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Renal function, N-terminal Pro-B-Type natriuretic peptide, propeptide big-endothelin and patients with heart failure
Ingrid Gergei1, Bernhard K Krämer1, Hubert Scharnagl2
1Vth Department of Medicine, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
Insights
NT-proBNP is useful for diagnosing heart failure but requires adjusted cut-off levels in patients with chronic kidney disease (CKD). Big-Endothelin-1 offers a reliable HFpEF diagnostic marker independent of kidney function, improving diagnosis in CKD patients.
Area of Science:
- Cardiology
- Nephrology
- Biomarker Research
Background:
- Renal dysfunction complicates NT-proBNP use in heart failure diagnosis.
- A need exists for reliable heart failure with preserved ejection fraction (HFpEF) biomarkers, especially in patients with co-existing chronic kidney disease (CKD).
- Cardiac and renal diseases often occur together, necessitating effective risk stratification.
Purpose of the Study:
- To evaluate NT-proBNP and Big-Endothelin-1 (Big-ET-1) as biomarkers for HFpEF in patients with CKD.
- To determine if Big-ET-1 can serve as a GFR-independent marker for HFpEF diagnosis.
Main Methods:
- Analysis of NT-proBNP and Big-ET-1 plasma levels in 439 HFpEF patients from the LURIC study.
- Assessment of biomarker performance across varying levels of glomerular filtration rate (GFR).
- Comparison of diagnostic cut-off points for NT-proBNP and Big-ET-1 in HFpEF detection.
Main Results:
- NT-proBNP levels increased exponentially with declining GFR, necessitating higher diagnostic cut-offs (750 pg/mL) for HFpEF in CKD patients (GFR < 60 mL/min/1.73m²).
- Big-ET-1 levels increased linearly with declining GFR but maintained a consistent diagnostic cut-off (0.85 fmol/L) for HFpEF, irrespective of GFR.
- Big-ET-1 demonstrated utility in distinguishing HFpEF from non-HF patients independently of renal function.
Conclusions:
- NT-proBNP is a valuable heart failure indicator, but its diagnostic accuracy for HFpEF is GFR-dependent.
- Big-ET-1 serves as a robust, GFR-independent biomarker for HFpEF diagnosis, particularly in CKD patients.
- Combined assessment of NT-proBNP and Big-ET-1 enhances HFpEF diagnosis in patients with chronic kidney disease.
Abstract:
Renal dysfunction may limit the clinical application of NT-proBNP in the diagnosis of heart failure. In general practice, where echocardiography is not readily available, a biomarker for the diagnosis of a heart failure with preserved ejection fraction (HFpEF) would be useful. Since cardiac diseases frequently coincide with renal disease, there is a high need of valid risk stratification methods in patients affected with both. We therefore examined NT-proBNP and another biomarker, Big-Endothelin-1, as a marker of HFpEF in patients with CKD. NT-proBNP and Big-ET-1 were determined in 439 patients with HFpEF in the Ludwigshafen Risk and Cardiovascular Health (LURIC) study. NT-proBNP plasma level has shown an exponential increase with declining GFR, while Big-ET-1 plasma level increased only in a moderate and linear fashion. In patients without CKD, a NT-proBNP cut-off point at 250 pg/mL was suitable for the discrimination between HFpEF and patients without HF. When the GFR was less than 60 mL/min/1.73m2, the NT-proBNP cut-off point should be raised to 750 pg/mL. At a cutoff point at 0.85 fmol/L, Big-ET-1 allowed to distinguish patients with HFpEF from persons without HF, independently of GFR. In general, NT-proBNP is a good indicator of suspected heart failure. While for NT-proBNP different cut-off points have to be considered in the diagnosis of HFpEF, a single cut-off point of Big-ET-1 was appropriate in the diagnosis of HFpEF, regardless of the presence or absence of CKD. An additional measurement of Big-ET-1 improves the diagnosis of HFpEF in patients with chronic kidney disease.
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