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Clinical Chemistry

Cardiac-related tests

Natriuretic Peptides (BNP and Amino-terminal proBNP)


Author: Larry Bernstein, M.D., Triplex Consulting (see Reviewers/Authors page)
Revised: 12 December 2010, last major update December 2010
Copyright: (c) 2003-2010, PathologyOutlines.com, Inc.

General
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● Brain natriuretic peptide (BNP), now known as B-type natriuretic peptide (also BNP), is a 32 amino acid polypeptide secreted by the cardiac ventricles in response to excessive stretching of cardiomyocytes (Wikipedia)
● BNP was originally identified in extracts of porcine brain, although in humans it is produced mainly in the cardiac ventricles
● BNP is co-secreted with a 76 amino acid N-terminal fragment (NT-proBNP), which is biologically inactive

Indications
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● Evaluation of dyspneic patient with suspected congestive heart failure, regardless of renal function (J Am Coll Cardiol 2006;47:91)
● B-type natriuretic peptide levels are higher in patients with congestive heart failure than in dyspnea from other causes (J Am Coll Cardiol 2002;39:202, N Engl J Med 2004;350:647)
● NT-proBNP measurement is a valuable addition to standard clinical assessment for the identification and exclusion of acute CHF in the emergency department setting (Am J Cardiol 2005;95:9480)

Clinical features
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● Reduces misdiagnosis of congestive heart failure, which occurs 50% to 75% of the time
● NT-proBNP is superior to BNP for predicting mortality and morbidity for heart failure (Clin Chem 2006;52:1528), and coexisting renal disease and heart failure (Clin Chem 2007;53:1511)

Reference ranges
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● BNP levels below 100 pg/mL indicate no heart failure

Limitations
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● Determination of endogenous BNP with the AxSYM assay using frozen plasma samples may not be valid after 1 day, but NT-proBNP as measured by the Elecsys assay may be stored at -20 degrees C for at least four months without a relevant loss of the immunoreactive analyte (Clin Chem Lab Med 2004;42:942)

Additional references
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Clin Chem 2007;53:1928, Am J Kidney Dis 2005;46:610, Hypertension 2005;46:118, Hypertension 2006;47:874, Eur J Heart Fail 2004;6:269

End of Clinical Chemistry > Cardiac-related tests > Natriuretic Peptides (BNP and Amino-terminal proBNP)


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