Interpretation and Use of Natriuretic Peptides in Non-Congestive Heart Failure Settings

Natriuretic peptides (NPs) have been found to be useful markers in differentiating acute dyspneic patients presenting to the emergency department (ED) and emerged as potent prognostic markers for patients with congestive heart failure (CHF).The best-established and widely used clinical application of BNP and NT-proBNP testing is for the emergent diagnosis of CHF in patients presenting with acute dyspnea.BNP and NT-proBNP, as the European Society of Cardiology recommended, are helpful in the diagnosis of HF and providing prognostic potential; as well at a low-normal concentration in untreated patients makes HF unlikely as the cause of symptoms. 1The Food and Drug Administration (FDA) approved a cutoff value of BNP for the diagnosis of CHF is 100 pg/mL.In NT-proBNP, the optimal cutoff values for confirmatory (rule in) decision limits for CHF are 450, 900 and 1,800 pg/mL for ages less than 50 years, between 50 to 75 years, and older than 75 years of age.The exclusionary (rule out) decision limit of NT-proBNP for cardiogenic acute dyspnea in all ages is less than 300 pg/mL.