Comparative Utility of B-type Natriuretic Peptide (BNP) and N-terminal Pro-BNP (NT-proBNP) in the Management of Acute Heart Failure: A Study From a Tertiary Care Hospital in Kashmir, India

Background Among the various biomarkers, B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) have proved particularly useful in helping clinicians diagnose acute heart failure (AHF) and evaluate the risk a patient faces at the time of presentation. However, data from the Indian subcontinent, particularly from the Kashmir Valley, with its unique demographic profile and altitude-related cardiovascular burden, remain sparse. This study aimed to compare the utility of these biomarkers in the management of AHF in a tertiary care setting and to evaluate their relationship with disease severity parameters, including New York Heart Association (NYHA) functional class, ejection fraction, and lung ultrasound B-lines. Methods The study was a prospective observational study conducted at the Government Medical College, Srinagar, over a period of 18 months. A total of 223 patients admitted to the hospital with acute heart failure were included. Both BNP and NT-proBNP were measured simultaneously at admission. All patients underwent lung ultrasonography (LUS) for B-line quantification before and after diuretic therapy and echocardiography for ejection fraction assessment. Statistical analyses included Pearson and Spearman correlations, one-way ANOVA, paired t-tests, and receiver operating characteristic (ROC) curve analysis. Results The majority of patients were male, 133 (59.6%), with a mean age of 62.3 ± 10.7 years. Mean BNP and NT-proBNP levels were 581.5 ± 180.1 pg/mL and 1707.5 ± 629.5 pg/mL, respectively. The two biomarkers correlated strongly with each other (Pearson r = 0.750, p < 0.001), and both varied significantly across NYHA functional classes (BNP: F = 6.118, p = 0.001; NT-proBNP: F = 4.405, p = 0.005). Lung ultrasound B-lines showed a significant reduction following diuretic therapy (15.24 ± 1.07 vs 6.77 ± 1.06; p < 0.001). NT-proBNP showed non-significantly higher diagnostic performance over BNP for severe HF (area under the curve (AUC) 0.420 vs. 0.387). No significant difference was noted between the two biomarkers with respect to ejection fraction categories. Conclusion Both BNP and NT-proBNP are comparably effective in reflecting the haemodynamic and clinical severity of acute heart failure in the Kashmiri population. Their strong mutual correlation supports interchangeable use in clinical practice. Integration of lung ultrasound B-line monitoring with natriuretic peptide measurement provides superior assessment of decongestion. These findings have direct implications for resource-limited tertiary care settings, where single-biomarker assay selection is often dictated by cost and availability.