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Best Tests December 2005

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BNP in heart failure

Heart failure can be difficult to diagnose, particularly in the early stages or when the disease is masked by other conditions. BNP and NT-proBNP are naturally occurring hormones synthesised in the cardiac ventricles. Levels are sensitive for elevated filling pressures in patients with left ventricular dysfunction, but the test may also be affected by age, gender, renal function, body habits, and underlying etiology of heart failure. The greatest clinical usefulness of BNP and NT-proBNP lies in excluding heart failure in a patient with equivocal symptoms.

  • Testing is not recommended in patients with an obvious clinical diagnosis of heart failure but may be useful when the diagnosis is in doubt.
  • BNP or NT-proBNP testing should not be used to replace conventional assessment of left ventricular structural or functional abnormalities (e.g. echocardiography, invasive haemodynamic assessment).
  • The diagnostic ranges and cost-effectiveness of plasma BNP or NT-proBNP are controversial for the identification of patients with left ventricular systolic dysfunction in the post-MI setting, or in patients at high risk of developing heart failure (e.g. history of myocardial infarction, diabetes mellitus).

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