Congestive heart failure laboratory tests: Difference between revisions

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(/* 2009 ACC/AHA Focused Update and 2005 Guidelines for the Diagnosis and Management of Chronic Heart Failure in the Adult (DO NOT EDIT) Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates J...)
(/* 2009 ACC/AHA Focused Update and 2005 Guidelines for the Diagnosis and Management of Chronic Heart Failure in the Adult (DO NOT EDIT) Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates J...)
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' In ambulatory patients with dyspnea, measurement of BNP or N-terminal pro-B-type natriuretic peptide (NT-proBNP) is useful to support clinical decision making regarding the diagnosis of HF, especially in the setting of clinical uncertainty. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' In ambulatory patients with dyspnea, measurement of BNP or N-terminal pro-B-type natriuretic peptide (NT-proBNP) is useful to support clinical decision making regarding the diagnosis of HF, especially in the setting of clinical uncertainty. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>
|-
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' Measurement of BNP or NT-proBNP is useful for establishing prognosis or disease severity in chronic HF. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' In hospitalized patients/acute setting, measurement of BNP or NT-proBNP is useful to support clinical judgment for the diagnosis of acutely decompensated HF, especially in the setting of uncertainty for the diagnosis. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''4.''' In hospitalized patients/acute setting, Measurement of BNP or NT-proBNP and/or cardiac troponin is useful for establishing prognosis or disease severity in acutely decompensated HF. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''5.''' Measurement of BNP or NT-proBNP is useful for establishing prognosis or disease severity in chronic HF. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>
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| colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
| colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
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|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Measurement of natriuretic peptides ([[BNP]] and NT-proBNP) can be useful in the evaluation of patients presenting in the urgent care setting in whom the clinical diagnosis of HF is uncertain. Measurement of natriuretic peptides (BNP and NT-proBNP) can be useful in risk stratification.<ref name="pmid12892964">{{cite journal |author=de Lemos JA, McGuire DK, Drazner MH |title=B-type natriuretic peptide in cardiovascular disease |journal=[[Lancet]] |volume=362 |issue=9380 |pages=316–22 |year=2003 |month=July |pmid=12892964 |doi=10.1016/S0140-6736(03)13976-1 |url=http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(03)13976-1 |accessdate=2012-04-05}}</ref><ref name="pmid16950189">{{cite journal |author=Siebert U, Januzzi JL, Beinfeld MT, Cameron R, Gazelle GS |title=Cost-effectiveness of using N-terminal pro-brain natriuretic peptide to guide the diagnostic assessment and management of dyspneic patients in the emergency department |journal=[[The American Journal of Cardiology]] |volume=98 |issue=6 |pages=800–5 |year=2006 |month=September |pmid=16950189 |doi=10.1016/j.amjcard.2006.06.005 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9149(06)01090-3 |accessdate=2012-04-05}}</ref><ref name="pmid15474693">{{cite journal |author=Gackowski A, Isnard R, Golmard JL, Pousset F, Carayon A, Montalescot G, Hulot JS, Thomas D, Piwowarska W, Komajda M |title=Comparison of echocardiography and plasma B-type natriuretic peptide for monitoring the response to treatment in acute heart failure |journal=[[European Heart Journal]] |volume=25 |issue=20 |pages=1788–96 |year=2004 |month=October |pmid=15474693 |doi=10.1016/j.ehj.2004.07.038 |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=15474693 |accessdate=2012-04-05}}</ref><ref name="pmid14987580">{{cite journal |author=Bayés-Genís A, Santaló-Bel M, Zapico-Muñiz E, López L, Cotes C, Bellido J, Leta R, Casan P, Ordóñez-Llanos J |title=N-terminal probrain natriuretic peptide (NT-proBNP) in the emergency diagnosis and in-hospital monitoring of patients with dyspnoea and ventricular dysfunction |journal=[[European Journal of Heart Failure]] |volume=6 |issue=3 |pages=301–8 |year=2004 |month=March |pmid=14987580 |doi=10.1016/j.ejheart.2003.12.013 |url=http://eurjhf.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=14987580 |accessdate=2012-04-05}}</ref><ref name="pmid11216950">{{cite journal |author=Dao Q, Krishnaswamy P, Kazanegra R, Harrison A, Amirnovin R, Lenert L, Clopton P, Alberto J, Hlavin P, Maisel AS |title=Utility of B-type natriuretic peptide in the diagnosis of congestive heart failure in an urgent-care setting |journal=[[Journal of the American College of Cardiology]] |volume=37 |issue=2 |pages=379–85 |year=2001 |month=February |pmid=11216950 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(00)01156-6 |accessdate=2012-04-05}}</ref><ref name="pmid17915204">{{cite journal |author=Worster A, Balion CM, Hill SA, Santaguida P, Ismaila A, McKelvie R, Reichert SM, McQueen MJ, Booker L, Raina PS |title=Diagnostic accuracy of BNP and NT-proBNP in patients presenting to acute care settings with dyspnea: a systematic review |journal=[[Clinical Biochemistry]] |volume=41 |issue=4-5 |pages=250–9 |year=2008 |month=March |pmid=17915204 |doi=10.1016/j.clinbiochem.2007.08.008 |url=http://linkinghub.elsevier.com/retrieve/pii/S0009-9120(07)00303-7 |accessdate=2012-04-05}}</ref><ref name="pmid17950786">{{cite journal |author=O'Donoghue M, Kenney P, Oestreicher E, Anwaruddin S, Baggish AL, Krauser DG, Chen A, Tung R, Cameron R, Januzzi JL |title=Usefulness of aminoterminal pro-brain natriuretic peptide testing for the diagnostic and prognostic evaluation of dyspneic patients with diabetes mellitus seen in the emergency department (from the PRIDE Study) |journal=[[The American Journal of Cardiology]] |volume=100 |issue=9 |pages=1336–40 |year=2007 |month=November |pmid=17950786 |doi=10.1016/j.amjcard.2007.06.020 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9149(07)01420-8 |accessdate=2012-04-05}}</ref><ref name="pmid17408803">{{cite journal |author=Silvers SM, Howell JM, Kosowsky JM, Rokos IC, Jagoda AS |title=Clinical policy: Critical issues in the evaluation and management of adult patients presenting to the emergency department with acute heart failure syndromes |journal=[[Annals of Emergency Medicine]] |volume=49 |issue=5 |pages=627–69 |year=2007 |month=May |pmid=17408803 |doi=10.1016/j.annemergmed.2006.10.024 |url=http://linkinghub.elsevier.com/retrieve/pii/S0196-0644(06)02461-9 |accessdate=2012-04-05}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' BNP- or NT-proBNP–guided HF therapy can be useful to achieve optimal dosing of GDMT in select clinically euvolemic patients followed in a well-structured HF disease management program. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
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|bgcolor="LemonChiffon"| <nowiki>"</nowiki>'''2.''' Screening for [[hemochromatosis]], [[Cheyne-Stokes respiration#Association with Congestive Heart Failure (CHF)|sleep-disturbed breathing]], or [[HIV|human immunodeficiency virus]] is reasonable in selected patients who present with [[heart failure]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|bgcolor="LemonChiffon"| <nowiki>"</nowiki>'''2.''' Screening for [[hemochromatosis]], [[Cheyne-Stokes respiration#Association with Congestive Heart Failure (CHF)|sleep-disturbed breathing]], or [[HIV|human immunodeficiency virus]] is reasonable in selected patients who present with [[heart failure]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
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|-
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' The value of serial measurements of [[BNP]] to guide therapy for patients with [[heart failure]] is not well established. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' The usefulness of serial measurement of BNP or NT-proBNP to reduce hospitalization or mortality in patients with HF is not well established.  ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|-
|-|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' The usefulness of BNP- or NT-proBNP–guided therapy for acutely decompensated HF is not well established. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
|-
|-|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.''' Measurement of other clinically available tests such as biomarkers of myocardial injury or fibrosis may be considered for additive risk stratification in patients with acutely decompensated HF. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])'' <nowiki>"</nowiki>
|-
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.''' Measurement of other clinically available tests such as biomarkers of myocardial injury or fibrosis may be considered for additive risk stratification in patients with chronic HF. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
|}
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Revision as of 17:28, 17 November 2016
Resident
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ACC/AHA Guideline Recommendations

Initial and Serial Evaluation of the HF Patient
Hospitalized Patient
Patients With a Prior MI
Sudden Cardiac Death Prevention
Surgical/Percutaneous/Transcather Interventional Treatments of HF
Patients at high risk for developing heart failure (Stage A)
Patients with cardiac structural abnormalities or remodeling who have not developed heart failure symptoms (Stage B)
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Obstructive Sleep Apnea in the Patient with CHF
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Lakshmi Gopalakrishnan, M.B.B.S. [2]

Overview

BNP levels may be useful in the initial establishment of the diagnosis of heart failure in the patient with dyspnea of unclear etiology. In a meta-analysis, BNP was superior N-terminal pro-BNP (NTproBNP) and was associated with a sensitivity of 85% and specificity of 84% in the diagnosis of heart failure in the primary care setting.[1] Once the diagnosis of heart failure is made, subsequent laboratory studies should be directed toward the identification of an underlying cause of heart failure.

Laboratory Tests

Renal Function

Renal function should be assessed as a rough guide to the patient's intravascular volume status and renal perfusion. A urinalysis is helpful in the assessment of the patient's volume status. Electrolyte assessment and the correction of electrolyte disturbances such as hypokalemia, hyperkalemia and hypomagnesemia is critical in those patients treated with diuretics. Hyponatremia (due to poor stimulation of the baroreceptors and appropriate ADH release and free water retention) is associated with a poor prognosis.

Hematologic Studies

A complete blood count should be obtained to assess for the presence of anemia which may exacerbate heart failure and to assess the patients coagulation status which may be impaired due to hepatic congestion.

Thyroid Studies

The assessment of thyroid function tests is particularly important in the patient who is being treated with concomitant therapy with an agent such as amiodarone.

2009 ACC/AHA Focused Update and 2005 Guidelines for the Diagnosis and Management of Chronic Heart Failure in the Adult (DO NOT EDIT)[2][3]

Initial Clinical Assessment of Patients Presenting With Heart Failure (DO NOT EDIT)[2][3]

Class I
"1. Initial laboratory evaluation of patients presenting with heart failure should include complete blood count, urinalysis, serum electrolytes (including calcium and magnesium), blood urea nitrogen, serum creatinine, fasting blood glucose (glycohemoglobin), lipid profile, liver function tests, and thyroid-stimulating hormone. (Level of Evidence: C) "
"2. In ambulatory patients with dyspnea, measurement of BNP or N-terminal pro-B-type natriuretic peptide (NT-proBNP) is useful to support clinical decision making regarding the diagnosis of HF, especially in the setting of clinical uncertainty. (Level of Evidence: A) "
"3. In hospitalized patients/acute setting, measurement of BNP or NT-proBNP is useful to support clinical judgment for the diagnosis of acutely decompensated HF, especially in the setting of uncertainty for the diagnosis. (Level of Evidence: A) "
"4. In hospitalized patients/acute setting, Measurement of BNP or NT-proBNP and/or cardiac troponin is useful for establishing prognosis or disease severity in acutely decompensated HF. (Level of Evidence: A) "
"5. Measurement of BNP or NT-proBNP is useful for establishing prognosis or disease severity in chronic HF. (Level of Evidence: A) "
Class III (No Benefit)
"1. Routine measurement of circulating levels of neurohormones (e.g., norepinephrine or endothelin) is not recommended for patients presenting with heart failure. (Level of Evidence: C) "
Class IIa
"1. BNP- or NT-proBNP–guided HF therapy can be useful to achieve optimal dosing of GDMT in select clinically euvolemic patients followed in a well-structured HF disease management program. (Level of Evidence: B) "
"2. Screening for hemochromatosis, sleep-disturbed breathing, or human immunodeficiency virus is reasonable in selected patients who present with heart failure. (Level of Evidence: C) "
"3. Diagnostic tests for rheumatologic diseases, amyloidosis, or pheochromocytoma are reasonable in patients presenting with heart failure in whom there is a clinical suspicion of these diseases. (Level of Evidence: C) "

Serial Clinical Assessment of Patients Presenting With Heart Failure (DO NOT EDIT)[2][3]

Class IIb
"1. The usefulness of serial measurement of BNP or NT-proBNP to reduce hospitalization or mortality in patients with HF is not well established. (Level of Evidence: B) "
"4. Measurement of other clinically available tests such as biomarkers of myocardial injury or fibrosis may be considered for additive risk stratification in patients with chronic HF. (Level of Evidence: B) "

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Sources

References

  1. ↑ Ewald B, Ewald D, Thakkinstian A, Attia J (2008). "Meta-analysis of B type natriuretic peptide and N-terminal pro B natriuretic peptide in the diagnosis of clinical heart failure and population screening for left ventricular systolic dysfunction". Intern Med J. 38 (2): 101–13. doi:10.1111/j.1445-5994.2007.01454.x. PMID 18290826.
  2. ↑ 2.0 2.1 2.2 2.3 Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Rhythm Society. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005 Sep 20; 112(12): e154-235. Epub 2005 Sep 13. PMID 16160202
  3. ↑ 3.0 3.1 3.2 3.3 Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG et al. (2009) 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation 119 (14):1977-2016. DOI:10.1161/CIRCULATIONAHA.109.192064 PMID: 19324967


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