Heart Failure and the BNP Blood Test

Heart Failure and the BNP Blood Test

Article from
webmed: https://www.webmd.com/heart-disease/heart-failure/bnp-blood-test

When you have heart failure, your heart makes two proteins. Your doctor will call them B-type natriuretic peptide (BNP) and N-terminal-pro-BNP (NT-pro-BNP). Levels of both in your blood go up when your heart failure gets worse and go down when it gets better.

A test called a BNP blood test measures those two important levels. It’s able to spot heart failure more than 80% of the time.

Why Is a BNP Blood Test Needed?
BNP levels help your doctor figure out if you have heart failure or something else that has similar symptoms such as shortness of breath. The test also shows if your heart failure has worsened. It’ll help your doctor decide what treatments you need and if you need to be hospitalized. It may also give him a look into what the future may hold. It is a sensitive test to allow the doctor to evaluate improvement or worsening of heart failure and to help monitor whether or not the medication is working well.

Depending on your medical center, you may get tested for one or both proteins.

What Happens During a BNP Blood Test?
A small amount of blood will be taken from you. Then it’s placed in a machine that reads the level of BNP and NT-pro-BNP. The test takes about 15 minutes. In some places, the blood sample needs to be sent away to a lab to be tested.

What Do the Results of the BNP Blood Test Mean?
The level of BNP tends to increase as heart failure gets worse. But it can also increase with age. Testing BNP levels is one of the most sensitive ways to show how well you're doing on heart failure treatment.

Ask your doctor to explain the results of your BNP tests.

Note: This article is about heart failure diagnosis and not common as ECG or EKG, So I had decided to share it on this blog. Original article is from webmed and the actual article link is over there.

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DETAIL ABOUT Brain Natriuretic peptide
NT-proB-type Natriuretic Peptide (BNP)

Article From: https://my.clevelandclinic.org/health/articles/b-type-natriuretic-peptide-bnp-bloodtest

NT-proB-type Natriuretic Peptide (BNP) blood test
B-type natriuretic peptide (BNP) is a hormone produced by your heart. N-terminal (NT)-pro hormone BNP (NT-proBNP) is a non-active prohormone that is released from the same molecule that produces BNP. Both BNP and NT-proBNP are released in response to changes in pressure inside the heart. These changes can be related to heart failure and other cardiac problems. Levels goes up when heart failure develops or gets worse, and levels goes down when heart failure is stable. In most cases, BNP and NT-proBNP levels are higher in patients with heart failure than people who have normal heart function.

How is my level of BNP/NT-proBNP measured?
You may hear your healthcare team refer to BNP or NT-proBNP levels, depending on the equipment used by the laboratory. BNP and NT-proBNP are measured as a simple blood test to help diagnose and monitor heart failure. BNP and NT-proBNP test results provide different values. At Cleveland Clinic, doctors rely mostly on NT-proBNP testing to monitor patients with heart failure. You do not need to fast or do anything to prepare for the test.

What do the results mean?
The results help your doctor or nurse determine if you have heart failure, if worsening fatigue or shortness of breath are due to heart failure or another problem or if heart failure has progressed toward end-of-life. It is important to note that this test is only one method your doctor or nurse uses to monitor your condition. Based on your results, your doctor can choose the best treatment plan for you.

A normal level of NT-proBNP, based on Cleveland Clinic’s Reference Range is:
Less than 125 pg/mL for patients aged 0-74 years
Less than 450 pg/mL for patients aged 75-99 years
If you have heart failure, the following NT-proBNP levels could mean your heart function is unstable:

Higher than 450 pg/mL for patients under age 50
Higher than 900 pg.mL for patients age 50 and older
Your doctor or nurse can give you more specific information about your test results. Depending on your personal health history, your normal range may differ from other patients with different backgrounds.

More information about BNP/NT-proBNP is available in the references below.

References:
♦Yancy, CW, Jessup M, Bozkurt B, et al. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. July 11, 2017, Volume 136, Issue 2. http://circ.ahajournals.org/content/early/2017/04/26/CIR.0000000000000509
♦Yancy, CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.  Circulation. 2013 Jun 5 (epub ahead of print). http://circ.ahajournals.org/content/early/2013/06/03/CIR.0b013e31829e8776
♦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;27:330 –337. http://eurheartj.oxfordjournals.org/content/27/3/330.long


This information is about testing and procedures and may include instructions specific to Cleveland Clinic. Please consult your physician for information pertaining to your testing.

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CLINICAL DATA
B-Type Natriuretic Peptide (BNP), Plasma

Article From: https://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/83873

Useful For 
Aids in the diagnosis of congestive heart failure (CHF)

The role of brain natriuretic peptide in monitoring CHF therapy is under investigation

Clinical Information
B-type natriuretic peptide (brain natriuretic peptide; BNP) is a 32-amino acid-ringed peptide secreted by the heart to regulate blood pressure and fluid balance.(1) BNP is stored in and secreted predominantly from membrane granules in the heart ventricles, and is continuously released from the heart in response to both ventricle volume expansion and pressure overload.(2)

The natriuretic peptide system and the renin-angiotensin system counteract each other in arterial pressure regulation. When arterial pressure decreases, the kidneys release renin, which activates angiotensinogen resulting in increased peripheral resistance of the arterioles, thus increasing arterial pressure.

The natriuretic peptides counteract the effects of renin secretion, causing a reduction of blood pressure and in extracellular fluid volume.(3) Both BNP and atrial natriuretic peptide (ANP) are activated by atrial and ventricular distension due to increased intracardiac pressure. These peptides have both natriuretic and diuretic properties: they raise sodium and water excretion by increasing the glomerular filtration rate and inhibiting sodium reabsorption by the kidney.

The New York Heart Association (NYHA) developed a functional classification system for congestive heart failure (CHF) consisting of 4 stages based on the severity of the symptoms. Various studies have demonstrated that circulating BNP concentrations increase with the severity of CHF based on the NYHA classification.(4-6)

Reference Values
Males
< or =45 years: < or =35 pg/mL
46 years: < or =36 pg/mL
47 years: < or =37 pg/mL
48 years: < or =38 pg/mL
49 years: < or =39 pg/mL
50 years: < or =40 pg/mL
51 years: < or =41 pg/mL
52 years: < or =42 pg/mL
53 years: < or =43 pg/mL
54 years: < or =45 pg/mL
55 years: < or =46 pg/mL
56 years: < or =47 pg/mL
57 years: < or =48 pg/mL
58 years: < or =49 pg/mL
59 years: < or =51 pg/mL
60 years: < or =52 pg/mL
61 years: < or =53 pg/mL
62 years: < or =55 pg/mL
63 years: < or =56 pg/mL
64 years: < or =57 pg/mL
65 years: < or =59 pg/mL
66 years: < or =60 pg/mL
67 years: < or =62 pg/mL
68 years: < or =64 pg/mL
69 years: < or =65 pg/mL
70 years: < or =67 pg/mL
71 years: < or =69 pg/mL
72 years: < or =70 pg/mL
73 years: < or =72 pg/mL
74 years: < or =74 pg/mL
75 years: < or =76 pg/mL
76 years: < or =78 pg/mL
77 years: < or =80 pg/mL
78 years: < or =82 pg/mL
79 years: < or =84 pg/mL
80 years: < or =86 pg/mL
81 years: < or =88 pg/mL
82 years: < or =91 pg/mL
> or =83 years: < or =93 pg/mL
Females
< or =45 years: < or =64 pg/mL
46 years: < or =66 pg/mL
47 years: < or =67 pg/mL
48 years: < or =69 pg/mL
49 years: < or =71 pg/mL
50 years: < or =73 pg/mL
51 years: < or =74 pg/mL
52 years: < or =76 pg/mL
53 years: < or =78 pg/mL
54 years: < or =80 pg/mL
55 years: < or =82 pg/mL
56 years: < or =84 pg/mL
57 years: < or =87 pg/mL
58 years: < or =89 pg/mL
59 years: < or =91 pg/mL
60 years: < or =93 pg/mL
61 years: < or =96 pg/mL
62 years: < or =98 pg/mL
63 years: < or =101 pg/mL
64 years: < or =103 pg/mL
65 years: < or =106 pg/mL
66 years: < or =109 pg/mL
67 years: < or =112 pg/mL
68 years: < or =114 pg/mL
69 years: < or =117 pg/mL
70 years: < or =120 pg/mL
71 years: < or =123 pg/mL
72 years: < or =127 pg/mL
73 years: < or =130 pg/mL
74 years: < or =133 pg/mL
75 years: < or =137 pg/mL
76 years: < or =140 pg/mL
77 years: < or =144 pg/mL
78 years: < or =147 pg/mL
79 years: < or =151 pg/mL
80 years: < or =155 pg/mL
81 years: < or =159 pg/mL
82 years: < or =163 pg/mL
> or =83 years: < or =167 pg/mL

Interpretation
>normal <200 pg/mL: likely compensated congestive heart failure (CHF)
> or =200 to < or =400 pg/mL: likely moderate CHF
>400 pg/mL: likely moderate-to-severe CHF

Brain natriuretic peptide (BNP) levels are loosely correlated with New York Heart Association (NYHA) functional class (see Table).
 

Interpretive Levels for CHF         
Functional Class                        5th to 95th Percentile                   Median
----------------------                     ---------------------------                 ------------
I                                                   15 to 499 pg/mL                           95 pg/mL
II                                                 10 to 1,080 pg/mL                        222 pg/mL
III                                               38 to >1,300 pg/mL                      459 pg/mL
IV                                               147 to >1,300 pg/mL                    1,006 pg/mL
All CHF                                     22 to >1,300 pg/mL                      360 pg/mL



Elevation in BNP can occur due to right heart failure with cor pulmonale (200-500 pg/mL), pulmonary hypertension (300-500 pg/mL), and acute pulmonary embolism (150-500 pg/mL). Elevations also occur in patients with acute coronary syndromes.

Cautions
Lack of elevations have been reported if congestive heart failure is very acute (first hour) or with ventricular inflow obstruction (hypertrophic obstructive cardiomyopathy, mitral stenosis, atrial myxoma).

Some patients who have been exposed to animal antigens, either in the environment or as part of treatment or imaging procedures, may have circulating antianimal antibodies present. These antibodies may interfere with the assay reagents to produce unreliable results.

Clinical Reference
1. Krishnaswamy P, Lubien E, Clopton P, et al: Utility of B-natriuretic peptide as a rapid, point-of-care test for screening patients undergoing echocardiography to determine left ventricular dysfunction. Am J Med  2001;111(4):274-279
2. McNairy M, Gardetto N, Clopton P, et al: Stability of B-type natriuretic peptide levels during exercise in patients with congestive heart failure: implications for outpatient monitoring with B-type natriuretic peptide. Am Heart J 2002 March;143(3):406-411

3. Redfield MM, Rodeheffer RJ, Mahoney DW, et al: What is a normal BNP? - a community-based study employing two assays for measurement of BNP. J Card Fail 2001 September;7(3):30