Researchers at the University of Dundee have shown how plasma levels of brain/B-type natriuretic peptide can help diagnose types of heart failure.
Around 900,000 people in the UK have heart failure. Both the incidence and prevalence of heart failure increase steeply with age. Heart failure accounts for a total of 1 million inpatient bed days and 5% of all emergency medical admissions to hospital with readmission rates among the highest for any common condition in the UK. Financially, this adds up to some 2% of healthcare costs, about two thirds of which are hospital costs. The costs of GP consultations have been estimated at £45 million per year with an additional £35 million for GP referrals to outpatient clinics. Community based drug therapy for heart failure costs the NHS around £129 million per year.
The diagnosis of heart failure is difficult because its symptoms are non-specific and the physical signs are often not obvious. Early and accurate diagnosis is important so that patients can start appropriate life-saving treatment.
Professor Allan Struthers (Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital and Medical School, Dundee) and his team showed that plasma levels of brain/B-type natriuretic peptide (BNP) could be used in clinical practice to detect left ventricular systolic dysfunction. This was followed by a study of the diagnostic role of BNP in a community population providing the evidence leading to National and International Guidelines recommending BNP testing in patients with suspected heart failure in the community.
The team's work on BNP as a biomarker of left ventricular wall stress showed for the first time that BNP was elevated in patients with the other form of heart failure (isolated diastolic dysfunction). The diagnosis of heart failure with preserved ejection fraction (HFpEF) due to diastolic dysfunction is difficult, especially in patients with multiple co-morbidities. To aid diagnosis, the use of plasma BNP as a biomarker which is elevated in elevated left ventricular wall stress has been recommended in Guidelines including the European Society of Cardiology consensus statement on HFpEF. This test is used as an inclusion criterion in most ongoing studies of HFpEF including the on-going Treatment Of Preserved Cardiac function heart failure with an Aldosterone anTagonist (TOPCAT) study.
Aortic stenosis is the most common valvular disease in Western countries. Identification of subgroups of symptomatic patients with aortic stenosis who may benefit from early surgery is a clinical challenge. The research of Professor Struthers and his team led to a 1997 American Heart Journal publication that was the first study to show elevated plasma BNP in aortic stenosis. International investigations following this publication provided the evidence underpinning the latest European Society of Cardiology recommendation on BNP testing in asymptomatic severe aortic stenosis to select patients for aortic valve replacement.
In further recent related work, the University of Dundee team have expanded the diagnostic role for BNP into other populations of patients. They have recently described for the first time how BNP could be used in primary prevention to detect patients with silent asymptomatic heart disease such as left ventricular hypertrophy and silent coronary artery disease.
- the research on brain/B-type natriuretic peptide (BNP) has helped diagnose both types of heart failure (systolic and diastolic heart failure) and to identify high-risk aortic stenosis patients for surgery.
- demonstrated the value of BNP as a biomarker for left ventricular systolic dysfunction, isolated diastolic dysfunction and for aortic stenosis.
- BNP testing is now recommended in Guidelines as a screening test for patients with suspected heart failure (Class I recommendation) and in the current European Society of Cardiology consensus statement for diagnosis of diastolic heart failure.
- The European Society of Cardiology Guidelines have also introduced BNP testing in the management of patients with aortic stenosis (Class IIb recommendation).