Abstract 11746: Best Use of Cardiac Biomarkers for Left Ventricular Structure in Japanese Patients with Chronic Kidney Disease and a High Risk for Cardiovascular Disease: The Japan Morning Surge - Home Blood Pressure (J-HOP) LVH Study

Abstract

Introduction: Currently, the potential advantages of either B-type natriuretic peptide (BNP) or N-terminal pro-BNP (NT-proBNP) in diagnosing cardiac mass and geometry in patients with chronic kidney disease (CKD) remain unclear.

Hypothesis: We performed a comprehensive evaluation of the screening performance of BNP and NT-proBNP for left ventricular (LV) structure.

Methods: In 1356 patients recruited for the J-HOP study with one or more cardiovascular risk factors, we performed measurement of BNP and NT-proBNP and echocardiography, and excluded the patients with left ventricular (LV) dysfunction (ejection fraction < 50%).Patients were placed into quintiles based on BNP and NT-proBNP levels after dividing them into a non-CKD (eGFR >60ml/min/1.73m², n=1026) and a CKD (eGFR <60ml/min/1.73m², n=330) group.

Results: Among patients of the non-CKD group, the odds ratio (OR) of LV hypertrophy and concentric hypertrophy (CH) increased from the lowest BNP quintile to the highest. The highest NT-pro BNP category also showed an increased likelihood of LV hypertrophy and CH in comparison with the lowest. In the CKD group, the OR of LV hypertrophy increased from the lowest BNP quintile to the highest. Patients in the highest NT-pro BNP category had increased likelihood of LV hypertrophy compared with those in the lowest. In addition, patients in the highest NT-pro BNP category had increased likelihood of CH compared with those in the lowest, while this association was not found in BNP quintiles (Table). Among patients of the non-CKD group, the values of the area under the receiver operating characteristic curve (AUROC)s were similar between BNP (0.586) and NT-pro BNP (0.620) for CH, but in subjects of the CKD group, the AUROCs for NT-pro BNP were higher than those for BNP ( 0.596 vs. 0.533, p<0.05).

Conclusion: In Japanese patients who were at high risk for cardiovascular disease and who had CKD, NT-proBNP was superior to BNP for detecting concentric hypertrophy.