Importance and interpretation of intermediate (gray zone) amino-terminal pro-B-type natriuretic peptide concentrations.


Journal Article (Review)

Amino-terminal pro-B-type natriuretic peptide (NT-proBNP) values between the cut point of 300 ng/L for "ruling out" acute heart failure (HF) and the consensus-recommended age-adjusted cut points for "ruling in" acute HF are referred to as intermediate or gray zone values, which may be seen in approximately 20% of patients with dyspnea in the emergency department. Knowledge of the differential diagnosis of the causes of a gray zone NT-proBNP finding is useful to ascertain the correct diagnosis. Possible causes include cardiac ischemia, atrial fibrillation, and infectious/inflammatory pulmonary diseases. Importantly, a gray zone NT-proBNP result is not associated with a benign prognosis. Regardless of the cause, it should not be ignored because it is a "negative" result. Patients with a gray zone NT-proBNP value are at higher risk for hazard compared with those with a negative NT-proBNP result.

Full Text

Duke Authors

Cited Authors

  • van Kimmenade, RRJ; Pinto, YM; Januzzi, JL

Published Date

  • February 4, 2008

Published In

Volume / Issue

  • 101 / 3A

Start / End Page

  • 39 - 42

PubMed ID

  • 18243857

Pubmed Central ID

  • 18243857

International Standard Serial Number (ISSN)

  • 0002-9149

Digital Object Identifier (DOI)

  • 10.1016/j.amjcard.2007.11.018


  • eng

Conference Location

  • United States