N-terminal prohormone of brain natriuretic peptide

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natriuretic peptide B
Identifiers
Symbol NPPB
Entrez 4879
HUGO 7940
OMIM 600295
RefSeq NM_002521
UniProt P16860
Other data
Locus Chr. 1 p36.2

The N-terminal of the prohormone brain natriuretic peptide (NT-proBNP) is a 76 amino acid N-terminal inactive protein that is cleaved from proBNP to release brain natriuretic peptide.

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.[1] 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 and myocardial ischemia. [2][3][4][5][6]

Blood levels[edit]

Upper limit (95th percentile) of blood ranges
for NT-proBNP in healthy people
Sex Age Limit
in pg/mL
Male < 45 yrs 90[7]
45-59 yrs 140[7]
55-64 yrs 180[7]
65-74 yrs 230[7]
> 75 yrs 850[7]
Females < 45 yrs 180[7]
45-54 yrs 190[7]
55-64 yrs 230[7]
65-74 yrs 350[7]
> 75 yrs 620[7]
Interpretation Age Range
Congestive heart failure likely <75years > 125 pg/mL[8]
>75 years >450pg/mL[8]

There is no level of BNP that perfectly separates patients with and without heart failure.[9]

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%.[10] 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.[10] 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[10]

Test usage in a clinical setting[edit]

Canada[edit]

While discussed in Canadian medical journals in the mid to late 2000's,[11] the test is not widely used. It was only approved for use in Alberta in February 2012.[12]

See also[edit]

References[edit]

  1. ^ Bhalla V, Willis S, Maisel AS (2004). "B-type natriuretic peptide: the level and the drug--partners in the diagnosis of congestive heart failure". Congest Heart Fail 10 (1 Suppl 1): 3–27. doi:10.1111/j.1527-5299.2004.03310.x. PMID 14872150. 
  2. ^ Atisha D, Bhalla MA, Morrison LK, Felicio L, Clopton P, Gardetto N, Kazanegra R, Chiu A, Maisel AS (September 2004). "A prospective study in search of an optimal B-natriuretic peptide level to screen patients for cardiac dysfunction". Am. Heart J. 148 (3): 518–23. doi:10.1016/j.ahj.2004.03.014. PMID 15389242. 
  3. ^ Nakamura T, Sakamoto K, Yamano T, Kikkawa M, Zen K, Hikosaka T, Kubota T, Azuma A, Nishimura T (May 2002). "Increased plasma brain natriuretic peptide level as a guide for silent myocardial ischemia in patients with non-obstructive hypertrophic cardiomyopathy". J. Am. Coll. Cardiol. 39 (10): 1657–63. PMID 12020494. 
  4. ^ Talwar S, Squire IB, Downie PF, Davies JE, Ng LL (October 2000). "Plasma N terminal pro-brain natriuretic peptide and cardiotrophin 1 are raised in unstable angina". Heart 84 (4): 421–4. PMC 1729429. PMID 10995414. 
  5. ^ Kim H, Yang DH, Park Y, Han J, Lee H, Kang H, Park HS, Cho Y, Chae SC, Jun JE, Park WH (November 2006). "Incremental prognostic value of C-reactive protein and N-terminal proB-type natriuretic peptide in acute coronary syndrome". Circ. J. 70 (11): 1379–84. PMID 17062957. 
  6. ^ Ruwald MH, Goetze JP, Bech J, Nielsen OW, Madsen BK, Nielsen LB, Mouridsen M, Ruwald AC, Madsen JK, Pedersen S (October 2012). "NT-ProBNP Independently Predicts Long-Term Mortality in Patients Admitted for Coronary Angiography". Angiology. doi:10.1177/0003319712462758. PMID 23070682. 
  7. ^ a b c d e f g h i j The University of Iowa (UIHC) > Department of Pathology > LABORATORY SERVICES HANDBOOK > N-terminal-pro-BNP Showing 95th percentiles. Epic Lab Code: LAB649. Updated: 10/27/2009
  8. ^ a b Lee MA (2009). Basic Skills in Interpreting Laboratory Data. Amer Soc of Health System. p. 220. ISBN 1-58528-180-8. 
  9. ^ 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 (July 2002). "Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure". N. Engl. J. Med. 347 (3): 161–7. doi:10.1056/NEJMoa020233. PMID 12124404. 
  10. ^ a b c Moses EJ, Mokhtar SAI, Hamzah A, Abdullah BS, Yusoff NM (2011). "Usefulness of N-Terminal-Pro-B-Type Natriuretic Peptide as a Screening Tool for Identifying Pediatric Patients With Congenital Heart Disease". Laboratory Medicine 42 (2): 75–80. doi:10.1309/LMW0U87COTHXGELF. 
  11. ^ Murray H, Cload B, Collier CP, Sivilotti ML (July 2006). "Potential impact of N-terminal pro-BNP testing on the emergency department evaluation of acute dyspnea". CJEM 8 (4): 251–8. PMID 17324304. 
  12. ^ "B-type Natriuretic Peptide (BNP) & NT-proBNP Test Implementation". Alberta Health Services. Retrieved 3 January 2013. 

External links[edit]