Brain natriuretic peptide and n-terminal brain natriuretic peptide in the diagnosis of heart failure in patients with acute shortness of breath

J Am Coll Cardiol. 2003 Aug 20;42(4):728-35. doi: 10.1016/s0735-1097(03)00787-3.


Objectives: This study sought to compare the utility of measurement of plasma brain natriuretic peptide (BNP) and N-terminal brain natriuretic peptide (N-BNP) in the diagnosis of heart failure (HF) in patients with acute dyspnea.

Background: Plasma BNP is useful in differentiating HF from other causes of dyspnea in the emergency department. The N-terminal component of BNP has a longer half-life, and in HF increases in plasma N-BNP are proportionately greater.

Methods: We studied 205 patients (average age 70 +/- 14 years) presenting to the emergency department with acute dyspnea. Brain natriuretic peptide was analyzed using a point-of-care test and two locally developed radioimmunoassays. N-terminal BNP was measured using a locally developed radioimmunoassay and a commercially available assay. Final diagnosis of HF was adjudicated by two cardiologists.

Results: Patients with HF (n = 70) had higher mean levels of both hormones by all assays (p < 0.001 for all). Results with all assays correlated closely (r values between 0.902 and 0.969). Subjects with left ventricular (LV) dysfunction or left-sided valvular disease but no HF had intermediate levels of BNP and N-BNP (lower than subjects with HF, and higher than subjects without HF with no LV dysfunction or left-sided valvular disease) (p < 0.01 for all). Using optimum cut-offs, specificity for the diagnosis of HF ranged between 70% and 89% (highest for the N-BNP assays). Sensitivity ranged between 80% and 94% (highest for the point-of-care BNP assay).

Conclusions: Measurement of BNP or N-BNP is useful in the diagnosis of HF in acute dyspnea. Commercially available assays compare favorably with well-validated laboratory assays. Differences in sensitivity and specificity may influence the assay choice in this setting.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Aged
  • Aged, 80 and over
  • Diagnostic Techniques, Cardiovascular
  • Dyspnea / blood
  • Dyspnea / etiology*
  • Dyspnea / metabolism
  • Female
  • Heart Failure / blood
  • Heart Failure / complications
  • Heart Failure / diagnosis*
  • Heart Failure / metabolism
  • Humans
  • Male
  • Middle Aged
  • Natriuretic Peptide, Brain / blood
  • Natriuretic Peptide, Brain / metabolism*
  • Radioimmunoassay


  • Natriuretic Peptide, Brain