The Effectiveness of NT-proBNP in Diagnosing Heart Failure_Chinese Journal of Evidence-Based Medicine

Authors：

CAI Bei ¹ , WANG Lan lan ¹ , LIU Jin ¹ , HUANG De jia ² , LIU Xing bin ² , LI Li xin ¹ , TANG Jiang tao ¹

1.Department of Laboratory Medicine; West China Hospital of Sichuan University（Chengdu610041）2.Department of Cardiology; West China Hospital of Sichuan University;

Corresponding author：

Keywords：

NT-proBNP; Heart failure; Diagnostic test

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Objective 　To evaluate the diagnostic value of N terminal pro-brain natriuretic peptide (NT-proBNP) for heart failure (HF) and the relationship between NT-proBNP and HF.
Methods 　Applying electrochemiluminescence immunoassay on Elecsys 2 010 quantitatively detects NT-proBNP in HF patients with varing heart damage.
Results 　① Using 155 pg/ml as the cutoff for diagnosis of HF, the sensitivity and specificity are both 80 %, positive likelihood ratio (PLR) is more than 4.0; when NT-proBNP is more than 350 pg/ml, PLR is more than 14. ② NT-proBNP significantly increases in HF patients，and has significant difference compared with disease control group, P lt;0.05. In dilated cardiomyopathy (DCMP) and acute myocardial infarction (AMI) NT-proBNP is the highest, in coronary heart disease (CHD) and hypertension it’s the smallest. With rising NYHA classes, NT-proBNP increases exponentially. The correlation between NT-proBNP and heart function is good, rs=0.859 (P lt;0.01).
Conclusions 　NT-proBNP for diagnosing HF has a high sensitivity and specificity and can effectively evaluate heart function. With worsening of heart damage, NT-proBNP shows exponential or linear increase.

Citation： CAI Bei,WANG Lan lan,LIU Jin,HUANG De jia,LIU Xing bin,LI Li xin,TANG Jiang tao. The Effectiveness of NT-proBNP in Diagnosing Heart Failure. Chinese Journal of Evidence-Based Medicine, 2005, 05(3): 224-228. doi: Copy

1.	［1］Berendes E, Schmidt C, Van Aken H, Hartlage MG, Rothenburger M, Wirtz S, Scheld HH, Brodner G, Walter M. A-type and B-type natriuretic peptides in cardiac surgical procedures[J]. Anesth Analg, 2004; 98(1): 11-19.
2.	［2］Mair J, Hammerer-Lercher A, Puschendorf B. The impact of cardiac natriuretic peptide determination on the diagnosis and management of heart failure[J]. Clin Chem Lab Med, 2001; 39(7): 571-588.
3.	［3］Mueller T, Gegenhuber A, Poelz W, Haltmayer M. Biochemical diagnosis of impaired left ventricular ejection fraction--comparison of the diagnostic accuracy of brain natriuretic peptide (BNP) and amino terminal proBNP (NT-proBNP)[J]. Clin Chem Lab Med, 2004; 42(2): 159-163.
4.	［4］Meune C, Martins E, Fulla Y, Bergmann JF, Devaux JY, Mourad JJ. New biological markers for acute coronary artery disease [J]. J Mal Vasc, 2003; 28(5): 251-257.
5.	［5］Prontera C, Emdin M, Zucchelli GC, Ripoli A, Passino C, Clerico A. Analytical performance and diagnostic accuracy of a fully-automated electrochemiluminescent assay for the N-terminal fragment of the pro-peptide of brain natriuretic peptide in patients with cardiomyopathy: comparison with immunoradiometric assay methods for brain natriuretic peptide and atrial natriuretic peptide[J]. Clin Chem Lab Med, 2004; 42(1): 37-44.
6.	［6］Pfister R, Scholz M, Wielckens K, Erdmann E, Schneider CA. Use of NT-proBNP in routine testing and comparison to BNP[J]. Eur J Heart Fail, 2004; 6(3): 289-293.
7.	［7］Vanderheyden M, Bartunek J, Goethals M. Brain and other natriuretic peptides: molecular aspects[J]. Eur J Heart Fail, 2004; 6(3): 261-268.
8.	［8］Richards AM, Doughty R, Nicholls MG, MacMahon S, Sharpe N, Murphy J, Espiner EA, Frampton C, Yandle TG; Australia-New Zealand Heart Failure Group. Plasma N-terminal pro-brain natriuretic peptide and adrenomedullin: prognostic utility and prediction of benefit from carvedilol in chronic ischemic left ventricular dysfunction. Australia-New Zealand Heart Failure Group[J]. J Am Coll Cardiol, 2001; 37(7): 1 781-1 787.
9.	［9］Wu X, Seino Y, Ogura H, Fukuma N, Katoh T, Takano T. Plasma natriuretic peptide levels and daily physical activity in patients with pacemaker implantation[J]. Jpn Heart J, 2001; 42(4): 471-482.
10.	［10］Maisel AS, Krishnaswamy P, Nowak RM, McCord J, Hollander JE, Duc P, Omland T, Storrow AB, Abraham WT, Wu AH, Clopton P, Steg PG, Westheim A, Knudsen CW, Perez A, Kazanegra R, Herrmann HC, McCullough PA; Breathing Not Properly Multinational Study Investigators. Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure[J]. N Engl J Med, 2002; 347(3): 161-167.
11.	［11］McCullough PA, Nowak RM, McCord J, Hollander JE, Herrmann HC, Steg PG, Duc P, Westheim A, Omland T, Knudsen CW, Storrow AB, Abraham WT, Lamba S, Wu AH, Perez A, Clopton P, Krishnaswamy P, Kazanegra R, Maisel AS. B-type natriuretic peptide and clinical judgment in emergency diagnosis of heart failure: analysis from Breathing Not Properly (BNP) Multinational Study[J]. Circulation, 2002; 106(4): 416-422.
12.	［12］Bay M, Kirk V, Parner J, Hassager C, Nielsen H, Krogsgaard K, Trawinski J, Boesgaard S, Aldershvile J. NT-proBNP: a new diagnostic screening tool to differentiate between patients with normal and reduced left ventricular systolic function[J]. Heart, 2003; 89(2): 150-154.
13.	［13］Omland T, Persson A, Ng L, O’Brien R, Karlsson T, Herlitz J, Hartford M, Caidahl K. N-terminal pro-B-type natriuretic peptide and long-term mortality in acute coronary syndromes[J]. Circulation, 2002; 106(23): 2 913-2 918.
14.	［14］Jernberg T, Stridsberg M, Venge P, Lindahl B. N-terminal pro brain natriuretic peptide on admission for early risk stratification of patients with chest pain and no ST-segment elevation[J]. J Am Coll Cardiol, 2002; 40(3): 437-445.

1. ［1］Berendes E, Schmidt C, Van Aken H, Hartlage MG, Rothenburger M, Wirtz S, Scheld HH, Brodner G, Walter M. A-type and B-type natriuretic peptides in cardiac surgical procedures[J]. Anesth Analg, 2004; 98(1): 11-19.
2. ［2］Mair J, Hammerer-Lercher A, Puschendorf B. The impact of cardiac natriuretic peptide determination on the diagnosis and management of heart failure[J]. Clin Chem Lab Med, 2001; 39(7): 571-588.
3. ［3］Mueller T, Gegenhuber A, Poelz W, Haltmayer M. Biochemical diagnosis of impaired left ventricular ejection fraction--comparison of the diagnostic accuracy of brain natriuretic peptide (BNP) and amino terminal proBNP (NT-proBNP)[J]. Clin Chem Lab Med, 2004; 42(2): 159-163.
4. ［4］Meune C, Martins E, Fulla Y, Bergmann JF, Devaux JY, Mourad JJ. New biological markers for acute coronary artery disease [J]. J Mal Vasc, 2003; 28(5): 251-257.
5. ［5］Prontera C, Emdin M, Zucchelli GC, Ripoli A, Passino C, Clerico A. Analytical performance and diagnostic accuracy of a fully-automated electrochemiluminescent assay for the N-terminal fragment of the pro-peptide of brain natriuretic peptide in patients with cardiomyopathy: comparison with immunoradiometric assay methods for brain natriuretic peptide and atrial natriuretic peptide[J]. Clin Chem Lab Med, 2004; 42(1): 37-44.
6. ［6］Pfister R, Scholz M, Wielckens K, Erdmann E, Schneider CA. Use of NT-proBNP in routine testing and comparison to BNP[J]. Eur J Heart Fail, 2004; 6(3): 289-293.
7. ［7］Vanderheyden M, Bartunek J, Goethals M. Brain and other natriuretic peptides: molecular aspects[J]. Eur J Heart Fail, 2004; 6(3): 261-268.
8. ［8］Richards AM, Doughty R, Nicholls MG, MacMahon S, Sharpe N, Murphy J, Espiner EA, Frampton C, Yandle TG; Australia-New Zealand Heart Failure Group. Plasma N-terminal pro-brain natriuretic peptide and adrenomedullin: prognostic utility and prediction of benefit from carvedilol in chronic ischemic left ventricular dysfunction. Australia-New Zealand Heart Failure Group[J]. J Am Coll Cardiol, 2001; 37(7): 1 781-1 787.
9. ［9］Wu X, Seino Y, Ogura H, Fukuma N, Katoh T, Takano T. Plasma natriuretic peptide levels and daily physical activity in patients with pacemaker implantation[J]. Jpn Heart J, 2001; 42(4): 471-482.
10. ［10］Maisel AS, Krishnaswamy P, Nowak RM, McCord J, Hollander JE, Duc P, Omland T, Storrow AB, Abraham WT, Wu AH, Clopton P, Steg PG, Westheim A, Knudsen CW, Perez A, Kazanegra R, Herrmann HC, McCullough PA; Breathing Not Properly Multinational Study Investigators. Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure[J]. N Engl J Med, 2002; 347(3): 161-167.
11. ［11］McCullough PA, Nowak RM, McCord J, Hollander JE, Herrmann HC, Steg PG, Duc P, Westheim A, Omland T, Knudsen CW, Storrow AB, Abraham WT, Lamba S, Wu AH, Perez A, Clopton P, Krishnaswamy P, Kazanegra R, Maisel AS. B-type natriuretic peptide and clinical judgment in emergency diagnosis of heart failure: analysis from Breathing Not Properly (BNP) Multinational Study[J]. Circulation, 2002; 106(4): 416-422.
12. ［12］Bay M, Kirk V, Parner J, Hassager C, Nielsen H, Krogsgaard K, Trawinski J, Boesgaard S, Aldershvile J. NT-proBNP: a new diagnostic screening tool to differentiate between patients with normal and reduced left ventricular systolic function[J]. Heart, 2003; 89(2): 150-154.
13. ［13］Omland T, Persson A, Ng L, O’Brien R, Karlsson T, Herlitz J, Hartford M, Caidahl K. N-terminal pro-B-type natriuretic peptide and long-term mortality in acute coronary syndromes[J]. Circulation, 2002; 106(23): 2 913-2 918.
14. ［14］Jernberg T, Stridsberg M, Venge P, Lindahl B. N-terminal pro brain natriuretic peptide on admission for early risk stratification of patients with chest pain and no ST-segment elevation[J]. J Am Coll Cardiol, 2002; 40(3): 437-445.

Chinese Journal of Evidence-Based Medicine

The Effectiveness of NT-proBNP in Diagnosing Heart Failure

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