Effects of hemoglobin concentration and creatinine clearance in pro-B-type natriuretic peptide-based left ventricular filling pressure prediction in patients with preserved left ventricular systolic function.
Although N-terminal pro-B-type natriuretic peptide (pro-BNP) has been shown to correlate with left ventricular (LV) filling pressure, pro-BNP-based LV filling pressure prediction has some limitations due to several factors that affect pro-BNP. The aim of this study was to evaluate the effects of blood hemoglobin concentration and creatinine clearance (CCr) on pro-BNP-based LV filling pressure prediction in patients with preserved LV systolic function. A total of 421 consecutive patients referred for coronary angiography underwent LV pressure measurement by fluid-filled catheters. Patients with plasma creatinine levels>or=1.5 mg/dl and LV ejection fractions<50% were excluded. LV diastolic pressures and echocardiographic parameters were compared with pro-BNP levels in 281 patients. Blood hemoglobin levels and CCr were measured simultaneously. Log pro-BNP was independently correlated with hemoglobin concentration (beta=-0.261, p<0.001), CCr (beta=-0.230, p<0.001) and LV pre-A-wave pressure (beta=0.384, p<0.001). A pro-BNP level of 124 pg/ml was the optimal cutoff for LV pre-A-wave pressure>15 mm Hg in all patients (sensitivity 67%, specificity 67%, p<0.001). However, by subclassification according to hemoglobin and CCr tertiles, optimal cut-off values varied significantly, and their predictive accuracies could be improved (from 89 to 331 pg/dl, with diagnostic accuracy up to 79%). In conclusion, in the pro-BNP-based prediction of elevated LV filling pressure, subclassification on the basis of hemoglobin concentration and CCr should be considered in patients with preserved LV systolic and renal function.
Choi
Eui-Young
EY
Cardiology Division, Yonsei Cardiovascular Center and Cardiovascular Research Institute, Seoul, Republic of Korea.
Ha
Jong-Won
JW
Joung
Boyoung
B
Ko
Young-Guk
YG
Choi
Donghoon
D
Rim
Se-Joong
SJ
Jang
Yangsoo
Y
Chung
Namsik
N
Shim
Won-Heum
WH
Cho
Seung-Yun
SY
D000368:Aged; D019540:Area Under Curve; D003404:Creatinine / Q000097:blood*; D005260:Female; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000502:physiology*; D012680:Sensitivity and Specificity; D013599:Systole / Q000502:physiology; D016277:Ventricular Function, Left / Q000502:physiology*; D017725:Ventricular Pressure / Q000502:physiology*
D006454:Hemoglobins; D020097:Natriuretic Peptide, Brain; D003404:Creatinine