Biomarkers · Cardiac & Hemodynamics
N-Terminal Pro-B-Type Natriuretic Peptide (NT-proBNP)
Lower values go with lower risk of death. Not measured in our NHANES panel. The curve is drawn from the published study (source below).
NT-proBNP and risk of death
Published curve higher than the NHANES fitNHANES fit higher
Risk of death relative to the curve's reference value, drawn from the published study (source below).
Published risk of death1.67×>=75th percentile (81.5 pg/mL) vs <25th percentile (20.5 pg/mL), among participants… (95% CI 1.39–2.00) · NHANES 1999-2004 US adults aged >=20 y, nationally representative; HR estimated among those without prior CVD
What studies found when this marker was changed
They describe what happened in those study groups, not a recommendation. See all catalogued interventions.
Measured changes in NT-proBNP, study by study
6 effects with a numeric size, each from one study arm: the dot is the reported change, the line its 95% interval where one was given. Green points move the marker the way lower risk of death lies; amber the other way. Study results in the groups studied, not predictions for a person.
| Type | Intervention | Reported effect | Evidence | Source |
|---|---|---|---|---|
| clinical | Implanted carotid baroreflex activation therapy device plus optimal medical management for 6 months in HFrEF patients (NYHA II-III, LVEF <=35%, NT-proBNP <1600 pg/mL) | NT-proBNP decreased by 25% (95% CI -38% to -9%) vs control at 6 months (P=0.004) | RCT | Zile MR, et al. J Am Coll Cardiol. 2020. Baroreflex Activation Therapy in… |
| lifestyle | Structured exercise training / cardiac rehabilitation in heart failure | Exercise training reduced NT-pro-BNP by 37.4% (p<0.0001) and BNP by 28.3% in heart failure (10 RCTs, 565 patients) | meta-analysis | Smart NA, et al. Individual patient meta-analysis of exercise training effects… |
| pharmacologic | ARNI (Sacubitril/Valsartan) in heart failure with reduced ejection fraction | Sacubitril-valsartan reduced NT-proBNP by 46.7% vs 25.3% with enalapril over weeks 4-8 (ratio of change 0.71; 95% CI 0.63 to 0.81) in HFrEF | RCT | Velazquez EJ, et al. N Engl J Med. 2019. Angiotensin-Neprilysin Inhibition in… |
| pharmacologic | SGLT2 inhibitor empagliflozin 10 mg in HFrEF | Empagliflozin significantly reduced NT-proBNP; adjusted mean difference from placebo 13% by 52 weeks | RCT | Januzzi JL, et al. Prognostic Importance of NT-proBNP and Effect of… |
| pharmacologic | Mavacamten orally once daily (dose-titrated) in adults with symptomatic hypertrophic cardiomyopathy (EXPLORER-HCM, VALOR-HCM, MAVERICK-HCM, EXPLORER-CN) | Mavacamten lowers NT-proBNP by 528.62 ng/L (= pg/mL) vs placebo (P<0.0001) in HCM | meta-analysis | Liao HL, et al. J Cardiovasc Med (Hagerstown). 2024. Evaluation of mavacamten… |
| pharmacologic | Inhaled treprostinil via ultrasonic nebulizer up to 12 breaths (72 ug) four times daily for 16 weeks in patients with PH-ILD (INCREASE) | NT-proBNP fell 15% with treprostinil vs rose 46% with placebo at 16 weeks; treatment ratio 0.58 (95% CI 0.47 to 0.72) | RCT | Waxman A, et al. N Engl J Med. 2021. Inhaled Treprostinil in Pulmonary… |
Things that worsen it
| Type | Condition or exposure | Reported effect | Evidence | Source |
|---|---|---|---|---|
| clinical | Acute decompensated congestive heart failure | Acute HF identified by age-stratified NT-proBNP cutoffs of 450, 900 and 1,800 pg/ml; <300 pg/ml excludes acute HF (NPV 98.0%) | cross-sectional | Januzzi JL Jr, et al. J Am Coll Cardiol. 2018;71:1191-1200. |
| clinical | Severe pulmonary arterial hypertension and right ventricular strain | Median NT-proBNP 1,674 pg/mL (range 51 to 10,951) in severe PH; >= 1,400 pg/mL predicted fatal outcome; levels track RV dysfunction | prospective cohort | Fijalkowska A, et al. Serum N-terminal brain natriuretic peptide as a… |
What else moves this marker
They describe those study groups, not an individual, and an association is not a cause.
Diseases and conditions
| What | Effect on the marker | Comparison · population | Source |
|---|---|---|---|
| ↑ Overt hyperthyroidism (without heart failure) · overt hyperthyroidism vs euthyroid, participants without heart failure | SMD +2.38 (95% CI 1 to 3.76) | overt hyperthyroidism vs euthyroid subjects, no heart failure · Adults with thyroid dysfunction and euthyroid comparators, pooled across studies | meta analysis · PMID 36777339 |
| ↑ Overt hyperthyroidism in pre-existing heart failure · overt hyperthyroidism vs euthyroid, patients with heart failure | SMD +0.31 (95% CI 0.01 to 0.62) | overt hyperthyroidism vs euthyroid, patients with heart failure · Patients with pre-existing heart failure and thyroid dysfunction | meta analysis · PMID 36777339 |
| ↑ Overt hypothyroidism in pre-existing heart failure · overt hypothyroidism vs euthyroid, patients with heart failure | SMD +0.32 (95% CI 0.08 to 0.56) | overt hypothyroidism vs euthyroid, patients with heart failure · Patients with pre-existing heart failure and thyroid dysfunction | meta analysis · PMID 36777339 |
| ↑ Subclinical hypothyroidism in pre-existing heart failure · subclinical hypothyroidism vs euthyroid, patients with heart failure | SMD +0.33 (95% CI 0.21 to 0.46) | subclinical hypothyroidism vs euthyroid, patients with heart failure · Patients with pre-existing heart failure and subclinical hypothyroidism | meta analysis · PMID 36777339 |
Sources
- Risk curve: Echouffo-Tcheugui 2023 (PMID 37232235): all-cause HR 1.67 (1.39-2.0) >=75th percentile (81.5 pg/mL) vs <25th percentile (20.5 pg/mL), among participants without prior CVD. Scaled to US values (NHANES).
- Echouffo-Tcheugui et al. NT-proBNP and All-Cause and Cardiovascular Mortality in US Adults: A Prospective Cohort Study. Journal of the American Heart Association. 2023;12:e029110.
Map N-Terminal Pro-B-Type Natriuretic Peptide (NT-proBNP) against another biomarker.
Related markers: Abdominal Aortic Calcification (AAC) · Ankle-Brachial Index (ABI) · Cardiac (Valvular/Annular) Calcification · Carotid Intima-Media Thickness (CIMT) · Carotid-Femoral Pulse Wave Velocity (PWV) · Copeptin · Coronary Artery Calcium Score (Agatston) · Corrected QT Interval (QTc)