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Diagnostic potential of cardiac natriuretic peptides in dialysis patients
F Mallamaci1, C Zoccali, G Tripepi
1CNR Centro Fisiologia Clinica e Divisione di Nefrologia, Ospedali Riuniti, Reggio Calabria, Italy.
Insights
Brain natriuretic peptide (BNP) and atrial natriuretic peptide (ANP) can help identify left ventricular hypertrophy (LVH) in dialysis patients. BNP is particularly effective for diagnosing LVH and excluding systolic dysfunction.
Area of Science:
- Cardiology
- Nephrology
- Biomarkers
Background:
- Plasma concentrations of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) predict left ventricular hypertrophy (LVH) and LV systolic dysfunction in the general population.
- The diagnostic potential of these cardiac hormones in dialysis patients remains largely unknown.
Purpose of the Study:
- To investigate the diagnostic value of ANP and BNP for assessing left ventricular (LV) mass and function in dialysis patients.
- To compare the efficacy of ANP and BNP in identifying LVH and LV systolic dysfunction in this population.
Main Methods:
- A cohort of 246 dialysis patients without clinical heart failure was studied.
- Diagnostic value of ANP and BNP for LV mass and function was assessed.
- Analyses included prospectively defined thresholds and ROC curve-derived cut-offs.
Main Results:
- Both ANP and BNP correlated significantly with LV mass and ejection fraction.
- BNP demonstrated higher sensitivity (88%) than ANP (51%) for LVH diagnosis.
- BNP showed a significantly higher negative predictive value for excluding LVH (53% vs. 31%).
- Both peptides exhibited high sensitivity for LV dysfunction but low positive predictive values.
- Both ANP and BNP were highly effective in excluding LV dysfunction (negative predictive values 97% and 96%).
Conclusions:
- Plasma concentrations of cardiac natriuretic hormones, especially BNP, are valuable for identifying LVH in dialysis patients.
- BNP is particularly useful for excluding systolic dysfunction in this patient group.
Background:
In the general population, the plasma concentrations of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) are useful to predict left ventricular hypertrophy (LVH) and LV systolic dysfunction. Whether these cardiac hormones have a similar diagnostic potential in dialysis patients is unknown.
Methods:
We studied the diagnostic value of ANP and BNP for alterations in LV mass and function in a cohort of 246 dialysis patients without clinical evidence of heart failure.
Results:
Both ANP and BNP were independently related to left ventricular mass (P < 0.0001) as well as to ejection fraction (P < 0.0001). In an analysis based on a prospectively defined threshold (95th percentile of the normal range), BNP had a significantly higher (P < 0.01) sensitivity (88%) than ANP (51%) for the diagnosis of LVH, but the positive predictive value of the two peptides was very similar (92 and 87%, respectively, P = NS). However, the negative predictive value of BNP for excluding LVH was 22% higher than that of ANP (53 vs. 31%, P = 0.05). Both natriuretic peptides had a high sensitivity for the detection of LV dysfunction (87 and 94%), but their positive predictive value was low (25 and 15%). Importantly, both ANP and BNP proved to be very useful for excluding this alteration (negative predictive value 97 and 96%, respectively). An analysis based on the "best cut-offs" of each peptide as identified on the basis of the ROC curves augmented the positive and negative prediction values of BNP for the diagnosis of LVH to 95 and 61%, respectively. This approach also raised the BNP-positive prediction value for the identification of LV dysfunction to 31% but did not modify the diagnostic potential of ANP (either for LVH or for LV dysfunction).
Conclusions:
Measuring the plasma concentration of cardiac natriuretic hormones, particularly BNP, may be useful for the identification of dialysis patients with LVH or for excluding systolic dysfunction.