B-type natriuretic peptide in the diagnosis and management of congestive heart failure.

Finding a simple blood test that would aid in the diagnosis and management of patients with CHF clearly would have a favorable impact on the staggering costs associated with the disease. BNP, which is synthesized in the cardiac ventricles and correlates with LV pressure, amount of dyspnea, and the state of neurohormonal modulation, makes this peptide the first potential "white count" for heart failure. The fact that a point-of-care rapid assay for BNP has been approved by the FDA gives the clinician an opportunity to explore its potential usefulness. The author's data, and data from others, suggest that serial point-of-care testing of BNP will be of immense help in patients presenting to urgent care clinics with dyspnea. Additionally, BNP might serve as a screen for patients referred for echocardiography. A low BNP level makes echocardiographic indices of LV dysfunction (systolic and diastolic) highly unlikely. BNP also might be an effective way to improve the in-hospital management of patients admitted with decompensated CHF. In some instances, BNP levels may obviate the need for invasive hemodynamic monitoring and, in cases where such monitoring is used, may help tailor treatment of the decompensated patient. Finally, the role of BNP in the outpatient cardiac or primary care clinic may be one of critical importance in titration of therapies and in assessment of the state of neurohormonal compensation of the patient.