The diagnostic value of serum and urinary NT-proBNP for heart failure

Ann Clin Biochem 2008;45:389-394
doi:10.1258/acb.2007.007069
© 2008 Association for Clinical Biochemistry

 

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Articles by Michielsen, E. C H J

Articles by Dieijen-Visser, M. P V.
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Original Articles


Etienne C H J Michielsen1,
Jaap A Bakker1,
Roland R J Van Kimmenade2,
Yigal M Pinto2 and
Marja P Van Dieijen-Visser1


1 Department of Clinical Chemistry;
2 Department of Cardiology, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands


Corresponding author: Professor Dr Marja P Van Dieijen-Visser. Email: Dieijen{at}klinchem.azm.nl


Background: Serum B-type natriuretic peptide (BNP) and the amino-terminalcleavage product of the prohormone (NT-proBNP) have been shownto be valuable parameters for the diagnosis of heart failure(HF) in the general population. Urinary BNP and NT-proBNP havealso been suggested for diagnosis of HF. The present study investigatedthe diagnostic value of both serum and urinary NT-proBNP inselected groups of controls and patients diagnosed with HF.

Methods: Creatinine clearance and serum and urinary NT-proBNP were measuredin 76 controls and in 47 patients diagnosed with HF (NYHA IIIand IV). Echocardiography was used to exclude cardiac dysfunctionin the control population by the combined normality of leftventricular ejection fraction (LVEF), E/A ratio (echocardiographicearly [E] and late, or atrial [A] phases of ventricular filling),deceleration time and LV mass index. All patients diagnosedwith HF had LVEF <40%.

Results: NT-proBNP measurements in urine samples are subject to highvariability. Receiver-operating characteristic area under thecurve (AUC) for serum, urinary NT-proBNP and their productswere 0.94, 0.72 and 0.93, respectively. Correction of urinaryNT-proBNP for urinary creatinine content improved the AUC from0.72 to 0.80. Negative predictive values for ruling out HF were0.94, 0.67 and 0.89, respectively. Linear regression analysisrevealed that creatinine clearance was more important in determiningserum NT-proBNP concentrations than age.

Conclusions: Serum NT-proBNP is the best parameter to rule out HF. The productof the serum and urinary concentrations has equal value. UrinaryNT-proBNP alone performs rather poorly. Renal function influencesNT-proBNP concentrations more than age in this selected population.

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