The serum concentration of brain natriuretic peptide (BNP) may be affected by a number of concurrent conditions. The presence of one or more of these conditions makes the interpretation of BNP more difficult.
An elevation of the BNP concentration in the absence of congestive heart failure can occur in (false positive result):
(1) renal failure (decreased excretion)
(2) advanced age
(3) acute coronary syndromes
(4) lung disease with cor pulmonale
(5) large pulmonary embolism
(6) high output cardiac state (was high output heart failure exclude?)
A lower than expected BNP concentration in the presence of congestive heart failure can occur in (false negative result):
(1) acute pulmonary edema
(2) stable NYHA Class I patient with a low ejection fraction
(3) acute mitral regurgitation
(4) mitral stenosis
(5) atrial myxoma
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