POWER OF PLASMA N-TERMINAL PROATRIAL NATRIURETIC FACTOR TO DETERMINE HEMODYNAMICS IN PATIENTS WITH CARDIAC DISEASE - RELATION TO SERUM CREATININE

Objective. The aim was to examine the usefulness of plasma N-terminal proatrial natriuretic factor (N-terminal proANP) as a non-invasive mar ker of cardiac pressure in patients with normal to mildly elevated ser um creatinine. Methods: Blood samples were drawn at rest from 100 pati ents with cardiac disease undergoing diagnostic cardiac catheterizatio n. Results: Using multivariate analysis, N-terminal proANP was indepen dently related to mean pulmonary capillary wedge pressure (PCWP), mean right atrial pressure, serum creatinine (s-creatinine) and cardiac in dex. These indices accounted for about 50% of the variation in N-termi nal proANP All patients with N-terminal proANP <1000 pmol/l had normal PCWP (<13 mmHg). Areas under the receiver-operating characteristic (R OC) curves for N-terminal proANP for the detection of PCWP greater tha n or equal to 13, greater than or equal to 18 and greater than or equa l to 24 mmHg were 0.903, 0.870 and 0.876, respectively. Conclusion: Th ese results suggest that analysis of plasma N-terminal proANP is a sim ple and powerful method for assessing cardiac pressure in patients wit h heart disease and normal and mildly elevated s-creatinine (<165 mu m ol/l). The value of N-terminal proANP cannot, however, indiscriminatel y be used to assess cardiac haemodynamics. N-terminal proANP measureme nt is a useful screening parameter for identifying patients with norma l cardiac pressures.