In patients presenting with acute
dyspnea of any cause, elevation of amino-terminal pro-B-type
natriuretic peptides (
NT-proBNP) is powerfully prognostic for adverse outcomes, including death. Among those with acute destabilized
heart failure (HF), an
NT-proBNP cut point of approximately 5,000 ng/L is powerfully predictive of death by 76 days after presentation. For 1-year risk stratification, an
NT-proBNP value of approximately 1,000 ng/L at presentation is optimal. Among those patients with elevated
NT-proBNP levels, a posttreatment
NT-proBNP value may be of even greater value than the presenting value. Although
NT-proBNP is powerfully prognostic in patients with acute
dyspnea with and without HF, the addition of clinical variables strengthens the ability to discriminate risk. In addition, multimarker approaches, including
NT-proBNP, for the assessment of acute
dyspnea or acute HF appear promising. Indeed, when combined with conventional markers, such as measures of renal dysfunction,
anemia, myocardial injury, or
inflammation, the predictive value of
NT-proBNP is considerably strengthened. Given the strong value of
NT-proBNP for risk assessment of the patient with acute
dyspnea, a baseline measurement for all patients with
dyspnea is recommended, with pretreatment and posttreatment measurement of
NT-proBNP recommended for patients with an elevated value, especially those with HF.