NT-proBNP Levels and Hypertension. Their Importance in the Diagnosis of Heart Failure (original) (raw)
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European Heart Journal, 2005
Aims Diastolic heart failure is a frequent entity but difficult to diagnose. N-terminal pro-B type natriuretic peptide (NT-proBNP) was therefore investigated as a possible non-invasive parameter to diagnose isolated diastolic dysfunction. Methods and results Sixty-eight symptomatic patients with isolated diastolic dysfunction and preserved left ventricular ejection fraction (LVEF) (!50%) and 50 patients with regular left ventricular (LV) function were examined by conventional echocardiography, tissue Doppler imaging (TDI), and left and right heart catheterization. Plasma NT-proBNP levels were determined simultaneously. Median NT-proBNP plasma levels were elevated [189.54 pg/mL (86.16-308.27) vs. 51.89 pg/mL (29.94-69.71); P , 0.001] and increased with greater severity of the diastolic dysfunction (R ¼ 0.67, P , 0.001). According to the recevier operating characteristic analysis, LV end-diastolic pressure [area under the curve (AUC) 0.84] was the most specific parameter, which had a low sensitivity (61%), however. The reliability of NT-proBNP was similar to TDI indices (AUC 0.83 vs. 0.81) and improved when compared with conventional echocardiography (AUC 0.59-0.70). NT-proBNP levels had the best negative predictive value of all methods (94%) and correlated strongly with indices of LV filling pressure, as determined by invasive measurements. Multivariable linear regression analysis confirmed NT-proBNP as an independent predictor of diastolic dysfunction with an Odds ratio of 1.2 (1.1-1.4, CI 95%) for every unit increase of NT-proBNP. Conclusion NT-proBNP can reliably detect the presence of isolated diastolic dysfunction in symptomatic patients and is an useful tool to rule out patients with reduced exercise tolerance of non-cardiac origin.
Diastolic dysfunction in asymptomatic hypertensives—Apollo study
Heart, Lung and Circulation, 2008
The purpose of this study was to establish the relationship between elevated N-terminal pro-brain natriuretic peptide (NT-proBNP) levels and high risk heart failure patients in our intensive coronary care unit (ICCU), during hospital stay and/or short term follow-up. Methods: We prospectively evaluated 60 consecutive patients with heart failure, admitted in our ICCU. All patients were evaluated clinically and underwent echocardiography and NT-proBNP estimation on admission. We also evaluated short-term follow-up of these patients. Results: This study included 60 patients-39 (65%) males and 21 (35%) females. Mean age of patients was 58.2 ± 15.6 years. Mean follow-up period was 6.5 ± 2.1 months. Nineteen (31.5%) patients were in NYHA Class IV, while 25 (41.5%) patients were in Class III and 16 (26.5%) were in Class II. NT-proBNP levels were significantly higher in patients in higher NYHA Classes (p = 0.0084). Left ventricular (LV) systolic dysfunction (LV ejection fraction-LVEf < 45%, mean 32.6 ± 7%) was present in 37 (61.5%) patients. Isolated diastolic dysfunction was seen in 14 patients. Those with higher grades of diastolic dysfunction had significantly elevated levels of NT-proBNP (impaired relaxation: n = 11; pseudonormal: n = 6; restrictive: n = 23; p = 0.021). Patients with higher transmitral early diastolic velocity/tissue Doppler early diastolic mitral annular velocity (E/Ea) ratio had higher NT-proBNP levels (E/Ea > or = 14, n = 22, v.E/Ea < 14, n = 34, p = 0.033). Patients who developed ventricular tachycardia (n = 14) had higher NT-proBNP levels compared to other patients (n = 46). Similarly, patients who needed ventilatory support (n = 16) had higher NT-proBNP levels. Patients with higher NT-proBNP levels needed longer stay in the ICCU (>2days). Patients who had adverse events (worsening heart failure, readmission or death) on follow-up (n = 18) had significantly higher NT-proBNP levels than other patients. Conclusions: Elevated NT-proBNP levels on admission in heart failure patients are useful to identify the higher risk subset with higher in-hospital and follow-up mortality and morbidity; and hence have prognostic value.
International Journal of Cardiovascular Imaging, 2008
The utility of N-Terminal pro Brain Natriuretic Peptide (NT-proBNP) and Brain Natriuretic Peptide (BNP) for detecting left ventricular (LV) diastolic dysfunction in hypertensive patients without heart failure symptoms is unclear. In this study, we investigated the relation between NT-proBNP plasma levels and LV diastolic dysfunction in hypertensive patients without systolic dysfunction. Method: We studied 40 ambulatory patients (26 women, mean age 52 ± 5) with controlled hypertension. LV diastolic function was assessed with conventional Doppler, by means of mitral inflow and with tissue Doppler echocardiography by means of mitral annulus. The ratio of early diastolic transmitral E wave velocities to tissue Doppler mitral annulus early diastolic E' wave velocities (E/E′), was used to detect LV filling pressures. Patients were divided in three groups according to E/E′ ratios E/E′ ratios ''between'' 10 and 15 (group II) and E/E′ ratios > 15 (group III). Plasma concentrations of NT-proBNP were measured by electro chemiluminescence's immunoassay. Results: The NT-proBNP blood levels were positively correlated significantly with E/E′ ratio (r = 0.80, P E/E′ > 15 (n = 8) had highest NT-proBNP (203 ± 75 pg/ml) levels. E/E′ 10 to 15 group (n = 16) had a mean NT-proBNP level of 71 ± 26 pg/ml, and those with E/E′ E/E′ > 15. Conclusion: The assessment of the blood concentration of NT-proBNP is of potential value for identification of those patients with hypertension to detect early cardiovascular changes, especially LV diastolic dysfunction.
Circulation Journal, 2012
Background: Diagnosis of left ventricular (LV) diastolic dysfunction by blood testing is expedient in the clinical setting. Methods and Results: In 98 patients with LV ejection fraction ≥50% who underwent cardiac catheterization for evaluation of coronary artery disease, LV pressure (LVP) was measured using a catheter-tipped micromanometer. A time constant, τ, of LV relaxation was computed from LVP decay; the inertia force (IF) of late systolic aortic flow, a surrogate index of LV elastic recoil, was also computed from the LVP−dP/dt relation (phase loop). Patients were classified into 2 groups: those with impaired LV relaxation (τ ≥48 ms) and those with preserved LV relaxation (τ <48 ms). Patients were also classified into another 2 groups: those with IF (≥0.5 mmHg) and those without (<0.5 mmHg). Plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) ≥56.5 pg/ml had a sensitivity of 100%, specificity of 52.5%, and negative predictive value of 100% for identifying impaired LV relaxation. NT-proBNP ≥244.5 pg/ml had a sensitivity of 62.5% and specificity of 93.9% for detecting lack of IF. Conclusions: NT-proBNP level <56.5 pg/ml could be used as a value to sensitively identify patients with preserved LV systolic and diastolic function among those with coronary artery disease. NT-proBNP level ≥244.5 pg/ml is able to specifically detect a lack of IF and has potential for specifically diagnosing LV isolated diastolic dysfunction.
Biomedical papers of the Medical Faculty of the University Palacký, Olomouc, Czechoslovakia, 2006
We investigated the performance of brain natriuretic peptides (BNP and NT-proBNP) in detecting various degrees of left ventricular systolic dysfunction. The NT-proBNP assay (Roche) and the BNP assay (Bayer Shionoria) were performed in 46 patients (mean age 50 years; range 20-79 years) with various types of heart disease (chronic heart failure due to coronary artery disease, cardiomyopathy, acquired valve disease, congenital heart diseases) and different impairment of left ventricular systolic dysfunction was assessed by echocardiography. Patients were divided into four groups according to the left ventricular ejection fraction (LVEF) correlated with clinical severity. Significant differences in medians of NT-proBNP and BNP values between all groups were determined (P= 0.0161 for NT-proBNP and P=0.0180 for BNP). For identifying patients with severe systolic dysfunction (LVEF<40%), receiver operating characteristic (ROC) analysis for both BNP and NT-proBNP was performed. The diagno...
International Journal of Cardiology, 2010
Backgrounds: B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NTproBNP) levels showed frequent discrepancies in individual patients. Objectives: The aims were 1) to compare the abilities of BNP and NTproBNP for the detection of left ventricular systolic dysfunction (LVSD) or diastolic dysfunction (LVDD) in the symptomatic patients, and 2) to assess the direct correlation and its independent determinants between them. Methods: 1032 patients with dyspnea underwent BNP and NTproBNP measurements simultaneously. 967/1032 (93.7%) patients underwent echocardiography. Using the receiver operation characteristic curve analyses for the detection of LVSD (EF b 45%) or advanced LVDD, the area under the curves (AUC) of both biomarkers was compared according to age, gender, body mass index (BMI), hemoglobin (Hb), and glomerular filtration rate (eGFR). Using multiple regression analysis, the direct correlation and its independent determinants were identified between them. Results: In the entire population, the AUCs of BNP and NTproBNP had no significant differences (LVSD: 0.909 vs. 0.893, p = 0.20; advanced LVDD: 0.897 vs. 0.879, p = 0.13). In patients with BMI b 25, the AUCs of BNP were significantly higher than those of NTproBNP (LVSD: 0.897 vs. 0.869, p = 0.03; advanced LVDD: 0.916 vs. 0.885, p = 0.02). They had strong correlation (r = 0.895, p b 0.001) and LVEF, eGFR b 60 ml/min, Hb b 12 g/dl and use of diuretics were the independent determinants between them. Conclusion: BNP and NTproBNP displayed strong correlation and near-identical performances for the screening of cardiac dysfunction. However, LVEF, renal function, Hb and use of diuretics should be considered for clinical interpretation.
European Heart Journal, 2010
The study evaluated the use of age-related decision limits for N-terminal pro-B-type natriuretic peptide (NT-proBNP), for ruling out suspected systolic dysfunction in symptomatic patients in primary care, compared with the present standards. Methods and results Data were obtained from 5508 patients from 10 studies in the UK, New Zealand, Europe, and USA. All have had NT-proBNP analysis and echocardiography. The median age was 62 years (range 18-100 years) with a prevalence of reduced left ventricular systolic function (left ventricular ejection fraction ≤40%) of 18%. In a receiver operating characteristic curve analysis, overall area under the curve (AUC) was 0.89. When looking at different age groups, AUC was highest (0.95) for ,50 years, intermediate (0.90) for 50-75 years, and lowest (0.82) for .75 years. Using optimized decision limits, sensitivity, specificity, and negative predictive values (NPVs) were: ,50 years (50 ng/L): 99.2, 57.2, and 99.7%; 50-75 years (75 ng/L): 95.9, 51.0, and 96.8%; and .75 years (250 ng/L): 87.9, 53.7, and 92.4%, respectively. Using only a single decision value (125 ng/L for all ages) gave sensitivities of 89.1, 91.9, and 94.3%; specificities of 84.0, 69.1, and 29.3% and NPVs of 97.7, 97.6, and 93.4%. A decision value of 400 ng/L for all ages gave much lower sensitivities. Conclusion In a large population of patients in primary care, the use of age-stratified NT-proBNP decision limits considerably improves performance over current standards, with an excellent NPV for exclusion of reduced left ventricular systolic function.