Dr Januzzi : COVID-19 may manifest from a cardiac perspective in a number of different ways – atrial fibrillation is common, heart muscle dysfunction whether related to myocarditis (which is probably a little bit more uncommon, but may still happen or not) and stress cardiomyopathy. There is also triggering of ischaemic heart disease and other […]
Role of NT-proBNP & use in HF management
From a diagnostic perspective, what is your experience of using NT-proBNP in heart failure with preserved ejection fraction (HFpEF)?
Dr Januzzi: A normal NT-proBNP for a middle-aged individual is 20 pg/mL or 30 pg/mL, maybe not much higher. If a patient presents with NT-proBNP of 300 pg/mL with shortness of breath, obesity and some oedema, it is very likely they have heart failure with preserved ejection fraction (HFpEF). Diagnosis in patients with HFpEF is […]
What is the role of natriuretic peptides testing in patients with diabetes to identify risk? Would that help you make decisions about which drugs you might want to give them?
Dr Sim: There is no clear guideline, especially in the Asian setting like, after X number of years of diabetes, we should start doing NT-proBNP. The traditional way of treating diabetes is just checking on HbA1c, and then wait till the patient develops coronary artery disease or heart failure. Then treatment initiated is with a […]
What is the role of NT-proBNP for discharge planning in patients with acute heart failure who are improving and then sent home?
Dr Sim : NT-proBNP if done as the one-off reading, is not as useful as a serial reading. If somebody starts at a high reading, and if shown that on discharge and one month after discharge the value is coming down, then you can be assured that you are in the right direction. If just […]
The decrease of NT-proBNP, 30% or more, from admission to discharge indicates the patient will have a better prognosis. For the obese patient, can we use the same logic?
Dr Januzzi: Analyses shows that obesity did not affect the prognostic meaning of the 30% reduction during hospitalisation. Although obesity suppresses natriuretic peptide, when an obese patient is admitted for heart failure, they usually have elevated values. It is just that they are not as high as one might expect. The reduction is largely the same. […]