What is the role of brain natriuretic peptide (BNP) testing in the evaluation of RVf dysfunction and pulmonary disease?

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

Danish researchers extrapolated the relationship between BNP and left ventricular (LV) dysfunction and the relationship between BNP and right ventricular (RV) dysfunction. [64] In 50 patients with normal LV function and normal coronary arteries who were referred for lung transplantation, NT-proBNP levels were determined before they underwent right heart catheterization. Patients with primary pulmonary hypertension had NT-proBNP concentrations 40 times higher than those of patients with terminal parenchymal lung disease.

Levels of NT-proBNP have also been useful in predicting uncomplicated clinical courses of patients with a diagnosis of acute pulmonary embolism (PE). [65, 66, 67, 68] Swiss investigators measured the NT-proBNP levels in 73 patients with confirmed PE within 4 hours of diagnosis. [65] Twenty patients had adverse outcomes, which was defined as death or the need for any of cardiopulmonary resuscitation, thrombolysis, embolectomy, vasoactive medications, or mechanical ventilation.

In this small study, a NT-proBNP level less than 500pg/mL had a negative predictive value (NPV) of 97% for complications due to PE. The NT-proBNP level remained an independent predictor for adverse outcome even after the analysis was adjusted for age, sex, history of CHF, and severity of PE.

A group in Poland performed a similar study in 79 patients with acute PE and concluded that NT-proBNP values were elevated in most cases of PE that caused RV dysfunction. They further suggested that plasma levels reflected the degree of RV overload and may help in predicting short-term outcomes. [69]

In the study, the investigators measured NT-proBNP and performed RV echocardiography to measure the extent of RV dysfunction. NT-proBNP levels were significantly higher in patients with RV dysfunction. The NPV of a normal NT-proBNP level in avoiding adverse events was 100%. Fifteen in-hospital deaths occurred, all in patients with levels greater than 600pg/mL, which were also observed in 24 patients with adverse events. However, because most NT-proBNP elevations were still less than 1000pg/mL, the positive predictive value (PPV) for adverse events with an elevated NT-proBNP level was only 36%.


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