Natriuretic Peptides in Acute Coronary Syndromes: Prognostic Value and Clinical Implications

Farmakis, Dimitrios; Filippatos, Gerasimos; Tubaro, Marco; Peacock, W. Frank; DiSomma, Salvatore; Müeller, Christian; Kremastinos, Dimitrios Th.; Maisel, Alan S.

doi:10.1111/j.1751-7133.2008.tb00007.x

Cited by 8 publications

(2 citation statements)

References 38 publications

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“…B-type natriuretic peptides have been reported to be high both in coronary artery disease and CHF and have been shown to be strong prognostic markers for mortality [19][20][21] .…”

Section: Discussionmentioning

confidence: 99%

Relationship between N-Terminal Pro-B-Type Natriuretic Peptide Plasma Levels and Renal Function Evaluated with Different Formulae in Older Adult Subjects Admitted because of Dyspnea

Fabbian¹,

Giorgi²,

Portaluppi³

et al. 2011

Gerontology

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Background: N-terminal pro-B-type natriuretic peptide (NT-proBNP) plasma levels are associated with congestive heart failure severity, and are an important diagnostic tool for assessing patients with acute dyspnea. Reduced renal function increases NT-proBNP concentrations, and therefore it might be a confounding factor in chronic kidney disease (CKD) patients. Objective: The aim of the present study was to relate NT-proBNP plasma levels to different stages of renal function assessed with different methods in older adult subjects admitted because of dyspnea. Methods: NT-proBNP plasma levels (Roche Diagnostic, Mannheim, Germany) were measured in 134 older adult patients (age: 80 ± 6 years) admitted to hospital because of dyspnea. Anthropometrics, anamnesis, and biochemical data were collected. Glomerular filtration rate (GFR) was evaluated with different equations, the 4 variables MDRD equations (GFR_MDRD186, GFR_MDRD175), Mayo Clinic Quadratic formula (GFR_MAYO), and the new CKD-EPI formula (GFR_CKD-EPI). Patients were classified into the five K/DOQI stages of CKD and median NT-proBNP values were calculated evaluating their relationship with GFR. Results: Median NT-proBNP values were better stratified into the five K/DOQI stages by GFR_MAYO (stage 1 (n = 10) 1,640 pg/ml vs. stage 2 (n = 61) 2,371 pg/ml vs. stage 3 (n = 42) 3,815 pg/ml vs. stage 4 (n = 18) 6,320 pg/ml vs. stage 5 (n = 3) 7,256 pg/ml, p = 0.017). However, similar results were obtained with the other formulae. NT-proBNP was negatively correlated with GFR as evaluated with all the different formulae (r –0.25 to –0.29; all p < 0.01). Multiple regression analysis confirmed the independent association between LnNT-proBNP and GFR. Conclusion: NT-proBNP plasma levels progressively increase with worsening of renal function, and appear to be related to the five K/DOQI stages of CKD. For this purpose, GFR assessed with the GFR_MAYO formula appears to better stratify NT-proBNP in older adult subjects. Renal function should be considered when interpreting NT-proBNP levels in older adult patients admitted for dyspnoea.

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“…B-type natriuretic peptides have been reported to be high both in coronary artery disease and CHF and have been shown to be strong prognostic markers for mortality [19][20][21] .…”

Section: Discussionmentioning

confidence: 99%

Relationship between N-Terminal Pro-B-Type Natriuretic Peptide Plasma Levels and Renal Function Evaluated with Different Formulae in Older Adult Subjects Admitted because of Dyspnea

Fabbian¹,

Giorgi²,

Portaluppi³

et al. 2011

Gerontology

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“…Furthermore, BNPs have established their role in diagnosing acute heart failure [5, 6] and have been shown to be strong prognostic markers for mortality in CAD [7, 8] and CHF patients [9], with and without renal insufficiency [10–13]. …”

Section: Introductionmentioning

confidence: 99%

Heart-Kidney Biomarkers in Patients Undergoing Cardiac Stress Testing

Haapio

House

Cal

et al. 2011

International Journal of Nephrology

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We examined association of inducible myocardial perfusion defects with cardiorenal biomarkers, and of diminished left ventricular ejection fraction (LVEF) with kidney injury marker plasma neutrophil gelatinase-associated lipocalin (NGAL). Patients undergoing nuclear myocardial perfusion stress imaging were divided into 2 groups. Biomarkers were analyzed pre- and poststress testing. Compared to the patients in the low ischemia group (n = 16), the patients in the high ischemia group (n = 18) demonstrated a significantly greater rise in cardiac biomarkers plasma BNP, NT-proBNP and cTnI. Subjects were also categorized based on pre- or poststress test detectable plasma NGAL. With stress, the group with no detectable NGAL had a segmental defect score 4.2 compared to 8.2 (P = .06) in the detectable NGAL group, and 0.9 vs. 3.8 (P = .03) at rest. BNP rose with stress to a greater degree in patients with detectable NGAL (10.2 vs. 3.5 pg/mL, P = .03). LVEF at rest and with stress was significantly lower in the detectable NGAL group; 55.8 versus 65.0 (P = .03) and 55.1 vs. 63.8 (P = .04), respectively. Myocardial perfusion defects associate with biomarkers of cardiac stress, and detectable plasma NGAL with significantly lower LVEF, suggesting a specific heart-kidney link.

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