Usefulness of the N-Terminal Fraction of Brain Natriuretic Peptide for Deciding When to Refer Patients With Sleep Apnea-Hypopnea Syndrome to the Cardiologist

Fernández Fabrellas, Estrella; Almenar Bonet, Luis; Ponce Pérez, Silvia; Moro López, José Antonio; Blanquer Olivas, Rafael; Salvador Sanz, Antonio

doi:10.1016/S1579-2129(09)71017-1

Archivos de Bronconeumología

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Vol. 45. Issue 4.

Pages 173-180 (April 2009)

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Pages 173-180 (April 2009)

Original article

DOI: 10.1016/S1579-2129(09)71017-1

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Usefulness of the N-Terminal Fraction of Brain Natriuretic Peptide for Deciding When to Refer Patients With Sleep Apnea-Hypopnea Syndrome to the Cardiologist

¿Cuándo remitir al cardiólogo al paciente con síndrome de apneas-hipopneas durante el sueño? Utilidad del NT-proBNP

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Estrella Fernández Fabrellasa,

Corresponding author

fernandez_est@gva.es

Corresponding author.

, Luis Almenar Bonetb, Silvia Ponce Péreza, José Antonio Moro Lópezb, Rafael Blanquer Olivasa, Antonio Salvador Sanzc

a Servicio de Neumología, Hospital Universitario Dr. Peset, Valencia, Spain

b Servicio de Cardiología, Hospital Universitario La Fe, Valencia, Spain

c Servicio de Cardiología, Hospital Universitario Dr. Peset, Valencia, Spain

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Abstract

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Abstract

Introduction and objective

When sleep apnea-hypopnea syndrome (SAHS) and cardiovascular disease occur concurrently, prognosis is affected. Echocardiography can detect structural cardiac abnormalities but using this technique in all patients would place a heavy burden on resources. The objective of this study was to investigate whether the N-terminal fraction of brain natriuretic peptide (NT-proBNP) can be used as a marker for silent heart disease.

Patients and methods

NT-proBNP concentration was measured in the 114 consecutive patients with SAHS who underwent echocardiography before starting treatment. Left and right ventricular systolic and diastolic function, as well as structural abnormalities, were studied. Correlations between NT-proBNP concentration and the abnormalities detected were investigated. A receiver operating characteristics (ROC) curve was plotted for NT-proBNP concentration and cardiac abnormalities.

Results

Data for 98 patients were finally analyzed. NT-proBNP concentration was significantly correlated with ventricular septal thickness (r=0.63), posterior wall thickness (r=0.45), and left ventricular enddiastolic diameter (r=0.51) (P<.0001 for all correlations). The area under the ROC curve was significant (0.870; 95% confidence interval, 0.801-0.939; P<.0001). Assuming that specificity would be more useful for clinical practice, we calculated that NT-proBNP concentrations below 100 and 200 pg/mL could rule out structural abnormalities with a reliability of 90% and 100%, respectively.

Conclusions

NT-proBNP concentration was strongly correlated with echocardiographic abnormalities and so could be a useful tool for identifying patients who should be referred to the cardiologist.

Keywords:

Sleep apnea-hypopnea syndrome

Doppler echocardiography

Natriuretic peptides

Resumen

Introducción y objetivo

La comorbilidad cardiovascular del síndrome de apneas-hipopneas durante el sueño (SAHS) condiciona su pronóstico. La ecocardiografía detecta alteraciones estructurales, pero realizarla a todos los pacientes ocasionaría un gran consumo de recursos. El objetivo de este trabajo ha sido estudiar el papel de la fracción N-terminal del péptido natriurético cerebral (NT-proBNP) para detectar cardiopatía silente.

Pacientes y métodos

Se seleccionó a 114 pacientes consecutivos con SAHS, a quienes se les determinó la concentración de NT-proBNP y se les realizó una ecocardiografía antes de que recibieran tratamiento. Se estudiaron las funciones sistólica y diastólica de ambos ventrículos, así como las alteraciones morfológicas. Se analizaron las correlaciones existentes entre el NT-proBNP y las alteraciones halladas. Se realizó una curva de eficacia diagnóstica entre el NT-proBNP y la presencia de alteración cardíaca.

Resultados

Finalmente se estudió a 98 pacientes. El NT-proBNP se correlacionó de forma significativa (p<0,0001) con el grosor del tabique interventricular (r=0,63), con el de la pared posterior (r=0,45) y con el diámetro telediastólico del ventrículo izquierdo (r=0,51). La curva de eficacia diagnóstica calculó un área bajo la curva significativa (0,870; intervalo de confianza del 95%, 0,801-0,939; p<0,0001). Se consideró más útil para la práctica clínica el valor de especificidad. Así, unos valores de NT-proBNP inferiores a 100 y 200 pg/ml descartan que haya alteraciones morfológicas cardíacas con una fiabilidad del 90 y el 100%, respectivamente.

Conclusiones

El NT-proBNP tiene correlaciones relevantes con la presencia de alteraciones ecocardiográficas y podría ser una herramienta útil para identificar a los pacientes que deberían ser remitidos para estudio cardiológico.

Palabras clave:

Síndrome de apneas-hipopneas durante el sueño

Ecocardiografía Doppler

Péptidos natriuréticos

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