Factors related to NT-proBNP values in haemodynamically stable patients with normal systolic function of the left ventricle

Česká verzia

Authors: M. Vytiska ¹; P. Kala ¹; I. Klabenešová ²; O. Boček ¹; P. Jeřábek ¹; P. Neugebauer ¹; M. Poloczek ¹; J. Pařenica ¹; O. Ludka ¹; J. Špinar ¹
Authors place of work: Interní kardiologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Jindřich Špinar, CSc., FESC ¹; Oddělení klinické biochemie a hematologie FN Brno, pracoviště Bohunice, přednosta doc. MUDr. Milan Dastych, CSc., MBA ²
Published in the journal: Vnitř Lék 2008; 54(2): 150-155
Category: Original Contributions

Summary

Introduction:
Increased values of natriuretic peptides are considered prognostically significant in normal population with respect to mortality and the incidence of cardiovascular events, regardless of the left ventricular function. The objective of the study is to point out the factors related to NT-proBNP values in patients without the heart failure syndrome and with normal left ventricular systolic function.

Methods:
The group consisted of 290 elective patients aged between 50 and 82, with the mean age of 62 years, of whom 47 % were women. The enrolled patients were heamodynamically stable, without a history of MI, with a normal left ventricular systolic function and with the serum creatinine level < 150 μmol/l. On the same day, the following procedures were performed: left heart catheterisation, NT-proBNP sampling and echocardiographic examination. Diabetes mellitus, hypertension, coronary heart disease, body mass index, age, sex, left ventricular end-diastolic pressure and aortic pulse pressure were chosen as factors with possible impact on the level of NT-proBNP. We used echo parametres to assess the size of the left ventricle, the left ventricular mass index and the presence of left ventricular diastolic function.

Results:
The median of NT-proBNP was 110 pg/ml (min. 11; max. 1,943 pg/ml), and higher values were recorded for116 (i.e. 40 %) of the total number of patients. Based on the above-referred factors, a significant relation was demonstrated between NT-proBNP and age (p < 0.01), sex (p < .01), BMI (p = 0.03), left ventricular size (p = 0.02), left ventricular mass index (p = 0.01), and aortic pulse pressure (p < 0.01).

Conclusion:
The study has shown that the level of NT-proBNP in patients does not solely depend on the haemodynamic status and left ventricular function, but is related to many other risk factors of cardiovascular mortality and morbidity.

Key words:
NT-proBNP and age – sex – pulse pressure – left ventricle

Zdroje

1. Takayoshi T, Atsuyuki W, Keiko M et al. Attenuation of Compensation of Endogenous Cardiac Natriuretic Peptide System in Chronic Heart Failure: Prognostic Role of Plasma Brain Natriuretic Peptide Concentration in Patients With Chronic Symptomatic Left Ventricular Dysfunction. Circulation 1997; 96: 509-516.

2. Bay M, Kirk V, Parner J et al. NT-proBNP: a new diagnostic screening tool to differentiate between patients with normal and reduced left ventricular systolic function. Heart 2003; 89: 150-154.

3. Wright SP, Doughty RN, Pearl A et al. Plasma amino-terminal pro-brain natriuretic peptide and accuracy of heart-failure diagnosis in primary care. J Am Coll Cardiol 2003; 42: 1793-1800.

4. Lainchbury JG, Campbell E, Frampton CM et al. Brain natriuretic peptide and n-terminal brain natriuretic peptide in the diagnosis of heart failure in patients with acute shortness of breath. J Am Coll Cardiol 2003; 42: 728-735.

5. Morrow DA, de Lemos JA, Sabatine MS et al. Evaluation of B-type natriuretic peptide for risk assessment in unstable angina/non-ST elevation myocardial infarction: B-type natriuretic peptide and prognosis in TACTICS-TIMI-18. J Am Coll Cardiol 2003; 41: 1264-1272.

6. De Lemos JA, Morrow DA, Bentley JH et al. The prognostic value of B-type natriuretic peptide in patients with acute coronary syndromes. N Engl J Med 2001; 345: 1014-1021.

7. Richards AM, Nicholls MG, Espiner EA et al. B-type natriuretic peptides and ejection fraction for prognosis after myocardial infarction. Circulation 2003; 107: 2786-2792.

8. Anand IS, Fisher LD, Chiang YT et al. for the Val-HeFT Investigators Changes in brain natriuretic peptide and norepinephrine over time and mortality and morbidity in the Valsartan Heart Failure Trial (Val-HeFT). Circulation 2003; 107: 1278-1283.

9. Kucher N, Printzen G, Doernhoefer T et al. Low pro-brain natriuretic peptide levels predict benign clinical outcome in acute pulmonary embolism. Circulation 2003; 107: 1576-1568.

10. ten Wolde M, Tulevski II, Mulder JWM et al. Brain natriuretic peptide as a predictor of adverse outcome in patients with pulmonary embolism. Circulation 2003; 107: 2082-2084.

11. Gerber IL, Stewart R, Legget ME et al. Increased plasma natriuretic peptide levels reflect symptom onset in aortic stenosis. Circulation 2003; 107: 1884-1890.

12. Sutton TM, Stewart RAH, Gerber IL et al. Plasma natriuretic peptide levels increase with symptoms and severity of mitral regurgitation. J Am Coll Cardiol 2003; 41: 2280-2287.

13. Januzzi JL, Camargo CA, Anwaruddin S et al. N-terminal ProBNP for emergency evaluation for shortness of breath: the ProBNP investigation of dyspnea in the Emergency Department (PRIDE) study. Am J Cardiol 2005; 95: 948-954.

14. Catherine MO. Textbook of clinical echocardiography. 3. ed. Elsevier, Sauders 2004, 541 s.

15. Rimarčík M. Štatistický navigátor [online]. 2007, http://rimarcik.com/navigator

16. Vanderheyden M, Bartunek J, Goethals M. Brain and other natriuretic peptides: molecular aspects. The European journal of heart failure 2004; 6: 261-268.

17. Luchner A, Stevens TL, Borgeson DD et al. Differential atrial and ventricular expression of myocardial BNP during evolution of heart failure. Am J Physiol Heart Circ Physiol 1998; 274: 1684-1689

18. Toshihiro T, Boerrigter G, Huntley BK et al. Brain Natriuretic Peptide Is Produced in Cardiac Fibroblasts and Induces Matrix Metalloproteinases. Circ Res 2002; 91: 1127-1134.

19. McKie PM, Rodeheffer RJ, Cataliotti A et al. Amino-Terminal Pro-B-Type Natriuretic Peptide and B-Type Natriuretic Peptide: Biomarkers for Mortality in a Large Community-Based Cohort Free of Heart Failure. Hypertension 2006; 47; 874-880.

20. Wang TJ, Larson MG, Levy D et al. Plasma Natriuretic Peptide Levels and the Risk of Cardiovascular Events and Death. N Engl J Med 2004; 350: 655-663.

21. Redfield MM, Rodeheffer RR et al. Plasma Brain Natriuretic Peptide Concentration: Impact of Age and Gender. J Am Coll Cardiol 2002; 40: 976-982.

22. Wang TJ, Larson MG, Keyes MJ et al. Association of Plasma Natriuretic Peptide Levels With Metabolic Risk Factors in Ambulatory Individuals. Circulation 2007; 115: 115-119.

23. Yamamoto K, Burnett JC Jr, Jougasaki M et al. Superiority of brain natriuretic peptide as a hormonal marker of ventricular systolic and diastolic dysfunction and ventricular hypertrophy. Hypertension 1996; 28: 988-994.

24. Minoru Y, Hirofumi T, Yutaka K. et al. B-Type Natriuretic Peptide and Arterial Stiffness in Healthy Japanese Men. AJH 2006; 19: 443-447.

25. Vytiska M, Kala P, Peciar M et al. Je zvýšený enddiastolický tlak v levé komoře u populace staršího věku patologický? Vnitř Lék 2006; 52: 40-43.

26. Rodeheffer RJ. Measuring Plasma B-Type Natriuretic Peptide in Heart Failure Good to Go in 2004? J Am Coll Cardiol 2004; 44: 740-749.

27. Redfield MM, Rodeheffer RJ, Jacobsen SJ et al. Plasma Brain Natriuretic Peptide to Detect Preclinical Ventricular Systolic or Diastolic Dysfunction A Community-Based Study. Circulation 2004; 109: 3176-3181.

28. The SOLVD investigators: Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fraction. N Engl J Med 1992; 327: 685-691.

29. Topol EJ et al. Textbook of Cardiovascular medicine 3rd. ed. Lippincott Williams & Wilkins 2006.