Hi Soren,

Thank you for that article.  This seems to support the evidence that BNP should be used for prognostic indicator of HFPEF as well. 

As a followup question: Is it standard of care (in any country) to order BNP for a patient with Grade II diastolic dysfunction: Pseudonormal filling pattern?

Kumar

Hi Kumar,

If you look at the latest ESC guidelines, which are appended, you will find the precise answer to your question. NT-pro-BNP is a step to diagnosis and helps for the prognosis. It is less well established (and presumably not wise) to use it to guide therapy. Unfortunately the test is not yet reimbursed for these indications in some countries, for budget reasons.  

For prognosis look at the I_PRESERVE prognostic data (Michael Zile Circulation 2011) and the TOPCAT prognostic data (Amil Shah Circ HF 2014). 

Best regards,

Thierry

BNP levels are lower in patients with HFPEF than in patients with HF with reduced LVEF, but for a given BNP level, the prognosis in patients with HFPEF is as poor as in those with reduced LVEF. (J Am Coll Cardiol 2013;

61:1498–506) © 2013 by the American College of Cardiology Foundation

BNP and NT-proBNP are secreted by ventricles in response to increased end-diastolic pressure and volume. BASEL trial (NEJM 2004;350;647-54) had indicated improvement of clinical outcomes after measurement of B-type natriuretic peptide in patients with acute dyspnea. Patients suffering from CHF, AFib, PE, COPD exacerbation, and pulmonary HTN may have an elevated BNP.

In our setup, we primarily rely on troponins and CK – MB (for acute coronary syndrome and heart failure). You may order BNP and NT-pro BNP cardiac biomarkers, depending on local laboratory protocol.