N-terminal (NT)-pro-brain natriuretic peptide (NT-proBNP)
| Category | Biochemistry |
|---|---|
| Test background |
Natriuretic peptides are released from the myocardium in response to fluid overload. The two main natriuretic peptides used in clinical practice are amino-terminal pro-B-type natriuretic peptide (NT-proBNP) and B-type natriuretic peptide (BNP). The levels of natriuretic peptides correlate with prognosis in patients with heart failure (HF). |
| Clinical Indications |
In the recent NICE guideline for Chronic Heart Failure in adults (NG106 2018), NT-proBNP replaced BNP as the biomarker of choice in people with suspected heart failure for two main reasons. Firstly, NT-proBNP has a greater sensitivity compared to BNP for the diagnosis of heart failure. As the test is used as a ‘rule out’ for heart failure, the sensitivity is of more clinical importance than specificity. Secondly on a practical level, NT-proBNP has a longer stability in blood samples than BNP (days versus 4-6 hours), therefore NT-proBNP is more appropriate for testing in primary care where samples need to be transported to laboratories. Additionally, NT-proBNP may be requested by the Cardiology team for the monitoring of patients on Entresto. |
| Reference range | As per the Pan London Heart Failure Diagnostic Pathway: NT-proBNP <400 ng/L: HF unlikely, consider alternative. Please refer to: https://www.nice.org.uk/guidance/ng106/resources/chronic-heart-failure-diagnosis-visual-summary-pdf-6663137726 NT-proBNP 400-2000 ng/L: Requires assessment by a specialist heart failure team (including an echocardiogram), should be seen within 6 weeks. NT-proBNP >2000 ng/L: Requires assessment by a specialist heart failure team (including an echocardiogram), should be seen within 2 weeks. For further guidance, please see the North West London pathway: https://www.healthiernorthwestlondon.nhs.uk/sites/nhsnwlondon/files/documents/heart_failure.pdf Note: Obesity, diuretics, ACE-I/ARB, beta blockers and mineralocorticoid receptor antagonists can reduce levels of NT-proBNP |
| Sample & container required | Serum (yellow top) so no separate sample is required |
| Sample volume | 0.5ml |
| Sample collection | No special requirements. Collect in serum (yellow top) |
| Turnaround time | 5 days |
| Notes | Newly launched test – UKAS accreditation pending |