Download biomedica product listRenal dysfunction may limit the clinical application of NT-proBNP in the diagnosis of heart failure.
Big ET is an excellent biomarker candidate for the diagnosis of HFpEF in CKD, independent of GFR
This was recently discussed in: Renal function, N-terminal Pro-B-Type natriuretic peptide, propeptide big-endothelin and patients with heart failure and preserved ejection fraction.
Ingrid Gergei, Bernhard K. Krämer, Hubert Scharnagl, Tatjana Stojakovic, Winfried März. Peptides. 2018 Apr 21. pii: S0196-9781(18)30071-8. Click link for abstract.
Highlights:
- NT-proBNP is strongly associated with GFR and shows an exponential negative correlation with GFR decline.
- Big ET-1 is much less affected by GFR decline than NT-proBNP
- A single cut-off point is sufficient in the diagnosis of HFpEF in CKD, independent of GFR
Big ET for the diagnosis of HFpEF
The Biomedica Big Endothelin ELISA Assay is:
- EASY – can be used in every lab
- ROBUST & fully VALIDATED
- CE registered – for IVD use in EU
- GOOD ANALYTE STABILITY in serum and plasma
Related publications
Prognostic value of plasma big endothelin-1 in left ventricular non-compaction cardiomyopathy.
Fan P, Zhang Y, Lu YT, Yang KQ, Lu PP, Zhang QY, Luo F, Lin YH, Zhou XL, Tian T. Heart. 2021. 107(10):836-841. PMID: 33055147; PMCID: PMC8077223.
Abstract
Objective: To determine the prognostic role of big endothelin-1 (ET-1) in left ventricular non-compaction cardiomyopathy (LVNC).
Methods: We prospectively enrolled patients whose LVNC was diagnosed by cardiac MRI and who had big ET-1 data available. Primary end point was a composite of all-cause mortality, heart transplantation, sustained ventricular tachycardia/fibrillation and implanted cardioverter defibrillator discharge. Secondary end point was cardiac death or heart transplantation.
Results: Altogether, 203 patients (median age 44 years; 70.9% male) were divided into high-level (≥0.42 pmol/L) and low-level (<0.42 pmol/L) big ET-1 groups according to the median value of plasma big ET-1 levels. Ln big ET-1 was positively associated with Ln N-terminal pro-brain natriuretic peptide, left ventricular diameter, but negatively related to age and Ln left ventricular ejection fraction. Median follow-up was 1.9 years (IQR 0.9-3.1 years). Kaplan-Meier analysis showed that, compared with patients with low levels of big ET-1, those with high levels were at greater risk for meeting both primary (p<0.001) and secondary (p<0.001) end points. The C-statistic estimation of Ln big ET-1 for predicting the primary outcome was 0.755 (95% CI 0.685 to 0.824, p<0.001). After adjusting for confounding factors, Ln big ET-1 was identified as an independent predictor of the composite primary outcome (HR 1.83, 95% CI 1.27 to 2.62, p=0.001) and secondary outcome (HR 1.93, 95% CI 1.32 to 2.83, p=0.001).
The big ET-1 concentrations were quantified using the Big Endothelin-1 ELISA Kit (NO. BI-20082H; Biomedica, Wien, Austria.
Related publications
Li P, Schmidt IM, Sabbisetti V, Tio MC, Opotowsky AR, Waikar SS. Clin J Am Soc Nephrol. 2020. 8;15(6):784-793. PMID: 32381583.
Abstract
Background and objectives: Endothelin-1 is a potent endothelium-derived vasoconstrictor peptide implicated in the pathogenesis of hypertension, congestive heart failure, and inflammation, all of which are critical pathophysiologic features of CKD.
Design, setting, participants, & measurements: To test the hypothesis that plasma endothelin-1 levels are associated with increased risks of mortality and hospitalization in patients with chronic kidney failure, we measured plasma endothelin-1 levels in a prospective cohort of 794 individuals receiving maintenance hemodialysis. The primary outcomes were time to death and time to hospitalization.
Results: The median plasma endothelin-1 level was 2.02 (interquartile range, 1.57-2.71) pg/ml. During a median follow-up period of 28 (interquartile range, 21-29) months, 253 individuals (32%) died and 643 individuals (81%) were hospitalized at least once. In multivariable models adjusted for demographic, clinical, and laboratory variables, individuals in the highest quartile of plasma endothelin-1 had a 2.44-fold higher risk of death (hazard ratio, 2.44; 95% confidence interval, 1.61 to 3.70) and a 1.54-fold higher risk of hospitalization (hazard ratio, 1.54; 95% confidence interval, 1.19 to 1.99) compared with individuals in the lowest quartile. The Harrell C-statistic of the fully adjusted model increased from 0.73 to 0.74 after addition of natural log-transformed plasma endothelin-1 (P<0.001) for all-cause mortality, and increased from 0.608 to 0.614 after addition of natural log-transformed plasma endothelin-1 (P=0.002) for hospitalization.
Conclusions: Higher plasma endothelin-1 is associated with adverse clinical events in patients receiving hemodialysis independent of previously described risk factors.
Podcast: This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2020_05_15_CJN11130919.mp3.
Keywords: Chronic; Cohort Studies; Endothelin-1; Endothelins; Inflammation; Kidney Failure; Prospective Studies; Renal Insufficiency; Vasoconstrictor Agents; cardiovascular disease; dialysis; endothelium; heart failure; hemodialysis; hospitalization; hypertension; mortality; risk factors.
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Biomedica’s NT-proBNP ELISA complies with strict quality standards confirmed by RfB, an accredited international provider for proficiency testing for NT-proBNP. The Biomedica NT-proBNP ELISA successfully passes QC circle.
NT-proBNP ELISA successfully passes QC circle
– Link to RfB NT-proBNP Biomedica Certificate Proficiency Testing
-Link to RfB NT-proBNP Comments and Evaluation
FEATURES & BENEFITS
Biomedica NT-proBNP ELISA, cat# SK-1204:
- EASY – can be used in every lab
- RELIABLE – proved by RfB proficiency testing
- ROBUST & fully VALIDATED
- CE registered – for IVD use in EU
- GOOD ANALYTE STABILITY in serum and plasma
RELATED PUBLICATIONS
NT-proBNP as a Cornerstone for Prognosis in Valve Disease: All We Need Is Blood. Bergler-Klein J. J Am Coll Cardiol. 2020 Apr 14;75(14):1673-1675. doi: 10.1016/j.jacc.2020.02.030. PMID: 32273032.
NT-proBNP (N-Terminal Pro-B-Type Natriuretic Peptide) and the Risk of Stroke. Di Castelnuovo A, Veronesi G, Costanzo S, Zeller T, Schnabel RB, de Curtis A, Salomaa V, Borchini R, Ferrario M, Giampaoli S, Kee F, Söderberg S, Niiranen T, Kuulasmaa K, de Gaetano G, Donati MB, Blankenberg S, Iacoviello L; BiomarCaRE Investigators. Stroke. 2019 Mar;50(3):610-617. doi: 10.1161/STROKEAHA.118.023218. PMID: 30786848.
Abstract
Background and Purpose- NT-proBNP (N-terminal pro-B-type natriuretic peptide) is a risk factor for atrial fibrillation and a marker of cardiac function used in the detection of heart failure. Given the link between cardiac dysfunction and stroke, NT-proBNP is a candidate marker of stroke risk. Our aim was to evaluate the association of NT-proBNP with stroke and to determine the predictive value beyond a panel of established risk factors. Methods- Based on the Biomarkers for Cardiovascular Risk Assessment in Europe-Consortium, we analyzed data of 58 173 participants (50% men; mean age 52 y) free of stroke from 6 community-based cohorts. NT-proBNP measurements were performed in the central Biomarkers for Cardiovascular Risk Assessment in Europe laboratory. The outcomes considered were total stroke and subtypes of stroke (ischemic/hemorrhagic). Results- During a median follow-up time of 7.9 years, we observed 1550 stroke events (1176 ischemic). Increasing quarters of the NT-proBNP distribution were associated with increasing risk of stroke ( P for trend <0.0001; multivariable Cox regression analysis adjusted for risk factors and cardiac diseases). Individuals in the highest NT-proBNP quarter (NT-proBNP >82.2 pg/mL) had 2-fold (95% CI, 75%-151%) greater risk of stroke than individuals in the lowest quarter (NT-proBNP <20.4 pg/mL). The association remained unchanged when adjusted for interim coronary events during follow-up, and though it was somewhat heterogeneous across cohorts, it was highly homogenous according to cardiovascular risk profile or subtypes of stroke. The addition of NT-proBNP to a reference model increased the C-index discrimination measure by 0.006 ( P=0.0005), yielded a categorical net reclassification improvement of 2.0% in events and 1.4% in nonevents and an integrated discrimination improvement of 0.007. Conclusions- In European individuals free of stroke, levels of NT-proBNP are positively associated with risk of ischemic and hemorrhagic stroke, independently from several other risk factors and conditions. The addition of NT-proBNP to variables of established risk scores improves prediction of stroke, with a medium effect size.