What are the cutoff values for brain-type natriuretic peptide (BNP) testing in the evaluation of cardiogenic pulmonary edema (CPE)?

Updated: Jul 23, 2020
  • Author: Ali A Sovari, MD, FACP, FACC; Chief Editor: Gyanendra K Sharma, MD, FACC, FASE  more...
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Answer

Although the predictive value of a BNP measurement with a cutoff value of 100 pg/mL is high, its positive predictive value is not as high as its negative predictive value. This means that mildly to moderately elevated levels of BNP should be interpreted in accordance with the patient's clinical status and other diagnostic results.

Values of 100-400 pg/mL may be related to various pulmonary conditions, such as cor pulmonale, COPD, and pulmonary embolism. Atrial fibrillation is another factor that may mildly increase the BNP cutoff value in diagnosing heart failure. It is important to know the patient's baseline heart function. Patients with chronic heart failure and BNP values of less than or equal to 400 pg/mL may have pulmonary causes of dyspnea without exacerbation of their CHF.

Until additional studies establish the precise cutoff values for different conditions, the threshold of 100 pg/mL is recommended, with the exceptions noted above. This cutoff value has an accuracy of 80-85%, a sensitivity of 90%, and a specificity of about 75% along with other appropriate clinical and laboratory findings.


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