Elevated NT-ProBNP Levels in Patients With Increased Left Ventricular Filling Pressure During Exercise Despite Preserved Systolic Function

Abstract

Background The role of brain natriuretic peptides in the detection of mild forms of isolated diastolic dysfunction is still uncertain. We therefore investigated the plasma levels of the N-terminal pro–B-type natriuretic peptide (NT-proBNP) in patients with heart failure symptoms during exercise, despite preserved systolic cardiac function. Methods and Results Fifteen control subjects and 15 symptomatic patients with preserved left ventricular ejection fraction of ≥50%, near normal Doppler echocardiographic indices, and left and right heart catheter indices at rest but increased filling pressures during exercise were studied. Plasma NT-proBNP levels and surrogate parameters of diastolic function were determined simultaneously. The median NT-proBNP plasma level was elevated (median, 145.2 pg/mL [range, 69.7–273.4 pg/mL] vs 38.3 pg/mL [range, 22.1–64.7 pg/ml]; P < .0001) in patients with increased filling pressure during exercise and correlated strongly with the pulmonary capillary wedge pressure ( r = 0.78; P < .001). Conclusion NT-proBNP levels are increased in patients with increased filling pressures during exercise and useful for the detection of diastolic dysfunction in patients with exertional dyspnea.