Use of NT‐proBNP in routine testing and comparison to BNP

Abstract

Objectives: B-type natriuretic peptide (BNP) is a strong diagnostic predictor of left-ventricular (LV)-dysfunction. Recently, the aminoterminal portion of pro-BNP (NT-proBNP) has been introduced, which could be even more sensitive because of its longer half-life. The aim of this study was to evaluate the new marker NT-proBNP within a large, heterogeneous population of patients with suspected cardiovascular disease at risk of cardiovascular dysfunction and to compare it with the established diagnostic parameter BNP. Subjects and methods: NT-proBNP and BNP were measured in 339 hospitalised patients undergoing diagnostic angiography (median age 66 years, 244 male vs. 95 female). Results: Median values of NT-proBNP increased with worsening LV-dysfunction and higher NYHA class. The area under the receiver operator characteristics curve (AUC) of NT-proBNP for detecting severe systolic dysfunction or for detecting any systolic LV-dysfunction was 0.83 and 0.77, respectively. The latter improved (AUCs0.81) when patients with clinically relevant heart disease like valvular dysfunction were included, independent of the haemodynamic values. Compared to BNP, NT-proBNP tended to be more accurate in identifying lesser degrees of LVdysfunction. Conclusions: Even after optimisation of target criteria, there was still a substantial overlap of NT-proBNP values between patients with and without relevant heart disease. Therefore, NT-proBNP is not suitable as a screening test for LVdysfunction in the community. Nevertheless, because of its good negative predictive value, NT-proBNP could be an easy and effective tool to rule out severe systolic LV-dysfunction in high risk patients. No clinically significant advantage of BNP testing could be found.

The Effect of Percutaneous Balloon Mitral Valvuloplasty on N-Terminal- Pro B- Type Natriuretic Peptide Plasma Levels in Mitral Stenosis

“…However, the presence of atrial fibrillation may lead to a substantial increase in left atrial overload in the setting of MS that may give rise to a further increase in BNP levels. The lack of association between the left atrial pressure and plasma levels of NT-proBNP is most likely due to the rel-Vol 48 No 5 atively small number of patients with atrial fibrillation included in the present study. Taken together with previous reports on BNP and atrial fibrillation, we may speculate that continuous pressure load on the left atrium may account in part for the increased levels of NT-proBNP despite the absence of a statistically significant correlation between left atrial pressure and plasma NT-proBNP levels.…”

“…Moreover, plasma NT-proBNP levels were decreased after PBMV and the percentage decrease in systolic pulmonary artery pressure was the only factor that associated with the percentage decrease in NT-proBNP levels. These find-Vol 48 No 5 ings imply that measurement of plasma NT-proBNP after PBMV may be useful for evaluating changes in pulmonary artery pressure. Larger prospective studies are needed to confirm our findings and identify the definite secretion site of NTproBNP in the setting of MS.…”

“…None of the patients had left atrial thrombus or unfavorable valve morphology for PBMV on transesophageal Vol 48 No 5 echocardiography.…”

“…3,4) The N-terminal part of preproBNP (NT-proBNP) is secreted in a proportion equivalent to BNP and it was thought to be more sensitive because of its longer half-life. 5) Both BNP and NT-proBNP are synthesized and secreted by cardiac myocytes in response to volume expansion and pressure overload 1,6,7) and they also correlate with left ventricular filling pressures in patients with depressed systolic functions. 8) In addition to numerous reports on left ventricular dysfunction, there is also evidence that plasma concentrations of BNP increase in pathologic conditions that cause right ventricular pressure or volume overload.…”

N-terminal probrain natriuretic peptide and patent ductus arteriosus in preterm infants

“…[20][21][22][23] Studies in adults have shown that NT-proBNP is a more sensitive and more specific marker for ventricular dysfunction than the biologically active BNP. 24,25 Previous studies in healthy full-term infants showed that the plasma BNP level rapidly rises after birth, reaching its peak at day 2-3 of life 26-28 and a high plasma BNP level correlates with HsPDA. A decline of BNP level is noted after PDA is closed by indomethacin.…”