Brain natriuretic peptide

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Brain natriuretic peptide (BNP)

  • 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%)

NT-proBNP[1][2][3]

  • N-terminal proBNP
  • Biologically inert metabolite of proBNP
  • < 300 ng/mL, CHF unlikely
  • CHF likely in:
    • > 450 pg/mL in age < 50 years old
    • > 900 in 50-75 years old
    • > 1800 in > 75 years old

Differential Diagnosis (Elevated BNP)

May have false negatives with obesity and diastolic dysfunction

Utility

  • Obtaining BNP value may not add anything to patient centered outcomes[4]
  • May be used to gauge treatment response in acute decompensated CHF

See Also

External Links

References

  1. 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.
  2. 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.
  3. 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.
  4. 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.