NTpro-BNP – diagnostic significance and recommended clinical applications

Brain natriuretic peptides are elevated in circulation in proportion to a decrease in myocardial function. They have been uni-formly shown to have excellent negative predictive value in differential diagnosis of dyspnoea. They can also be used in diag-nosing heart failure and have been recently shown as possible prognostic markers in acute coronary syndrome and pulmonary embolism. It is important to note that brain natriuretic peptide values rise with age and are inversely proportional to body mass index and glomerular filtration rate.

Brain natriuretic peptide N-terminal brain natriuretic peptide, heart failure

1. Roberts E, Ludman AJ, Dworzynski K, Al-Mohammad A, Cowie MR, McMurray JJV, Mant J (on behalf of the NICE Guideline Development Group for Acute Heart Failure). The diagnostic accuracy of the natriuretic peptides in heart failure: systematic review and diagnostic meta-analysis in the acute care setting. BMJ 205;350:h910 doi: 10.1136/bmj.h910.

2. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner M, et al. ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circula-tion 2013;128:e240-327.

3. McMurray JJV, Adamopoulos S, Anker SD, Auricchio A, Bohm M, Dickstein K, et al. ESC guidelines for the diagnosis and treat-ment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2012;14:803-69.

4. Thygesen K1, Mair J, Mueller C, Huber K, Weber M, Plebani M, et al. Recommendations for the use of natriuretic peptides in acute cardiac care: a position statement from the Study Group on Biomarkers in Cardiology of the ESC Working Group on Acute Cardiac. Care Eur Heart J 2012;33;2001-6.

5. Novielli, N, Cooper NJ, Abrams KR, Sutton AJ. How is evidence on test performance synthetized for economic decision models of diagnostic tests? A systematic appraisal of Health Technology Assessments in the UK since 1997. Value Health 2010;13:952-7.

6. Chenevier-Gobeaux C, Guerin S, Andre S, Ray P, Cynober L, Gestin S, et al. Midregional pro-atrial natriuretic peptide for the di-agnosis of cardiac-related dyspnea according to renal function in the emergency department: a comparison with B-type natriuretic peptide (BNP) and N-terminal proBNP. Clin Chem 2010;56:1708-17.

7. Nazerian P, Vanni S, Zanobetti M, Polidori G, Pepe G, Federico R, et al. Diagnostic accuracy of emergency Doppler echocardiog-raphy for identification of acute left ventricular heart failure in patients with acute dyspnea: comparison with Boston criteria and N-terminal prohormone brain natriuretic peptide. Acad Emerg Med 2010;17:18-26.