Russian Heart Failure Journal 2008year Comparative efficacy of using natriuretic peptide end fragments in diagnostics of CHF in patients with preserved left ventricular systolic function


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2008/

Comparative efficacy of using natriuretic peptide end fragments in diagnostics of CHF in patients with preserved left ventricular systolic function

Ovechkin A. O., Boiko E. R., Zelenin A. A., Bernikova O. G.

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Urgency. Most studies on effective evaluation of natriuretic peptides (NP) for detection of CHF have used LV EF <40% as a criterion for CHF. Diagnostic value of the NP system for detection of CHF in patients with preserved systolic function is less studied. Aim. To evaluate and compare the appropriateness of using plasma NT-pro-ANP and NT-pro-BNP for diagnosis of CHF in patients with preserved LV systolic function and to determine the relationship of plasma NT-pro-ANP and NT-pro-BNP with CHF severity based on the evaluation method. Materials and methods. 69 patients with IHD and/or essential hypertension were enrolled in the study after examination. The exclusion criterion was LV EF ≤40%. Patients were assigned to a group with no clinical or instrumental SSHF signs of CHF (CHF−) (28 patients) and a group with I-IIA stage CHF (CHF+) (41 patients). Serum levels of NT-pro-ANP and NT-pro-BNP were measured by the immune enzyme assay. Results. Levels of NP precursor terminal fragments were significantly higher in patients with CHF than without CHF (290 [200–440] vs. 95 [0–315] fmol/ml for NT-рro-ANP, р=0.014 and 175 [140‑215] vs. 148.5 (126.5–172.5) fmol/ml for NT-рro-BNP, р=0.035). Diagnostic value of both parameters was similar: Se 70.7%, Sp 60.7%, PV (+) 72.2%, PV (–) 58.6%. The level of NT-pro-BNP more closely correlated with CHF severity than the level of NT-pro-АNP as evaluated by NYHA (r=0.43, р<0.001) or SSHF (r=0.41, р<0.001) classification and by the clinical condition scale (r=0.42, р<0.001). Therefore the parameters of NT-рro-BNP and NT-рro-АNP used in the study demonstrated similar and limited diagnostic effectiveness in establishing the presence or absence of CHF. This may be due to the fact that only patients with considerable impairment of LV systolic function were included in the study; most patients received drugs used for the treatment of CHF during the study.
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