Fifth Annual Meeting of the Heart Failure Society of America (HFSA) Washington, D.C., USA September 2001 Download PDF of full report

Attendance at this meeting broke previous records, with more than 2,100 physicians, nurses, and researchers coming from the United States, as well as clinicians from as far away as Brazil and Australia.

For all attendees, however, this meeting was defined by its shattering and sad circumstances. On September 11, the meeting was cut short by horrific acts of terrorism, including a strike on the Pentagon just six miles from the meeting site. Despite its abrupt ending, the first two days of this meeting were replete with reports of new ways to manage and treat patients with heart failure. Notable among these was a sponsored symposium describing potential new roles for B-type natriuretic peptide.

BNP – a small peptide promises to play a big role

Dr. A. Maisel (California, USA) described B-type natriuretic peptide (BNP) as cardiology’s latest “Eureka!” He proposed that BNP measurements offer considerable promise for diagnosis and management of heart failure. The recent approval by the U.S. Food and Drug Administration of a rapid, point-of-care BNP assay now gives clinicians a chance to fully explore its usefulness. According to Dr. Maisel, serum levels of BNP correlate directly with the severity of heart failure, as rated by NYHA classifications (Figure 1). BNP ranges by NYHA classification are 60-150 pg/ml for class I; 150-300 pg/ml for class II; 300-600 pg/ml for class III; and > 600 pg/ml for class IV. Decompensated heart failure patients who require hospitalisation typically have BNP levels of 600-1500 pg/ml, and values fall to 200-400 pg/ml post-hospitalisation.

Figure 1 BNP and heart failure severity

A 32-amino acid chain, BNP is produced by the ventricular myocardium when the heart is failing; increased wall pressure and tension trigger BNP release. BNP mediates complementary physiologic actions—vasodilation, natriuresis, and diuresis—to ease workload on the heart. In addition, BNP decreases levels of neurohormones (endothelin, aldosterone, and angiotensin II) that can cause a wide range of harmful cardiovascular consequences over time.

BNP provides a myriad of immediate uses as a diagnostic tool, along with numerous possibilities for patient screening and management. For emergency room patients who present with dyspnoea, BNP determinations reliably distinguish between congestive cardiac and pulmonary diseases; studies have shown that BNP assay values less than 80 pg/ml have a negative predictive value of 98%. BNP can serve as a screening tool, since elevated levels support a need for follow-up echocardiography. If such echocardiographic studies show normal ventricular systole, studies indicate that diastolic dysfunction is likely. BNP levels may ultimately prove useful to guide management of hospitalised patients. With a half-life of just 20 minutes, elevated BNP levels drop rapidly as patients respond to therapy. BNP levels also predict prognosis; heart failure patients with discharge BNP levels lower than 400 pg/ml had fewer readmissions than did those with higher levels.

Perhaps the most exciting potential use of BNP measurement is for community-based heart failure screening. According to Dr. J. Cohn (Minnesota, USA), the frequency of higher-than-normal BNP in a Minnesota population was 10%. However, studies are needed to determine whether such BNP elevation is a marker of early heart disease.

©2002 Failinghearts.com