![]() 24 The two studies that measured BNP against echocardiographic criteria for systolic and diastolic heart failure had a pooled diagnostic odds ratio of 38 (95% CI, 6 to 237). The seven studies that measured BNP against clinical criteria (i.e., a consensus view using all other clinical information and often using a panel of two or three cardiologists) had a pooled diagnostic odds ratio of 31 (95% CI, 27 to 35). 24 This result is consistent with a moderately accurate diagnostic test. ![]() 24 The eight studies that measured BNP against a reference standard of reduced left ventricular ejection fraction (i.e., 40 percent or lower or the equivalent) had a pooled diagnostic odds ratio of 12 (95% confidence interval, 8 to 16). 20Ī systematic review included 20 studies evaluating BNP testing in the diagnosis of heart failure. 18 No circadian variation has been reported when BNP is measured every three hours for 24 hours, 19 and there is less hourly variation with BNP than with ANP. 14 – 16 Exercise causes a short-term increase in BNP levels, 17 although only small changes (i.e., increase of 0.9 percent in patients without heart failure, 3.8 percent in patients with New York Heart Association class I or II heart failure, and 15 percent in patients with NYHA class III to IV heart failure) are detectable one hour after exercise. However, digoxin and some beta blockers appear to increase natriuretic peptide concentrations. 8 – 13 Therefore, many patients with chronic stable heart failure will have BNP levels in the normal diagnostic range (i.e., BNP level less than 100 pg per mL ). Many medications used to treat heart failure (e.g., diuretics such as spironolactone, angiotensin-converting enzyme inhibitors, angiotensin-II receptor blockers) reduce natriuretic peptide concentrations. BNP level is a strong predictor of risk of death and cardiovascular events in patients previously diagnosed with heart failure or cardiac dysfunction. BNP tests are correlated with other measures of cardiac status such as New York Heart Association classification. Increases in BNP levels may be caused by intrinsic cardiac dysfunction or may be secondary to other causes such as pulmonary or renal diseases (e.g., chronic hypoxia). ![]() However, patients with treated chronic stable heart failure may have levels in the normal range (i.e., BNP less than 100 pg per mL and N-terminal proBNP less than 125 pg per mL in patients younger than 75 years). Treatment with angiotensin-converting enzyme inhibitors, angiotensin-II receptor blockers, spironolactone, and diuretics reduces BNP levels, suggesting that BNP testing may have a role in monitoring patients with heart failure. The high negative predictive value of BNP tests is particularly helpful for ruling out heart failure. These measurements can be used to diagnose heart failure, including diastolic dysfunction, and using them has been shown to save money in the emergency department setting. Brain natriuretic peptide (BNP) levels are simple and objective measures of cardiac function.
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