Amino-Terminal Pro-B-Type Natriuretic Peptide and B-Type Natriuretic Peptide in the General Community: Determinants and Detection of Left Ventricular Dysfunction Original Research Article

Amino-Terminal Pro-B-Type Natriuretic Peptide and B-Type Natriuretic Peptide in the General Community: Determinants and Detection of Left Ventricular Dysfunction Original Research Article Pages 345-353 Lisa C. Costello-Boerrigter, Guido Boerrigter, Margaret M. Redfield, Richard J. Rodeheffer, Lynn H. Urban, Douglas W. Mahoney, Steven J. Jacobsen, Denise M. Heublein, John C. Burnett Jr Close Close preview | PDF (211 K) | Related articles | Related reference work articles AbstractAbstract | Figures/TablesFigures/Tables | ReferencesReferences 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. Article Outline Methods Study population Assays Influence of clinical characteristics Detection of LV dysfunction Statistical methods Results Effect of clinical characteristics on NT-proBNP Impact of estrogen and beta-blockers Detection of LVSD Developing age- and gender-specific reference ranges Detection of combined LVSD and moderate to severe DD Discussion Impact of clinical factors on NT-proBNP Amino-terminal pro-BNP in detection of LV dysfunction Differences in NT-proBNP and BNP immunoassays Perspective References