Comprehensive Review of the Relative Clinical Utility of B-Type Natriuretic Peptide and N-Terminal Pro-B-Type Natriuretic Peptide Assays in Cardiovascular Disease

Abstract

Measurable B-type natriuretic peptides, which are largely produced by the left ventricle, include B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP). These proteins are released by cardiomyocytes in response to wall-tension and neurohumoral signals. In this review the literature is summarized to date with respect to the approved indications for testing which include the diagnostic evaluation and prognosis of heart failure. PubMed in 2009 was searched and 5496 references were reduced to 242 studies that reported on either diagnosis, prognosis, screening, or monitoring of heart failure. In head-to-head diagnostic comparisons, 58 studies measured both assays, and 11 studies in adults that included at least 100 patients compared commercially available tests. We performed the analogous search in acute coronary syndromes (ACS) and found 82 articles of which 11 papers focused on the study of BNP and NT-proBNP in either stable angina, non-ST-segment elevation myocardial infarction or ST-segment elevation myocardial infarction. For heart failure diagnosis, BNP and NT-proBNP had similar decision statistics; however, while optimal diagnostic cutpoints for both markers varied depended on age and degree of renal dysfunction, and the clinical application; NT-proBNP had a much more widely variable optimal cutpoint than did BNP. Sufficient evidence for clinical utility of both tests exists for other applications of prognosis, screening, and monitoring of heart failure. In addition, both tests have a role in the risk stratification of all forms of ACS. Future trials of clinical strategies are warranted using these tools in advancing both inpatient and outpatient management of heart failure and ACS.

Prognostic utility of B-type natriuretic peptides in patients with heart failure and renal dysfunction

“…Elevation of NT-ProBNP is claimed to be more accentuated in elderly patients and in those with renal disease as the clearance is thought to be more kidney dependent [29]. Van Kimmenade et al .…”

“…It might be criticized that BNP and NT-ProBNP were pooled together as the mechanisms of degradation differ between the two peptides and the correlation with the eGFR is found to be different for the two peptides [ 6 , 11 ]. Elevation of NT-ProBNP is claimed to be more accentuated in elderly patients and in those with renal disease as the clearance is thought to be more kidney dependent [ 29 ]. Van Kimmenade et al .…”

Common laboratory parameters as indicators of multi‐organ dysfunction in acute heart failure

“…This is not surprising given the confounded nature of NT‐proBNP concentrations and the lack of stable concentration thresholds . In our view, B‐type natriuretic peptide would have been the preferred marker to employ in the present study given its greater independence from renal dysfunction and complementary nature to troponin …”

Type 4 Cardiorenal Syndrome: Myocardial Dysfunction, Fibrosis, and Heart Failure in Patients with Chronic Kidney Disease

“…B-type (or brain) natriuretic peptide is a 32-amino acid peptide hormone released into circulation from cardiac myocytes in response to mechanical stress. It is therefore a useful indicator of both acute and chronic ventricular overload [115]. B-type natriuretic peptide has several physiologic effects that act to relieve stress on the heart.…”