The Importance of Amino-terminal pro-Brain Natriuretic Peptide Testing in Clinical Cardiology

Abstract

In 1981 de Bold et al. reported that the injection of atrial tissue extracts in rats induced natriuresis, a discovery that initiated a flurry of research leading to the discovery of a new class of cardiac hormones, the natriuretic peptides. These peptides represent the first line of response of the heart to defend the body against a number of processes, especially plasma volume expansion. Since circulating concentrations of natriuretic peptides are elevated in heart failure (HF) and given that clinical parameters for the evaluation and management of HF have a poor sensitivity and specificity, these peptides were a more than welcome addition to standard clinical evaluation, as a marker to identify HF. Nowadays, Brain Natriuretic Peptide (BNP) and its cleavage equivalent aminoterminal proBNP (NT-proBNP) have proven its clinical diagnostic but also prognostic value in HF, and have shown to be superior as a diagnostic parameter for HF when compared to chest X-ray and parameters of physical examination. In this paper, we aim to discuss the background, the value, and of course the potential pitfalls encountered by clinicians using NT-proBNP testing in their daily clinical practice.