At this time, there is insufficient evidence to support BNP testing for screening asymptomatic, low-risk populations for LV systolic dysfunction. There may be some role for BNP to screen high-risk subgroups such as patients with prior myocardial infarction, patients with diabetes, or those with an extended history of uncontrolled hypertension. However, echocardiography is likely to remain the primary method of assessing LV function in this setting. Figure 11 depicts one possible algorithm for BNP testing in the outpatient setting (55). This algorithm is framed around a lower cut point of 20 pg/mL and an intermediate cut point of 40 pg/mL. Patients with values above the cut points of 20 and 40 pg/mL should be referred for echocardiography with consideration of evaluation by a cardiovascular specialist.
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