The value of BNP and NT-ProBNP testing in the diagnosis of heart failure

Abstract

Heart failure (HF) is the situation in which the heart isn’t able to meet the hemodynamic and metabolic needs of the body. HF is a medical emergency, which depends on quick diagnosis, in the context of the presence of nonspecific symptoms common to many pathologies, including shortness of breath, fatigue, tachycardia and rhythm disorders Initial misdiagnosis occurs in approximately 15­ 20% of patients presenting to the emergency department with dyspnea secondary to an exacerbation of heart failure. The objective of this work is to present a method for optimizing the diagnosis of HF with irrelevant clinical features or associated with other diseases, clinical masking HF. According to international statistics, the determination of BNP and NT-proBNP proved to be useful in diagnosis of left HF in patients with suspected HF and in the differential diagnosis of severe dyspnea of cardiac or respiratory etiology. The natriuretic peptides (ANP, BNP, CNP, DNP) constitute a family of cardiac polypeptides which presents three main proprieties: natriuretic, diuretic and vasodilating. BNP is a natriuretic hormone released primarily by the myocardial cells from the left ventricle (LV) in response to increased volume expansion and wall stress. An elevated BNP or NT-proBNP level is a marker of increased LV filling pressure and LV dysfunction. BNP or NT-proBNP determination, has both diagnostic (BNP - normal: 100-500pg/ml; NT-proBNP - normal: <75 years - <125 pg / ml,> 75 years - 450 pg / ml) and predicting value in the evolution of HF. Serum level of BNP and NT-proBNP is age-dependent, it increases in cases of renal failure, atrial fibrillation and it decreases in obesity. Diagnostic thresholds of BNP and NT-proBNP are different in case of presence of these factors.