Plasma brain natriuretic peptide after long-term treatment for heart failure in general practice.
OBJECTIVE
Plasma brain natriuretic peptide (BNP) concentrations are known to have high sensitivity and specificity in the diagnosis of heart failure in newly symptomatic patients. The relationship of plasma BNP to cardiac function in stable patients on long-term established treatment for heart failure is unknown. Plasma BNP was assessed for its ability to predict echocardiographic abnormality in 100 patients receiving long-term treatment in general practice for a provisional diagnosis of heart failure.


RESULTS
BNP >35 pmol/l had a sensitivity and specificity of 69% and 67%, respectively, for a left ventricular ejection fraction of <45%. However, 19% of patients had an LVEF of below 45% whilst BNP was below 35 pmol/l. These patients, in whom a diagnosis of heart failure had been made years previously (mean 3.9 years), were all clinically stable on treatment.


CONCLUSIONS
These findings support the view that BNP can be restored to normal levels in well-compensated patients despite persisting significant systolic dysfunction and suggest that BNP assays may be helpful for monitoring adequacy of therapy. BNP assays will have limited utility in the diagnosis of cardiac impairment once anti-failure therapy is well established and symptoms have been abolished.
McGeoch
Graham
G
Department of Public Health and General Practice, The Christchurch School of Medicine, University of Otago, New Zealand. graham_m@pegasus.org.nz
Lainchbury
John
J
Town
G Ian
GI
Toop
Les
L
Espiner
Eric
E
Richards
A Mark
AM
D000368:Aged; D000369:Aged, 80 and over; D002316:Cardiotonic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D004452:Echocardiography; D005194:Family Practice; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000188:drug therapy*; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D013599:Systole / Q000187:drug effects; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000188:drug therapy; D016277:Ventricular Function, Left / Q000187:drug effects
D002316:Cardiotonic Agents; D020097:Natriuretic Peptide, Brain