Determination of the B-type Natriuretic Peptide Level as a Criterion for Abnormalities in Japanese Individuals in Routine Clinical Practice: The J-ABS Multi-center Study (Japan Abnormal BNP Standard)

Abstract

Objective The present study was undertaken to establish a useful range for the B-type natriuretic peptide (BNP) level, with the ultimate goal of determining a cut-off BNP level that will make it possible to identify patients with clinically important organic heart disorders among patients encountered in clinical practice. Methods A total of 11,967 outpatients were evaluated for this study, and, after applying the exclusion criteria, 361 patients were finally recruited for the analysis. Compared to the factors of gender and body mass index, aging was considered to be an indispensable factor in this analysis. The 'median' plasma BNP level was found to increase slowly with age, but remained lower than 30 pg/mL, even in patients aged 60 years or older. In contrast, the overall '95th percentile' of the plasma BNP level in the patients younger than 60 years was 41 pg/mL, which increased to 139.8 pg/mL in the patients aged 60 years or older. Conclusion These findings suggest that the lower range of the BNP level allowing for identification of patients with clinically important organic heart disorders increases with age; however, it might be appropriate to adopt a level of approximately 40 pg/mL, even in elderly patients, in order to avoid any possible age-related effects of diastolic dysfunction or other factors.

The Optimal Cut-off Value of Plasma BNP to Differentiate Heart Failure in the Emergency Department in Japanese Patients with Dyspnea

“…Moreover, when renal function is disturbed, volume overload might affect the diagnosis of HF. Additionally, the plasma BNP levels are known to differ by gender; the plasma BNP levels of females are higher than those of males (17,28). However, in the present study, there were no significant differences in the plasma BNP levels between males and females in either group (data not shown).…”

“…Plasma BNP levels were measured at the time of admission with a fluorescent enzyme immunoassay using two monoclonal antibodies for BNP (E Test TOSOH II, Tosoh Corporation, Tokyo, Japan). The E Test TOSHO II has previously been shown to be comparable to Shionoria BNP (the current gold standard for BNP measurement in Japan) (17).…”

“…Several factors are involved in the regulation of the plasma BNP levels (17,24,26,27). The renal function is known to significantly affect the plasma BNP levels, therefore patients with an eGFR <30 mL/min/1.73 m 2 were excluded from the present study.…”

Significance of Screening the General Population for Potential Cardiovascular Diseases with a Combination Assay of B-type Natriuretic Peptide and High Sensitive Troponin I

“…Considering the report by Kawai et al that the BNP level was negatively correlated with BMI [14], and the result that the BNP level was negatively correlated with dyslipidemia as shown in Table 3, we assumed that the suppression of the BNP level in the male group by the higher BMI and the higher percentage of dyslipidemia surpassed the elevation of the BNP level by the other risk factors.…”

“…Using the clinical cut-off values of BNP [14] and TnI [15], we defined quadrants according to BNP and TnI levels as follows: 1) Quadrant A: BNP equal to or less than 40.0 pg/mL and TnI more than 26.2 pg/mL 2) Quadrant B: BNP equal to or less than 40.0 pg/mL and TnI equal to or less than 26.2 pg/mL 3) Quadrant C: BNP more than 40.0 pg/mL and TnI equal to or less than 26.2 pg/mL 4) Quadrant D: BNP more than 40.0 pg/mL and TnI more than 26.2 pg/mL With these quadrants, we assessed factors that differentiated pairs of quadrants by performing the Wilcoxon's test. For the assessment, we chose age, BMI, SBP, HR, CTR, VC, Hb, PLT, UA, eGFR, BUN, LDL-C, HDL-C, TG, HbA1c, FBG as the parameters with possible cardiovascular risks.…”