Dr Januzzi: BMI stratified cut-off values for NT-proBNP are, not recommended. The reason is, the age-stratified approach of 450 pg/mL, 900 pg/mL and 1800 pg/mL for people less than 50 yrs, 50 to 75 yrs, greater than 75 yrs, really addresses (to a large extent) the BMI differences. Younger patients tend to be heavier and […]
Uncategorized FAQ
What are your views on improvement in NT-proBNP but no improvement in clinical endpoints?
Dr Januzzi: NT-proBNP changes from minute to minute, from hour to hour. The studies that have shown improvement in NT-proBNP but no improvement in clinical endpoints were studies that gave a short -term treatment. For example, Levosimendan (calcium sensitizer) given for a week, shows the NT-proBNP decrease, but then the endpoints were a month later or […]
Are NT-proBNP results from different companies transferable?
Dr Januzzi: In the early days, when NT-proBNP and BNP were first released, all of the NT-proBNP assays were quite similar in terms of reference ranges because they were all based on the same antibodies. The BNP assays out in the market are completely different; as they are based on different capture and detection antibodies. More […]
Are there different cut-offs for NT-proBNP in patients with heart failure preserved (HEpEF) or reduced ejection fraction (HFrEF) conditions?
Dr Januzzi: Different cut-offs for preserved ejection fraction (HFpEF) are not recommended. However, it is recognised that preserved EF heart failure may be more likely to be below the rule in the threshold. 300 pg/mL is the rule out level and then from 300 pg/mL up to 1800 pg/mL is a grey zone. Patients with preserved […]
Can NT-proBNP be used in a paediatric patient?
Dr Januzzi: If NT-proBNP is measured in a neonate or in a baby that’s about one or two days old, it is in the 5000 pg/mL to 10,000 pg/mL range. This has to do with the fact that in the peripartum period, at the near term and then in delivery, the infant’s cardiac output is […]
Do heart failure drugs affect the NT-proBNP itself qualitatively?
Dr Januzzi: Certain therapies may change the amount of glycosylation in the amino-terminal portion of the biomarker, which may allow for differences in measurements as well as differences in processing, improving heart failure status. There is a lot to this that still needs better understanding. […]
What should be the timing of initiation for SGLT2 inhibitors in patients with acute heart failure and how should Neprilysin inhibitors be used in acute heart failure with these two new therapies?
Dr Sim: There is an ongoing trial looking at the use of SGLT2 inhibitors in acute heart failure settings. The result should be out in a couple of years. In acute heart failure setting (like the design in PIONEER–HF trial), after the first 24 to 48 hours when the patient is stabilised in terms of the […]
Should we forget about symptoms and just use NT-proBNP as the way that we decide who gets an ARNi or who gets a SGLT2i?
Dr Sim: In practice, we should go with both symptoms and NT-proBNP. It is hard to ignore the symptoms. It does not cost a single cent to ask a patient for history; it is something very easy. NT-proBNP is mainly done for two reasons – One, beside symptoms, NT-proBNP gives us more information about the prognosis, […]
Is there a target for treatment for heart failure with reduced ejection fraction?
Dr Januzzi: For chronic heart failure with reduced ejection fraction, the target is less than 1000 pg/mL. Below a 1000 pg/mL value, indicates ventricular remodelling begins to improve. That would be the target for chronic ambulatory heart failure. For inpatient heart failure management, there is a wide range of values in patients that are hospitalised. 30% […]
How should we use NT-proBNP guided therapy and anticipate that NT-proBNP is augmented in patients with chronic heart failure and acute kidney injury?
Dr Sim : Most of the time in Singapore, when a patient is received from the emergency department, an NT-proBNP would have been done. ED physicians are very aggressive in ordering the NT-proBNP so that the results would be quick. In the setting of pneumonia, acute kidney injury, they would definitely affect the NT-proBNP result. […]
What is the role of NT-proBNP in COVID -19?
Dr Januzzi : COVID-19 may manifest from a cardiac perspective in a number of different ways – atrial fibrillation is common, heart muscle dysfunction whether related to myocarditis (which is probably a little bit more uncommon, but may still happen or not) and stress cardiomyopathy. There is also triggering of ischaemic heart disease and other […]
From a diagnostic perspective, what is your experience of using NT-proBNP in heart failure with preserved ejection fraction (HFpEF)?
Dr Januzzi: A normal NT-proBNP for a middle-aged individual is 20 pg/mL or 30 pg/mL, maybe not much higher. If a patient presents with NT-proBNP of 300 pg/mL with shortness of breath, obesity and some oedema, it is very likely they have heart failure with preserved ejection fraction (HFpEF). Diagnosis in patients with HFpEF is […]
What is the role of natriuretic peptides testing in patients with diabetes to identify risk? Would that help you make decisions about which drugs you might want to give them?
Dr Sim: There is no clear guideline, especially in the Asian setting like, after X number of years of diabetes, we should start doing NT-proBNP. The traditional way of treating diabetes is just checking on HbA1c, and then wait till the patient develops coronary artery disease or heart failure. Then treatment initiated is with a […]
What is the role of NT-proBNP for discharge planning in patients with acute heart failure who are improving and then sent home?
Dr Sim : NT-proBNP if done as the one-off reading, is not as useful as a serial reading. If somebody starts at a high reading, and if shown that on discharge and one month after discharge the value is coming down, then you can be assured that you are in the right direction. If just […]
The decrease of NT-proBNP, 30% or more, from admission to discharge indicates the patient will have a better prognosis. For the obese patient, can we use the same logic?
Dr Januzzi: Analyses shows that obesity did not affect the prognostic meaning of the 30% reduction during hospitalisation. Although obesity suppresses natriuretic peptide, when an obese patient is admitted for heart failure, they usually have elevated values. It is just that they are not as high as one might expect. The reduction is largely the same. […]