© 2004 European Society of Cardiology
Use of NT-proBNP in routine testing and comparison to BNP
a Department III of Internal Medicine, University of Cologne Josef-Stelzmann Str. 9, 50924 Cologne, Germany
b Department of Clinical Chemistry, University of Cologne Germany
* Corresponding author. Tel.: +49-221-478-6207; Fax: +49-221-478-3763 E-mail address: christian.schneider{at}medizin.uni-koeln.de
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Abstract |
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Objectives: B-type natriuretic peptide (BNP) is a strong diagnostic predictor of left-ventricular (LV)-dysfunction. Recently, the aminoterminal portion of pro-BNP (NT-proBNP) has been introduced, which could be even more sensitive because of its longer half-life. The aim of this study was to evaluate the new marker NT-proBNP within a large, heterogeneous population of patients with suspected cardiovascular disease at risk of cardiovascular dysfunction and to compare it with the established diagnostic parameter BNP.
Subjects and methods: NT-proBNP and BNP were measured in 339 hospitalised patients undergoing diagnostic angiography (median age 66 years, 244 male vs. 95 female).
Results: Median values of NT-proBNP increased with worsening LV-dysfunction and higher NYHA class. The area under the receiver operator characteristics curve (AUC) of NT-proBNP for detecting severe systolic dysfunction or for detecting any systolic LV-dysfunction was 0.83 and 0.77, respectively. The latter improved (AUC=0.81) when patients with clinically relevant heart disease like valvular dysfunction were included, independent of the haemodynamic values. Compared to BNP, NT-proBNP tended to be more accurate in identifying lesser degrees of LV-dysfunction.
Conclusions: Even after optimisation of target criteria, there was still a substantial overlap of NT-proBNP values between patients with and without relevant heart disease. Therefore, NT-proBNP is not suitable as a screening test for LV-dysfunction in the community. Nevertheless, because of its good negative predictive value, NT-proBNP could be an easy and effective tool to rule out severe systolic LV-dysfunction in high risk patients. No clinically significant advantage of BNP testing could be found.
Key Words: B-type natriuretic peptide (BNP) • NT-proBNP • Heart failure • Left-ventricular dysfunction
Received November 26, 2003; Accepted December 22, 2003
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