Plasma brain natriuretic peptide as a biochemical marker of high left ventricular end-diastolic pressure in patients with symptomatic left ventricular dysfunction,☆☆,,★★

https://doi.org/10.1016/S0002-8703(98)70041-9Get rights and content

Abstract

Background: Plasma atrial natriuretic peptide (ANP), mainly from the atrium, brain natriuretic peptide (BNP), mainly from the ventricle, norepinephrine (NE), and endothelin-1 (ET-1) levels are increased with the severity of congestive heart failure (CHF). Although a close correlation between the left ventricular end-diastolic pressure (LVEDP) and plasma ANP in patients with left ventricular dysfunction has been reported, it is not yet known which cardiac natriuretic peptide is a better predictor of high LVEDP in patients with CHF. Methods: To investigate the biochemical predictors of the high LVEDP in patients with left ventricular dysfunction, we measured plasma ANP, BNP, NE, and ET-1 levels and the hemodynamic parameters in 72 patients with symptomatic left ventricular dysfunction. Stepwise multivariate regression analyses were also used to determine whether the plasma levels of ANP, BNP, NE, and ET-1 could predict high LVEDP. Results: Although significant positive correlations were found among the plasma levels of ANP, BNP, ET-1, and NE and the LVEDP, only BNP (p = 0.0001) was an independent and significant predictor of high LVEDP in patients with CHF. In all eight patients with severe CHF measured for hemodynamics before and after the treatments, the plasma BNP levels decreased in association with the decrease of LVEDP, whereas other factors increased in some patients despite the decrease of LVEDP. Conclusions: These findings suggest that plasma BNP is superior to ANP as a predictor of high LVEDP in patients with symptomatic left ventricular dysfunction. (Am Heart J 1998;135:825-32.)

Section snippets

Patients

Seventy-two patients with left ventricular dysfunction (LVEF <50%) undergoing right and left heart catheterization for clinically indicated purposes were studied continually from December 1994 until March 1997 in our institution. Informed consent was obtained from all patients for participation in the study according to a protocol approved by the Committee on Human Investigation at our institution. The 53 men and 19 women ranged in age from 20 to 80 years (mean age 61 years). Fifty-one patients

Hemodynamic data

Cardiac catheterization data are shown in Table I.

. Plasma neurohormonal levels and hemodynamic data in 72 patients with CHF

Empty CellMild CHF (n = 57)Severe CHF (n = 15)
NYHA (functional class)1.74 ± 0.443.53 ± 0.52*
Age (yr)60.6 ± 13.164.1 ± 13.1
ANP (pg/ml)67.1 ± 48.3152.7 ± 96.9*
BNP (pg/ml)86.8 ± 82.6690.6 ± 491.1*
ET-1 (pg/ml)2.21 ± 0.673.56 ± 1.67*
NE (pg/ml)260 ± 2181032 ± 1042*
HR (beats/min)68 ± 1791 ± 8.7*
RAP (mm Hg)2.9 ± 1.95.6 ± 4.1*
MPAP (mm Hg)13.7 ± 5.624.7 ± 11.9*
PCWP (mm Hg)6.8 ± 4.215.1 ± 6.8*

Discussion

Previous studies reported the correlation between hemodynamics and neurohumoral factors such as plasma cardiac natriuretic peptides, and plasma levels of ANP were thought to be a hemodynamic predictor in patients with CHF.10, 13 In fact, we previously reported a close correlation between the LVEDP and plasma ANP in patients with left ventricular dysfunction.17 However, it remained unknown as to which cardiac natriuretic peptide, ANP, mainly from the atrium, or BNP, mainly from the ventricle, is

Acknowledgements

We thank Ms. Ikuko Sakaguchi for excellent technical assistance.

References (30)

  • JN Cohn et al.

    Plasma norepinephrine as a guide to prognosis in patients with chronic congestive heart failure

    N Engl J Med

    (1984)
  • M. Packer

    Neurohumoral interactions and adaptations in congestive heart failure

    Circulation

    (1988)
  • RJ Cody et al.

    Plasma endothelin correlates with extent of pulmonary hypertension in patients with chronic heart failure

    Circulation

    (1994)
  • K Swedberg et al.

    Hormones regulating cardiovascular function in patients with severe congestive heart failure and relation to mortality

    Circulation

    (1990)
  • M Yoshimura et al.

    Different secretion pattern of atrial natriuretic peptide and brain natriuretic peptide in patients with congestive heart failure

    Circulation

    (1993)
  • Cited by (725)

    View all citing articles on Scopus

    From the First Department of Internal Medicine, Shiga University of Medical Science.

    ☆☆

    Supported in part by a Grant-in-Aid for Scientific Research (C) in Japan.

    Reprint requests: Takayoshi Tsutamoto, MD, First Department of Internal Medicine, Shiga University of Medical Science, Tsukinowa, Seta, Otsu 520-2192, Japan.

    ★★

    4/1/87272

    View full text