Comparison of atrial natriuretic peptide, B-type natriuretic peptide, and N-terminal proatrial natriuretic peptide as indicators of left ventricular systolic dysfunction - 11/09/11
Abstract |
We have directly compared atrial natriuretic peptide (ANP), B-type natriuretic peptide (BNP), and N-terminal pro-ANP (N-ANP) as markers of patients with left ventricular ejection fraction (LVEF) ≤35%, as measured by radionuclide ventriculography. Venous blood samples were obtained from an unselected group of 87 patients who had been referred for assessment of ventricular function. ANP, BNP, and N-ANP were measured by radioimmunoassay using commercial kits. Receiver-operating characteristic analysis was used for the objective assessment of the diagnostic performance of each assay. There was a weak negative correlation between LVEF and plasma levels of ANP-li (r = −0.50,), BNP-li (r =−0.57), and N-ANP-li (r = −0.49) (p <5.01 for each peptide). Areas under the receiver-operating characteristic curves for BNP (0.880) and N-ANP (0.832) were not significantly different from each other, but were both significantly greater than the value for ANP (0.761): BNP versus ANP, p <0.01; and N-ANP versus ANP, p <0.05. The optimal sensitivity and specificity of each assay for the detection of patients with LVEF ≤35% were: BNP >4 pmol/L—sensitivity 1.0, specificity 0.58; N-ANP >200 pmol/L—sensitivity 0.95, specificity 0.35; and ANP >10 pmol/L—sensitivity 0.90, specificity 0.30. Plasma concentrations of BNP and N-ANP provide sensitive indicators of moderate to severe LV dysfunction; both peptides are objectively superior to ANP for identifying patients with LVEF ≤35%. These simple tests could be used to screen patients with suspected ventricular dysfunction to reduce the demand for further cardiac investigations.
Le texte complet de cet article est disponible en PDF.Vol 77 - N° 10
P. 828-831 - avril 1996 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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