The N-terminal prohormone of brain natriuretic peptide (NT-proBNP or BNPT) is a prohormone with a 76 amino acid N-terminal inactive protein that is cleaved from the molecule to release brain natriuretic peptide.
Both BNP and NT-proBNP levels in the blood are used for screening, diagnosis of acute congestive heart failure (CHF) and may be useful to establish prognosis in heart failure, as both markers are typically higher in patients with worse outcome.[1] The plasma concentrations of both BNP and NT-proBNP are also typically increased in patients with asymptomatic or symptomatic left ventricular dysfunction and is associated with coronary artery disease and myocardial ischemia.[2][3][4][5][6]
Contents
1Blood levels
2Test usage in a clinical setting
2.1Canada
3Test usage in the life insurance industry
4See also
5References
6External links
Blood levels
Upper limit (95th percentile) of blood ranges for NT-proBNP in healthy people
Sex
Age
Limit in pg/mL
Male
< 45 yrs
90[7]
45-59 yrs
140[7]
55-64 yrs
180[7]
65-74 yrs
230[7]
> 75 yrs
850[7]
Females
< 45 yrs
180[7]
45-54 yrs
190[7]
55-64 yrs
230[7]
65-74 yrs
350[7]
> 75 yrs
620[7]
Interpretation
Age
Range
Congestive heart failure likely
<75 years
> 125 pg/mL[8]
>75 years
>450pg/mL[8]
There is no level of BNP that perfectly separates patients with and without heart failure.[9]
In screening for congenital heart disease in pediatric patients, an NT-proBNP cut-off value of 91 pg/mL could differentiate an acyanotic heart disease (ACNHD) patient from a healthy patient with a sensitivity of 84% and specificity of 42%.[10] On the other hand, an NT-proBNP cut-off value of 318 pg/mL is more appropriate in differing patients with congenital nonspherocytic hemolytic disease (CNHD) from healthy patients, with 94% sensitivity and 97% specificity.[10] An NT-proBNP value of 408 pg/mL has been estimated to be 83% sensitive and 57% specific in differentiating patients with ACNHD from patients with CNHD[10]
Test usage in a clinical setting
Canada
While discussed in Canadian medical journals in the mid to late 2000s,[11] the test is not widely used. It was only approved for use in Alberta in February 2012.[12]
Test usage in the life insurance industry
The test has been widely used in the life insurance industry to screen applicants as part of the routine requirements when applying for a life insurance policy. It is also inexpensive and can be measured from blood samples routinely drawn as part of the application process. The test can be used to evaluate for a number of health conditions.[13][14]
See also
Brain natriuretic peptide
References
^Bhalla V, Willis S, Maisel AS (2004). "B-type natriuretic peptide: the level and the drug--partners in the diagnosis of congestive heart failure". Congestive Heart Failure. 10 (1 Suppl 1): 3–27. doi:10.1111/j.1527-5299.2004.03310.x. PMID 14872150.
^Atisha D, Bhalla MA, Morrison LK, Felicio L, Clopton P, Gardetto N, Kazanegra R, Chiu A, Maisel AS (September 2004). "A prospective study in search of an optimal B-natriuretic peptide level to screen patients for cardiac dysfunction". American Heart Journal. 148 (3): 518–23. doi:10.1016/j.ahj.2004.03.014. PMID 15389242.
^Nakamura T, Sakamoto K, Yamano T, Kikkawa M, Zen K, Hikosaka T, Kubota T, Azuma A, Nishimura T (May 2002). "Increased plasma brain natriuretic peptide level as a guide for silent myocardial ischemia in patients with non-obstructive hypertrophic cardiomyopathy". Journal of the American College of Cardiology. 39 (10): 1657–63. doi:10.1016/s0735-1097(02)01813-2. PMID 12020494.
^Talwar S, Squire IB, Downie PF, Davies JE, Ng LL (October 2000). "Plasma N terminal pro-brain natriuretic peptide and cardiotrophin 1 are raised in unstable angina". Heart. 84 (4): 421–4. doi:10.1136/heart.84.4.421. PMC 1729429. PMID 10995414.
^Kim H, Yang DH, Park Y, Han J, Lee H, Kang H, Park HS, Cho Y, Chae SC, Jun JE, Park WH (November 2006). "Incremental prognostic value of C-reactive protein and N-terminal proB-type natriuretic peptide in acute coronary syndrome". Circulation Journal. 70 (11): 1379–84. doi:10.1253/circj.70.1379. PMID 17062957.
^ abcdefghijThe University of Iowa (UIHC) > Department of Pathology > LABORATORY SERVICES HANDBOOK > N-terminal-pro-BNP Archived 2008-10-11 at the Wayback Machine Showing 95th percentiles. Epic Lab Code: LAB649. Updated: 10/27/2009
^ abLee MA (2009). Basic Skills in Interpreting Laboratory Data. Amer Soc of Health System. p. 220. ISBN 978-1-58528-180-0.
^Maisel AS, Krishnaswamy P, Nowak RM, McCord J, Hollander JE, Duc P, Omland T, Storrow AB, Abraham WT, Wu AH, Clopton P, Steg PG, Westheim A, Knudsen CW, Perez A, Kazanegra R, Herrmann HC, McCullough PA (July 2002). "Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure". The New England Journal of Medicine. 347 (3): 161–7. doi:10.1056/NEJMoa020233. PMID 12124404.
^ abcMoses EJ, Mokhtar SA, Hamzah A, Abdullah BS, Yusoff NM (2011). "Usefulness of N-Terminal-Pro-B-Type Natriuretic Peptide as a Screening Tool for Identifying Pediatric Patients With Congenital Heart Disease". Laboratory Medicine. 42 (2): 75–80. doi:10.1309/LMW0U87COTHXGELF.
^Murray H, Cload B, Collier CP, Sivilotti ML (July 2006). "Potential impact of N-terminal pro-BNP testing on the emergency department evaluation of acute dyspnea" (PDF). Canadian Journal of Emergency Medicine. 8 (4): 251–8. doi:10.1017/s1481803500013798. PMID 17324304.
^"B-type Natriuretic Peptide (BNP) & NT-proBNP Test Implementation". Alberta Health Services. Retrieved 3 January 2013.
^George H (2010). "NT-proBNP The Finest Cardiovascular Screening and Reflexive Test In the History of Life Underwriting" (PDF). Insureintell. Retrieved 11 July 2016.
^Clark M, Kaufman V, Fulks M, Dolan VF, Stout RL (2014). "NT-proBNP as a predictor of all-cause mortality in a population of insurance applicants". Journal of Insurance Medicine. 44 (1): 7–16. PMID 25004594.
External links
BNP and NT-proBNP at Lab Tests Online
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… ventricles. Cleavage of the prohormone proBNP produces biologically active 32 amino acid BNP as well as biologically inert 76 amino acid N-terminal pro-BNP (NT-proBNP). Atrial natriuretic peptide (ANP) is …
…ventricles. Cleavage of the prohormone pro-BNP produces biologically active 32 amino acid BNP as well as biologically inert 76 amino acid N-terminal pro-BNP (NT-proBNP). Atrial natriuretic peptide (ANP) is …
…expansion and possibly increased wall stress. The N-terminal fragment, N-pro-BNP, is also released into the circulation. Serum BNP and N-pro-BNP are increased in patients with heart failure and are predictors…
…globally assessing the patient clinical course and monitoring response to treatment. BNP and N-terminal pro-BNP (NT-proBNP) are biomarkers that are commonly used to assess severity and monitor response to therapy…
English Journal
N-terminal pro-B-type natriuretic peptide in chronic heart failure: The impact of sex across the ejection fraction spectrum.
Faxén UL, Lund LH, Orsini N, Strömberg A, Andersson DC, Linde C, Dahlström U, Savarese G.
International journal of cardiology. 2019 Jul;287()66-72.
The aim was to assess sex-specific differences in N-terminal B-type natriuretic peptide (NT-proBNP) regarding concentrations, predictors of high concentrations, and prognostic role, in a large and unselected population with chronic heart failure (HF) with preserved (HFpEF), mid-range (HFmrEF), and r
Value of N-terminal pro-brain natriuretic peptide and aortic diameter in predicting in-hospital mortality in acute aortic dissection.
Wen D, Jia P, Du X, Dong JZ, Ma CS.
Cytokine. 2019 Jul;119()90-94.
To determine the value of N-terminal pro-brain natriuretic peptide (NT-proBNP) and aortic diameter in predicting in-hospital mortality in acute aortic dissection (AD). A single-center prospective study was designed in the setting of University hospital in China. 122 patients with acute AD were enrol
Detection of cardiac amyloidosis with F-Florbetaben-PET/CT in comparison to echocardiography, cardiac MRI and DPD-scintigraphy.
Kircher M, Ihne S, Brumberg J, Morbach C, Knop S, Kortüm KM, Störk S, Buck AK, Reiter T, Bauer WR, Lapa C.
European journal of nuclear medicine and molecular imaging. 2019 Jul;46(7)1407-1416.
Cardiac amyloidosis (CA) is a rare cause of heart failure with frequently delayed diagnosis, because specific early signs or symptoms are missing. Recently, direct amyloid imaging using positron emission tomography/computed tomography (PET/CT) has emerged. The aim of this study was to examine the pe
