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Influence of acute and chronic myocardial loading conditions, function, structural changes and extracardiac factors on NT-proBNP in asymptomatic patients with preserved ejection fraction

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Abstract

Background

We compared the effect of different loading conditions, parameters of structural heart disease and extracardiac confounders on NT-proBNP to validate the application of NT-proBNP for a characterisation of loading conditions and clinical course of patients with chronic heart diseases.

Methods

NT-proBNP was measured in 15 controls and 34 patients with preserved ejection fraction and chronic pressure (by aortic stenosis) or volume overload (by aortic or mitral regurgitation) before and after physical as well as dobutamine stress. Myocardial fibrosis was evaluated by contrast-enhanced cardiovascular magnetic resonance.

Results

In patients with elevated NT-proBNP due to chronic pressure or volume overloaded ventricles, physical and dobutamine stress were associated with only marginal nonsignificant additional NT-proBNP responses. Univariate analyses showed that myocardial fibrosis has the greatest effect on NT-proBNP (P < 0.01). Forward regression analyses revealed left ventricular filling, systolic function, the presence of valvular heart disease, serum creatinine and responses to dobutamine stress as independent determinants of NT-proBNP (P < 0.05 each).

Conclusion

NT-proBNP cannot be used simply to characterise intensity of ventricular load. Character and duration of loading conditions, cardiac structure and function, as well as confounders should be considered when NT-proBNP is used for clinical follow-up assessment.

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Acknowledgments

The authors thank Oliver Hartmann, Brahms AG, Hennigsdorf, Germany, for statistical help. Reagents for measuring NT-proBNP were kindly provided by Roche Diagnostics.

Conflict of interest

None.

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Authors and Affiliations

  1. Interventionelle Kardiologie Spandau, Neuendorfer Str. 70, 13585, Berlin, Germany

    Olaf Schulz, Sarah Scheiner, Gunnar Berghoefer, Ricarda Bensch & Jochen Kraemer

  2. Working Group Cardiac MR, Universitätsmedizin Berlin, Charite Campus Buch, HELIOS-Klinikum Berlin-Buch, Berlin, Germany

    Andre Rudolph & Jeanette Schulz-Menger

  3. Medizinische Klinik (Kardiologie), Universitätsmedizin Berlin, Charite Campus Mitte, Berlin, Germany

    Helena Mut & Ingolf Schimke

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  1. Olaf Schulz
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  2. Andre Rudolph
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Correspondence to Olaf Schulz.

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Schulz, O., Rudolph, A., Scheiner, S. et al. Influence of acute and chronic myocardial loading conditions, function, structural changes and extracardiac factors on NT-proBNP in asymptomatic patients with preserved ejection fraction. Clin Res Cardiol 100, 57–65 (2011). https://doi.org/10.1007/s00392-010-0210-2

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  • DOI: https://doi.org/10.1007/s00392-010-0210-2

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