NT-proBNP: a new diagnostic screening tool to differentiate between patients with normal and reduced left ventricular systolic function

Abstract

Objective: To evaluate whether measurements of N-terminal pro-brain natriuretic peptide (NT-proBNP) can be used to differentiate patients with normal and reduced left ventricular ejection fraction (LVEF) in an unselected consecutive group of hospital inpatients. Setting: City general hospital, Copenhagen, Denmark. Patients and design: During a 10 month period 2230 admissions to a city general hospital (80% of targeted patients) had an echocardiographic evaluation of left ventricular function, a comprehensive clinical evaluation, and blood analysis of N-terminal-pro-brain natriuretic peptide (NT-proBNP) within 24 hours of admission. Exclusions resulted from lack of informed consent or failure to obtain the required evaluations before death or discharge from hospital. Echocardiography was unsatisfactory in 37 patients, so the final number studied was 2193. Results: A raised NT-proBNP (> 357 pmol/l) identified patients with an LVEF of < 40% (n = 157) with a sensitivity of 73% and a specificity of 82%. The negative predictive value of having an NT-proBNP concentration below 357 pmol/l was 98%. Concentrations of NT-proBNP increased with increasing age and with decreasing LVEF (p < 0.05). A predicted concentration of NT-proBNP (corrected for age, sex, and serum creatinine) was determined for each patient. In patients with an NT-proBNP value less than predicted, the probability of having an LVEF of > 40% was more than 97%. This probability rapidly decreased to 70% as the measured NT-proBNP increased to 150% of the predicted value. Conclusions: A single measurement of NT-proBNP at the time of hospital admission provides important information about LVEF in unselected patients.

Prognostic value of N-terminal pro-B-type natriuretic peptide in patients with non-ST-segment elevation acute coronary syndromes

“…Sensitivity of NT-proBNP for SLVF in both examinations was high (95.1 and 93.3%, respectively). These high levels of sensitivity, found also in other studies (Emdin et al, 2005;Foote and Pearlman, 2004;Bay et al, 2003), suggest that NT-proBNP may be valid marker for SLVF estimation. Sensitivity of NT-proBNP for DLVF was lower than for SLVF, while specificity in the initial examination was 100%.…”

“…Thus, our subjects were classified into these groups according to their NT-proBNP levels, and there was higher number of patients (> 70.0% of all examinees) in group 2 (levels of NT-proBNP higher than 14.75 pmol/L) as expected, since it was shown in earlier studies that patients with NSTE-ACS have elevated levels of NTproBNP (Sabatine et al, 2002;Lindahl et al, 2005;Jernberg et al, 2004;Heeschen and Hamm, 2004). It was also suggested that the NT-proBNP level increases with the level of symptoms as assessed by New York Heart Association (NYHA) classification and the level of impaired left ventricular dysfunction as assessed by echocardiography (Bay et al, 2003;Pfister et al, 2004;Hess et al, 2005a;Drewniak et al, 2008;Kaski et al, 2010). Numerous studies indicate that levels of NTproBNP in ACS patient can vary between very low and very high (James et al, 2003;Heeschen and Hamm, 2004;Hess et al, 2005a), for example in a study by NT-proBNP, N-Terminal pro-B-type natriuretic peptide; CK, creatine kinase; CK-MB, creatine kinase-mB; cTnT, cardiac troponin T; CRP, C-reactive protein; HF, heart failure; UA, unstable angina; AMI, acute myocardial infarction; LE, lethal event.…”

“…That NT-proBNP can be an independent predictor of diastolic dysfunction was confirmed in a study by Tschöpe et al (2005), who researched the role of NT-proBNP in the diagnostics of diastolic dysfunction and its correlation to echocardiographic and invasive measurements. Regarding predictive value of NT-proBNP, Tschöpe et al (2005) found out that NT-proBNP had the best negative predictive value of all methods investigated, Bay et al (2003) suggested that the negative predictive value of having a "normal" value of NT-proBNP is very high (98.0%) and NT-proBNP therefore seems to be a valuable tool for excluding a decreased LVEF at the time of admission to hospital. In this study, negative predictive value of NT-proBNP for SLVF was 88.9% (initial examination) and 76.9% (control examination), while for DLVF it was low (16.6 and 30.8%).…”

Role of natriuretic peptides in the diagnosis and treatment of patients with carcinoid heart disease

“…Large studies in the general population or in noncardiac patients showed that measuring natriuretic peptides might be an effective screening method for left-ventricular systolic dysfunction (McDonagh et al, 1998;Luchner et al, 2000;Bay et al, 2003). In patients with the suspicion of heart failure several other studies showed natriuretic peptides to be useful indicators for the detection of heart failure (Lerman et al, 1993;Davidson et al, 1996;Cowie et al, 1997;Hammerer-Lercher et al, 2001;Maisel et al, 2002Maisel et al, , 2003.…”

Nonheart failure-associated elevation of amino terminal pro-brain natriuretic peptide in the setting of sepsis

“…Other patient characteristics that may influence the BNP level, independent of disease, are advancing age, probably reflecting LV subclinical abnormalities (15) and female sex, both of which result in increased BNP level (15,16). Two additional studies have confirmed the correlation of NT pro-BNP with age, but not with sex (17,18). In contrast, obesity is associated with decreased levels of BNP, probably as a result of increased clearance through a receptor contained in adipose tissue (19).…”