Cor Vasa 2005, 46(10):371-374
N-terminal proBNP in patients with advanced heart failure: its value for non-in-vasive hemodynamic status estimate
- Klinika kardiologie, Institut klinické a experimentální medicíny, Praha, Česká republika
Introduction:
Changes in the plasma levels of brain natriuretic peptide (BNP) have been shown to correlate closely with left ventricular filling pressure in the treatment of acute heart failure. However, it is not known whether or not this peptide, and/or its N-terminal fragment, can be used to estimate the hemodynamic status in relatively stable patients with advanced heart failure.
Method:
A total of 119 patients with advanced chronic heart failure had their plasma N-terminal fragment proBNP (N-BNP) determined and right-heart catheterization performed in the morning of the same day; in 40 patients, the procedure was repeated at an interval of there months.
Results:
On baseline examination, N-BNP showed a loose correlation (r = 0.52; p < 0.0001) with catheter wedged pressure (CWP). The positive predictive value of N-BNP < 155 pmol/l for CWP < 20 mm Hg was 76.5 % (area under the ROC of 0.699). On repeat examination, a change in N-BNP ≤ +14 pmol/l or ≤ +17% had a positive predictive value of 96.2% for a change in CWP by ≤ +5 mm Hg (area under the ROC curves of 0.772 and 0.756, respectively).
Conclusion:
N-BNP does not allow a reliable CWP estimate on single assessment; but its trend makes it possible to rule out, with a high degree of probability, a significant increase in CWP (i. e., by more than 5 mm Hg) over a period of three months.
Keywords: Heart failure; Natriuretic peptides; Left ventricular filling pressure
Published: October 1, 2005 Show citation