New Blood Test Useful
For Detecting Congestive
Heart Failure
by John A. Osborne, M.D., Ph.D.

B-type (or Brain) Natriuretic Peptide, or BNP, is a neurohormone released by the cardiac ventricles in response to volume expansion and pressure overload. Treatment of heart failure has advanced recently,
largely due to a growing understanding of the role of neurohormonal factors. Studies to date have shown BNP and its aminoterminal portion, N-BNP, are the most powerful neurohormonal predictors of left
ventricular (LV) function and prognosis. Both are secreted primarily from the left ventricle in response to changes in LV wall stretch and concentrations of both have been related to LV filling pressures and
wall stress.

While other tests have been used to identify congestive heart failure (CHF) and while echocardiography is currently the "gold standard" for detecting left ventricular dysfunction, its expense and limited availability hamper its use. Moreover, it may not always reflect an acute condition or may be difficult to perform in patients whose dyspnea makes it difficult for them to remain still, or who have other complicating conditions, like obesity or pulmonary disease. Other diagnostic tests for heart failure, such as heart catheterization, are limited by their invasive nature, the risk of complications,
limited accessibility, and very high costs.

BNP (so called because it was first identified in porcine brains), is one of several peptides secreted by the left ventricle in response to the stretch that occurs in heart failure, and is the one cardiac peptide thought to have the most diagnostic value. Researchers believe that BNP may be an excellent screening tool for left ventricular dysfunction, and may, in fact, represent an important adjunct for the diagnosis of diastolic dysfunction. A small bedside BNP machine for rapid point-of-care BNP assessment is currently available, costs about $20, and can measure a patient's BNP level in about 15 minutes.

Point-of-care testing for B-type natriuretic peptide should prove valuable in assessing patients with dyspnea, in screening patients with LV dysfunction, assessing the severity and progression of CHF and treatment efficacy. The test is easy and rapid to perform, and it can reliably predict the presence or absence of even mild degrees of left ventricular systolic function, as well as delineate diastolic
dysfunction in those patients with a normal ejection fraction.

The BNP diagnostic system consists of two parts. About 6 drops of venous whole blood are applied to a small cartridge, which is then inserted into a portable meter (about the size of a desk-top telephone).
Quantitative results appear on an electronic screen or can be printed out, and the entire process takes about 15 minutes.

Evidence for Predictive Value of BNP in CHF Diagnosis

In terms of its diagnostic accuracy, BNP testing for congestive heart failure is as good as or better than methods used to diagnose prostate, cervical, and breast cancer, according to investigators for the
Breathing Not Properly (BNP) trial. Results of the study appear in the July 17, 2002 issue of the New England Journal of Medicine after being presented at the American College of Cardiology meeting
in March 2002.

B-type natriuretic peptide levels by themselves were more accurate than any other finding in the history, physical finding, or laboratory value in delineating the cause of dyspnea. Use of this test, in conjunction
with other clinical information, should lead to more accurate initial diagnoses of CHF.

BNP Trial Results

Dr. Osborne is a cardiologist with CSANT, PA, in Grapevine, Texas.

Dr. Eichhorn is currently the Medical Director of the Cardiopulmonary Research Science and Technology Institute (CRSTI) and a cardiologist with The Dallas Heart Group and CSANT, PA. Formerly, Dr. Eichhorn
served as a Professor of Medicine at the University of Texas Southwestern Medical Center in Dallas and Director of the Cardiac Catheterization Laboratory at the Dallas Veterans Administration Medical
Center and is now an Adjunct Professor of Medicine at the University of Colorado in Denver.

His research interests include the use of beta-adrenergic blockade in patients with congestive heart failure, and substance abuse and its effect on the heart. Dr. Eichhorn has been an invited lecturer on these
topics and others at grand rounds and symposia sponsored by hospitals and medical societies. In addition, he was Study Co-chairman and Principal Investigator for the Beta-Blocker Evaluation of Survival Trial
(BEST) sponsored by the Clinical Trials Division of the National Heart, Lung, and Blood Institute and the Cooperative Studies Program of the Veterans Administration.

Dr. Eichhorn is author and coauthor of 100 articles and 50 abstracts for such notable journals as The New England Journal of Medicine, Circulation, Journal of the American College of Cardiology and American
Journal of Cardiology. He is also on the editorial board for many of these publications and serves as a reviewer for several other well-known medical journals.

Dr. Eichhorn has received several honors during his professional career, including the Arthur S. Flemming National Award for Outstanding Service and Scientific Merit given by the Downtown Jaycees of Washington, DC. He is also a member of the Scientific Advisory Board of the Task Force
on Heart Failure for the European Society of Cardiology. The Association of Military Surgeons of the United States(AMSUS) awarded him the Paul Dudley White award. Dr. Eichhorn is a Fellow of the American College of Cardiology and the Council on Clinical Cardiology of the AHA.

The speakers for the lecture series are Dr. Eric J. Eichhorn, CRSTI Medical Director and Dr. Jerry H. Gilbert, cardiologist with The Dallas Heart Group.

Space is limited. Please register by calling Michelle at 972-566-4088. Online registration and complete program information is available by visiting CRSTI’s website at www.crsti.org.

CME Lecture Series Schedule

August 7 - Dr. Gilbert
“Carotid Artery Stenting - A Less Invasive Approach”

August 21 - Dr. Eichhorn
“Beta Blocker Therapy of CHF”

September 18 - Dr. Eichhorn
“Energetic Alterations in CHF”

September 25 - Dr. Gilbert
“Peripheral Vascular Disease: An Overview”

October 2 - Dr. Eichhorn
“Medical Therapy of Far Advanced CHF”

October 16 - Dr. Gilbert
“Drug-Eluting Stents - A Revolution in Coronary Intervention”

Hillary Prince and Shannon Horswell of Greenhill School; Katie Crumrine of Texas Christian University;
Todd Sisson of Kaufman High School; Katherine Jones of University of Texas; and Laura Ley of University
of Kansas, successfully completed their eight-week internship at the nonprofit research organization, the Cardiopulmonary Research Science & Technology Institute (CRSTI). The six were recognized at a special
reception on Wednesday, July 24, at the Cooper Clinic Guest Lodge in Dallas, Texas.

These students were selected from over 40 local applicants, both high school and college-level, to participate in the organization's Summer Internship Program. Each year, CRSTI selects students from the Dallas Fort Worth community to participate in the paid, eight-week program, encouraging their pursuit of a medical career.

The interns have spent the last several weeks learning about the concepts of clinical and pre-clinical cardiac research, basic scientific principles of research, clinical outcomes, and data collection and
management. Each was assigned his/her own specific research project, and paired with physician and staff mentors to assist them in completing their assignment. Mentoring physicians and staff included Donna
Bachand, RN, Ph.D.,Walter Bobechko, M.D., Michelle Borg-Bruns, Jorge Cheirif, M.D., Todd Dewey, M.D., Lisa Fitzgibbons, Ph.D., Morley Herbert, Ph.D., Jeffrey Horswell, M.D., Lisa Johnson, ACNP,
Allie Leonard, RN, Michael Mack, M.D., Mitchell Magee, M.D., Miriam Muallem, MLS, Cayla Perdue,
Syma Prince, RN, BSN, Angela Riley, RT, William Ryan, M.D, Janet Williams, and Tina Worley, RN, BSN, CCRC.

All students were held accountable for their assigned tasks, providing progress reports to their designated mentor. Each student had the opportunity to take ownership in one project of interest and take it from infancy to completion. For many, this opportunity allows them to co-author a study for national and/or international publication, an accomplishment that is normally not achieved until one is well into medical school.

Ms. Prince is a May 2002 graduate of Greenhill School and will attend the University of Richmond in the Fall. Ms. Horswell attends Greenhill School and will be a junior this year. Ms. Crumrine attends Texas
Christian University and will graduate in May 2003. Mr. Sisson is a May 2002 graduate of Kaufman High School and will attend the University of the South in Sewanee, Tennessee. Ms. Jones attends The University of Texas at Austin and will graduate in May 2004 and Ms. Ley attends the University of Kansas and will graduate in May 2005.

CRSTI Summer Intern Program sponsors are Edwards Life Sciences, Medtronic, St. Jude Medical, Sulzer Carbomedics, Dr. and Mrs. Jeffrey Horswell, Dr. and. Mrs. Will Ryan, and Dr. and Mrs. Robert Scruggs.

As a nonprofit organization, CRSTI depends on volunteers and donations to support research that is not only saving lives today, but is preventing heart, lung and circulatory disease for thousands in the future.

Please help the fight against America’s number one killer. To learn more about volunteer opportunities and discover how you can make a difference, call (972) 566-6820 or visit our web site: www.crsti.org.

CRSTI Research Protocols

CRSTI currently maintains several protocols with active enrollment. CLICK HERE for a description of current protocols, including sponsors, investigators and designated sites.