Natriuretic peptides (NP) are useful to rule out heart failure1,2
NP cut-off levels differ for the diagnosis of patients seen in acute vs outpatient settings. They are best suited to assist in ruling out heart failure as a diagnosis, but should not be used independent of signs, symptoms and other diagnostic information3.
In a non-acute setting, a test result of ≤ 125 pg/ml suggests a strong possibility that heart failure can be excluded as a cause of symptoms2.
Elevated NPs help establish an initial working diagnosis, identifying those who require further cardiac investigation; patients with values below the cut-off point for the exclusion of important cardiac dysfunction do not require echocardiography3.
Recommended natriuretic peptide cut-off levels for non-acute setting1,2 (pg/mL)
| NT-proBNP | BNP | NPV | PPV | ||
|---|---|---|---|---|---|
| HF unlikely | < 125 | < 35 | 0.94–0.98 | ||
| ‘Grey zone’ | 125–600 | 35–150 | |||
| HF likely | > 600 | > 150 | 0.44–0.57 |
- Below the cut-off points, HF can be excluded with high confidence (high NPV:0.94-0.98)1,2
- Positive predictive value lower (0.44-0.57): Natriuretic peptides recommended for ruling out HF (not for diagnosis)2
References
BNP: B-type natriuretic peptide; HF: heart failure; NPV: negative predictive value; NT-proBNP: N-terminal pro-B type natriuretic peptide; PPV: positive predictive value
- Mueller C, et al. Eur J Heart Fail 2019; 21: 715-31;
- Ponikowski P, et al. Eur Heart J 2016; 37: 2129-200;
- Ezekowitz J, et al. Can J Cardiol 2017; 33: 1342-1433.
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