N-terminal B-type Natriuretic Peptide In Heart Failure Patients In The Clinical Study

1 The plasma concentration of N-terminal pro-B-type natriuretic peptide in persons without organic heart diseases and the factors influencing itObjective This sdudy aimed to examine the plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentration in subjects without organic heart diseases and analyze the factors affecting it.Methods The plasma concentration of NT-proBNP was measured with ELISA method in 300 adults who were proved no organic heart disease through examinations including electrocardiography, echocardiography, X-ray and coronary artery angiography. The plasma NT-proBNP concentration was compared between age-groups 30-39, 40-49, 50-59, 60-69 and≥70 years old, between male and female in the same age-group and between subjects with and without hypertension, diabetes and obesity. A multiple linear regression analysis was used to detect factors influencing NT-proBNP among age, sex, body mass index, blood pressure, heart rate, serum creatinine, hypertension, diabetes mellitus, angiotensin-converting-enzyme inhibitors, Ca²⁺-antagonist, andβ-blocker.Results From age-groups 30-39, 40-49, 50-59, 60-69 to≥70 years old, the median (25 percent,75 percent) value of plasma NT-proBNP concentration in male subject was 291.2(247.5, 330.2) pmol/L,272.0(229.2, 305.3) pmol/L,279.8(228.9, 325.3) pmol/L,331.5(284.0, 437.0) pmol/L and 425.8(307.7, 496.0) pmol/L respectively , and was 345.5(255.3, 414.4) pmol/L,307.7(240.1, 387.1) pmol/L,313.9(257.6, 422.7) pmol/L,305.7(262.7, 375.0) pmol/L and 319.3(268.4, 396.6) pmol/L respectively in female subject, it was increasing with age in male subjects more than 60 years old (P<0.05), but not in male less than 60 years old and female (P >0.05). In subjects less than 60 years old, the plasma NT-proBNP concentration was higher in female than male(P<0.05), but it was higher in male than female in those more than 60 years old (P<0.05). Multiple linear regression analysis demonstrated that age was the only independent predictor for plasma NT-proBNP in these subjects (P<0.01). The reference range of plasma NT-proBNP were computed seperatly in male subjects of less than and more than 60 years old as 160～470, 180～760 pmol/L, in female subjects of less than and more than 60 years old as 170～660, 180～560 pmol/L.Conclusion The plasma concentration of NT-proBNP in subjects without organic heart diseases was different between male and female, and was increasing with age in male subjects more than 60 years old.2 The plasma concentration of NT-proBNP in patients with dilated cardiomyopathy and the factors influencing itObjective This research aimed to examine the plasma concentration of NT-proBNP in patients with dilated cardiomyopathy (DCM) and analysis the factors influencing it.Methods The plasma concentration of NT-proBNP was measured with ELISA method in 203 DCM patients and 203 normal controls. The results were compared between them. A multiple linear regression analysis was used to detect factors influencing the plasma concentration of NT-proBNP in DCM patients.Results The plasma concentration of NT-proBNP was much higher in DCM patients than normal controls, with a median (25 percent, 75 percent) value of 2247.3 (1086.1, 3837.0) pmol/L and 300.4 (251.7, 373.6) pmol/L, respectively (P < 0.01). It was increasing with the NYHA class from II, through III to IV, with median (25 percent, 75 percent) values of 579.7(453.6,819.4) pmol/L,2192.8 (1380.7,3650.4) pmol/L and 3663.3 (2362.7,5505.9) pmol/L, respectively (P < 0.01). Patients with a body mass index (BMI) of≥25 kg/cm² have lower NT-proBNP concentration than those with a BMI of <25 kg/cm², with median median (25 percent, 75 percent) values of 1422.7(749.0,3295.9) pmol/L and 2724.6(1418.6,4333.3) pmol/L, respectively (P<0.01) . Patients whose serum creatinine concentration were≥107μmol/L had higher NT-proBNP concentration than those whose serum creatinine concentration < 107μmol/L, with median (25 percent, 75 percent) values of 3709.5(1909.2,5110.5)pmol/Lå’Œ1644.1(802.2,3255.6)pmol/L, respectively (P< 0.01) .A multiple linear regression analysis demonstrated that NYHA class, BMI, creatinine, left ventricular ejection fraction (LVEF), heart rate and left atrial dimension ( all P < 0.01) were independently associated with plasma NT-proBNP concentration.Conclusion The plasma concentration of NT-proBNP was much higher in DCM patients than normal controls, it was affected by NYHA class, BMI, serum creatinine, LVEF, heart rate and left atrial dimension. NYHA class was the strongest factor among them.3 The plasma concentration of NT-proBNP in patients with heart failure due to varial heart diseases and the factors influencing itObjective This research aimed to examine and compare the plasma concentration of NT-proBNP in patients with heart failure due to varial heart diseases and analysis the factors affecting it.Methods We enrolled 804 heart failure patients due to varial heart diseases, including valvular heart disease (VHD), dilated cardiomyopathy (DCM), ischemic cardiomyopathy (ICM), restrictive cardiomyopathy (RCM), hypertensive heart disease, hypertrophic cardiomyopathy (HCM), chronic pulmonary heart disease, aldult chongenital heart disease (CHD). The plasma concentration of NT-proBNP was measured with ELISA method. A multiple linear regression analysis was used to detect factors that influence the plasma concentration of NT-proBNP in these patients. Results The plasma concentration of NT-proBNP had no significant difference between heart failure patients with different heart diseases, with median (25 percent, 75 percent) values of 1866.0(803.3,3972.7) pmol/L, 2247.3(1086.8, 3864.5) pmol/L, 2399.8 (1182.4, 4241.7) pmol/L, 2455.8 (1385.0, 5839.2) pmol/L, 2203.9 (1052.8, 3186.0) pmol/L, 2285.3 (1154.8, 3423.5) pmol/L, 2312.7 (654.8, 3850.2) pmol/L and 2768.2 (794.8,4370.5) pmol/L, P > 0.05] in VHD, DCM, ICM, RCM, HCM, chronic pulmonary heart disease, hypertensive heart disease and adult CHD respectively. It was increasing with the NYHA class from II, through III to IV, with median (25 percent, 75 percent) values of 646.0(446.8, 1014.5) pmol/L, 2160.3(1118.1,3749.7) pmol/L and 3342.3(1548.6,5454.8) pmol/L, respectively (P < 0.01). Patients with a body mass index (BMI) of≥25 kg/cm², have lower NT-proBNP concentration than those with a BMI of <25 kg/cm², with median (25 percent, 75 percent) values of 1467.5 (784.0, 3177.0) pmol/L and 2423.7(1090.3,4213.0) pmol/L, respectively (P<0.01) . Patients whose serum creatinine concentration were≥107μmol/L had higher NT-proBNP concentration than those whose serum creatinine concentration <107μmol/L, with median (25 percent, 75 percent) values of 3336.8 (1469.9,5379.6) pmol/L and 1644.1(781.4,3375.3) pmol/L respectively, P<0.01. A multiple linear regression analysis demonstrated that NYHA class, creatinine, BMI, hepatic damage and diastolic pressure (all P<0.01) were independently associated with plasma NT-proBNP concentration.Conclusion The plasma concentration of NT-proBNP had no significant difference between heart failure patients with different heart diseases, it was affected by NYHA class, serum creatinine, BMI, hepatic damage and diastolic pressure. NYHA class was the strongest factor among them. 4 The value of admission NT-proBNP in predicting in-hospital mortality in decompensated heart failureObjective: This study aimed to evaluate the value of admission plasma NT-proBNP in predicting in-hospital mortality in patients with decompensated heart failure.Methods: Plasma NT-proBNP levels were measured in patients with decompensated heart failure within 24 hours after admission with ELISA method. The NT-proBNP levels were compared between dying patients in hospital and survival patients at discharge. ROC analyses were performed to evaluate if admission plasma NT-proBNP was a predictor for in-hospital mortality and identify the optimal NT-proBNP cut-point for predicting in-hospital mortality. A binary logistic regress analyses was used to evaluate if NT-proBNP was an independent predictor for in-hospital mortality.Results: Total 804 patients with decompensated heart failure enrolled in his study, including 293 cases of valvular heart diseases, 219 cases of ischemic cardiomyopathy, 141 cases of dilated cardiomyopathy, 14 cases of hypertrophic cardiomyopathy, 21 cases of restrictive cardiomyopathy, 39 cases of hypertensive heart disease, 41 cases of chronic pulmonary heart disease and 36 cases of adult congenital heart disease. The number of NYHA class II, III, IV was 96 cases, 450 cases and 258 cases respectively. 64 cases of the 804 patients died in hospital. The plasma NT-proBNP levels of the dying cases were much higher than those of the survivals C with 4321.1 (3063.8, 6606.5) pmol/L to 1921.6 (873.9, 3739.2) pmol/L respectively, P<0.01 ) . ROC analysis of plasma NT-proBNP to predict in-hospital mortality had an area under the curve (AUC) of 0.772 (95%CI: 0.718-0.825, P<0.01), the optimal plasma NT-proBNP cut-point for predicting in-hospital mortality was 3500 pmol/L, with a sensitivity of 70.3%, a specificity of 72.0%, an accuracy of 71.9%, a positive predictive value of 17.8% and a negative predictive value of 96.6%. Patients whose NT-proBNP levels were equal or more than 3500 pmol/L had a much higher in-hospital mortality (17.8%), compared with that (3.4%) in those with NT-proBNP levels of less than 3500 pmol/L (P<0.01). Binary logistic regress analyses demonstrated that, in factors such as age, sex, body mass index, systolic blood pressure, diastolic blood pressure, heart rate, NYHA class, serum creatinine levels, plasma NT-proBNP levels, atrial fibrillation, anemia, pneumonia, abnormal hepatitis function and high bilirubinemia, admission plasma NT-proBNP, pneumonia, heart rate and NYHA class were selected as independent predictors for in-hospital mortality in patients with decompensated heart failure (P<0.05 or 0.01). In all of them, admission plasma NT-proBNP was the strongest predictor for in-hospital mortality.Conclusion: Admission plasma NT-proBNP level was an independent predictor for in-hospital mortality in patients with decompensated heart failure. The optimal NT-proBNP cut-point for predicting in-hospital mortality was 3500 pmol/L.5 The value of NT-proBNP in diagnosing heart failure in patients with previousmyocardial infarctionObjective: This study aimed to evaluate the value of plasma NT-proBNP in diagnosing heart failure in patients with previous myocardial infarction.Methods: The plasma concentration of NT-proBNP was measured in patients of previous myocardial infarction with ELISA method. Their heart function was evaluated by NYHA class, and was divided into two groups: heart failure group and non heart failure group. The patients in non heart failure group were all with NYHA class I , those with NYHA class II, III and IV were divided as heart failure group. The NT-proBNP levels were compared between NYHA class I , II, III and IV, and between heart failure group and non heart failure grooup. ROC analyses were performed to evaluate if plasma NT-proBNP was a valuable diagnosing factor for heart failure and identify the optimal cut-point for diagnosing heart failure petients.Results: Total 586 patients with previous myocardial infarction enrolled in his study, including 374 cases of NYHA class I , 99 cases of NYHA classes II, 82 cases of NYHA class III, 31 cases of NYHA class IV, the plasma NT-proBNP levels of them were 484.7(381.6, 647.8) pmol/L, 907.6(516.6, 1290.3) pmol/L, 1420.2(879.5, 2336.2) pmol/L, 2442.6(1695.4, 3670.7) pmol/L, respectively (P<0.01). The plasma NT-proBNP levels of heart failure cases were much higher than those of non heart failure patients C with 1148.2(707.9, 2145.3) pmol/L to 484.7(381.6, 647.8) pmol/L respectively, P<0.01 ) . ROC analysis of plasma NT-proBNP to diagnosis heart failure patients had an area under the curve (AUC) of 0.844 (95%CI: 0.809-0.880, P <0.01) , the optimal plasma NT-proBNP cut-point for diagnosing heart failure was 700 pmol/L, with a sensitivity of 75.9%, a specificity of 79.9%, an accuracy of 78.3%, a positive predictive value of 67.9% and a negative predictive value of 85.3%. ROC analysis of plasma NT-proBNP to diagnosis systolic myocardiodysfunction (LVEF< 40%) patients had an AUC of 0.815 (95% CI: 0.767-0.862, P<0.01). ROC analysis of plasma NT-proBNP to diagnosis left ventricular enlargement patients had an AUC of 0.730 (95% CI: 0.688-0.773, P<0.01).Conclusion: plasma NT-proBNP level was a valuable factor for diagnosing heart failure, systolic myocardiodysfunction and left ventricular enlargement in patients with previous myocardial infarction. The optimal NT-proBNP cut-point was 700pmol/L.