Natriuretic Peptides as Markers of Mild Forms of Left Ventricular Dysfunction: Effects of Assays on Diagnostic Performance of Markers

Hammerer-Lercher, Angelika; Ludwig, Wilma; Falkensammer, Gerda; Müller, Silvana; Neubauer, Elke; Puschendorf, Bernd; Pachinger, Otmar; Mair, Johannes

doi:10.1373/clinchem.2003.028316

Cited by 91 publications

(52 citation statements)

References 43 publications

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“…However, the clinical results of this study cannot be extrapolated to other clinical settings. Comparison of our results with those of other recent studies (7)(8)(9)(10)(11)(12)(13)(14) suggests that diagnostic accuracy can strongly depend on patient selection and on the cardiac natriuretic peptide assayed (BNP, N-terminal pro-A-type natriuretic peptide, or NT-proBNP), as well as on the analytical performance and diagnostic accuracy of the immunoassay chosen. Tuberculosis imposes a major burden of death and disease on the human population.…”

supporting

confidence: 65%

Analytical Performance and Diagnostic Accuracy of Immunometric Assays for the Measurement of Plasma B-Type Natriuretic Peptide (BNP) and N-Terminal proBNP

Clerico¹,

Prontera²,

Emdin

et al. 2005

Clinical Chemistry

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Over the last 5 years, several immunoassay methods for the measurement of B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) became commercially available. Recent studies have confirmed the clinical usefulness of measurements of these cardiac natriuretic peptides for the prognostic stratification of patients with congestive heart failure, for the detection of left ventricular systolic and/or diastolic dysfunction, and for the differential diagnosis of dyspnea (1-4 ). However, to answer the most urgent requests of current clinical practice and to allow widespread use of BNP and NT-proBNP assays, some key issues had to be solved, such as increasing the sensitivity, precision, and experimental practicability (5 ). The aim of the present study was to evaluate and compare the analytical and clinical performance of five commercial natriuretic peptide immunoassays.Throughout this report, the values in healthy individuals and patients are reported as the range, median, and 25th and 75th percentiles. We enrolled 172 healthy adults (89 women and 83 men; age range, 16 -73 years; median age, 49.0 years; 25th percentile, 38 years; 75th percentile, 58 years). All participants were nonobese (body mass index, 19.4 -27.6 kg/m 2 , 24 kg/m 2 , 22.8 kg/m 2 , and 25.6 kg/m 2 ), normotensive (diastolic blood pressure, 60 -85 mmHg, 70 mmHg, 70 mmHg, and 80 mmHg; systolic blood pressure, 90 -140 mmHg, 120 mmHg, 102.5 mmHg, and 124.5 mmHg), and free from acute or chronic diseases. All participants had main plasma indices (including creatinine, urea nitrogen, glucose, uric acid, albumin, enzymes, electrolytes, and hemoglobin) within the appropriate reference intervals, and normal erythrocyte and leukocyte counts and urine analyses. All were asymptomatic and underwent a complete examination by a cardiologist, including a visit, standard 12-lead electrocardiogram, Doppler echocardiographic examination, and a bicycle stress test (when older than 50 years), which excluded silent heart disease.We also prospectively evaluated 279 consecutive patients with heart failure (211 men and 68 women; age, 20 -89 years, 66.0 years, 57.3 years, and 73 years). Cardiac morphology and function were assessed by two-dimensional echocardiography, or cardiac catheterization when needed. Idiopathic dilated cardiomyopathy was diagnosed in 136 patients (48.7%), whereas the other 143 patients suffered from secondary cardiomyopathy. Of these, 126 (45.1%) had ischemic cardiomyopathy. The inclusion criterion was a depressed (Ͻ50%) left ventricular ejection fraction [mean (SD), 31.8 (9.4)%; range, 10 -48%]. Heart failure severity was evaluated clinically according to the New York Heart Association (NYHA) classification: 32 patients were in functional NYHA class I, 133 were in class II, 81 were in class III, and 33 were in class IV, respectively. Patients were treated with a multidrug treatment (78% of patients treated with frusemide, 94% with angiotensin-converting enzyme inhibitor, 70% with carvedilol, and 58% with spironolactone), which was not stoppe...

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supporting

confidence: 65%

Analytical Performance and Diagnostic Accuracy of Immunometric Assays for the Measurement of Plasma B-Type Natriuretic Peptide (BNP) and N-Terminal proBNP

Clerico¹,

Prontera²,

Emdin

et al. 2005

Clinical Chemistry

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“…This study demonstrates a significant stimulation of BNP expression, a sensitive marker of myocardial dysfunction and increased wall stress (21,22 ), with a high negative predictive value (15)(16)(17) by intermediate HHcy (Hcy1 and Hcy2), but not by moderate HHcy (Meth). This Co1, control group 1st run; Co2, control group 2nd run; Meth, methionine group; Hcy1, homocystine 1% group; Hcy2, homocystine 2% group.…”

Section: Discussionmentioning

confidence: 73%

“…They are increased in systolic and diastolic dysfunction (18,19 ) and have been found to be useful for differential diagnosis of dyspnea in CHF and pulmonary diseases (20 ). Especially in early disease stages, NT-proBNP seems to be more sensitive than echocardiography (21,22 ). Moreover, measurements of BNP and NT-proBNP are free from subjective influences and have good reproducibility (23 ).…”

mentioning

confidence: 99%

Hyperhomocysteinemia and Myocardial Expression of Brain Natriuretic Peptide in Rats

et al. 2007

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Background: Hyperhomocysteinemia (HHcy) has been linked to impaired left ventricular function and clinical class in patients with chronic heart failure. We hypothesized that HHcy stimulates myocardial brain natriuretic peptide (BNP) expression and induces adverse left ventricular remodeling. Methods: We randomized 50 rats into 5 groups. Groups Co1 and Co2 (controls) received a typical diet. Groups Meth, Hcy1, and Hcy2 were fed the same diet supplemented with 2.4% methionine, 1% homocystine, and 2% homocystine, respectively. After 12 weeks, we measured total plasma homocysteine (tHcy) and BNP in plasma and tissue, and we performed histomorphometric analyses. Results: All animals had comparable baseline body weight [mean (SD) 234 (26) g] and total circulating Hcy

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“…Patients with chronic heart failure are usually enrolled and studied in cardiological outpatient clinics or during community screening of large general population studies performed with the collaboration of general practitioners. Dyshomogeneity also occurs as the result of differing inclusion (or exclusion) criteria for patient enrollment; in particular, for some studies exclusion criteria included the presence of some degree of renal failure (14,18,23,24,34,35 ). Thus, the prevalence and severity of heart failure varied greatly among the studies, a circumstance that clearly affected the diagnostic accuracy of the BNP and NT-proBNP assays (3,4 ).…”

Section: Clinical Chemistrymentioning

confidence: 99%

Comparison of the Diagnostic Accuracy of Brain Natriuretic Peptide (BNP) and the N-Terminal Part of the Propeptide of BNP Immunoassays in Chronic and Acute Heart Failure: A Systematic Review

et al. 2007

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Background: We used evidence-based laboratory medicine principles to compare the diagnostic accuracy of brain natriuretic peptide (BNP) and the N-terminal part of the propeptide of BNP (NT-proBNP) assays for the diagnosis of heart failure. Methods: In May 2006, we performed a computerized literature search of the online National Library of Medicine to select studies specifically designed to compare the diagnostic accuracy of BNP and NT-proBNP assays. The comparison took into account the area under the curve and diagnostic odds ratio (DOR) derived from ROC analysis of original studies. Results: Both BNP and NT-proBNP assays were found to be clinically useful for the diagnosis of heart failure. Metaanalysis of these data was difficult because of the heterogeneity of data regarding patient population, diagnostic criteria, end-points, and immunoassay methods for both BNP and NT-proBNP. Separate metaanalyses were performed for acute and chronic heart failure. In chronic heart failure, the diagnostic DOR for BNP (8.44, 95% CI 4.66 -15.30) was not significantly different from that of NT-proBNP (23.36, 95% CI 9.38 -58.19). In patients with acute heart failure, the mean DOR for BNP

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Natriuretic Peptides as Markers of Mild Forms of Left Ventricular Dysfunction: Effects of Assays on Diagnostic Performance of Markers

Cited by 91 publications

References 43 publications

Analytical Performance and Diagnostic Accuracy of Immunometric Assays for the Measurement of Plasma B-Type Natriuretic Peptide (BNP) and N-Terminal proBNP

Analytical Performance and Diagnostic Accuracy of Immunometric Assays for the Measurement of Plasma B-Type Natriuretic Peptide (BNP) and N-Terminal proBNP

Hyperhomocysteinemia and Myocardial Expression of Brain Natriuretic Peptide in Rats

Comparison of the Diagnostic Accuracy of Brain Natriuretic Peptide (BNP) and the N-Terminal Part of the Propeptide of BNP Immunoassays in Chronic and Acute Heart Failure: A Systematic Review

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