Myocardial stiffness is an important determinant of the plasma brain natriuretic peptide concentration in patients with both diastolic and systolic heart failure (original) (raw)
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2010
We explored the stimulus for B-type natriuretic peptide (BNP) secretion in the clinical setting of heart failure (HF). BACKGROUND Increasingly, plasma BNP levels are being incorporated into the clinical assessment and management of systolic heart failure (SHF) as well as diastolic heart failure (DHF). However, heterogeneity in BNP levels among individuals with HF can cause some confusion in interpreting results. METHODS In 160 consecutive patients presenting with HF, we measured plasma BNP levels and performed echocardiography and cardiac catheterization. Systolic and diastolic meridional wall stress was calculated from echocardiographic and hemodynamic data. RESULTS Although plasma BNP had a significant correlation (r 2 ϭ 0.296 [p Ͻ 0.001]) with left ventricular end-diastolic pressure (EDP) as previously reported, the correlation between plasma BNP and end-diastolic wall stress (EDWS) (r 2 ϭ 0.887 [p Ͻ 0.001]) was more robust. In a subanalysis of 62 patients with DHF, a similar result was obtained (r 2 ϭ 0.143 for EDP and r 2 ϭ 0.704 for EDWS). In a comparison between SHF and DHF, the BNP level was significantly higher in SHF (p Ͻ 0.001). Although EDP did not show any difference, EDWS was significantly higher in SHF than in DHF (p Ͻ 0.001). CONCLUSIONS The present study shows that plasma BNP levels reflect left ventricular EDWS more than any other parameter previously reported, not only in patients with SHF, but also in patients with DHF. The relationship of left ventricular EDWS to plasma BNP may provide a better fundamental understanding of the interindividual heterogeneity in BNP levels and their clinical utility in the diagnosis and management of HF.
Journal of the American College of Cardiology, 2006
We explored the stimulus for B-type natriuretic peptide (BNP) secretion in the clinical setting of heart failure (HF). BACKGROUND Increasingly, plasma BNP levels are being incorporated into the clinical assessment and management of systolic heart failure (SHF) as well as diastolic heart failure (DHF). However, heterogeneity in BNP levels among individuals with HF can cause some confusion in interpreting results.
Plasma B-type natriuretic peptide levels in systolic heart failure
Journal of the American College of Cardiology, 2004
This study was designed to characterize the importance of echocardiographic indexes, including newer indexes of diastolic function, as determinants of plasma B-type natriuretic peptide (BNP) levels in patients with systolic heart failure (SHF). BACKGROUND Plasma BNP levels have utility for diagnosing and managing heart failure. However, there is significant heterogeneity in BNP levels that is not explained by left ventricular size and function alone.
PLOS ONE, 2017
Background Central arterial stiffness has been shown to play a key role in cardiovascular disease. However, evidence regarding such arterial stiffness from various arterial segments in relation to B-type natriuretic peptide (BNP) remains elusive. Methods A total of 1255 participants (47.8% men; mean age: 62.6 ± 12.3 [SD] years) with preserved left ventricular function (ejection fraction !50%) and !1 risk factors were consecutively studied. Arterial pulse wave velocity (PWV) by automatic device (VP-2000; Omron Healthcare) for heart-femoral (hf-PWV), brachial-ankle (ba-PWV), and heart-carotid (hc-PWV) segments were obtained and related to BNP concentrations (Abbott Diagnostics, Abbott Park, IL, USA). Results Subjects in the highest hf-PWV quartile were older and had worse renal function and higher blood pressure (all P < 0.05). Elevated PWV (m/s) was correlated with elevated BNP (pg/ml) (beta coefficient = 19.3, 12.4, 5.9 for hf-PWV, ba-PWV, hc-PWV respectively, all p < 0.05). After accounting for clinical co-variates and left ventricle mass index (LVMI), both hf-PWV and ba-PWV were correlated with higher BNP (beta coefficient = 8.3, 6.4 respectively, P < 0.01 for each). Adding both hf-PWV and ba-PWV to LVMI significantly expanded ROC in predicting abnormal BNP>100 pg/ml (both P < 0.01), but only hf-PWV presented significant integrated discrimination improvement to predict risk for BNP concentrations (0.7%, P = 0.029).
Heart, 2009
Objective Recent studies have shown that plasma levels of brain natriuretic peptide (BNP)-32 and proBNP-108 are increased in heart failure (HF) and that the BNP-32 assay kit in current clinical use cross-reacts with proBNP-108. We investigated why proBNP is increased without processing in HF was investigated. Design, setting and patients Plasma BNP-32 and proBNP-108 in normal individuals (n¼10) and in patients with atrial fibrillation (AF) (n¼18) and HF (n¼132) was measured. BNP-32 and proBNP-108 in ventricular and atrial tissue and in pericardial fluid using a specific fluorescent enzyme immunoassay following Sep-Pak C18 (Waters, Milford, Massachusetts, USA) cartridge extraction and gel filtration was also measured. Main outcome measures Levels of both BNP-32 and proBNP-108 were higher in HF than in control or AF (both p<0.01), and the levels of these peptides significantly correlated (r¼0.94, p<0.001). The proBNP-108/total BNP (BNP-32+proBNP-108) ratio was widely distributed and lower in HF (0.33 (0.17)) than in control (0.41 (0.06), p<0.05) and AF (0.45 (0.04), p<0.002). The proBNP-108/total BNP ratio was higher in HF with ventricular than in HF with atrial overload (0.45 (0.10) vs 0.20 (0.11), p<0.001). Consistent with this finding, the major molecular form were proBNP-108 and BNP-32 in ventricular (n¼6, 0.67 (0.04)) and atrial (n¼7, 0.76 (0.05), p<0.0001) tissues, respectively. ProBNP-108 was also the major molecular form of BNP in pericardial fluid (n¼8, 0.82 (0.05)). The proBNP-108/total BNP ratio increased and decreased with HF deterioration and improvement, respectively. Conclusion These results suggest that BNP-32 and proBNP-108 is increased in HF and that the proBNP/total BNP ratio increases in association with pathophysiological conditions such as ventricular overload.
The Correlation between the Plasma Level of NT-Pro BNP and Left Ventricular Diastolic Dysfunction
Objective: To study the correlation between plasma level of N-terminal pro-BNP and left ventricular diastolic dysfunction in asymptomatic patients. Methods: The study included 35 patients divided into control group: included 10 patients with normal systolic and diastolic function and patient group: included 25 patients with normal systolic and asymptomatic diastolic dysfunction. The patients were evaluated by conventional echocardiography (diameters, systolic and diastolic function) and tissue Doppler (early diastolic velocity) then E/e` was measured. Serum pro BNP was measured and correlated with demographic and echocardiographic parameters and its sensitivity, specificity were evaluated. Results: Both groups were of comparable age, gender, BMI, risk factors and systolic function. By Doppler echocardiography there was no difference in E velocity between two groups (0.64+0.18 m/sec Vs 0.67+0.14 P = 0.302), but by tissue Doppler there was significant difference in the mean value of e` velocity (m/sec) (0.14+0.06 Vs 0.06+0.01 P=0.001) and E/eˋ (5.03+0.149 Vs 0.55+1.79 P= 0.001). There was significant difference between two groups according to serum NT pro BNP (ng/ml) was (59.1) in the control group Vs (154.1) in patient group (P = 0.001). There was significant correlation between serum NT pro BNP and E (P= 0.001) and E/e` (P = 0.001). The sensitivity of serum NT Pro BNP was 94.2, specificity was 88.1, positive predictive value was 90.6 and its accuracy was 86.2. Conclusion: Serum level of NT pro BNP can be used as innovative method in predicting asymptomatic diastolic dysfunction and so prevent the progression to symptomatic diastolic heart failure