What is the role of brain natriuretic peptide (BNP) and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) in the emergency department (ED) evaluation of acute dyspnea?

Updated: Jan 08, 2018
  • Author: Donald Schreiber, MD, CM; Chief Editor: Erik D Schraga, MD  more...
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Answer

The utility of brain natriuretic peptide (BNP) testing in the acute care setting is derived from the landmark Breathing Not Properly study and later studies. [16, 17, 18, 19, 20, 21] The initial Breathing Not Properly multicenter prospective study involved 1586 patients presenting to the emergency department (ED) with acute dyspnea.

In the patient with dyspnea, overlapping or even conflicting historical, physical, and radiographic findings often hinder the differentiation between cardiac and noncardiac etiology. Initial misdiagnosis occurs in approximately 15-20% of patients presenting to the emergency department (ED) with dyspnea secondary to an acute exacerbation of congestive heart failure (CHF). This misdiagnosis may incur clinically significant morbidity and mortality.

The primary value of BNP and NT-proBNP testing in the ED is its diagnostic value in the differential diagnosis of acute dyspnea and possible CHF. levels of the natriuretic peptides may also assist the emergency physician in appropriately triaging the patient with CHF.

Studies have shown that measurements of BNP or NT-proBNP in the ED can be used to establish the diagnosis of CHF when the clinical presentation is ambiguous or when confounding comorbidities are present. Given that BNP and NT-proBNP assays have different cutoff values for ruling in and ruling out CHF, these values are specified separately below where appropriate.


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