N-terminal pro-brain natriuretic peptide - A promising biomarker for the diagnosis of left ventricular hypertrophy in hypertensive women

Introduction. - No agreement has been reached regarding the best strategy to detect left ventricular hypertrophy (LVH). This study examined the rote of N-terminal pro-brain natriuretic peptide (NT-proBNP) in the diagnosis of LVH in hypertensive patients and the potential factors that may influence its diagnostic performance. Methods. - The global accuracy of NT-proBNP in diagnosing LVH was assessed using a receiver-operating characteristic (ROC) curve. The influence of patients' characteristics on test accuracy was studied with a ROC regression based on a probit model. Ninety-three subjects were included. All had NT-proBNP measured and underwent electrocardiography with calculation of the left ventricutar mass index (LVMI). Results. - The diagnostic performance of NT-proBNP in WH varied slightly depending on the indexation mode of LVMI. In cases of body surface area indexation, the area under the ROC curve of 81.6% suggested a good performance. The accuracy of the marker was significantly higher in women than in men (p < 0.0001). There were no significant effects of age, treatment, body mass index, left ventricular mass index, 24-h systolic blood pressure, or creatinine clearance on the test performance. Slight differences were observed when an indexation to height2.7 instead of body surface area was used. Conclusions. - The present results may lead to a new strategy for risk stratification in hypertension: in women, NT-proBNP alone or preferably in combination with electrocardiography seems sufficient to confirm or exclude diagnosis of LVH. In men, echocardiography would only be needed in cases of negative electrocardiography and NT-proBNP test. © 2008 Published by Elsevier Masson SAS.