The test is also useful in the early stages of heart failure, where symptoms may be transient rather than present all the time. The high sensitivity of NT‑proBNP allows also the detection of mild forms of cardiac dysfunction in asymptomatic patients with structural heart disease. NT‑proBNP can also be used for prognostic applications in patients with acute coronary syndrome. The GUSTO IV study, with more than 6800 patients, showed that NT‑proBNP was the strongest independent predictor of one year mortality in patients with acute coronary syndrome. In chronic heart failure, serial measurement of NT‑proBNP concentration can be used to monitor the disease progression, to predict outcomes and evaluate the success of treatment. Elevated NT‑proBNP values are strongly predictive of adverse outcomes and rising values identify a risk, while significant lowering of NT‑proBNP denotes improved outcomes and better prognosis. In addition NT‑proBNP can be used to identify patients at higher risk of cardiotoxicity which can lead to heart failure and may be helpful in
monitoring the use and dosing of cardiotoxic tumor drugs or interventions causing fluid retention or volume overload (e.g. COX‑2 inhibitors, nonsteroidal anti‑inflammatory drugs).