More evidence for bedside BNP in heart failure assessment

The central role of neurohormones, including brain natriuretic peptide (BNP), in the pathophysiology of heart failure is now firmly established. Plasma levels of BNP are elevated in patients with chronic heart failure (CHF); there is now the prospect of plasma BNP being used in diagnosing heart failure, in assessing prognosis and even in tailoring therapy in CHF. Despite the increasing wealth of evidence supporting clinical BNP assessment, it is not yet used in everyday clinical practice. A major limitation has been the complexity and hence relative inaccessibility of earlier assays. New developments in BNP assay methodology should improve things. In this issue of the Journal, Tjeerdsma et al. provide data that support the use of a rapid bedside (Triage® BNP Test, Biosite Diagnostics) BNP test in the assessment of stable patients with CHF in an outpatient setting. The assay is performed using a portable kit and a result can be obtained within 20 minutes. In this study a BNP level of <20 pmol/L had a negative predictive value of 95% and a positive predictive value of 85% for the diagnosis of left ventricular systolic dysfunction. Many heart failure patients remain unidentified or misdiagnosed. In those correctly diagnosed, a wide discrepancy in the provision of care is encountered. The development of assays, including rapid bedside kits, has made the assessment of plasma BNP a clinical reality. It is hoped that the incorporation of routine BNP testing in the diagnosis and treatment of CHF will help to improve morbidity and mortality.