Clinical and Interpretive

This assay aids in the diagnosis of congestive heart failure (CHF).

Reference Range   ≤ 100 pg/mL

>100 to <200 pg/mL: likely compensated congestive heart failure (CHF)

200 to 400 pg/mL: likely moderate CHF

>400 pg/mL: likely moderate to severe CHF

The role of brain natriuretic peptide in monitoring CHF therapy is under investigation. B-type natriuretic peptide (brain natriuretic peptide; BNP) is a 32-amino acid-ringed peptide secreted by the heart to regulate blood pressure and fluid balance. BNP is stored in and secreted predominantly from membrane granules in the heart ventricles, and is continuously released from the heart in response to both ventricle volume expansion and pressure overload.

The natriuretic peptide system and the renin-angiotensin system counteract each other in arterial pressure regulation. When arterial pressure decreases, the kidneys release renin, which activates angiotensinogen resulting in increased peripheral resistance of the arterioles, thus increasing arterial pressure.

The natriuretic peptides counteract the effects of renin secretion, causing a reduction of blood pressure and in extracellular fluid volume. Both BNP and atrial natriuretic peptide (ANP) are activated by atrial and ventricular distension due to increased intracardiac pressure. These peptides have both natriuretic and diuretic properties: they raise sodium and water excretion by increasing the glomerular filtration rate and inhibiting sodium reabsorption by the kidney.

The New York Heart Association (NYHA) developed a functional classification system for congestive heart
failure (CHF) consisting of 4 stages based on the severity of the symptoms. Various studies have demonstrated that circulating BNP concentrations increase with the severity of CHF based on the NYHA classification.

Elevation in BNP can occur due to right heart failure with cor pulmonale (200-500 pg/mL), pulmonary hypertension (300-500 pg/mL), and acute pulmonary embolism (150-500 pg/mL). Elevations also occur in patients with acute coronary syndromes.

Lack of elevations have been reported if congestive heart failure is very acute (first hour) or with ventricular inflow obstruction (hypertrophic obstructive cardiomyopathy, mitral stenosis, atrial myxoma).

Some patients who have been exposed to animal antigens, either in the environment or as part of treatment or imaging procedures, may have circulating antianimal antibodies present. These antibodies may interfere with the assay reagents to produce unreliable results.