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

To access this material please log in or register

Register Authorize

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.



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.
  1. Kisch B. Electron microscopy of the atrium of the heart. I. Guinea pig. Exp Med Surg. 1956; 14 (2–3):99‑112.
  2. de Bold AJ. Heart atria granularity effects of changes in water-electrolyte balance. Proc Soc Exp Biol Med. 1979; 161 (4):508‑511.
  3. Flynn TG, de Bold ML, de Bold AJ. The amino acid sequence of an atrial peptide with potent diuretic and natriuretic properties. Biochem Biophys Res Commun. 1983; 117 (3):859‑865.
  4. Sudoh T, Kangawa K, Minamino N, Matsuo H. A new natriuretic peptide in porcine brain. Nature. 1988; 332 (6159):78–81.
  5. Sudoh T, Minamino N, Kangawa K, Matsuo H. C-type natriuretic peptide (CNP): a new member of natriuretic peptide family identified in porcine brain. Biochem Biophys Res Commun. 1990; 168 (2):863‑870.
  6. Kuhn M. Molecular physiology of natriuretic peptide signalling. Basic Res Cardiol. 2004; 99 (2):76–82.
  7. Gower WR Jr, Chiou S, Skolnick KA, Vesely DL. Molecular forms of circulating atrial natriuretic peptides in human plasma and their metabolites. Peptides. 1994; 15 (5):861‑867.
  8. Kazanegra R, Cheng V, Garcia A et al. A rapid test for B-type natriuretic peptide correlates with falling wedge pressures in patients treated for decompensated heart failure: a pilot study. J Card Fail. 2001; 7 (1):21–29.
  9. Maeda K, Tsutamoto T, Wada A et al. Plasma brain natriuretic peptide as a biochemical marker of high left ventricular end-diastolic pressure in patients with symptomatic left ventricular dysfunction. Am Heart J. 1998; 135 (5 Pt 1):825‑832.
  10. Baxter GF. Natriuretic peptides and myocardial ischemia. Basic Res Cardiol. 2004; 99 (2):90–93.
  11. Burley DS, Hamid SA, Baxter GF. Cardioprotective actions of peptide hormones in myocardial ischemia. Heart Fail Rev. 2007; 12 (3–4):279‑291.
  12. Sakai H, Tsutamoto T, Ishikawa C et al. Direct comparison of brain natriuretic peptide (BNP) and N-terminal pro-BNP secretion and extent of coronary artery stenosis in patients with stable coronary artery disease. Circ J. 2007; 71 (4):499‑505.
  13. Ruskoaho H. Atrial natriuretic peptide: synthesis, release, and metabolism. Pharmacol Rev. 1992; 44 (4):479‑602.
  14. D’Souza SP, Davis M, Baxter GF. Autocrine and paracrine actions of natriuretic peptides in the heart. Pharmacol Ther. 2004; 101 (2):113‑129.
  15. Clerico A, Iervasi G, Mariani G. Pathophysiologic relevance of measuring the plasma levels of cardiac natriuretic peptide honnones in hymans. Horm Metab Res. 1999; 31 (9):487‑498.
  16. Muders F, Kromer EP, Griese DP et al. Evaluation of plasma natriuretic peptides as markers for left ventricular dysfunction. Am Heart J. 1997; 134 (3):442‑449.
  17. McDonagh T, Robb S, Murdoch D et al. Biochemical detection of left ventricular systolic dysfunction. Lancet. 1998; 351 (9095):9–13.
  18. Бокерия Л. А., Голухова Е. З., Еремеева М. В. и др. Использование предшественников натрийуретических пептидов в диагностике сердечной недостаточности ишемической этиологии до и после операции аорто-коронарного шунтирования. Сердечная Недостаточность. 2004; 5 (6):272‑274.
  19. Сафрыгина Ю. В., Габрусенко С. А., Овчинников А. Г. и др. Сердечные натрийуретические пептиды у больных с гипертрофической кардиомиопатией. Кардиология. 2007; 47 (5):50–57.
  20. Sundsfjord JA, Thibault G, Larochelle P et al. Identification and plasma concentrations of the N-terminal fragment of proatrial natriuretic factor in man. J Clin Endocrinol Metab. 1988; 66 (3):605‑610.
  21. Davidson NC., Naas AA., Hanson JK. et al. Comparison of atrial natriuretic peptide, B-type natriuretic peptide, and N-terminal proatrial natriuretic peptide as indicators of left ventricular systolic dysfunction. Am J Cardiol. 1996; 77 (10):828‑831.
  22. Daggubati S, Parks JR, Overton RM et al. Adrenomedullin, endothelin, neuropeptide Y, atrial, brain, and C-natriuretic prohormone peptides compared as early heart failure indicators. Cardiovasc Res. 1997; 36 (2):246‑255.
  23. Yamamoto K, Burnett JC Jr, Jougasaki M et al. Superiority of brain natriuretic peptide as a hormonal marker of ventricular systolic and diastolic dysfunction and ventricular hypertrophy. Hypertension. 1996; 28 (6):988‑994.
  24. Bay M, Kirk V, Parner J et al. NT-proBNP: a new diagnostic screening tool to differentiate between patients with normal and reduced left ventricular systolic function. Heart. 2003; 89 (2):150‑154.
  25. Fuat A, Murphy JJ, Hungin AP et al. The diagnostic accuracy and utility of a B-type natriuretic peptide test in a community population of patients with suspected heart failure. Br J Gen Pract. 2006 May; 56 (526):327‑333.
  26. Cowie MR, Struthers AD, Wood DA et al. Value of natriuretic peptides in assessment with patients with possible new heart failure in primary care. Lancet. 1997; 350 (9088):1349–1353.
  27. Национальные Рекомендации ВНОК И ОССН по диагностике и лечению ХСН (второй пересмотр). Журнал Сердечная Недостаточность. 2007; 8 (1):4–41.
  28. Беленков Ю. Н., Мареев В. Ю. Принципы рационального лечения сердечной недостаточности. – М.: Materia Medica, 2000. – 266с.
  29. Parsonage WA, Galbraith AJ, Koerbin GL et al. Value of B-type natriuretic peptide for identifying significantly elevated pulmonary artery wedge pressure in patients treated for established chronic heart failure secondary to ischemic or idiopathic dilated cardiomyopathy. Am J Cardiol. 2005; 95 (7):883‑885.
  30. De Bold AJ, Bruneau BG, De Bold K. Mechanical and neuroendocrine regulation of the endocrine heart. Cardiovasc Res. 1996; 31 (1):7–18.

To access this material please log in or register

Register Authorize
Ru En