What is the role of BNP assays in the workup of dilated cardiomyopathy?

Updated: Mar 02, 2021
  • Author: Vinh Q Nguyen, MD, FACC; Chief Editor: Gyanendra K Sharma, MD, FACC, FASE  more...
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B-type natriuretic peptide (BNP) assays help monitor the presence and severity of fluid overload. Changes in BNP level can reflect response to treatment. A low level of BNP is helpful in ruling out the condition.

In one study, a serum BNP below 100 pg/mL proved useful in excluding heart failure as a cause of dyspnea in emergency department (ED) patients. [78] A number of studies have correlated BNP or NT-proBNP with a worse prognosis.

Tsutamoto et al found that plasma levels of BNP may be a better prognostic indicator of mortality in patients with chronic heart failure than atrial natriuretic peptide (ANP) and is able to provide prognostic information independent of other poor prognostic variables. [79] In their study of 85 patients with chronic heart failure (left ventricular ejection fraction [LVEF] < 45%) who were followed for 2 years, the nonsurvivors' (n = 25) BNP levels were 436 ± 83 pg/mL as compared to that of the survivors (n = 60), 89 ± 15 pg/mL. Of note, only 25 patients total were on beta blockers. [79]

In the PARADIGM-HF trial (Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortality and morbidity in Heart Failure), patients with heart failure and reduced LVEF who received sacubitril/valsartan had lower NT-proBNP levels after 12 weeks (from 783 pg/mL to 605 pg/mL) compared to patients on valsartan alone (from 862 pg/mL to 835 pg/mL). [80]  The decreased in NT-proBNP levels were associated with improved mortality (13.3% vs 16.5%, respectively).

In an analysis of data from 1215 patients with systolic heart failure to determine the utility of 5 predictors of mortality—blood urea nitrogen (BUN), BNP, peak VO2 (oxygen consumption), systolic blood pressure (SBP), and pulmonary capillary wedge pressure (PCWP)—BNP was the strongest predictor for death, urgent transplantation, and all-cause mortality in the 2-year follow-up period. [81] The C-statistic (concordance statistic; measures the predictive accuracy of a logistic regression model) for BNP was 0.756 (ie, a good model). On multivariate analysis of all-cause mortality, patients with BNP levels above 579 pg/mL had an odds ratio of 4.4. The 2-year survival for those with BNP levels over 579 pg/mL was 44% compared to 82% for those with BNP levels below 579 pg/mL. [81]

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