From the Guidelines
Pro-BNP can be elevated in various conditions beyond congestive heart failure (CHF), including acute coronary syndromes, pulmonary embolism, pulmonary hypertension, renal failure, sepsis, and critical illness, as well as in certain cardiac conditions like atrial fibrillation, valvular heart disease, and myocarditis. According to the most recent and highest quality study 1, pro-BNP levels may increase in response to cardiac wall stress and myocardial stretch, which can occur in conditions other than CHF. The study highlights that factors such as advanced age, female sex, and decreased body mass index can also lead to higher baseline pro-BNP levels.
Conditions that can Elevate Pro-BNP
- Acute coronary syndromes
- Pulmonary embolism
- Pulmonary hypertension
- Renal failure
- Sepsis
- Critical illness
- Atrial fibrillation
- Valvular heart disease
- Myocarditis
Importance of Clinical Context
When interpreting pro-BNP results, clinicians should consider these potential confounding factors and evaluate the patient's complete clinical picture rather than relying solely on this biomarker 1. The threshold for what constitutes an abnormal pro-BNP level may need adjustment in patients with these comorbidities to maintain diagnostic accuracy. As noted in another study 1, partition values for diagnostic criteria of BNP ≥100 pg/mL and NT-proBNP ≥800 pg/mL have been suggested to support the diagnosis of HFpEF, but these values may need to be adjusted in patients with significant comorbid states.
Diagnostic Approach
A diagnostic flowchart for patients with suspected heart failure, showing alternative 'echocardiography first' or 'natriuretic peptide first' approaches, is provided in a previous study 1. This approach emphasizes the importance of considering the clinical context and using a combination of diagnostic tools to accurately diagnose heart failure.
Conclusion is not allowed, so the answer just ends here.
From the Research
Conditions with Elevated Pro-BNP
- Acute coronary syndromes: Pro-BNP levels may be elevated in patients with acute coronary syndromes, particularly those with myocardial ischemia or infarction 2, 3
- Pulmonary embolism: Elevated NT-proBNP levels have been associated with worse immediate prognoses and increased risk of all-cause death in patients with pulmonary embolism 2, 4
- Chronic obstructive pulmonary disease (COPD): Pro-BNP levels may be elevated in patients with COPD, particularly those with severe disease or acute exacerbations 2
- Pneumonia: Pro-BNP levels may be elevated in patients with pneumonia, particularly those with severe disease or respiratory failure 2
- Sepsis: Pro-BNP levels may be elevated in patients with sepsis, particularly those with cardiac involvement or multi-organ failure 2
- Renal failure: Pro-BNP levels may be elevated in patients with renal failure, particularly those with cardiac involvement or volume overload 2, 5
- Acute respiratory distress syndrome (ARDS): Pro-BNP levels may be elevated in patients with ARDS, particularly those with cardiac involvement or multi-organ failure 2
- Cardiac arrhythmias: Pro-BNP levels may be elevated in patients with cardiac arrhythmias, particularly those with underlying cardiac disease or heart failure 2
- Anemia: Pro-BNP levels may be elevated in patients with anemia, particularly those with underlying cardiac disease or heart failure 2
- Hypoxia: Pro-BNP levels may be elevated in patients with hypoxia, particularly those with underlying cardiac disease or heart failure 2
Clinical Utility of Pro-BNP
- Pro-BNP has diagnostic and prognostic value in patients with heart failure, acute coronary syndrome, and other cardiovascular diseases 6, 2, 3, 5
- Pro-BNP can help identify patients with worse immediate prognoses and increased risk of all-cause death in pulmonary embolism cases 4
- Pro-BNP can be used for risk stratification in patients with cardiovascular diseases, including heart failure and acute coronary syndrome 3, 5