Abstract
Background
B-type natriuretic peptide (BNP) is widely accepted in the evaluation of left ventricular systolic dysfunction and heart failure. However, little is known of the implications of elevated BNP levels in individuals with preserved systolic function (PSF).
Aims
To investigate the drivers and clinical implications of elevated BNP levels in asymptomatic individuals with established PSF.
Methods
We enrolled 154 individuals who all underwent physical examination, BNP evaluation and Doppler-echocardiographic studies. They were divided into those above and below the median BNP level (50pg/ml).
Results
Independent predictors of higher BNP were older age, more severe left ventricular hypertrophy (LVH), reduced E/A ratio and ischaemic heart disease. Survival and multivariable analysis demonstrated more death and/or admission in those above the median BNP (HR: 4.79, p = 0.007).
Conclusions
Elevated BNP is the strongest, independent predictor of serious adverse cardiovascular outcomes in this population and requires closer clinical follow-up.
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References
Chen HH, Burnett JC. The natriuretic peptides in heart failure: diagnosis and therapeutic potentials.Proc Assoc Am Physicians 1999:111:406–16
Cheung BMY, Kumana CR. Natriuretic peptidesrelevance in cardiac disease.JAMA 1998;280:1983–4.
Maeda K, Takayoshi T, Wada A, Hisanaga T, Kinoshita M. Plasma Brain Natriuretic Peptide as a biochemical marker of high left ventricular end-diastolic pressure in individuals with symptomatic heart failure.Am Heart J 1998;135:825–32.
Clarkson PB, Wheeldon NM, McLeod C, Coutie W, MacDonald TM. Brain natriuretic peptide: effect on left ventricular filling patterns in healthy subjects.Clin Sci 1995; 88:159–164
Cao L, Fardner DG. Natriuretic peptides inhibit DNA synthesis in cardiac fibroblasts.Hypertension 1995; 25:227–234.
Cowie MR, Struthers AD, Wood DA et al. Value of natriuretic peptides in assessment of individuals with possible new heart failure in primary care.Lancet 1997; 350:1349–1353.
Tsutamoto T, Wada A, Maeda K et al. Attenuation of compensation of endogenous cardiac natriuretic peptide system in chronic heart failure: prognostic role of plasma brain natriuretic peptide concentration in individuals with chronic symptomatic left ventricular dysfunction.Circulation 1997; 96:509–516.
Maeda K, Tsutamoto T, Wada A et al High levels of plasma brain natriuretic peptide and interleukin-6 after optimised treatment for heart failure are independent risk factors for mortality.J Am Coll Cardiol 2000; 36:1587–1593.
Omland T, Aakvasg A, Vik-Mo EB Plasma cardiac natriuretic peptide determination as a screening test for the detection of individuals with mild left ventricular impairment.Heart 1996;76:232–237.
Maisel AS, Krishnashwamy P, Nowak RM et al Rapid measurement of B-Type Natriuretic Peptide in the emergency diagnosis of Heart Failure.N Eng J Med 2002; 347:161–167.
Maisel AS, McCord J, Nowak RM et al. Bedside B-type natriuretic peptide in the emergency diagnosis of heart failure with reduced or preserved ejection fraction.J Am Coll Cardiol 2003; 41:2010–17.
Omland T, Ankvaang A, Bonarjee VV et al. Plasma brain natriuretic peptide as an indicator of left ventricular systolic function and long term survival post myocardial infarction: comparison with plasma atrial natriuretic peptide and NT-proatrial natriuretic peptide.Circulation 1996; 93:1963–1969.
de Lemos JA, Morrow DA, Bentley JH et al The prognostic value of brain natriuretic peptide in individuals with acute coronary syndromesN Engl J Med 2001; 345:1014–21.
Mallamaci F Zoccali C Tripepsi G et al Diagnostic potential of natriuretic peptides in dialysis individuals.Kidney Int 2001; 59:1559–63.
McDonagh TA, Robb SD, Murdoch DR et al. Biochemical detection of left-ventricular systolic dysfunction.Lancet 1998; 351:9–13.
Wang TJ, Larson MG, Levy D, Benjamin EJ, Leip EP Omland T, Wolf P and Vasan RS. Plasma Natriuretic Peptide Levels and the Risk of Cardiovascular Events and Death.N Engl J Med 2004; 350:655–663.
Nakamura M, Endo EB, Nasu M, Arakawa N et al Value of B type natriuretic peptide measurement for heart disease screening in a Japanese population.Heart 2002; 87:131–135.
McKie PM, Rodeheffer RJ, Cataliotti A, Martin FL, Urban LH, Mahoney DW, Jacobsen SJ, Redfield MM, Burnett JC Jr. Amino-terminal pro-B-type natriuretic peptide and B-type natriuretic peptide: biomarkers for mortality in a large community-based cohort free of heart failure. Hypertension 2006:47 (5): 874–880.
Dao Q, Krishnaswamy P, Kazanegra R et al. Utility of B-Type Natriuretic Peptide in the diagnosis of congestive heart failure in an urgent care setting.J Am Coll Cardiol 2001; 37:379–385.
Morrison LK, Harrison A, Krishnaswamy P et al Utility of a rapid B-natriuretic peptide assay in differentiating congestive heart failure from lung disease in individuals presenting with dyspnoea.J Am Coll Cardiol 2002; 39:202–209.
Remme WJ, Swedberg K. Task Force Report. Guidelines for the diagnosis and treatment of chronic heart failure. Task Force for the Diagnosis and Treatment of Chronic Heart Failure, European Society of Cardiology. Euro Heart Journal 2001; 22:1527–1560.
Struthers AD. Introducing a new role for BNP: as a general indicator of cardiac structural disease rather than a specific indicator of systolic dysfunction only.Heart 2002; 87:109–10.
Kranelund C, Gronning B, Kober L, Hildebrandt P, Steffensen R. N-Terminal Pro-B-Type Natriuretic Peptide and Long-Term Mortality in Stable Coronary Heart Disease.New Eng J Med 2005;352:666–675.
Yu CM Sanderson JE Shum IO et al Diastolic dysfunction and natriuretic peptides in systolic heart failure: higher ANP and BNP levels are associated with restrictive filling pattern.Eur Heart J 1996; 17:1694–702.
Lubien E, De Maria A, Krishnaswamy P et al. Utility of B-natriuretic peptide in detecting diastolic dysfunction: comparison with Doppler velocity recordings.Circulation 2002; 105:595–601.
Yamamoto K Burnett JC Jougasaki M et al Superiority of Brain natriuretic peptide as a hormonal marker of ventricular systolic and diastolic dysfunction and left ventricular hypertrophy.Hypertension 1996; 28:988–94.
Tsutamoto T Wada A Maeda K et al Effect of spironolactone on plasma brain natriuretic peptide and left ventricular remodelling in individuals with congestive heart failureJ Am Coll Cardiol 2001; 37:1228–1233
Holmes SJ, Espiner EA, Richards AM, Yandle TG, Framoton C. Renal, endocrine and haemodynamic effects of human brain natriuretic peptide in normal manJ Clin Endocrinol Metab 1993; 76:91–96.
Redfield M, Rodeheffer MD, Jacobsen S et al. Plasma concentration of Brain Natriuretic Peptide: impact of age and genderJ Am Coll Cardiol 2002; 40:976–82.
Wu AH, Packer M, Smith A, Bijou R, Fink D, Mair J, Wallentin L, Johnston N, Feldcamp CS, Haverstick DM, Ahnadi CE, Grant A, Despres N, Bluestein B, Ghani F. Analytical and clinical evaluation of the Bayer ADVIA Centaur automated B-type natriuretic peptide assay in patients with heart failure: a multisite study.Clin Chem. 2004; 50:867–873
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Karuppiah, S., Graham, F., Ledwidge, M. et al. Elevated BNP with normal systolic function in asymptomatic individuals at-risk for heart failure: a marker of diastolic dysfunction and clinical risk. Ir J Med Sci 175, 5–13 (2006). https://doi.org/10.1007/BF03167960
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DOI: https://doi.org/10.1007/BF03167960