Are Serial BNP Measurements Useful in Heart Failure Management?: Serial Natriuretic Peptide Measurements Are Not Useful in Heart Failure Management The Art of Medicine Remains Long

Natriuretic peptides, including B-type natriuretic peptide (BNP) and N-terminal-proBNP (NT-proBNP), have emerged as powerful markers of cardiovascular risk in patients with heart failure.1 Circulating natriuretic peptide (NP) levels add incremental prognostic value to standard clinical risk stratification algorithms for both ambulatory and hospitalized heart failure patients, with a steady increase in the risk of mortality and recurrent heart failure hospitalization as NT-proBNP levels rise above 1000 pg/mL.2–5 A systematic review of 19 studies of patients with heart failure demonstrated that for every 100-pg/mL rise in BNP concentration, there was a corresponding 35% increase in the relative risk of death.6 Response by Januzzi and Troughton on p 516 Beyond the prognostic value of a single NP measurement, changes in NP concentrations over time may help to further stratify risk.2,7 Reductions in NP levels, whether achieved spontaneously or through application of appropriate medical therapy, appear to be associated with improvement in clinical outcomes.8,9 In the Valsartan Heart Failure Trial, subjects with the largest proportional reductions in BNP levels at 4 months after randomization experienced the best outcomes, whereas those with the greatest increase in BNP levels experienced the highest event rates.7 Among patients hospitalized with decompensated heart failure, both predischarge NP levels and the relative change in NP levels during hospital treatment are strong predictors of the risk for death or hospital readmission at 6 months.8,10,11 In addition to their association with risk for adverse cardiovascular outcomes, circulating levels of NP appear to vary in relationship to the biology of heart failure progression. NP levels tend to rise during acute heart failure decompensation and to fall with successful treatment in a pattern that mirrors reductions in filling pressure, improvements in left ventricular structure and function, …

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[70]  G. Fonarow,et al.  Relationship between admission serum sodium concentration and clinical outcomes in patients hospitalized for heart failure: an analysis from the OPTIMIZE-HF registry. , 2007, European heart journal.

[71]  K. Swedberg,et al.  Effects of oral tolvaptan in patients hospitalized for worsening heart failure: the EVEREST Outcome Trial. , 2007, JAMA.

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[73]  J. Cohn,et al.  Direct comparison of B-type natriuretic peptide (BNP) and amino-terminal proBNP in a large population of patients with chronic and symptomatic heart failure: the Valsartan Heart Failure (Val-HeFT) data. , 2006, Clinical chemistry.

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[76]  J. Cohn,et al.  Incremental prognostic value of changes in B-type natriuretic peptide in heart failure. , 2006, The American journal of medicine.

[77]  R. Califf,et al.  Lower Serum Sodium Is Associated With Increased Short-Term Mortality in Hospitalized Patients With Worsening Heart Failure: Results From the Outcomes of a Prospective Trial of Intravenous Milrinone for Exacerbations of Chronic Heart Failure (OPTIME-CHF) Study , 2005, Circulation.

[78]  A. Dobson,et al.  How well does B-type natriuretic peptide predict death and cardiac events in patients with heart failure: systematic review , 2005, BMJ : British Medical Journal.

[79]  A. Ferreira,et al.  N-Terminal–Pro-Brain Natriuretic Peptide Predicts Outcome After Hospital Discharge in Heart Failure Patients , 2004, Circulation.

[80]  J. Rouleau,et al.  Prognostic Impact of Plasma N-Terminal Pro–Brain Natriuretic Peptide in Severe Chronic Congestive Heart Failure: A Substudy of the Carvedilol Prospective Randomized Cumulative Survival (COPERNICUS) Trial , 2004, Circulation.

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[82]  Gabriel Thabut,et al.  Predischarge B-type natriuretic peptide assay for identifying patients at high risk of re-admission after decompensated heart failure. , 2004, Journal of the American College of Cardiology.

[83]  J. Cohn,et al.  The comparative prognostic value of plasma neurohormones at baseline in patients with heart failure enrolled in Val-HeFT. , 2004, European heart journal.

[84]  MiltonPacker.  Should B-Type Natriuretic Peptide Be Measured Routinely to Guide the Diagnosis and Management of Chronic Heart Failure? , 2003 .

[85]  F. van Lente,et al.  Plasma B-Type Natriuretic Peptide Levels in Ambulatory Patients With Established Chronic Symptomatic Systolic Heart Failure , 2003, Circulation.

[86]  L. Fisher,et al.  Changes in Brain Natriuretic Peptide and Norepinephrine Over Time and Mortality and Morbidity in the Valsartan Heart Failure Trial (Val-HeFT) , 2003, Circulation.

[87]  Douglas W Mahoney,et al.  Plasma brain natriuretic peptide concentration: impact of age and gender. , 2002, Journal of the American College of Cardiology.

[88]  M. Redfield,et al.  The potential of brain natriuretic peptide as a biomarker for New York Heart Association class during the outpatient treatment of heart failure. , 2002, Journal of cardiac failure.

[89]  R. Latini,et al.  [Treatment of heart failure guided by plasma aminoterminal brain natriuretic peptide (N-BNP) concentrations]. , 2000, Italian heart journal. Supplement : official journal of the Italian Federation of Cardiology.

[90]  M. Metra,et al.  Clinical relevance and management of the major electrolyte abnormalities in congestive heart failure: hyponatremia, hypokalemia, and hypomagnesemia. , 1994, American heart journal.

[91]  A. Struthers,et al.  Plasma brain natriuretic peptide as an indicator for angiotensin-converting-enzyme inhibition after myocardial infarction , 1993, The Lancet.

[92]  M. Packer,et al.  Prognostic importance of serum sodium concentration and its modification by converting-enzyme inhibition in patients with severe chronic heart failure. , 1986, Circulation.