B-type natriuretic peptide predicts an ischemic etiology of acute heart failure in patients with stage 4-5 chronic kidney disease.
OBJECTIVE
The non-invasive differentiation of ischemic and non-ischemic acute heart failure (AHF) not resulting from acute myocardial infarction is difficult and has therapeutic and prognostic implications. The aim of this study was to assess whether plasma B-type natriuretic peptide (BNP) can identify ischemic etiology in patients with stage 4-5 chronic kidney disease (CKD) presenting with AHF.


METHODS
We prospectively analyzed 61 patients. The diagnosis of ischemic AHF was confirmed by coronary angiography or stress myocardial perfusion imaging. Plasma levels of BNP were measured at admission (BNP1) and 48 h after admission (BNP2).


RESULTS
The mean age of the study patients was 67 years. In these patients, 70.5% had diabetes and 47.5% had dialysis-dependent CKD; 28 of these patients (45.9%) had an ischemic etiology with significantly higher concentrations of BNP1 and BNP2 than did patients without ischemia. The area under the receiver operating characteristic curve was 0.755 (P=0.001) for BNP1 and 0.868 (P<0.001) for BNP2 to detect ischemic etiology of AHF. Plasma BNP1 >2907 ng/L (odds ratio [OR], 10.9; 95% confidence interval [CI] 2.5-48.4; P=0.002) and BNP2 >2322 ng/L (OR 93.1, 95% CI 7.0-1238.7; P=0.001) were independently associated with an ischemic etiology of AHF.


CONCLUSIONS
Plasma BNP may represent a clinically useful non-invasive tool for identification of ischemic etiology of AHF in patients with stage 4-5 CKD.
Department of Internal Medicine, Kangdong Sacred Heart Hospital, Seoul, Republic of Korea.
Sung Eun
SE
Kim
Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea.
Sunghoon
S
Park
Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea; Department of Internal Medicine, Kidney Research Institute, Hallym University College of Medicine, Republic of Korea.
Jwa-Kyung
JK
Kim
Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea; Department of Internal Medicine, Kidney Research Institute, Hallym University College of Medicine, Republic of Korea.
Sung Gyun
SG
Kim
Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea; Department of Internal Medicine, Kidney Research Institute, Hallym University College of Medicine, Republic of Korea.
Hyung Jik
HJ
Kim
Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea; Department of Internal Medicine, Kidney Research Institute, Hallym University College of Medicine, Republic of Korea. Electronic address: youngrim@hallym.or.kr.
Young Rim
YR
Song
D000368:Aged; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000000981:diagnostic imaging / Q000209:etiology*; D006760:Hospitalization; D006801:Humans; D008297:Male; D017202:Myocardial Ischemia / Q000097:blood / Q000150:complications* / Q000000981:diagnostic imaging; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D012372:ROC Curve; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000150:complications*; D012307:Risk Factors; D014463:Ultrasonography
D020097:Natriuretic Peptide, Brain
Acute heart failure; B-type natriuretic peptide; Chronic kidney disease; Ischemia