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CLINICAL RESEARCH: HEART FAILURE

Elevation of plasma brain natriuretic peptide is a hallmark of diastolic heart failure independent of ventricular hypertrophy

Hitoshi Yamaguchi, MD, PhD^*,, Junichi Yoshida, MD^,, Kazuhiro Yamamoto, MD, PhD, FACC^,*, Yasushi Sakata, MD, PhD, Toshiaki Mano, MD, PhD, Noriyuki Akehi, MD, Masatsugu Hori, MD, PhD, FACC, Young-Jae Lim, MD, PhD^*, Masayoshi Mishima, MD, PhD^* and Tohru Masuyama, MD, PhD, FACC

^* Department of Cardiology, Kawachi General Hospital, Higashi-Osaka, Japan
Department of Internal Medicine and Therapeutics, Osaka University Graduate School of Medicine, Suita, Japan

Manuscript received April 4, 2003; revised manuscript received June 12, 2003, accepted July 29, 2003.

^* Reprint requests and correspondence: Dr. Kazuhiro Yamamoto, Department of Internal Medicine and Therapeutics (A8), Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita 565-0871, Japan.
kazuhiro{at}medone.med.osaka-u.ac.jp

OBJECTIVES: We tested a hypothesis that elevation of the plasma level of brain natriuretic peptide (BNP) is one of the characteristics of patients with diastolic heart failure (DHF) independent of left ventricular (LV) hypertrophy.

BACKGROUND: The clinical characteristics of DHF are not well acknowledged, although DHF has become a great social burden. Such a lack of clinical information leads to inaccuracy in the diagnosis of DHF. We have demonstrated enhancement of ventricular production of BNP with progression of maladaptive ventricular hypertrophy, but not with development of compensatory hypertrophy in an animal DHF model.

METHODS: Of 372 patients who presented to the emergency department because of acute pulmonary congestion without acute coronary syndrome between January 1996 and May 2002, those with an ejection fraction 45% upon admission, who were stably controlled at least for a year in our outpatient clinics, comprised the DHF group (n = 19). A control group consisted of 22 hypertensive patients with a LV mass index greater than or equal to its minimum value of the DHF group and an ejection fraction 45%, in whom cardiac symptoms had not occurred.

RESULTS: Despite a similar distribution of LV mass index, the BNP level was higher in the DHF group than in the control group (149 ± 38 vs. 31 ± 5 pg/ml, p < 0.01). There was no difference in LV cavity size or parameters derived from pulsed Doppler transmitral flow velocity curves.

CONCLUSIONS: An elevation of BNP may be a hallmark of patients with or at risk of DHF among subjects with preserved systolic function independent of LV hypertrophy.

Abbreviations and Acronyms   ANP = atrial natriuretic peptide   BNP = brain natriuretic peptide   DHF = diastolic heart failure   E/A = ratio of peak mitral E-wave velocity to peak mitral A-wave velocity   EF = ejection fraction   HF = heart failure   LV = left ventricular   NYHA = New York Heart Association

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