B-type natriuretic peptide predicts an ischemic etiology of acute heart failure in patients with stage 4-5 chronic kidney disease.

Abstract

OBJECTIVES:

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.

DESIGN AND 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.

• Authors: Sung Eun Kim, Sunghoon Park, Jwa-Kyung Kim, Sung Gyun Kim, Hyung Jik Kim, Young Rim Song
• Journal: Clinical biochemistry (Clin Biochem) Vol. 47 Issue 6 Pg. 344-8 (Apr 2014) ISSN: 1873-2933 [Electronic] United States
• PMID: 24486650 (Publication Type: Journal Article, Observational Study, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2014 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

Chemical References

• Natriuretic Peptide, Brain

Topics

• Aged
• Female
• Heart Failure (blood, diagnostic imaging, etiology)
• Hospitalization
• Humans
• Male
• Myocardial Ischemia (blood, complications, diagnostic imaging)
• Natriuretic Peptide, Brain (blood)
• ROC Curve
• Renal Insufficiency, Chronic (blood, complications)
• Risk Factors
• Ultrasonography