N-terminal fragment of the prohormone B-type natriuretic peptide is an endogenously produced neurohormone secreted from the cardiac ventricular myocytes in response to cardiac stress. NT-proBNP is a progressive cardiovascular disease (CVD) risk marker with powerful independent prognostic value for detection of clinical and subclinical cardiac dysfunction. Elevated NT-proBNP levels indicate the presence of ongoing myocardial stress and potentially an underlying, possibly unsuspected, cardiac disorder.

Clinical Implications:

Measurements of NT-proBNP are now used in the diagnosis of left ventricular systolic and diastolic dysfunction (cardiac stretch/stress) and prognostically in a variety of cardiac disease states, including Acute Coronary Syndrome (ACS), stable coronary artery disease (CAD), Heart Failure (HF), and chronic stable angina pectoris. An elevation of NT-proBNP, in the setting of undiagnosed, subclinical CVD, is prognostic of future cardiovascular events. Addressing the source of myocardial stress through appropriate therapy will reduce NT-proBNP levels to normal.

When used as a prognostic biomarker, NT-proBNP levels above 125 pg/mL suggest increased CVD risk and further diagnostic studies may be indicated to determine the causative factor. Levels above 450 pg/mL suggest structural or functional cardiac dysfunction.

Treatment considerations:

• Complete cardiology evaluation to exclude causes of cardiac dysfunction. Tests to consider:
  • ECG and echocardiogram
  • Stress ECG or echocardiogram
  • Nuclear Medicine Study
  • Cardiac catheterization
• Dependent on etiology:
  • Common first-line pharmacological considerations:
    • Preload medications: nitrates, diuretics
    • Rate control medications: beta blockers
    • Afterload medications: ACE inhibitors, ARBs, alpha blockers, calcium channel blockers, direct vasodilators
  • Cardiac pacing

For more information and detailed references, please refer to our Clinical Implications Reference Manual.