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[Value of plasma NT-proBNP for diagnosing heart failure in patients with previous myocardial infarction]
Bing-qi Wei1, Jian Zhang, Yue-jin Yang
1Chinese Academy of Medical Sciences, Beijing, China.
Insights
Plasma N-terminal B-type natriuretic peptide (NT-proBNP) effectively diagnoses heart failure in patients with prior myocardial infarction. Elevated NT-proBNP levels indicate heart failure, with specific cut-off points aiding diagnosis.
Area of Science:
- Cardiology
- Biomarker Research
- Diagnostic Medicine
Context:
- Heart failure is a significant complication following myocardial infarction.
- Accurate diagnosis is crucial for timely intervention and improved patient outcomes.
- NT-proBNP is a widely studied biomarker for cardiac stress.
Purpose:
- To assess the diagnostic utility of plasma NT-proBNP for heart failure in post-myocardial infarction patients.
- To determine optimal cut-off values for NT-proBNP in diagnosing heart failure within this population.
- To correlate NT-proBNP levels with heart failure severity (NYHA classes).
Summary:
- Plasma NT-proBNP levels were significantly higher in heart failure patients (NYHA II-IV) compared to non-heart failure patients (NYHA I) post-myocardial infarction.
- Receiver Operating Characteristic (ROC) analysis demonstrated strong diagnostic performance (AUC 0.844) for NT-proBNP.
- Optimal cut-off points were identified, varying slightly by age, to diagnose heart failure.
Impact:
- Plasma NT-proBNP serves as a valuable and reliable biomarker for diagnosing heart failure in patients with a history of myocardial infarction.
- The study provides evidence-based cut-off values to aid clinicians in diagnosing heart failure.
- This can lead to earlier detection and management of heart failure, potentially improving prognosis.
Objective:
The study aimed to evaluate the value of plasma NT-proBNP in diagnosing heart failure in patients with previous myocardial infarction.
Methods:
Plasma concentration of NT-proBNP was measured in patients with previous myocardial infarction by ELISA method at admission. Patients were divided into non heart failure group (NYHA class I) and heart failure group (NYHA class II-IV). The NT-proBNP levels were compared between NYHA class I, II, III and IV, and between heart failure group and non heart failure group. ROC analyses were performed to evaluate the diagnosing value of plasma NT-proBNP for heart failure and to identify the optimal cut-off point for diagnosing heart failure patients.
Results:
Total 586 patients [aged from 25 - 83 (58 ± 11) years, 80% male] with previous myocardial infarction were enrolled in his study (n = 374 of NYHA class I, n = 99 of NYHA classes II, n = 82 of NYHA class III, n = 31 of NYHA class IV). Plasma NT-proBNP levels in these four NYHA classes were 484.7 (381.6, 647.8) pmol/L, 907.6 (516.6, 1290.3) pmol/L, 1420.2 (879.5, 2336.2) pmol/L, 2442.6 (1695.4, 3670.7) pmol/L, respectively (P < 0.01). The plasma NT-proBNP level in heart failure group was significantly higher than in non heart failure group [1148.2 (707.9, 2145.3) pmol/L vs. 484.7 (381.6, 647.8) pmol/L, P < 0.01]. Plasma NT-proBNP level in patients with age ≥ 60 years was significantly higher than patients with age < 60 years [702.3 (472.4, 1208.5) pmol/L vs. 526.6 (392.1, 855.6) pmol/L, P < 0.01]. ROC analysis showed that the area under the curve (AUC) for diagnosing heart failure was 0.844 (95%CI: 0.809 - 0.880, P < 0.01), the optimal plasma NT-proBNP cut-off point for diagnosing heart failure was 700 pmol/L with a sensitivity of 75.9%, a specificity of 79.9%, an accuracy of 78.3%, a positive predictive value of 67.9% and a negative predictive value of 85.3%. The optimal plasma NT-proBNP cut-off point was 600 pmol/L for patients ≥ 60 years old and 800 pmol/L for patients < 60 years old.
Conclusion:
Plasma NT-proBNP level is a valuable parameter for diagnosing heart failure in patients with previous myocardial infarction.
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