Rationale:

There are numerous recommended examination techniques for patients diagnosed with heart failure (HF). Pulmonary auscultation is one such technique where the detection of crackles may indicate a shift from compensated to decompensated HF. More recently, Brain Natriuretic Peptide (BNP) has become an important clinical variable to assess during the examination of patients with HF.

Objectives:

The purpose of the present study is to examine the relationship between pulmonary auscultation findings and BNP in a group of patients diagnosed with HF.

Methodology:

364 (197 male/167 female) subjects enrolled in a HF collaborative care program were included in this analysis. All subjects reported no history of tobacco use. Mean age of the group was 75.7 (+/-10.8) years. Brain natriuretic peptide (BNP) was collected during clinic visits. Pulmonary auscultation was conducted by a Nurse Practitioner, under the direction of a cardiologist, prior to the initiation of any therapy during that visit. Subjects were classified as either having clear lung fields or pulmonary crackles in one or more lobes. Unpaired t-testing was used to assess differences in BNP between these two pulmonary auscultation based groups. A mean difference between groups with a p-value <0.05 was considered statistically significant.

Results:

Two hundred and sixty-eight subjects had clear lung fields. Ninety-six subjects had pulmonary crackles in one or more lung fields. Mean BNP values for the subjects with clear lung fields and the subjects with pulmonary crackles were 580.5 (+/-829.7) pg/ml and 1217.6 (+/-1495.6) pg/ml, respectively. Unpaired t-testing revealed the difference in BNP values between these two groups was statistically significant (P < 0.001).

Conclusions:

The results of the present study indicate pulmonary crackles may be reflective of an elevated BNP in subjects with HF. Clinicians who perform examinations in patients with HF should consider the potential relationship between pulmonary auscultation findings and BNP.