Clinical utility of NT-proBNP, a new biomarker of cardiac function and heart failure

Recently, N-terminal pro-B-type natriuretic peptide (NT-proBNP), a new biomarker of cardiac function and heart failure, has become available as a clinical laboratory test in Japan. Its diagnostic and prognostic utility appears to be equivalent to BNP in the clinical setting; however, there are some biologic differences between NT-proBNP and BNP. Unlike BNP, NT-proBNP is not degraded in the circulation, and is stable even in serum. It has a longer half-life of approximately 1 to 2 hours, leading to higher circulating levels and slower fluctuations than BNP. Both of these biomarkers are influenced by renal function, but the effect is greater for NT-proBNP. Recently, NT-proBNP has become an important diagnostic tool for assessing patients who present acutely with dyspnea, and provides important prognostic information in both acute and chronic heart failure. Also, monitoring NT-proBNP levels in the outpatient setting is expected to improve patient care and outcomes. Furthermore, a recent study has reported that NT-proBNP may be independently associated with future cardiovascular events in a large community-based cohort free of heart failure. However, NT-proBNP is affected primarily by renal function, gender, age, and obesity, which should be considered when interpreting values.