B‐type natriuretic peptide and C‐terminal‐pro‐endothelin‐1 for the prediction of severely impaired peak oxygen consumption

Abstract

Objective. To assess the utility of B-type natriuretic peptide (BNP) and C-terminal-pro-endothelin-1 (CTproET-1) to predict a severely impaired peak oxygen consumption (peak VO 2 , < 14 mL kg )1 min )1 ) in patients referred for cardiopulmonary exercise testing.Design. Cross-sectional study.Setting. Tertiary care center.Methods. Peak VO 2 , BNP and CT-proET-1 were assessed in 141 consecutive patients referred for cardiopulmonary exercise testing.Results. B-type natriuretic peptide [median (interquartile range) 48 (38-319) vs. 33 (15-86) pg mL )1 ; P = 0.002] and vs. 60 (52-74) pmol L )1 ; P < 0.001] were higher in patients with a peak VO 2 < 14 mL kg )1 min )1 (n = 30) than in those with a peak VO 2 ‡ 14 mL kg )1 min )1 (n = 111). CT-pro-ET-1 had a higher area under the receiver-operator-characteristics curve (AUC) to predict a peak VO 2 < 14 mL kg )1 min )1 than BNP (0.79 vs. 0.68; P = 0.04). The optimal BNP cut-off of 37.2 pg mL )1 had a sensitivity of 80% and a specificity of 56%. The optimal CT-proET-1 cut-off of 74.4 pmol L )1 had a sensitivity of 80% and specificity of 76%. A five-item score composed of body mass index, diabetes, forced expiratory volume within the first second, alveolo-arterial oxygen pressure difference, and BNP had an AUC of 0.88 to predict a peak VO 2 < 14 mL kg )1 min )1 . Adding CT-proET-1 to the score resulted in an AUC of 0.92.Conclusions. C-terminal-pro-endothelin-1 is superior to BNP for the prediction of a peak VO 2 < 14 mL kg )1 min )1 in patients referred for CPET. A score incorporating body mass index, diabetes status, spirometry, blood gases, BNP and CT-proET-1 improves the prediction of a peak VO 2 < 14 mL kg )1 min )1 based on single biomarkers.

Biomarkers and Peak Oxygen Uptake in Patients with Chronic Lung Disease

“…Nineteen patients not fulfilling criteria for appropriate effort (see below) were secondarily excluded, leaving 85 patients for the present analysis. The study population represents a subgroup of a population on which we have reported previously [24]. All patients underwent CPET including spirometry and blood gases as well as biomarker measurement in a prospective manner.…”