What is BNP and NT-proBNP, and what role they play in heart failure.
B-type natriuretic peptide (BNP) is a hormone produced by your heart. N-terminal-pro hormone BNP (NT-proBNP) is a non-active prohormone that is released from the same molecule that produces BNP. Both BNP and NT-proBNP are released in response to changes in pressure inside the heart. These changes can be related to heart failure and other cardiac problems. Levels goes up when heart failure develops or gets worse, and levels goes down when heart failure is stable. In most cases, BNP and NT-proBNP levels are higher in patients with heart failure than people who have normal heart function.
For the longer half-life, better stability from rhBNP (recombinant human BNP) medicines, N terminal proBNP is considered to be a better biomarker than BNP.
The diagnosis usage of NT-proBNP
1. Application of NT-proBNP in the diagnosis of acute heart failure
NT-proBNP testing in patients presenting with acute dyspnea and suspected acute HF can differentiate between acute HF and non-HF patients. Studies have shown that NT-proBNP has the best negative predictive value and a better positive predictive value when the cut-off value for the diagnosis of acute heart failure is 300 pg/ml. Age-stratified diagnostic cutoffs should be used for patients of different ages.
2. Application of NT-proBNP in the diagnosis of chronic heart failure
For non-acute patients with suspected heart failure, by assessing the clinical possibility of heart failure (clinical history, physical examination, ECG), observing echocardiography, and combining test of NT-proBNP and BNP levels, non-HF diseases can be identified in patients with chronic heart failure.
3. For prognostic assessment and risk stratification
For patients with chronic heart failure, the level of NT-proBNP was positively correlated with the severity of heart failure. NT-proBNP can be used as an effective means for prognostic evaluation, and it has greater guiding significance with the deterioration of cardiac function classification and hemodynamic data.
NT-proBNP levels in patients with acute heart failure were independently associated with patient prognosis. NT-proBNP can be used as a prognostic indicator for acute heart failure. The event rate of patients with NT-proBNP>1000 pg/ml was significantly increased. The level of NT-proBNP before discharge and the change rate during hospitalization were more meaningful for the prognosis evaluation of acute heart failure.
4. For treatment plan adjustment and treatment effect monitoring
The concentration change of NT-proBNP is related to the curative effect, and the drug dose can be adjusted according to the change to estimate the curative effect. The main cause of acute heart failure is myocardial ischemia and myocardial injury caused by a rapid increase in ventricular volume load and subsequent imbalance of oxygen supply. After effective unloading therapy, NT-proBNP levels may fall by 25% to 40%. If it does not reach the expected level of decline after treatment or rises instead, it indicates that the treatment effect is not good.
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