Dj. Campbell et al., Plasma amino-terminal pro-brain natriuretic peptide: A novel approach to the diagnosis of cardiac dysfunction, J CARD FAIL, 6(2), 2000, pp. 130-139
Background: Heart failure is a common cause of hospitalization and death ac
ross the industrialized world. Improving the diagnosis and care of patients
with heart failure is therefore likely to have a major impact on morbidity
, mortality, and health care costs.
Methods and Results: To determine the relation between cardiac function and
plasma levels of amino-terminal brain natriuretic peptide precursor (NT-pr
oBNP), plasma NT-pmBNP levels and ventricular function (by radionucleotide
ventriculography) were measured in healthy patients, patients with renal fa
ilure, patients with recent myocardial infarction, and patients investigate
d for cardiorespiratory symptoms. Plasma NT-proBNP revels were greater in h
ealthy women (median, 1.5 fmol/mL; range, 1.0 to 13.8 fmol/mL; n = 34) than
healthy men (median, 1.0 fmol/mL; range, 1.0 to 3.3 fmol/mL; n = 33; P = .
012). NT-proBNP levels were elevated in subjects with renal failure (geomet
ric mean, 314 fmol/mL; range, 18 to 5,800 fmol/mL) and were related to left
ventricular ejection fraction (LVEF) (r = -0.86; P < .0001; n = 19). NT-pr
oBNP levels were also related to LVEF in patients with recent myocardial in
farction (r = -0.62; P = .0003; n = 29) and those investigated for cardiore
spiratory symptoms (r = -0.56; P < .0001; n = 129). Applying an upper limit
of normal of 5 fmol/mL for men and 15 fmol/mL for women (specificity, 100%
), elevated plasma NT-proBNP levels had 100% sensitivity for the detection
of LVEF less than 45% after myocardial infarction and 97% sensitivity for t
he detection of LVEF less than 45% in patients investigated for cardiorespi
ratory symptoms. NT-proBNP levels were also elevated in 87% of the patients
with normal systolic function (LVEF greater than or equal to 45%) after my
ocardial infarction and in 87% of the patients investigated for cardiorespi
ratory symptoms with heart failure and normal systolic function (LVEF great
er than or equal to 45%).
Conclusions: Plasma NT-proBNP level is a sensitive indicator of cardiac dys
function, both in the presence and absence of systolic dysfunction, and may
prove to be a useful tool for the identification and management of cardiac
dysfunction in the general community.