Vnitr Lek 2013, 59(9):769-775

Use of natriuretic peptides in diagnosis of left ventricular hypertrophy in obese hypertensive patients with metabolic syndrome

J. Špác^1,*, M. Beránek², H. Němcová¹, B. Kianička¹, M. Souček¹

¹ II. interní klinika Lékařské fakulty MU a FN u sv. Anny Brno, přednosta prof. MUDr. Miroslav Souček, CSc.

² Data Marketing Management s.r.o., Brno, ředitel RNDr. Michal Beránek

Introduction:
Presence of left ventricular (LV) hypertrophy significantly increases cardiovascular risk in patients suffering from hypertension. Diagnostics of LV hypertrophy in hypertensive patients is not easy and there is still no method of enabling a simple and sufficiently sensitive diagnosis across a large patient population. The golden standard in LV hypertrophy diagnostics is echocardiography, and there are adverse opinions regarding the use of natriuretic peptides BNP and NT-proBNP (NP) to diagnose LV hypertrophy.

Patients and methods:
We examined through echocardiography 173 hypertensive patients with signs of metabolic syndrome and a moderate increase in blood pressure (130-159/85-99 mm Hg) with an average age of 54.8 ± 13.54 years, i.e. 119 men and 54 women, who were divided into 2 groups; 1 with BMI > 30 (group A with a severe obesity) and the other without obesity, BMI < 30 (group B). Both groups were examined for BNP and NT-proBNP levels.

Results:
We found a positive correlation between NP and LVMi, both for BNP (r = 0.169; p = 0.033) and for NT-proBNP (r = 0.240; p = 0.002). NT-proBNP statistically significantly predicts the given LV hypertrophy LK in people with BMI < 30 but not in obese people (BMI > 30).

Conclusion:
Obese patients suffer from a higher occurrence of left ventricular hypertrophy and paradoxically a lower NP value than patients with a metabolic syndrome (MS) who are not obese. Natriuretic peptides have a limited diagnostic value when assessing left ventricular hypertrophy. They are only of value in patients who are not obese and whose kidney function and systolic myocardial function have not been impaired.

Keywords: left ventricular hypertrophy; metabolic syndrome

Received: October 29, 2012; Accepted: April 3, 2013; Published: September 1, 2013  Show citation