What Is Congestive Heart Failure
Congestive heart failure is a dangerous condition in which the heart fails to adequately pump blood throughout the body. As a result, the bodys tissues and organs do not get enough nutrients and oxygen.
CHF is failure of the heart muscle and inability to perform properly. Heart failure can be either acute, happens quickly, or chronic, develops slowly over a long period of time.
Heart failure does not mean that the heart has stopped beating, it simply means the heart is not functioning properly. It can affect one or both sides of the heart. Specifically, congestive heart failure is a type of heart failure however, the terms are often used interchangeably.
Congestive heart failure is specifically when blood returning to the heart backs up and causes congestion in the body resulting in edema. The fluid can also back up into the lungs causing pulmonary edema. CHF affects the body’s inability to function properly including the kidneys’ ability to dispose of sodium and water.
According to the Centers for Disease Control and Prevention, approximately 6.2 million adults in the United States have heart failure.
Medical conditions that can increase risk associated with CHF include but are not limited to:
- Coronary artery disease
- Valvular heart disease
Why Is Bnp Released In Heart Failure
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. Moreover, why is BNP high in heart failure?
Increases in BNP levels may be caused by intrinsic cardiac dysfunction or may be secondary to other causes such as pulmonary or renal diseases . BNP level is a strong predictor of risk of death and cardiovascular events in patients previously diagnosed with heart failure or cardiac dysfunction.
Beside above, can BNP be elevated without heart failure? BNP predicts mortality, even in patients without heart failure. The results suggest that an elevated B-type natriuretic peptide level in a patient without heart failure may warrant additional investigation, including assessment of cardiac structure and function, study authors said.
Similarly one may ask, what BNP level indicates heart failure?
BNP levels go up when the heart cannot pump the way it should. A result greater than 100 pg/mL is abnormal. The higher the number, the more likely heart failure is present and the more severe it is. Sometimes other conditions can cause high BNP levels.
How sensitive is BNP for heart failure?
A BNP cutoff of 100 pg/mL was found to be the optimal level for the diagnosis of heart failure with a sensitivity of 90% and a specificity of 76% the negative predictive value was 89% . BNP was the single most reliable predictor with an accuracy of 83%.
How Is This Test Performed
A BNP test is done by drawing blood from a vein in your arm using a hypodermic needle. This process is known as venipuncture.
A machine then measures levels of BNP or another heart hormone, called N-terminal-pro BNP , in the blood sample.
The results from the test are usually ready in 15 to 20 minutes. Results may take up to a week if the blood is sent to a separate lab facility for analysis.
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What Is A B
A B-type natriuretic peptide test is a blood test. It measures the levels of a certain type of hormone in your blood called a B-type natriuretic peptide. This test gives your healthcare provider information about your heart.
Higher-than-normal levels of BNP in your blood can be a sign that your heart isnt working as it should. It can mean that your heart isnt pumping enough blood through your body. Since BNP is cleared by your kidneys, it may also mean that your kidneys are not functioning properly.
Some laboratories offer a similar test called aminoterminal pro B-type natriuretic peptide . Both the BNP and NT-proBNP tests show similar information, although the absolute values of NT-proBNP are about five to 10 times higher than BNP.
Providers use a BNP or an NT-proBNP test to diagnose heart failure. If you already know you have heart failure, your provider may order this test to check the severity of your condition. They may also use this test to monitor how heart failure treatments are working. In some cases, your provider may also order it if they think you may be at higher risk of developing heart failure.
Correlations Between Bnp And Parameters
The linear regression analysis in 559 CHF patients revealed a negative correlation between plasma BNP level and LVEF , but positive correlations between BNP level and NYHA , age and LVW thickness .
There was also a positive correlation between plasma BNP and fasting plasma glucose levels .
Correlation between plasma B-type natriuretic peptide and fasting plasma glucose levels.
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When Should I Call My Doctor About A Bnp Or Nt
A note from Cleveland Clinic
A B-type natriuretic peptide test or aminoterminal pro B-type natriuretic peptide test gives your provider essential information about your heart health. It helps them diagnose heart failure, so they can develop a treatment plan. It also helps them monitor how well treatments are working. Talk to your provider if you have any questions about the test results. If youve received a heart failure diagnosis, there are things you can do to live with heart failure, including lifestyle and dietary changes.
What Happens During A Natriuretic Peptide Test
For a BNP test or an NT-proBNP test, a health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.
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Ask A Laboratory Scientist
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How Is It Measured
There has been a gradual introduction of point of care assays, however the mainstay is lab based testing of NT-ProBNP.
Concentrations are reported in numerous units with a range of 5-1300pg/mL or 1.4 to 376 pmol/L
BNP and NT-proBNP levels are roughly similar in the general population, but there is up to 40% variation due to genetic factors. Age, sex and BMI can also vary the levels, . Oddly increased BMI and obesity reduces BNP and NT-proBNP.
In Ventricular dysfunction, however, NT-proBNP rises at an increased rate compared to BNP, so levels cannot be easily converted between the two.
Estimated cost is £25 per test
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Are Test Results Accurate
Many variables affect the accuracy and interpretation of the BNP and NT-proBNP tests, which is why it is so important to discuss your results with your physician.
For example, some factors that may affect test accuracy include:
- Type of test: There can be some variation in results from rapid tests and tests analyzed by a laboratory. Reference ranges may also differ by laboratory.
- Individual factors: The expected BNP and NT-proBNP level in healthy people varies by age. A doctor will also take into account your sex, genetics, and body mass index when interpreting your results.
- Other health conditions: More than one type of health problem can cause BNP or NT-proBNP levels to be elevated, which means that this test alone may not be able to diagnose congestive heart failure or another condition.
If you have any questions about the accuracy of your test results, talk with your health care provider to learn more about the type of test you had and its significance for your health.
Is A Bnp Blood Test Fasting
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.
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Clinical And Neurohormonal Characteristics
Table summarizes medical therapy, clinical findings, chest radiograph and ECG findings, biochemical profiles and pericardial thickness subdivided according to the BNP levels. The subjects were 77 men and 65 women, ages 73.7 ± 9.9 years old . The B group was significantly older than the NB group . Although hypertension was more common in the B group, no differences were observed for diabetes and dyslipidemia. According to the New York Heart Association classification, the severity of heart failure was class II in 113 patients and class III in 29 patients, with no intergroup differences. As for treatment drugs, the B group received significantly more angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers, while the NB group received significantly more digitalis, diuretic drugs, and warfarin .
Table 1 Clinical and neurohormonal characteristics of the patients.
Can You Have Congestive Heart Failure With A Normal Bnp
Congestive heart failure with a normal BNP levels is very less likely. BNP levels have a very high negative predictive value, this means that normal BNP levels almost always rule out the diagnosis of heart failure and alternative diagnosis for the patients symptoms should be considered in such cases.
What is MR-proANP
Midregional pro-atrial natriuretic peptide is one of the members of natriuretic peptides.
It is a novel peptide first isolated in 1981 & has similar functions of diuresis and natriuresis as BNP and NT-pro-BNP.
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Why Do I Need A Natriuretic Peptide Test
You may need a BNP test or an NT-proBNP test if you have symptoms of heart failure. These include:
If you are being treated for heart failure, your health care provider may order one of these tests to see how well your treatment is working.
Influences On Bnp Levels
Many medications used to treat heart failure reduce natriuretic peptide concentrations.813 Therefore, many patients with chronic stable heart failure will have BNP levels in the normal diagnostic range . However, digoxin and some beta blockers appear to increase natriuretic peptide concentrations.1416 Exercise causes a short-term increase in BNP levels,17 although only small changes are detectable one hour after exercise.18 No circadian variation has been reported when BNP is measured every three hours for 24 hours,19 and there is less hourly variation with BNP than with ANP.20
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When Should I Get A Bnp Or Nt
Your doctor may order a BNP or NT-proBNP test if you have symptoms of heart failure. If you have already been diagnosed with heart failure, your doctor might order a test to get more information about your condition.
The main symptoms of heart failure are:
- Shortness of breath or difficulty breathing
- Swelling of your legs, ankles, or abdomen
Shortness of breath is extremely common among people who have congestive heart failure, but this symptom can also occur in other conditions such as lung, kidney, and liver disease. For this reason, your doctor is likely to order a BNP or NT-proBNP test if you have unexplained shortness of breath.
Does Bnp Level Predict Symptoms
Not always. As with a lot of tests, patients with high BNP may be asymptomatic and some symptomatic HF patients may have low levels. In one study, 26% of symptomatic patients had normal levels. Of these patients, more were likely to by young and female with cardiomyopathy of non-ischaemic origin.
What may be more useful is using levels to track course of disease and treatment.
Check out the study below which discusses normal levels
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Bnp As A Prognostic Biomarker In Hf Patients
There are several studies performed to evaluate prognostic significance of natriuretic peptide. The predictive value of BNP/NT-proBNP was evaluated in the following trials of large cohort of patients with symptoms of HF.
Prognostic value in patients with LV systolic dysfunction
In a larger study of 452 patients with LVEF < 35%, Berger et al. found that BNP levels were a strong independent predictor of sudden death . The prospective Copenhagen Hospital Heart Failure study showed that measurements of NT-proBNP add additional prognostic information independent of LVEF, and is a strong predictor of 1-year mortality in hospitalized patients with HF regardless of systolic dysfunction . The COPERNICUS NT-proBNP substudy investigated the prognostic value of NT-proBNP in a large number of patients with severe CHF. NT-proBNP was consistently associated with increased risk for all-cause mortality and or hospitalization for HF in patients with severe CHF .
Prognostic value in patients with chronic HF and preserved LV systolic function
Although some studies have shown the promising results of the BNP/NT-proBNP assay in patients with chronic HF and preserved LV systolic function for the prediction of adverse cardiovascular incidence, its prognostic value is still not well established because there are scarce evidence in this group of patients.
Bnp In The Management Of Heart Failure
- the NICE clinical guideline on CHF the use of BNP as a diagnostic tool for heart failure
-
refer patients with suspected heart failure and previous myocardial infarction urgently, to have transthoracic Doppler 2D echocardiography and specialist assessment within 2 weeks
- refer people with suspected heart failure and an NT-proBNP level above 2,000 ng/litre urgently, to have specialist assessment and transthoracic echocardiography within 2 weeks â because very high levels of NT-proBNP carry a poor prognosis
- refer people with suspected heart failure and an NT-proBNP level between 400 and 2,000 ng/litre to have specialist assessment and transthoracic echocardiography within 6 weeks
- review alternative causes for symptoms of heart failure in people with NTproBNP levels below 400 ng/litre. If there is still concern that the symptoms might be related to heart failure, discuss with a physician with subspeciality training in heart failure
- perform transthoracic echocardiography to exclude important valve disease, assess the systolic function of the ventricle, and detect intracardiac shunts
- if a poor image is produced by transthoracic echocardiography
- consider alternative methods of imaging the heart
Notes:
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Rothenburger Et Al Study
German researchers evaluated NT-proBNP levels in 550 extremely ill patients with severe dilated cardiomyopathy in whom cardiac transplantation was being considered. All patients underwent extensive cardiac evaluation, including echocardiography and right heart catheterization. The annual mortality was predicted by using the NT-proBNP level.
At 1 year, patients with levels below 1000 pg/mL had a lower than 1% mortality, patients with levels of 1000-5000 pg/mL had 2% mortality, and patients with levels over 5000 pg/mL had 28% mortality.
What Is Postpartum Cardiomyopathy
Peripartum cardiomyopathy is a weakness of the heart muscle that by definition begins sometime during the final month of pregnancy through about five months after delivery, without any other known cause. Most commonly, it occurs right after delivery. It is a rare condition that can carry mild or severe symptoms.
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How Do I Lower Nt
Four months of combined endurance/resistance training significantly reduced circulating levels of NT-proBNP in patients with CHF, without evidence of adverse remodelling. Exercise training might offer additional non-pharmacological modulation of the activated neurohormonal pathways in the setting of CHF.
How Does The Test Work
BNP, first discovered in 1988, belongs to the natriuretic peptide family that also contains atrial natriuretic peptide , Ctype natriuretic peptide , and urodilatin.
Naturally the heart secretes natriuretic peptides to maintain a normostatic blood pressure and blood plasma volume and to prevent excess salt and water retention. The major source of BNP synthesis and secretion is the ventricular myocardium specifically in response to the left ventricular stretching or wall tension.
Other actions of natriuretic peptides, including BNP include:
- Down-regulating the sympathetic nervous system and the renin-angiotensin-aldosterone system
- Facilitating natriuresis and diuresis through the afferent and efferent hemodynamic mechanisms of the kidney and distal tubules
- Increasing smooth muscle relaxation
In CHF, these natriuretic peptides are damaged and unable to function properly. This causes a rise in your BNP which is used as an indicator for new onset heart failure or worsening heart failure.
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What Else Can Elevate Bnp Levels
- Inverse relationship between GFR and BNP levels. BNP is removed by a receptor and enzyme system, and also through passive excretion.
- NT-proBNP is cleared mainly by the kidney and so it rises in isolated renal failure without LV dysfunction.
When Do Doctors Use The Bnp Test
Doctors often order the BNP test for people they believe may experiencing heart failure. Heart failure is where a persons heart does not pump blood efficiently enough to support their bodys needs or when the heart does not relax normally, leading to elevated heart pressure.
However, any factors that can increase pressure in the heart or stretch its atria chambers, such as blood clots in the lungs which doctors refer to as pulmonary embolism can cause elevated BNP levels.
Some signs that an individual may be experiencing heart failure include:
- feeling easily fatigued
- shortness of breath
- an inability to lay flat due to shortness of breath
Doctors usually use a BNP test to help detect heart failure. Additionally, they can use the test to help with prognoses, as elevated BNP levels can increase the risk of adverse outcomes, even in those without heart failure. Healthcare professionals may also order a blood screening to investigate what might be contributing to heart failure and to help devise a treatment plan.
Additionally, doctors may use the BNP test to assess how well a persons heart failure treatments are working.
The BNP test follows a standard blood test procedure, which a doctor, nurse, or phlebotomist performs. A phlebotomist is a person trained in drawing blood.
The medical professional will:
Most people can resume their normal activities immediately after the screening.
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