It has been suggested that plasma B-type natriuretic peptide(BNP) level may be used as a noninvasive biomarker of the adequacy of long-term heart failure therapy. The effect of contemporary therapy on the relation between BNP measured using modern commercially available assays and cardiac filling pressures has not been studied in detail, because most of the original studies predate these developments. The investigators sought to assess the diagnostic accuracy of BNP to identify significantly elevated pulmonary capillary wedge pressure(PCWP) in a group of patients with severe chronic heart failure on treatment. BNP correlated well with PCWP(r=0.50, p15 mm Hg was only 74%, largely because of poor sensitivity or a large number of false-negative test results. Maximizing medical therapy irrespective of plasma BNP results remains the best approach to managing chronic heart failure.
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