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Natriuretic Peptide testing in primary care.

Rehman SU, Januzzi JL - Curr Cardiol Rev (2008)

Bottom Line: The optimal approach for applying NP testing in general populations is to select the target population and optimal cut off values carefully.Superior diagnostic performance is observed among those with higher baseline risk (such as hypertensives or diabetics).Among those with established HF, it is logical to assume that titration of treatment to achieve lower NPs levels may be advantageous.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine and Division of Cardiology, Harvard Medical School and Massachusetts General Hospital, Boston, MA, 02114, USA.

ABSTRACT
The incidence, as well as the morbidity and mortality associated with heart failure (HF) continue to rise despite advances in diagnostics and therapeutics. A recent advance in the diagnostic and therapeutic approach to HF is the use of natriuretic peptide (NP) testing, including both B-type natriuretic peptide (BNP) and its amino terminal cleavage equivalent (NT-proBNP). NPs may be elevated at an early stage among those with symptoms as well among those without. The optimal approach for applying NP testing in general populations is to select the target population and optimal cut off values carefully. Superior diagnostic performance is observed among those with higher baseline risk (such as hypertensives or diabetics). As well, unlike for acute HF, the cut off value for outpatient testing for BNP is 20-40 pg/mL and for NTproBNP it is 100-150 ng/L. In symptomatic primary care patients, both BNP and NT-proBNP serve as excellent tools for excluding HF based on their excellent negative predictive values and their use may be cost effective. Among those with established HF, it is logical to assume that titration of treatment to achieve lower NPs levels may be advantageous. There are several ongoing trials looking at that prospect.

No MeSH data available.


Related in: MedlinePlus

A suggested algorithm for evaluation of symptomatic patients.Clinical evaluation should be supplemented with natriuretic peptide measurement.
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Figure 3: A suggested algorithm for evaluation of symptomatic patients.Clinical evaluation should be supplemented with natriuretic peptide measurement.

Mentions: Thus, in the presence of symptoms, a general recommendation would be to apply NP testing with the goal to exclude HF. Using cut-points of 20-40 pg/mL for BNP and 125-150 ng/L for NT-proBNP provides excellent NPV in this regard. Results above these levels do not necessarily confirm HF, but suggest that further evaluation is necessary (Fig. 3). Importantly, age exerts a significant effect on NP concentrations, thus, lower cut-points might be useful for younger patients, while higher cut-points (e.g. an NT-proBNP of 300-450 ng/L) might provide superior NPV for elders. The optimal cut-points for BNP in elders remain unclear.


Natriuretic Peptide testing in primary care.

Rehman SU, Januzzi JL - Curr Cardiol Rev (2008)

A suggested algorithm for evaluation of symptomatic patients.Clinical evaluation should be supplemented with natriuretic peptide measurement.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2801862&req=5

Figure 3: A suggested algorithm for evaluation of symptomatic patients.Clinical evaluation should be supplemented with natriuretic peptide measurement.
Mentions: Thus, in the presence of symptoms, a general recommendation would be to apply NP testing with the goal to exclude HF. Using cut-points of 20-40 pg/mL for BNP and 125-150 ng/L for NT-proBNP provides excellent NPV in this regard. Results above these levels do not necessarily confirm HF, but suggest that further evaluation is necessary (Fig. 3). Importantly, age exerts a significant effect on NP concentrations, thus, lower cut-points might be useful for younger patients, while higher cut-points (e.g. an NT-proBNP of 300-450 ng/L) might provide superior NPV for elders. The optimal cut-points for BNP in elders remain unclear.

Bottom Line: The optimal approach for applying NP testing in general populations is to select the target population and optimal cut off values carefully.Superior diagnostic performance is observed among those with higher baseline risk (such as hypertensives or diabetics).Among those with established HF, it is logical to assume that titration of treatment to achieve lower NPs levels may be advantageous.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine and Division of Cardiology, Harvard Medical School and Massachusetts General Hospital, Boston, MA, 02114, USA.

ABSTRACT
The incidence, as well as the morbidity and mortality associated with heart failure (HF) continue to rise despite advances in diagnostics and therapeutics. A recent advance in the diagnostic and therapeutic approach to HF is the use of natriuretic peptide (NP) testing, including both B-type natriuretic peptide (BNP) and its amino terminal cleavage equivalent (NT-proBNP). NPs may be elevated at an early stage among those with symptoms as well among those without. The optimal approach for applying NP testing in general populations is to select the target population and optimal cut off values carefully. Superior diagnostic performance is observed among those with higher baseline risk (such as hypertensives or diabetics). As well, unlike for acute HF, the cut off value for outpatient testing for BNP is 20-40 pg/mL and for NTproBNP it is 100-150 ng/L. In symptomatic primary care patients, both BNP and NT-proBNP serve as excellent tools for excluding HF based on their excellent negative predictive values and their use may be cost effective. Among those with established HF, it is logical to assume that titration of treatment to achieve lower NPs levels may be advantageous. There are several ongoing trials looking at that prospect.

No MeSH data available.


Related in: MedlinePlus