Advances in Clinical and Experimental Medicine
2017, vol. 26, nr 2, March-April, p. 295–301
Publication type: original article
Echocardiographic assessment and N-terminal pro-brain natriuretic peptide in hypertensives with metabolic syndrome
1 Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warszawa, Poland
2 Department of Laboratory Diagnostics, Military Institute of Medicine, Warszawa, Poland
Background. N-terminal pro-brain natriuretic peptide (NT-proBNP) release is associated with left ventricular expansion and pressure overload. Elevation of serum levels of natriuretic peptides is observed in patients with impaired as well as preserved left ventricular systolic function. High NT-proBNP has been shown to be related not only to preload but also to increased afterload, especially blood pressure and arterial stiffness.
Objectives. The aim of the study was to evaluate the association of NT-proBNP and echocardiographic parameters in hypertensives with metabolic syndrome.
Material and Methods. The study group comprised 133 patients (99 men; mean age 45.9 ± 9.4 years) with at least a 3-month history of arterial hypertension (stages 1 and 2) and fulfilling the diagnostic criteria for metabolic syndrome. Following initial clinical assessment, which included NT-proBNP levels, they underwent two-dimensional echocardiography.
Results. Echocardiographic abnormalities were observed in 60 subjects (45.1%), including left ventricular diastolic dysfunction (LVDdf) in 41 (30.8%) and left ventricular hypertrophy (LVH) in 35 (26.3%). Higher NT-proBNP concentrations were observed in patients with LVH, especially in the presence of LVDdf. Further analysis demonstrated that NT-proBNP correlated negatively with septal E’ (r = –0.38; p = 0.015) and heart rate (r = –0.42; p = 0.006) in patients with LVDdf, and positively with left ventricular end diastolic diameter (r = 0.46; p = 0.006) and left ventricular mass index (r = 0.49; p = 0.005) in subjects with LVH. However, the analysis of ROC curves revealed no NT-proBNP level of good sensitivity and specificity in diagnosing LVDdf/LVH (maximal area under the curve 0.571).
Conclusion. Even a relatively low NT-proBNP concentration can be a useful marker of left ventricular hypertrophy and end-diastolic wall stretch. However, in the present study there was no NT-proBNP level of satisfactory predictive value to diagnose LV abnormalities.
natriuretic peptides, echocardiography, left ventricular hypertrophy, left ventricular diastolic dysfunction
- McCullough PA, Neyou A. Comprehensive review of the relative clinical utility of B-type natriuretic peptide and N-terminal pro-B-type natriuretic peptide assays in cardiovascular disease. Open Heart Failure Journal. 2009;2:6–17.
- Ceyhan C, Unal S, Yenisey C, Tekten T, Ceyhan FB. The role of N-terminal pro-brain natriuretic peptide in the evaluation of left ventricular diastolic dysfunction: Correlation with echocardiographic indexes in hypertensive patients. Int J Cardiovasc Imaging. 2008; 24(3):253–259.
- McMurray JJ, Adamopoulos S, Anker SD, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Eur Heart J. 2012;33(14):1787–1847.
- Vasan RS, Benjamin EJ, Larson MG, et al. Plasma natriuretic peptides for community screening for left ventricular hypertrophy and systolic dysfunction: The Framingham heart study. JAMA. 2002; 288(10):1252–1259.
- Bricca G, Lantelme P. Natriuretic peptides: Ready for prime-time in hypertension? Arch Cardiovasc Dis. 2011;104(6–7):403–409.
- Parekh N, Maisel AS. Utility of B-natriuretic peptide in the evaluation of left ventricular diastolic function and diastolic heart failure. Curr Opin Cardiol. 2009;24(2):155–160.
- Lubien E, DeMaria A, Krishnaswamy P, et al. Utility of B-natriuretic peptide in detecting diastolic dysfunction: Comparison with Doppler velocity recordings. Circulation. 2002;105(5):595–601.
- Santosa YP, Tjandrawati A, Noormartany, et al. Comparison of pro B-natriureticpeptide in hypertensive patients with and without diastolic dysfunction. Acta Med Indones. 2008;40(1):19–23.
- Hildebrandt P, Boesen M, Olsen M, Wachtell K, Groenning B. N-terminal pro brain natriuretic peptide in arterial hypertension: A marker for left ventricular dimensions and prognosis. Eur J Heart Fail. 2004;6(3):313–317.
- Morillas P, Castillo J, Quiles J, et al. Usefulness of NT-proBNP level for diagnosing left ventricular hypertrophy in hypertensive patients: A cardiac magnetic resonance study. Rev Esp Cardiol. 2008;61(9): 972–975.
- Pedersen F, Raymond I, Kistorp C, Sandgaard N, Jacobsen P, Hildebrandt P. N-terminal pro-brain natriuretic peptide in arterial hypertension: A valuable prognostic marker of cardiovascular events. J Card Fail. 2005;11:S70–75.
- Olsen MH, Wachtell K, Tuxen C, et al. N-terminal pro-brain natriuretic peptide predicts cardiovascular events in patients with hypertension and left ventricular hypertrophy: A LIFE study. J Hypertens. 2004;22(8):1597–1604.
- Mancia G, De Backer G, Dominiczak A, et al. 2007 Guidelines for the management of arterial hypertension: The Task Force for the Manage-ment of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2007;25:1105–87.
- Alberti KG, Zimmet P, Shaw J, IDF Epidemiology Task Force Consensus Group. The metabolic syndrome: A new worldwide definition. Lancet. 2005;366:1059–1062.
- Lang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantification. Eur J Echocardiogr. 2006;7(2):79–108.
- Nagueh SF, Appleton CP, Gillebert TC, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. Eur J Echocardiogr. 2009;10(2):165–193.
- Mueller T, Gegenhuber A, Dieplinger B, Poelz W, Haltmayer M: Capability of B-type natriuretic peptide (BNP) and amino-terminal proBNP as indicators of cardiac structural disease in asymptomatic patients with systemic arterial hypertension. Clin Chem. 2005;51(12):2245–2251.
- Karaca I, Gülcü E, Yavuzkir M, et al. B-type natriuretic peptide level in the diagnosis of asymptomatic diastolic dysfunction. Anadolu Kardiyol Derg. 2007;7(3):262–267.
- Wei T, Zeng C, Chen L, et al. Bedside tests of B-type natriuretic peptide in the diagnosis of left ventricular diastolic dysfunction in hyperten-sive patients. Eur J Heart Fail. 2005;7(1):75–79.
- Dokainish H. Combining tissue Doppler echocardiography and B-type natriuretic peptide in the evaluation of left ventricular filling pres-sures: Review of the literature and clinical recommendations. Can J Cardiol. 2007;23(12):983–989.
- Goetze JP, Mogelvang R, Maage L, et al. Plasma pro-B-type natriuretic peptide in the general population: Screening for left ventricular hypertrophy and systolic dysfunction. Eur Heart J. 2006;27(24): 3004–3010.
- Rivera Otero JM, Taléns-Visconti R, Salvador A, et al. Ventricular hypertrophy increases NT-proBNP in subjects with and without hyperten-sion. Int J Cardiol. 2004;96(2):265–271.
- Luchner A, Burnett JC Jr, Jougasaki M, et al. Evaluation of brain natriuretic peptide as marker of left ventricular dysfunction and hypertrophy in the population. J Hypertens. 2000;18:1121–1128.
- Belluardo P, Cataliotti A, Bonaiuto L, et al. Lack of activation of molecular forms of the BNP system in human grade 1 hypertension and rela-tionship to cardiac hypertrophy. Am J Physiol Heart Circ Physiol. 2006;291(4):H1529–1535.
- Talwar S, Siebenhofer A, Williams B, Ng L. Influence of hypertension, left ventricular hypertrophy, and left ventricular systolic dysfunction on plasma N terminal proBNP. Heart. 2000;83(3):278–282.
- Mak GS, DeMaria A, Clopton P, Maisel AS. Utility of B-natriuretic peptide in the evaluation of left ventricular diastolic function: Comparison with tissue Doppler imaging recordings. Am Heart J. 2004;148(5):895–902.
- Cheung BMY, Kumana CR. Natriuretic peptides: Relevance in cardiac disease. JAMA. 1998;280:1983–1984.
- Maeda K, Tsutamoto T, Wada A, Hisanaga T, Kinoshita M. Plasma brain natriuretic peptide as a biochemical marker of high left ventricular end-diastolic pressure in patients with symptomatic left ventricular dysfunction. Am Heart J. 1998;135:825–832.
- Ambrosi P, Oddoze C, Habib G. Utility of B-natriuretic peptide in detecting diastolic dysfunction: Comparison with Doppler velocity record-ings. Circulation. 2002;106(15):e70.
- Bettencourt P, Ferreira A, Sousa T, et al. Brain natriuretic peptide as a marker of cardiac involvement in hypertension. Int J Cardiol. 1999; 69(2):169–177.