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N-terminal Pro-B-type natriuretic peptide and its correlation to haemodialysis-induced myocardial stunning
Breidthardt, T; Burton, J O; Odudu, A; Eldehni, M T; Jefferies, H; McIntyre, C W
Nephron Clin Pract. 2013;123(1-2):118-22.
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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. CONCLUSION: 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.
Keyword(s)
Causality; Comorbidity; Female; Great Britain/epidemiology; Humans; Kidney Failure, Chronic/*blood/epidemiology/*rehabilitation; Male; Middle Aged; Myocardial Stunning/*blood/diagnosis/*epidemiology; Natriuretic Peptide, Brain/*blood; Peptide Fragments/*blood; Prevalence; Renal Dialysis/*statistics & numerical data; Reproducibility of Results; Risk Factors; Sensitivity and Specificity; Statistics as Topic; Treatment Outcome
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- Related website http://www.ncbi.nlm.nih.gov/pubmed/23880872
- Breidthardt, Tobias Burton, James O Odudu, Aghogho Eldehni, Mohamed Tarek Jefferies, Helen McIntyre, Christopher W eng Controlled Clinical Trial Switzerland 2013/07/25 06:00 Nephron Clin Pract. 2013;123(1-2):118-22. doi: 10.1159/000351190. Epub 2013 Jul 18.