An innovative marker to which is used to diagnose cardiac patients. It has longer half life and higher stability than BNP.

1. Hafij Ali
(MSc in Genetic Engineering & Biotechnology, SUST)
Product Executive (PMD)
Labaid Hospital & Diagnostic
NT-ProBNP

2. Heart Failure
 Heart failure (HF) is a global health problem associated
with high morbidity and mortality
 Detection in its early stages and appropriate treatment
are key to improving quality of life
 Patients with HF – especially with mild symptoms – are
often not diagnosed

3. PrePro-BNP
 When heart failure develops or worsens, the ventricles
or lower chambers of the heart produce a substance
called PrePro-BNP.
 PreproBNP is 134 amino acids peptide.
 Cleaved into proBNP (108 amino acids) and a signal
peptide of 26 amino acids. ProBNP is subsequently
cleaved into BNP (32 amino acids) and the inactive N-
terminal proBNP peptide (NT-proBNP; 76 amino
acids).

4. Figure of Heart

5. Production Procedure

6. NT-ProBNP
 Innovative marker to improve clinical decisions
 Produced from heart muscle cells, mainly in the left
ventricular myocardium but also in the atrial
myocardium, as a pro-hormone BNP.

7. Why Is a NT-ProBNP Blood
Test Needed?
NT-ProBNP levels help to determine -
Heart failure
Determine heart failure worsened condition
Other treatments are needed
Need to be hospitalized
Determine prognosis

8. Testing may be performed
 A person has symptoms such as swelling in the
legs (Edema)
 Difficulty breathing
 Shortness of breath
 Fatigue
It can be used, along with other cardiac biomarker tests, to
detect heart stress and damage and/or along with lung
function tests to distinguish between causes of shortness of
breath. Chest X-rays and an ultrasound test called
echocardiography may also be performed.

9. What does the test result
mean?
 Higher-than-normal results suggest that a person has
some degree of heart failure, and the level of BNP or
NT-proBNP in the blood is related to its severity.
 Higher levels of BNP or NT-proBNP are often
associated with a worse outlook (prognosis) for the
person.
 Normal results indicate that the person's symptoms
are likely due to something other than heart failure.

10. Why NT-ProBNP but Not BNP?
 Both tests have similar diagnostic accuracy for
detecting CHF in patients with depressed left
ventricular ejection fraction (LVEF), but NT-proBNP
has greater sensitivity for detecting CHF in patients
with preserved LVEF
 Both tests can be used to screen a general
population of asymptomatic subjects for depressed
LVEF (≤ 40%), although for this population NT-
proBNP yields more accurate results than BNP
(p=.01)
 NT-proBNP has a circulating half-life of ~120
minutes, available for measurement longer than BNP
 Longer half-life reduces the possibility of false
negative result
 NT-ProBNP’s stability increases early detection

11. Conti…
 NT-ProBNP has less laboratory variation (Biosite
BNP: CV=9.9-12.0%; NT-proBNP: CV=2.9-6.1% -
data supplied by Roche Diagnostics).
 NT-ProBNP has higher stability than BNP.
 In response to myocardial stress (e.g., increased
ventricular stretch, ischemia), the rise in NT-proBNP
is often several orders of magnitude higher than BNP.
CV=Coefficient of Variation

12. BNP
 < 100 pg/mL - HF unlikely
 >400 pg/mL - HF likely
 100-400 pg/mL - Use clinical judgment
NT-proBNP
 < 300 pg/mL - HF unlikely
 Age < 50 years, NT-proBNP >450 pg/mL - HF
likely
 Age 50-75 years, NT-proBNP >900 pg/mL – HF
likely
 Age >75 years, NT-proBNP >1800 – HF likely
Cut-off Level

13. Raised NTproBNP
• If NTproBNP is above the cut off levels but below
2000pg/ml – refer routinely for echocardiography
and specialist opinion
• If > 2000pg/ml – refer urgently for
echocardiography and specialist opinion

14. Price
NT-ProBNP
Labaid: 3,000/=
BNP
IBNSINA: 3200 (Without Discount)
Popular: 3,000/=
Square: 4,200/=
Apollo: 4,950/=

15. Information About Test
Collection Specimen: Blood - 4ml (Lithium heparin
tube)
Test Perform from Plasma : 50 µl
Machine: Immulite - 2000, USA, Siemens
Test Performing Time: 35min

16. Thank you….