Practical considerations for BNP use.

The evolving paradigm of heart failure has now been expanded to include the favorable neurohormonal, structural and hemodynamic profile of B-type natriuretic peptide [BNP]. As a marker of left ventricular dysfunction, BNP is a practical tool that facilitates diagnosis, contributes to prognostic evaluations and tracks disease severity. BNP elevations vary according to gender, disease states and perhaps obesity but in general elevated levels are consistent not only with left ventricular stress but likely represent the best surrogate for ongoing left ventricular remodeling. The full utility of BNP surveys has not yet been realized but emerging areas of use include clinical assessment by physician extenders, post-MI assessment, and a target of tailored therapy for heart failure. New biomarkers for heart failure similar to BNP are on the horizon but their clinical niche has yet to be determined.