PLASMA ATRIAL NATRIURETIC PEPTIDE AS A NON-INVASIVE BIOCHEMICAL MARKER OF DYSPNOEA IN CONGESTIVE HEART FAILURE PATIENTS (original) (raw)
Related papers
Effect of exercise on natriuretic peptides in plasma and urine in chronic heart failure
International Journal of Cardiology, 2004
Background: Plasma atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) are elevated in chronic heart failure (CHF). ANP is known to be increased during exercise in healthy subjects and CHF, while the response in BNP during exercise is less clear and does not exist in C-type natriuretic peptide (CNP) and aquaporin-2 (AQP2) in either healthy subjects or CHF. Methods: Eleven patients with CHF and eleven healthy subjects performed a maximal aerobic exercise test. ANP and BNP in plasma were determined every 3 min and at maximum exercise by radioimmunoassay (RIA) and CNP and AQP2 in urine were determined before and after the exercise test by RIA. Results: The absolute increase in BNP during exercise was higher in patients with CHF (CHF: 4.1 pmol/l; healthy subjects: 1.3 pmol/l, P < 0.05) and was positively correlated to BNP at rest (P < 0.05), while the absolute increase in ANP during exercise was the same in the two groups (CHF: 4.2 pmol/l; healthy subjects: 6.8 pmol/l, not significant, NS). In CHF, exercise did not change either u-CNP excretion (rest: 9.8 ng/mmol creatinine; after exercise: 8.8 ng/mmol, NS) or u-AQP2 (rest: 466 ng/mmol creatinine; after exercise: 517 ng/mmol creatinine, NS) as well as in healthy subjects where u-CNP (rest: 9.7 ng/mmol creatinine; after exercise: 9.2 ng/mmol creatinine) and u-AQP2 (rest: 283 ng/mmol creatinine; after exercise: 307 ng/mmol creatinine) were the same at rest and after exercise. Conclusion: The absolute increase in BNP during exercise is higher in patients with CHF compared to healthy subjects. It is suggested that this is a compensatory phenomenon to improve the exercise capacity in CHF, and that BNP is a more important factor in cardiovascular homeostasis during exercise in CHF than ANP.
B-type natriuretic peptide kinetics and cardiopulmonary exercise testing in heart failure
International Journal of Cardiology, 2007
Background: In patients with chronic heart failure (CHF), B-type natriuretic peptide (BNP) is related to peak oxygen consumption (peak VO 2 ) and the relationship between minute ventilation and carbon dioxide production (VE/VCO 2 slope). However, the exercise response depends on the mode of exercise. This study sought to compare peak treadmill and bicycle exercise responses with respect to their relationship with BNP and to assess whether BNP measured at rest or during exercise could identify patients with greater functional impairment and ventilatory inefficiency. Methods: Twenty-three patients with mild-to-moderate stable systolic CHF (age 72 ± 8 years, left ventricular ejection fraction 32 ± 7%) underwent treadmill and bicycle cardiopulmonary exercise testing within 5 (interquartile range 3-7) days. BNP was measured at rest and at peak exercise. Results: BNP at rest was an independent multivariate predictor of both peak VO 2 and the VE/VCO 2 slope for both exercise modes. However, the proportion of variance explained univariately and multivariately was ≤0.55, indicating that BNP did not strongly explain the variation of peak VO 2 and the VE/VCO 2 slope. The exercise-induced rise in circulating BNP did not differ between the test modes [treadmill: 50 (24-89) pg/ml vs. bicycle: 46 (15-100) pg/ml; p = 0.73]. BNP levels at peak exercise were strongly related to resting values, but did not provide additional information on peak VO 2 or the VE/VCO 2 slope. Conclusions: In typical CHF patients, BNP measured at rest or at peak exercise does not strongly predict peak VO 2 or the VE/VCO 2 slope regardless of the exercise mode, and is therefore not a sufficiently accurate surrogate for cardiopulmonary exercise testing.
International Journal of Cardiology, 1996
Plasma concentrations of atrial natriuretic peptide were measured in eight patients with cardiac disease but normal resting right atrial pressure, during cardiac catheterization. No patient had clinical evidence of overt heart failure. An increase in peptide concentrations was observed between the aorta or the peripheral vein and the pulmonary artery. A linear relation was found between peripheral vein and pulmonary artery peptide concentration. Mean pulmonary artery and capillary wedge pressure also correlated with the peptide levels. No correlation was observed between mean right atrial pressure and peptide concentration. These findings demonstrate that atrial natriuretic peptide release, even in the absence of cardiac failure, seems at least partly regulated by left atrial pressure. Finally, peripheral levels reflect the central concentrations of atrial natriuretic peptide.
The American Journal of Cardiology, 2007
Although much is known about the value of B-type natriuretic peptide (BNP) at rest, the significance of the responsiveness of BNP during exercise in patients with chronic heart failure (HF) without coronary artery disease remains to be established. A role of BNP release during exercise in the functional disability of patients with chronic HF and idiopathic dilated cardiomyopathy (IDC) was hypothesized. One hundred five consecutive patients with an established diagnosis of HF and IDC who underwent symptom-limited cardiopulmonary exercise testing were studied. BNP was measured immediately before exercise and within 1 minute of the end of exercise. BNP at rest increased significantly at peak exercise (median from 66.5 (first, third quartiles 18, 168) to 72.0 pg/ml (26, 208), p <0.001), but BNP response was not uniform. BNP response increased in 63% of patients, did not change in 22%, and decreased in 15%. BNP at rest and BNP response showed an inverse correlation (p <0.001, r ؍ ؊0.523). Aging and low left ventricular ejection fraction were independent predictors of higher BNP levels at rest, but lower BNP response. Beta-blocker therapy did not influence BNP response. BNP at rest correlated negatively with functional capacity (p <0.001, r ؍ ؊0.516), whereas BNP response correlated positively (p ؍ 0.002, r ؍ 0.326). Patients with BNP release (vs patients without) had higher maximum oxygen consumption (19.2 ؎ 5.1 vs 15.9 ؎ 3.6, p <0.001), better functional capacity (59 ؎ 13% vs 50 ؎ 15%, p ؍ 0.002), and lower minute ventilation/ carbon dioxide production slope (33.6 ؎ 4.8 vs 36.5 ؎ 7.7, p ؍ 0.026) independent of other clinical parameters. In conclusion, BNP release during exercise could be a determinant of functional capacity in patients with chronic HF and IDC.
Minerva cardioangiologica, 2005
Aim of the study was to evaluate if brain natriuretic peptide (BNP) levels, a cardiac neurohormone well correlated with prognosis in chronic heart failure (CHF), are associated with enhanced ventilatory response to exercise, in ambulatory patients with intermediate peak oxygen uptake (PVO2). Resting BNP was measured in 129 consecutive stable CHF patients with mild to moderate heart failure (90% New York Heart Association (NYHA) class II or III) and intermediate (10-18 mL/kg/min) PVO2, assessed during cardiopulmonary exercise test. Mean (SD) left ventricular ejection fraction (EF) and pulmonary systolic pressure (PAP) were 41 +/- 3% and 47 +/- 14 mmHg, respectively. The enhanced ventilatory response to exercise (EVR) was assessed as a slope of the relation between minute ventilation and carbon dioxide production (VE/VCO2 slope) > 35. Thirty-three over 129 patients (26%) had EVR. Mean BNP plasma level was 394 +/- 347 pg/mL. A significant correlation between BNP and EVR (r = 0.310; ...
ESC Heart Failure
Aims N-terminal prohormone of brain natriuretic peptide (NT-proBNP) plays an important role in diagnosis and management of heart failure. The aim of the present study was to assess haemodynamic response to exercise and to evaluate the relationship between NT-proBNP, cardiac function, and exercise tolerance in chronic heart failure. Methods and results A single-centre, cross-sectional pilot study recruited 17 patients with chronic heart failure with reduced left ventricular ejection fraction (age 67 ± 7 years) and 20 healthy volunteers (age 65 ± 12 years). The NT-proBNP was measured in the heart failure group. All participants completed maximal graded cardiopulmonary exercise stress testing coupled with gas exchange (using metabolic analyser for determination of exercise tolerance, i.e. peak O 2 consumption) and continuous haemodynamic measurements (i.e. cardiac output and cardiac power output) using non-invasive bioreactance technology. Heart failure patients demonstrated significantly lower peak exercise cardiac function and exercise tolerance than healthy controls, i.e. cardiac power output (5.0 ± 2.0 vs. 3.2 ± 1.2 W,
Plasma B-type Natriuretic Peptide Levels in Stable Heart Failure Patients
Indian Journal of Medical Biochemistry, 2019
Introduction: Heart failure (HF) is a major and growing public health problem among the global population. Cardiac biomarkers are a promising tool for the early and specific detection of heart failure. B-type natriuretic peptide (BNP) is one such cardiac biomarker released in response to ventricular myocyte stretch. Aim: The aim of the present study was to estimate the levels of plasma BNP in patients with stable chronic heart failure (CHF) and to compare them with controls. Further to correlate the relationship between plasma BNP levels and factors like age, gender and left ventricular ejection fraction (LVEF), in the two groups. Materials and methods: A case-control study conducted in Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India consisting of 55 stable CHF patients on treatment and 35 controls. Serum creatinine was estimated adopting modified Jaffe's method. eGFR was calculated using the modification of diet in renal disease (MDRD) formula. Plasma BNP levels were measured by ELISA. Results: The mean BNP concentration in patients with stable CHF was 60.46 ± 16.13 pg/mL, while in controls it was 20.94 ± 5.81pg/mL and the difference was highly significant (p= 0.001). As the age increases an increasing trend in the values of plasma BNP was observed in both groups. There was a strong negative linear relationship (r =-0.798) observed between LVEF and BNP levels in the study population. A cutoff level of 30.2pg/mL for plasma BNP had a 100% sensitivity and specificity to predict CHF. Conclusion: Our study concludes that plasma BNP was significantly higher in patients with stable chronic heart failure than in the controls. Plasma BNP as a biomarker will help in identifying stable CHF patients who are asymptomatic, on their adequacy of treatment.
Clinical Chemistry and Laboratory Medicine, 2000
The concentration of atrial natriuretic peptide was measured in order to evaluate its importance in patients suffering from a variety of cardiac diseases. There was a correlation between plasma concentrations of atrial natriuretic peptide and its "second messenger" cyclic guanosine monophosphate (cGMP) in all of the cases examined. We investigated the relationship between atrial natriuretic peptide and cGMP plasma concentrations during rest and exercise in comparison with the scintigraphically assessed left-and rightventricular ejection fraction in patients with chronic heart disease (n = 20), and after orthotopic heart transplantation (n = 16); plasma concentrations were also measured in healthy controls (n = 14). Atrial natriuretic peptide and cGMP concentrations showed a similar correlation during rest and exercise with r = 0.74 and r = 0.81, respectively. With the exception of patients after heart transplantation, a significant negative correlation was seen between the left ventricular ejection fraction and atrial natriuretic peptide or cGMP plasma concentrations during rest conditions (r = 0.76 or 0.58, respectively). No correlation was apparent between plasma concentrations of atrial natriuretic peptide or cGMP and the left-or right ventricular ejection fraction during exercise.