The Role of Natriuretic Peptides in Diagnosis and Management of Heart Failure
Prof. Mueller provides an overview of the clinical implementations of BNP and NT-proBNP tests, confirming, that both tests play an important role in the diagnostic evaluation of patients with dyspnea whenever heart failure is included in the differential diagnosis, and pays attention to similar clinical usage of these tests, keeping in mind their different cutoffs.
Prof. Mueller also highlights that BNP testing has valuable clinical input, but with revised cutoffs, by the diagnosis of HF in some groups of patients, for example:
- In obesity, BNP cutoff should be lower than expected.
- In terminal kidney failure, BNP cutoff should be higher than expected.
BNP: An Evidence-based Biomarker with a Bright Future
Prof. Plebani highlights that current guidelines recommend the measurement of both NPs, but active hormone BNP should give different, but complementary, pathophysiological, and clinical information than the inactive form:
- BNP was found to reduce all causes of mortality and the composite outcome of mortality and re-admission in patients with acute heart failure
- BNP and NT-proBNP present different biochemical properties leading to different circulating levels, kinetics, samples of choice, such as:
- BNP has rapid variations of circulating values in both physiological and pathological conditions
- More rapid changes related to therapeutic treatments
Prof. Plebani emphasizes that both tests have cross-reactions: BNP methods could cross-react with proBNP and measure several BNP fragments instead of the intact hormone; NT-proBNP assays may cross-react with proBNP and its degradation products. Clinicians should consider the clinical picture of patients and analytical characteristics of both immunoassays.
