Laboratory testing for B-type natriuretic peptides (BNP and NT-proBNP): clinical usefulness, utilization, and impact on hospital operations.

B-type natriuretic peptides (BNP, NT-proBNP) are involved in cardiovascular remodeling, fluid and electrolyte balance, and myocardial response to coronary ischemia. Recent literature has demonstrated the usefulness of natriuretic peptides in the diagnosis of congestive heart failure (CHF). Further studies also have shown that B-type natriuretic peptides (BNPs) are useful to guide therapy in patients with established CHF and might be useful to estimate prognosis in patients with CHF and in those with left ventricular dysfunction due to acute coronary syndromes. Consequently, the majority of laboratories in the United States perform testing for BNP or its inactive aminoterminal fragment, NT-proBNP Most experts agree that blood levels of BNP and NT-proBNP can be used interchangeably, although important differences have been identified. Although the clinical usefulness of BNPs has been well described, few studies have reported data on the utilization of these markers or their impact on patient outcomes and hospital operations. This review describes the biochemical characteristics, clinical usefulness, patterns of utilization, and economic impact of laboratory testing for the BNPs.