CLINICAL RESEARCH: HEART FAILURE
Plasma B-type natriuretic peptide levels in systolic heart failure
importance of left ventricular diastolic function and right ventricular systolic function
Richard W. Troughton, MB, ChB, PhD*,
David L. Prior, MBBS, PhD ,
Jeremy J. Pereira, MBBS*,
Maureen Martin*,
Annette Fogarty, RDCS, RN*,
Annitta Morehead, RDCS, FASE*,
Timothy G. Yandle, PhD ,
A. Mark Richards, MD, PhD, DSc,
Randall C. Starling, MD, FACC ,
James B. Young, MD, FACC,
James D. Thomas, MD, FACC* and
Allan L. Klein, MD, FRCP(C), FACC, FASE*,*
* Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
Kaufman Center for Heart Failure, Cleveland Clinic Foundation, Cleveland, Ohio, USA
St. Vincent's Department of Medicine, University of Melbourne, Melbourne, Australia
Christchurch Cardioendocrine Research Group, Christchurch, New Zealand
Manuscript received May 13, 2003;
revised manuscript received August 4, 2003,
accepted August 25, 2003.
* Reprint requests and correspondence: Dr. Allan L. Klein, Director of Cardiovascular Imaging Research, Department of Cardiovascular Medicine, Professor of Medicine, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk F-15, Cleveland, Ohio 44195, USA.
kleina{at}ccf.org
OBJECTIVES: 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.
METHODS: In 106 patients with symptomatic SHF (left ventricular ejection fraction [LVEF] <0.35), we measured plasma BNP levels and performed comprehensive echocardiography with assessment of left ventricular diastolic function, including color M-mode (CMM) and tissue Doppler imaging (TDI), and of right ventricular (RV) function.
RESULTS: Median plasma BNP levels were elevated and increased with greater severity of diastolic dysfunction. We found significant correlations (p < 0.001 for all) between BNP and indexes of myocardial relaxation (early diastolic velocity: r = –0.26), compliance (deceleration time: r = –0.55), and filling pressure (early transmitral to early annular diastolic velocity ratio: r = 0.51; early transmitral flow to the velocity of early left ventricular flow propagation ratio: r = 0.41). In multivariate analysis, overall diastolic stage, LVEF, RV systolic dysfunction, mitral regurgitation (MR) severity, age and creatinine clearance were independent predictors of BNP levels (model fit r = 0.8, p < 0.001).
CONCLUSIONS: Plasma BNP levels are significantly related to newer diastolic indexes measured from TDI and CMM in SHF. Heterogeneity of BNP levels in patients with SHF reflects the severity of diastolic abnormality, RV dysfunction, and MR in addition to LVEF, age, and renal function. These findings may explain the powerful relationship of BNP to symptoms and prognosis in SHF.
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Abbreviations and Acronyms
| | AR | = atrial reversal | | BNP | = B-type natriuretic peptide | | CMM | = color M-mode | | DT | = deceleration time | | IQR | = interquartile range | | LVEF | = left ventricular ejection fraction | | MR | = mitral regurgitation | | NYHA | = New York Heart Association | | PV | = pulmonary vein | | RV | = right ventricle/ventricular | | SHF | = systolic heart failure | | TDI | = tissue Doppler imaging | | TR | = tricuspid regurgitation | | Vp | = velocity of early left ventricular flow propagation |
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