Heart 2001;86:21-26 ( July )

Cardiovascular medicine

Left ventricular dysfunction, natriuretic peptides, and mortality in an urban population T A McDonagh^a, A D Cunningham^b, C E Morrison^c, J J V McMurray^b, I Ford^d, J J Morton^b, H J Dargie^b

^a Department of Medical Cardiology, University of Glasgow, Royal Infirmary, 10 Alexandra Parade, Glasgow G31 2ER, UK, ^b Department of Cardiology, University of Glasgow, Western Infirmary, ^c Greater Glasgow Health Board, ^d Robertson Centre for Biostatistics, University of Glasgow

Correspondence to: Dr McDonagh t.mcdonagh{at}bio.gla.ac.uk

Accepted 18 January 2001

OBJECTIVETo report the mortality of left ventricular systolic dysfunction (LVD), assessed objectively by echocardiography, and its association with natriuretic peptide hormones in a random sample of 1640 men and women aged 25-74 years from a geographical, urban population.
METHODSLeft ventricular function was measured by echocardiography in 1640 attendees studied in 1992-3. LVD was defined as a left ventricular ejection fraction (LVEF)  30%. Plasma concentrations of N-terminal atrial natriuretic peptide (N-ANP) and brain natriuretic peptide (BNP) were measured by standard radioimmunoassays. Mortality was documented at four years.
RESULTSThe four year all cause mortality rate in the whole cohort was 4.9% (80 deaths). It was 21% (nine deaths) in those with an LVEF  30% and 4% in those whose LVEF was > 30% (p < 0.001). The median (interquartile range) BNP concentration in those who died was 16.9 pg/ml (8.8-27) and 7.8 pg/ml (3.4-13) in survivors (p < 0.0001). Similarly, N-ANP had a median concentration of 2.35 ng/ml (1.32-3.36) in those with a fatal outcome and 1.27 ng/ml (0.9-2.0) in those alive at four years (p < 0.0001). Subjects with an LVEF  40% also had a significant mortality rate of 17% if they also had a BNP concentration  17.9 pg/ml compared with 6.8% if their BNP was below this concentration (p = 0.013). Multivariate analysis revealed the independent predictors of four year all cause mortality to be increasing age (p < 0.001), a BNP concentration  17.9 pg/ml (p = 0.006), the presence of ischaemic heart disease (p = 0.03), and male sex (p = 0.04).
CONCLUSIONSLVD is associated with a considerable mortality rate in this population. BNP also independently predicts outcome. In addition to its role as a diagnostic aid in chronic heart failure and LVD, it provides prognostic information and clarifies the meaning of a given degree of LVD.


Keywords: epidemiology; left ventricular dysfunction; natriuretic peptides

---

© 2001 by Heart
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Cleland, J. G., McMurray, J. J.V., Kjekshus, J., Cornel, J. H., Dunselman, P., Fonseca, C., Hjalmarson, A., Korewicki, J., Lindberg, M., Ranjith, N., van Veldhuisen, D. J., Waagstein, F., Wedel, H., Wikstrand, J., on behalf of the CORONA Study Group, (2009). Plasma concentration of amino-terminal pro-brain natriuretic peptide in chronic heart failure: prediction of cardiovascular events and interaction with the effects of rosuvastatin: a report from CORONA (Controlled Rosuvastatin Multinational Trial in Heart Failure).. J Am Coll Cardiol 54: 1850-1859 [Abstract] [Full Text]  
• Kurl, S, Ala-Kopsala, M, Ruskoaho, H, Makikallio, T, Nyyssonen, K, Vuolteenaho, O, Sivenius, J, Salonen, J T, Laukkanen, J A (2009). Plasma N-terminal fragments of natriuretic peptides predict the risk of stroke and atrial fibrillation in men. Heart 95: 1067-1071 [Abstract] [Full Text]  
• Frankenstein, L, Clark, A L, Goode, K, Ingle, L, Remppis, A, Schellberg, D, Grabs, F, Nelles, M, Cleland, J G F, Katus, H A, Zugck, C (2009). The prognostic value of individual NT-proBNP values in chronic heart failure does not change with advancing age. Heart 95: 825-829 [Abstract] [Full Text]  
• Hobbs, F.D.R. (2009). Clinical burden and health service challenges of chronic heart failure. Eur J Heart Fail Suppl 8: i1-i4 [Full Text]  
• Troughton, R. W., Richards, A. M. (2009). B-type natriuretic peptides and echocardiographic measures of cardiac structure and function.. J Am Coll Cardiol Img 2: 216-225 [Abstract] [Full Text]  
• Johansson, P., Brostrom, A., Dahlstrom, U., Alehagen, U. (2008). Global perceived health and ten-year cardiovascular mortality in elderly primary care patients with possible heart failure. Eur J Heart Fail 10: 1040-1047 [Abstract] [Full Text]  
• de Mattos, A. M., Siedlecki, A., Gaston, R. S., Perry, G. J., Julian, B. A., Kew, C. E. II, Deierhoi, M. H., Young, C., Curtis, J. J., Iskandrian, A. E. (2008). Systolic Dysfunction Portends Increased Mortality among Those Waiting for Renal Transplant. J. Am. Soc. Nephrol. 19: 1191-1196 [Full Text]  
• Whalley, G. A., Wright, S. P., Pearl, A., Gamble, G. D., Walsh, H. J., Richards, M., Doughty, R. N. (2008). Prognostic role of echocardiography and brain natriuretic peptide in symptomatic breathless patients in the community. Eur Heart J 29: 509-516 [Abstract] [Full Text]  
• Shankar, S. M., Marina, N., Hudson, M. M., Hodgson, D. C., Adams, M. J., Landier, W., Bhatia, S., Meeske, K., Chen, M. H., Kinahan, K. E., Steinberger, J., Rosenthal, D. (2008). Monitoring for Cardiovascular Disease in Survivors of Childhood Cancer: Report From the Cardiovascular Disease Task Force of the Children's Oncology Group. Pediatrics 121: e387-e396 [Abstract] [Full Text]  
• Struthers, A., Lang, C. (2007). The potential to improve primary prevention in the future by using BNP/N-BNP as an indicator of silent 'pancardiac' target organ damage: BNP/N-BNP could become for the heart what microalbuminuria is for the kidney. Eur Heart J 28: 1678-1682 [Abstract] [Full Text]  
• Olsen, M. H., Hansen, T. W., Christensen, M. K., Gustafsson, F., Rasmussen, S., Wachtell, K., Ibsen, H., Torp-Pedersen, C., Hildebrandt, P. R. (2007). N-terminal pro-brain natriuretic peptide, but not high sensitivity C-reactive protein, improves cardiovascular risk prediction in the general population. Eur Heart J 28: 1374-1381 [Abstract] [Full Text]  
• Luthje, L., Vollmann, D., Drescher, T., Schott, P., Zenker, D., Hasenfuss, G., Unterberg, C. (2007). Intrathoracic impedance monitoring to detect chronic heart failure deterioration: Relationship to changes in NT-proBNP. Eur J Heart Fail 9: 716-722 [Abstract] [Full Text]  
• Smith, L. A., Vennelle, M., Gardner, R. S., McDonagh, T. A., Denvir, M. A., Douglas, N. J., Newby, D. E. (2007). Auto-titrating continuous positive airway pressure therapy in patients with chronic heart failure and obstructive sleep apnoea: a randomized placebo-controlled trial. Eur Heart J 28: 1221-1227 [Abstract] [Full Text]  
• Hobbs, F.D. R., Roalfe, A. K., Davis, R. C., Davies, M. K., Hare, R., and the Midlands Research Practices Consortium (Mi, (2007). Prognosis of all-cause heart failure and borderline left ventricular systolic dysfunction: 5 year mortality follow-up of the Echocardiographic Heart of England Screening Study (ECHOES). Eur Heart J 28: 1128-1134 [Abstract] [Full Text]  
• Murphy, A., McMurray, J. J.V. (2007). Heart failure: are we neglecting the silent majority?. Eur Heart J 28: 1047-1048 [Full Text]  
• Galasko, G., Collinson, P. O, Barnes, S. C, Gaze, D., Lahiri, A., Senior, R. (2007). Comparison of the clinical utility of atrial and B type natriuretic peptide measurement for the diagnosis of systolic dysfunction in a low-risk population. J. Clin. Pathol. 60: 570-572 [Abstract] [Full Text]  
• Berry, C., Murphy, N., De Vito, G., Galloway, S., Seed, A., Fisher, C., Sattar, N., Vallance, P., Hillis, W. S., McMurray, J. (2007). Effects of aldosterone receptor blockade in patients with mild-moderate heart failure taking a beta-blocker. Eur J Heart Fail 9: 429-434 [Abstract] [Full Text]  
• Gardner, R. S., Chong, K. S., Morton, J. J., McDonagh, T. A. (2007). A change in N-terminal pro-brain natriuretic peptide is predictive of outcome in patients with advanced heart failure. Eur J Heart Fail 9: 266-271 [Abstract] [Full Text]  
• Bibbins-Domingo, K., Gupta, R., Na, B., Wu, A. H. B., Schiller, N. B., Whooley, M. A. (2007). N-Terminal Fragment of the Prohormone Brain-Type Natriuretic Peptide (NT-proBNP), Cardiovascular Events, and Mortality in Patients With Stable Coronary Heart Disease. JAMA 297: 169-176 [Abstract] [Full Text]  
• Goetze, J. P., Mogelvang, R., Maage, L., Scharling, H., Schnohr, P., Sogaard, P., Rehfeld, J. F., Jensen, J. S. (2006). Plasma pro-B-type natriuretic peptide in the general population: screening for left ventricular hypertrophy and systolic dysfunction. Eur Heart J 27: 3004-3010 [Abstract] [Full Text]  
• Rienstra, M., Van Gelder, I. C., Van den Berg, M. P., Boomsma, F., Van Veldhuisen, D. J. (2006). Natriuretic peptides in patients with atrial fibrillation and advanced chronic heart failure: determinants and prognostic value of (NT-)ANP and (NT-pro)BNP. Europace 8: 482-487 [Abstract] [Full Text]  
• Laukkanen, J. A., Kurl, S., Ala-Kopsala, M., Vuolteenaho, O., Ruskoaho, H., Nyyssonen, K., Salonen, J. T. (2006). Plasma N-terminal fragments of natriuretic propeptides predict the risk of cardiovascular events and mortality in middle-aged men. Eur Heart J 27: 1230-1237 [Abstract] [Full Text]  
• Gould, P.A., D'Agostino, J., Schneider, H.G., Kaye, D.M. (2006). Influence of atrial fibrillation on cardiac brain natriuretic peptide release during haemodynamic stress in heart failure. Eur J Heart Fail 8: 263-269 [Abstract] [Full Text]  
• Berry, C, Kingsmore, D, Gibson, S, Hole, D, Morton, J J, Byrne, D, Dargie, H J (2006). Predictive value of plasma brain natriuretic peptide for cardiac outcome after vascular surgery.. Heart 92: 401-402 [Full Text]  
• Wright, G A, Struthers, A D (2006). Natriuretic peptides as a prognostic marker and therapeutic target in heart failure. Heart 92: 149-151 [Abstract] [Full Text]  
• De Sutter, J., De Bacquer, D., Cuypers, S., Delanghe, J., De Buyzere, M., Kornitzer, M., De Backer, G. (2005). Plasma N-terminal pro-brain natriuretic peptide concentration predicts coronary events in men at work: a report from the BELSTRESS study. Eur Heart J 26: 2644-2649 [Abstract] [Full Text]  
• Campbell, D. J., Woodward, M., Chalmers, J. P., Colman, S. A., Jenkins, A. J., Kemp, B. E., Neal, B. C., Patel, A., MacMahon, S. W. (2005). Prediction of Myocardial Infarction by N-Terminal-Pro-B-Type Natriuretic Peptide, C-Reactive Protein, and Renin in Subjects With Cerebrovascular Disease. Circulation 112: 110-116 [Abstract] [Full Text]  
• Gavin, A D, Struthers, A D (2005). Allopurinol reduces B-type natriuretic peptide concentrations and haemoglobin but does not alter exercise capacity in chronic heart failure. Heart 91: 749-753 [Abstract] [Full Text]  
• Adlam, D., Silcocks, P., Sparrow, N. (2005). Using BNP to develop a risk score for heart failure in primary care. Eur Heart J 26: 1086-1093 [Abstract] [Full Text]  
• Stanton, E., Hansen, M., Wijeysundera, H. C., Kupchak, P., Hall, C., Rouleau, J. L., On behalf of the PRAISE-2 study investigators, (2005). A direct comparison of the natriuretic peptides and their relationship to survival in chronic heart failure of a presumed non-ischaemic origin. Eur J Heart Fail 7: 557-565 [Abstract] [Full Text]  
• Makikallio, A.M., Makikallio, T.H., Korpelainen, J.T., Vuolteenaho, O., Tapanainen, J.M., Ylitalo, K., Sotaniemi, K.A., Huikuri, H.V., Myllyla, V.V. (2005). Natriuretic Peptides and Mortality After Stroke. Stroke 36: 1016-1020 [Abstract] [Full Text]  
• Kistorp, C., Raymond, I., Pedersen, F., Gustafsson, F., Faber, J., Hildebrandt, P. (2005). N-Terminal Pro-Brain Natriuretic Peptide, C-Reactive Protein, and Urinary Albumin Levels as Predictors of Mortality and Cardiovascular Events in Older Adults. JAMA 293: 1609-1616 [Abstract] [Full Text]  
• Doust, J. A, Pietrzak, E., Dobson, A., Glasziou, P. (2005). How well does B-type natriuretic peptide predict death and cardiac events in patients with heart failure: systematic review. BMJ 330: 625- [Abstract] [Full Text]  
• Dickstein, K. (2005). Diagnosis and assessment of the heart failure patient: the cornerstone of effective management. Eur J Heart Fail 7: 303-308 [Abstract] [Full Text]  
• Gardner, R. S., Chong, V., Morton, I., McDonagh, T. A. (2005). N-terminal brain natriuretic peptide is a more powerful predictor of mortality than endothelin-1, adrenomedullin and tumour necrosis factor-{alpha} in patients referred for consideration of cardiac transplantation. Eur J Heart Fail 7: 253-260 [Abstract] [Full Text]  
• Verdecchia, P., Angeli, F., Gattobigio, R., Sardone, M., Porcellati, C. (2005). Asymptomatic Left Ventricular Systolic Dysfunction in Essential Hypertension: Prevalence, Determinants, and Prognostic Value. Hypertension 45: 412-418 [Abstract] [Full Text]  
• Lindahl, B., Lindback, J., Jernberg, T., Johnston, N., Stridsberg, M., Venge, P., Wallentin, L. (2005). Serial analyses of N-terminal pro-B-type natriuretic peptide in patients with non-ST-segment elevation acute coronary syndromes: A Fragmin and fast Revascularisation during InStability in coronary artery disease (FRISC)-II substudy. J Am Coll Cardiol 45: 533-541 [Abstract] [Full Text]  
• Daugaard, G., Lassen, U., Bie, P., Pedersen, E. B., Jensen, K. T., Abildgaard, U., Hesse, B., Kjaer, A. (2005). Natriuretic peptides in the monitoring of anthracycline induced reduction in left ventricular ejection fraction. Eur J Heart Fail 7: 87-93 [Abstract] [Full Text]  
• Williams, S. G., Ng, L. L., O'Brien, R. J., Taylor, S., Wright, D. J., Tan, L.-B. (2004). Is plasma N-BNP a good indicator of the functional reserve of failing hearts? The FRESH-BNP study. Eur J Heart Fail 6: 891-900 [Abstract] [Full Text]  
• Patrianakos, A. P., Parthenakis, F. I., Papadimitriou, E. A., Diakakis, G. F., Tzerakis, P. G., Nikitovic, D., Vardas, P. E. (2004). Restrictive filling pattern is associated with increased humoral activation and impaired exercise capacity in dilated cardiomyopathy. Eur J Heart Fail 6: 735-743 [Abstract] [Full Text]  
• Menezes Falcao, L., Pinto, F., Ravara, L., van Zwieten, P. A. (2004). BNP and ANP as diagnostic and predictive markers in heart failure with left ventricular systolic dysfunction. Journal of Renin-Angiotensin-Aldosterone System 5: 121-129 [Abstract]  
• Raymond, I., Mehlsen, J., Pedersen, F., Dimsits, J., Jacobsen, J., Hildebrandt, P. R. (2004). The prognosis of impaired left ventricular systolic function and heart failure in a middle-aged and elderly population in an urban population segment of Copenhagen. Eur J Heart Fail 6: 653-661 [Abstract] [Full Text]  
• Tsirka, A. E., Trinkaus, K., Chen, S.-C., Lipshultz, S. E., Towbin, J. A., Colan, S. D., Exil, V., Strauss, A. W., Canter, C. E. (2004). Improved outcomes of pediatric dilated cardiomyopathy with utilization of heart transplantation. J Am Coll Cardiol 44: 391-397 [Abstract] [Full Text]  
• Georges, A., Forestier, F., Valli, N., Plogin, A., Janvier, G., Bordenave, L. (2004). Changes in type B natriuretic peptide (BNP) concentrations during cardiac valve replacement. Eur. J. Cardiothorac. Surg. 25: 941-945 [Abstract] [Full Text]  
• McDonagh, T.A., Holmer, S., Raymond, I., Luchner, A., Hildebrant, P., Dargie, H.J. (2004). NT-proBNP and the diagnosis of heart failure: a pooled analysis of three European epidemiological studies. Eur J Heart Fail 6: 269-273 [Abstract] [Full Text]  
• Hildebrandt, P., Boesen, M., Olsen, M., Wachtell, K., Groenning, B. (2004). N-terminal pro brain natriuretic peptide in arterial hypertension--a marker for left ventricular dimensions and prognosis. Eur J Heart Fail 6: 313-317 [Abstract] [Full Text]  
• Schinkel, A F L, Vourvouri, E C, Bax, J J, Boomsma, F, Bountioukos, M, Rizzello, V, Biagini, E, Agricola, E, Elhendy, A, Roelandt, J R T C, Poldermans, D (2004). Relation between left ventricular contractile reserve during low dose dobutamine echocardiography and plasma concentrations of natriuretic peptides. Heart 90: 293-296 [Abstract] [Full Text]  
• Groenning, B A, Raymond, I, Hildebrandt, P R, Nilsson, J C, Baumann, M, Pedersen, F (2004). Diagnostic and prognostic evaluation of left ventricular systolic heart failure by plasma N-terminal pro-brain natriuretic peptide concentrations in a large sample of the general population. Heart 90: 297-303 [Abstract] [Full Text]  
• Sliwa, K., Woodiwiss, A., Kone, V. N., Candy, G., Badenhorst, D., Norton, G., Zambakides, C., Peters, F., Essop, R. (2004). Therapy of Ischemic Cardiomyopathy With the Immunomodulating Agent Pentoxifylline: Results of a Randomized Study. Circulation 109: 750-755 [Abstract] [Full Text]  
• Wang, T. J., Larson, M. G., Levy, D., Benjamin, E. J., Leip, E. P., Omland, T., Wolf, P. A., Vasan, R. S. (2004). Plasma Natriuretic Peptide Levels and the Risk of Cardiovascular Events and Death. NEJM 350: 655-663 [Abstract] [Full Text]  
• Clerico, A., Emdin, M. (2004). Diagnostic Accuracy and Prognostic Relevance of the Measurement of Cardiac Natriuretic Peptides: A Review. Clin. Chem. 50: 33-50 [Abstract] [Full Text]  
• Vourvouri, E. C., Schinkel, A. F.L., Roelandt, J. R.T.C., Boomsma, F., Sianos, G., Bountioukos, M., Sozzi, F. B., Rizzello, V., Bax, J. J., Karvounis, H. I., Poldermans, D. (2003). Screening for left ventricular dysfunction using a hand-carried cardiac ultrasound device. Eur J Heart Fail 5: 767-774 [Abstract] [Full Text]  
• Wendelboe Nielsen, O, Hilden, J, McDonagh, T, Fischer Hansen, J (2003). Survival differences between heart failure in general practices and in hospitals. Heart 89: 1298-1302 [Abstract] [Full Text]  
• Gardner, R.S., Ozalp, F., Murday, A.J., Robb, S.D., McDonagh, T.A. (2003). N-terminal pro-brain natriuretic peptide: A new gold standard in predicting mortality in patients with advanced heart failure. Eur Heart J 24: 1735-1743 [Abstract] [Full Text]  
• Wang, T. J., Evans, J. C., Benjamin, E. J., Levy, D., LeRoy, E. C., Vasan, R. S. (2003). Natural History of Asymptomatic Left Ventricular Systolic Dysfunction in the Community. Circulation 108: 977-982 [Abstract] [Full Text]  
• Fisher, C, Berry, C, Blue, L, Morton, J J, McMurray, J (2003). N-terminal pro B type natriuretic peptide, but not the new putative cardiac hormone relaxin, predicts prognosis in patients with chronic heart failure. Heart 89: 879-881 [Abstract] [Full Text]  
• Richards, A. M., Nicholls, M. G., Espiner, E. A., Lainchbury, J. G., Troughton, R. W., Elliott, J., Frampton, C., Turner, J., Crozier, I. G., Yandle, T. G. (2003). B-Type Natriuretic Peptides and Ejection Fraction for Prognosis After Myocardial Infarction. Circulation 107: 2786-2792 [Abstract] [Full Text]  
• Wang, T. J., Levy, D., Benjamin, E. J., Vasan, R. S. (2003). The Epidemiology of "Asymptomatic" Left Ventricular Systolic Dysfunction: Implications for Screening. ANN INTERN MED 138: 907-916 [Abstract] [Full Text]  
• Ruskoaho, H. (2003). Cardiac Hormones as Diagnostic Tools in Heart Failure. Endocr. Rev. 24: 341-356 [Abstract] [Full Text]  
• Nielsen, O. W., McDonagh, T. A., Robb, S. D., Dargie, H. J. (2003). Retrospective analysis of thecost-effectiveness of using plasmabrain natriuretic peptide inscreening for left ventricularsystolic dysfunction in the general population. J Am Coll Cardiol 41: 113-120 [Abstract] [Full Text]  
• de Lemos, J. A., Morrow, D. A. (2002). Brain Natriuretic Peptide Measurement in Acute Coronary Syndromes: Ready for Clinical Application?. Circulation 106: 2868-2870 [Full Text]  
• McDonagh, T A (2002). Screening for left ventricular dysfunction: a step too far?. Heart 88: ii12-14 [Full Text]  
• Struthers, A D (2002). Introducing a new role for BNP: as a general indicator of cardiac structural disease rather than a specific indicator of systolic dysfunction only. Heart 87: 97-98 [Full Text]  
• Ciotti, R., Ucci, G., Belotti, G., Facchi, E., Cremonesi, M., Gatti, C., Baccheta, G. (2001). Prospective Evaluation of Anthracycline-Related Early Cardiac Damage: How Do We Monitor It?. JCO 19: 4269-4270 [Full Text]