Dr James L Januzzi
Cardiologist, Massachusetts General Hospital. Prof of Medicine, Harvard Medical School

How will NT-proBNP testing evolve in the future?


  • In future NT-proBNP would be beneficial for early detection of structural heart disease in patients without symptoms in the primary care settings. The PONTIAC II study is an ongoing study to assess the effect of optimizing and intensifying treatment in T2D patients without HF symptoms depending on the NT-proBNP levels, will shed more light on the value of the biomarker based risk stratification of T2D patients.

So I think in the future, another area where we can expect to see NT-proBNP used substantially is in the primary care setting, for earlier detection of structural heart disease and identification of heart failure at even earlier stages.

We know very well that in symptomatic patients, NT-proBNP is valuable. So, in primary care, just as in the hands of specialists, recognising heart failure may be quite challenging. And so use of NT-proBNP is already supported in this setting.

However, I’d emphasise that the processes that lead to heart failure, the heart muscle changes, the various cardiac abnormalities that lead to heart failure, may occur well before symptoms develop. And it is now known that NT-proBNP values in these patients are typically abnormal, well before symptoms start.

So ultimately, it may be possible to recognise the signature of heart failure before it even develops symptomatically and intervene at an even earlier stage. Ultimately, these are studies that need to be done in the primary care setting. We know, for example, in a pilot study called the PONTIAC study that early diagnosis of heart failure in patients with diabetes, without symptoms, treated more aggressively, these patients did better in the NT-proBNP strategy versus a strategy without NT-proBNP evaluation.

We’re now performing a PONTIAC II study where patients with diabetes will have NT-proBNP measured, and if above 125 pg/ml, these patients will be treated more aggressively, with the hope that we can reduce new onset heart failure in these patients.

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