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Proteomics and Protein Markers |
1 Department of Cardiology, Linköping University Hospital, SE-581 85 Linköping, Sweden.
2 Sahlgren Academy at Gothenburg University, SE-413 45 Gothenburg, Sweden.
3 Department of Medicine, Sahlgrenska University Hospital-Östra, SE-416 85 Gothenburg, Sweden.
aAuthor for correspondence. Fax 46-13-222224; e-mail urban.alehagen{at}ihs.liu.se.
Background: The aims of this study were to measure the N-terminal fragment of pro-brain natriuretic peptide (proBNP) in plasma in medical conditions commonly found in primary care and to evaluate the utility of these measurements in identifying impaired cardiac function in elderly patients with symptoms associated with heart failure.
Methods: We studied 415 patients (221 men and 194 women; mean age, 72 years) who had contacted a primary healthcare center for dyspnea, fatigue, and/or peripheral edema. One cardiologist evaluated the patients in terms of history, physical examination, functional capacity, electrocardiography, and suspicion of heart failure. Plasma N-terminal proBNP was measured by an in-house RIA. An ejection fraction 
40% by Doppler echocardiography was regarded as reduced cardiac function. Abnormal diastolic function was defined as an abnormal mitral inflow defined as reduced ratio of peak early diastolic filling velocity to peak filling velocity at atrial contraction (E/A ratio), or as abnormal pulmonary venous flow pattern.
Results: Patients with impaired functional capacity, impaired systolic function, and/or impaired renal function had significantly increased N-terminal proBNP concentrations. By multiple regression analysis, N-terminal proBNP concentrations were also influenced by ischemic heart disease, cardiac enlargement, and certain medications but not by increased creatinine. No gender differences were observed. Patients with isolated diastolic dysfunction attributable to relaxation abnormali-ties had lower concentrations than those with normal cardiac function, whereas those with pseudonormal E/A ratios or restrictive filling patterns had higher concentrations.
Conclusions: Plasma N-terminal proBNP concentrations increase as a result of impaired systolic function, age, impaired renal function, cardiac ischemia and enlargement, and certain medications. Values are high in diastolic dysfunction with pseudonormal patterns, but not in patients with relaxation abnormalities. An increase in plasma N-terminal proBNP might be an earlier sign of abnormal cardiac function than abnormalities identified by currently used echocardiographic measurements.
The following articles in journals at HighWire Press have cited this article:
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  M Schou, U Alehagen, J P Goetze, F Gustafsson, and U Dahlstrom Effect of estimated glomerular filtration rate on plasma concentrations of B-type natriuretic peptides measured with multiple immunoassays in elderly individuals Heart, September 15, 2009; 95(18): 1514 - 1519. [Abstract] [Full Text] [PDF]
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 R. R.J. van Kimmenade, J. L. Januzzi Jr, J. A. Bakker, A. J. Houben, R. Rennenberg, A. A. Kroon, H. J.G.M. Crijns, M. P. van Dieijen-Visser, P. W. de Leeuw, and Y. M. Pinto Renal clearance of B-type natriuretic peptide and amino terminal pro-B-type natriuretic peptide a mechanistic study in hypertensive subjects. J. Am. Coll. Cardiol., March 10, 2009; 53(10): 884 - 890. [Abstract] [Full Text] [PDF]
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 S. Ghio, S. Perlini, G. Palladini, N. A. Marsan, G. Faggiano, M. Vezzoli, C. Klersy, C. Campana, G. Merlini, and L. Tavazzi Importance of the echocardiographic evaluation of right ventricular function in patients with AL amyloidosis Eur J Heart Fail, August 1, 2007; 9(8): 808 - 813. [Abstract] [Full Text] [PDF]
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 W.H. Wilson Tang, G. S. Francis, D. A. Morrow, L. K. Newby, C. P. Cannon, R. L. Jesse, A. B. Storrow, R. H. Christenson, COMMITTEE MEMBERS, R. H. Christenson, et al. National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: Clinical Utilization of Cardiac Biomarker Testing in Heart Failure Circulation, July 31, 2007; 116(5): e99 - e109. [Full Text] [PDF]
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 H. G. Wahl, S. Graf, H. Renz, and W. Fassbinder Elimination of the Cardiac Natriuretic Peptides B-Type Natriuretic Peptide (BNP) and N-Terminal proBNP by Hemodialysis Clin. Chem., June 1, 2004; 50(6): 1071 - 1074. [Full Text] [PDF]
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