N-terminal pro-brain natriuretic peptide as an indicator of right ventricular dysfunction

Plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) and brain natriuretic peptide (BNP) are elevated in most patients with acute pulmonary embolism (APE) that results in right ventricular overload. Therefore, APE should be considered in the differential diagnosis of patients with acute dyspnea and abnormal levels of BNPs. Moreover, plasma BNPs have been proved to predict outcome in APE.

Low NT-proBNP or BNP levels characterize an uneventful hospital course, and NT-proBNP levels of <500 pg/mL identify patients who could potentially be candidates for care on a complete outpatient basis. Moreover, plasma NT-proBNP and BNP reflect the degree of right ventricular overload in APE. Plasma BNPs can also be elevated in chronic precapillary pulmonary hypertension and are strongly related to total pulmonary resistance. Elevated plasma levels of BNP/NT-proBNP and especially their further increase during follow-up are a potent predictor of poor survival.

Because levels of brain natriuretic peptides are elevated significantly not only in pathologic conditions that affect the left ventricle but also in clinical conditions that lead to isolated acute or chronic right ventricular overload, it could be proposed that these peptides should not be regarded as biomarkers of congestive heart failure, but as indicators of cardiovascular dyspnea.