Copyright © 2003 by the European Society of Cardiology.
Review
Clinical applications of B-type natriuretic peptide (BNP) testing
a National Heart & Lung Institute, Imperial College, London, UK
b Heart Failure Department CHR, Dubos 6 avenue d’Ile de France 95300Pontoise, France
c University of California, VA San Diego Healthcare System, Cardiology 111-A, 3350 La Jolla Village, San Diego, CA 91261, USA
d Department of Cardiology, Linköping University Hospital, S-58185 Linköping, Sweden
e Department of Medicine, University Hospital Zürich, Zürich, Switzerland
f Service Cardiologie, Hôpital Salpétrière, 50, boulevard Vincent Auriol, 75013 Paris, France
g Klinik und Poliklinik für Innere Medzin II, Klinikum der Universität, 93042 Regebsburg, Germany
h Department of Cardiology, University of Glasgow, Glasgow, UK
i Department of Internal Medicine, Division of Cardiology, University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
j Division of Cardiology University Central Hospital P.O.Box 340, 00029 HUS Helsinki, Finland
k Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
* Corresponding author. Professor Martin R Cowie, National Heart & Lung Institute, Clinical Cardiology, Dovehouse Street, London SW3 6LY, UK. Tel.: +44-207-351-8856; fax: +44-207-351-8148
E-mail address: m.cowie{at}imperial.ac.uk
Received 9 June 2003; revised 21 July 2003; accepted 31 July 2003
Abstract
Many claims have been made in recent years regarding the utility of plasma B-type natriuretic peptide (BNP) concentration measurements in the diagnosis, risk stratification and monitoring of patients with heart failure. This paper summarizes the current evidence and provides guidance for practising clinicians. Overall, plasma BNP testing appears to be of most value in the diagnostic arena, where it is likely to improve the performance of non-specialist physicians in diagnosing heart failure. In clinical practice, BNP testing is best used as a ‘rule out’ test for suspected cases of new heart failure in breathless patients presenting to either the outpatient or emergency care settings; it is not a replacement for echocardiography and full cardiological assessment, which will be required for patients with an elevated BNP concentration. Although work is ongoing in establishing the ‘normal’ values of BNP, heart failure appears to be highly unlikely below a plasma concentration of 100pg/ml. However, as BNP levels rise with age and are affected by gender, comorbidity and drug therapy, the plasma BNP measurement should not be used in isolation from the clinical context.
Key Words: B-type natriuretic peptide • Heart failure • Diagnosis • Prognosis • Monitoring
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