Circulating N-terminal atrial natriuretic peptide as a marker for symptomless left-ventricular dysfunction

Amir Lerman, Raymond J Gibbons, R. J. Rodeheffer, Kent R Bailey, L. J. McKinley, D. M. Heublein, John C Jr. Burnett

Research output: Contribution to journalArticle

288 Citations (Scopus)

Abstract

Early identification of patients with symptomless left-ventricular dysfunction and early pharmacologic intrervention may have an impact on the outlook of patients with heart failure. Atrial natriuretic peptide (ANP) is a cardiac hormone that is released as a C-terminal (C-ANP) and an N-terminal peptide (N-ANP). Since N-ANP has reduced clearance rates compared with C-ANP, N-ANP circulates at higher concentrations. Based on the known increased concentration of C-ANP in symptomatic congestive heart failure, our study was designed to evaluate prospectively N-ANP profile and left-ventricular function in subjects with symptomless and symptomatic heart failure, and the role of plasma N-ANP as a marker for early identification of patients with heart failure. 180 patients who were referred for rest and exercise radionuclide angiography for evaluation of left-ventricular function were studied. Blood was taken for measurement of C-AN P and N-AN P before angiography. Patients were grouped according to New York Heart Association (NYHA) heart failure classification and left-ventricular function. Mean (SD) plasma N-ANP concentration in patients with symptomless left-ventricular dysfunction (NYHA class I, n=70) was 243 (256) pmol/L (range 27-922 pmol/L), and was higher (p<0·001) than in 25 control subjects (28 [13] pmol/L). A plasma N-ANP concentration above 54 pmol/L (mean±1·96SD of the control group) had a sensitivity of 90% and a specificity of 92% for detection of patients with symptomless left-ventricular dysfunction. We have shown that plasma N-ANP concentrations are significantly increased in patients with symptomless left-ventricular dysfunction and that this peptide can serve as a marker for diagnosis of such patients.

Original languageEnglish (US)
Pages (from-to)1105-1109
Number of pages5
JournalThe Lancet
Volume341
Issue number8853
DOIs
StatePublished - May 1 1993

Fingerprint

Left Ventricular Dysfunction
Atrial Natriuretic Factor
Peptides
Heart Failure
Left Ventricular Function
Radionuclide Angiography
Angiography
Hormones
Exercise
Control Groups

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Circulating N-terminal atrial natriuretic peptide as a marker for symptomless left-ventricular dysfunction. / Lerman, Amir; Gibbons, Raymond J; Rodeheffer, R. J.; Bailey, Kent R; McKinley, L. J.; Heublein, D. M.; Burnett, John C Jr.

In: The Lancet, Vol. 341, No. 8853, 01.05.1993, p. 1105-1109.

Research output: Contribution to journalArticle

@article{58ed8c561b3943b485305a4375308bde,
title = "Circulating N-terminal atrial natriuretic peptide as a marker for symptomless left-ventricular dysfunction",
abstract = "Early identification of patients with symptomless left-ventricular dysfunction and early pharmacologic intrervention may have an impact on the outlook of patients with heart failure. Atrial natriuretic peptide (ANP) is a cardiac hormone that is released as a C-terminal (C-ANP) and an N-terminal peptide (N-ANP). Since N-ANP has reduced clearance rates compared with C-ANP, N-ANP circulates at higher concentrations. Based on the known increased concentration of C-ANP in symptomatic congestive heart failure, our study was designed to evaluate prospectively N-ANP profile and left-ventricular function in subjects with symptomless and symptomatic heart failure, and the role of plasma N-ANP as a marker for early identification of patients with heart failure. 180 patients who were referred for rest and exercise radionuclide angiography for evaluation of left-ventricular function were studied. Blood was taken for measurement of C-AN P and N-AN P before angiography. Patients were grouped according to New York Heart Association (NYHA) heart failure classification and left-ventricular function. Mean (SD) plasma N-ANP concentration in patients with symptomless left-ventricular dysfunction (NYHA class I, n=70) was 243 (256) pmol/L (range 27-922 pmol/L), and was higher (p<0·001) than in 25 control subjects (28 [13] pmol/L). A plasma N-ANP concentration above 54 pmol/L (mean±1·96SD of the control group) had a sensitivity of 90{\%} and a specificity of 92{\%} for detection of patients with symptomless left-ventricular dysfunction. We have shown that plasma N-ANP concentrations are significantly increased in patients with symptomless left-ventricular dysfunction and that this peptide can serve as a marker for diagnosis of such patients.",
author = "Amir Lerman and Gibbons, {Raymond J} and Rodeheffer, {R. J.} and Bailey, {Kent R} and McKinley, {L. J.} and Heublein, {D. M.} and Burnett, {John C Jr.}",
year = "1993",
month = "5",
day = "1",
doi = "10.1016/0140-6736(93)93125-K",
language = "English (US)",
volume = "341",
pages = "1105--1109",
journal = "The Lancet",
issn = "0140-6736",
publisher = "Elsevier Limited",
number = "8853",

}

TY - JOUR

T1 - Circulating N-terminal atrial natriuretic peptide as a marker for symptomless left-ventricular dysfunction

AU - Lerman, Amir

AU - Gibbons, Raymond J

AU - Rodeheffer, R. J.

AU - Bailey, Kent R

AU - McKinley, L. J.

AU - Heublein, D. M.

AU - Burnett, John C Jr.

PY - 1993/5/1

Y1 - 1993/5/1

N2 - Early identification of patients with symptomless left-ventricular dysfunction and early pharmacologic intrervention may have an impact on the outlook of patients with heart failure. Atrial natriuretic peptide (ANP) is a cardiac hormone that is released as a C-terminal (C-ANP) and an N-terminal peptide (N-ANP). Since N-ANP has reduced clearance rates compared with C-ANP, N-ANP circulates at higher concentrations. Based on the known increased concentration of C-ANP in symptomatic congestive heart failure, our study was designed to evaluate prospectively N-ANP profile and left-ventricular function in subjects with symptomless and symptomatic heart failure, and the role of plasma N-ANP as a marker for early identification of patients with heart failure. 180 patients who were referred for rest and exercise radionuclide angiography for evaluation of left-ventricular function were studied. Blood was taken for measurement of C-AN P and N-AN P before angiography. Patients were grouped according to New York Heart Association (NYHA) heart failure classification and left-ventricular function. Mean (SD) plasma N-ANP concentration in patients with symptomless left-ventricular dysfunction (NYHA class I, n=70) was 243 (256) pmol/L (range 27-922 pmol/L), and was higher (p<0·001) than in 25 control subjects (28 [13] pmol/L). A plasma N-ANP concentration above 54 pmol/L (mean±1·96SD of the control group) had a sensitivity of 90% and a specificity of 92% for detection of patients with symptomless left-ventricular dysfunction. We have shown that plasma N-ANP concentrations are significantly increased in patients with symptomless left-ventricular dysfunction and that this peptide can serve as a marker for diagnosis of such patients.

AB - Early identification of patients with symptomless left-ventricular dysfunction and early pharmacologic intrervention may have an impact on the outlook of patients with heart failure. Atrial natriuretic peptide (ANP) is a cardiac hormone that is released as a C-terminal (C-ANP) and an N-terminal peptide (N-ANP). Since N-ANP has reduced clearance rates compared with C-ANP, N-ANP circulates at higher concentrations. Based on the known increased concentration of C-ANP in symptomatic congestive heart failure, our study was designed to evaluate prospectively N-ANP profile and left-ventricular function in subjects with symptomless and symptomatic heart failure, and the role of plasma N-ANP as a marker for early identification of patients with heart failure. 180 patients who were referred for rest and exercise radionuclide angiography for evaluation of left-ventricular function were studied. Blood was taken for measurement of C-AN P and N-AN P before angiography. Patients were grouped according to New York Heart Association (NYHA) heart failure classification and left-ventricular function. Mean (SD) plasma N-ANP concentration in patients with symptomless left-ventricular dysfunction (NYHA class I, n=70) was 243 (256) pmol/L (range 27-922 pmol/L), and was higher (p<0·001) than in 25 control subjects (28 [13] pmol/L). A plasma N-ANP concentration above 54 pmol/L (mean±1·96SD of the control group) had a sensitivity of 90% and a specificity of 92% for detection of patients with symptomless left-ventricular dysfunction. We have shown that plasma N-ANP concentrations are significantly increased in patients with symptomless left-ventricular dysfunction and that this peptide can serve as a marker for diagnosis of such patients.

UR - http://www.scopus.com/inward/record.url?scp=0027190324&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0027190324&partnerID=8YFLogxK

U2 - 10.1016/0140-6736(93)93125-K

DO - 10.1016/0140-6736(93)93125-K

M3 - Article

C2 - 8097801

AN - SCOPUS:0027190324

VL - 341

SP - 1105

EP - 1109

JO - The Lancet

JF - The Lancet

SN - 0140-6736

IS - 8853

ER -