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BNP: soon to become a routine measure in the care of patients with heart failure?
  1. Cardiology Department
  2. Aberdeen Royal Infirmary
  3. Aberdeen AB25 2ZD, UK
  4. email:

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Clinicians are increasingly using biochemical markers of disease to help diagnose and monitor disease states. Might B-type natriuretic peptide (BNP) become the same to heart failure as thyroid function tests are to hypothyroidism?

BNP is a 32 amino acid peptide secreted chiefly from the cardiac ventricles in response to ventricular strain. On secretion, proBNP, the storage form of BNP, is cleaved into the inactive N-terminal-proBNP and the endocrinologically active BNP. The active moiety promotes natriuresis, diuresis, and vasodilatation. The blood concentration of BNP is raised in patients with cardiac disease, particularly those with heart failure.

Both plasma BNP and NT-proBNP can be rapidly measured by radioimmunoassay or immunoradiometric assay from an EDTA blood sample. Reliable near patient testing is also just around the corner. These technical advances have made the use of BNP in routine practice a much more practical proposal.

BNP as an aid to the diagnosis of heart failure

The reliability of a clinical diagnosis of heart failure is poor, especially in primary care. Recent guidelines have recommended that the clinical diagnosis of heart failure should be backed up by objective confirmation of underlying cardiac dysfunction. Echocardiography is the safest and most practical method of confirming dysfunction. However, there are at least 120 000 suspected new cases of heart failure each year in the UK. If we are to advocate echocardiography for all such patients we must consider the …

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