Is There Anything Else I Need To Know About A Natriuretic Peptide Test
Your health care provider may order one or more of the following tests in addition to or after you’ve had a BNP or NT-proBNP test:
- Electrocardiogram, which looks at heart’s electrical activity
- Stress test, which shows how well your heart handles physical activity
- Chest x-ray to see if your heart is larger than normal or if you have fluid in your lungs
You may also get one or more of the following blood tests:
- ANP test. ANP stands for atrial natriuretic peptide. ANP is similar to BNP but it is made in a different part of the heart.
- Metabolic panel to check for kidney disease, which has similar symptoms to heart failure
- Complete blood count to check for anemia or other blood disorders
Does Bnp Level Predict Symptoms
Not always. As with a lot of tests, patients with high BNP may be asymptomatic and some symptomatic HF patients may have low levels. In one study, 26% of symptomatic patients had normal levels. Of these patients, more were likely to by young and female with cardiomyopathy of non-ischaemic origin.
What may be more useful is using levels to track course of disease and treatment.
Check out the study below which discusses normal levels
Influences On Bnp Levels
Many medications used to treat heart failure reduce natriuretic peptide concentrations.813 Therefore, many patients with chronic stable heart failure will have BNP levels in the normal diagnostic range . However, digoxin and some beta blockers appear to increase natriuretic peptide concentrations.1416 Exercise causes a short-term increase in BNP levels,17 although only small changes are detectable one hour after exercise.18 No circadian variation has been reported when BNP is measured every three hours for 24 hours,19 and there is less hourly variation with BNP than with ANP.20
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When The Bnp Blood Test Is Needed
The BNP blood test will help a medical provider be able to distinguish whether the symptoms are due to heart failure or another condition. It can also help doctors determine if heart failure has become worse or if a change in treatment needs to happen. Depending on the results, the decision to hospitalize may also be made.
What Do The Bnp Blood Test Results Mean
The BNP blood test only takes about 15 minutes to complete. Once the blood draw has been completed, it will be run through a machine at the laboratory that can determine the overall BNP level in the sample. Based on what the results are, a medical provider can begin making decisions about how aggressive a treatment plan should be and what a patients future prognosis happens to be. Test results are reported in pg/ML in most laboratories and are expressed as a number.
- Normal levels of BNP are below 100. This indicates that no heart failure has occurred.
- When BNP levels are 300 or below, then this is an indication that heart failure is present in some form. It may have just occurred or the heart may have stabilized after progression.
- Levels above 300 indicate that mild heart failure is currently happening. Levels above 600 are considered to be moderate heart failure, while levels above 900 are considered an indication that severe heart failure has happened.
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What Are They Used For
A BNP test or an NT-proBNP test is most often used to diagnose or rule out heart failure. If you’ve already been diagnosed with heart failure, the test may be used to:
- Find out the severity of the condition
- Find out if treatment is working
The test may also be used to find out whether or not your symptoms are due to heart failure.
Preparing For The Bnp Lab Test
You dont need to fast or do anything to prepare for the test. You can get it at any time of day.
Make sure your doctor knows about all medications, vitamins, herbs, and supplements you take. That includes ones that dont need a prescription. These can affect how your doctor interprets your BNP readings.
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Sacubitril: A Problem For Measuring Natriuretic Peptides
Among the bioactive peptides, sacubitril reduces the breakdown of the biologically active NPs by inhibiting the enzyme neprilysin, a circulating neutral endopeptidase involved in the degradation of NPs. This is true for both ANP and BNP, but BNP is a poorer substrate for neprilysin than ANP. Therefore, the increase of BNP may be less. The increase in BNP was only small although significant whereas the increase in urinary cGMP was much larger with sacubitril/valsartan in the PARADIGM-HF study.
Sacubitril has no direct influence on NT-proBNP because neprilysin has no effect on cleavage of NT-proBNP. However, it might be speculated that an increasing level of BNP results in a negative feedback regarding production of proBNP, thereby reducing NT-proBNP. To the best of our knowledge, this has not been properly tested. In clinical trials, sacubitril/valsartan resulted in a reduction of NT-proBNP, as well as a small increase in BNP as mentioned above. This reduction was accompanied by a better outcome. Therefore, it is likely that the decrease in NT-proBNP is, at least in part, related to more effective treatment of HF. To what extent NT-proBNP levels are influenced by a negative feedback mechanism remains to be determined.
What Happens During A Natriuretic Peptide Test
For a BNP test or an NT-proBNP test, a health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.
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What Does The Test Measure
These tests measure blood levels of BNP or NT-proBNP, which are proteins that are made by the heart and blood vessels. These hormones are secreted into the bloodstream in response to excess fluid accumulating in the blood vessels. The active hormone, BNP, encourages the removal of water and salt from the blood.
Bnp Blood Test Results Explained
Your results will indicate if your BNP levels are high enough to suspect a diagnosis of heart failure. If you already have a diagnosis of heart failure, the results can help your doctor find out whether heart failure treatments are working.
Generally, BNP levels below 100 picograms per milliliter are considered normal. But normal BNP levels may vary depending on your age and sex.
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What Else Can Elevate Bnp Levels
- Inverse relationship between GFR and BNP levels. BNP is removed by a receptor and enzyme system, and also through passive excretion.
- NT-proBNP is cleared mainly by the kidney and so it rises in isolated renal failure without LV dysfunction.
How Is This Test Performed
A BNP test is done by drawing blood from a vein in your arm using a hypodermic needle. This process is known as venipuncture.
A machine then measures levels of BNP or another heart hormone, called N-terminal-pro BNP , in the blood sample.
The results from the test are usually ready in 15 to 20 minutes. Results may take up to a week if the blood is sent to a separate lab facility for analysis.
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When Should I Get A Bnp Or Nt
Your doctor may order a BNP or NT-proBNP test if you have symptoms of heart failure. If you have already been diagnosed with heart failure, your doctor might order a test to get more information about your condition.
The main symptoms of heart failure are:
- Shortness of breath or difficulty breathing
- Swelling of your legs, ankles, or abdomen
Shortness of breath is extremely common among people who have congestive heart failure, but this symptom can also occur in other conditions such as lung, kidney, and liver disease. For this reason, your doctor is likely to order a BNP or NT-proBNP test if you have unexplained shortness of breath.
When Should I Know The Results Of A Bnp Test
Providers often do this test in the emergency room or hospital when youre having symptoms of heart failure. Its important to diagnose heart failure accurately so you can start treatment as soon as possible.
That means youll probably get your results right away, usually in under 15 minutes. Your provider will let you know when to expect results and explain what they mean.
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Correlations Between Bnp And Parameters
The linear regression analysis in 559 CHF patients revealed a negative correlation between plasma BNP level and LVEF , but positive correlations between BNP level and NYHA , age and LVW thickness .
There was also a positive correlation between plasma BNP and fasting plasma glucose levels .
Correlation between plasma B-type natriuretic peptide and fasting plasma glucose levels.
What Is A B
A B-type natriuretic peptide test is a blood test. It measures the levels of a certain type of hormone in your blood called a B-type natriuretic peptide. This test gives your healthcare provider information about your heart.
Higher-than-normal levels of BNP in your blood can be a sign that your heart isnt working as it should. It can mean that your heart isnt pumping enough blood through your body. Since BNP is cleared by your kidneys, it may also mean that your kidneys are not functioning properly.
Some laboratories offer a similar test called aminoterminal pro B-type natriuretic peptide . Both the BNP and NT-proBNP tests show similar information, although the absolute values of NT-proBNP are about five to 10 times higher than BNP.
Providers use a BNP or an NT-proBNP test to diagnose heart failure. If you already know you have heart failure, your provider may order this test to check the severity of your condition. They may also use this test to monitor how heart failure treatments are working. In some cases, your provider may also order it if they think you may be at higher risk of developing heart failure.
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Probnp Reference Ranges In Heart Failure
Last reviewed 06/2021
- BNP > 400 pg/ml or NTproBNP > 2000 pg/ml
Notes:
- serum natriuretic peptides:
- obesity or treatment with diuretics, angiotensin-converting enzyme inhibitors, beta-blockers, angiotensin II receptor antagonists and aldosterone antagonists can reduce levels of serum natriuretic peptides
- high levels of serum natriuretic peptides can have causes other than heart failure
- a serum BNP level less than 100 pg/ml or an NTproBNP level less than 400 pg/ml in an untreated patient makes a diagnosis of heart failure unlikely
- the level of serum natriuretic peptide does not differentiate between heart failure due to left ventricular systolic dysfunction and heart failure with preserved left ventricular ejection fraction
Reference:
What Are Natriuretic Peptide Tests
Natriuretic peptides are substances made by the heart. Two main types of these substances are brain natriuretic peptide and N-terminal pro b-type natriuretic peptide . Normally, only small levels of BNP and NT-proBNP are found in the bloodstream. High levels can mean your heart isn’t pumping as much blood as your body needs. When this happens, it’s known as heart failure, sometimes called congestive heart failure.
Natriuretic peptide tests measure the levels of BNP or NT-proBNP in your blood. Your health care provider may order a BNP test or an NT-proBNP test, but not both. They are both useful in diagnosing heart failure, but rely on different types of measurements. The choice will depend on the equipment available in your provider’s recommended laboratory.
Other names: brain natriuretic peptide, NT-proB-type natriuretic peptide test, B-type natriuretic peptide
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How To Prepare For The Test
No special preparation is needed for a BNP test. As it is possible for stress and anxiety to temporarily raise your BNP levels, just do your best to stay calm during the blood draw.
If you faint at the sight of blood or feel weak from fasting, your doctor may recommend that someone come with you in case youre not able to drive or get yourself home.
What Are Normal And High Bnp Levels
BNP tests, also called a B-type natriuretic peptide test, measure BNP by picograms per milliliter or nanograms per liter. The range includes:
- Normal: Less than 100 pg/mL
- High: More than 400 pg/mL
- Between 100 to 400 pg/mL requires a doctors evaluation
Another test that measures BNP, called the NT-proBNP, has these ranges that vary by age:
BNP Levels by Ages Chart
| Condition | |
|---|---|
| Over the age of 75 | More than 1,800 |
Tests results can also vary by sex, body mass index, health history, and other factors. Levels tend to get higher as you age. BNP is also usually higher in women than men. People who are obese tend to have lower levels. Ask your doctor what your specific results mean for you.
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What Do The Results Mean
Doctors typically use the BNP test as an indicator of whether a person is experiencing heart failure. If the test shows low or normal levels of BNP, they may rule out the possibility of this condition.
If an individuals BNP levels are higher than normal, a healthcare professional may recommend additional tests. Examples of these tests include:
Normal Bnp Range By Age And Sex
BNP levels increase naturally as you age, and people assigned female at birth typically have slightly higher levels. Underlying conditions can raise your BNP levels, too. Regardless of age or gender, a BNP level of 100 pg/mL or less is considered normal. The higher your level goes above that, the higher your chances are of developing heart failure. Other conditions, like kidney disease, can increase these chances even more.
Your doctor may use BNP tests alongside other diagnostic tests to confirm if you have heart failure, or if other conditions are responsible for the increase in your BNP levels.
The chart below shows the normal range, as well as the cutoff levels for a heart failure diagnosis at different ages. These figures use data from a specific type of BNP test called the N-terminal -pro hormone BNP .
| Age Range |
| Acute heart failure |
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What Does It Do
High ventricular filling pressures stimulate the release of ANP and BNP. Both peptides have diuretic, natriuretic, and antihypertensive effects, which they exert by inhibiting the renin-angiotensin-aldosterone system. They also have systemic and renal sympathetic activity, with effects on endothelia secretion. In addition, BNP may provide a protective effect against the detrimental fibrosis and remodeling that occurs in progressive heart failure.Patients with heart failure often have elevated catecholamines and increased angiotensin II secretion and BNP may act to reduce the hypertensive and sodium retention in these patients.
How Is My Level Of Bnp/nt
You may hear your healthcare team refer to BNP or NT-proBNP levels, depending on the equipment used by the laboratory. BNP and NT-proBNP are measured as a simple blood test to help diagnose and monitor heart failure. BNP and NT-proBNP test results provide different values. At Cleveland Clinic, doctors rely mostly on NT-proBNP testing to monitor patients with heart failure. You do not need to fast or do anything to prepare for the test.
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Are Test Results Accurate
Many variables affect the accuracy and interpretation of the BNP and NT-proBNP tests, which is why it is so important to discuss your results with your physician.
For example, some factors that may affect test accuracy include:
- Type of test: There can be some variation in results from rapid tests and tests analyzed by a laboratory. Reference ranges may also differ by laboratory.
- Individual factors: The expected BNP and NT-proBNP level in healthy people varies by age. A doctor will also take into account your sex, genetics, and body mass index when interpreting your results.
- Other health conditions: More than one type of health problem can cause BNP or NT-proBNP levels to be elevated, which means that this test alone may not be able to diagnose congestive heart failure or another condition.
If you have any questions about the accuracy of your test results, talk with your health care provider to learn more about the type of test you had and its significance for your health.
Review Question: In People With Suspected Heart Failure What Thresholds Of Pro
For full details see review protocol in .
Clinical
Plasma BNP
Five studies explored the diagnostic test accuracy of plasma BNP for diagnosing chronic heart failure. The quality of the included evidence ranged from high to very low. Evidence was downgraded due to risk of bias and imprecision due to the range of the confidence interval around the point estimate. A number of studies were also downgraded due to indirectness as a result of the study population having a prevalence of CHF much higher than that of a representative sample or due to a lack of information regarding the reference standard used in the study. Two high quality studies reported a high sensitivity of plasma BNP at the thresholds 30pg/ml and 77pg/ml and 97 respectively) which met the pre specified threshold of 95% set by the committee for possible recommendation. A further single study reported a high specificity of 100 at the threshold 400pg/ml. The committee placed an emphasis on specificity for the very high ârule inâ threshold of 400pg/ml of which this study met the specificity threshold. Very low quality evidence was found for plasma BNP at the threshold of 178pg/ml which reported a poor sensitivity of 47 . A further single study of very low quality reported an AUC 0.69. This study did not accurately report the threshold at which this accuracy data was collected.
Plasma NT-pro BNP
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