December 1, 1996Hypertension
Superiority of Brain Natriuretic Peptide as a Hormonal Marker of Ventricular Systolic and Diastolic Dysfunction and Ventricular Hypertrophy
Why the study?
Does plasma BNP measurement improve the detection of left ventricular systolic dysfunction, diastolic dysfunction, and hypertrophy compared to ANP in patients referred for cardiac catheterization?
Population
94 patients referred for cardiac catheterization and 15 age-matched normal subjects (n=109)
Comparison
Measurement of plasma brain natriuretic peptide vs Measurement of plasma C-terminal atrial…
Design
Cohort
Authors
Discussion
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Implication
May support BNP over ANP for LV assessment in catheterization referrals; leaves open prospective validation and outcome impact.
Key Points
- To prospectively compare the diagnostic accuracy of plasma brain natriuretic peptide (BNP), C-terminal ANP, and N-terminal ANP-(1-30) for detecting left ventricular systolic dysfunction, diastolic dysfunction, and left ventricular hypertrophy.
- Prospectively evaluated 94 patients referred for cardiac catheterization and 15 age-matched normal control subjects.
- Assessed diagnostic performance using receiver operating characteristic (ROC) analysis to identify systolic dysfunction (ejection fraction < 45%), diastolic dysfunction (relaxation time constant > 55 ms, end-diastolic pressure > 18 mm Hg), and hypertrophy (mass index > 120 g/m²).
- BNP demonstrated ROC area under the curve values ranging from 0.715 to 0.908 across all ventricular abnormalities, significantly outperforming C-terminal ANP and N-terminal ANP-(1-30).
- Elevated plasma BNP (> mean + 3 SD of normal controls) yielded sensitivities of 0.83 for systolic dysfunction (specificity 0.77), 0.85 for delayed ventricular relaxation (specificity 0.70), 0.63 for elevated end-diastolic pressure (specificity 0.76), and 0.81 for ventricular hypertrophy (specificity 0.85).
- Combining BNP with an additional natriuretic peptide increased diagnostic sensitivity to 0.90–0.96, accompanied by a reduction in specificity (0.56–0.71).
Structured PICO
Does plasma BNP measurement improve the detection of left ventricular systolic dysfunction, diastolic dysfunction, and hypertrophy compared to ANP in patients referred for cardiac catheterization?
P
Population
94 patients referred for cardiac catheterization and 15 age-matched normal subjects (n=109)
I
Intervention
Measurement of plasma brain natriuretic peptide (BNP)
C
Comparator
Measurement of plasma C-terminal atrial natriuretic peptide (ANP) and N-terminal ANP-(1-30)
O
Outcome
Diagnostic ability to identify systolic dysfunction (ejection fraction < 45%), diastolic dysfunction (time constant of left ventricular relaxation > 55 milliseconds, left ventricular end-diastolic pressure > 18 mm Hg), and left ventricular hypertrophy (left ventricular mass index > 120 g/m2) using receiver operating characteristic analysissurrogate
Elevated plasma BNP is a superior hormonal marker for detecting left ventricular systolic dysfunction, diastolic dysfunction, and hypertrophy compared to ANP.
Cite This Study
Yamamoto et al. (1996) studied this question.