Ver el código de «Brain natriuretic peptide»

==Background==
*Biologically active metabolite of proBNP (released from ventricles in response to increased volume/pressure)
*Utility is controversial and may not affect patient centered outcomes<ref>Carpenter CR et al. BRAIN NATRIURETIC PEPTIDE IN THE EVALUATION OF EMERGENCY DEPARTMENT DYSPNEA: IS THERE A ROLE? J Emerg Med. 2012 Feb; 42(2): 197–205.</ref>
*May be trended to gauge treatment response in acute decompensated CHF
*May have false negative with isolated diastolic dysfunction
*N-terminal proBNP is a biologically inert metabolite of proBNP

===Indications for Use===
*American College of Cardiology, American Heart Association, Heart Failure Society of America guidelines as of May 2017<ref>Yancy CW et al. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure.</ref>
**BNP should be measured in patients presenting with dyspnea to help diagnose or exclude heart failure
**BNP or nt-pro-BNP should be measured to determine prognosis or disease severity in chronic heart failure
**Baseline BNP, cardiac troponin, or both should be measured upon hospital admission to determine prognosis in patients with acutely decompensated heart failure

==Interpretation==
{{BNP value}}

==Special Patient Populations==

===BNP In Obese Patients===
*Visceral fat expansion leads to increased clearance of active natriuretic peptides<ref>Clerico A, Giannoni A, Vittorini S, Emdin M. The paradox of low BNP levels in obesity. Heart Fail Rev. 2011;17(1):81-96. doi:10.1007/s10741-011-9249-z.</ref>
*Obese patients also frequently treated for hypertension or coronary artery disease which may also contribute to lower BNP levels

====Interpretation====
*In one study of 204 patients with acute CHF, an inverse relationship between BMI and BNP was noted. The standard cutoff of 100pg/mL resulted in a 20% false-negative rate<ref>Krauser DG, Lloyd-Jones DM, Chae CU, et al. Effect of body mass index on natriuretic peptide levels in patients with acute congestive heart failure: A ProBNP Investigation of Dyspnea in the Emergency Department (PRIDE) substudy. Am Heart J. 2005;149(4):744-750. doi:10.1016/j.ahj.2004.07.010.</ref>
*Analysis of a subgroup of patients with documented BMI from the Breathing Not Properly study showed that a lower cutoff was more appropriate to maintain 90% sensitivity in obese and morbidly obese patients (54pg/mL)<ref>Daniels LB, Clopton P, Bhalla V, et al. How obesity affects the cut-points for B-type natriuretic peptide in the diagnosis of acute heart failure. Results from the Breathing Not Properly Multinational Study. Am Heart J. 2006;151(5):999-1005. doi:10.1016/j.ahj.2005.10.011.</ref>

==Differential Diagnosis==
{{Elevated BNP}}

==See Also==
*[[Congestive heart failure]]

==External Links==
*[http://pemplaybook.org/podcast/big-labs-little-people-troponin-bnp-d-dimer-and-lactate/ Pediatric Emergency Playbook Podcast: Big Labs, Little People]
*http://lifeinthefastlane.com/ccc/brain-natriuretic-peptide-bnp/

==References==
<references/>

[[Category:Cardiology]]
[[Category:Labs]]