N-terminal proBrain Natriuretic Peptide as Indicator of Left Ventricle Hypertrophy In Hypertensive Patients Compared with Left Ventricle Mass Index in Echocardiography
Abstract
Background: Some research reports the usefulness of the N-terminal proBrain natriuretic peptide (NT proBNP) as a diagnostic tool for left ven-tricular hypertrophy due to increased levels of NT proBNP in hypertensive patients with left ventricular hypertrophy.Objective:To determine the role of NT pro-BNP in terms of diagnostic tool in hypertensive patients with left ventricular hypertrophy, knowing the value of sensitivity, specificity, positive predictive value, negative predictive value of NT proBNP and levels of NT proBNP in hypertensive patients with left ventricular hypertrophy.
Methods: Cross sectional observational study conducted in outpatient clinic RSSA Malang from July 2008 until December 2008. This study mea-sures the level of NT proBNP and echocardiography examinations on 79 hypertensive patients. Pearson correlation test was used to analyze the correlation between NT proBNP with left ventricle mass index(LVMI). Chisquare test was used to determine the value of sensitivity, specificity, positive predictive value, negative predictive value NT proBNP compared with echocardiography. All calculations using a= 5%, 95% confidence intervals and considered significant if p <0.05.
Results: The level of NT proBNP left ventricular hypertrophy group were significantly higher than non-left ventricular hypertrophy (797,31±546,08 v 56,09±29,81 pg/ml). There is significant positive correlation between LVMI with NT proBNP (p=0.006, r=0.306). NT proBNP had a sensitivity of 60%, specificity 65.5%, 75% positive predictive value, negative predic-tive value 48.7% and AUC (area under curve) of 0.649.
Conclusion: The level of NT proBNP increased in hypertensive patients with left ventricular hypertrophy and there is significant positive correlation between LVMI with NT proBNP. NT proBNP less sensitive and specific than echocardiography to determine left ventricular hypertrophy.
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References
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Pewsner D, Ju¨ni P, Egger M, Sundstrom J. Accuracy of elec-trocardiography in diagnosis of left ventricular hypertrophy in arterial hypertension: systematic review. BMJ. 2007:335:711.
Mancia G, Backer Gd, Dominiczak A, RCifkova, Fagard R, Germano G, et al. Guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2007;28:1462-536.
Alfakih K, Reid S, Hall A, Sivananthan M. The assessment of left ventricular hypertrophy in hypertension. J Hypertens. 2006;24:1223-30.
Cuspidi C, Meani S, Valerio C, Fusi V, Sala C, Zanchetti A. Left ventricular hypertrophy and cardiovascular risk strati-fication: impact and cost-effectiveness of echocardiography in recently diagnosed essential hypertensives. J Hypertens. 2006;24:1671-7.
Almenar L, Martínez-Dolz L. Péptidos natriuréticos en insufi-ciencia cardiaca. Rev Esp Cardiol. 2006;6 Supl F:15-26.
Mueller T, Gegenhuber A, Dieplinger B. Capability of B-Type Natriuretic Peptide (BNP) and Amino-Terminal proBNP as Indicators of Cardiac Structural Disease in Asymptomatic Pa-tients with Systemic Arterial Hypertension. Clinical Chemistry. 2005;51:2245-51.
Vasan RS, Benjamin EJ, Larson MG. Plasma natriuretic peptides for community screening for left ventricular hypertrophy and systolic dysfunction. J Am Med Assoc. 2002;288:1252-9.
Rivera JM, Talens-Visconti R, Salvador A, Bertomeu V, Miró V, Jordán A. Ventricular hypertrophy increases NT-proBNP in subjects with and without hypertension. Int J Cardiol. 2004;96:265-71.
Dangri P, Agarwal S, Kalra O, Rajpal S. Echocardiographic as-sessment of left ventricular hypertrophy in patients of chronic renal failure. Indian Journal of Nephrology. 2003;13:92-3.
Selvetella G, Notte A, Maffei A, Calistri V, Scamardella V. Left Ventricular Hypertrophy Is Associated With Asymp-tomatic Cerebral Damage in Hypertensive Patients. Stroke. 2003;34:1766-7.
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Belluardo P, Cataliotti A, Bonaiuto L. Lack of activation of molecular forms of the BNP system in human grade I hyper-tension and relationship to cardiac hypertrophy. Am J Physiol Heart Circ. 2006;291:1529-34.
Talwar S, Siebenhofer A, Williams B. Influence of hypertension, left ventricular hypertrophy, and left ventricular systolic dysfunc-tion on plasma N terminal proBNP. Heart 2000;83:278-82.
Cheung BM. Plasma concentration of brain natriuretic peptide is related to diastolic dysfunction in hypertension. Clin Exp Pharmacol Physiol. 1997;24:966-8.
Lukowicz Tv, Fischera M, Hense HW, Doring A, Stritzke J, Riegger G, et al. BNP as a marker of diastolic dysfunction in the general population:Importance of left ventricular hypertrophy. The European Journal of Heart Failure 2005;7 525– 31.
Goetze JP, Mogelvang R, Maage L, Scharling H, Schnohr P, Sogaard P, et al. Plasma pro-B-type natriuretic peptide in the general population: screening for left ventricular hyper-trophy and systolic dysfunction. European Heart Journal 2006;27:3004–10.
Yamamoto K, Burnett JC, Jougasaki M. Superiority of brain natriuretic peptide as a hormonal marker of ventricular systolic and diastolic dysfunction and ventricular hypertrophy. Hyper-tension. 1996;28:988-94.
Yamaguchi H, Yoshida J, Yamamoto K. Elevation of plasma brain natriuretic peptide is a hallmark of diastolic heart failure independent of ventricular hypertrophy. J Am Coll Cardiol. 2004;43:55-60.
Levin ER, Gardner DG, Samson WK. Natriuretic Peptides. N Engl J Med. 1998;339:321-7.
Luchner A, Burnett JC, Jougasaki M. Evaluation of brain na-triuretic peptide as marker of left ventricular dysfunction and hypertrophy in the population. J Hypertens. 2000;18:1121-8.
Baggish AL, Kimmenade RRJv, Januzzi JL. The Differential Di-agnosis of an Elevated Amino-Terminal Pro-B-Type Natriuretic Peptide Level. Am J Cardiol. 2008;101:43-8.
Hirata Y, Matsumoto A, Aoyagi T, Yamaoki K. Measurement of plasma brain natriuretic peptide level as a guide for cardiac overload. Cardiovascular Research 2001;51: 585–91.
Nakamura M, Tanaka F, Yonezawa S, Satou K, Nagano M, Hi-ramori K. The limited value of Plasma B-type natriuretic peptide for screening left ventricular hypertrophy among hypertensive patients. American journal of hypertension. 2003;16:1025-9.
Morillas P, Castillo J, Quiles J, Núñez D, Guillén S, Maceira A. Usefulness of NT-proBNP Level for Diagnosing Left Ventricular Hypertrophy in Hypertensive Patients. A Cardiac Magnetic Resonance Study. Rev Esp Cardiol. 2008;61:972-5.
Magnusson M, Jovinge S, Rydberg E, Dahlof B, Hall C, Nielsen OW, et al. Natriuretic peptides as indicators of cardiac remodeling in hypertensive patients. Blood Pressure. 2009;18:196-203.
Hildebrandt P, Boesen M, Olsen M, Wachtell K, Groenning B. N-terminal pro brain natriuretic peptide in arterial hyperten-sion: a marker for left ventricular dimensions and prognosis. The European Journal of Heart Failure 2004;6:313-7.
Pudil R, Tichy M, Praus R, Blaha V, Vojacek J. NT proBNP And Echocardiographic Parameters In Patients With Acute Heart Failure. ACTA MEDICA (Hradec Králové). 2007;52:51-6.
Setiawan Z. Prevalensi dan Determinan Hipertensi di Pulau Jawa Tahun 2004 Banten; 2004 [updated 2004; cited]; Available from: http://www.fkm_ui.
Pewsner D, Ju¨ni P, Egger M, Sundstrom J. Accuracy of elec-trocardiography in diagnosis of left ventricular hypertrophy in arterial hypertension: systematic review. BMJ. 2007:335:711.
Mancia G, Backer Gd, Dominiczak A, RCifkova, Fagard R, Germano G, et al. Guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2007;28:1462-536.
Alfakih K, Reid S, Hall A, Sivananthan M. The assessment of left ventricular hypertrophy in hypertension. J Hypertens. 2006;24:1223-30.
Cuspidi C, Meani S, Valerio C, Fusi V, Sala C, Zanchetti A. Left ventricular hypertrophy and cardiovascular risk strati-fication: impact and cost-effectiveness of echocardiography in recently diagnosed essential hypertensives. J Hypertens. 2006;24:1671-7.
Almenar L, Martínez-Dolz L. Péptidos natriuréticos en insufi-ciencia cardiaca. Rev Esp Cardiol. 2006;6 Supl F:15-26.
Mueller T, Gegenhuber A, Dieplinger B. Capability of B-Type Natriuretic Peptide (BNP) and Amino-Terminal proBNP as Indicators of Cardiac Structural Disease in Asymptomatic Pa-tients with Systemic Arterial Hypertension. Clinical Chemistry. 2005;51:2245-51.
Vasan RS, Benjamin EJ, Larson MG. Plasma natriuretic peptides for community screening for left ventricular hypertrophy and systolic dysfunction. J Am Med Assoc. 2002;288:1252-9.
Rivera JM, Talens-Visconti R, Salvador A, Bertomeu V, Miró V, Jordán A. Ventricular hypertrophy increases NT-proBNP in subjects with and without hypertension. Int J Cardiol. 2004;96:265-71.
Dangri P, Agarwal S, Kalra O, Rajpal S. Echocardiographic as-sessment of left ventricular hypertrophy in patients of chronic renal failure. Indian Journal of Nephrology. 2003;13:92-3.
Selvetella G, Notte A, Maffei A, Calistri V, Scamardella V. Left Ventricular Hypertrophy Is Associated With Asymp-tomatic Cerebral Damage in Hypertensive Patients. Stroke. 2003;34:1766-7.
Panteghini M, Clerico A. Cardiac Natriuretic Hormones as Markers of Cardiovascular Disease: Methodological Aspects. In: Clerico A, Emdin M, editors. Natriuretic Peptide. Italy: Springer Verlag; 2006. p. 72.
Belluardo P, Cataliotti A, Bonaiuto L. Lack of activation of molecular forms of the BNP system in human grade I hyper-tension and relationship to cardiac hypertrophy. Am J Physiol Heart Circ. 2006;291:1529-34.
Talwar S, Siebenhofer A, Williams B. Influence of hypertension, left ventricular hypertrophy, and left ventricular systolic dysfunc-tion on plasma N terminal proBNP. Heart 2000;83:278-82.
Cheung BM. Plasma concentration of brain natriuretic peptide is related to diastolic dysfunction in hypertension. Clin Exp Pharmacol Physiol. 1997;24:966-8.
Lukowicz Tv, Fischera M, Hense HW, Doring A, Stritzke J, Riegger G, et al. BNP as a marker of diastolic dysfunction in the general population:Importance of left ventricular hypertrophy. The European Journal of Heart Failure 2005;7 525– 31.
Goetze JP, Mogelvang R, Maage L, Scharling H, Schnohr P, Sogaard P, et al. Plasma pro-B-type natriuretic peptide in the general population: screening for left ventricular hyper-trophy and systolic dysfunction. European Heart Journal 2006;27:3004–10.
Yamamoto K, Burnett JC, Jougasaki M. Superiority of brain natriuretic peptide as a hormonal marker of ventricular systolic and diastolic dysfunction and ventricular hypertrophy. Hyper-tension. 1996;28:988-94.
Yamaguchi H, Yoshida J, Yamamoto K. Elevation of plasma brain natriuretic peptide is a hallmark of diastolic heart failure independent of ventricular hypertrophy. J Am Coll Cardiol. 2004;43:55-60.
Levin ER, Gardner DG, Samson WK. Natriuretic Peptides. N Engl J Med. 1998;339:321-7.
Luchner A, Burnett JC, Jougasaki M. Evaluation of brain na-triuretic peptide as marker of left ventricular dysfunction and hypertrophy in the population. J Hypertens. 2000;18:1121-8.
Baggish AL, Kimmenade RRJv, Januzzi JL. The Differential Di-agnosis of an Elevated Amino-Terminal Pro-B-Type Natriuretic Peptide Level. Am J Cardiol. 2008;101:43-8.
Hirata Y, Matsumoto A, Aoyagi T, Yamaoki K. Measurement of plasma brain natriuretic peptide level as a guide for cardiac overload. Cardiovascular Research 2001;51: 585–91.
Nakamura M, Tanaka F, Yonezawa S, Satou K, Nagano M, Hi-ramori K. The limited value of Plasma B-type natriuretic peptide for screening left ventricular hypertrophy among hypertensive patients. American journal of hypertension. 2003;16:1025-9.
Morillas P, Castillo J, Quiles J, Núñez D, Guillén S, Maceira A. Usefulness of NT-proBNP Level for Diagnosing Left Ventricular Hypertrophy in Hypertensive Patients. A Cardiac Magnetic Resonance Study. Rev Esp Cardiol. 2008;61:972-5.
Magnusson M, Jovinge S, Rydberg E, Dahlof B, Hall C, Nielsen OW, et al. Natriuretic peptides as indicators of cardiac remodeling in hypertensive patients. Blood Pressure. 2009;18:196-203.
Hildebrandt P, Boesen M, Olsen M, Wachtell K, Groenning B. N-terminal pro brain natriuretic peptide in arterial hyperten-sion: a marker for left ventricular dimensions and prognosis. The European Journal of Heart Failure 2004;6:313-7.
Pudil R, Tichy M, Praus R, Blaha V, Vojacek J. NT proBNP And Echocardiographic Parameters In Patients With Acute Heart Failure. ACTA MEDICA (Hradec Králové). 2007;52:51-6.
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How to Cite
Munir, M., & Sargowo, D. (1). N-terminal proBrain Natriuretic Peptide as Indicator of Left Ventricle Hypertrophy In Hypertensive Patients Compared with Left Ventricle Mass Index in Echocardiography. Indonesian Journal of Cardiology, 31(2), 87-98. https://doi.org/10.30701/ijc.v31i2.140
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Clinical Research
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