BNP Blood Test
 
Updated August 12, 2006

The BNP test is a heart failure blood test. It measures the level of a hormone in your blood called B-type Natriuretic Peptide. Your heart's pumping chambers - the ventricles - produce extra BNP when they can't pump enough blood to meet your body's needs. So if your BNP level is high, you probably have heart failure. The higher your BNP level is at diagnosis, the worse your heart failure is likely to be.
     This blood test is designed to diagnose heart failure. As we CHFers know, misdiagnosis is a terrible thing because our hearts suffer more damage the longer it takes to get a correct diagnosis and proper treatment. Hopefully, the BNP test will put an end to diagnosis mistakes - if doctors make prompt, proper use of it. It only takes about 15 minutes after the blood is drawn to get the result.

Is This Test Properly Used?

Doctors now use BNP level to guide treatment. They are also trying to predict exercise tolerance, risk of death, and much more from BNP level. Once a CHFer has been on an ACE inhibitor and beta-blocker for awhile, his heart size often returns to normal or near-normal. Those drugs plus a diuretic reduce pressures. EF may improve. At that point, his BNP level will drop since the heart produces BNP in response to abnormal pressures and heart enlargment. Other CHFers will show higher-than-normal BNP levels even with normal heart size and pressures.
     Unless used with great care, testing BNP routinely this way can definitely hurt us, the CHFers. Disability insurers will see a new way to quit paying sick people disability. "His BNP level is normal? Then he can go back to work!" It happened with beta-blockers - think about it. It's like Coreg improving EF without improving ability to function in many of us. Social Security is using that to get rid of many of us - right now - today. Yet when I told doctors years ago this would happen, they thought I was nuts. Here we go again.

One Test Cannot Tell The Whole Story

Heart failure involves many bodily systems - not just the heart. Our neurohormonal systems go crazy; our muscle fiber types change; our endothelium no longer works right; our heart's energy reserve is reduced; our body's gas transfer changes for the worse (reduced Vo2max), and more.
     That's why a normal BNP reading in a CHFer who has been on proper drug therapy for awhile may be very misleading. Frankly, it may mean nothing useful at all then. So why aren't doctors thinking this way? It's like their view of EF: If it's easy to measure and if it nails down one area well, let's just apply it to the whole person.
     Unfortunately, the whole person - and his health - are not accurately described so easily. This is a tremendously useful test, up to a point. That's my take on it.

Be aware of what units are used in your test results! Some labs are reporting BNP Test results in femtomoles, a metric measure. The manufacturer of the most popular test kit - from Biosite Diagnostics - did the unit conversion for me. If your report is in fmol/ml, you can compare your results to the numbers in the tables on this page by dividing your result by 3.45098.

 
 

BNP Levels and What They Mean 

The most common device in the USA for measuring BNP is made by Biosite Diagnostics - (the Triage test). Their machine tests a range between 5 pg/mL to 1300 pg/mL. A pg is a picogram, which equals one 1/trillionth of one gram. A ml is a milliliter, or 1/1000 of a liter. (See this page for some medical units of measurement) Average levels from a clinical trial are:

 class 1class 2class 3class 4
CHFers men 146 pg/ml  306 pg/ml  557 pg/ml  928 pg/ml 
CHFers women 149 pg/ml  385 pg/ml  614 pg/ml  858 pg/ml 
 age 45 and underage 75 and older
Non-CHF (healthy) men 10 pg/ml  47 pg/ml 
Non-CHF (healthy) women 17 pg/ml  77 pg/ml 
The numbers below come from Biosite Diagnostics - the company that makes the Triage BNP Test kit and Meter
People Who Do Not Have CHF
Men and Women Combined - pg/ml
   Under age 45   Age 45 to 54   Age 55 to 64   Age 65 to 74   Over age 75 
Average    13.9    19.7    26.2    31.0    63.7 
Lowest Result     5.0     5.0     5.0     5.0     5.0 
Highest Result   251.3   252.0   207.7   197.9   218.5 
People Who Do Not Have CHF
Men Only - pg/ml
   Under age 45   Age 45 to 54   Age 55 to 64   Age 65 to 74   Over age 75 
Average     9.8    14.3    19.2    23.3    46.1 
Lowest Result     5.0     5.0     5.0     5.0     5.0 
Highest Result   251.3   252.0   207.7   127.3   218.5 
People Who Do Not Have CHF
Women Only - pg/ml
   Under age 45   Age 45 to 54   Age 55 to 64   Age 65 to 74   Over age 75 
Average    17.0    25.2    33.6    37.7    76.5 
Lowest Result     5.0     5.0     5.0     5.0     5.0 
Highest Result    92.6   142.8   143.2   197.9   194.1 
 
People Who Do Have CHF
Men and Women Combined - pg/ml
   All Heart Classes Combined  Class 1   Class 2   Class 3   Class 4 
Average   525.9   145.9   326.7   575.6   897.8 
Lowest Result     5.0     5.0     5.0     5.2     5.0 
Highest Result   Over 1300   904.6   Over 1300   Over 1300   Over 1300 
People Who Do Have CHF
Men Only - pg/ml
   All Heart Classes Combined  Class 1   Class 2   Class 3   Class 4 
Average   486.7   145.5   306.4   557.4   927.9 
Lowest Result     5.0     5.0     5.0     5.2     5.0 
Highest Result   Over 1300   904.6   Over 1300   Over 1300   Over 1300 
People Who Do Have CHF
Women Only - pg/ml
   All Heart Classes Combined  Class 1   Class 2   Class 3   Class 4 
Average   614.7   148.5   384.5   613.8   858.4 
Lowest Result     5.0     5.0     5.0    11.7    15.5 
Highest Result   Over 1300   519.6   Over 1300   Over 1300   Over 1300 

 Fat Patients May Have CHF With Lower BNP

November 22, 2005 - BMI (body mass index) is a measure of obesity. The higher the BMI, the fatter you are. As BMI increases, BNP blood test results take on different meaning. A very fat CHFer may have a lower BNP result and still have serious heart failure. This study suggests that instead of saying you have heart failure at 100 pg/ml or higher, very fat people may have CHF at 54 pg/ml and higher.
     To find out what BNP level would identify 90% of patients with different body weights who had CHF, researchers studied 1,368 patients who were enrolled in the BNP Multinational Study. These patients went to an ER for shortness of breath. BNP was measured on arrival, and two cardiologists (who did not know the BNP results [blinded]) confirmed a HF diagnosis based on various factors, including x-rays, echos, history and physical exams, and all lab work except BNP - after a BNP test was done.
     Patients were divided into 3 categories based on BMI: In severely obese patients, a cut-off of 54 pg/mL detected 90% of patients in CHF in this study. In all patients not seriously obese, a cut-off point of 100 pg/ml accurately predicted heart failure.
     This study shows how important it is to consider all factors in diagnosing CHF, including BNP, x-ray, echo, physical exam and more.
 
Source: AHA 2005 Scientific Sessions: Abstract 3512. Presented 11/16/2005.

 How The Triage BNP Test Works

August 16, 2002 - The Triage BNP Test measures the BNP in a certain-sized blood sample that has been thinned with a blood thinner called EDTA. Here is how the test kit works in a nutshell:

  1. A blood sample is drawn from the patient.
  2. The test device is removed for the refrigerator and allowed to reach room temperature, taking at least 15 minutes.
  3. The test device is then removed from the sealed pouch.
  4. The patient ID number is written on the label for this use of the device.
  5. The blood sample is put into the test device, where EDTA (a chemical to stop the blood from clotting) is added.
  6. Now inside the device, the red blood cells are separated from the rest of the blood by a filter.
  7. A preset amount of the separated blood plasma moves into a reaction chamber.
  8. In that chamber, the plasma reacts with fluorescent BNP antibodies (from mice) to form a "reaction mixture."
  9. That mixture is heated inside the device for about 2 minutes.
  10. Then the reaction mixture flows through a "detection lane" inside the device.
  11. In this "lane," different parts of the mixture "stick" to different parts of the detection channel.
  12. Leftover, unneeded plasma washes away the part of the mixture that did not "stick" to anything, into a waste trap.
  13. The percentage of BNP is then figured by how much of the sample "stuck" to certain parts of the test device's detection channel.
  14. The test device is inserted into the Triage Meter. This must be done no more than 30 minutes after the blood is put in the test device.
  15. The BNP level is displayed on the meter's display screen.

The mouse-derived BNP antibodies in the device are tagged with a fluorescent dye. This enables a laser to "read" the levels involved. The test kit must be kept sealed and refrigerated before use. Each kit has an expiration date just like milk in the grocery store. The kit must be stored refrigerated at 35° to 46° F. Once removed from refrigeration, the device is stable for up to 14 days. Testig should be done within 4 hours of drawing the blood.

An electronic chip with calibrating information comes with each kit. The chip is inserted into the Triage Meter and sends the meter all the necessary information for "tuning" the device accurately.
     Each test device also has 2 internal dummy-proof control checks: One alerts you if not enough blood for an accurate test was put into the device or if not enough leftover plasma washed the detection channel during the test. The other one alerts you if the device was not inserted and read properly by the Triage Meter. If either warning is given, the test must be repeated.
     A simulator also comes with the test kit. This should be run once a day to make sure the device is functioning properly. It confirms laser stability, alignment, and calibration.
     No blood thinner (anticoagulant) other than EDTA can be used for accurate results.

 Blood Test For CHF Approved

2001 - The FDA has approved the Triage BNP blood test by Biosite Diagnostics for early diagnosis of CHF in people age 55 years and older. The test measures levels of BNP (B-type natriuretic peptide) in your blood. BNP is a natural hormone the heart's ventricles produce when they can't pump enough blood.
     Doctors have relied on chest x-rays and physical exam to diagnose heart failure. These methods are not very accurate, says Dr. Jay Cohn. The Triage BNP test measures BNP levels from just 6 drops of blood. Results are available in 15 minutes.
     BNP in heart failure patients has been studied quite a bit. Dr. Alan Maisel studied measuring BNP to predict CHF outcomes. He measured daily BNP levels in 72 class 3 to class 4 male hospital patients. He then compared these BNP levels to mortality and 30-day readmission rates. BNP levels were highest when the patients' CHF was worst. Extremely high BNP level was a strong predictor of death and readmission.
     Dr. Keisuke Kawai studied 30 DCM patients already taking the standard drugs. BNP, norepinephrine levels, and echo measurements were taken before, and 2 and 6 months after starting Coreg in 21 patients; and at study start and after 6 months in 9 patients who did not take Coreg.
     After 6 months, Coreg had improved heart size and EF, and BNP level went down from 127 to 69pg/mL. BNP level went down as heart size went down and as EF went up. The researchers concluded that blood level of BNP may accurately reflect changes in heart function.
 
Source: Reuters Health
Source: J Am Coll Cardiol 2001;37:386-391
Source: Am Heart J 141(6):925-932, 2001

 BNP Blood Test Now In Use

March 21, 2002 - The Triage BNP blood test is now being used in clinics and emergency rooms. It only takes 15 minutes and is proving very accurate. The test "is the most significant improvement in heart failure diagnosis in the past 20 years," says Dr. Alan Maisel.
     Millions of people go to an ER every year because of trouble breathing. Heart failure is only one possible cause. Until recently, there was no simple test for heart failure. Many people were wrongly diagnosed and got much, much sicker as a result.
     A study just released shows that a quick blood test measuring a hormone can confirm whether breathing problems mean heart failure or not. The hormone is released by stressed heart muscle. Dr. Maisel directed the study and presented the results at the annual meeting of the American College of Cardiology.
     The "Triage" test is already used by about 500 U.S. hospitals. It measures levels of BNP or B-type natriuretic peptide. Levels of this hormone are very high in people with acute heart failure. Doctors have often been wrong when faced with a person having CHF, calling it asthma, respiratory infection, pneumonia, or gallstones.
     That should change. The BNP test was 83% accurate in diagnosing heart failure in people with unexplained shortness of breath. The study included 1,586 men and women at 7 hospitals in the USA and Europe. In 43% of the patients, doctors felt unsure without the blood test whether patients' breathing problems were caused by heart failure. The test results reduced this uncertainty to 11%.
 
Source: AP

 Measuring BNP Detects Heart Failure

February 18, 2002 - Measuring blood levels of BNP is an effective way to screen large numbers of people quickly for heart problems - including heart failure. Dr. M. Nakamura studied 1,098 consecutive men and women with an average age of 56 years, whose BNP levels were measured.
     Regular test methods showed that 11 patients had a-fib, 7 had suffered a previous heart attack, 7 had valve disease, 6 had high blood pressure, 6 had cardiomyopathy, one had atrial septal defect, and one had cor pulmonale. BNP measurement had a positive predictive value of of 44.3% and a negative predictive value of over 99%.
     "BNP could be a useful test to screen for valve disease, heart enlargement, a-fib, and left ventricular dysfunction, as well as for left ventricular systolic dysfunction," said Dr. Allan Struthers.
 
Source: Heart 2002;87:97-98,131-135

 BNP Helps Diagnose Diastolic CHF

INTRODUCTION August, 2002 -   Diastole is the part of the heart beat when the pumping chambers (ventricles) relax and fill with blood. Problems with this part of the heart's cycle are called diastolic dysfunction or DHF for diastolic heart failure. You can read more about DHF here.
     DHF is harder to diagnose than systolic dysfunction, which is a problem with the part of the heart beat when the heart squeezes (contracts) and pumps blood out into the body. Although echocardiograms measure the heart's filling during diastole, echo has limits. Another way to help diagnose DHF without doing a cath is needed.
     BNP is a heart hormone (peptide) produced by the heart's pumping chambers when the heart can't supply the body with enough blood. BNP levels are high in patients with systolic dysfunction, and the worse the heart class, the higher the BNP level.
     We tested whether DHF patients also have high BNP levels. A rapid blood test for BNP (Triage by Biosite Diagnostics) was used to detect DHF in patients having an echo whether or not they had ever had CHF before.

ECHO  All echos were interpreted by experienced cardiologists who were not told patients' BNP levels. Only patients with normal systolic function were studied. No hypertrophic cardiomyopathy patients were in this study either. Patients were classified into 4 heart filling patterns: 

  1. normal filling
  2. impaired heart muscle relaxation
  3. pseudonormal filling pattern (seeming normal but not really)
  4. restrictive-like filling pattern

PATIENTS  294 patients referred for an echo to check their heart function were studied. Patients whose echo was to check for valve disease were not included. Patients with abnormal systolic function were not included. Some eligible patients refused to participate. Patients' medical history was taken and their medical records were studied.

The Patients
 Patient
 Characteristic 
No Diastolic Dysfunction 
 (175 patients) 
Yes Diastolic Dysfunction 
 (119 patients) 
 Average Age   60 years   71 years 
 Sex   159 men and 16 women   106 men and 13 women 
 High Blood Pressure   58%   79% 
 Diabetes   35%   54% 
 Coronary Artery Disease   26%   50% 
 Shortness of Breath   34%   46% 
 Edema   19%   29% 
 History of CHF   one %   21% 

MEASURING BNP  Blood samples were kept at room temperature and analyzed within 4 hours of being taken from the patient. Each blood sample was analyzed 3 times using the Triage BNP test kit. The test kit is a disposable device. You add 250 ml of blood to it and the kit does the rest. See this article for more on how it works.

RESULTS  Patients were divided into 2 groups based on whether they showed normal or abnormal diastolic function on echo. Patients with abnormal echos were older and more likely to have CHF (35%), shortness of breath (46%), and edema (29%). They were also more likely to have high blood pressure, diabetes, and CAD.
     Patients diagnosed with DHF had an average BNP level of 286 pg/ml, while healthy patients had an average BNP level of 33 pg/ml.
     Patients with any abnormal mitral valve flow patterns had higher BNP levels than healthy people. Patients with the restrictive-like filling pattern had the highest levels (408 pg/mL). A BNP level of 62 pg/ml was 84% accurate for detecting DHF when systolic function was normal.
     Practically speaking, age, history of CHF, and BNP each contributed a lot to identifying DHF.

 Percent of patients with stated condition above or below the cut-off point of 62pg/ml 
 Characteristic   Average BNP   BNP under 62 pg/ml   BNP over 62 pg/ml 
 Left atrial enlargement 
 136 patients
 209   34.6%   65.4% 
 Left ventricle enlargement 
 120 patients 
 170   41.7%   58.3% 
 Left atrial and left 
 ventricle enlargement
 63 patients
 231   17.5%   82.5% 
 Impaired heart muscle 
 relaxation
 58 patients
 202 patients   25.9%   74.1% 
 Pseudo-normal 
 20 patients 
 294   10%   90% 
 Restrictive-like filling 
 41 patients 
 402   2.4%   97.6% 

HISTORY OF CHF  In patients with no history of CHF and no past measurements of heart function, 35% had DHF. This group had an average BNP level of 263 pg/ml compared to 33 pg/ml in healthy people (normal echo).

DISCUSSION  As many as 40% to 50% of patients diagnosed with heart failure have normal systolic function. The rate of diastolic heart failure increases with age:

  1. 15% to 25% in patients under 60 years of age
  2. 35% to 40% in patients from 60 to 70 years of age
  3. 50% in patients over 70 years of age

Usually you cannot tell diastolic heart failure from systolic heart failure just by medical history, physical exam, chest x-ray, and EKG. What you do is rule out other causes and you're then left with a DHF diagnosis. We've shown that a BNP test gives positive evidence of DHF.
     Using echo for diagnosing DHF has some definite limits: Blood velocity across the mitral valve can be altered by changes in heart rate, preload, afterload, the heart's squeezing strength, or valve regurgitation.
     The worse the heart function, the higher the BNP level. In patients with normal systolic function, high BNP levels accurately predict DHF, whether or not the patient has symptoms of heart failure.

CONCLUSIONS  The best treatment for diastolic heart failure has not yet been officially defined. The first step is to develop guidelines for diagnosing DHF. One proposed standard for diagnosing DHF requires solid evidence of heart failure, normal systolic function, and solid evidence of DHF. That third item currently requires a heart cath, so a quick blood test to help make the diagnosis would be great - especially in patients with normal systolic function.
     A low BNP level might remove the need for an echo in some patients. High BNP levels suggest that more tests are needed even in patients with very mild symptoms. Future studies will decide if BNP levels can be part of a gold standard for diagnosing DHF.
 
Title: Utility of B-Natriuretic Peptide in Detecting Diastolic Dysfunction, Comparison With Doppler Velocity Recordings
Authors: Emily Lubien, Anthony DeMaria, Padma Krishnaswamy, Paul Clopton, Jen Koon, Radmila Kazanegra, Nancy Gardetto, Erin Wanner, Alan S. Maisel.
Source: Circulation 2002;105:595-601.

 BNP Not Good Screening Test

September 11, 2002 - Blood BNP level is used to help diagnose heart failure in patients with symptoms who go to a doctor. Dr. Vasan Ramachandran says, "In this study, we asked a different question. Is blood BNP level a useful screening test for heart failure in patients without any symptoms?"
     To find out, Dr. Ramachandran studied information about 3,177 people (1,470 men and 1,707 women) in the Framingham Study. All had undergone a routine exam during a 4-year period that included an echo and BNP blood level test.
     BNP blood level was a poor screening tool for both enlarged heart size and reduced left heart function. It identified only about 30% of people with these problems. The test was even less useful in women than men. Summing up, Dr Ramachandran said that, "... good diagnostic tests need not be good screening tests."
Source: JAMA 2002;288:1252-1259.

 Men and Women At Risk Different

April 3, 2003 - Men and women at risk for heart "events" show different risk markers in blood tests. Men more often show high troponin T, troponin I, and CK-MB levels. Women show high CRP (C-reactive protein) and BNP levels more often. Dr. Stephen Wiviott presented this from the ongoing TACTICS-TIMI 18 trial.
     Troponin T levels were high in 57% of the men versus 47% of the women. Troponin I levels were high in 63% of the men versus 54% of the women. CK-MB levels were high in 42% of the men versus 29% of the women.
     On the other hand, 26% of the women had high CRP levels, compared to 21% of the men, and 25% of the women had high BNP levels, compared to 16% of the men. This knowledge may help blood tests be better used to accurately identify high risk men and women.
 
Source: Reuters Health coverage of the 52nd annual ACC scientific session

 Using BNP to Predict Future Events

April 2, 2003 - One European study suggests that BNP levels can help doctors decide which patients with advanced heart failure are most likely to die quickly, and so need a transplant fastest. Two other studies showed that certain patients with high BNP levels - but not heart failure - were more likely to have a heart attack or stroke.
     Scottish researchers measured BNP in 142 advanced heart failure patients. After 9 months, they compared those BNP readings for two groups of patients: those who died or needed an urgent transplant, and those who survived without transplant.
     Lead researcher Dr. Roy Gardner compared how well BNP predicted need for heart transplant compared to other tests commonly used like ejection fraction and Vo2max. Patients whose BNP levels were higher than the group average were 5 times more likely to die or need a quick transplant. Dr. Gardner told one reporter the BNP test "accurately identified patients at highest risk of death, so this single test can be used to stratify patients for transplant."

Austrian researchers measured BNP in 1,730 patients who were having heart caths. Within 3 months, 68 of the patients had died, suffered a stroke or heart attack, or needed an angioplasty to open clogged arteries. In this study, a BNP of 5000 pg/mL or higher predicted a 60% higher risk of dying within 3 months of leaving the hospital. A BNP of 1500 pg/mL meant a 37% increased risk.

A Danish study looked at BNP in 184 patients with high blood pressure and left heart damage. Patients with high BNP who did not have any known heart problems or diabetes were more likely to have a heart attack or stroke than similar patients with lower BNP. BNP levels did not predict heart attacks or strokes in people who had other heart problems, though.
 
Source: Intelihealth and Medscape coverage of the 52nd annual ACC scientific session

 BNP Test Needed In Emergency Rooms

September 21, 2003 - The REDHOT trial shows that BNP testing for CHF will help get the right patients into and out of the hospital at the right times. Dr. Alan Maisel said the trial shows a "strong disconnect" between how ER doctors perceive shortness of breath complaints and their actual seriousness as shown by BNP levels.
     REDHOT is a two phase trial studying BNP testing to manage people who might have heart failure in the ER. In the first phase, 464 patients visiting ERs with breathing difficulty had BNP levels measured on arrival, then every 3 hours in the ER, as well as at time of hospital admission or discharge. Doctors were only told whether the first BNP reading was more or less than 100 pg/mL - nothing further.
     With little knowledge of the test results, patients discharged from the ER had higher BNP levels than patients admitted to the hospital! Average BNP level in discharged patients was 976 pg/mL, 27% higher than the average BNP level in patients admitted to the hospital. (766 pg/mL).
     Most patients were admitted to the hospital from the ER. Of the admitted patients, 11% had BNP levels under 200 pg/mL, which indicates less severe CHF that does not usually need hospitalization.
     Seventy-eight percent of patients discharged home had BNP over 400 pg/mL. At 30 days, mortality in these patients was zero, but at 90 days was 9%. Other studies suggest that patients with BNP levels of 230 to 480 pg/mL are at risk for death or readmission so may need hospitalization.
     Dr. Maisel also described the savings possible using the BNP test in this situation. With total inpatient costs for CHF at $46 billion annually in the USA, savings based on the 11% of patients in this study with BNP under 200 pg/mL who did not need to be hospitalized might be over $500 million.
     BNP testing could identify patients in whom heart failure could be ruled out (BNP under 100 pg/mL). Other patients could probably be managed in the ER and then discharged if their BNP improved to 100 to 250 pg/mL. REDHOT's second phase has now started. In that phase, doctors will not be blinded to BNP test results.


Results of a similar European trial named BASEL (B-type Natriuretic Peptide for Acute Shortness of Breath Evaluation) were also recently reported. BASEL found that in 425 patients admitted to an ER with shortness of breath - 225 of whom had BNP tests - BNP testing reduced hospitalizations, need for intensive care, and total treatment time. Total treatment costs went down 25%. In BASEL, however, doctors were not blinded to BNP results.
 
Title: Primary results of the Rapid Emergency Department Heart Failure Outpatient Trial (REDHOT): A multi-center trial examining BNP levels, emergency physician decision-making and outcomes in patients presenting with shortness of breath.
Author: Maisel AS.
Source: Late Breaking and Recent Clinical Trials, presented at the 7th Annual Meeting of the Heart Failure Society of America; September 21-24, 2003; Las Vegas, Nevada.
Title: Brain natriuretic peptide for Acute Shortness of breath EvaLuation: a randomized comparison (BASEL).
Author: Muller C.
Source: Presented at the ESC Congress 2003; August 30 to September 3, 2003; Vienna, Austria. Hot Line I: Medical Treatment/Heart Failure, Presentation number 84.

 High BNP Level Predicts DHF

January 7, 2004 - We studied whether high blood BNP level can predict diastolic heart failure (DHF) whether or not the left side of the heart is enlarged.
     Nineteen patients were the DHF group. They were picked from 372 patients coming to a hospital emergency department for acute lung congestion, but without acute heart failure or heart attack. They had EFs averaging 45% on admission and were stable for the following year.
     A control group was 22 high blood pressure patients with left heart size at least as big as the DHF patients and with EFs also averaging 45%. Control patients had not yet suffered any heart-related symptoms.
     BNP level was higher in the DHF group (149 pg/ml) than in control patients (31 pg/ml). There was no difference in left heart size between groups. We conclude that high BNP blood level in patients with normal systolic function may indicate diastolic heart failure. This is true whether or not the left side of the heart is enlarged.
 
Title: Elevation of plasma brain natriuretic peptide is a hallmark of diastolic heart failure independent of ventricular hypertrophy.
Authors: Hitoshi Yamaguchi, Junichi Yoshida, Kazuhiro Yamamoto, Yasushi Sakata, Toshiaki Mano, Noriyuki Akehi, Masatsugu Hori, Young-Jae Lim, Masayoshi Mishima,Tohru Masuyama.
Source: J Am Coll Cardiol. 2004 Jan 7;43(1):55-60.
PMID: 14715184.

 BNP Test Good Risk Assessment at First CHF Hospitalization

February 2, 2006 - For people in the hospital with heart failure both BNP and echo test results can help decide how high-risk they really are. Echos are much more expensive. Is a BNP blood test just as useful while reducing cost?
     116 hospitalized CHFers were studied. None had suffered heart attacks and all were in normal heart rhythm. However, 40% had diabetes and about half had high blood pressure. Since this was a small trial with not-quite-usual CHFers, it's interesting results show the need for a larger, more inclusive trial.
     All patients had both a BNP blood test and an echo when ready to go home from the hospital. The primary endpoint was whether both tests predicted heart-related death or re-hospitalization for CHF. Average follow-up was 527 days and 110 patients completed the study.
     Half the CHFers reached primary endpoint - 17 died heart-related deaths and 37 were re-hospitalized for CHF. Echos predicted 52 of the 54 heart-related events while a BNP test predicted 47 of them. The dollar difference was huge with echo costing more than 8 times as much.
     The cutoff point where an event was predicted had to be set somewhere for the BNP test. In this study any BNP result over 250 pg/ml was said to predict a heart-related event. The BNP test was almost as accurate and vastly cheaper.
 
Source: theHeart.org
Source: Am J Cardiol. 2006 Feb 1;97(3):400-3
Title: Comparative cost-effectiveness of B-type natriuretic peptide and echocardiography for predicting outcome in patients with congestive heart failure.
Authors: Dokainish H, Zoghbi WA, Ambriz E, Lakkis NM, Quinones MA, Nagueh SF.
PMID: 16442404

All information on this site is opinion only. All concepts, explanations, trials, and studies have been re-written in plain English and may contain errors. I am not a doctor. Use the reference information at the end of each article to search MedLine for more complete and accurate information. All original copyrights apply. No information on this page should be used by any person to affect their medical, legal, educational, social, or psychological treatment in any way. I am not a doctor. This web site and all its pages, graphics, and content copyright © 1997, 1998, 1999, 2000, 2001, 2002, 2003, 2004, 2005, 2006 Jon C.

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