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NT-proBNP Monitoring in HF — EECC MCQ

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ModerateHeart FailureNT-proBNP Monitoring in HFEECC

A 56-year-old woman with HFrEF (LVEF 32%) has stable NYHA class II symptoms on optimal GDMT. Her NT-proBNP was 1,200 pg/mL 6 months ago and is now 2,800 pg/mL. She reports no change in symptoms, exercise tolerance, or weight. What is the most appropriate clinical interpretation?

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Correct answer: D — Rising NT-proBNP despite stable symptoms suggests subclinical disease progression and warrants further investigation

Serial NT-proBNP monitoring is recommended in HF management. A significant rise (>30% increase or doubling from a stable baseline) even in asymptomatic patients should prompt further evaluation, as it may indicate subclinical disease progression, fluid retention, worsening cardiac function, or a new comorbidity (e.g. AF, renal impairment, infection). This may precede overt clinical decompensation. The ESC HF Guidelines recommend using natriuretic peptides for prognostic assessment and to guide management intensity (Class IIa). Investigation should include repeat echocardiography, renal function, and review of medication adherence.

Reference: ESC (2023): Focused Update on Heart Failure