Published online before print April 28, 2003, doi: 10.1161/01.CIR.0000068314.02595.B2
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(Circulation. 2003;107:2440.)
© 2003 American Heart Association, Inc.
Clinical Investigation and Reports |
Serum N-Terminal Pro–Brain Natriuretic Peptide Is a Sensitive Marker of Myocardial Dysfunction in AL Amyloidosis
From the Department of Internal Medicine (G.P., V.P., S.P., E.A.); Biotechnology Research Laboratory (G.P., L.O., G.M.); Department of Cardiology (C.C.); Clinical Epidemiology and Biometry Unit (C.K.); Clinical Chemistry Laboratory (A.B., G.V., R.M.); Department of Biochemistry (A.B., R.M., G.M.); University Hospital "IRCCS Policlinico San Matteo"–University of Pavia, Pavia; and the Department of Experimental and Clinical Biomedical Sciences, University of Insubria, Varese, Italy (G.M.d.’E.).
Correspondence to Prof Giampaolo Merlini, MD, Biotechnology Research Laboratories, IRCCS Policlinico S. Matteo. Piazzale Golgi, 19-27100-Pavia, Italy. E-mail gmerlini{at}unipv.it
Background— Brain natriuretic peptide (BNP) is a marker of ventricular dysfunction and can be used to assess prognosis in heart failure and after myocardial infarction. Heart involvement is the most important prognostic factor and causes death in almost all patients with light-chain amyloidosis (AL). We investigated the prognostic value of NT-proBNP and its utility in monitoring amyloid heart dysfunction.
Methods and Results— NT-proBNP was quantified at diagnosis in 152 consecutive patients seen at the coordinating center of the Italian Amyloidosis Study Group (Pavia) from 1999 throughout 2001. Heart involvement was estimated on the basis of clinical signs, electrocardiography, and echocardiography. NT-proBNP concentrations differed in patients with (n=90, 59%) and without (n=62, 41%) heart involvement (median: 507.8 pmol/L versus 22.1 pmol/L, P=10-7). The best cutoff for heart involvement was at 152 pmol/L (sensitivity: 93.33%, specificity: 90.16%, accuracy: 92.05%) and distinguished two groups with different survival (P<0.001). The Cox multivariate model including NT-proBNP was better than models including echocardiographic and clinical signs of heart involvement. NT-proBNP appeared to be more sensitive than conventional echocardiographic parameters in detecting clinical improvement or worsening of amyloid cardiomyopathy during follow-up.
Conclusions— NT-proBNP appeared to be the most sensitive index of myocardial dysfunction and the most powerful prognostic determinant in AL amyloidosis. It adds prognostic information for newly diagnosed patients and can be useful in designing therapeutic strategies and monitoring response. NT-proBNP is a sensitive marker of heart toxicity caused by amyloidogenic light chains.
Key Words: amyloid • cardiomyopathy • natriuretic peptides • prognosis • survival
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