Published online before print June 6, 2005, doi: 10.1161/01.HYP.0000170140.36633.8f
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(Hypertension. 2005;46:118.)
© 2005 American Heart Association, Inc.
Original Articles |
Effect of Compensated Renal Dysfunction on Approved Heart Failure Markers
Direct Comparison of Brain Natriuretic Peptide (BNP) and N-Terminal Pro-BNP
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.).
Correspondence to Priv. Doz. Dr Andreas Luchner, Klinik und Poliklinik für Innere Medizin II, Klinikum der Universität Regensburg, Franz-Josef-Strauss-Allee 11, 93042 Regensburg, Germany. E-mail andreas.luchner{at}klinik.uni-regensburg.de
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.
Key Words: myocardial infarction • ventricular function • hypertrophy • kidney • natriuretic peptides
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