Brain natriuretic peptide: Difference between revisions

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==Effect on clinical decision making==
==Effect on clinical decision making==
Providing physicians quick access to BNP results may<ref name="pmid14960741">{{cite journal |author=Mueller C, Scholer A, Laule-Kilian K, ''et al.'' |title=Use of B-type natriuretic peptide in the evaluation and management of acute dyspnea |journal=N. Engl. J. Med. |volume=350 |issue=7 |pages=647–54 |year=2004 |month=February |pmid=14960741 |doi=10.1056/NEJMoa031681 |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=14960741&promo=ONFLNS19 |issn=}}</ref> or may not<ref name="pmid19293069">{{cite journal |author=Schneider HG, Lam L, Lokuge A, ''et al.'' |title=B-type natriuretic peptide testing, clinical outcomes, and health services use in emergency department patients with dyspnea: a randomized trial |journal=Ann. Intern. Med. |volume=150 |issue=6 |pages=365–71 |year=2009 |month=March |pmid=19293069 |doi= |url=http://www.annals.org/cgi/pmidlookup?view=long&pmid=19293069 |issn=}}</ref> improve the emergency evaluation of [[dyspnea]].
Providing physicians quick access to BNP results may<ref name="pmid14960741">{{cite journal |author=Mueller C, Scholer A, Laule-Kilian K, ''et al.'' |title=Use of B-type natriuretic peptide in the evaluation and management of acute dyspnea |journal=N. Engl. J. Med. |volume=350 |issue=7 |pages=647–54 |year=2004 |month=February |pmid=14960741 |doi=10.1056/NEJMoa031681 |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=14960741&promo=ONFLNS19 |issn=}}</ref> or may not<ref name="pmid19293069">{{cite journal |author=Schneider HG, Lam L, Lokuge A, ''et al.'' |title=B-type natriuretic peptide testing, clinical outcomes, and health services use in emergency department patients with dyspnea: a randomized trial |journal=Ann. Intern. Med. |volume=150 |issue=6 |pages=365–71 |year=2009 |month=March |pmid=19293069 |doi= |url=http://www.annals.org/cgi/pmidlookup?view=long&pmid=19293069 |issn=}}</ref> improve the emergency evaluation of [[dyspnea]].
==Clinical practice guidelines==
[[Clinical practice guideline]]s state regarding the BNP and NT-proBNP:<ref name="pmid19324966">{{cite journal| author=Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG et al.| title=2009 focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. | journal=Circulation | year= 2009 | volume= 119 | issue= 14 | pages= e391-479 | pmid=19324966
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=19324966 | doi=10.1161/CIRCULATIONAHA.109.192065 }} <!--Formatted by http://sumsearch.uthscsa.edu/cite/--></ref>
:"Measurement of natriuretic peptides (BNP and NT-proBNP) can be useful in the evaluation of patients presenting in the urgent care setting in whom the clinical diagnosis of HF is uncertain. Measurement of natriuretic peptides (BNP and NT-proBNP) can be helpful in risk stratification."


==References==
==References==
<references/>
<references/>

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In medicine, brain natriuretic peptide (BNP), also called B-Type natriuretic peptide, is a "peptide that is secreted by the brain and the heart atria, stored mainly in cardiac ventricular myocardium. It can cause natriuresis; diuresis; vasodilation; and inhibits secretion of renin and aldosterone. It improves heart function. It contains 32 amino acids."[1]

BNP is one member or a family of closely related peptides called "natriuretic peptides" because of their ability to stimulate sodium excretion (natriuresis). Natriuretic peptides are functional antagonists to the renin-angiotensin-aldosterone system. BNP was given its name because it was first discovered in the porcine brain. [2] However, confusingly, there appears to be relatively little BNP expressed in the brain compared to atrial natriuretic peptide [3] A related peptide is N-terminal pro-B-type natriuretic peptide.

An elevated concentration of BNP in the circulation can detect heart failure:[4]

Test accuracy

Usig the BNP to detect heart failure[4]
  Sensitivity Specificity
BNP > 100 pg per milliliter 90% 76%
BNP > 50 pg per milliliter 97% 62%

The optimal level to exclude heart failure may depend on the clinical setting.[5]

A value over 500 pg per milliliter is proposed to indicate that heart failure is likely[6]; however, the accuracy of that value is not certain.

Effect on clinical decision making

Providing physicians quick access to BNP results may[7] or may not[6] improve the emergency evaluation of dyspnea.

Clinical practice guidelines

Clinical practice guidelines state regarding the BNP and NT-proBNP:[8]

"Measurement of natriuretic peptides (BNP and NT-proBNP) can be useful in the evaluation of patients presenting in the urgent care setting in whom the clinical diagnosis of HF is uncertain. Measurement of natriuretic peptides (BNP and NT-proBNP) can be helpful in risk stratification."

References

  1. Anonymous (2024), Brain natriuretic peptide (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. Baxter GF (2004) The natriuretic peptides. Basic Res Cardiol 99:71-5. PMID 14963664
  3. Langub MC et al. (1995) Distribution of natriuretic peptide precursor mRNAs in the rat brain. J Comp Neurol 356:183-99. PMID 7629314
  4. 4.0 4.1 Maisel AS, Krishnaswamy P, Nowak RM, et al (July 2002). "Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure". N Engl J Med 347: 161–7. DOI:10.1056/NEJMoa020233. PMID 12124404. Research Blogging.
  5. Rogers RK, Stoddard GJ, Greene T, Michaels AD, Fernandez G, Freeman A et al. (2009). "Usefulness of adjusting for clinical covariates to improve the ability of B-type natriuretic peptide to distinguish cardiac from noncardiac dyspnea.". Am J Cardiol 104 (5): 689-94. DOI:10.1016/j.amjcard.2009.04.043. PMID 19699346. Research Blogging.
  6. 6.0 6.1 Schneider HG, Lam L, Lokuge A, et al. (March 2009). "B-type natriuretic peptide testing, clinical outcomes, and health services use in emergency department patients with dyspnea: a randomized trial". Ann. Intern. Med. 150 (6): 365–71. PMID 19293069[e]
  7. Mueller C, Scholer A, Laule-Kilian K, et al. (February 2004). "Use of B-type natriuretic peptide in the evaluation and management of acute dyspnea". N. Engl. J. Med. 350 (7): 647–54. DOI:10.1056/NEJMoa031681. PMID 14960741. Research Blogging.
  8. Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG et al. (2009). "2009 focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation.". Circulation 119 (14): e391-479. DOI:10.1161/CIRCULATIONAHA.109.192065. PMID 19324966. Research Blogging.