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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:

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:

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

Newly launched test – UKAS accreditation pending