CLINICAL RESEARCH: HEART FAILURE
Amino-Terminal Pro-B-Type Natriuretic Peptide and B-Type Natriuretic Peptide in the General Community
Determinants and Detection of Left Ventricular Dysfunction
Lisa C. Costello-Boerrigter, MD, PhD*, ,*,
Guido Boerrigter, MD*,
Margaret M. Redfield, MD*,,
Richard J. Rodeheffer, MD,
Lynn H. Urban, MS ,
Douglas W. Mahoney, MS,
Steven J. Jacobsen, MD, PhD ,
Denise M. Heublein, CLT* and
John C. Burnett, Jr, MD*,
* Cardiorenal Research Laboratory, Mayo Clinic and Mayo Clinic College of Medicine, Rochester, Minnesota.
Division of Cardiovascular Diseases, Mayo Clinic and Mayo Clinic College of Medicine, Rochester, Minnesota.
Division of Biostatistics, Mayo Clinic and Mayo Clinic College of Medicine, Rochester, Minnesota.
Division of Epidemiology, Mayo Clinic and Mayo Clinic College of Medicine, Rochester, Minnesota.
Manuscript received April 27, 2005;
revised manuscript received August 26, 2005,
accepted September 8, 2005.
* Reprint requests and correspondence: Dr. Lisa C. Costello-Boerrigter, Cardiorenal Research Laboratory, Guggenheim 915, Mayo Clinic and Mayo Clinic College of Medicine, 200 First Street SW, Rochester, Minnesota 55905. (Email: costello.lisa{at}mayo.edu).
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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Abbreviations and Acronyms
| | AUC = area under the curve | | BMI = body mass index | | BNP = B-type natriuretic peptide/brain natriuretic peptide | | DD = diastolic dysfunction | | EF = ejection fraction | | GFR = glomerular filtration rate | | HF = heart failure | | HR = heart rate | | NT-proBNP = amino-terminal pro-B-type natriuretic peptide | | LA = left atrial | | LR = likelihood ratio | | LV = left ventricular | | LVSD = left ventricular systolic dysfunction | | ROC = receiver-operating characteristic |
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