Download Measure serum B-type natriuretic peptide (BNP) levels If unable to

Measure serum B-type natriuretic peptide (BNP) levels
If unable to access an echocardiogram in a timely fashion, refer for BNP. Please note this not
reimbursed by Medicare.
Interpreting BNP and NT-proBNP levels:





heart failure (HF) is unlikely if levels of BNP or NT-proBNP are low or normal in an untreated
person
increased levels of BNP or NT-proBNP are not used exclusively to diagnose HF because
levels are also known to:
o increase with age
o differ between men and women
o be affected by co-morbidities, eg renal failure, and pharmacological treatments
the following are known to reduce BNP levels:
o obesity
o treatment with:
 diuretics
 angiotensin-converting enzyme (ACE) inhibitors
 beta blockers
 angiotensin II receptor antagonists (ARBs)
 aldosterone antagonists
the following are known to increase BNP levels:
o left ventricular hypertrophy (LVH)
o ischaemia
o tachycardia
o right ventricular (RV) overload
o hypoxaemia, including pulmonary embolism (PE)
o renal dysfunction − indicated by a eGFR of less than 60ml/minute
o sepsis
o chronic obstructive pulmonary disease (COPD)
o diabetes mellitus (DM)
o age of more than 70 years
o cirrhosis of the liver
level of serum natriuretic peptide does not differentiate between HF due to left ventricular
systolic dysfunction (LVSD) and HF with preserved left ventricular ejection fraction (LVEF)
Normal BNP levels
Patients with normal natriuretic peptide levels are unlikely to have heart failure − differential diagnoses
should be considered in these patients].
Normal levels are defined as either of the following:
 serum B-type natriuretic peptide (BNP) level of less than 100pg/mL (29pmol/L)
 N-terminal pro-B-type natriuretic peptide (NT-proBNP) level of less than 400pg/mL (47pmol/L)
Intermediate/high BNP levels
Intermediate natriuretic peptide levels are defined as either of the following:
 serum B-type natriuretic peptide (BNP) level of 100-400pg/mL (29-116pmol/L)
 N-terminal pro-B-type natriuretic peptide (NT-proBNP) level of 400-2000pg/mL (47236pmol/L)
High levels are defined as either of the following:
 BNP level above 400pg/mL (116pmol/L)
 level above 2000pg/mL (236pmol/L)
Refer patients for echocardiography.
Be aware that very high BNP levels carry a poor prognosis.
Abstract from Map of Medicine international ‘Heart failure – suspected’ pathway nodes