Elsevier

American Heart Journal

Volume 134, Issue 3, September 1997, Pages 442-449
American Heart Journal

Evaluation of plasma natriuretic peptides as markers for left ventricular dysfunction,☆☆

https://doi.org/10.1016/S0002-8703(97)70079-6Get rights and content

Abstract

To test the hypothesis that elevated plasma levels of natriuretic peptides may serve to identify patients with left ventricular (LV) dysfunction, we assessed the predictive diagnostic value of natriuretic peptide levels, in addition to clinical and electrocardiographic risk factors, as noninvasive indicators of cardiac dysfunction. Plasma levels of atrial natriuretic peptide (cANP) (99-126), N-terminal fragment of proANP (nANP) (26-55), nANP(80-96), brain natriuretic peptide (BNP-32), proBNP(22-46), and C-type natriuretic peptide (CNP-22) were measured in 211 subjects before cardiac catheterization. The strongest correlations with parameters of LV function were found for nANP(80-96) (up to r = –0.55, p < 0.0001), whereas there was no significant correlation with proBNP(22-46) or CNP-22. In patients with LV ejection fractions (LVEF) ≤45% ( n = 38) nANP(26-55), nANP(80-96), cANP(99-126), and BNP-32 were significantly increased ( p < 0.001). Partition values for elevated versus normal natriuretic peptide levels were obtained from normal controls and used to separate subjects with and without LV dysfunction. Receiver operating characteristic analysis for LVEF ≤45% indicated a significantly better diagnostic accuracy for high levels of nANP(80-96), nANP(22-56), cANP(99-126), and BNP-32 than for proBNP and CNP-22. Multivariate analysis by logistic regression identified Q waves and bundle branch block in the electrocardiogram as well as elevated plasma levels of cANP, nANP(80-96), and nANP(26-55) as the strongest independent predictors of low ejection fractions. The relative risk of LV dysfunction was raised up to tenfold in subjects with high natriuretic peptide levels ( p < 0.001). The addition of nANP(80-96) and nANP(26-55) to the combination of clinical and electrocardiographic risk factors did not further improve the diagnostic sensitivity for the detection of LVEF ≤45%, but it markedly increased the overall accuracy (59% to 81%, p < 0.001) and specificity (55% to 81%, p < 0.001). Among natriuretic peptides, elevated nANP(80-96) and nANP(26-55) levels have the strongest impact on the detection of LV dysfunction. They add to the diagnostic information contained in clinical and electrocardiographic factors. Plasma levels alone or in combination with clinical factors seem to be of value for a refined identification of abnormal LV function in the individual patient. (Am Heart J 1997;134:442-9.)

Section snippets

Study protocol

Two hundred twenty-one consecutive patients (155 men, 66 women, aged 56 to 77 years) undergoing diagnostic cardiac catheterization at our clinic for known or suspected heart disease were included in this study. Of these patients 43.7% were smokers, 59.3% had a history of hypertension, and 17.0% had diabetes. They were undergoing treatment with acetyl salicylic acid (73.5%), β-blockers (67.4%), angiotensin-converting enzyme inhibitors (37.6%), nitrates (44.3%), calcium-channel blockers (21.3%),

Patient characteristics

The age of the 221 study patients ranged from 56 to 77 years (mean 60.3 ± 10.3 years). Cardiac catheterization revealed no apparent heart disease in 23 (10.4%) normotensive persons who served as controls in this study. Hypertension without coronary artery disease was diagnosed in 26 (11.8%). Coronary artery disease was found in 156 (70.6%) patients. Of those, 35 had previously had an anterior myocardial infarction, and 36 had a myocardial infarction not involving the anterior wall. Diagnosis of

Discussion

This study was designed to assess the diagnostic value of plasma levels of circulating natriuretic peptides as noninvasive indicators of cardiac dysfunction. Candidates for whom the measurement of cardiac natriuretic levels might be useful as a screening method for LV dysfunction, would be asymptomatic or mildly symptomatic patients with a history of previous myocardial infarction and patients with nonspecific symptoms or signs compatible with heart failure. Therefore the evaluation for

Acknowledgements

We thank Mrs. Ingrid Kirst for her excellent technical assistance.

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    Reprint requests: Frank Muders, MD, Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum, 93042 Regensburg, Germany.

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