Discriminating Between Cardiac and Pulmonary Dysfunction in the General Population With Dyspnea by Plasma Pro-B-Type Natriuretic Peptide
Rasmus Mogelvang, MD*, ,*,
Jens P. Goetze, MD, DMSc*, ,
Peter Schnohr, MD, DMSc*,
Peter Lange, MD, DMSc*, ,
Peter Sogaard, MD, DMSc,
Jens F. Rehfeld, MD, DMSc and
Jan S. Jensen, MD, PhD, DMSc*,
* Copenhagen City Heart Study, Epidemiological Research Unit, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
Department of Cardiology, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
Department of Clinical Biochemistry, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
Department of Heart and Lung Diseases, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark.
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Figure 1 Differences in Measurement of proBNP Between the Processing-Independent Assay and the Roche Assay
(A) Summary of the processing-independent assay (PIA) for measurement of pro-B-type natriuretic peptide (proBNP) 1-108 and 1-76. During analysis, both peptides are cleaved with an endoprotease (trypsin) releasing an N-terminal fragment (proBNP 1-21, red boxes). The larger, blue boxes represent the glycosylated midregion in proBNP. Note that both proBNP 1-108 and 1-76 will be quantified with equal affinity and irrespective of the glycosylation degree. (B) The N-terminal (NT)-proBNP assay by Roche (Karlsruhe, Germany). Two antibodies raised against distinct regions in proBNP 1-76 are used in a sandwich assay. One antibody is raised against the glycosylated region in endogenous proBNP. The assay is calibrated with synthetic, nonglycosylated proBNP 1-76, and the assay affinity to proBNP 1-108 is unknown.
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Figure 3 Mean Plasma proBNP Concentrations According to Severity of Dyspnea
Dyspnea was classified according to a slightly modified Medical Research Council (MRC) dyspnea scale. No dyspnea refers to MRC category 0, mild dyspnea to MRC category 1 to 2, and severe dyspnea to MRC category 3 to 5. proBNP = pro-B-type natriuretic peptide.
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Figure 5 Curves for Expected Level of Plasma proBNP According to Gender and Age for Dyspneic Subjects
A measured pro-B-type natriuretic peptide (proBNP) above the blue area indicates a value >2.5 times the expected level and thus a high risk of left ventricular systolic and/or diastolic dysfunction. A measured proBNP below the blue area indicates a value less than one-half of the expected level and thus left ventricular systolic and diastolic dysfunction can be ruled out. A measured proBNP in the blue area indicates that the risk of left ventricular systolic and/or diastolic dysfunction is small and further diagnostic evaluation is required.
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