Diagnostic and prognostic evaluation of left ventricular systolic heart failure by plasma N-terminal pro-brain natriuretic peptide concentrations in a large sample of the general population

Groenning, Bjoern A.; Raymond, Ilan; Hildebrandt, Per; Nilssøn, Jens; Baumann, Matthias; Pedersen, Frants

doi:10.1136/hrt.2003.026021

Cited by 172 publications

(116 citation statements)

References 33 publications

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“…16 The optimal threshold NT-proBNP levels for prediction of CHF from ROC curve analysis of NT-proBNP alone (22 pmol/L) and from NT-proBNP and CRP in combination (50 pmol/L) were within the range currently regarded as normal. 5,17,18 Median NT-proBNP levels from population studies approximate 33 pmol/L, 5,17 although a lower median of 16 to 19 pmol/L is reported for healthy subjects without a history or symptoms of heart disease or other chronic disease. 17,18 Wang et al 12 similarly found BNP levels within a range currently regarded as normal were associated with an increased risk of CHF.…”

Section: Discussionmentioning

confidence: 99%

“…2 BNP-related peptides and CRP are elevated in congestive heart failure (CHF), and the levels correlate with symptom severity and prognosis. [3][4][5][6][7][8] Additionally, elevated CRP level predicts risk of CHF, 9 -11 and recently, Wang et al 12 reported BNP level predicts risk of death and cardiovascular events, including CHF, in an asymptomatic population. However, limited data are available directly comparing CRP and BNP-related peptides in persons at risk of CHF.…”

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confidence: 99%

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Prediction of Heart Failure by Amino Terminal-pro–B-Type Natriuretic Peptide and C-Reactive Protein in Subjects With Cerebrovascular Disease

et al. 2005

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Abstract-B-type natriuretic peptide (BNP) and C-reactive protein (CRP) are elevated in persons at risk for congestive heart failure (CHF). However, limited data are available directly comparing BNP-related peptides and CRP in persons at risk of CHF. To evaluate amino terminal-pro-BNP (NT-proBNP) and CRP, separately and together, for assessment of risk of CHF, we performed a nested case-control study of the 6105 participants of the Perindopril pROtection aGainst REcurrent Stroke Study (PROGRESS), a placebo-controlled study of a perindopril-based blood pressure-lowering regimen among individuals with previous stroke or transient ischemic attack (TIA). Each of 258 subjects who developed CHF resulting in death, hospitalization, or withdrawal of randomized therapy during a mean follow-up of 3.9 years was matched to 1 to 3 control subjects. NT-proBNP and CRP predicted CHF; the odds ratio for subjects in the highest compared with the lowest quarter was 4.5 (95% confidence interval, 2.7 to 7.5) for NT-proBNP and 2.9 (confidence interval, 1.9 to 4.7) for CRP, and each remained a predictor of CHF after adjustment for all other predictors. Screening for both markers provided better prognostic information than screening for either alone. Elevation of NT-proBNP above 50 pmol/L and CRP above 0.84 mg/L predicted CHF with sensitivity of 64% and specificity of 66%. NT-proBNP and CRP predicted CHF in subjects receiving perindopril-based therapy. We conclude that NT-proBNP and CRP are independent predictors of CHF risk after stroke or TIA. Moreover, NT-proBNP and CRP may be markers of mechanisms of CHF pathogenesis distinct from those responsive to angiotensin-converting enzyme inhibitor-based therapy. Key Words: heart failure Ⅲ natriuretic peptides Ⅲ cerebrovascular disorders Ⅲ stroke Ⅲ renin B -type natriuretic peptide (BNP) is synthesized as a high molecular weight precursor, proBNP, which is cleaved to release BNP and the amino-terminal fragment NT-proBNP, and both peptides are released from the cardiac ventricles in response to increased wall stress. 1 C-reactive protein (CRP) is released from the liver in response to inflammation. 2 BNP-related peptides and CRP are elevated in congestive heart failure (CHF), and the levels correlate with symptom severity and prognosis. [3][4][5][6][7][8] Additionally, elevated CRP level predicts risk of CHF, 9 -11 and recently, Wang et al 12 reported BNP level predicts risk of death and cardiovascular events, including CHF, in an asymptomatic population. However, limited data are available directly comparing CRP and BNP-related peptides in persons at risk of CHF. 13 We evaluated the prognostic performance of NTproBNP and CRP in a population with cerebrovascular disease and increased risk of CHF by conducting a nested case-control study of 258 subjects who developed CHF and 516 control subjects who did not develop CHF, who were participants in the Perindopril pROtection aGainst REcurrent Stroke Study (PROGRESS). PROGRESS was designed to determine the effects of active therapy with a perindopr...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Prediction of Heart Failure by Amino Terminal-pro–B-Type Natriuretic Peptide and C-Reactive Protein in Subjects With Cerebrovascular Disease

et al. 2005

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“…In humans, the plasma concentration of BNP is emphasized as a parameter of the severity of heart failure, a prognostic factor, and an item for evaluating the treatment response [15,16,18]. In addition, some studies have indicated that NT-proBNP is diagnostically more significant than BNP [3,5,6,10,11].…”

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confidence: 99%

Evaluation of Plasma N-Terminal Pro-Brain Natriuretic Peptide (NT-proBNP) Concentrations in Dogs with Mitral Valve Insufficiency

Takemura

Toda

Miyagawa

et al. 2009

The Journal of Veterinary Medical Science

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ABSTRACT. The diagnostic significance of the plasma concentration of N-terminal pro-brain natriuretic peptide (NT-proBNP) was evaluated in 72 dogs with mitral valve insufficiency and 36 control dogs. In the controls, the plasma NT-proBNP concentration was 163.9  114.7 (SD) pmol/l. The values in those with International Small Animal Cardiac Health Council (ISACHC) functional classification of heart failure class Ia, Ib, II and IIIa mitral valve insufficiency were 302.8  257.1 (n=21), 634.2  642.5 (n=23), 1,277.9  756.2 (n=18) and 1,908.9  538.8 (n=10) pmol/l, respectively; those in the class Ib or severer groups were significantly higher than that in the controls. In dogs in which the intensity of cardiac murmurs was Levine 3, 4, 5 and 6, plasma NT-proBNP concentrations were 647.6  577.3 (n=27), 1,184.7  841.0 (n=18), 1,532.4  784.2 (n=10) and 1,461.8  932.2 (n=4) pmol/l, respectively, and were significantly higher than that in the controls. The plasma NT-proBNP concentration was significantly correlated with the cardiac size (VHS) and LA/Ao (r=0.611, n=89, p<0.01; and r=0.705, n=91, p<0.01, respectively). When dogs with ISACHC class II or IIIa were regarded as heart failure, the cut-off value was 713.5 pmol/l, and the sensitivity and specificity were 0.913 and 0.857, respectively. These findings could indicate that plasma NT-proBNP concentration was significantly associated with the severity of heart failure due to mitral valve insufficiency in dogs. Further investigation is required to determine factors other than heart failure affecting plasma NT-proBNP concentration.KEY WORDS: canine, mitral valve insufficiency, NT-pro BNP.

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“…Equally favourable results were observed in Canadian urgent care settings from the recently presented Canadian multicentre Improved Management of Congestive Heart Failure (IMPROVE-CHF) trial (Figure 3). Other than in acute settings, several studies have also established the value of NT-proBNP levels in the diagnosis of heart failure in an outpatient setting (196)(197)(198). A potentially useful application of BNP levels is for the diagnosis of heart failure in patients with heart failure and preserved LVEF.…”

Section: The Natriuretic Peptidesmentioning

confidence: 99%

Canadian Cardiovascular Society Consensus Conference recommendations on heart failure update 2007: Prevention, management during intercurrent illness or acute decompensation, and use of biomarkers

Arnold¹,

Howlett²,

Dorian³

et al. 2007

Canadian Journal of Cardiology

123

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Diagnostic and prognostic evaluation of left ventricular systolic heart failure by plasma N-terminal pro-brain natriuretic peptide concentrations in a large sample of the general population

Cited by 172 publications

References 33 publications

Prediction of Heart Failure by Amino Terminal-pro–B-Type Natriuretic Peptide and C-Reactive Protein in Subjects With Cerebrovascular Disease

Prediction of Heart Failure by Amino Terminal-pro–B-Type Natriuretic Peptide and C-Reactive Protein in Subjects With Cerebrovascular Disease

Evaluation of Plasma N-Terminal Pro-Brain Natriuretic Peptide (NT-proBNP) Concentrations in Dogs with Mitral Valve Insufficiency

Canadian Cardiovascular Society Consensus Conference recommendations on heart failure update 2007: Prevention, management during intercurrent illness or acute decompensation, and use of biomarkers

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