Recommended Clinical Use of B-Type Natriuretic Peptide (BNP) and Congestive Heart Failure.
| Clinical Scenario | BNP Level | Recommendation |
|---|---|---|
| Diagnostic uses of BNP* | ||
| Screening asymptomatic patients for left ventricular dysfunction and heart failure | Not available | No evidence supports use of BNP for mass screening |
| Acute symptoms without a history of left ventricular dysfunction or CHF | >80 pg/mL | Suggestive of an acute exacerbation of CHF |
| Acute symptoms with history of left ventricular dysfunction | >80 pg/mL–<200 pg/mL | Limited diagnostic value |
| Without known BNP baseline | >200 pg/mL | Limited diagnostic value but possible acute exacerbation of CHF |
| Correlate with New York Heart Association classification (Table 3) | ||
| With known BNP baseline | Increase of BNP >2–3 times baseline suggests acute exacerbation of CHF. Mild to moderate increases can suggest natural progression of CHF or other causes | |
| Prognostic utility or therapeutic monitoring value of BNP | ||
| Hospitalized patient | ||
| Without known BNP baseline | Consider observing a downward trend of BNP before discharge | |
| With known BNP baseline | Consider observing a downward trend of BNP before discharge or attempt to bring BNP level back to patient’s baseline | |
| Outpatient | ||
| Left ventricular dysfunction CHF, well controlled | Goal: <100 pg/mL | Consider aggressive management based on BNP level. Adjust therapy when BNP >200 pg/mL. Consider monitoring effects of therapy by BNP levels. |
| Left ventricular dysfunction, CHF poorly controlled or deteriorating | Maintain baseline BNP | Monitor effects of therapy by BNP levels. Limited diagnostic value otherwise |
| Conditions affecting BNP levels | Cause | |
| Cardiovascular | Myocardial infarction | |
| Cardiomyopathy | ||
| Ventricular hypertrophy | ||
| Pulmonary | Pulmonary embolism | |
| COPD | ||
| Lung cancer | ||
| Infectious | Tuberculosis | |
| Renal | Renal failure |
CHF—congestive heart failure, COPD—chronic obstructive pulmonary disease.
* Include thorough history and physical examination. Consider other causes of elevated BNP based on clinical signs and symptoms (dyspnea, chest pain, peripheral edema, paroxysmal nocturnal dyspnea, dyspnea with exertion, dry cough, etc).