A 68-year-old man arrives at the emergency department with acute breathlessness. Which single value of NT-proBNP is most useful to rule OUT acute heart failure as the cause of his symptoms?

• A NT-proBNP less than 300 pg/mL ✓
• B NT-proBNP between 300 and 900 pg/mL
• C NT-proBNP greater than 1800 pg/mL
• D NT-proBNP between 900 and 1800 pg/mL

Explanation

In acute dyspnea, an NT-proBNP below 300 pg/mL makes acute heart failure very unlikely and carries a strong negative predictive value, so it functions as the rule-out threshold. Values above roughly 900 pg/mL in patients over 50 years support the diagnosis of acute heart failure. Intermediate values are nondiagnostic, and renal impairment can elevate natriuretic peptides independently, so only the low cut-off is reliable for exclusion.

Reference: Braunwald's Heart Disease, 12th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.