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Summary
Early diagnosis is important to improve patient outcomes1.
Value of BNP/NT-proBNP testing
Testing may improve diagnostic certainty and decrease time to referral
Use of BNP/NT-proBNP measurement2
- Increased diagnostic certainty: Less additional work-up needed to ensure correct diagnosis
In studies of chronic unexplained shortness of breath, the addition of BNP/NT-proBNP testing has improved diagnostic accuracy and time to diagnosis for cardiomyopathy-related disease3.
BNP/NT-proBNP is useful as a rule-in test for heart disease, which enables appropriate selection of candidates for in-depth evaluation by cardiology4.
BNP and NT-proBNP are key tools in the diagnosis of heart failure5
Need for further diagnostic work-up2
Use of NT-proBNP testing can increase diagnostic certainty
Benefits of NT-proBNP in primary care
Improvement of time-to-diagnosis and referral quality
EXCLUSION THRESHOLDS OF NATRIURETIC PEPTIDES FOR SUSPECTED HEART FAILURE6
| Sensitivity % (CI) n = 104 | Specificity % (Cl) n = 104 | |
| Clinical decision rules (CDR) + NT-proBNP (lower cut-offs) | 90.4 (83.0-95.3) | 45.5 (38.5-52.7) |
| NT-proBNP < 400 pg/ml | 76.9 (67.6-84.6) | 91.5 (86.7-95.0) |
| NT-proBNP < 125 pg/ml | 94.2 (87.9-97.9) | 49.0 (41.9-56.1) |
Prospective, observational diagnostic validation study of patients > 55 years presenting with unexplained shortness of breath6
Thanks to the blood test, 104 (34.2%; 95% Cl 28.9-39.8) confirmed diagnoses of heart failure (HF) from 304 patients6
At threshold of NT-proBNP < 125 pg/mL, the sensitivity of the test alone was better than a validated CDR+NT-proBNP approach for identifying patients who were subsequently diagnosed with HF6
Higher NT-proBNP threshold of 400 pg/mL may result in one in five patients with HF not being appropriately referred6
Although testing can help detect cardiac conditions, other causes of raised NT-proBNP levels should be considered5,7.
Measuring NT-proBNP* levels can help differentiate cardiac causes from other causes of unexplained shortness of breath
- NT-proBNP is exclusively produced by the cardiac tissue and reflects wall stress5
- While a broad range of structural and functional cardiac abnormalities can lead to elevations of NT-proBNP, this biomarker is of substantial medical value in diagnosing suspected heart failure5
- In the primary care setting**, the upper limit of normal for NT-proBNP is 125 pg/mL and patients with normal NT-proBNP levels (< 125 pg/mL) are unlikely to have heart failure8
- NT-pro BNP can be measured in the primary care setting with either a point-of-care device or by a central laboratory5
*Alternatively, BNP levels can be measured; **A higher cut-off of 300 pg/mL for NT-proBNP is recommended in the acute setting.
Elevated NT-proBNP levels can also be associated with other conditions9
Cardiac conditions
- PH and PAH
- Heart muscle disease, including LVH
- Valvular heart disease
- Acute coronary syndromes
- Pericardial disease
- Atrial fibrillation
- Myocarditis
- Cardiac surgery
- Cardioversion
- Toxic-metabolic myocardial insults, including cancer chemotherapy
Non-cardiac conditions
Pulmonary
- Obstructive sleep apnoea
- Severe pneumonia
- Acute embolism
Others
- Advancing age
- Anaemia
- Renal failure
- Critical illness
- Bacterial sepsis
- Severe burns
NT-proBNP levels should always be interpreted in conjunction with all other clinical information5
References
BNP: B-type natriuretic peptide; NT-pro BNP: N-terminal pro-BNP, CDR: clinical decision rules; HF: heart failure; LVH: left ventricular hypertrophy; RAH: pulmonary arterial hypertension; PH: pulmonary hypertension.
- Taylor KS, et al. BMJ 2018; 361:k1450;
- Burri E, et al. J Intern Med 2012; 272: 504-13;
- Ferry OR, et al. J Thorac Dis 2019; 11: S2117-S2128;
- Wieshammer S, al. Respiration 2009; 77: 370-80;
- Mueller C, et al. Eur J Heart Fail 2019; 21: 715-31;
- Taylor CJ, et al. Br J Gen Pract 201 7; 67: e94-e102;
- Ponikowski P, et al. Eur Heart J 2016; 37: 2129-200;
- Yancy CW, et al. Circulation 201 7; 136:e137-61.
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