BNP has role in CHF as diagnostic aid, but not in therapy

Used appropriately, measurement of B-type natriuretic peptide (BNP) can be a useful tool in the diagnosis of heart failure, but outpatient infusion with human BNP (nesiritide, Natrecor) has no proven benefit for the treatment of acutely decompensated heart failure and may increase risks, said Audrey Wu, MD, of the Department of Internal Medicine at the University of Michigan, Ann Arbor.

Results of the Breathing Not Properly study showed that BNP assay using a cutoff of 100 pg/ml or greater significantly increased the diagnostic accuracy of congestive heart failure among patients seen in the emergency department with acute shortness of breath when compared with clinical judgment alone. However, in evaluating BNP levels, it is important that clinicians interpret the information in the context of clinical judgment and not in isolation, as there are multiple factors other than heart failure that can influence BNP levels. Physicians should also be aware that BNP cannot distinguish between heart failure with a normal versus a reduced ejection fraction, Wu said.

Regarding the role of BNP therapy, although results from early studies showed that nesiritide treatment was associated with initial improvements in hemodynamics and subjective impressions of symptoms in patients with acute decompensated HF, more recent evidence indicates that nesiritide treatment may have detrimental effects, including an increase in intermediate term mortality and worsening of renal function.

"Currently, clinicians should consider alternative agents for inotropy and vasodilation in the acute setting while waiting for larger, prospective studies to better define nesiritide's benefits and risks," said Wu.