CPT: 83880
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  • proBNP
  • Propeptide of Brain Natriuretic Peptide

Special Instructions

This test may exhibit interference when sample is collected from a person who is consuming a supplement with a high dose of biotin (also termed as vitamin B7 or B8, vitamin H, or coenzyme R). It is recommended to ask all patients who may be indicated for this test about biotin supplementation. Patients should be cautioned to stop biotin consumption at least 72 hours prior to the collection of a sample.

Expected Turnaround Time

1 - 2 days

Related Documents

Specimen Requirements




1 mL

Minimum Volume

0.7 mL (Note: This volume does not allow for repeat testing.)


Gel-barrier tube (preferred) or red-top tube


If a red-top tube is used, transfer separated serum to a plastic transport tube.

Storage Instructions

Room temperature

Stability Requirements



Room temperature

3 days


6 days


24 months

Freeze/thaw cycles

Stable x1

Causes for Rejection

Citrate plasma specimen; grossly hemolyzed samples; improper labeling

Test Details


This assay is used as an aid in the diagnosis of individuals suspected of having congestive heart failure. The test is further indicated for the risk stratification of patients with acute coronary syndrome and congestive heart failure. The test may also serve as an aid in the assessment of increased risk of cardiovascular events and mortality in patients at risk for heart failure who have stable coronary artery disease.


NT‑proBNP values should be assessed in conjunction with other cardiovascular risk factors and clinical findings.

Interpreting results in the setting of comorbidities such as cardiac, pulmonary, and renal disease, which are likely to increase natriuretic peptides above current thresholds for HF, should be done with caution.1

The accuracy of natriuretic peptides for the detection of HF is reduced in the setting of atrial fibrillation and sepsis, and careful interpretation is warranted.1


Electrochemiluminescence immunoassay (ECLIA)

Reference Interval

See table.2


Male (pg/mL)

Female (pg/mL)

0 to 11 m

Not established

Not established

1 to 3 y



4 to 6 y



7 to 9 y



10 y



11 y



12 y



13 y



14 y



15 y



16 y



17 y



18 y



19 to 44 y



45 to 54 y



55 to 64 y



65 to 74 y



>74 y



Additional Information

Left ventricular dysfunction can occur as a part of coronary heart disease, arterial hypertension, valvular disease, and primary myocardial disease. If the left ventricular dysfunction remains untreated and is progressive, the potential for mortality is high ,e.g. due to sudden cardiac death. Chronic cardiac insufficiency is a clinical syndrome caused by impairment of the cardiac pumping function. Based on the symptoms, the severity of cardiac insufficiency is classified in stages (New York Heart Association classification [NYHA] I‑IV).3,4 Clinical information and imaging procedures are used to diagnose left ventricular dysfunction.5

The significance of natriuretic peptides in the control of cardiovascular system function has been demonstrated. Studies reveal that natriuretic peptides can be used for diagnostic clinical problems associated with left ventricular dysfunction.6 The following natriuretic peptides have been described: atrial natriuretic peptide (ANP), B-type natriuretic peptide (BNP), and C-type natriuretic peptide (CNP).7,8 ANP and BNP, as antagonists of the renin‑angiotensin‑aldosterone system, influence by means of their natriuretic and diuretic properties, the electrolyte and fluid balance in an organism.9,10 In subjects with left ventricular dysfunction, serum and plasma concentrations of BNP increase, as do the concentrations of the biologically inactive prohormone, proBNP. ProBNP, comprising 108 amino acids, is secreted mainly by the ventricle and, in this process, is cleaved into physiologically active BNP (77‑108) and the N‑terminal fragment NT‑proBNP (1‑76).8

Studies indicate that NT‑proBNP can be used in diagnostic and prognostic applications.11-13 The concentration of NT‑proBNP in serum or plasma correlates with the prognosis of the left ventricular dysfunction. Fisher et al found that congestive heart failure patients with NT‑proBNP values above median had a 1-year mortality rate of 53% compared to 11% in patients below median.14 In the GUSTO IV study, which involved more than 6800 patients, it was shown that NT‑proBNP was the strongest independent predictor of 1-year mortality in patients with acute coronary syndrome.15

The following cut-points have been suggested for the use of proBNP for the diagnostic evaluation of heart failure (HF) in patients with acute dyspnea16,17:




Optimal Cut


Diagnosis (rule in HF)


450 pg/mL

50 - 75

900 pg/mL


1800 pg/mL

Exclusion (rule out HF)

Age independent

300 pg/mL


1. Chow SL, Maisel AS, Anand, et al. Role of Biomarkers for the Prevention, Assessment, and Management of Heart Failure: A Scientific Statement from the American Heart Association. Circulation. 2017 May 30;135(22):e1054-e1091.28446515
2. Albers S, Mir TS, Haddad M, Läer S. N-Terminal pro-brain natriuretic peptide: normal ranges in the pediatric population including method comparison and interlaboratory variability. Clin Chem Lab Med. 2006;44(1):80-85.16375591
3. Pfister R, Scholz M, Wielckens K, Erdmann E, Schneider CA. Use of NT-proBNP in routine testing and comparison to BNP. Eur J Heart Fail. 2004 Mar 15;6(3):289-293.14987578
4. Seino Y, Ogawa A, Yamashita T, et al. Application of NT-proBNP and BNP measurements in cardiac care: a more discerning marker for the detection and evaluation of heart failure. Eur J Heart Fail. 2004 Mar 15;6(3):295-300.14987579
5. Remme WJ, Swedberg K. The European Society of Cardiology Task Force Report: Guidelines for the diagnosis and treatment of chronic heart failure. Eur Heart J. 2001 Sep;22(17):1527-1560.11492984
6. Richards AM, Nicholls GM, Yandle TG, et al. Plasma N-Terminal Pro-Brain Natriuretic Peptide and Adrenomedullin: New Neurohormonal Predictors of Left Ventricular Function and Prognosis After Myocardial Infarction. Circulation. 1998 May 19;97:1921-1929.9609085
7. de Bold AJ. Atrial Natriuretic Factor: A Hormone Produced by the Heart. Science. 1985 Nov 15;230(4727):767-770.2932797
8. Valli N, Gobinet A, Bordenave L. Review of 10 years of the clinical use of brain natriuretic peptide in cardiology. J Lab Clin Med. 1999 Nov;134(5):437-444.10560935
9. de Bold AJ, Boerenstein HB, Veress AT, et al. A rapid and potent natriuretic response to intravenous injection of atrial extracts in rats. Life Sci. 1981 Jan 5;28(1):89-94.7219045
10. Epstein M, Loutzenhiser R, Friedland E, Aceto RM, Camargo MJ, Atlas SA. Relationship of Increased Plasma Atrial Natriuretic Factor and Renal Sodium Handling During Immersion-induced Central Hypervolemia in Normal Humans. J Clin Invest. 1987 Mar;79(3):738-745.2950133
11. Struthers AD. How to use natriuretic peptide levels for diagnosis and prognosis. Eur Heart J. 1999 Oct;20(19):1374-1375.10487796
12. Hunt PJ, Richards AM, Nicholls MG, Yandle TC, Doughty RM, Espiner EA. Immunoreactive amino terminal pro-brain natriuretic peptide (NT-PROBNP): a new marker of cardiac impairment. Clin Endocrinol (Oxf). 1997 Sep; 47(3):287-296.9373449
13. Talwar S, Squire IB, Davies JE, Barnett DB, Ng LL. Plasma N-terminal pro-brain natriuretic peptide and the ECG in the assessment of left-ventricular systolic dysfunction in a high risk population. Eur Heart J. 1999 Dec;20(23):1736-1744.10562482
14. Fisher C, Berry C, Blue L, Morton JJ, McMurray J. NT proBNP Predicts Prognosis in Patients with Chronic Heart Failure. Heart. 2003 Aug,89(8):879-881.12860863
15. James SK, Lindahl B, Siegbahn A, et al. NT proBNP and other Risk Markers for the Separate Prediction of Mortality and Subsequent Myocardial Infarction in Patients with Unstable Coronary Artery Disease. GUSTO IV Substudy. Circulation. 2003 Jul 22,108(3):275-281.12847065
16. Januzzi JL Jr, Chen-Tournoux AA, Moe G. Amino-terminal pro-B-type natriuretic peptide testing for the diagnosis or exclusion of heart failure in patients with acute symptoms. Am J Cardiol. 2008 Feb 4;101(3A):29-38.18243855
17. Januzzi JL Jr, Chen-Tournoux AA, Christenson RH, et al. N-Terminal Pro-B-Type Natriuretic Peptide in the Emergency Department: The ICON-RELOADED Study. J Am Coll Cardiol. 2018 Mar 20;71(11):1191-1200.29544601


Elecsys proBNP II [package insert]. Indianapolis, IN: Roche Diagnostics; 2018, V1.0 English.
McCullough PA, Kluger AY. Interpreting the Wide Range of NT-proBNP Concentrations in Clinical Decision Making. J Am Coll Cardiol. 2018 Mar 20;71(11):1201-1203.29544602
McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021 Sep 21;42(36):3599-3726.34447992


Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
143000 NT-proBNP 33762-6 143001 NT-proBNP pg/mL 33762-6

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