Circulating N-terminal pro-atrial natriuretic peptide is an independent predictor of left ventricular hypertrophy in the general population - The Tromso Study

Purpose The purpose of this study was to determine whether circulating N-te rminal pro-atrial natriuretic peptide (N-ANP) levels predict left ventricul ar hypertrophy in the general population after adjustment for relevant risk factors. Method and Results In a population-based sample of 3287 subjects aged 25-85 years, circulating N-ANP was measured in a subgroup of 389 subjects. Left ventricular mass and ejection fraction were determined by two-dimensional g uided hi-mode echocardiography. Left ventricular hypertrophy was defined as height adjusted mass above 145.5 g.m(-1) and 125.4 g.m(-1), in men and wom en, respectively. Fifty-one subjects with left ventricular hypertrophy had significantly higher N-ANP levels than controls (1075 vs 763 pmol.l(-1) I; P<0.0001). A gradually increasing prevalence of left ventricular hypertroph y over increasing 500 pmol. l(-1) intervals of N-ANP was observed (1.8 to 6 4.3%; (Chi-squared P for trend <0.001). N-ANP was an independent predictor of left ventricular hypertrophy after adjustment for ejection fraction, bod y mass index, hypertension, valvular disease, a history of myocardial infar ction, gender, and age. The adjusted odds ratio for left ventricular hypert rophy was 1.79 (95% CI 1.04-3.07) for a 500 pmol . l(-1) increase in N-ANP. A substantial proportion of subjects with elevated N-ANP levels had combin ed left Ventricular hypertrophy and left ventricular dysfunction. Conclusion These results suggests that N-ANP is an independent predictor of left ventricular hypertrophy in the general population. N-ANP determinatio n is, however, poorly suited to distinguish between subjects with isolated left ventricular hypertrophy and left ventricular dysfunction with or witho ut left ventricular hypertrophy.