Table 2.
Natriuretic peptides cut-off values in different heart failure setting.
| HF Clinical Setting | NT-ProBNP (pg/mL) | BNP (pg/mL) | MR-ProANP (pg/mL) | Comments | ||
|---|---|---|---|---|---|---|
| Rule-In | Rule-Out | Rule-In | Rule-Out | Rule-Out | ||
| Suspected acute HF (Patients with acute dyspnoea) * |
Age–related <50 y >450 51–75 y >900 >75 y >1800 |
<300 | >400 | <100 | <120 | Higher NP levels in HFREF vs HFPEF [13] Less data for MR-proANP |
| Suspected acute HF and eGFR < 60 mL/min | Same as in suspected Acute HF | <200 | - | No supplementary correction recommended for NT-proBNP age-adjusted cut-offs due to correspondence between renal function decline and increasing age [13] | ||
| Suspected acute HF and AF | >600 (SOCRATES trial [106]) >900 (PARAGON trial [107]) |
<400 | >240 | <150 | - | Higher NP levels occasionally observed in patients with AF but no clinical data to sustain HF diagnosis [108] In HFPEF trials, the NP cut-off values as inclusion criteria were higher in patients with AF vs sinus rhythm [106,107] |
| Suspected acute HF and obesity > 30 kg/m2 | Lowering the cut-off levels by up to 50% | <50 | - | Presumed overlap between NP levels in HFPEF and obesity [109] | ||
| HF in the community (Non-acute setting) | >600 | <125 | >150 | <35 | <40 | NP serial dosing during follow-up in conjunction with symptoms and weight gain are recommended in order to recognize early decompensation [13]. |
AF = atrial fibrillation; BNP = B-type natriuretic peptide; Egfr = estimated glomerular filtration rate; HF = heart failure; HFPEF = heart failure with preserved ejection fraction; HFREF = heart failure with reduced ejection fraction; MR-proANP = Mid-regional pro-atrial natriuretic peptide; NP = natriuretic peptide; NT-proBNP = N-terminal pro-B-type natriuretic peptide; * During HF hospitalization the lack of decrease/ any increase and, during the follow-up visits an increase more than 50% of NP value is likely to be of clinical relevance of increased filling pressures [13]. NT-proBNP <1500 pg/mL or ≥30% decrease/BNP <250 pg/mL under treatment at discharge is considered a favorable NPs change in HFREF patients [7], although other data sustain a greater benefit when lower target NP concentration is attempted (BNP < 100 pg/mL, NT-proBNP < 1000 pg/mL) [110].