Measuring BNP

If atrial natriuretic peptide (ANP) is released by distension of the atria, then brain natriuretic peptide (BNP) must be released by distension of the… ventricles? Don’t think about it too hard.

BNP and the N-terminal fragment of proBNP (NT-proBNP) are useful for diagnosing heart failure, especially when there’s uncertainty. In fact, at least one trial1 has suggested that it should be used for screening of high-risk patients to identify those who have preclinical heart failure (if such a thing can be said to exist).

Measurements of BNP and NT-proBNP can be used interchangeably, but have different cutoffs. The cutoffs stratify people into three categories: low likelihood of having heart failure (good LR-), high likelihood (good LR+), and intermediate (not terribly helpful).

Besides diagnosis, it can also be used for prognosis as well as for tracking response to treatment. That last one hasn’t made it into the guidelines yet.

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Works cited:

  1. Ledwidge M, Gallagher J, Conlon C, et al. Natriuretic Peptide–Based Screening and Collaborative Care for Heart Failure: The STOP-HF Randomized Trial. JAMA. 2013;310(1):66-74. doi:10.1001/jama.2013.7588.

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