Difference between revisions of "Template:BNP value"

(Differential Diagnosis (Elevated))
(Brain natriuretic peptide (BNP)Maisel AS, Krishnaswamy P, Nowak RM, et al. Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med. 2002;347(3):161-167. doi:10.1056/NEJMoa020233.)
 
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===[[Brain natriuretic peptide (BNP)]]===
+
===[[Brain natriuretic peptide (BNP)]]<ref>Maisel AS, Krishnaswamy P, Nowak RM, et al. Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med. 2002;347(3):161-167. doi:10.1056/NEJMoa020233.</ref>===
*<100 [[CHF]] ruled out (Sn 90%, NPV 89%)
+
*Measurement
*100-500: Consider differential diagnosis and pre-test probability
+
**'''<100 pg/mL''': Negative for acute CHF (Sn 90%, NPV 89%)
*> 500 Positive ([[CHF]] Sp 87%, PPV 90%)  
+
**'''100-500 pg/mL''': Indeterminate (Consider differential diagnosis and pre-test probability)
 +
**'''>500 pg/mL''': Positive for acute CHF (Sp 87%, PPV 90%)
 +
**Combination of BNP with clinician judgment 94% sensitive 70% specific (compared to 49% sn and 96% spec clinical judgement alone) <ref> McCullough et al. B-Type natriuretic peptide and clinical judgment in emergency diagnosis of heart failure: analysis from breathing not properly (BNP) multinational study. Circulation. 2002:DOI: 10.1161/01.CIR.0000025242.79963.4</ref>
  
==== Differential Diagnosis (Elevated)====
+
===[[NT-proBNP]]<ref>Januzzi JL, van Kimmenade R, Lainchbury J, et al. NT-proBNP testing for diagnosis and short-term prognosis in acute destabilized heart failure: an international pooled analysis of 1256 patients: the International Collaborative of NT-proBNP Study. Eur Heart J. 2006 Feb. 27(3):330-7.</ref><ref>Kragelund C, Gronning B, Kober L, Hildebrandt P, Steffensen R. N-terminal pro-B-type natriuretic peptide and long-term mortality in stable coronary heart disease. N Engl J Med. 2005 Feb 17. 352(7):666-75.</ref><ref>Moe GW, Howlett J, Januzzi JL, Zowall H,. N-terminal pro-B-type natriuretic peptide testing improves the management of patients with suspected acute heart failure: primary results of the Canadian prospective randomized multicenter IMPROVE-CHF study. Circulation. 2007 Jun 19. 115(24):3103-10.</ref>===
* [[CHF]]/[[ACS]]/[[Cardiogenic shock]]
+
*<300 pg/mL → [[CHF]] unlikely
* [[PE]]
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*[[CHF]] likely in:
* [[Pulmonary Hypertension]]
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**'''>450 pg/mL''' in age < 50 years old
* [[Renal Failure]]
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**'''>900 pg/mL''' in 50-75 years old
 
+
**'''>1800 pg/mL''' in > 75 years old
''May have false negatives with obesity and diastolic dysfunction''
 

Latest revision as of 21:51, 24 November 2019

Brain natriuretic peptide (BNP)[1]

  • Measurement
    • <100 pg/mL: Negative for acute CHF (Sn 90%, NPV 89%)
    • 100-500 pg/mL: Indeterminate (Consider differential diagnosis and pre-test probability)
    • >500 pg/mL: Positive for acute CHF (Sp 87%, PPV 90%)
    • Combination of BNP with clinician judgment 94% sensitive 70% specific (compared to 49% sn and 96% spec clinical judgement alone) [2]

NT-proBNP[3][4][5]

  • <300 pg/mL → CHF unlikely
  • CHF likely in:
    • >450 pg/mL in age < 50 years old
    • >900 pg/mL in 50-75 years old
    • >1800 pg/mL in > 75 years old
  • Maisel AS, Krishnaswamy P, Nowak RM, et al. Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med. 2002;347(3):161-167. doi:10.1056/NEJMoa020233.
  • McCullough et al. B-Type natriuretic peptide and clinical judgment in emergency diagnosis of heart failure: analysis from breathing not properly (BNP) multinational study. Circulation. 2002:DOI: 10.1161/01.CIR.0000025242.79963.4
  • Januzzi JL, van Kimmenade R, Lainchbury J, et al. NT-proBNP testing for diagnosis and short-term prognosis in acute destabilized heart failure: an international pooled analysis of 1256 patients: the International Collaborative of NT-proBNP Study. Eur Heart J. 2006 Feb. 27(3):330-7.
  • Kragelund C, Gronning B, Kober L, Hildebrandt P, Steffensen R. N-terminal pro-B-type natriuretic peptide and long-term mortality in stable coronary heart disease. N Engl J Med. 2005 Feb 17. 352(7):666-75.
  • Moe GW, Howlett J, Januzzi JL, Zowall H,. N-terminal pro-B-type natriuretic peptide testing improves the management of patients with suspected acute heart failure: primary results of the Canadian prospective randomized multicenter IMPROVE-CHF study. Circulation. 2007 Jun 19. 115(24):3103-10.