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Variability in Measurement of BNP in Routine Evaluation of Heart Failure(VAMPIRE)

Pam R.Taub, Kevin Shah, Kevin Jiang, Paul Clopton, Mitchell Saltzberg, Alan S. Maisel and Robert L. Fitzgerald

Background: B-type natriuretic peptide (BNP) is an established biomarker for diagnosis of acute heart failure (HF). However, criteria for interpreting BNP changes over time prior to clinical decompensation have not been well established.
Methods: BNP concentrations were followed in 192 patients with HF who had at least 5 BNP measurements over 6 month to 2 year period. Decompensation was defined as a hospitalization for HF. For patients (N = 30) who had a recent (within 2 weeks) BNP measured prior to decompensation, BNP concentrations were examined to determine if there was a significant rise prior to decompensation.
Results: For patients who had a BNP concentration measured within 2 weeks of decompensation, there was a significant increase in BNP concentration prior to decompensation. When patients with a baseline BNP < 200 pg/mL decompensated, their BNP changed by a mean of 560% while when patients with a high baseline BNP (> 200 pg/ mL) decompensated, their concentrations changed by 62% ( p<.0001).
Conclusion: Patients with low baseline BNP have significantly larger percent changes in BNP concentrations prior to decompensation than those with higher baseline BNP levels. In conclusion, serial sampling demonstrated that there is potential window prior to hospitalization for HF where a rise in BNP concentrations signals decompensation.