Amino-terminal Pro-B-type Natriuretic Peptide Testing - Past, Present, and Future Applications

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Asia Pacific Cardiology - Volume 2 Issue 1;2008:2(1):69-73

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Amino-terminal pro-B-type natriuretic peptide (NT-proBNP) is one of the natriuretic peptide family of hormones that play a vital role in the regulation of circulatory volume and pressure, reducing activity of the renin–angiotensin–aldosterone system and minimising myocardial fibrosis in the setting of heart muscle stretch. Therefore, natriuretic peptides exert favourable effects on the heart in the context of heart failure (HF), and recent data suggest that the measurement of natriuretic peptide concentrations in patients with both acute and chronic HF not only aids in the diagnosis and prognosis of HF in both symptomatic and asymptomatic patients, but may also be useful in their clinical management. In recognition of the importance of NT-proBNP as an adjunct to the diagnosis, prognosis and management of patients with heart disease, NT-proBNP has been added to numerous guideline statements,1–4 and an international consensus panel recently published recommendations for its optimal use.5,6 This article will discuss the up-to-date understanding of NT-proBNP as a tool for HF applications.

Natriuretic Peptide Biology

Recent changes in the understanding of BNP and NT-proBNP biology have led to the recognition that what is measured clinically by assays designed to detect these analytes is actually a mixture of degraded BNP, NT-proBNP and an un-cleaved precursor protein (which lacks the biological activity of BNP) called proBNP. That clinical assays cross-react with proBNP remains purely speculative; however, data argue that there is no clear advantage of direct measurement of un-cleaved proBNP over clinical assays for NT-proBNP.7

Role of NT-proBNP in the Diagnosis of Heart Failure

Abundant data indicate that NT-proBNP is valuable for the diagnostic evaluation of HF in asymptomatic patients and those presenting with acute dyspnoea. It is important to note that as a sensitive indicator of structural heart disease, NT-proBNP may be elevated in a variety of clinical conditions, including non-systolic heart muscle diseases, valvular heart disease, atrial arrhythmias, anaemia, septic shock and shock due to other causes, ischaemic stroke and pulmonary hypertension8–22 (see Table 1). In each of these cases, irrespective of diagnosis, NT-proBNP has been shown to be prognostically meaningful.

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