What is the role of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) in the monitoring therapeutic response in patients with congestive heart failure (CHF)?

Updated: Jan 08, 2018
  • Author: Donald Schreiber, MD, CM; Chief Editor: Erik D Schraga, MD  more...
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Monitoring the therapeutic response in patients with acute decompensated congestive heart failure (CHF) is based on several clinical factors, including symptomatic relief of dyspnea, weight change, fluid balance, and resolution of S3 cardiac sounds, jugular venous distention, and lower-extremity edema. Researchers have explored the use of serial natriuretic peptide measurements to objectively follow up therapeutic responses. [55]

Data from a Spanish study suggested that serial NT-proBNP—or brain natriuretic peptide (BNP)—levels may be useful adjuncts in monitoring therapeutic responses in patients admitted to the hospital with acute CHF. However, the sample size in the study was small.

In the study, NT-proBNP levels were measured in 100 patients with acute dyspnea when they presented in the emergency department (ED), at 24 hours, and at 7 days. [56] CHF was echocardiographically diagnosed. Patients were classified as those with acute CHF exacerbations, those with underlying heart failure and superimposed acute pulmonary disease, and those with a noncardiac etiology of dyspnea.

NT-proBNP levels were highly predictive of LV dysfunction, and patients with complete symptom resolution had mean decreases in NT-proBNP values of 56%. Patients whose conditions were stabilized but still symptomatic had intermediate mean decreases of 37%. Patients whose decompensation persisted at 7 days had decreases of 21%.

Some investigators have suggested that the absolute change between the baseline, or dry, natriuretic peptide level and the ED admission level might be the best predictor of the patient’s outcome and the most useful triage tool. [31, 32]

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