I. Clinical Studies II. Perspective
GLOSSARY
heart failure a failure of the heart to pump sufficient blood from the chambers into the aorta; inadequate supply of blood reaches organs and tissues.
dyspnea shortness of breath, usually on exertion.
edema accumulation of fluid
myocardium the heart muscle.

failure is readily diagnosed by the symptoms of severe shortness of breath on minimal effort, shortness of breath in bed, and swelling of the ankles caused by accumulation of fluid. Confirmation is obtained on clinical examination and from a chest x-ray (see the chapter Heart Failure). Although NT-pro BNP levels are 2 to 10 times higher than the BNP levels in patients with heart failure, NT-proBNP is eliminated from the blood by the kidneys and is not reliable in patients with coexisting renal insufficiency, a condition that is often associated with heart failure. Clearance of BNP is not dependent on kidney function.

THE NATRIURETIC PEPTIDE SYSTEM INCLUDES atrial (ANP) and brain or B-type (BNP) natriuretic peptide. Brain natriuretic peptide (BNP) is a 32 amino acid cardiac natriuretic peptide that was originally isolated from porcine brain tissue. The human BNP gene is located on chromosome 1 and encodes the 108 amino acid prohormone pro-BNP which circulates with the 32 amino acid biologically active BNP and the N terminal 76 amino acid component of the prohormone (NT-proBNP). These three components can be measured by immunoassay.

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• I. CLINICAL STUDIES A. Maisel et al.
  Methods: A study was done of 1586 patients who visited the emergency with acute shortness of breath, dyspnea, and whose BNP level was measured with a bedside assay. The diagnosis of heart failure was confirmed by two indepen¬dent cardiologists.
• II. PERSPECTIVE
  Rapid measurement of BNP is useful in establishing or excluding the diagnosis of heart failure in patients with acute severe shortness of breath. BNP levels can confirm the diagnosis of heart failure when the cause of acute severe shortness of breath remains uncertain after assessment of the history, physical findings, and chest x-ray. The severity of heart failure appears to be reflected by the height of BNP levels. The discovery that A-type (atrial), natriuretic peptide is secreted by the atrium (atrial natriuretic factor), was a major breakthrough that paved the way for the revelation of BNPs.
• BIBLIOGRAPHY
  Adams, J., Apple, F. et al. New blood tests for detecting heart disease.

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