Amino-terminal pro-B-type natriuretic peptide and B-type natriuretic peptide in the general community - Determinants and detection of left ventricular dysfunction

被引:292
作者
Costello-Boerrigter, LC
Boerrigter, G
Redfield, MM
Rodeheffer, RJ
Urban, LH
Mahoney, DW
Jacobsen, SJ
Heublein, DM
Burnett, JC
机构
[1] Mayo Clin & Mayo Clin Coll Med, Cardiorenal Res Lab, Rochester, MN 55905 USA
[2] Mayo Clin & Mayo Clin Coll Med, Div Cardiovasc Dis, Rochester, MN 55905 USA
[3] Mayo Clin & Mayo Clin Coll Med, Div Biostat, Rochester, MN 55905 USA
[4] Mayo Clin & Mayo Clin Coll Med, Div Epidemiol, Rochester, MN 55905 USA
关键词
D O I
10.1016/j.jacc.2005.09.025
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVES This study sought to characterize factors influencing amino-terminal pro-B-type natriuretic peptide (NT-proBNP) and to evaluate the ability of NT-proBNP to detect left ventricular (LV) dysfunction in a large community sample. BACKGROUND Secretion of BNP increases in cardiac disease, making BNP an attractive biomarker. Amino-terminal proBNP, a fragment of the BNP prohormone, is a new biomarker. We evaluated factors influencing NT-proBNP in normal patients and compared the ability of NT-proBNP and BNP to detect LV dysfunction in a large community sample. METHODS Amino-terminal pro-BNP was determined in plasma samples of a previously reported and clinically and echocardiographically characterized random sample (n = 1,869, age >= 45 years) of Olmsted County, Minnesota. RESULTS In normal patients (n = 746), female gender and older age were the strongest independent predictors of higher NT-proBNP. Test characteristics for detecting an LV ejection fraction <= 40% or <= 50% were determined in the total sample with receiver operating characteristic curves. Amino-terminal pro-BNP had significantly higher areas under the curve for detecting an LV ejection fraction <= 40% or <= 50% than BNP in the total population and in several male and age subgroups, whereas areas were equivalent in female subgroups. Age- and gender-adjusted cutpoints improved test characteristics of NT-proBNP. Both assays detected patients with systolic and/or moderate to severe diastolic dysfunction to a similar degree, which was less robust than the detection of LV systolic dysfunction alone. CONCLUSIONS Amino-terminal pro-BNP in normal patients is affected primarily by gender and age, which should be considered when interpreting values. Importantly, in the entire population sample NT-proBNP performed at least equivalently to BNP in detecting LV dysfunction and was superior in some subgroups in detecting LV systolic dysfunction.
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收藏
页码:345 / 353
页数:9
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