Guiding and monitoring of heart failure therapy with NT-ProBNP: Concepts and clinical studies

Background: Since 1988 with the discovery of B-type natriuretic peptide (BNP), many reports have confirmed the elevation of plasma BNP in symptomatic heart failure and confirmed that plasma levels are an independent predictor of death and cardiovascular events in both acute and chronic heart failure. Methods and Results: A more slender evidence base attests that knowledge of plasma BNP levels can be used to produce clinical benefit. One randomized controlled trial demonstrated that measurements of N-terminal pro-brain natriuretic peptide (NT-proBNP) can be used to improve diagnostic accuracy in patients with heart failure in the community. A second study demonstrated that the provision of plasma BNP data improves the speed of diagnosis and reduces the rates of hospital admission and length of hospital stay (while reducing the costs of care) in patients with heart failure who are seen the emergency department with acute dyspnea. Finally, a randomized controlled pilot study demonstrated that serial measurements of NT-proBNP can be used to more effectively optimize heart failure pharmacotherapy with a concomitant improvement in outcome. Conclusion: The large body of observational data, coupled with this small but promising evidence base from controlled trials (which attests to beneficial effects on clinical outcomes) encourages an optimistic outlook for the further implementation of plasma BNP and/or NT-proBNP in the diagnosis and treatment of acute and chronic heart failure.