NPPB and infarction: N terminal pro-B-type natriuretic peptide (NT-pro BNP) is a 32-amino acid peptide that is synthesized and released predominantly from the ventricular myocardium in response to myocyte stretching.3 However, NT-pro BNP is secreted not only in response to increased left ventricular wall stretch but also to myocardial ischemia and infarction.