

Does B-Type Natriuretic Peptide Testing Affect Outcome and Management of Patients With Acute Dyspnea?

Letters18 August 2009Does B-Type Natriuretic Peptide Testing Affect Outcome and Management of Patients With Acute Dyspnea?Ajay Pachika, MD, Malek Numeir, MD, and Kiranmayi Adimoolam, MBBSAjay Pachika, MDFrom Crozer Chester Medical Center, Upland, PA 19013, and Siddhartha Medical College, Andhra Pradesh, India 520008.Search for more papers by this author, Malek Numeir, MDFrom Crozer Chester Medical Center, Upland, PA 19013, and Siddhartha Medical College, Andhra Pradesh, India 520008.Search for more papers by this author, and Kiranmayi Adimoolam, MBBSFrom Crozer Chester Medical Center, Upland, PA 19013, and Siddhartha Medical College, Andhra Pradesh, India 520008.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-151-4-200908180-00020 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Schneider and colleagues (1) reported on a well-conducted randomized trial on the impact of BNP testing on management of patients with dyspnea who present to the emergency department. They examined the impact of BNP measurement on clinical outcomes among patients with acute dyspnea. It is a well-powered study, given the large sample size.Schneider and colleagues noted that, within the BNP-tested group, patients with a final diagnosis of heart failure had markedly elevated BNP values compared with patients without heart failure and that BNP testing accurately discriminated between the groups. However, it is very important to know ...

Does B-Type Natriuretic Peptide Testing Affect Outcome and Management of Patients With Acute Dyspnea?

Does B-Type Natriuretic Peptide Testing Affect Outcome and Management of Patients With Acute Dyspnea?

Does B-Type Natriuretic Peptide Testing Affect Outcome and Management of Patients With Acute Dyspnea?

Does B-Type Natriuretic Peptide Testing Affect Outcome and Management of Patients With Acute Dyspnea?

Rapid Emergency Department Heart Failure Outpatients Trial (REDHOT II)

Background— B-type natriuretic peptide is useful to diagnose heart failure. We determined whether the use of serial B-type natriuretic peptide measurements to guide treatment improves the outcome in patients with acute heart failure. Methods and Results— We conducted a randomized controlled trial of patients with acute heart failure in 10 academic and community emergency departments. The experimental group received serial B-type natriuretic peptide testing (at 3, 6, 9, and 12 hours then daily). The control group received usual care. Our outcomes were hospital length of stay, 30-day readmission rate, and all-cause mortality. There were 219 controls and 228 experimental patients. Mean age was 64 years, 49% were women, 58% were blacks, and 34% were whites. Groups were similar in baseline characteristics. Comparing the serial testing with the control group, there was no difference in length of stay (6.5 days [95% CI, 5.2 to 7.9] versus 6.5 days [95% CI, 5.6 to 7.3]; difference, 0.1 [95% CI, −1.7 to 1.5]), in-hospital mortality (2.2% [95% CI, 0.9 to 5.0] versus controls, 3.2% [95% CI, 1.6 to 6.5]; difference, 1.0% [95% CI, −2.3 to 4.5]), 30-day mortality (3.7% [95% CI, 1.8 to 7.5] versus 5.5% [95% CI, 3.0 to 9.8]; difference, 1.8% [95% CI, −2.8 to 6.5]), or hospital revisit rate (20.2% [95% CI, 15.0 to 26.6] versus 23.7% [95% CI, 18.0 to 30.6]; difference, 3.5% [95% CI, −5.1 to 12.1]). Conclusions— In this study of 447 patients hospitalized for suspected heart failure, we were unable to demonstrate a benefit of serial testing with B-type natriuretic peptide in terms of hospital length of stay, mortality, or readmission rate.

P-27 B-Type Natriuretic Peptide Testing in Patients with Shortness of Breath in the Emergency Department to Improve Patient Outcome

the control group using standard ED care. The clinicians making the diagnosis had in addition to patients’ presentation and history also access to laboratory tests and chest X-ray. The final diagnosis of HF was determined by one cardiologist and one emergency physician independently reviewing all available information while being blinded to the BNP result. Results: In the control group, the diagnosis of HF had a sensitivity of 65%, a specificity of 92% and an accuracy of 81%. In the BNP group, the diagnosis had a higher sensitivity of 66%, but a lower specificity and accuracy at 90% and 78% respectively. There was no significant difference between the BNP and non BNP groups in any of the measures of accuracy. Conclusion: In the clinical setting of Australian emergency departments, availability of BNP levels do not significantly improve the accuracy of a diagnosis of HF.

P-26 B-Type Natriuretic Peptide Testing and the Accuracy of Heart Failure Diagnosis in the Emergency Department

P-26 B-Type Natriuretic Peptide Testing and the Accuracy of Heart Failure Diagnosis in the Emergency Department

B-Type Natriuretic Peptide Testing, Clinical Outcomes, and Health Services Use in Emergency Department Patients With Dyspnea

B-type natriuretic peptide (BNP) is used to diagnose heart failure, but the effects of using the test on all dyspneic patients is uncertain. To assess whether BNP testing alters clinical outcomes and health services use of acutely dyspneic patients. Randomized, single-blind study. Patients were assigned to a treatment group through randomized numbers in a sealed envelope. Patients were blinded to the intervention, but clinicians and those who assessed trial outcomes were not. 2 Australian teaching hospital emergency departments. 612 consecutive patients who presented with acute severe dyspnea from August 2005 to March 2007. BNP testing (n = 306) or no testing (n = 306). Admission rates, length of stay, and emergency department medications (primary outcomes); mortality and readmission rates (secondary outcomes). There were no between-group differences in hospital admission rates (85.6% [BNP group] vs. 86.6% [control group]; difference, -1.0 percentage point [95% CI, -6.5 to 4.5 percentage points]; P = 0.73), length of admission (median, 4.4 days [interquartile range, 2 to 9 days] vs. 5.0 days [interquartile range, 2 to 9 days]; P = 0.94), or management of patients in the emergency department. Test discrimination was good (area under the receiver-operating characteristic curve, 0.87 [CI, 0.83 to 0.91]). Adverse events were not measured. Most patients were very short of breath and required hospitalization; the findings might not apply for evaluating patients with milder degrees of breathlessness. Measurement of BNP in all emergency department patients with severe shortness of breath had no apparent effects on clinical outcomes or use of health services. The findings do not support routine use of BNP testing in all severely dyspneic patients in the emergency department. Janssen-Cilag.

B-Type Natriuretic Peptide and Impedance Cardiography at the Time of Routine Echocardiography Predict Subsequent Heart Failure Events

Background Detection of heart failure (HF) in stable outpatients can be difficult until an overt event occurs. This study sought to determine whether the combination of B-type natriuretic peptide (BNP) and impedance cardiography (ICG) could be used in a nonacute clinical setting to risk stratify and predict HF-related events in stable outpatients. Methods and Results Patients undergoing routine outpatient echocardiography underwent ICG and BNP testing and were followed for one year for HF-related events (Emergency Department [ED] visit or hospitalization due to HF or all-cause death). A total of 524 patients were analyzed, resulting in 57 HF-related events; 16 ED visits, 17 hospitalizations, and 24 all-cause deaths. Using Cox regression analyses, BNP and systolic time ratio index (STRI) by ICG proved to be the strongest predictors of future HF-related events. Patients with a BNP >100 pg/ml and STRI >0.45 sec -1 had a significantly lower event-free survival rate than those with a high BNP and low STRI (67% versus 89%, P=.001). In patients with LV dysfunction only, if both BNP and STRI values were high, the relative risk of a HF-related event increased by 12.5 (95 % C.I. 4.2-36.7), when compared with patients with a low BNP and low STRI (P<.001). Conclusions In a nonacute clinical setting, both BNP and ICG testing can provide unique predictive power of long-term HF-related events in a stable cohort of patients with and without LV dysfunction.

Pulmonary hypertension in COPD

Mild-to-moderate pulmonary hypertension is a common complication of chronic obstructive pulmonary disease (COPD); such a complication is associated with increased risks of exacerbation and decreased survival. Pulmonary hypertension usually worsens during exercise, sleep and exacerbation. Pulmonary vascular remodelling in COPD is the main cause of increase in pulmonary artery pressure and is thought to result from the combined effects of hypoxia, inflammation and loss of capillaries in severe emphysema. A small proportion of COPD patients may present with "out-of-proportion" pulmonary hypertension, defined by a mean pulmonary artery pressure >35-40 mmHg (normal is no more than 20 mmHg) and a relatively preserved lung function (with low to normal arterial carbon dioxide tension) that cannot explain prominent dyspnoea and fatigue. The prevalence of out-of-proportion pulmonary hypertension in COPD is estimated to be very close to the prevalence of idiopathic pulmonary arterial hypertension. Cor pulmonale, defined as right ventricular hypertrophy and dilatation secondary to pulmonary hypertension caused by respiratory disorders, is common. More studies are needed to define the contribution of cor pulmonale to decreased exercise capacity in COPD. These studies should include improved imaging techniques and biomarkers, such as the B-type natriuretic peptide and exercise testing protocols with gas exchange measurements. The effects of drugs used in pulmonary arterial hypertension should be tested in chronic obstructive pulmonary disease patients with severe pulmonary hypertension. In the meantime, the treatment of cor pulmonale in chronic obstructive pulmonary disease continues to rest on supplemental oxygen and a variety of measures aimed at the relief of airway obstruction.

Genetic variation in the natriuretic peptide system and heart failure

Heart failure (HF) is a modern epidemic and is one of the few cardiovascular diseases which is increasing in prevalence. The growing importance of the Natriuretic Peptide (NP) system in HF is well recognized. Laboratory tests for B-type Natriuretic Peptide (BNP) have proven value as diagnostic and prognostic tools in HF and are now part of routine clinical care. Furthermore, recombinant atrial natriuretic peptide (ANP) (carperitide) and BNP (nesiritide) and are approved HF therapies in Japan and the US, respectively and additional natriuretic peptides (e.g., CNP, urodilatin, and designer NPs) are under investigation for use in HF. Common genetic sequence variants are increasingly being recognized as determinants of disease risk or drug response and may help explain a portion of the inter-individual variation in the human NP system. This review describes current knowledge of NP system genetic variation as it pertains to HF as well as ongoing studies and where the field is expected to progress in the near future. To briefly summarize, NP system genetic variants have been associated with alterations in gene expression, NP levels, and cardiovascular disease. The next step forward will include specific investigations into how this genetic variation can advance 'Personalized Medicine', such as whether they impact the utility of diagnostic BNP testing or effectiveness of therapeutic NP infusion. This is already in progress, with pharmacogenetic studies of nesiritide currently underway. We expect that within 5 years there should be a reasonable idea of whether NP system genetic variation will have important clinical implications.

The use of B-type natriuretic peptide in the management of patients with atrial fibrillation and dyspnea

The utility of B-type natriuretic peptide (BNP) testing in patients with atrial fibrillation (AF) is poorly defined. We analyzed patients ( n = 452) included in the BNP for Acute Shortness of Breath Evaluation (BASEL) study. Patients were randomly assigned to a diagnostic strategy with or without the use of BNP. Ninety-nine patients presented with AF ( n = 48 BNP group; n = 51 control group). Although comparable with respect to gender and cardiopulmonary comorbidity, patients with AF were older and more often had heart failure as the cause of dyspnea. In addition, patients with AF had higher in-hospital mortality (13% versus 6%, P = 0.012). The use of BNP significantly reduced time to discharge (BNP group median 8 days [1–16] versus 12 days [IQR 4–21] control group; P = 0.046) in patients with AF. Initial total treatment costs (median) were $4239 [769–7422] in the BNP group and $5940 [4024–10848] in the control group ( P = 0.041). These benefits were maintained after 90 days: patients in the BNP group had spent fewer days in hospital (10 days [2–21] versus 15 days [IQR 9–27]; P = 0.022) and induced lower total treatment costs ($4790 [1260–9387] versus $7179 [4311–13173]; P = 0.016). In conclusion, the use of BNP seems to improve the management of patients with AF presenting with dyspnea.

Cost‐Effectiveness of B‐Type Natriuretic Peptide Testing

As with any other diagnostic method, the cost-effectiveness of B-type natriuretic peptide (BNP) testing depends on the indication of its use and the specific clinical setting. The use of BNP levels, in conjunction with other clinical information, provides information that seems to be particularly helpful in the diagnosis, prognosis, and management of heart failure (HF) as well as screening for left ventricular systolic dysfunction. In the screening for asymptomatic left ventricular systolic dysfunction, BNP testing seems to be cost-effective (<$50,000 per quality-adjusted life-years gained) when used in a population with a prevalence of at least 1%. BNP testing, in fact, results in cost savings in the diagnosis of HF. Although the data are less robust, BNP seems cost-effective in the risk stratification of hospitalized HF patients when compared with echocardiography. Because BNP guidance seems to reduce the number of rehospitalizations in recently hospitalized patients with chronic HF, the use of BNP is also most likely cost-effective in this indication. For the remaining and, in part, evolving indications, further studies are needed to assess cost-effectiveness.

Cost‐Effectiveness of B‐Type Natriuretic Peptide Testing

As with any other diagnostic method, the cost‐effectiveness of B‐type natriuretic peptide (BNP) testing depends on the indication of its use and the specific clinical setting. The use of BNP levels, in conjunction with other clinical information, provides information that seems to be particularly helpful in the diagnosis, prognosis, and management of heart failure (HF) as well as screening for left ventricular systolic dysfunction. In the screening for asymptomatic left ventricular systolic dysfunction, BNP testing seems to be cost‐effective (&lt;$50,000 per quality‐adjusted life‐years gained) when used in a population with a prevalence of at least 1%. BNP testing, in fact, results in cost savings in the diagnosis of HF. Although the data are less robust, BNP seems cost‐effective in the risk stratification of hospitalized HF patients when compared with echocardiography. Because BNP guidance seems to reduce the number of rehospitalizations in recently hospitalized patients with chronic HF, the use of BNP is also most likely cost‐effective in this indication. For the remaining and, in part, evolving indications, further studies are needed to assess cost‐effectiveness.

Effects of functional electrical stimulation on quality of life and emotional stress in patients with chronic heart failure secondary to ischaemic or idiopathic dilated cardiomyopathy: A randomised, placebo‐controlled trial

Functional electrical stimulation (FES) improves exercise capacity and endothelial function in chronic heart failure (CHF) patients. This study evaluates the impact of FES on quality of life and emotional stress in patients with moderate to severe CHF. Thirty patients with stable CHF (24 men; NYHA class II-III; left ventricular ejection fraction <35%) were randomly assigned (2:1) to a 6-week FES training program (n=20) or placebo (n=10). Questionnaires addressing quality of life [Kansas City Cardiomyopathy Questionnaire (KCCQ), functional and overall], and emotional stress [Zung self-rating depression scale (SDS), Beck Depression Inventory (BDI)], as well as plasma B-type natriuretic peptide (BNP) and 6-min walking distance test (6MWT) were assessed at baseline and after completion of training protocol. A significant improvement in KCCQ functional (F=76.666, p<0.001), KCCQ overall (F =41.508, p<0.001), BDI (F =17.768, p<0.001) and Zung SDS (F =27.098, p<0.001) was observed in the FES group compared to placebo. Patients in the FES group had also a significant increase in 6MWT (F =19.413, p<0.001) and a trend towards reduction in plasma BNP (F =4.252, p=0.053) compared to placebo. FES seems to have a beneficial effect on quality of life, exercise capacity and emotional stress in patients with moderate to severe CHF.

Biomarkers in heart failure management

Purpose of review Recent literature on the role of biomarkers in heart failure is reviewed, focusing on B-type natriuretic peptide. Recent findings Knowledge of the processes which increase ventricular stress, thus increasing B-type natriuretic peptide, is key to appropriate utilization and interpretation of B-type natriuretic peptide levels. B-type natriuretic peptide is a useful adjunct to confirm or rule out heart failure. B-type natriuretic peptide is a robust prognostic indicator in all stages of heart failure, with prognostic significance in patients undergoing cardiac and noncardiac surgery, and in those with acute coronary syndromes. Serial B-type natriuretic peptide testing predicts outcomes in hospitalized patients with heart failure. The role of B-type natriuretic peptide in screening high-risk populations is promising, but its use in unselected populations is unclear. There is increasing evidence that the use of B-type natriuretic peptide to guide heart failure management is associated with improved clinical outcomes and reduced health costs. Summary Biomarkers play an important role in heart failure, but there remain unanswered questions regarding optimization of their use. They should be used as an adjunct to, not replacement for, clinical assessment. Currently available B-type natriuretic peptide assays have limitations relating to clinical variability and assay specificity. Other neurohormonal, inflammatory and metabolic markers may add complementary information to that provided by currently available B-type natriuretic peptide assays.

Accuracy of chest radiographs in the emergency diagnosis of heart failure

The purpose of this study was to determine the diagnostic accuracy of chest radiographic findings of heart failure (HF) in current patients presenting with dyspnea in the emergency department. In a secondary analysis of the BASEL study, initial chest radiographs of 277 patients with acute dyspnea were evaluated by two radiologists blinded to the adjudicated diagnosis (56% had the final diagnosis of HF). Predefined radiographic criteria of HF were used. Statistical analysis included receiver-operating characteristic (ROC) analysis and calculation of a logistic regression model including B-type natriuretic peptide (BNP) levels. The reader's overall impression showed the highest area under the ROC curve for the diagnosis of HF in both supine and erect patient positions (0.855 and 0.857). Among individual radiographic findings, peribronchial cuffing in the supine position (0.829) showed the highest accuracies. The lowest accuracy was found for the vascular pedicle width in the supine position (0.461). Logistic regression analysis showed no significant differences between the reader's overall impression, the radiographic model, and BNP testing. In our study, the combination of radiographic features provided valuable information and was of comparable accuracy as BNP-testing for the diagnosis of HF.

32: B-Type Natriuretic Peptide Testing in Patients With Shortness of Breath in the Emergency Department: A Preliminary Analysis of the Accuracy of Heart Failure Diagnosis

Dyspnea is the most common presenting symptom of acute decompensated heart failure (HF) to the emergency department (ED). Correct and early diagnosis is essential to prevent adverse outcomes. This study aimed to determine whether B-type Natriuretic peptide (BNP) testing in patients presenting with dyspnea to the ED improves the accuracy of diagnosis of HF.

158: Is Bioelectrical Impedance Analysis Helpful for Heart Failure Management in the Emergency Department?

Decompensated heart failure (DHF) is characterized by the early accumulation of fluid in the interstitial space of the lungs and of whole body. Nevertheless, diagnostic errors in patients with respiratory symptoms are frequent and the diagnosis of DHF can remain unsuspected in patients with chronic obstructive pulmonary disease (COPD). So, appropriate selection of patients with DHF, especially among those obese and elderly, represents a diagnostic challenge for physicians. Recently, B-type natriuretic peptide (BNP) test was validated in this setting and helps to uncover unsuspected DHF in patients with COPD.