Comprehensive Review of the Relative Clinical Utility of B-Type Natriuretic Peptide and N-Terminal Pro-B-Type Natriuretic Peptide Assays in Cardiovascular Disease

Measurable B-type natriuretic peptides, which are largely produced by the left ventricle, include B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP). These proteins are released by cardiomyocytes in response to wall-tension and neurohumoral signals. In this review the literature is summarized to date with respect to the approved indications for testing which include the diagnostic evaluation and prognosis of heart failure. PubMed in 2009 was searched and 5496 references were reduced to 242 studies that reported on either diagnosis, prognosis, screening, or monitoring of heart failure. In head-to-head diagnostic comparisons, 58 studies measured both assays, and 11 studies in adults that included at least 100 patients compared commercially available tests. We performed the analogous search in acute coronary syndromes (ACS) and found 82 articles of which 11 papers focused on the study of BNP and NT-proBNP in either stable angina, non-ST-segment elevation myocardial infarction or ST-segment elevation myocardial infarction. For heart failure diagnosis, BNP and NT-proBNP had similar decision statistics; however, while optimal diagnostic cutpoints for both markers varied depended on age and degree of renal dysfunction, and the clinical application; NT-proBNP had a much more widely variable optimal cutpoint than did BNP. Sufficient evidence for clinical utility of both tests exists for other applications of prognosis, screening, and monitoring of heart failure. In addition, both tests have a role in the risk stratification of all forms of ACS. Future trials of clinical strategies are warranted using these tools in advancing both inpatient and outpatient management of heart failure and ACS.