title: N-terminal Pro-B-type natriuretic peptide and its correlation to haemodialysis-induced myocardial stunning.
abstract: BACKGROUND
  Haemodialysis (HD) is able to induce recurrent myocardial ischemia and segmental left-ventricular dysfunction (myocardial stunning). The association of N-terminal Pro-B-type natriuretic peptide (NTpro-BNP) with HD-induced myocardial stunning is unclear.
  
  
  METHODS
  In 70 prevalent HD patients, HD-induced myocardial stunning was assessed echocardiographically at baseline and after 12 months. The extent to which pre-dialysis NTpro-BNP was associated with the occurrence of HD-induced myocardial stunning was assessed as the primary endpoint.
  
  
  RESULTS
  The median Ntpro-BNP concentration in this cohort was 2,154 pg/ml (IQR 1,224-3,014). Patients experiencing HD-induced myocardial stunning at either time point displayed elevated NTpro-BNP values (2,418 pg/ml, IQR, 1,583-3,474 vs. 1,751 pg/ml, IQR (536-2,029), p = 0.02). NTpro-BNP levels did not differ between patients showing HD-induced stunning at baseline and those developing stunning during the observational period (p = 0.8). NTpro-BNP levels drawn at the beginning of the dialysis session achieved a poor diagnostic accuracy for the detection of myocardial stunning (area under the ROC curve 0.61, 95% CI 0.45-0.77), but provided an accurate rule out for myocardial stunning during the subsequent year (AUC 0.85, 95% CI 0.70-0.99). The calculated cut-off of 1,570 pg/ml achieved a sensitivity of 66% and a specificity of 78% for the exclusion of myocardial stunning at any time point. In logistic regression analysis, only low NTpro-BNP levels (OR 0.92 for every additional 100 pg/ml, 95% CI 0.85-0.99, p = 0.03) were significantly associated with absence of myocardial stunning at any time point.
  
  
  CONCLUSIONS
  Predialytic NTpro-BNP levels fail to adequately diagnose current dialysis-induced myocardial stunning, but help to identify patients with a propensity to develop dialysis-induced myocardial stunning at any time during the next 12 months.
authors.affiliation: School of Graduate Entry Medicine and Health, University of Nottingham Medical School at Derby, Derby, UK. tobias.breidthardt@usb.ch
authors.forename: Tobias
authors.initials: T
authors.lastname: Breidthardt
authors.forename: James O
authors.initials: JO
authors.lastname: Burton
authors.forename: Aghogho
authors.initials: A
authors.lastname: Odudu
authors.forename: Mohamed Tarek
authors.initials: MT
authors.lastname: Eldehni
authors.forename: Helen
authors.initials: H
authors.lastname: Jefferies
authors.forename: Christopher W
authors.initials: CW
authors.lastname: McIntyre
mesh_terms: D015984:Causality; D015897:Comorbidity; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood* / Q000453:epidemiology / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D017682:Myocardial Stunning / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology*; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D015995:Prevalence; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013223:Statistics as Topic; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain