The Roche Column
NT-proBNP: An aid to
diagnosing heart failure
Nearly 25 million people suffer globally
from heart failure1, and out of every five
patients, one will die within a year of being
diagnosed2. The risk for ventricular
dysfunction, or heart failure, increases
with age and its diagnosis carries a high
morbidity rate and high mortality rate
that exceeds many cancers. Chronic
conditions of heart failure is among the
greatest economic burdens to healthcare
systems, but novel diagnostic solutions
can provide healthcare professionals
with the methods needed to improve a
patient’s outcome and life expectancy
with early detection.
Reliability is essential to diagnosis
The symptoms for heart failure are not distinct
and can be linked to a number of other
morbidities and physical conditions, limiting
the accuracy in diagnosis, according to
the European Society of Cardiology (ESC)
Heart Failure Guidelines 20123. Early diagnosis
of cardiovascular cases is key to a patient’s
survival; thus fast intervention is an
invaluable part of the healthcare cycle.
Measured by immunology methods, normal
levels of BNP or NT-proBNP can rule out
acute heart failure in the emergency setting.
While elevated levels BNP or NT-proBNP
cannot indicate heart failure alone, both can
be used to screen and predict cardiac cases.
In a risk prediction study, the Cardiovascular
Health Study showed that elevated levels of
NT-proBNP correlated to an increased risk
of heart failure and confirmed that the biomarker
could divide patients into lower and
higher-risk groups5. In the primary care setting,
NT-proBNP is an ideal biomarker for
heart failure setting due to its ability to detect
subtle preclinical cardiac changes. Approved
by the FDA4, NT-proBNP can aid in the diagnosis
of heart failure, assessing its severity, and
detecting mild forms of cardiac dysfunction.
The strong prognostic value of NT-proBNP
with its sample stability at room temperature,
delivers greater reliability in both outpatient
settings and primary care settings. Healthcare professionals can use reliable measurements
of the NT-proBNP, from assays such
as Roche’s NT-proBNP laboratory or point
of care assays, for patients who display signs
of heart failure, to stratify and identify those
at high risk of cardiovascular hospitalization
The importance of NT-proBNP in aiding
the diagnosis, risk stratification and treatment
monitoring is evident in heart failure
patients due to its improved sample
stability, longer circulating half-life6, and
lower biological variability7. A number
of international guidelines recommend
the measurement of NPs for the diagnosis
and management of heart failure.
The ESC states that a normal NP level
in untreated patients practically excludes
significant cardiac disease and that the
measurement of NPs should be considered
for more prognosis details. Both the
American College of Cardiology/American
Heart Association and the Heart
Failure Society of America, recommends
testing NP levels in patients with dyspnea
as well, especially if symptoms are related
to heart failure8. At the same time, the National
Institute for Health Clinical Excellence
recommends NP measurements before
an echocardiogram is done for a patient with
suspected heart failure, who has not suffered
any prior myocardial infarction.
Alongside other diagnostic tools available
to evaluate high-risk patients for heart failure,
NT-proBNP is a vital, useful and recommended
additional test that can provide general
practitioners, specialists or lab physicians
with the reliability and precision needed to
determine which patients can benefit from
aggressive treatment. The NT-proBNP level
is an independent and long-term predictor
of new-onset heart failure and cardiovascular
death that can improve clinical decision
making with its strong negative predictive
value and accurate results.
1 Hildebrandt, P., Collinson, P.O., Doughty,
R.N., Fuat, A., Gaze, D.C. et al. (2010). Age-dependent
values of N-terminal pro-B-type natriuretic
peptide are superior to a single cut-point for ruling
out suspected systolic dysfunction in primary care.
Eur Heart J 31(15), 1881-1889.
2 Rosamond, W., Flegal, K., Furie, K., Go, A.,
Greenlund, K. et al. (2008). Heart disease and stroke
statistics--2008 update: a report from the American
Heart Association Statistics Committee and Stroke
Statistics Subcommittee. Circulation 117(4), e25-146.
3 McMurray, J.J., Adamopoulos, S., Anker, S.D.,
Auricchio, A., Bohm, M. et al. (2012). ESC Guidelines
for the diagnosis and treatment of acute and
chronic heart failure 2012: The Task Force for the
Diagnosis and Treatment of Acute and Chronic
Heart Failure 2012 of the European Society of Cardiology.
Developed in collaboration with the Heart
Failure Association (HFA) of the ESC. Eur Heart J
4 Roche Diagnostics. Getting ahead: Coincidence
or superior performance? 2009.
5 de Filippi, C.R., Christenson, R.H., Gottdiener,
J.S., Kop, W.J., Seliger, S.L. (2010). Dynamic
cardiovascular risk assessment in elderly people. The
role of repeated N-terminal pro-B-type natriuretic
peptide testing. J Am Coll Cardiol 55(5), 441-450.
6 Felker GM, Petersen JW, Mark DB. Natriuretic
peptides in the diagnosis and management
of heart failure. CMAJ 2006; 175: 611-7.
7 Rademaker MT, Richards AM. Cardiac natriuretic
peptides for cardiac health. Clin Sci (Lond)
2005; 108: 23-36.
8 Jessup, M., Abraham, W.T., Casey, D.E., Feldman,
A.M., Francis, G.S. et al. (2009). 2009 focused
update: ACCF/AHA Guidelines for the Diagnosis
and Management of Heart Failure in Adults: a report
of the American College of Cardiology Foundation/
American Heart Association Task Force on Practice
Guidelines: developed in collaboration with the International
Society for Heart and Lung Transplantation.
Circulation 119(14), 1977-2016.
The Durbin Column
Should you fast while
As I write, many Muslims around the
world are fasting during the holy month of
Ramadan. Patients that are taking medicines
or indeed even those who are pregnant
are exempt from fasting. However,
doctors around the world are increasingly
voicing their concerns over the numbers
of people who fast while on medication.
The degree to which patients are prepared
to delay treatment or cancel medical
appointments during Ramadan does
of course vary from person to person. In
the UK doctors have warned that we have
some patients who are putting their lives
at risk by delaying or stopping vital medication,
including cancer treatments, in order
to focus on their religious obligations.
Many campaigns by community groups
and organisations have been aimed at
educating those with chronic health
problems such as diabetes, heart disease
and high blood pressure – all of which
are highly prevalent in the Middle East
– about the risks associated with fasting.
Other awareness programmes have focused on pregnant women, advising
against fasting because of the risk of hypoglycaemia,
ketosis and dehydration.
Whatever the campaign, the fundamental
message is always the same: patients
should always speak to a physician about
how to stay safe and healthy as possible
We must remember that fasting is a
personal decision, and if somebody with
a medical condition wishes to fast, doctors
are unable to stop them. I have written
about the high rate of diabetes in the
Middle East before, and a large number
of campaigns in the region have focused
on providing those with the disease all
the information and medical advice necessary
to ensure they do not suffer from
complications as a result of fasting.
Diabetics who face a high risk of complications
if they fast include pregnant
women, patients who need insulin injections
and those whose blood sugar levels
severely fluctuate. Fasting diabetics are
advised to see their doctor a month before
Ramadan to arrange a plan of how
it can be achieved without harm. A drop
or rise in sugar level can cause symptoms
such as shivering, cold sweats, heart palpitations
and slurred speech.
Medical experts have advised that
diabetics should not overeat when they
break their fast as this can cause blood
sugar levels to rise dangerously. Eating
a few smaller meals as opposed to one
large one after sunset is a much safer option.
They are also advised to wake up
before dawn to eat their second meal so
that the period of fasting is shortened as
much as possible, thereby reducing the
risk of hypoglycaemia and dehydration.
Finally, diabetics should test their blood
sugar levels in the middle of the day and
before they break their fast. This is particularly important in the first few days
of Ramadan. Exercise is also encouraged,
especially after the fast has been broken.
It is a common misconception that exercise
should be reduced during the holy
month, when in reality it is still important
to keep healthy, maintain energy levels
and keep active. Furthermore, many
people gain weight during Ramadan as
large amounts of food are consumed late
at night followed by sleep, causing the
body to slow down. With obesity a growing
concern in the region this is another
factor that individuals should consider
when planning their meals after breaking
Most Muslims believe that fasting is
one of the basic tenets of Islam and that
they have to fast whether they have a
medical condition or not. A little bit of
care and attention to diet, as well as discussing
your medication programme with
your doctor a month before Ramadan begins,
is all it will take to ensure that you
have a safe and healthy month.
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of upload: 16th Sep 2014