Document Detail

NT-ProBNP in outpatients after myocardial infarction: interaction between symptoms and left ventricular function and optimized cut-points.
MedLine Citation:
PMID:  15948096     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: N-terminal pro-brain natriuretic peptide (NT-proBNP) allows us to rule out left ventricular dysfunction (LVD) in the general population at a recommended cut-off concentration of 125 pg/mL. It was our objective to reassess this cut-point in outpatients after myocardial infarction. METHODS AND RESULTS: NT-proBNP was assessed in 418 randomly selected outpatients who had experienced myocardial infarction and 352 siblings who had not experienced myocardial infarction (control). Left ventricular ejection fraction (LVEF) and mass-index (LVMI) were assessed by echocardiography. NT-proBNP was elevated in outpatients after myocardial infarction (mean [+/-SEM], 305 +/- 25 pg/mL vs control, 84 +/- 8 pg/mL; P < .01) and was correlated inversely with LVEF ( P < .001). When patients were stratified according to the presence or absence of heart failure, NT-proBNP was elevated significantly throughout all LVEF strata (each P < .05). On regression analysis, NT-proBNP was correlated independently with LVEF, LVMI, heart failure, and glomerular filtration rate (all P < .01). In patients with heart failure, the optimal cut-point for the detection of an LVEF <35% was 348 pg/mL (sensitivity 80%; specificity 69%) and for the detection of an LVEF <45% was 260 pg/mL (sensitivity 60%; specificity 60%). The relative risk for LVD in the presence of elevated NT-proBNP increased from 2.7 to 7.7 (EF < 35%) and from 1.4 to 2.4 (EF < 45%) when these cut-points were applied instead of the 125 pg/mL cut-point. An LVEF of <35% could be ruled out in symptomatic outpatients after myocardial infarction with a negative predictive value of 97% (cut-point 348 pg/mL) and in asymptomatic outpatients after myocardial infarction with a negative predictive value of 98% (cut-point 157 pg/mL). CONCLUSION: NT-proBNP is higher in outpatients after myocardial infarction than in the general population. In symptomatic patients, a cut-point of 348 pg/mL yields satisfactory sensitivity and specificity for the detection of significant LVD (EF < 35%). Furthermore, significant LVD can be virtually ruled out in symptomatic and asymptomatic outpatients after myocardial infarction at below-threshold concentrations.
Andreas Luchner; Christian Hengstenberg; Hannelore Löwel; S Buchner; Heribert Schunkert; Günter A J Riegger; Stephan Holmer
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of cardiac failure     Volume:  11     ISSN:  1071-9164     ISO Abbreviation:  J. Card. Fail.     Publication Date:  2005 Jun 
Date Detail:
Created Date:  2005-06-10     Completed Date:  2006-03-09     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9442138     Medline TA:  J Card Fail     Country:  United States    
Other Details:
Languages:  eng     Pagination:  S21-7     Citation Subset:  IM    
Klinik und Poliklinik für Innere Medizin II, University of Regensburg, Regensburg, Germany.
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MeSH Terms
Ambulatory Care
Biological Markers / blood
Case-Control Studies
Middle Aged
Multivariate Analysis
Myocardial Infarction / blood*,  diagnosis*,  physiopathology
Natriuretic Peptide, Brain / blood*
Peptide Fragments / blood*
Predictive Value of Tests
Research Design
Sensitivity and Specificity
Ventricular Dysfunction, Left / blood*,  diagnosis
Ventricular Function, Left* / physiology
Reg. No./Substance:
0/Biological Markers; 0/Peptide Fragments; 0/pro-brain natriuretic peptide (1-76); 114471-18-0/Natriuretic Peptide, Brain

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