- Biologically active metabolite of proBNP
- <100 pg/mL CHF ruled out (Sn 90%, NPV 89%)
- 100-500: Consider differential diagnosis and pre-test probability
- > 500 Positive (CHF Sp 87%, PPV 90%)
- N-terminal proBNP
- Biologically inert metabolite of proBNP
- < 300 ng/mL, CHF unlikely
- CHF likely in:
- > 450 pg/mL in age < 50 yoa
- > 900 in 50-75 yoa
- > 1800 in > 75 yoa
Differential Diagnosis (Elevated BNP)
May have false negatives with obesity and diastolic dysfunction
↑ Januzzi JL, van Kimmenade R, Lainchbury J, et al. NT-proBNP testing for diagnosis and short-term prognosis in acute destabilized heart failure: an international pooled analysis of 1256 patients: the International Collaborative of NT-proBNP Study. Eur Heart J. 2006 Feb. 27(3):330-7.
↑ Kragelund C, Gronning B, Kober L, Hildebrandt P, Steffensen R. N-terminal pro-B-type natriuretic peptide and long-term mortality in stable coronary heart disease. N Engl J Med. 2005 Feb 17. 352(7):666-75.
↑ Moe GW, Howlett J, Januzzi JL, Zowall H,. N-terminal pro-B-type natriuretic peptide testing improves the management of patients with suspected acute heart failure: primary results of the Canadian prospective randomized multicenter IMPROVE-CHF study. Circulation. 2007 Jun 19. 115(24):3103-10.
↑ Carpenter CR et al. BRAIN NATRIURETIC PEPTIDE IN THE EVALUATION OF EMERGENCY DEPARTMENT DYSPNEA: IS THERE A ROLE? J Emerg Med. 2012 Feb; 42(2): 197–205.
- Obtaining BNP value may not add anything to patient centered outcomes
- May be used to gauge treatment response in acute decompensated CHF