A 70-year-old man presenting to the emergency department with acute severe dyspnea has a plasma BNP measured to help differentiate cardiac from pulmonary causes. Below which BNP value is acute heart failure effectively ruled out according to the original Breathing Not Properly study cut-off?

• A 50 pg/mL
• B 100 pg/mL ✓
• C 300 pg/mL
• D 500 pg/mL

Explanation

The landmark Breathing Not Properly study established 100 pg/mL as the BNP cut-off for diagnosing acute heart failure in patients presenting with dyspnea; values below this make acute heart failure very unlikely, giving a high negative predictive value. A value above 400 to 500 pg/mL makes the diagnosis highly probable, but intermediate values require clinical correlation. Values of 300 pg/mL and above are used for ruling out heart failure with NT-proBNP in some settings, not BNP.

Reference: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 12th ed.

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