From the Guidelines
Yes, BNP can be elevated in right-sided heart failure. BNP is a hormone released primarily by the ventricles of the heart in response to stretching of heart muscle cells due to increased volume or pressure. While BNP elevations are classically associated with left-sided heart failure, right ventricular strain and volume overload also trigger BNP release. According to the 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 1, BNP levels can be elevated in various cardiac conditions, including pulmonary hypertension, which is a common cause of right-sided heart failure.
The levels of BNP in isolated right heart failure may be lower than those seen in left heart failure or biventricular failure, but they are typically still above normal reference ranges. Clinicians should interpret BNP levels in the context of the patient's overall clinical presentation, as other conditions including renal dysfunction, advanced age, and atrial fibrillation can also cause BNP elevations. BNP testing remains valuable in the diagnostic workup of patients with suspected right heart failure, though echocardiography is often needed to confirm the diagnosis and determine the specific cardiac chambers involved.
Some key points to consider when interpreting BNP levels in right-sided heart failure include:
- BNP levels can be elevated in right-sided heart failure, but may be lower than in left-sided heart failure 1
- Other conditions, such as renal dysfunction and advanced age, can also cause BNP elevations 1
- Echocardiography is often needed to confirm the diagnosis and determine the specific cardiac chambers involved 1
- BNP testing remains valuable in the diagnostic workup of patients with suspected right heart failure 1
From the Research
BNP Elevation in Right-Sided Heart Failure
- BNP can be elevated in right-sided heart failure, as it is a marker of ventricular wall stress [(2,3,4)].
- Studies have shown that BNP levels are increased in patients with right ventricular dysfunction, such as those with pulmonary embolism 3 or pulmonary arterial hypertension 4.
- BNP elevation is highly predictive of right ventricular dysfunction in acute pulmonary embolism 3.
Clinical Significance of BNP Elevation
- BNP levels can be used to differentiate between dyspneic patients with pure respiratory defects and those with right ventricular dysfunction 4.
- Elevated BNP levels are associated with increased mortality and morbidity in patients with heart failure 5.
- However, BNP levels do not always correlate with the degree of congestion or clinical symptoms 5.
Diagnostic Utility of BNP
- BNP can be a useful diagnostic tool in patients with suspected heart failure, including right-sided heart failure [(2,6)].
- However, BNP levels should be interpreted in the context of clinical symptoms and other diagnostic tests, such as echocardiography 6.
- Non-cardiac factors, such as renal dysfunction, can also affect BNP levels 6.