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

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Abstract

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.

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Abbreviations

ADHF:

Acute decompensated heart failure

AF:

Atrial fibrillation

BMI:

Body mass index

BNP:

Brain natriuretic peptide/B-type natriuretic peptide

CHF:

Congestive heart failure

COPD:

Chronic obstructive pulmonary disease

GFR:

Glomerular filtration rate

NP:

Natriuretic peptides

NPV:

Negative predictive value

NT-proBNP:

N-terminal pro brain natriuretic peptide

RCM:

Restrictive cardiomyopathy

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Acknowledgments

The authors would like to thank Dr. Priya Kohli for her assistance with this manuscript.

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Authors and Affiliations

  1. Department of Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Michael A. Burke

  2. Division of Cardiology, Department of Internal Medicine, Feinberg School of Medicine, 201 East Huron Street, Galter 11-120, Chicago, IL, 60611, USA

    William G. Cotts

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Correspondence to William G. Cotts.

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Burke, M.A., Cotts, W.G. Interpretation of B-type natriuretic peptide in cardiac disease and other comorbid conditions. Heart Fail Rev 12, 23–36 (2007). https://doi.org/10.1007/s10741-007-9002-9

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