Objective
Cardiac secretion of brain natriuretic peptide (BNP) increases with the progression
of congestive heart failure (CHF). The plasma measurement of BNP emerged recently
as a useful, cost-effective biomarker for the diagnosis and prognosis of CHF.
Methods
BNP assay is useful for evaluating patients with acute dyspnea, because a low level
can help rule out CHF in primary care settings and reduce the demand for echocardiography.
Equally, BNP level can be particularly useful in recognizing heart failure in a patient
with acute dyspnea and a history of chronic obstructive pulmonary disease.
Results
However, although the clinical use of BNP as a biomarker in CHF is increasing, the
specificity of BNP in CHF is not strong, suggesting that other mechanisms beyond simple
ventricular stretch stimulate BNP release. Multiple disorders in the intensive care
unit, apart from CHF, cause elevated BNP levels, including cardiovascular disease
states such as ischemia, arrhythmias, cardiac hypertrophy, and coronary endothelial
dysfunction, as well as disorders of no cardiac origin, such as sepsis, septic shock,
and acute respiratory distress syndrome. Moreover, the impact of increased BNP in
patients with sepsis is not clear. The relationship between BNP and both left ventricular
ejection fraction and left-sided filling pressures is weak, and data on the prognostic
impact of high BNP levels in patients with sepsis are conflicting.
Conclusion
Nevertheless, this review highlights the potential benefits of BNP in the recognition
and management of heart failure, and defines the gray zones of BNP levels; it also
identifies conditions influencing BNP levels in relation to a certain heart failure
and describes conditions of no cardiac origin with increased BNP.
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