Abstract - NT-proBNP AS THE GOLD STANDARD BIOMARKER IN HEART FAILURE AND ITS ROLE BEYOND THE DIAGNOSIS OF HEART FAILURE
Prof A Mark Richards BA, MB ChB, MD, PhD, DSc, FRCP, FRACP, FRSNZ
Director, Christchurch Heart Institute, University of Otago, New Zealand.
Director, Cardiovascular Research Institute, National University of Singapore, Singapore.
Plasma NT-proBNP is endorsed within authoritative international guidelines, as a valuable aid in diagnosis and in risk stratification (prognosis) in both acute and non-acute heart failure (HF). In addition, ongoing research points to a role for serial measurements of NT-proBNP in guiding titration of pharmacotherapy in chronic HF. In acutely dyspnoeic patients, at the threshold of 300pg/ml, plasma NT-proBNP has very high sensitivity and negative predictive value distinguishing acute HF from other sources of breathlessness. Factors which influence plasma NT-proBNP and may alter test performance include atrial fibrillation, renal dysfunction, obesity and age. In, non-acute HF in the community a threshold of 125pg/ml is useful but in this setting the marker performs less well than in acute HF, especially in HF with preserved ejection fraction. NT-proBNP is a powerful independent prognostic marker in all stages of HF and guidelines recommend obtaining pre-discharge measurements for risk stratification. Achieving plasma NT-proBNP levels below 1,000pg/ml in chronic HF portends a significantly better prognosis. Trials of marker-guided titration of pharmacotherapy in the management of chronic HF treatment titration of chronic heart failure has shown promise but remains controversial.