NT-proBNP

The biomarker of choice to aid the diagnosis of heart failure

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  • Accurate and early diagnosis of heart failure
  • Risk stratification
  • Improved patient management

NT-proBNP testing at the emergency department

When acute heart failure (HF) is suspected the NT-proBNP test at the point-of-care (POC) helps differentiate acute heart failure from non-cardiac causes. Using NT-proBNP testing as an aid in the diagnosis of acute heart failure may improve diagnostic accuracy in patients presenting at the ED with shortness of breath (acute dyspnea) [1, 2].


NT-proBNP is a non-active pro-hormone that is released into the bloodstream in response to increased cardiac wall stress and volume overload [3].

Guidelines for the diagnosis of acute heart failure recommend that all patients with suspected heart failure should have diagnostic workup using natriuretic peptides, such as NT-proBNP and if available, perform the testing as a POC assay [4].

Immunoassay biomarkers


Figure 1 [3-5]. *Patient history, signs and/or symptoms suspected of acute heart failure together with diagnostic workups such as electrocardiogram, pulse oximetry, echocardiography, initial laboratory investigations, chest X-ray, lung ultrasound, etc.

NT-proBNP—an effective biomarker for heart failure

Using NT-proBNP measurements in conjunction with patient history (medical record) assessments are particularly useful for the urgent evaluation and triage of patients with acute dyspnea [1, 5, 6].


NT-proBNP is highly sensitive and specific and can help to rule out acute heart failure (Single rule out cut-off value of 300 pg/mL). See figure 1 [4].

NT-proBNP measurements as an aid in risk stratification of patients with heart failure

In the case of heart failure, NT-proBNP adds value to each step of the patient journey from diagnosis of acute heart failure to risk stratification and disease progression in patients with heart failure [3, 7].

Using NT-proBNP as an aid in risk stratification for patients with acute coronary syndrome and heart failure can predict hospital readmission and mortality among patients with acute coronary syndrome [7-10].

Measurements of NT-proBNP levels over time can provide information about chronic heart failure disease progression [10].

Improved patient management with NT-proBNP testing

NT-proBNP testing improves early diagnosis of acute heart failure when used in conjunction with clinical assessment [1, 6, 15].


Heart failure can be ruled out faster with NT-proBNP testing in conjunction with the clinical evaluation than without an NT-proBNP test [15].

The use of NT-proBNP may increase diagnostic accuracy and improve patient management with reduced waiting time in the ED and may be associated with cost savings [2, 6, 15]. One study has shown that the implementation of NT-proBNP testing in the ED can reduce cost by 15% [6].

Ultimately, NT-proBNP testing information aids the planning of efficient care and discharge strategy [6].

 
 

Diagnosis

NT-proBNP measurements reduce the risk for missed diagnosis and support triaging [9, 12, 13, 16]

 

Acute patient management

NT-proBNP enables effective patient management through identification of high-risk patients [8, 20]

 

Discharge

NT-proBNP levels at discharge provides information about the risk of re-hospitalization [8]

 

Follow up

Continuous measurements of NT-proBNP can help identify patients at high risk for recurrent acute events [14]

 

Stabilization phase

NT-proBNP enables effective patient management through identification of high-risk patients [8, 20]

 

Diagnosis / Referral

NT-proBNP levels can provide information about chronic disease progression [10]

Testing NT-proBNP on the Radiometer AQT90 FLEX analyzer

The AQT90 FLEX analyzer helps speed up time to reliable results. Being comparable to a central lab assay, the AQT may offer the advantages of POC testing as an aid in timely rule out of heart failure [1, 2, 15, 16].


The AQT90 FLEX analyzer's closed tube system makes NT-proBNP testing easy through simple handling. The operator simply loads the test tube directly into the analyzer and begins testing. There is no need for sample preparation. The analyzer performs all assay steps automatically and delivers the test result in less than 11 minutes [16, 18].

With access to fast and reliable test results for your patient, you are one step closer to improving the time of diagnosing heart failure.

Learn more about the AQT90 FLEX analyzer

Key benefits of NT-proBNP on the AQT90 FLEX analyzer

  • No blood exposure: closed-tube system
  • No sample or assay preparation
  • High analytical performance
  • No presence of hook effect or carry over
  • Hemolytic, lipemic and icteric samples do not interfere with the assay
  • Specimen types: venous whole blood and plasma
  • Sample tubes: fits most 13 × 75 mm standard tubes

NT-proBNP assay specifics

Turnaround time:
< 11 min.
CV% (plasma): Within-lab CV% at conc. 101 ng/L: 7.2%
95th percentile*: 133 ng/L

Traceability: Harmonized to correlate with results of 1st generation NT-proBNP assay on the Roche Elecsys 1010, Elecsys 2010 and MODULAR ANALYTICS E170 immunoassay analyzers.

* This value should only be used as an example. Each laboratory should establish its own decision threshold level.

References

1. Mueller C, Scholer A, Laule-Kilian K, et al. Use of B-type natriuretic peptide in the evaluation and management of acute dyspnea. N Engl J Med 2004; 350: 647-54
2. Bingisser R et al. Measurement of natriuretic peptides at the point of care in the emergency and ambulatory setting: Current status and future perspectives. American Heart Journal. 2013; 166:4, 614-621
3. Kragelund C et al. N-terminal pro-B-type natriuretic peptide and long-term mortality in stable coronary heart disease. New Engl J Med 2005; 352, 7: 666-75
4. Theresa A. McDonagh T A, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European Heart Journal (2021) 42, 3599_3726 ESC GUIDELINES doi:10.1093/eurheartj/ehab368
5. Ponikowski et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European Journal of Heart Failure. (2016); 18(8):891-975
6. Moe GW, et al. 2007. N-Terminal Pro-B-Type Natriuretic Peptide Testing Improves the Management of Patients With Suspected Acute Heart Failure: Primary Results of the Canadian Prospective Randomized Multicenter IMPROVE-CHF Study, Circulation 115:3103–3110
7. Yancy, C.W. et al. CLINICAL PRACTICE GUIDELINE: FOCUSED UPDATE. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure. Journal of the American College of Cardiology. 2017; 70(6). 776-803.
8. Bettencourt, P.; Azevedo, A.; Pimenta, J.; Friões, F.; Ferreira, S.; Ferreira, A. (2004): N-terminal-pro-brain natriuretic peptide predicts outcome after hospital discharge in heart failure patients. In Circulation 110 (15), pp. 2168–2174.
9. Borke J. Natriuretic Peptides in Congestive Heart Failure.The heart.org. 2021
10. Pascual-Figal DA, Casademont J, Lobos JM, Piñera P, Bayés-Genis A, Ordóñez-Llanos J et al. Consensus document and recommendations on the use of natriuretic peptides in clinical practice. Revista Clínica Española (English Edition) 2016; 216(6):313–22
11. Oremus, M., Don-Wauchope, A., McKelvie, R. et al. BNP and NT-proBNP as prognostic markers in persons with chronic stable heart failure. Heart Fail Rev 19, 471–505 (2014).
12. Hildebrandt, P.; Collinson, P. O.; Doughty, R. N.; et al. (2010): Age-dependent values of N-termal pro-B-type natriuretic peptide are superior to a single cut-point for ruling out suspected systolic dysfunction in primary care. In Eur Heart J 31 (15), pp. 1881–1889. DOI:
13. Asphaug M, et al. Natriuretic peptide levels taken following unplanned admission to a cardiology department predict the duration of hospitalization. European Journal of Heart Failure (2016) 18, 1499–1505
14. Wu, Alan H. B. (2006): Serial testing of B-type natriuretic peptide and NTpro-BNP for monitoring therapy of heart failure. The role of biologic variation in the interpretation of results. In Am Heart J 152 (5), pp. 828–834.
15. Green SM, Martinez-Rumayor A, Gregora SA et al.Clinical uncertainty, diagnostic accuracy, and outcomes in emergency department patients presenting with dyspnea. Arch Intern Med 2008; 168(7): 741-48. http://archinte.jamanetwork.com/article.aspx?articleid=414143
16. Chapman, A. R.; Leslie, S. J.; Walker, S. W.; Bickler, C.; Denvir, M. A. (2015): Potential costs of B-type natriuretic peptide for the identification of people with heart failure in primary care in Scotland - a pilot study. In The journal of the Royal College of Physicians of Edinburgh 45 (1), pp. 27–32.
17. Januzzi, J. L.; Camargo, C. A.; Anwaruddin S.; Baggish, A.; Chen, A. A.; Krauser, D. G. (2005): The N-terminal Pro-BNP Investigation of dyspney in the emergency department (PRIDE) study. In Am J Cardiol (95), pp. 948–954.
18. Lepoutre T, et al. Measurement NT-proBNP Circulating Concentrations in Heart Failure Patients with a New Point-Of-Care Assay. Clin Lab. 2013
19. Renaud B et al. Impact of point-of-care testing in the emergency department evaluation and treatment of patients with suspected acute coronary syndromes. Acad Emerg 2008; 15:216-24
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