In the ICON study NT-proBNP was a valuable tool for the diagnosis of acute heart failure with the age-independent “rule-out” cut-off of 300pg/mL which had very high sensitivity and the age-stratified triple “rule-in” cut-points of 450 pg/mL (< 50 years) 900 pg/mL (50-75 years) and 1800 pg/mL (>75 years) demonstrating a high sensitivity and specificity. 1
This case demonstrated NT-proBNP is useful to rule out the diagnosis of heart failure in the acute setting when the diagnosis is inconclusive based on the clinical information.
NT-proBNP at 125 pg/mL is a cut off value for patients suspicious of heart failure in the non-acute setting, the age stratified cut off values should be used in acute setting.2
Patients with COVID-19 often demonstrate significant elevation of NT-proBNP. The significance of this finding is uncertain and should not necessarily trigger an evaluation or treatment for heart failure unless there is clear clinical evidence for the diagnosis (such as clinical signs and symptoms).3
Acute Heart Failure (AHF) is one of the common causes for NT-proBNP elevation.
For patients suspected of AHF, when NT-proBNP levels are within the normal range it makes the diagnosis highly unlikely. (thresholds: NT-proBNP < 300pg/mL)11
The elevated levels of NPs do not automatically confirm the diagnosis of AHF, as they may also be associated with a wide variety of cardiac and non-cardiac causes.1 In addition, we think about acute conditions associated with elevated NP levels other than CHF are as follows: renal failure, pulmonary disease and pulmonary embolism, older age, liver cirrhosis, and sepsis.1
In acute setting with suspected heart failure, we have to consider causes of AHF (CHAMP: acute coronary syndrome, hypertensive emergency, arrhythmia, acute mechanical causes, pulmonary thromboembolism).2
Plasma NT-proBNP is elevated in the majority of cases of pulmonary embolism resulting in right ventricular overload.
Plasma NT-proBNP levels reflect the degree of right ventricular overload and may help to predict short-term outcomes.
Acute pulmonary embolism should be considered in the differential diagnosis of patients with dyspnea and abnormal levels of natriuretic peptide.
Januzzi et al, Eur H Jour 2006; 27:330
Ponikowski P et al 2016 Eur J Heart Fail 2016; 18:891–975
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