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†

Hildebrandt, Per; Collinson, Paul; Doughty, Robert N.; Fuat, Ahmet; Gaze, David; Gustafsson, Finn; Januzzi, James L.; Rosenberg, Jens; Senior, Roxy; Richards, Mark

doi:10.1093/eurheartj/ehq163

Cited by 115 publications

(87 citation statements)

References 30 publications

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“…The inclusion of eGFR Ն60 mL ⅐ min Ϫ1 ⅐ (1.73 m 2 ) Ϫ1 after the initial questionnaire to the model had the most effect on the 99th percentile for cTnT but relatively less effect on the 99th percentile for cTnI. Although an NTproBNP value of 250 ng/L had previously been shown to achieve reasonable exclusion of an LVEF Ͻ40% (7 ), a more recent study had shown that a lower value of 100 ng/L is more appropriate for use in younger individuals, so we reanalyzed the data using this value (9 ). The more aggressive NT-proBNP cutoff of 100 ng/L (data not shown, n ϭ 279) reduced the 99th percentile to 37.2 ng/L for the Siemens cTnI assay, to 15.7 ng/L for the cTnT assay, and to 52 ng/L for the Beckman cTnI assay, comparable values to those obtained after full adjustment of the covariates.…”

Section: Resultsmentioning

confidence: 99%

Influence of Population Selection on the 99th Percentile Reference Value for Cardiac Troponin Assays

et al. 2012

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OBJECTIVE:We sought to determine the effect of patient selection on the 99th reference percentile of 2 sensitive and 1 high-sensitivity (hs) cardiac troponin assays in a well-defined reference population.METHODS: Individuals Ͼ45 years old were randomly selected from 7 representative local community practices. Detailed information regarding the participants was collected via questionnaires. The healthy reference population was defined as individuals who had no history of vascular disease, hypertension, or heavy alcohol intake; were not receiving cardiac medication; and had blood pressure Ͻ140/90 mmHg, fasting blood glucose Ͻ110 mg/dL (approximately 6 mmol/L), estimated creatinine clearance, and normal cardiac function according to results of echocardiography. Samples were stored at Ϫ70°C until analysis for cardiac troponin I (cTnI) and cardiac troponin T (cTnT) and N-terminal pro-B-type natriuretic peptide. RESULTS:Application of progressively more stringent population selection strategies to the initial baseline population of 545 participants until the only individuals who remained were completely healthy according to the study criteria reduced the number of outliers seen and led to a progressive decrease in the 99th-percentile value obtained for the Roche hs-cTnT assay and the sensitive Beckman cTnI assay but not for the sensitive Siemens Ultra cTnI assay. Furthermore, a sex difference found in the baseline population for the hscTnT (P ϭ 0.0018) and Beckman cTnI assays (P Ͻ 0.0001) progressively decreased with more stringent population selection criteria. CONCLUSIONS:The reference population selection strategy significantly influenced the 99th percentile reference values determined for troponin assays and the observed sex differences in troponin concentrations.

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Section: Resultsmentioning

confidence: 99%

Influence of Population Selection on the 99th Percentile Reference Value for Cardiac Troponin Assays

et al. 2012

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“…Based on the published literature, approximately 50 % of patients enrolled would have an elevated biomarker based on our low cut-off values which would provide a high sensitivity for detecting myocardial injury [23][24][25]. Those patients who were found to have an elevated biomarker (see Table 3 in Appendix for elevated cut-offs) or who met Framingham criteria for CHF based on their physical exam and symptom inventory were referred for an echocardiogram [10].…”

Section: Echocardiogram Proceduresmentioning

confidence: 99%

Doxorubicin-induced cardiac dysfunction in unselected patients with a history of early-stage breast cancer

Caram

Guo

Leja

et al. 2015

Breast Cancer Res Treat

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Cardiomyopathy is a known complication of anthracycline-based adjuvant chemotherapy and is more commonly reported in population-based studies of breast cancer survivors than in clinical trials. This study prospectively evaluated the prevalence of elevated cardiac biomarkers in unselected patients who had been treated with doxorubicin for early-stage breast cancer and the prevalence of reduced LVEF in patients with an elevated biomarker. All participants underwent an examination, symptom inventory, medical record review, and biomarker analysis for BNP, troponin, and plasma and urine NT-proBNP. Patients who had one or more elevated biomarkers were referred for echocardiogram; systolic dysfunction was defined as LVEF less than 55 %. Multivariable logistic regression was used to determine the associations between age, BMI, cumulative dose of doxorubicin, diabetes, hypertension, and left-sided radiation therapy and the risk of reduced LVEF. Among the 269 patients who underwent lab testing (mean age 56 years, mean time since completion of doxorubicin-based chemotherapy 6 years), 192 (72 %) had one or more elevated biomarker. Among the 166 patients who completed an echocardiogram, 11.5 % had a LVEF < 55 %. After adjusting for covariates known to affect cardiac function, multivariable logistic regression revealed plasma NT-proBNP to be the only measured cardiac biomarker associated with systolic dysfunction. There is a relationship between NT-proBNP and the frequency of reduced LVEF in women treated with doxorubicin for curative intent; further study of NT-proBNP as a potential biomarker for subclinical cardiac dysfunction after exposure to anthracyclines is warranted.

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“…87 The role of BNP measurements is in the differential diagnosis of breathlessness in patients suspected of acute [88][89][90] or chronic heart failure. 91,92 It has been suggested that BNP is elevated in patients with chest pain and suspected ischaemic heart disease as a consequence of myocardial ischaemia. 44,93 In addition, measurement has been shown to have prognostic value in patients presenting with ACS 94,95 and to be a predictive risk marker for recurrent cardiac events.…”

Section: Natriuretic Peptidesmentioning

confidence: 99%

Randomised Assessment of Treatment using Panel Assay of Cardiac markers – Contemporary Biomarker Evaluation (RATPAC CBE)

Collinson

Gaze²,

Thokala³

et al. 2013

Health Technol Assess

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Reports are published in Health Technology Assessment (HTA) if (1) they have resulted from work for the HTA programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors.Reviews in Health Technology Assessment are termed 'systematic' when the account of the search appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others. HTA programmeThe HTA programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care.The journal is indexed in NHS Evidence via its abstracts included in MEDLINE and its Technology Assessment Reports inform National Institute for Health and Care Excellence (NICE) guidance. HTA research is also an important source of evidence for National Screening Committee (NSC) policy decisions.For more information about the HTA programme please visit the website: http://www.hta.ac.uk/ This reportThe research reported in this issue of the journal was funded by the HTA programme as project number 09/22/16. The contractual start date was in August 2010. The draft report began editorial review in February 2012 and was accepted for publication in June 2012. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HTA editors and publisher have tried to ensure the accuracy of the authors' report and would like to thank the reviewers for their constructive comments on the draft document. However, they do not accept liability for damages or losses arising from material published in this report.This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, NETSCC, the HTA programme or the Department of Health. Published by the NIHR Journals Library, produced by Prepress Projects Ltd, Perth, Scotland (www.prepress-projects.co.uk). Objectives: To test the diagnostic accuracy for detecting an acute myocardial infarction (AMI) using highly sensitive troponin assays and a range of new cardiac biomarkers of plaque destabilisation, myocardial ischaemia and necrosis; to test the prognostic accuracy for detecting adverse cardiac events using highly sensitive troponin assays and this range of new cardiac biomarkers; and to estimate the cost-effectiveness of using highly sensitive troponin assays or this range of new cardiac biomarkers instead of an admission and 10-to 12-hour troponin measurement. NIHR Journals LibraryDesign: Substudy of the point-of-care arm of the RATPAC (Randomised Assessment ...

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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†

Abstract: 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.

Cited by 115 publications

References 30 publications

Influence of Population Selection on the 99th Percentile Reference Value for Cardiac Troponin Assays

Influence of Population Selection on the 99th Percentile Reference Value for Cardiac Troponin Assays

Doxorubicin-induced cardiac dysfunction in unselected patients with a history of early-stage breast cancer

Randomised Assessment of Treatment using Panel Assay of Cardiac markers – Contemporary Biomarker Evaluation (RATPAC CBE)

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