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B-type natriuretic peptide (BNP) is a predictor of long term adverse cardiac events, but not N-terminal pro-BNP (NTproBNP) in patients with acute dyspnea.
¹ 가톨릭 대학교 의과 대학 순환기 내과
고윤석¹, 백상홍¹ , 박훈준¹ , 박만원¹ , 백주열¹ , 윤성규¹ , 박재홍¹ , 최익준¹ , 추은호¹ , 정해억¹ , 승기배¹ , 김재형¹ , 최규보¹
Backgrounds : Plasma BNP and NTproBNP level have been known to be a predictive value of adverse cardiac events in patients with heart failure. However, whether BNP or NTproBNP measurements offer any advantage over the other in any clinical setting is controversial. So we evaluated which biomarker can be more useful in predicting long term adverse cardiac events in patients with acute dyspnea. Methods : From May 2005 to May 2006, we enrolled consecutive 961 patients with acute dyspnea (514 men and mean age 61.95 ± 12.895) who underwent BNP and NTproBNP measurement simultaneously by prospective registry. Median follow up period was 807 days (18-1041 days). We divided patients into two groups ; group I: cardiac events (cardiac death, rehospitalization due to heart failure) and group II: not cardiac events. We compared the baseline characteristics between two groups. And by reveiver operation characteristic curve, we compared area under curve (AUC) for adverse cardiac event by BNP and NTproBNP. Then to find the predictors of adverse cardiac events, we used Cox hazard regression analysis. Results : The plasma level of BNP and NTproBNP is higher in group I (408 ± 567 pg/ml vs. 153 ± 333 pg/ml, p=0.015, 3453 ± 6230 pg/ml vs. 1128 ± 3423 pg/ml,p=0.041, respectively). The AUC for adverse cardiac events was similar between both biomarkers (BNP vs. NTproBNP 0.735 vs. 0.745). In this results, we deduced cut off value of BNP (80 pg/ml) and NTproBNP (320 pg/ml) which was used for Cox hazard regression analysis. Table 1 shows the predictors of adverse cardiac events in patient with acute dyspnea by Cox hazard regression analysis. Conclusions : Our findings shows that plasma BNP level is independently associated with adverse cardiac events in patients with acute dyspnea, but not NTproBNP. And hemoglobin, body mass index are the predictors of adverse cardiac events in patients with acute dyspnea.

Table1. Predictors of adverse cardiac events in patients with acute dyspnea

Variables

Hazard ratio

Confidence interval

P-value

BNP above 80 pg/ml

3.268

1.543-6.922

0.002

Hemoglobin

0.820

0.703-0.957

0.012

Body mass index

0.880

0.786-0.984

0.025



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