N-terminal Pro brain natriuretic peptide is a reliable biomarker of reduced myocardial contractility in patients with lamin A/C gene mutations (original) (raw)
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Coronary Artery Disease, 2008
Background Data available on the correlation of N-terminal probrain natriuretic peptide (NT-proBNP) levels and right ventricular (RV) function in patients with coronary artery disease (CAD) are limited. Objective To determine the relation between plasma NT-proBNP and RV function in patients with CAD and abnormal left ventricular (LV) wall motion. Methods This is a cross-sectional study. We studied 176 patients with CAD and abnormal LV wall motion. All patients underwent cardiac magnetic resonance imaging for the assessment of LV and RV function and plasma NT-proBNP analysis on the same day. Multivariable analysis was performed to evaluate the independent factors associated with RV dysfunction. Receiver-operating characteristic analysis was used to assess the use of NT-proBNP levels for the diagnosis of LV and RV dysfunction. Results Average LV ejection fraction (LVEF) and RV ejection fraction were 37.6 and 52.0%, respectively. Median levels of NT-proBNP were 978 pg/ml. Log NT-proBNP levels had a positive correlation with age, LV and RV volume, LV and RV mass, and had a negative correlation with body size, creatinine clearance, LVEF, and RV ejection fraction. From a multivariable analysis, log NT-proBNP levels and LVEF were independently associated with RV dysfunction. From receiver-operating characteristic analysis, NT-proBNP at the levels of 1706 and 378 pg/ml was shown to detect RV dysfunction and LV dysfunction at an accuracy of 80.7 and 77.8% and area under the curve of 0.837 and 0.765, respectively. Conclusion NT-proBNP levels can be used to diagnose RV dysfunction in patients with CAD and abnormal LV wall motion.
Clinica Chimica Acta, 2001
Brain natriuretic peptide (BNP), NT-proBNP and NT-pro-atrial natriuretic peptide (NT-proANP) were measured in blood samples from 57 patients using immunoassays and immunoradiometric assays to evaluate the usefulness as diagnostic markers for the detection of heart failure. For the detection of impaired left ventricular ejection fraction (LVEF), receiver operating characteristic curves showed that BNP had the best diagnostic performance with an area under curve (AUC) of 0.75+/-0.06. However, NT-proBNP (AUC: 0.67+/-0.07) and NT-proANP (AUC: 0.69+/-0.08) showed no significant difference to BNP. In a further analysis for the detection of resting LVEF <40%, BNP again was the best marker with an AUC of 0.83+/-0.06. NT-proBNP showed only a slightly smaller AUC (0.79+/-0.07). The AUC for NT-proANP was significantly smaller (0.65+/-0.08) compared to BNP. Additionally, BNP and NT-proBNP correlated negatively with the resting LVEF (BNP: -0.472, p<0.001; NT-proBNP: -0.306, p=0.026), whereas NT-proANP showed no significant correlation. In summary, BNP was the best marker to detect patients with impaired LVEF compared to NT-proBNP and NT-proANP. However, NT-proBNP showed no significant differences to BNP and it is therefore a new promising alternative marker for the detection of left ventricular 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.
Wiener Klinische Wochenschrift, 2009
Vorhofflimmern ist eine unabhängige Determinante erhöhter NT-proBNP Werte bei Patienten mit Herzinsuffizienz Zusammenfassung. Hintergrund und Fragestellung: Das N-terminale pro-B-Typ natriuretische Peptid (NT-proB-NP) wird zunehmend sowohl in der Diagnostik als auch bei der prognostischen Einschätzung von Herzinsuffizienz verwendet. Allerdings ist der Einfluss des Vorhofflimmerns auf die NT-proBNP-Werte noch unklar. Deshalb haben wir den Einfluss von Vorhofflimmern auf die NT-proBNP Werte bei Patienten mit Herzinsuffizienzsymptomatik analysiert. Patienten und Methodik: Zufällig ausgewählte Patienten (n = 306), die in die Ambulanz für Herzinsuffizienz der Universitätsklinik Ljubljana aufgrund von Symptome und klinischen Zeichen einer Herzinsuffizienz eingewiesen wurden, wurden klinisch und elektrokardiographisch untersucht. Außerdem wurde bei jedem Patienten das NT-proBNP bestimmt (durch Einsatz einer "Sandwich chemiluminescent immunoassay" Methode mit zwei Antikörpern auf dem Elecsys Analysator). Ergebnisse: Vorhofflimmern war sowohl bei den Patienten mit (mediane Konzentration 1944 vs. 1390 pg/ mL) als auch ohne strukturelle Herzkrankheit (1093 vs. 172 pg/ml) (p < 0,001) mit höheren Werten von NT-proB-NP assoziiert. Vorhoffl immern blieb sogar unter Be-Vorhofflimmern blieb sogar unter Berücksichtigung möglicher Störfaktoren wie linksventrikuläre Pumpfunktion, end-diastolischer Durchmesser, Durchmesser des linken Vorhofes, Vorliegen einer Mitralinsuffizienz, Alter, Geschlecht, NYHA-Stadium bzw. Herzfrequenz eine unabhängige Determinante der NT-proBNP Werte (Propensity Score der linearen Regressionsanalyse: p = 0.023). Schlussfolgerung: Das Vorhofflimmern ist eine unabhängige Determinante von erhöhten NT-proBNP Werten. Diese Assoziation sollte immer in Betracht gezogen werden, wenn NT-proBNP Werte in der Diagnostik von Herzinsuffizienz bei Patienten mit Vorhofflimmern herangezogen werden.
Revista Española de Cardiología, 2011
Electrocardiography (ECG) is the most widely used method for diagnosing left ventricular hypertrophy (LVH) in hypertensive patients. We assessed the value of N-terminal pro-brain natriuretic peptide (NT-proBNP) determination compared with ECG for detecting LVH in 336 consecutive hypertensive patients with preserved systolic function. We found a significant correlation between NT-proBNP levels and left ventricular mass adjusted for body surface area (r = .41; P < .001). The area under the receiver operating characteristic curve was 0.75 (95% CI, 0.7-0.8). A cutoff of 74.2 pg/mL had a greater sensitivity than ECG (76.6% vs 25.5%; P < .001) and a higher negative predictive value (87.8% vs 76.6%; P < .001) in the identification of LVH. NT-proBNP determination may be a useful tool for LVH screening in hypertensive patients.
The Internet Journal of …, 2010
Background: Globally, role of amino-terminal pro-brain natriuretic peptide (NT pro-BNP) in diverse aspects of Congestive Heart Failure (CHF) has gained near-consensus status. Such experience is rare in many parts of Africa, and levels may be affected by ethnicity. Aim/Objectives: To determine NT pro-BNP levels in Nigerian healthy adults and hospitalised CHF patients; in order to establish its diagnostic accuracy. Methods: Controls and CHF patients were examined clinically, with trans-thoracic echocardiography; while plasma NT pro-BNP was measured by a point-of care-immunoassay system (Cardiac Reader R). We compared the diagnostic performance of our study-derived NT pro-BNP reference value with others. Main outcome: Obtain reference value of NT pro-BNP and compare its diagnostic performance with recommended product value of 125 pg/mL. ResultsParticipants were 42 CHF patients matched for age (p=0.26) and gender (p=0.78) with 30 controls. NT pro-BNP levels of controls differed significantly by gender (females: 64.8 ±12.3 versus males: 98.2 (54.8), p<0.05); and by CHF status (86.43±43.6 versus 1915 ±1082.1 pg/mL, p<0.001). NT pro-BNP demonstrated negative correlation with left ventricular function (r=-0.5, p<0.05). Our study NT pro-BNP reference value of 171 pg/mL yielded sensitivity, specificity, NPV, PPV of 88.1%, 93.3%, 90.3%, 95.2%, respectively, performing better than manufacturer's recommended value of 125 pg/mL(sensitivity 85.7%, specificity 86.7%, NPV 87.1%, and PPV 92.5% respectively. Conclusions: NT pro-BNP values were significantly higher in CHF patients; and demonstrated significant negative association with left ventricular function. Our point-of care reference value demonstrated better diagnostic performance than manufacturer's cutoff value. This calls for further local studies, using the new cutoff value.
European Journal of Heart Failure, 2004
Background: Measurement of brain natriuretic peptide (BNP) has become a potent diagnostic aid as a means of identifying patients with systolic or diastolic dysfunction. Due to better stability in circulating blood, we reasoned that measurement of Nterminal proBNP (NT-proBNP) may be a more discerning marker for the detection and evaluation of chronic heart failure. Methods: The relationships between plasma concentrations of NT-proBNP and BNP, and aetiology, New York Heart Association (NYHA) classification, and left ventricular ejection fraction (LVEF) were analyzed in 105 patients with chronic heart failure. Sixty-seven healthy volunteers were studied as the controls. Results: Both NT-proBNP and BNP showed progressive increases (P-0.001) in proportion to the NYHA classification; the increment of NT-proBNP was larger than that of BNP. Elevated NT-proBNP significantly correlated with BNP (rs0.737, P-0.001). Receiver operating characteristics analysis to detect LVEF-40% showed similar values (area under the curve, AUC: NT-proBNP 0.754 vs. BNP 0.770), however, AUC to detect LVEF-50% tended to be greater for NT-proBNP than that for BNP (NT-proBNP 0.820 vs. BNP 0.794). Conclusion: NT-proBNP may be a more discerning marker for the detection and evaluation of heart failure than BNP.
European …, 2006
Aims: N-terminal pro-brain natriuretic peptide (NT-proBNP) is useful in the diagnosis of heart failure (HF). LV two-dimensional cavity area from enddiastole (LVEDA) and end-systole (LVESA), and LV fractional area change (LVFAC) reflect changes in LV morphology and function without using geometric assumptions. In a multicenter study, we correlated LVEDA, LVESA and LVFAC with NT-proBNP, comparing patients with dilated and ischemic cardiomyopathy. Methods and results: We studied 106 HF patients. In the dilated group, NT-proBNP correlated with LVEDAI (r Z 0.6), LVESAI (r Z 0.7) and LVFAC (r Z ÿ0.6), all significant at p ! 0.001. In patients with ischemic cardiomyopathy we found LVESAI (r Z 0.3, p ! 0.05) and LVFAC (r Z ÿ0.4, p ! 0.01). After adjustment for age and BMI, LVFAC and LVESAI were associated in a multiple linear regression analysis with peptide levels (adjusted r 2 Z 0.5, p ! 0.001). Eur J Echocardiography (2006) 7, 45e52 Conclusions: In this study we found a good correlation of NT-proBNP with LV cavity areas and LVFAC. Multiple regression analysis showed that when adjusted for age and BMI, LVFAC and LVESAI are independent predictors of NT-proBNP levels in both dilated and ischemic etiologies. Patients with dilated cardiomyopathy showed better results than those with ischemic cardiomyopathy. We think LV areas are a useful and reproducible parameter, do not need geometric assumptions and reflect NT-proBNP plasma levels.
American Heart Journal, 2008
Functional mitral regurgitation (MR) is a factor affecting prognosis of patients with chronic left ventricular (LV) dysfunction. The aim of the study was to investigate whether the evaluation of plasma N-terminal protype-B natriuretic peptide (NT-proBNP) concentrations is useful for prognostic assessment of patients with functional MR due to either ischemic or nonischemic chronic LV dysfunction. Echocardiograms were obtained in 207 patients with chronic LV dysfunction (ejection fraction &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;or=45%) and secondary MR at color flow imaging. The NT-proBNP was measured at the time of the index echocardiogram. The MR was graded as mild when a small central jet &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;4 cm(2) or &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;20% of left atrial area or a vena contracta width &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.3 cm was present. It was considered moderate in the presence of signs of more-than-mild MR without criteria for severe MR. A vena contracta width &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;or=0.7 cm raised MR grade to severe. Median follow-up duration was 29 months. The NT-proBNP levels increased significantly with MR severity. At multivariate analysis, NT-proBNP was an independent predictor of cardiac death (hazard ratio 2.17, CI 1.10-4.30, P = .026) and the most powerful predictor of cardiac death or heart failure-related hospitalization (hazard ratio 3.19, CI 1.89-5.37, P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .0001). A progressively worse outcome was apparent when patients were stratified by a graded increase in MR severity and by quartiles of NT-proBNP levels. Increased NT-proBNP concentrations and more-than-mild MR identified patients with the highest risk of cardiac mortality. Assessment of plasma NT-proBNP allows for stratifying patients with functional MR regardless of their degree of valvular incompetence. Even in case of only mild or moderate MR, but increased NT-proBNP, patients have to face poor outcome.
Revista Espanola De Cardiologia, 2008
The presence of left ventricular hypertrophy (LVH) is associated with an increase in cardiovascular morbidity and mortality in hypertensive patients. We investigated the diagnostic value of the N-terminal probrain natriuretic peptide (NT-proBNP) level for detecting LVH in hypertensive patients with a conserved left ventricular ejection fraction. The study involved 27 consecutive patients. Cardiac magnetic resonance imaging was performed to determine left ventricular mass and the plasma NT-proBNP level was measured. A significant correlation was found between the NT-proBNP level and left ventricular mass (r=0.598; P=.001). Use of a cut-off point of 35 pg/mL enabled the presence of LVH to be identified with a sensitivity of 100% (95% confidence interval [CI], 69-100) and a specificity of 70.6% (95% CI, 44.1-89.6). The area under the receiver operating characteristic (ROC) curve was 0.867 (95% CI, 0.73-1; P<.05). The plasma NT-proBNP level may be useful for identifying patients with LVH.