Plasma pro-B-type natriuretic peptide in the general population: screening for left ventricular hypertrophy and systolic dysfunction
Plasma pro-B-type natriuretic peptide in the general population: screening for left ventricular hypertrophy and systolic dysfunction
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DOI：
10.1093/eurheartj/ehl406
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发表时间：
2006-12-01
影响因子：
39.3
通讯作者：
Jensen, Jan Skov
中科院分区：
文献类型：
--
作者：
Goetze, Jens Peter;Mogelvang, Rasmus;Jensen, Jan Skov
目的B型利钠肽(BNP)检测在筛查左室肥厚(LVH)和左心室收缩功能不全(LVSD)中的作用已在普通人群中得到评价，但有关ProBNP和ProBNP N端片段的相关信息仍然有限。方法与结果在第四届哥本哈根城市心脏研究中，3497名参与者接受了超声心动图检查，并评估了左心室射血分数(LVEF)和质量。用受试者工作特征(ROC)曲线评价性别和年龄对血浆ProBNP浓度诊断的影响。在1502名男性和1995名女性中，分别有4.1%和2.6%的人定义为左心室射血分数为60%，而只有0.4%的人定义为左心室射血分数为40%。女性的ProBNP浓度是男性的1.7倍(P<；0.0001)，并且与年龄有关。左心室肥厚患者的血浆ProBNP平均浓度是非左室肥厚患者的两倍(P<；0.0001)。同样，左心室肥厚使原BNP浓度增加了1.9倍(P<；0.0001)：在调整了缺血性心脏病、高血压、糖尿病、性别和年龄后，这两种差异仍然存在。ProBNP在检测LVEF及Lt；40%方面具有较高的诊断性能，女性ROC曲线下面积为0.92(95%可信区间0.79~1.00)，男性ROC曲线下面积为0.85(95%可信区间0.74~0.96)。结论我们在一个大型社区队列中建立了年龄和性别对ProBNP浓度的影响。ProBNP测量在普通人群中筛查LVH和LVSD的诊断性能与报道的BNP数据相似。
Aims B-type natriuretic peptide (BNP) measurement in screening for left ventricular hypertrophy (LVH) and left ventricular systolic dysfunction (LVSD) has been evaluated in the general population, but corresponding information on proBNP and the N-terminal proBNP fragment is still limited. We therefore examined whether proBNP measurement is useful for LVH and LVSD screening in the general population.Methods and results In the 4th Copenhagen City Heart Study, 3497 participants underwent echocardiography with assessment of left ventricular ejection fraction (LVEF) and mass. The impact of gender and age was determined and the diagnostic performance of the plasma proBNP concentration was evaluated using receiver operating characteristic (ROC) curves. Of 1502 men and 1995 women, 4.1 and 2.6% had LVSD defined as an LVEF < 60% whereas only 0.4% displayed LVEF < 40%. The proBNP concentration was 1.7-fold higher in women compared with men (P < 0.0001) and related to age in both genders. The mean proBNP plasma concentration was two-fold higher in subjects with LVSD than without LVSD (P < 0.0001). Likewise, LVH imposed a 1.9-fold increase in the proBNP concentration (P < 0.0001): Both differences persisted after adjusting for ischaemic heart disease, hypertension, diabetes, gender, and age. The diagnostic performance of proBNP in detecting LVEF < 40% was high with an area under the ROC curves of 0.92 (95% CI 0.79-1.00) in women and 0.85 (95% CI 0.74-0.96) in men.Conclusion We have established the impact of age and gender on the proBNP concentration in a large, community- based cohort. The diagnostic performance for proBNP measurement in screening for LVH and LVSD in the general population parallels the reported data for BNP.