doi: 10.1161/01.CIR.0000019121.91548.C2
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(Circulation. 2002;105:2328.)
© 2002 American Heart Association, Inc.
B-Type Natriuretic Peptide Levels: Diagnostic and Prognostic in Congestive Heart Failure
What’s Next?
From the Division of Cardiology and the Department of Medicine, Veteran’s Affairs Medical Center and University of California, San Diego.
Correspondence to Alan Maisel, MD, VAMC Cardiology 111-A, 3350 La Jolla Village Dr, San Diego, CA 92161. E-mail amaisel@ucsd.edu
Key Words: Editorials • natriuretic peptides • heart failure, congestive • tests • risk factors
Although major advances in our understanding of the pathophysiology of congestive heart failure (CHF) have resulted in treatments that lead to symptomatic improvement and longer life, CHF still remains a major clinical challenge, especially in the areas of diagnosis, prognosis, and risk stratification. For the first time since the introduction of echocardiography some 20 years ago, a simple blood test appears to offer a significant advance in these areas.
See p 2392
B-type natriuretic peptide (BNP) is a neurohormone secreted mainly in the cardiac ventricles in response to volume expansion and pressure overload.1,2 Activation of BNP in patients with left ventricular (LV) dysfunction has generated considerable interest in both its diagnostic and prognostic properties. Although data have shown that BNP levels correlate with the severity and prognosis of heart failure,3,4 it was not until the development of a rapid, inexpensive assay that BNP could be used in the active clinical setting. In fact, present data, including the article in this issue of Circulation by Berger et al,5 suggest that BNP has finally cemented its role in these areas.
BNP in the Diagnosis of Dyspnea
For diagnostic screening tests to be useful in acute care, a test should have a high negative predictive value by itself and, along with clinical findings, should aid in the identification of patients whose dyspnea is a result of CHF. Davis et al,6 who measured the natriuretic hormones atrial natriuretic peptide and BNP in 52 patients presenting with acute dyspnea, found that admission plasma BNP concentrations more accurately reflected the final diagnosis
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