Click on one of the 3 tabs below to switch between different type of heart failure patients
- Use of NT-proBNP for hospitalized
heart failure patients - Use of NT-proBNP for outpatient
heart failure patients with symptoms - Use of NT-proBNP for stable
heart failure patients without symptoms
53-Year old-Women
Key signs and symptoms
Acute decompensated heart failure requiring admission
for intravenous diuretic – LVEF 25%
Medical history
Diabetes mellitus for the last 3 years
Chronic heart failure for the last 2 years
Clinical examination
BP 120/80 mmHg
Heart rate 72/min
Pulmonary congestion with pedal edema
Potassium 4.2 mmol/L
Creatinine 90 Umol/L,
HbA1c 7.1%
BMI-22
Medications
Enalapril 10 mg bid
Bisoprolol 10 mg od
Spironolactone 25 mg od
Ivabradine 5 mg bid
Loop diuretic
Metformin 500 mg bid
Empagliflozin 10 mg od
Recommended Procedure
Conclusion
Patients who attained a significant reduction (>30%) in NT-proBNP between admission and discharge had a lower subsequent rate of cardiovascular death or heart failure hospitalization.
Author’s opinion:
Although the level of NT-proBNP and the change of NT-proBNP should not be used as the only criterion to determine admission and discharge of heart failure patients, NT-proBNP provides additional information to clinical evaluation in support of clinical decision on admission, triage, discharge and optimizing treatment.
References:
MR Ziles, BL Claggett, MF Prescott, et al. Prognostic Implications of Changes in N-Terminal Pro-B-type Natriuretic Peptide in Patients With Heart Failure. J Am Coll Cardiol 2016; 68: 2425-2436.
CSP Lam, YH Li, A Bayes-Genis, et al. The role of N-terminal pro-B-type natriuretic peptide in prognostic evaluation of heart failure. J Chin Med Assoc 2019; 82(6):447-451.
45-year old man
Key signs and symptoms
New referral to the heart failure clinic ,
NYHA class 2 , LVEF 35%
Medical history
Hypertension for the last 10 years
Chronic heart failure for the last 2 years
Acute myocardial infarction 7 years ago
Clinical examination
BP 110/70 mmHg
Heart rate 68/min
No evidence of fluid overload
Potassium 4.0 mmol/L
Creatinine 130 Umol/L
LDL 1.9 mmol/L
BMI-23
Medications
Sacubitril/Valsartan 200 mg bid
Carvedilol 25 mg bid
Spironolactone 25 mg od
Loop diuretic
Aspirin 100 mg od
Atorvastatin 40 mg on
Recommended Procedure
Conclusion
NT-proBNP values higher than 1000 pg/mL in heart failure patients indicates an increased risk of death or hospitalization.
Author’s opinion:
NT-proBNP values higher than 1000 pg/mL in heart failure patients indicates an increased risk of death or hospitalization.
References:
MR Ziles, BL Claggett, MF Prescott, et al. Prognostic Implications of Changes in N-Terminal Pro-B-type Natriuretic Peptide in Patients With Heart Failure. J Am Coll Cardiol 2016; 68: 2425-2436. CSP Lam, YH Li, A Bayes-Genis, et al. The role of N-terminal pro-B-type natriuretic peptide in prognostic evaluation of heart failure. J Chin Med Assoc 2019; 82(6):447-451.
65-year old man
Key signs and symptoms
Follow up in general cardiology clinic NYHA class 1,
LVEF 38%
Medical history
Hypertension for the last 15 years
Dyslipidaemia for the last 15 years
Coronary artery bypass surgery 10 years ago
Clinical examination
BP 115/70 mmHg
Heart rate 65/min
No evidence of fluid overload
Potassium 3.8 mmol/L
Creatinine 80 Umol/L
LDL 1.8 mmol/L
BMI-19
Medications
Sacubitril/Valsartan 100 mg bid
Bisorprolol 10 mg od
Spironolactone 25 mg od
Aspirin 100 mg od
Rosuvastatin 10 mg od
Recommended Procedure
Conclusion
In stable heart failure patients, NT-proBNP values less than 1000 pg/mL indicates better prognosis.
Author’s opinion:
NT-proBNP is a useful tool to help with the clinical evaluation and treatment of stable heart failure patients as the symptoms may be masked. Optimization of treatment to aim for a NT-proBNP level of less than 1000 pg/mL will reduce the subsequent risk for mortality and hospitalization.
References:
MR Ziles, BL Claggett, MF Prescott, et al. Prognostic Implications of Changes in N-Terminal Pro-B-type Natriuretic Peptide in Patients With Heart Failure. J Am Coll Cardiol 2016; 68: 2425-2436. CSP Lam, YH Li, A Bayes-Genis, et al. The role of N-terminal pro-B-type natriuretic peptide in prognostic evaluation of heart failure. J Chin Med Assoc 2019; 82(6):447-451.