A Brief Report on Utility of N-terminal pro-B-type Natriuretic Peptide (NT-proBNP) in Screening Patients at Risk of Atrial Fibrillation and Stroke

Abstract

N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a prohormone that is produced and released by the heart (ventricles) in response to alteration in pressure/strain/volume.[1-3] It is used as a biomarker of cardiac function and is involved in the regulation of fluid and electrolyte balance.1-3 When the heart is under stress or is experiencing decreased blood flow, the ventricular myocardium releases the precursor molecule proBNP, which is then cleaved (by a membrane-bound enzyme called corin) into B-type natriuretic peptide (BNP) and NT-proBNP in equimolar amounts.4,5 BNP is secreted into the blood and promotes vasodilation and diuresis, while NT-proBNP serves as a stable marker of cardiac function and is involved in the regulation of fluid and electrolyte balance.6,7 NT-proBNP synthesized in the cardiac ventricles as a prepropeptide (134 amino acids) undergoes several post-translational modifications, including signal peptide cleavage, propeptide cleavage, and glycosylation, before being released as the mature 76-amino acid NT-proBNP molecule.4,5 NT-proBNP is secreted into the bloodstream and is cleared primarily by the kidneys. NT-proBNP levels are influenced by a variety of factors, including age, sex, kidney function, and cardiac disease.8,9 Elevated levels of NT-proBNP are associated with an increased risk of cardiovascular events, such as heart failure, atrial fibrillation and stroke, and can be used as a diagnostic tool to identify individuals at risk of these conditions.6,10-12 The concentration NT-proBNP can be measured in serum/ plasma samples. The assays for NT-proBNP measurement typically use immunoassay techniques, such as Enzyme-Linked Immunosorbent Assay (ELISA) or Chemiluminescence Immunoassay (CLIA), which rely on the binding of specific antibodies to the NT-proBNP molecule. These assays are highly sensitive and specific, with low limits of detection and high precision, making them valuable tools for the diagnosis and management of cardiovascular disease