Heart Failure: Diagnosis, Causes & Latest Treatments

In a fully-accredited SelectScience^® webinar, now available on demand, SelectScience is joined by senior clinical specialist Dr. Jim Aguanno for a comprehensive review of heart failure: the pathophysiological state in which the heart fails to pump enough blood to meet the demands of the body. The webinar defines classifications of heart failure — as well as the signs, symptoms and causes — with a full review of the relevant and most up-to-date treatment options.

The American College of Cardiology Foundation (ACCF) and American Heart Association (AHA) heart failure guidelines, for both ambulatory outpatients with suspected heart failure and hospitalized acute patients, are presented and discussed.

Particular attention is paid to the natriuretic peptides – NT-proBNP and BNP – in the diagnosis of heart failure.

If you missed the webinar, you can now watch it on demand at your leisure. Read on for highlights from the webinar’s Q&A session.

Q: Should physicians use BNP over NT-proBNP in routine clinical practice?

JA: Not necessarily. Both BNP and NT-proBNP are useful to help physicians in the diagnosis and management of patients with heart failure, especially if the clinical presentation of those patients is complex. They are particularly useful as a rule-out test because they have a very high negative predictive value. They're both valuable markers.

Q: Do any vendors offer both BNP and NT-proBNP assays?

JA: At this time, only Siemens has both BNP and NT-proBNP. There are a number of other assays on the market for BNP, and others for NT-proBNP. But other vendors have either BNP or NT-proBNP.

Q: Is it better to use BNP or NT-proBNP in patients with renal failure?

JA: Both BNP and NT-proBNP can be elevated as GFR (glomerular filtration rate) decreases, particularly less than around 60 or so, even in the absence of heart failure. So, physicians must be aware of this; this is one limitation of natriuretic peptides when interpreting elevated values. They are both effective as a rule-out test even in patients with renal insufficiency.

Q: As physicians continue to prescribe Entresto for the treatment of heart failure, will BNP become obsolete?

JA: No, absolutely not. BNP may show this modest increase, or maybe not. More studies are needed. Our recent study suggests there may be no increase at all, in either case. Along with NT-proBNP, BNP is and will remain an important biomarker to help physicians with the diagnosis and management of patients suspected of heart failure. The choice of the natriuretic peptide really is one that is going to be a local decision, generally to be made between the medical staff in the laboratory.

Q: At what point is surgery or a defibrillator recommended for HF

JA: Heart failure is generally treated with medication, and not necessarily with surgery. But if the underlying cause may be a valvular problem, then surgery may be indicated.

Q: Is there a rule of thumb to compare BNP versus NT-proBNP values when consolidating a mixed set of values?

JA: The answer to this is no. However, this comes up frequently when a lab is switching from one method to the other. Physicians were used to one of the values, and now they're getting the other. Let's say they were going from BNP to NT-proBNP, and they're getting an NT-proBNP value of some number. In their head, they're saying, ‘Well, I wonder what the BNP would have been in this patient.’ There's no simple number that you can divide the NT-proBNP by and come up with the equivalent BNP. There's no easy numerical correlation between the two. They both tend to increase together, but numerically, you can't come up with a simple equation, or divisor to arrive at the other.

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