Key result
NT-proBNP cutoff of 556 pg/ml detects CHF in comorbid thyrotoxicosis with ~87% accuracy.
Why the study?
The optimal natriuretic peptide cut-off for diagnosing heart failure and its dynamics during therapy in comorbid patients with thyrotoxicosis needed to be determined.
Observational (n=111)
May inform adjusted natriuretic peptide thresholds in thyrotoxicosis with HF; leaves open prospective validation before practice change.
Objective:to determine the cut-off of natriuretic peptide for optimization dyagnosis heart failure in comorbid patients with thyrotoxicosis, to assess the dynamics of this indicator during therapy. Materials and methods:111 patients (58,3±5,6 years) were divided into 4 groups. Te main group consisted of 25 patients with CHD, CHF II-III FC and thyrotoxicosis; the 1st group of comparison - 30 patients with CHD and CHF II-III FC, without thyrotoxicosis; the 2nd group — 30 patients with thyrotoxicosis without CHD, the 3rd group - 26 patients with thyrotoxicosis and CHD, with no signs of CHF. Te fnding of thyroid gland, the level of NT-proBNP was estimated at baseline and afer 6 months therapy. A new cut-off NT-proBNP for the diagnosis of CHF in comorbid patients was calculated by using ROC analysis. Results:the high concentration of NT-proBNP was detected in all patients (more then 125 pg/ml), in the 2nd comparison group — 225.5 (180.1, 376.1) pg/ml. Te NT-proBNP values in the patients of the 1st and 3rd comparison groups did not differ signifcantly. Te highest level of NT-proBNP was detected in the main group — 712.1 (434.3, 893.9) pg/ml. A cut-off of this marker for screening CHF in comorbid patients with CHD and thyrotoxicosis was calculated - 556.4 pg/ml (a sensitivity of 72 %, a specifcity of 100 %, an accuracy of 87.2 % (p <0.001)). Afer 6 months therapy in the 2nd comparison group the level of NT-proBNP decreased by 74 % (р<0,0001) and has reached the normal value (64,6 (42,2;76,3)); in the main group the level decreased by 43% and was 406,7 (309,1; 498,6) pg/ml. Conclusions:the patients of all groups showed an increased concentration of NT-proBNP. Te highest level of NT-proBNP was observed in the group of patients with CHF by CHD and thyrotoxicosis. Te level of NT-proBNP was determined - 556.4 pg/ml, which allows us to diagnose CHF in patients with a combination of CHD and thyrotoxicosis.
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Pashchenko et al. (2018) conducted an observational in Chronic heart failure, coronary heart disease, and thyrotoxicosis (n=111). NT-proBNP measurement and 6-month medical therapy in comorbid CHD, CHF, and thyrotoxicosis vs. Patients with CHD and CHF without thyrotoxicosis, thyrotoxicosis without CHD, or thyrotoxicosis and CHD without CHF was evaluated on Diagnostic cut-off and levels of NT-proBNP for screening chronic heart failure in comorbid patients with CHD and thyrotoxicosis (p=<0.001). An NT-proBNP cut-off of 556.4 pg/ml diagnosed CHF in patients with comorbid CHD and thyrotoxicosis with 72% sensitivity, 100% specificity, and 87.2% accuracy (p<0.001).
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