Interpretation of B-type natriuretic peptide in cardiac disease and other comorbid conditions

B-Type natriuretic peptide (BNP) is elevated in states of increased ventricular wall stress. BNP is most commonly used to rule out congestive heart failure (CHF) in dyspneic patients. BNP levels are influenced by age, gender and, to a surprisingly large extent, by body mass index (BMI). In addition,...

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Bibliographic Details
Published in:Heart failure reviews 2007-03, Vol.12 (1), p.23-36
Main Authors: Burke, Michael A, Cotts, William G
Format: Article
Language:English
Subjects:
Amyloidosis
Animals
Biomarkers
Body mass index
Brain natriuretic peptide
Cardiomyopathy
Chronic obstructive pulmonary disease
Comorbidity
Congestive heart failure
Coronary artery disease
Critical Illness
Disease
Dyspnea
Dyspnea - blood
Embolism
Fibrillation
Heart Diseases - blood
Heart Diseases - metabolism
Heart Failure - blood
Heart Failure - metabolism
Humans
Lung diseases
Lung Diseases - blood
Natriuretic Peptide, Brain - genetics
Natriuretic Peptide, Brain - metabolism
Obstructive lung disease
Patients
Peptides
Predictive Value of Tests
Renal failure
Renal Insufficiency - blood
Respiration
Sensitivity and Specificity
Sepsis
Ventricle
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Summary:B-Type natriuretic peptide (BNP) is elevated in states of increased ventricular wall stress. BNP is most commonly used to rule out congestive heart failure (CHF) in dyspneic patients. BNP levels are influenced by age, gender and, to a surprisingly large extent, by body mass index (BMI). In addition, it can be elevated in a wide variety of clinical settings with or without CHF. BNP is elevated in other cardiac disease states such as the acute coronary syndromes, diastolic dysfunction, atrial fibrillation (AF), amyloidosis, restrictive cardiomyopathy (RCM), and valvular heart disease. BNP is elevated in non-cardiac diseases such as pulmonary hypertension, chronic obstructive pulmonary disease, pulmonary embolism, and renal failure. BNP is also elevated in the setting of critical illness such as in acute decompensated CHF (ADHF) and sepsis. This variation across clinical settings has significant implications given the increasing frequency with which BNP testing is being performed. It is important for clinicians to understand how to appropriately interpret BNP in light of the comorbidities of individual patients to maximize its clinical utility. We will review the molecular biology and physiology of natriuretic peptides as well as the relevant literature on the utilization of BNP in CHF as well as in other important clinical situations, conditions that are commonly associated with CHF and or dyspnea.
ISSN:1382-4147
1573-7322
DOI:10.1007/s10741-007-9002-9