From the Guidelines
Elevated B-Type Natriuretic Peptide (BNP) levels of 124.7 pg/mL can indeed be caused by conditions other than heart failure, including cardiac and non-cardiac causes as outlined in the 2016 ESC guidelines 1. While heart failure is the most common reason for BNP elevation, several other medical conditions can increase BNP levels. Some of these conditions include:
- Cardiac causes such as acute coronary syndromes, pulmonary embolism, myocarditis, left ventricular hypertrophy, hypertrophic or restrictive cardiomyopathy, valvular heart disease, congenital heart disease, atrial and ventricular tachyarrhythmias, heart contusion, cardioversion, ICD shock, surgical procedures involving the heart, and pulmonary hypertension 1
- Non-cardiac causes such as advanced age, ischemic stroke, subarachnoid haemorrhage, renal dysfunction, liver dysfunction (mainly liver cirrhosis with ascites), paraneoplastic syndrome, chronic obstructive pulmonary disease, severe infections (including pneumonia and sepsis), severe burns, anaemia, and severe metabolic and hormone abnormalities 1 It's also important to consider that BNP levels can be influenced by other factors, such as age-related changes, with older individuals typically having higher baseline values, and certain medications like steroids and some antidepressants may increase BNP as well 1. A comprehensive evaluation, including a physical examination, review of symptoms, and possibly additional cardiac testing, is necessary to determine the cause of elevated BNP levels 1. In the context of real-life clinical medicine, it is crucial to interpret BNP levels with caution, considering the clinical context and other diagnostic findings, as a value of 124.7 pg/mL is only moderately elevated and might even be considered within the upper range of normal for older adults 1.
From the Research
B-Type Natriuretic Peptide Elevation
Elevation of B-type natriuretic peptide (BNP) is often associated with heart failure, but it can also be caused by other conditions.
- BNP levels are influenced by age, gender, and body mass index (BMI) 2.
- BNP can be elevated in other cardiac disease states such as acute coronary syndromes, diastolic dysfunction, atrial fibrillation, amyloidosis, restrictive cardiomyopathy, and valvular heart disease 2, 3.
- Non-cardiac diseases such as pulmonary hypertension, chronic obstructive pulmonary disease, pulmonary embolism, and renal failure can also cause elevated BNP levels 2, 3, 4.
- Critical illness, including sepsis and septic shock, can also lead to elevated BNP levels 3, 5.
Conditions Influencing BNP Levels
Several conditions can influence BNP levels, including:
- Cardiac secretion of BNP increases with the progression of congestive heart failure (CHF) 3.
- BNP levels can be elevated in patients with acute dyspnea, and a low level can help rule out CHF in primary care settings 3, 4.
- The severity of critical illness, rather than septic cardiomyopathy, is probably the major determinant of BNP elevation in patients with critical sepsis 5.
- BNP levels can be elevated in patients with lung cancer, and sepsis 4.
Diagnostic Use of BNP
The diagnostic use of BNP is limited by its lack of specificity for heart failure.
- BNP testing can help select patients clinically suspected of heart failure who need echocardiography 6.
- However, the diagnostic actions following NP testing in daily primary care are poorly studied 6.
- A retrospective cohort study found that only 42.1% of patients with an elevated NP level were referred for echocardiography 6.