European Heart Journal Advance Access originally published online on January 23, 2006
European Heart Journal 2006 27(5):622; doi:10.1093/eurheartj/ehi738
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Normal range of N-terminal pro-brain natriuretic peptide: a note of caution
Department of Cardiology
University Hospital Zurich
Raemistr. 100
Zurich
Switzerland
Tel: +41 44 2551111
Fax: +41 44 2554401
E-mail address: thomas{at}wolber.at
Division of Cardiology
University Hospital
Petersgraben 4
4031 Basel
Switzerland
With interest we read the article by Galasko et al.1 in a recent issue. The authors present age- and gender-stratified normal values for N-terminal pro-brain natriuretic peptide (NTpBNP), which they validated in subjects with high risk for cardiovascular disease recruited from community practices and in a random sample of low-risk subjects without cardiovascular risk factors. In this study, the definition of significant cardiovascular disease was based on a history of cardiovascular risk factors and coronary artery disease (CAD) as well as pathologic echocardiographic findings. However, the authors' conclusion that the cut-off values provided offer excellent negative and positive predictive values for ruling in or out cardiovascular disease should be taken with caution. Significant cardiovascular disease cannot be ruled out by these cut-off values, because Galasko et al. did not reliably rule out silent CAD in the subjects assessed. Especially for groups with higher prevalence of CAD, as in older subjects, or with a higher rate of silent CAD, as in women, the cut-off values given might be too high. NTpBNP has been shown to be elevated in patients with CAD,2 and elevated levels are associated with adverse outcomes.3 Unless CAD is not excluded by an accurate diagnostic reference method, i.e. coronary angiography, subjects with silent but significant CAD will be misclassified as free of significant cardiovascular disease. In the paper addressed, NTpBNP levels of subjects with silent CAD might have been included in the calculation of the upper limit of the normal range of NTpBNP. The upper limit of the normal range of NTpBNP might therefore be lower than that stated in the study of Galasko et al.
References
- Galasko GI, Lahiri A, Barnes SC, Collinson P, Senior R. What is the normal range for N-terminal pro-brain natriuretic peptide? How well does this normal range screen for cardiovascular disease? Eur Heart J 2005;26:2269–2276.
[Abstract/Free Full Text] - Weber M, Dill T, Arnold R, Rau M, Ekinci O, Muller KD, Berkovitsch A, Mitrovic V, Hamm C. N-terminal B-type natriuretic peptide predicts extent of coronary artery disease and ischemia in patients with stable angina pectoris. Am Heart J 2004;148:612–620.[CrossRef][ISI][Medline]
- Kragelund C, Gronning B, Kober L, Hildebrandt P, Steffensen R. N-terminal pro-B-type natriuretic peptide and long-term mortality in stable coronary heart disease. N Engl J Med 2005;352:666–675.
[Abstract/Free Full Text]
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