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Feng P, Qin J, Chai Z, Zhang Y, Zhao M, Liu L, Zhang L, Chen Y, Xiong Y. Analytical and clinical performance evaluation of a new NT-proBNP assay. BMC Cardiovasc Disord 2024; 24:341. [PMID: 38969996 PMCID: PMC11229486 DOI: 10.1186/s12872-024-03994-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 01/29/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND The study evaluated the performance of the Mindray N-terminal pro-B-type natriuretic peptide (NT-proBNP) in a healthy population in China, focusing on creating a reference range for future clinical applications adjusted according to different demographics. METHODS The study measured NT-proBNP in 2277 healthy individuals. We analyzed age and sex-stratified data, performed precision, accuracy, linearitcvy, and detection limit studies, and evaluated method comparison and consistency between Roche and Mindray assays on 724 serum samples. We used Excel 2010, Medcalc, and GraphPad Prism 9. RESULTS In males, the 97.5th centile NT-proBNP concentration at age < 45, 45 to 54, 55 to 64, 65 to 74 and ≧ 75 were 89.4 ng/L, 126 ng/L, 206 ng/L, 386 ng/L and 522 ng/L, respectively. In females, the concentration of NT-proBNP at the same age was 132 ng/L, 229 ng/L, 262 ng/L, 297 ng/L and 807 ng/L, respectively. The repeatability precision coefficient of variation (CV%) for NT-proBNP was between 0.86 and 1.65 in analytical performance. In contrast, the reproducibility precision (CV%) for NT-proBNP was between 1.52 and 3.22, respectively. The study found a bias of accuracy of 3.73% in low-value samples (concentration: 148.69) and 7.31% in high-value samples (concentration: 1939.08). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 125 ng/L were 96.6%, 92.3%, 84.2%, and 98.5%, respectively. In contrast, those of 300 ng/L were 94.0%, 98.2%, 95.7% and 97.5%, respectively. CONCLUSIONS The Mindray NT-proBNP assay showed increased levels in both males and females with age, with higher levels in women. It performs well and aligns with manufacturer specifications. We recommend adjusting cutoff values based on demographic factors.
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Affiliation(s)
- Pingfeng Feng
- Department of Medical Laboratory, Nanfang Hospital Southern Medical University, No.1838, Guangzhou Avenue North, Guangzhou, 510515, China
| | - Junlong Qin
- Medical Laboratory of ShenzhenLuohu Hospital Group, Shenzhen, 518005, China
| | - Zhixin Chai
- Department of Medical Laboratory, Nanfang Hospital Southern Medical University, No.1838, Guangzhou Avenue North, Guangzhou, 510515, China
| | - Yajie Zhang
- Department of Medical Laboratory, Nanfang Hospital Southern Medical University, No.1838, Guangzhou Avenue North, Guangzhou, 510515, China
| | - Minghai Zhao
- Department of Medical Laboratory, Nanfang Hospital Southern Medical University, No.1838, Guangzhou Avenue North, Guangzhou, 510515, China
| | - Liya Liu
- Medical Laboratory of ShenzhenLuohu Hospital Group, Shenzhen, 518005, China
| | - Lijun Zhang
- Medical Laboratory of ShenzhenLuohu Hospital Group, Shenzhen, 518005, China
| | - Yaqiong Chen
- Medical Laboratory of ShenzhenLuohu Hospital Group, Shenzhen, 518005, China
| | - Yufeng Xiong
- Department of Medical Laboratory, Nanfang Hospital Southern Medical University, No.1838, Guangzhou Avenue North, Guangzhou, 510515, China.
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Gruson D, Hammerer-Lercher A, Collinson P, Duff C, Baum H, Pulkki K, Suvisaari J, Stankovic S, Laitinen P, Bayes-Genis A. The multidimensional value of natriuretic peptides in heart failure, integrating laboratory and clinical aspects. Crit Rev Clin Lab Sci 2024:1-15. [PMID: 38523480 DOI: 10.1080/10408363.2024.2319578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/13/2024] [Indexed: 03/26/2024]
Abstract
Natriuretic peptides (NP) play an essential role in heart failure (HF) regulation, and their measurement has improved diagnostic and prognostic accuracy. Clinical symptoms and objective measurements, such as NP levels, should be included in the HF definition to render it more reliable and consistent among observers, hospitals, and healthcare systems. BNP and NT-proBNP are reasonable surrogates for cardiac disease, and their measurement is critical to early diagnosis and risk stratification of HF patients. NPs should be measured in all patients presenting with dyspnea or other symptoms suggestive of HF to facilitate early diagnosis and risk stratification. Both BNP and NT-proBNP are currently used for guided HF management and display comparable diagnostic and prognostic accuracy. Standardized cutoffs for each NP assay are essential for data comparison. The value of NP testing is recognized at various levels, including patient empowerment and education, analytical and operational issues, clinical HF management, and cost-effectiveness.
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Affiliation(s)
- Damien Gruson
- Pôle de recherche en Endocrinologie, Diabète et Nutrition, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires St-Luc and Université Catholique de Louvain, Brussels, Belgium
- Department of Clinical Biochemistry, Cliniques Universitaires St-Luc and Université Catholique de Louvain, Brussels, Belgium
| | | | - Paul Collinson
- Department of Clinical Blood Science Chemical Pathology and Cardiology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Christopher Duff
- Department of Clinical Biochemistry, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | - Hannsjörg Baum
- Department Laboratory Medicine, Regionale Kliniken Holding RKH, Ludwigsburg, Germany
| | - Kari Pulkki
- Clinical Chemistry and Hematology, Diagnostic Center, Helsinki University Hospital and the University of Helsinki, Helsinki, Finland
| | - Janne Suvisaari
- Clinical Chemistry and Hematology, Diagnostic Center, Helsinki University Hospital and the University of Helsinki, Helsinki, Finland
| | - Sanja Stankovic
- Center for Medical Biochemistry, University Clinical Center of Serbia, Belgrade, Serbia
- Department of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Paivi Laitinen
- Center for Medical Biochemistry, University Clinical Center of Serbia, Belgrade, Serbia
| | - Antoni Bayes-Genis
- Germans Trias Heart Institute (iCor), Pujol, Universitat Autònoma de Barcelona; CIBERCV, Barcelona, Spain
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3
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Lundgren M, Ridefelt P, Karlsson M, Norling A, Larsson A. Interlaboratory variation for NT-proBNP among Swedish laboratories in an external quality program 2011-2021. Clin Chem Lab Med 2023; 61:1643-1651. [PMID: 36988017 DOI: 10.1515/cclm-2023-0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/14/2023] [Indexed: 03/30/2023]
Abstract
OBJECTIVES NT-proBNP is frequently used for ruling out heart failure. Different cut-offs are used depending on the clinical context, e.g. an acute or chronic condition. Medical decision limits have been suggested at 125 and 300 ng/L or 400 ng/L in international guidelines. However, there is limited standardization between NT-proBNP methods and using the same blood sample might cause different treatment of patients. METHODS Data from the external quality assessment program for NT-proBNP from Equalis, Sweden, were extracted for the period 2011-2021, and categorized according to manufacturer. Manufacturer median NT-proBNP values were compared to total median values. CV% was calculated for each manufacturer and in comparison to different levels of NT-proBNP. RESULTS Roche was the most common method, and its median results were closest to the median consensus results. When looking at the total CV at NT-proBNP levels in the range of 0-500 ng/L, the total CV varied from 4 to 27%. During 2019-2021, Siemens (Immulite, Centaur, Atellica) yielded results 16-20% above the consensus median depending on sample level. Similarly, Abbott was 5-7% above, while Roche and Siemens Stratus were 1% respectively 6-10% below the consensus median. CONCLUSIONS The introduction of new manufacturers and methods in 2017 have caused the agreement between manufacturers to decline. This highlights the need for a common calibrator and reference materials, particularly since medical decision limits in guidelines, e.g. European Society of Cardiology 2021, which are mostly based on Roche methods, do not take these method differences into account.
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Affiliation(s)
- Morgan Lundgren
- Department of Medical Sciences, Clinical Chemistry, Uppsala University, Uppsala, Sweden
| | - Peter Ridefelt
- Department of Medical Sciences, Clinical Chemistry, Uppsala University, Uppsala, Sweden
| | - Mathias Karlsson
- Equalis AB (External Quality Assurance in Laboratory Medicine in Sweden), Uppsala, Sweden
| | - Anna Norling
- Equalis AB (External Quality Assurance in Laboratory Medicine in Sweden), Uppsala, Sweden
| | - Anders Larsson
- Department of Medical Sciences, Clinical Chemistry, Uppsala University, Uppsala, Sweden
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Maidana D, Bonanad C, Ortiz-Cortés C, Arroyo-Álvarez A, Barreres-Martín G, Muñoz-Alfonso C, Maicas-Alcaine E, García-Pérez C, Aparici-Redal A, Freitas-Durks V, Esteban-Fernández A. Sex-Related Differences in Heart Failure Diagnosis. Curr Heart Fail Rep 2023; 20:254-262. [PMID: 37310594 DOI: 10.1007/s11897-023-00609-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/10/2023] [Indexed: 06/14/2023]
Abstract
PURPOSE OF REVIEW The literature on the importance of sex in heart failure diagnosis is scarce. This review aims to summarize current knowledge on sex differences regarding the diagnosis of heart failure. RECENT FINDINGS Comorbidities are frequent in patients with heart failure, and their prevalence differs between sexes; some differences in symptomatology and diagnostic imaging techniques were also found. Biomarkers also usually show differences between sexes but are not significant enough to establish sex-specific ranges. This article outlines current information related to sex differences in HF diagnosis. Research in this field remains to be done. Maintaining a high diagnostic suspicion, actively searching for the disease, and considering the sex is relevant for early diagnosis and better prognosis. In addition, more studies with equal representation are needed.
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Affiliation(s)
- Daniela Maidana
- INCLIVA Biomedical Research Institute, 46010, Valencia, Spain
| | - Clara Bonanad
- INCLIVA Biomedical Research Institute, 46010, Valencia, Spain.
- Cardiology Department, Clinic University Hospital of Valencia, 46010, Valencia, Spain.
- University of Valencia, Valencia, Spain.
| | | | | | | | | | | | | | | | | | - Alberto Esteban-Fernández
- University of Valencia, Valencia, Spain
- Cardiology Department, University Hospital Severo Ochoa, 28911, Leganés, Madrid, Spain
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Núñez-Marín G, Iraola D, Lorenzo M, de la Espriella R, Villar S, Santas E, Miñana G, Sanchis J, Carratalá A, Miró Ò, Bayés-Genís A, Núñez J. An update on utilising brain natriuretic peptide for risk stratification, monitoring and guiding therapy in heart failure. Expert Rev Mol Diagn 2023:1-13. [PMID: 37216616 DOI: 10.1080/14737159.2023.2216386] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/04/2023] [Accepted: 05/16/2023] [Indexed: 05/24/2023]
Abstract
INTRODUCTION Heart failure (HF) is a dominant health problem with an overall poor prognosis. Natriuretic peptides (NPs) are upregulated in HF as a compensatory mechanism. They have extensively been used for diagnosis and risk stratification. AREAS COVERED This review addresses the history and physiology of NPs in order to understand their current role in clinical practice. It further provides a detailed and updated narrative review on the utility of those biomarkers for risk stratification, monitoring, and guiding therapy in HF. EXPERT OPINION NPs show excellent predictive ability in heart failure patients, both in acute and chronic settings. Understanding their pathophysiology and their modifications in specific situations is key for an adequate interpretation in specific clinical scenarios in which their prognostic value may be weaker or less well evaluated. To better promote risk stratification in HF, NPs should be integrated with other predictive tools to develop multiparametric risk models. Both inequalities of access to NPs and evidence caveats and limitations will need to be addressed by future research in the coming years.
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Affiliation(s)
- Gonzalo Núñez-Marín
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia. Valencia, Spain. Valencia, Spain
| | - Diego Iraola
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia. Valencia, Spain. Valencia, Spain
| | - Miguel Lorenzo
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia. Valencia, Spain. Valencia, Spain
| | - Rafael de la Espriella
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia. Valencia, Spain. Valencia, Spain
| | - Sandra Villar
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia. Valencia, Spain. Valencia, Spain
| | - Enrique Santas
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia. Valencia, Spain. Valencia, Spain
| | - Gema Miñana
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia. Valencia, Spain. Valencia, Spain
| | - Juan Sanchis
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia. Valencia, Spain. Valencia, Spain
| | - Arturo Carratalá
- Clinical Chemistry Department, Hospital Clínico Universitario, INCLIVA
| | - Òscar Miró
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Antoni Bayés-Genís
- Cardiology Department, Hospital Universitari Germas Trias i Pujol. Badalona, Spain
- CIBER Cardiovascular, Madrid, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia. Valencia, Spain. Valencia, Spain
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
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6
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Li L, Semenov AG, Feygina EE, Yang C, Wang N, Chen C, Hu X, Ni X, Zhang Z. Diagnostic utility of total NT-proBNP testing by immunoassay based on antibodies targeting glycosylation-free regions of NT-proBNP. Clin Chem Lab Med 2023; 61:485-493. [PMID: 36457141 DOI: 10.1515/cclm-2022-1194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 11/24/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVES The N-terminal fragment of pro-B-type natriuretic peptide (NT-proBNP) is a widely used heart failure (HF) biomarker. Commercial NT-proBNP immunoassays detect only a subfraction of endogenous NT-proBNP, as the antibodies target a region of NT-proBNP that could be glycosylated at Ser44. The diagnostic utility of immunoassays measuring total NT-proBNP remains unclear. METHODS NT-proBNP was measured in 183 HF and 200 non-HF patients diagnosed by two independent cardiologists blinded to NT-proBNP results. Plasma samples either non-treated or treated with a mixture of glycosidases were analyzed by the Elecsys proBNP II assay (Roche Diagnostics, based on antibodies targeting a glycosylated region of NT-proBNP) and the SuperFlex NT-proBNP assay (PerkinElmer, based on antibodies targeting regions of NT-proBNP that are free of O-glycans). The diagnostic accuracy of the two assays was analyzed by comparison of ROC curves. RESULTS The ROC-AUC for the proBNP II assay was 0.943 (95% CI 0.922-0.964) for NT-proBNP measured in untreated samples and 0.935 (0.913-0.958) for NT-proBNP measured in glycosidase-treated samples. The SuperFlex NT-proBNP assay in untreated samples gave a ROC-AUC of 0.930 (95% CI 0.907-0.954). The median percentage of non-glycosylated NT-proBNP to total NT-proBNP was 1.5-1.6-fold lower in the non-HF group compared to that in the HF group. CONCLUSIONS The clinical value of total NT-proBNP for HF diagnosis was similar to the subfraction of NT-proBNP that was non-glycosylated at Ser44. The lower percentage of non-glycosylated NT-proBNP to total NT-proBNP in non-HF patients suggests that total NT-proBNP might be more sensitive in individuals without current or prior symptoms of HF.
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Affiliation(s)
- Ling Li
- Wuhan Asia Heart Hospital, Wuhan, P.R. China
| | | | | | | | - Nan Wang
- HyTest group, Shanghai, P.R. China
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7
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Nougué H, Michel T, Picard F, Lassus J, Sadoune M, Laribi S, Cohen-Solal A, Logeart D, Launay JM, Vodovar N. Deconvolution of BNP and NT-proBNP Immunoreactivities by Mass Spectrometry in Heart Failure and Sacubitril/Valsartan Treatment. Clin Chem 2023; 69:350-362. [PMID: 36762414 DOI: 10.1093/clinchem/hvac225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 12/13/2022] [Indexed: 02/11/2023]
Abstract
BACKGROUND Elevated BNP and the N-terminal fragment of the proBNP (NT-proBNP) are hallmarks of heart failure (HF). Generally, both biomarkers parallel each other. In patients receiving sacubitril/valsartan, BNP remained stable while NT-proBNP decreased. As BNP and NT-proBNP assays have limited specificity due to cross-reactivity, we quantified by mass spectrometry (MS) the contributing molecular species. METHODS We included 356 healthy volunteers, 100 patients with acute dyspnoea (49 acute decompensated HF; 51 dyspnoea of non-cardiac origin), and 73 patients with chronic HF and reduced ejection fraction treated with sacubitril/valsartan. BNP and NT-proBNP immunoreactivities (BNPir and NT-proBNPir) were measured by immunoassays (Abbott ARCHITECT and Roche Diagnostics proBNPII) and proBNP-derived peptides and glycosylation at serine 44 by MS on plasma samples. RESULTS BNPir corresponded to the sum of proBNP1-108, BNP1-32, BNP3-32, and BNP5-32 (R2 = 0.9995), while NT-proBNPir corresponded to proBNP1-108 and NT-proBNP1-76 not glycosylated at serine 44 (R2 = 0.992). NT-proBNPir was better correlated (R2 = 0.9597) than BNPir (R2 = 0.7643) with proBNP signal peptide (a surrogate of proBNP production). In patients receiving sacubitril/valsartan, non-glycosylated NT-proBNP1-76 remained constant (P = 0.84) despite an increase in NT-proBNP1-76 and its glycosylation (P < 0.0001). ProBNP1-108 remained constant (P = 0.12) while its glycosylation increased (P < 0.0001), resulting in a decrease in non-glycosylated proBNP1-108 (P < 0.0001), and in NT-proBNPir. CONCLUSIONS Glycosylation interfered with NT-proBNPir measurement, explaining the discrepant evolution of these 2 biomarkers in patients receiving sacubitril/valsartan. Both BNPir and NT-proBNPir are surrogates of proBNP1-108 production, NT-proBNPir being more robust in the clinical contexts studied.
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Affiliation(s)
- Hélène Nougué
- Université Paris Cité and Inserm UMR-S 942, Paris, France.,Department of Anesthesiology and Intensive Care, Saint-Louis and Lariboisière Hospital, Paris, France
| | | | | | - Johan Lassus
- Heart and Lung Center, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Malha Sadoune
- Université Paris Cité and Inserm UMR-S 942, Paris, France
| | - Said Laribi
- Emergency Medicine Department, Tours University Hospital, Tours, France
| | - Alain Cohen-Solal
- Université Paris Cité and Inserm UMR-S 942, Paris, France.,Department of Cardiology, Lariboisière Hospital, Paris, France
| | - Damien Logeart
- Université Paris Cité and Inserm UMR-S 942, Paris, France.,Department of Cardiology, Lariboisière Hospital, Paris, France
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Inflammageing and Cardiovascular System: Focus on Cardiokines and Cardiac-Specific Biomarkers. Int J Mol Sci 2023; 24:ijms24010844. [PMID: 36614282 PMCID: PMC9820990 DOI: 10.3390/ijms24010844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/26/2022] [Accepted: 12/28/2022] [Indexed: 01/05/2023] Open
Abstract
The term "inflammageing" was introduced in 2000, with the aim of describing the chronic inflammatory state typical of elderly individuals, which is characterized by a combination of elevated levels of inflammatory biomarkers, a high burden of comorbidities, an elevated risk of disability, frailty, and premature death. Inflammageing is a hallmark of various cardiovascular diseases, including atherosclerosis, hypertension, and rapid progression to heart failure. The great experimental and clinical evidence accumulated in recent years has clearly demonstrated that early detection and counteraction of inflammageing is a promising strategy not only to prevent cardiovascular disease, but also to slow down the progressive decline of health that occurs with ageing. It is conceivable that beneficial effects of counteracting inflammageing should be most effective if implemented in the early stages, when the compensatory capacity of the organism is not completely exhausted. Early interventions and treatments require early diagnosis using reliable and cost-effective biomarkers. Indeed, recent clinical studies have demonstrated that cardiac-specific biomarkers (i.e., cardiac natriuretic peptides and cardiac troponins) are able to identify, even in the general population, the individuals at highest risk of progression to heart failure. However, further clinical studies are needed to better understand the usefulness and cost/benefit ratio of cardiac-specific biomarkers as potential targets in preventive and therapeutic strategies for early detection and counteraction of inflammageing mechanisms and in this way slowing the progressive decline of health that occurs with ageing.
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Kavsak PA. The PROVE-HF Study: Additional Proof for the Inclusion of the Manufacturer’s Name When Reporting B-Type Natriuretic Peptide Results. Clin Chem 2022; 68:1353-1355. [DOI: 10.1093/clinchem/hvac156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Peter A Kavsak
- Department of Pathology and Molecular Medicine, McMaster University , Hamilton, ON , Canada
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10
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Lewis LK, Raudsepp SD, Whitlow JC, Appleby S, Pemberton CJ, Yandle TG, Mark Richards A. Assays Specific for BNP1-32 and NT-proBNP Exhibit a Similar Performance to Two Widely Used Assays in the Diagnosis of Heart Failure. Clin Chem 2022; 68:1292-1301. [PMID: 35932191 DOI: 10.1093/clinchem/hvac126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/29/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Secretion of cardioprotective B-type natriuretic peptide 1-32 (BNP1-32) is increased proportionately with cardiac dysfunction, but its measurement in plasma is difficult. Therefore, less specific BNP and amino-terminal proBNP (NT-proBNP) assays that detect the precursor molecule proBNP alongside BNP or NT-proBNP metabolites were developed to reflect BNP1-32 secretion and are now mandated in the diagnosis of heart failure (HF). We compared the diagnostic performance of 2 widely used clinical assays: the Roche proBNPII assay, and Abbott BNP assay, against our recently developed in-house assays that measure either intact BNP1-32 or NT-proBNP. METHODS EDTA plasma samples obtained from patients presenting with breathlessness (n = 195, 60 [31%] with clinically adjudicated HF) were assayed using the Roche NT-proBNP and our specific in-house BNP1-32 and NTBNP assays. A subset (n = 75) were also assessed with the Abbott BNP assay. RESULTS Roche NT-proBNP was highly correlated with BNP1-32 and NTBNP (Spearman rho = 0.92 and 0.90, respectively, both Ps < 0.001), and all 3 assays similarly discriminated acute HF from other causes of breathlessness (ROC analysis areas under the curve 0.85-0.89). The Abbott BNP assay performed similarly to the other assays. Roche NT-proBNP and BNP1-32 assays had similar sensitivity (83% and 80%), specificity (83% and 84%), positive (70% and 71%) and negative (91% and 90%) predictive values, and accuracy (both 83%) at their optimal cutoffs of 1536 and 12 ng/L, respectively. CONCLUSIONS Since all assays exhibited similar performance in the diagnosis of HF, currently mandated assays provide a reliable proxy for circulating concentrations of active BNP1-32 in HF diagnosis.
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Affiliation(s)
- Lynley K Lewis
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Sara D Raudsepp
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Joanna C Whitlow
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Sarah Appleby
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Christopher J Pemberton
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Timothy G Yandle
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, New Zealand
| | - A Mark Richards
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, New Zealand.,Cardiovascular Research Institute, National University Heart Centre, National University of Singapore, Singapore, Singapore
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11
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Averina M, Stylidis M, Brox J, Schirmer H. NT-ProBNP and high-sensitivity troponin T as screening tests for subclinical chronic heart failure in a general population. ESC Heart Fail 2022; 9:1954-1962. [PMID: 35322586 PMCID: PMC9065856 DOI: 10.1002/ehf2.13906] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/16/2022] [Accepted: 03/07/2022] [Indexed: 11/28/2022] Open
Abstract
Aims The aim of this study was to establish age‐specific and sex‐specific cut‐off values for N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) and high‐sensitivity troponin T (hs‐troponin T) in healthy subjects and assess cardiac biomarkers as screening tools for subclinical heart failure (HF) in a general population. Methods and results Altogether, 1936 participants were randomly selected from the general population Tromsø 7 study in Northern Norway. Diagnostic accuracy (sensitivity, specificity, and negative and positive predictive value) of cardiac markers for echocardiographically defined subclinical HF was evaluated. The receiver‐operating characteristic analysis showed that areas under the curve were relatively low (under 0.75) for both NT‐proBNP and hs‐troponin T, suggesting that the diagnostic accuracy of these biomarkers for subclinical HF was not excellent, especially for mild forms of HF and younger age group 40–49 years. Sex‐specific and age‐specific cut‐offs for hs‐troponin T (99th percentiles) and NT‐proBNP (97.5th percentiles) were established in healthy subjects from the same general population. The sex‐specific and age‐specific cut‐offs for NT‐proBNP had higher specificity for subclinical HF compared with the previously established single cut‐off 125 pg/mL. Age‐specific cut‐off for hs‐troponin T (18 ng/L) for men ≥60 years had also higher specificity than the single cut‐off 14 ng/L. These cut‐offs had high specificity, but low sensitivity, that makes hs‐troponin T and NT‐proBNP good biomarkers to rule in HF in case of a positive test, but not good enough to rule out all unrecognized HF due to false negative results. Conclusions N‐terminal pro‐brain natriuretic peptide and hs‐troponin T are suboptimal screening tools for subclinical HF in a general population due to low sensitivity.
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Affiliation(s)
- Maria Averina
- Department of Laboratory Medicine, University Hospital of North Norway, Tromsø, 9038, Norway.,Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Michael Stylidis
- Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Jan Brox
- Department of Laboratory Medicine, University Hospital of North Norway, Tromsø, 9038, Norway
| | - Henrik Schirmer
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, Cardiovascular Research Group, Campus Ahus, University of Oslo, Oslo, Norway.,Institute of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
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Serum N-terminal-pro-B-type natriuretic peptide is dependent on age and sex: a cross-sectional analysis in healthy adults from Northeast China. CARDIOLOGY PLUS 2022. [DOI: 10.1097/cp9.0000000000000004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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13
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Eriguchi M, Tsuruya K, Lopes M, Bieber B, McCullough K, Pecoits-Filho R, Robinson B, Pisoni R, Kanda E, Iseki K, Hirakata H. Routinely measured cardiac troponin I and N-terminal pro-B-type natriuretic peptide as predictors of mortality in haemodialysis patients. ESC Heart Fail 2022; 9:1138-1151. [PMID: 35026869 PMCID: PMC8934949 DOI: 10.1002/ehf2.13784] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 10/30/2021] [Accepted: 12/13/2021] [Indexed: 11/16/2022] Open
Abstract
Aims Cardiac troponin (cTn) and B‐type natriuretic peptide (BNP) are elevated in haemodialysis (HD) patients, and this elevation is associated with HD‐induced myocardial stunning/myocardial strain. However, studies using data from the international Dialysis Outcomes and Practice Patterns Study (DOPPS) have shown that these cardiac biomarkers are measured in <2% of HD patients in real‐world practice. This study aimed to examine whether routinely measured N‐terminal pro‐BNP (NT‐proBNP) and cTnI (contemporary assay) are more appropriate than clinical models for reclassifying the risk of HD patients who have the highest risk of death. Methods and results Pre‐dialysis levels of cTnI and NT‐proBNP at study enrolment were measured in 1152 HD patients (Japan DOPPS Phase 5). The patients were prospectively followed for 3 years. Cox regression was used to test the associations of cardiac biomarkers with all‐cause mortality, adjusting for potential confounders. Subgroup analyses were performed to assess potential effect modification of clinical characteristics, such as age, systolic blood pressure, HD vintage, diabetes mellitus, coronary artery disease, and a history of congestive heart failure. At baseline, 337 (29%) patients had elevated cTnI (99th percentile of a healthy population: >0.04 ng/mL) with a median (inter‐quartile range) level of 0.020 (0.005–0.041) ng/mL, and 1140 (99%) patients had elevated NT‐proBNP (cut‐off for heart failure: >125 pg/mL) with a median level of 3658 (1689–9356) pg/mL. There were 167 deaths during a median follow‐up of 2.8 (2.2–2.8) years. Higher levels of both cardiac biomarkers were incrementally associated with mortality after adjustment for potential confounders. Even after adjustment for alternative cardiac biomarkers, the overall P value for the association was <0.01 for both biomarkers. However, the prognostic significance of NT‐proBNP was moderately diminished when cTnI was added to the model. The hazard ratios of mortality for cTnI > 0.04 ng/mL (vs. cTnI < 0.006 ng/mL) and NT‐proBNP > 8000 pg/mL (vs. NT‐proBNP < 2000 pg/mL) were 2.56 (95% confidence interval: 1.37–4.81) and 1.90 (95% confidence interval: 0.95–3.79), respectively. Subgroup analyses showed that the associations of both cardiac biomarkers with mortality were generally consistent between stratified groups. Conclusions Routinely measured NT‐proBNP and cTnI levels are strongly associated with mortality among prevalent HD patients. These associations remain robust, even after adjustment for alternative biomarkers, suggesting that cTnI and NT‐proBNP have identical prognostic significance and may reflect different pathological aspects of cardiac abnormalities.
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Affiliation(s)
- Masahiro Eriguchi
- Department of Nephrology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
| | - Kazuhiko Tsuruya
- Department of Nephrology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
| | - Marcelo Lopes
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | - Brian Bieber
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | | | | | - Bruce Robinson
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | - Ronald Pisoni
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | - Eiichiro Kanda
- Department of Medical Science, Kawasaki Medical School, Kurashiki, Japan
| | - Kunitoshi Iseki
- Clinical Research Support Center, Nakamura Clinic, Okinawa, Japan
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Januzzi JL, Tan X, Yang L, Brady JE, Yang M, Banka P, Lautsch D. N-terminal pro-B-type natriuretic peptide testing patterns in patients with heart failure with reduced ejection fraction. ESC Heart Fail 2021; 9:87-99. [PMID: 34918487 PMCID: PMC8787988 DOI: 10.1002/ehf2.13749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/20/2021] [Accepted: 11/18/2021] [Indexed: 11/23/2022] Open
Abstract
Aims The N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) is a commonly used biomarker in heart failure for diagnosis and prognostication. We aimed to determine the prevalence of NT‐proBNP testing, distribution of NT‐proBNP concentrations, and factors associated with receiving an NT‐proBNP test in patients with heart failure with reduced ejection fraction (HFrEF), including the subset with a worsening heart failure event (WHFE). Methods and results This was a retrospective cohort study using two US databases: (i) the de‐identified Humana Research Database between January 2015 and December 2018 and (ii) the Veradigm PINNACLE Registry® between July 2013 and September 2017. We included adult patients with a confirmed diagnosis of HFrEF. In each data source, a subgroup of patients with a WHFE was identified, where a WHFE was defined as a heart failure‐related hospitalization or receipt of intravenous diuretics. Bivariate and multivariate analyses were conducted to assess factors associated with receiving NT‐proBNP testing. In Cohort 1 (n = 249 238), 9.2% of patients with HFrEF and 10.8% of patients with a WHFE received NT‐proBNP testing. When restricted to patients with at least one laboratory claim, 11.3% of patients with HFrEF and 13.2% of those with a WHFE received NT‐proBNP testing. In Cohort 2 (n = 91 444), 2.3% of patients with HFrEF were tested. Median (inter‐quartile range) NT‐proBNP concentrations among patients with HFrEF were 1399 (423–4087) pg/mL in Cohort 1 and 394 (142–688) pg/mL in Cohort 2. Median (inter‐quartile range) NT‐proBNP concentrations in the subset of patients with a WHFE in each cohort were 2209 (740–5894) and 464 (174–783) pg/mL, respectively. In Cohort 1, 13.4% of all HFrEF patients receiving NT‐proBNP testing and 18.9% of patients with a WHFE had NT‐proBNP values >8000 pg/mL; in Cohort 2, these percentages were 1.0% and 2.5%, respectively. Conclusions In US clinical practice, NT‐proBNP testing was not frequently performed in patients with HFrEF. NT‐proBNP concentrations varied across data sources and subpopulations within HFrEF.
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Affiliation(s)
- James L Januzzi
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Baim Institute for Clinical Research, Boston, MA, USA
| | - Xi Tan
- Merck & Co., Inc., Kenilworth, NJ, USA
| | | | | | - Mei Yang
- Merck & Co., Inc., Kenilworth, NJ, USA
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15
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Kavsak PA, Lam CSP, Saenger AK, Aakre KM, Body R, Hammarsten O, Collinson P, Ordóñez-Llanos J, Omland T, Jaffe AS, Apple FS. Biomarker Testing Considerations in the Evaluation and Management of Patients With Heart Failure: Perspectives From the International Federation of Clinical Chemistry and Laboratory Medicine Committee. J Card Fail 2021; 27:1456-1461. [PMID: 34256137 DOI: 10.1016/j.cardfail.2021.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 06/15/2021] [Accepted: 06/17/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Peter A Kavsak
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.
| | - Carolyn S P Lam
- National Heart Centre and Duke-National University of Singapore, Singapore, Singapore
| | - Amy K Saenger
- Department of Laboratory Medicine and Pathology, Hennepin Healthcare/HCMC, Minneapolis, Minnesota; USA and Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - Kristin Moberg Aakre
- Department of Medical Biochemistry and Pharmacology and Department of Heart Disease, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Richard Body
- Emergency Department, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK; Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK; Healthcare Sciences Department, Manchester Metropolitan University, Manchester, UK
| | - Ola Hammarsten
- Department of Clinical Chemistry and Transfusion Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Paul Collinson
- Department of Clinical Blood Sciences and Cardiology, St George's University Hospitals NHS Foundation Trust and St George's University of London, London, UK
| | - Jordi Ordóñez-Llanos
- Servicio de Bioquímica Clínica, Institut d'Investigacions Biomèdiques Sant Pau, Barcelona, Spain; Departamento de Bioquímica y Biología Molecular, Universidad Autònoma de Barcelona, Barcelona, Spain
| | - Torbjørn Omland
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Allan S Jaffe
- Departments of Laboratory Medicine and Pathology and Cardiology, Mayo Clinic, Rochester, Minnesota
| | - Fred S Apple
- Department of Laboratory Medicine and Pathology, Hennepin Healthcare/HCMC, Minneapolis, Minnesota; USA and Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
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Elhassan MG, Chao PW, Curiel A. The Conundrum of Volume Status Assessment: Revisiting Current and Future Tools Available for Physicians at the Bedside. Cureus 2021; 13:e15253. [PMID: 34188992 PMCID: PMC8231469 DOI: 10.7759/cureus.15253] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Assessment of patients’ volume status at the bedside is a very important clinical skill that physicians need in many clinical scenarios. Hypovolemia with hypotension and tissue under-perfusion are usually more alarming to physicians, but hypervolemia is also associated with poor outcomes, making euvolemia a crucial goal in clinical practice. Nevertheless, the assessment of volume status can be challenging, especially in the absence of a gold standard test that is reliable and easily accessible to assist with clinical decision-making. Physicians need to have a broad knowledge of the individual non-invasive clinical tools available for them at the bedside to evaluate volume status. In this review, we will discuss the strengths and limitations of the traditional tools, which include careful history taking, physical examination, and basic laboratory tests, and also include the relatively new tool of point-of-care ultrasound.
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Affiliation(s)
| | - Peter W Chao
- Internal Medicine, Saint Agnes Medical Center, Fresno, USA
| | - Argenis Curiel
- Internal Medicine, Saint Agnes Medical Center, Fresno, USA
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Savonnet M, Rolland T, Cubizolles M, Roupioz Y, Buhot A. Recent advances in cardiac biomarkers detection: From commercial devices to emerging technologies. J Pharm Biomed Anal 2020; 194:113777. [PMID: 33293175 DOI: 10.1016/j.jpba.2020.113777] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 11/13/2020] [Accepted: 11/16/2020] [Indexed: 01/09/2023]
Abstract
Although cardiac pathologies are the major cause of death in the world, it remains difficult to provide a reliable diagnosis to prevent heart attacks. Rapid patient care and management in emergencies are critical to prevent dramatic consequences. Thus, relevant biomarkers such as cardiac troponin and natriuretic peptides are currently targeted by commercialized Point-Of-Care immunoassays. Key points still to be addressed concern cost, lack of standardization, and poor specificity, which could limit the reliability of the assays. Consequently, alternatives are emerging to address these issues. New probe molecules such as aptamers or molecularly imprinted polymers should allow a reduction in cost of the assays and an increase in reproducibility. In addition, the assay specificity and reliability could be improved by enabling multiplexing through the detection of several molecular targets in a single device.
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Affiliation(s)
- Maud Savonnet
- Univ. Grenoble Alpes, CEA, CNRS, IRIG, SyMMES, F-38000, Grenoble, France; Univ. Grenoble Alpes, CEA, LETI, Technologies for Healthcare and Biology Division, Microfluidic Systems and Bioengineering Lab, F-38000, Grenoble, France
| | - Tristan Rolland
- Univ. Grenoble Alpes, CEA, LETI, Technologies for Healthcare and Biology Division, Microfluidic Systems and Bioengineering Lab, F-38000, Grenoble, France
| | - Myriam Cubizolles
- Univ. Grenoble Alpes, CEA, LETI, Technologies for Healthcare and Biology Division, Microfluidic Systems and Bioengineering Lab, F-38000, Grenoble, France
| | - Yoann Roupioz
- Univ. Grenoble Alpes, CEA, CNRS, IRIG, SyMMES, F-38000, Grenoble, France
| | - Arnaud Buhot
- Univ. Grenoble Alpes, CEA, CNRS, IRIG, SyMMES, F-38000, Grenoble, France.
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Mansueto G, Benincasa G, Della Mura N, Nicoletti GF, Napoli C. Epigenetic-sensitive liquid biomarkers and personalised therapy in advanced heart failure: a focus on cell-free DNA and microRNAs. J Clin Pathol 2020; 73:535-543. [DOI: 10.1136/jclinpath-2019-206404] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/07/2020] [Accepted: 04/04/2020] [Indexed: 12/15/2022]
Abstract
Dilated cardiomyopathy (DCM) represents a common genetic cause of mechanical and/or electrical dysfunction leading to heart failure (HF) onset for which truncating variants in titin (TTN) gene result in the most frequent mutations. Moreover, myocyte and endothelial cell apoptosis is a key endophenotype underlying cardiac remodelling. Therefore, a deeper knowledge about molecular networks leading to acute injury and apoptosis may reveal novel circulating biomarkers useful to better discriminate HF phenotypes, patients at risk of heart transplant as well as graft reject in order to improve personalised therapy. Remarkably, increased plasma levels of cell-free DNA (cfDNA) may reflect the extent of cellular damage, whereas circulating mitochondrial DNA (mtDNA) may be a promising biomarker of poor prognosis in patients with HF. Furthermore, some panels of circulating miRNAs may improve the stratification of natural history of disease. For example, a combination of miR-558, miR-122* and miR-520d-5p, as well as miR-125a-5p, miR-550a-5p, miR-638 and miR-190a, may aid to discriminate different phenotypes of HF ranging from preserved to reduced ejection fraction. We give update on the most relevant genetic determinants involved in DCM and discuss the putative role of non-invasive biomarkers to overcome current limitations of the reductionist approach in HF management.
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Yurttas T, Hidvegi R, Filipovic M. Biomarker-Based Preoperative Risk Stratification for Patients Undergoing Non-Cardiac Surgery. J Clin Med 2020; 9:jcm9020351. [PMID: 32012699 PMCID: PMC7074404 DOI: 10.3390/jcm9020351] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 01/21/2020] [Accepted: 01/24/2020] [Indexed: 12/22/2022] Open
Abstract
Perioperative morbidity and mortality remains a substantial problem and is strongly associated with patients’ cardiac comorbidities. Guidelines for the cardiovascular assessment and management of patients at risk of cardiac issues while undergoing non-cardiac surgery are traditionally based on the exclusion of active or unstable cardiac conditions, determination of the risk of surgery, the functional capacity of the patient, and the presence of cardiac risk factors. In the last two decades, strong evidence showed an association between cardiac biomarkers and adverse cardiac events, with newer guidelines incorporating this knowledge. This review describes a biomarker-based risk-stratification pathway and discusses potential treatment strategies for patients suffering from postoperative myocardial injury or infarction.
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20
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Duceppe E, Patel A, Chan MTV, Berwanger O, Ackland G, Kavsak PA, Rodseth R, Biccard B, Chow CK, Borges FK, Guyatt G, Pearse R, Sessler DI, Heels-Ansdell D, Kurz A, Wang CY, Szczeklik W, Srinathan S, Garg AX, Pettit S, Sloan EN, Januzzi JL, McQueen M, Buse GL, Mills NL, Zhang L, Sapsford R, Paré G, Walsh M, Whitlock R, Lamy A, Hill S, Thabane L, Yusuf S, Devereaux PJ. Preoperative N-Terminal Pro-B-Type Natriuretic Peptide and Cardiovascular Events After Noncardiac Surgery: A Cohort Study. Ann Intern Med 2020; 172:96-104. [PMID: 31869834 DOI: 10.7326/m19-2501] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Preliminary data suggest that preoperative N-terminal pro-B-type natriuretic peptide (NT-proBNP) may improve risk prediction in patients undergoing noncardiac surgery. OBJECTIVE To determine whether preoperative NT-proBNP has additional predictive value beyond a clinical risk score for the composite of vascular death and myocardial injury after noncardiac surgery (MINS) within 30 days after surgery. DESIGN Prospective cohort study. SETTING 16 hospitals in 9 countries. PATIENTS 10 402 patients aged 45 years or older having inpatient noncardiac surgery. MEASUREMENTS All patients had NT-proBNP levels measured before surgery and troponin T levels measured daily for up to 3 days after surgery. RESULTS In multivariable analyses, compared with preoperative NT-proBNP values less than 100 pg/mL (the reference group), those of 100 to less than 200 pg/mL, 200 to less than 1500 pg/mL, and 1500 pg/mL or greater were associated with adjusted hazard ratios of 2.27 (95% CI, 1.90 to 2.70), 3.63 (CI, 3.13 to 4.21), and 5.82 (CI, 4.81 to 7.05) and corresponding incidences of the primary outcome of 12.3% (226 of 1843), 20.8% (542 of 2608), and 37.5% (223 of 595), respectively. Adding NT-proBNP thresholds to clinical stratification (that is, the Revised Cardiac Risk Index [RCRI]) resulted in a net absolute reclassification improvement of 258 per 1000 patients. Preoperative NT-proBNP values were also statistically significantly associated with 30-day all-cause mortality (less than 100 pg/mL [incidence, 0.3%], 100 to less than 200 pg/mL [incidence, 0.7%], 200 to less than 1500 pg/mL [incidence, 1.4%], and 1500 pg/mL or greater [incidence, 4.0%]). LIMITATION External validation of the identified NT-proBNP thresholds in other cohorts would reinforce our findings. CONCLUSION Preoperative NT-proBNP is strongly associated with vascular death and MINS within 30 days after noncardiac surgery and improves cardiac risk prediction in addition to the RCRI. PRIMARY FUNDING SOURCE Canadian Institutes of Health Research.
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Affiliation(s)
- Emmanuelle Duceppe
- University of Montreal, Montreal, Québec, and McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada (E.D.)
| | - Ameen Patel
- McMaster University, Hamilton, Ontario, Canada (A.P., P.A.K., G.G., D.H., S.H., L.T.)
| | - Matthew T V Chan
- The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China (M.T.C., L.Z.)
| | - Otavio Berwanger
- Hospital Israelita Albert Einstein (Academic Research Organization-ARO), Sao Paulo, Brazil (O.B.)
| | - Gareth Ackland
- Translational Medicine & Therapeutics William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom (G.A., R.P.)
| | - Peter A Kavsak
- McMaster University, Hamilton, Ontario, Canada (A.P., P.A.K., G.G., D.H., S.H., L.T.)
| | - Reitze Rodseth
- University of KwaZulu-Natal, Glenwood, Durban, South Africa (R.R.)
| | - Bruce Biccard
- Groote Schuur Hospital and University of Cape Town, Western Cape, South Africa (B.B.)
| | - Clara K Chow
- Westmead Applied Research Centre, University of Sydney, Sydney, and Westmead Hospital, Westmead, Australia (C.K.C.)
| | - Flavia K Borges
- McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada (F.K.B., M.M., G.P., M.W., R.W., A.L., S.Y., P.D.)
| | - Gordon Guyatt
- McMaster University, Hamilton, Ontario, Canada (A.P., P.A.K., G.G., D.H., S.H., L.T.)
| | - Rupert Pearse
- Translational Medicine & Therapeutics William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom (G.A., R.P.)
| | | | - Diane Heels-Ansdell
- McMaster University, Hamilton, Ontario, Canada (A.P., P.A.K., G.G., D.H., S.H., L.T.)
| | - Andrea Kurz
- Cleveland Clinic, Cleveland, Ohio (D.I.S., A.K.)
| | - Chew Yin Wang
- University of Malaya, Kuala Lumpur, Malaysia (C.Y.W.)
| | | | | | - Amit X Garg
- Western University, London, Ontario, Canada (A.X.G.)
| | - Shirley Pettit
- Population Health Research Institute, Hamilton, Ontario, Canada (S.P.)
| | - Erin N Sloan
- University of British Columbia, Vancouver, British Columbia, Canada (E.N.S.)
| | - James L Januzzi
- Massachusetts General Hospital, Harvard Medical School, and Baim Institute for Clinical Research, Boston, Massachusetts (J.L.J.)
| | - Matthew McQueen
- McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada (F.K.B., M.M., G.P., M.W., R.W., A.L., S.Y., P.D.)
| | | | - Nicholas L Mills
- British Heart Foundation Centre for Cardiovascular Sciences and Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom (N.L.M.)
| | - Lin Zhang
- The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China (M.T.C., L.Z.)
| | | | - Guillaume Paré
- McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada (F.K.B., M.M., G.P., M.W., R.W., A.L., S.Y., P.D.)
| | - Michael Walsh
- McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada (F.K.B., M.M., G.P., M.W., R.W., A.L., S.Y., P.D.)
| | - Richard Whitlock
- McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada (F.K.B., M.M., G.P., M.W., R.W., A.L., S.Y., P.D.)
| | - Andre Lamy
- McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada (F.K.B., M.M., G.P., M.W., R.W., A.L., S.Y., P.D.)
| | - Stephen Hill
- McMaster University, Hamilton, Ontario, Canada (A.P., P.A.K., G.G., D.H., S.H., L.T.)
| | - Lehana Thabane
- McMaster University, Hamilton, Ontario, Canada (A.P., P.A.K., G.G., D.H., S.H., L.T.)
| | - Salim Yusuf
- McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada (F.K.B., M.M., G.P., M.W., R.W., A.L., S.Y., P.D.)
| | - P J Devereaux
- McMaster University and Population Health Research Institute, Hamilton, Ontario, Canada (F.K.B., M.M., G.P., M.W., R.W., A.L., S.Y., P.D.)
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