From the Guidelines
There is a strong correlation between ProBNP readings and heart failure severity, with higher levels indicating more severe heart failure and worse clinical outcomes. This correlation is supported by a study published in Circulation in 2017 1, which found that NT-proBNP levels are independently associated with mortality and morbidity in patients with heart failure. The study showed that NT-proBNP levels above the median of 339 pg/mL were associated with a nearly 80% increase in the risk of all-cause mortality and prespecified cardiovascular hospitalizations.
Some key points to consider when interpreting ProBNP readings include:
- The normal range for NT-proBNP is typically below 125 pg/mL for patients under 75 years and below 450 pg/mL for those over 75
- In heart failure patients, levels often exceed 450 pg/mL, with severe cases showing values in the thousands or tens of thousands
- ProBNP levels typically decrease when heart failure treatment is working effectively
- Factors like age, kidney function, obesity, and atrial fibrillation can influence readings independent of heart failure severity
As noted in the study published in Circulation 1, changes in NT-proBNP over time were also associated with outcomes, with a rise in NT-proBNP associated with an increase in risk of cardiovascular death or HF hospitalization, and a fall associated with a trend toward a decrease in risk. Therefore, ProBNP is a useful marker to monitor prognosis in heart failure patients. Clinicians can use ProBNP alongside clinical assessment to guide treatment decisions, adjust medications, and evaluate treatment effectiveness.
From the Research
Correlation Between ProBNP Readings and Heart Failure Severity
- The relationship between ProBNP readings and heart failure severity has been explored in several studies 2, 3, 4, 5, 6.
- According to a study published in 2010, natriuretic peptide (NP) levels, including ProBNP, are strictly related to heart failure severity and are particularly increased in more advanced New York Heart Association (NYHA) classes and in patients with poor outcomes 2.
- Another study published in 2014 found that B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) levels are increased in persons with heart failure, and low levels of these peptides can rule out heart failure 3.
- A 2024 study demonstrated that repeated NT-proBNP measurements can provide added prognostic value compared to single measurements alone for chronic heart failure patients, and that an increase in NT-proBNP can occur weeks before the onset of adjudicated events 4.
- A 2022 study found a significant positive correlation between NT-proBNP and age, and a significant negative correlation between creatinine clearance and NT-proBNP, as well as between left ventricular ejection fraction (LVEF) and NT-proBNP 5.
- A 2005 study explored the association between NT-proBNP levels, functional capacity, and stage in patients with heart failure, and found that NT-proBNP levels increased significantly with each increasing class of the disease and with increasing stages of the disease 6.
Key Findings
- ProBNP readings are correlated with heart failure severity, with higher levels indicating more advanced disease 2, 6.
- Repeated NT-proBNP measurements can provide valuable prognostic information for chronic heart failure patients 4.
- NT-proBNP levels are influenced by factors such as age, creatinine clearance, and LVEF 5.
- NT-proBNP can aid in the diagnosis and treatment of heart failure, but should be used in conjunction with clinical findings 5.