Article

Major role of Roche NT-proBNP as the initial test for diagnosing heart failure

Gatekeeper for improved diagnosis in both non-acute and acute settings to allow for better use of resources.1

 

In association with clinical evaluation, natriuretic peptides are recommended as the initial diagnostic test with the highest level of recommendation (IA) in major guidelines.2,3 Use Roche NT-proBNP to help you:

  • Exclude heart failure (HF) in a timely manner with a high sensitivity and negative predictive value2-5
  • Avoid unnecessary echocardiography and shorten the length of stay in the emergency department1,4,6-10
  • Identify patients with high probability of having HF who need further cardiac investigation to confirm the diagnosis and initiate treatment2,3,11
  • Identify patients in primary care who need referral to the specialist4,6,7

Non-Acute Heart Failure:

 

Guide to understanding Roche NT-proBNP levels when diagnosing patients in the non-acute setting1,2,4,6,11

Roche NT-proBNP < 125 pg/ml:

  • HF unlikely
  • Consider other diagnosis. 

 

Roche NT-proBNP > 125 pg/ml:

  • HF likely
  • Perform echocardiography to confirm HF diagnosis

Acute Heart Failure:

 

Guide to understanding Roche NT-proBNP levels when diagnosing patients in the acute setting2,5,8

 

The only clinically validated biomarker with age-specific cutoffs to help improve specificity and accuracy of heart failure diagnosis5,8

Roche NT-proBNP < 300 pg/mL

  • Search for other symptoms

Roche NT-proBNP > 300 pg/mL but under “rule-in” age-specific cutoffs

  • Diagnosis by imaging

"Rule-in" age-specific Roche NT-proBNP

> 450 pg/mL if < 50 years

> 900 pg/mL if 50 – 75 years

> 1,800 pg/mL if > 75 years

  • Confirmation by imaging

*Results in the grey zone have to be interpreted in the clinical context as other causes beyond heart failure can lead to elevation of natriuretic peptides.2

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Abbreviations

NT-proBNP: N-terminal prohormone of brain natriuretic peptide

 

References

  1. Hildebrandt et al. (2010). Eur Heart J. 31, 1881-1889
  2. Ponikowski et al. (2016). Eur J Heart Fail. 18, 891-975
  3. Yancy et al. (2017). Circulation. 136, e137-e161
  4. Taylor et al. (2017). Br J Gen Pract. 2017 Feb; 67, e94-e102
  5. Januzzi et al. (2018). J Am Coll Cardiol. 71, 1191-1200
  6. Taylor et al. (2017). Efficacy and Mechanism Evaluation, No. 4.3. National Institute for Health Research. ISSN 2050-4365. [Accessed on January 2018, 23rd]
  7. British Heart Foundation and the All-Party Parliamentary Group on Heart Disease (2016). Focus on Heart Failure. Report accessible on https://www.bhf.org.uk/get-involved/campaigning/inquiry-into-living-with- heart-failure [Accessed on January 2018, 23rd]
  8. Januzzi et al. (2006). Eur Heart J. 27, 330-337
  9. Moe et al. (2007). Circulation. 115, 3103-3110
  10. Behnes et al. (2009). Int J Cardiol. 135, 165-174
  11. Rutten et al. https://ipccs.org/2017/12/10/epccs-practical-guidance-on-heart-failurediagnosis-and-management-in-primary-care/ [Accessed on January 2018, 23rd]