Diagnosis of heart failure using urinary natriuretic peptides.
In the present study, we assessed the use of urinary natriuretic peptides [N-terminal proatrial natriuretic peptide (N-ANP) and N-terminal pro-brain natriuretic peptide (N-BNP) and C-type natriuretic peptide (CNP)] in the diagnosis of heart failure. Thirty-four consecutive hospitalized heart failure patients (median age, 75.5 years; 14 female) were compared with 82 age- and gender-matched echocardiographically normal controls. All subjects provided plasma and urine specimens. Plasma was assayed for N-BNP, and urine was assayed for N-ANP, N-BNP and CNP. The diagnostic efficiency of peptides was assessed using receiver operating characteristic (ROC) curve analysis. All three urinary natriuretic peptides were significantly elevated in heart failure patients ( P <0.001). Urine N-BNP was correlated with plasma N-BNP ( r (s)=0.53, P <0.0005). Areas under the ROC curves for urinary N-ANP, N-BNP and CNP were 0.86, 0.93 and 0.70 and for plasma N-BNP was 0.96. Correcting urinary peptide levels using urine creatinine produced ROC areas of 0.89, 0.93 and 0.76 respectively. A urine N-BNP level cut-off point of 11.6 fmol/ml had a sensitivity and specificity for heart failure detection of 97% and 78% respectively, with positive and negative predictive values of 64.7 and 98%. In conclusion, although all three natriuretic peptides were elevated in urine in heart failure, urinary N-BNP had diagnostic accuracy comparable with plasma N-BNP. Use of urinary N-BNP for heart failure diagnosis may be suitable for high-throughput screening, especially in subjects reluctant to provide blood samples.
D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D009320:Atrial Natriuretic Factor / Q000097:blood / Q000652:urine*; D015415:Biomarkers; D016022:Case-Control Studies; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis* / Q000652:urine; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain; D020098:Natriuretic Peptide, C-Type / Q000652:urine; D009419:Nerve Tissue Proteins / Q000652:urine*; D010446:Peptide Fragments / Q000652:urine*; D011237:Predictive Value of Tests; D011498:Protein Precursors / Q000097:blood / Q000652:urine*; D012680:Sensitivity and Specificity
D015415:Biomarkers; C099254:N-terminal proatrial natriuretic peptide; D009419:Nerve Tissue Proteins; D010446:Peptide Fragments; D011498:Protein Precursors; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D020098:Natriuretic Peptide, C-Type; D009320:Atrial Natriuretic Factor