N-terminal prohormone of brain natriuretic peptide
{{Short description|Precursor of a hormone}}
{{cs1 config|name-list-style=vanc}}
{{infobox protein
| Name = natriuretic peptide B
| caption =
| image =
| width =
| HGNCid = 7940
| Symbol = NPPB
| AltSymbols =
| EntrezGene = 4879
| OMIM = 600295
| RefSeq = NM_002521
| UniProt = P16860
| PDB =
| ECnumber =
| Chromosome = 1
| Arm = p
| Band = 36.2
| LocusSupplementaryData =
}}
N-terminal prohormone of brain natriuretic peptide (NT-proBNP or BNPT) is a 76 amino acid long protein that is cleaved from the N-terminal end of the 108 amino acid long prohormone proBNP to release brain natriuretic peptide 32 (BNP, also known as B-type natriuretic peptide). {{Cite journal |last=McKie |first=Paul M. |last2=Burnett |first2=John C. |date=2016-12-06 |title=NT-proBNP |url=https://www.jacc.org/doi/full/10.1016/j.jacc.2016.10.001 |journal=Journal of the American College of Cardiology |volume=68 |issue=22 |pages=2437–2439 |doi=10.1016/j.jacc.2016.10.001|url-access=subscription }}{{Cite journal |last=Hall |first=Christian |date=2004 |title=Essential biochemistry and physiology of (NT-pro)BNP |url=https://onlinelibrary.wiley.com/doi/full/10.1016/j.ejheart.2003.12.015 |journal=European Journal of Heart Failure |language=en |volume=6 |issue=3 |pages=257–260 |doi=10.1016/j.ejheart.2003.12.015 |issn=1879-0844|url-access=subscription }}{{Cite web |title=UpToDate |url=https://www.uptodate.com/contents/natriuretic-peptide-measurement-in-heart-failure |access-date=2024-12-21 |website=www.uptodate.com}}
Both BNP and NT-proBNP levels in the blood are used for screening, diagnosis of acute congestive heart failure (CHF) and may be useful to establish prognosis in heart failure, as both markers are typically higher in patients with worse outcome.{{cite journal | vauthors = Bhalla V, Willis S, Maisel AS | title = B-type natriuretic peptide: the level and the drug--partners in the diagnosis of congestive heart failure | journal = Congestive Heart Failure | volume = 10 | issue = 1 Suppl 1 | pages = 3–27 | year = 2004 | pmid = 14872150 | doi = 10.1111/j.1527-5299.2004.03310.x | doi-access = free }} The plasma concentrations of both BNP and NT-proBNP are also typically increased in patients with asymptomatic or symptomatic left ventricular dysfunction and is associated with coronary artery disease, myocardial ischemia, and severity of aortic valve stenosis.{{cite journal | vauthors = Atisha D, Bhalla MA, Morrison LK, Felicio L, Clopton P, Gardetto N, Kazanegra R, Chiu A, Maisel AS | display-authors = 6 | title = A prospective study in search of an optimal B-natriuretic peptide level to screen patients for cardiac dysfunction | journal = American Heart Journal | volume = 148 | issue = 3 | pages = 518–523 | date = September 2004 | pmid = 15389242 | doi = 10.1016/j.ahj.2004.03.014 }}{{cite journal | vauthors = Nakamura T, Sakamoto K, Yamano T, Kikkawa M, Zen K, Hikosaka T, Kubota T, Azuma A, Nishimura T | display-authors = 6 | title = Increased plasma brain natriuretic peptide level as a guide for silent myocardial ischemia in patients with non-obstructive hypertrophic cardiomyopathy | journal = Journal of the American College of Cardiology | volume = 39 | issue = 10 | pages = 1657–1663 | date = May 2002 | pmid = 12020494 | doi = 10.1016/s0735-1097(02)01813-2 | doi-access = free }}{{cite journal | vauthors = Talwar S, Squire IB, Downie PF, Davies JE, Ng LL | title = Plasma N terminal pro-brain natriuretic peptide and cardiotrophin 1 are raised in unstable angina | journal = Heart | volume = 84 | issue = 4 | pages = 421–424 | date = October 2000 | pmid = 10995414 | pmc = 1729429 | doi = 10.1136/heart.84.4.421 }}{{cite journal | vauthors = Kim H, Yang DH, Park Y, Han J, Lee H, Kang H, Park HS, Cho Y, Chae SC, Jun JE, Park WH | display-authors = 6 | title = Incremental prognostic value of C-reactive protein and N-terminal proB-type natriuretic peptide in acute coronary syndrome | journal = Circulation Journal | volume = 70 | issue = 11 | pages = 1379–1384 | date = November 2006 | pmid = 17062957 | doi = 10.1253/circj.70.1379 | doi-access = free }}{{cite journal | vauthors = Ruwald MH, Goetze JP, Bech J, Nielsen OW, Madsen BK, Nielsen LB, Mouridsen M, Ruwald AC, Madsen JK, Pedersen S | display-authors = 6 | title = NT-ProBNP independently predicts long-term mortality in patients admitted for coronary angiography | journal = Angiology | volume = 65 | issue = 1 | pages = 31–36 | date = January 2014 | pmid = 23070682 | doi = 10.1177/0003319712462758 | s2cid = 33475819 }}{{cite journal | vauthors = Hadziselimovic E, Greve AM, Sajadieh A, Olsen MH, Kesäniemi YA, Nienaber CA, Ray SG, Rossebø AB, Willenheimer R, Wachtell K, Nielsen OW | display-authors = 6 | title = Association of Annual N-Terminal Pro-Brain Natriuretic Peptide Measurements With Clinical Events in Patients With Asymptomatic Nonsevere Aortic Stenosis: A Post Hoc Substudy of the SEAS Trial | journal = JAMA Cardiology | volume = 7 | issue = 4 | pages = 435–444 | date = April 2022 | pmid = 35171199 | pmc = 8851368 | doi = 10.1001/jamacardio.2021.5916 }}
{{Clear}}
Blood levels
| class="wikitable" align="right"
!colspan=4| Upper limit (95th percentile) of blood ranges | ||
| Sex | Age | Limit in pg/mL |
|---|---|---|
| rowspan=5| Male | 19-44 yrs | 93 |
| 45-54 yrs | 138 | |
| 55-64 yrs | 177 | |
| 65-74 yrs | 229 | |
| > 75 yrs | 852 | |
| rowspan=5| Females | 19-44 yrs | 178 |
| 45-54 yrs | 192 | |
| 55-64 yrs | 226 | |
| 65-74 yrs | 353 | |
| > 75 yrs | 624 |
| class="wikitable" align="left"
! Interpretation !! Age !! Range | ||
| rowspan=2| Congestive heart failure likely | <75 years | > 125 pg/mL{{cite book | author = Lee MA | title = Basic Skills in Interpreting Laboratory Data | publisher = Amer Soc of Health System | year = 2009 | isbn = 978-1-58528-180-0 | url = https://books.google.com/books?id=AUSIRcV_as0C&pg=PA220 | page = 220 }} |
| >75 years | >450pg/mL |
{{clear left}}
There is no level of BNP that perfectly separates patients with and without heart failure.{{cite journal | vauthors = Maisel AS, Krishnaswamy P, Nowak RM, McCord J, Hollander JE, Duc P, Omland T, Storrow AB, Abraham WT, Wu AH, Clopton P, Steg PG, Westheim A, Knudsen CW, Perez A, Kazanegra R, Herrmann HC, McCullough PA | display-authors = 6 | title = Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure | journal = The New England Journal of Medicine | volume = 347 | issue = 3 | pages = 161–167 | date = July 2002 | pmid = 12124404 | doi = 10.1056/NEJMoa020233 | doi-access = free }}
In screening for congenital heart disease in pediatric patients, an NT-proBNP cut-off value of 91 pg/mL could differentiate an acyanotic heart disease (ACNHD) patient from a healthy patient with a sensitivity of 84% and specificity of 42%. On the other hand, an NT-proBNP cut-off value of 318 pg/mL is more appropriate in differing patients with congenital nonspherocytic hemolytic disease (CNHD) from healthy patients, with 94% sensitivity and 97% specificity. An NT-proBNP value of 408 pg/mL has been estimated to be 83% sensitive and 57% specific in differentiating patients with ACNHD from patients with CNHD.{{cite journal |vauthors=Moses EJ, Mokhtar SA, Hamzah A, Abdullah BS, Yusoff NM | title = Usefulness of N-Terminal-Pro-B-Type Natriuretic Peptide as a Screening Tool for Identifying Pediatric Patients With Congenital Heart Disease | journal = Laboratory Medicine | year=2011 | volume = 42 | issue = 2 | pages = 75–80 | doi = 10.1309/LMW0U87COTHXGELF | doi-access = free }} In patients with non-severe asymptomatic aortic valve stenosis, increased age- and sex adjusted NT-proBNP levels alone and combined with a 50% or greater increase from baseline had been found associated with increased event rates of aortic valve stenosis related events (cardiovascular death, hospitalization with heart failure due to progression of aortic valve stenosis, or aortic valve replacement surgery).{{cite journal | vauthors = Hadziselimovic E, Greve AM, Sajadieh A, Olsen MH, Kesäniemi YA, Nienaber CA, Ray SG, Rossebø AB, Willenheimer R, Wachtell K, Nielsen OW | display-authors = 6 | title = Association of Annual N-Terminal Pro-Brain Natriuretic Peptide Measurements With Clinical Events in Patients With Asymptomatic Nonsevere Aortic Stenosis: A Post Hoc Substudy of the SEAS Trial | journal = JAMA Cardiology | volume = 7 | issue = 4 | pages = 435–444 | date = April 2022 | pmid = 35171199 | pmc = 8851368 | doi = 10.1001/jamacardio.2021.5916 }} In severe aortic valve stenosis, NT-proBNP provide important prognostic information beyond clinical and echocardiographic evaluation.{{Cite journal |last1=Bergler-Klein |first1=Jutta |last2=Klaar |first2=Ursula |last3=Heger |first3=Maria |last4=Rosenhek |first4=Raphael |last5=Mundigler |first5=Gerald |last6=Gabriel |first6=Harald |last7=Binder |first7=Thomas |last8=Pacher |first8=Richard |last9=Maurer |first9=Gerald |last10=Baumgartner |first10=Helmut |date=2004-05-18 |title=Natriuretic Peptides Predict Symptom-Free Survival and Postoperative Outcome in Severe Aortic Stenosis |url=https://www.ahajournals.org/doi/10.1161/01.CIR.0000126825.50903.18 |journal=Circulation |language=en |volume=109 |issue=19 |pages=2302–2308 |doi=10.1161/01.CIR.0000126825.50903.18 |pmid=15117847 |issn=0009-7322|url-access=subscription }}
Test usage in a clinical setting
=Canada=
While discussed in Canadian medical journals in the mid to late 2000s,{{cite journal | vauthors = Murray H, Cload B, Collier CP, Sivilotti ML | title = Potential impact of N-terminal pro-BNP testing on the emergency department evaluation of acute dyspnea | journal = CJEM | volume = 8 | issue = 4 | pages = 251–258 | date = July 2006 | pmid = 17324304 | doi = 10.1017/s1481803500013798 | doi-access = free }} the test is not widely used. It was only approved for use in Alberta in February 2012.{{cite web | url = http://www.albertahealthservices.ca/6388.asp | title = B-type Natriuretic Peptide (BNP) & NT-proBNP Test Implementation | publisher = Alberta Health Services | access-date = 3 January 2013 | url-status = dead | archive-url = https://web.archive.org/web/20150422223354/http://www.albertahealthservices.ca/6388.asp | archive-date = 22 April 2015}}
Test usage in the life insurance industry
The test has been widely used in the life insurance industry to screen applicants as part of the routine requirements when applying for a life insurance policy. It is also inexpensive and can be measured from blood samples routinely drawn as part of the application process. The test can be used to evaluate for a number of health conditions.{{cite journal | vauthors = George H |date=2010 |title=NT-proBNP The Finest Cardiovascular Screening and Reflexive Test In the History of Life Underwriting |url= http://www.insureintell.com/sites/insureintell.com/files/NT-proBNP%20II%20-%20final.pdf |journal=Insureintell |access-date=11 July 2016}}{{cite journal | vauthors = Clark M, Kaufman V, Fulks M, Dolan VF, Stout RL | title = NT-proBNP as a predictor of all-cause mortality in a population of insurance applicants | journal = Journal of Insurance Medicine | volume = 44 | issue = 1 | pages = 7–16 | date = 2014 | pmid = 25004594 }}
See also
References
{{reflist}}
External links
- BNP and NT-proBNP at [http://labtestsonline.org/understanding/analytes/bnp/tab/test Lab Tests Online]