on June 6, 2005
Published online before print June 6, 2005, doi: 10.1161/01.HYP.0000170140.36633.8f
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Submitted on November 30, 2004
From the Klinik und Poliklinik für Innere Medizin II (A.L., C.H., G.A.J.R., S.H.), University of Regensburg, Germany; GSF-Forschungszentrum (H.L.), Institut für Epidemiologie, Neuherberg, Germany; University of Schleswig-Holstein (H.S.), Campus Lübeck, Germany; and the KORA group (A.L.). * To whom correspondence should be addressed. E-mail: andreas.luchner{at}klinik.uni-regensburg.de.
Abstract--Brain natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) are markers of heart failure. Although renal dysfunction may increase plasma concentrations, the magnitude of this effect has not been assessed in a head-to-head comparison between the clinically approved tests. We assessed the effect of compensated renal dysfunction on BNP (Triage BNP; Biosite) and NT-proBNP (elecsys proBNP; Roche) in 469 randomly selected stable outpatients after myocardial infarction (MI; Monitoring Trends and Determinants in Cardiovascular Diseases [MONICA] register Augsburg) who were characterized with respect to renal function (glomerular filtration rate [GFR]; Cockroft method) and left ventricular (LV) ejection fraction (EF) and mass (2D echocardiography). BNP and NT-proBNP were elevated in MI patients with LV dysfunction (LVD; EF <35%) compared with MI patients with preserved EF (>45%; BNP 139±27 pg/mL versus 75±6; NT-proBNP 816±237 pg/mL versus 243±20; both P<0.03). Among all MI patients, the prevalence of renal dysfunction (GFR <85 mL/min) was 24%. BNP and NT-proBNP were significantly elevated in MI patients with renal dysfunction (BNP 132±17 pg/mL versus 68±4 without renal dysfunction; NT-proBNP 535±80 pg/mL versus 232±19; both P<0.05), and both markers were correlated with GFR in univariate and multivariate analyses (all P<0.01). When binary cut-off values were stratified according to the absence or presence of renal dysfunction (BNP 75 pg/mL and 125 pg/mL, respectively; NT-proBNP 100 pg/mL and 350pg/mL, respectively), the predictive power of both markers for the detection of LVD increased substantially. BNP and NT-proBNP are almost similarly influenced by mild-to-moderate renal dysfunction. Renal dysfunction is a potential cause of elevated marker concentrations in the absence of LVD, and cut-off concentrations should be stratified according to renal function.
Revised on December 19, 2004
Effect of Compensated Renal Dysfunction on Approved Heart Failure Markers. Direct Comparison of Brain Natriuretic Peptide (BNP) and N-Terminal Pro-BNP
Andreas Luchner*;
Key words: myocardial infarction • ventricular function • hypertrophy • kidney • natriuretic peptides
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