CLINICAL RESEARCH: CHRONIC CORONARY ARTERY DISEASE
Comparison of B-Type Natriuretic Peptides for Assessment of Cardiac Function and Prognosis in Stable Ischemic Heart Disease
Mark Richards, MD*,*,
M. Gary Nicholls, MD*,
Eric A. Espiner, MD*,
John G. Lainchbury, MD*,
Richard W. Troughton, MD*,
John Elliott, MD*,
Christopher M. Frampton, PhD*,
Ian G. Crozier, MD*,
Timothy G. Yandle, PhD*,
Robert Doughty, MD , ,
Stephen MacMahon, PhD, ,
Norman Sharpe, MD, for the Christchurch Cardioendocrine Research Group and the Australia-New Zealand Heart Failure Group
* Christchurch Cardioendocrine Research Group, Christchurch Hospital, Christchurch, New Zealand
Australia-New Zealand Heart Failure Group
Department of Medicine, University of Auckland, Auckland, New Zealand
Institute for International Health, Newtown, Sydney, New South Wales, Australia
Manuscript received January 19, 2005;
revised manuscript received April 28, 2005,
accepted June 13, 2005.
* Reprint requests and correspondence: Dr. A. Mark Richards, Department of Medicine, Christchurch Hospital, Riccarton Avenue, PO Box 4345, Christchurch, New Zealand. (Email: mark.richards{at}cdhb.govt.nz).
OBJECTIVES: The aim of this work was to test B-type natriuretic peptides for assessment of function and prognosis in stable ischemic heart disease (IHD) and to compare brain natriuretic peptide (BNP) with amino terminal pro-brain natriuretic peptide (NTproBNP), including the relative effects of age and renal function on test performance.
BACKGROUND: Brain natriuretic peptide and NTproBNP are emerging diagnostic and prognostic markers in heart failure and acute coronary syndromes. Their performance in assessing function and prognosis in stable IHD is unknown. Whether one marker is superior and the relative effects of age and renal function on test performance are uncertain.
METHODS: In 1,049 patients with stable IHD, left ventricular ejection fraction (LVEF) was measured by radionuclide scanning and creatinine clearance estimated by the Cockroft-Gault equation. Age, gender, and body mass index were recorded. Twelve-month all-cause mortality or admission with heart failure was prospectively recorded; BNP and NTproBNP were measured by radioimmunoassay.
RESULTS: Brain natriuretic peptide and NTproBNP correlated closely (r = 0.90, p < 0.001) and had similar relationships to LVEF (r = –0.50 and –0.46, respectively, both p < 0.001), age (0.44 and 0.47, both p < 0.001), and creatinine clearance (–0.51 and –0.51, both p < 0.001). Areas under receiver-operating characteristic curves for detection of LVEF <30% were similar (0.83 and 0.80, both p < 0.001) with strong negative predictive values for both (95% and 94%). Both markers independently predicted the clinical end point with closely overlapping event-free survival curves.
CONCLUSIONS: In stable IHD, BNP and NTproBNP display strong and near-identical test performance in ruling out severely reduced LVEF and in prediction of all-cause mortality or heart failure despite significant effects of age, gender, and renal function on levels of both markers.
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Abbreviations and Acronyms
| | ANZ = Australia-New Zealand | | AUC = area under the curve | | BMI = body mass index | | BNP = brain natriuretic peptide | | IHD = ischemic heart disease | | LVEF = left ventricular ejection fraction | | NTproBNP = amino terminal pro-brain natriuretic peptide | | NYHA = New York Heart Association | | PMI = post-myocardial infarction | | ROC = receiver-operating characteristic |
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