Between B-type Natriuretic Peptide Levels Research Articles

Evaluation Left Ventricle Performance in hypertensive patients using heart ultrasound and levels of a salt-producing brain peptide in blood

Background: we studied on 100 patients in total, with 56 in the 'LV dysfunction' group and the rest in the 'control' group to evaluate of left ventricular functioning in hypertensive patients by examining the ultrasound of the heart by tracking the scores and their association with levels of a salt-producing brain peptide in the blood. . To find relevant research, a thorough online search was conducted. Data were retrieved and synthesized from the included studies after they were evaluated for quality and risk of bias. The findings demonstrated a robust association between B-type natriuretic peptide (BNP) levels and speckle-tracking echocardiography (STE) derived indices of left ventricular (LV) performance in hypertension individuals. The findings of this review highlight the potential of STE as a valuable tool for evaluating LV performance in hypertensive patients and its association with BNP levels in Baghdad. Aim: This study aims to find out how hypertension patients' LV function, as determined by speckle-tracking echocardiography (STE), correlated with B-type natriuretic peptide BNP levels in the blood. Methods: All subjects had echocardiographic tests using a commercially available ultrasonography equipment equipped with a phased-array transducer operating at 3.5 MHz, with the following parameters measured: Biplane with a few tweaks for this study, the LVEF was calculated using Simpson's method ,the left ventricular systolic volume (SV) ,systolic volume at the end of the left ventricle (LVESV), in order to determine the LVMI, the Devereux formula was used and the filling ratio of early to late diastole (E/A ratio). They were compared with a healthy group (control) to obtain accurate results. Results: There were statistically significant differences in LVEF, LVEDV, LVESV, LVMI, E/A ratio, E/e' ratio, and global longitudinal strain (GLS) between the control and LV dysfunction groups. Diastolic dysfunction was more common in LV dysfunction patients, and they also had lower GLS values than the control group. The levels of BNP were shown to have a favorable relationship with numerous echocardiographic parameters. Hypertensive individuals had greater BNP levels than the control group. The LVH group also had greater levels of BNP than the non-LVH group.

B-type natriuretic peptide and risk of sudden death in patients with hypertrophic cardiomyopathy

The association between B-type natriuretic peptide (BNP) levels and sudden cardiac death in patients with hypertrophic cardiomyopathy (HCM) remains unclear. This study evaluated the effect of elevated BNP levels on sudden death risk in a cohort of patients with HCM. This study included 346 patients with HCM. Plasma BNP levels were measured at the initial evaluation. The median (interquartile range) BNP level in the study patients was 197.2 (84.4-353.3) pg/mL. During a median (interquartile range) follow-up period of 8.4 (4.2-12.5) years, 37 patients (10.7%) experienced the combined end point of sudden death or potentially lethal arrhythmic events, including 11 patients with sudden death (3.2%), 8 resuscitated after cardiac arrest, and 18 with appropriate implantable defibrillator shocks. Time-dependent receiver operating characteristic curve analysis of the prognostic value of BNP for the combined end point showed that the Harrell's concordance index was 0.748 and the optimal BNP cutoff point was 312 pg/mL. Patients with high BNP levels (>312pg/mL) were at a significantly higher risk of sudden death (Gray test, P = .001) and the combined end point (Gray test, P<.001) than were patients with low BNP levels (≤312 pg/mL). Multivariable analysis that included BNP levels and established risk factors for sudden death showed that high BNP levels were an independent determinant of the combined end point (adjusted hazard ratio 5.71; 95% confidence interval 2.86-11.4; P < .001). Elevated BNP levels may be associated with sudden death and the combination of sudden death or potentially lethal arrhythmic events in patients with HCM.

The role of biomarkers in dilated cardiomyopathy: Assessment of clinical severity and reverse remodeling

IntroductionBiomarkers in dilated cardiomyopathy (DCM) reflect various pathobiological processes, including neurohormonal activation, oxidative stress, matrix remodeling, myocyte injury and myocyte stretch. We assessed the role of biomarkers in clinical and echocardiographic parameters and in left ventricular (LV) reverse remodeling (LVRR). MethodsIn this prospective study of 50 DCM patients (28 men, aged 59±10 years) with LV ejection fraction (LVEF) <40%, LVRR was defined as an increase of >10 U in LVEF after optimal medical therapy. ResultsBaseline LVEF was 25.4±9.8% and LV end-diastolic diameter (LVEDD)/body surface area (BSA) was 34.2±4.5 mm/m2. LVRR occurred in 34% of patients within 17.6±15.6 months. No correlation was found between B-type natriuretic peptide (BNP), 25-hydroxyvitamin D (25(OH)D), CA-125, high-sensitivity C-reactive protein (hs-CRP), lipoprotein(a) [Lp(a)], noradrenaline, adrenaline, renin or aldosterone and LVRR. Patients in NYHA class III or IV, with pulmonary congestion or ankle edema, had higher CA-125, cystatin C, BNP and hs-CRP levels (p<0.05). CA-125 was correlated with BNP (r=0.61), hs-CRP (r=0.56) and uric acid (r=0.52) (all p=0.01). BNP correlated directly with LVEDD (r=0.49), LV volumes (r=0.51), pulmonary artery systolic pressure (PASP) (r=0.43) and E/e′ (r=0.31), and was inversely correlated with LVEF (r=-0.50) and e′ velocity (r=-0.32) (p<0.05). CA-125 was positively correlated with left atrial volume/BSA (r=0.46), E/A ratio (r=0.60) and PASP (r=0.49) (p<0.05). ConclusionsNo correlation was found between biomarkers and LVRR, but CA-125, BNP and hs-CRP were predictors of clinical severity and congestion. BNP correlated with parameters of systolic and diastolic dysfunction, while CA-125 correlated with measures of diastolic dysfunction.

The role of biomarkers in dilated cardiomyopathy: Assessment of clinical severity and reverse remodeling

IntroductionBiomarkers in dilated cardiomyopathy (DCM) reflect various pathobiological processes, including neurohormonal activation, oxidative stress, matrix remodeling, myocyte injury and myocyte stretch. We assessed the role of biomarkers in clinical and echocardiographic parameters and in left ventricular (LV) reverse remodeling (LVRR). MethodsIn this prospective study of 50 DCM patients (28 men, aged 59±10 years) with LV ejection fraction (LVEF) <40%, LVRR was defined as an increase of >10 U in LVEF after optimal medical therapy. ResultsBaseline LVEF was 25.4±9.8% and LV end-diastolic diameter (LVEDD)/body surface area (BSA) was 34.2±4.5 mm/m2. LVRR occurred in 34% of patients within 17.6±15.6 months. No correlation was found between B-type natriuretic peptide (BNP), 25-hydroxyvitamin D (25(OH)D), CA-125, high-sensitivity C-reactive protein (hs-CRP), lipoprotein(a) [Lp(a)], noradrenaline, adrenaline, renin or aldosterone and LVRR. Patients in NYHA class III or IV, with pulmonary congestion or ankle edema, had higher CA-125, cystatin C, BNP and hs-CRP levels (p<0.05). CA-125 was correlated with BNP (r=0.61), hs-CRP (r=0.56) and uric acid (r=0.52) (all p=0.01). BNP correlated directly with LVEDD (r=0.49), LV volumes (r=0.51), pulmonary artery systolic pressure (PASP) (r=0.43) and E/e′ (r=0.31), and was inversely correlated with LVEF (r=-0.50) and e′ velocity (r=-0.32) (p<0.05). CA-125 was positively correlated with left atrial volume/BSA (r=0.46), E/A ratio (r=0.60) and PASP (r=0.49) (p<0.05). ConclusionsNo correlation was found between biomarkers and LVRR, but CA-125, BNP and hs-CRP were predictors of clinical severity and congestion. BNP correlated with parameters of systolic and diastolic dysfunction, while CA-125 correlated with measures of diastolic dysfunction.

B-type natriuretic peptide and renal function in Japanese patients with type 2 diabetes mellitus: The Dogo Study.

Among patients with type 2 diabetes mellitus, the association between B-type natriuretic peptide (BNP) and renal function remains controversial. We therefore investigated this issue among Japanese patients with type 2 diabetes mellitus. This study included 687 Japanese patients with type 2 diabetes mellitus. BNP levels were divided at quartile points on the basis of the distribution. We used four outcomes regarding the renal function: 1) chronic kidney disease (CKD): estimated glomerular filtration rate (eGFR) < 60ml/min/1.72m2, 2) advanced CKD: eGFR < 30ml/min/1.72m2, 3) microalbuminuria: urinary albumin creatinine ratio (UACR) ≥ 30 mg/g creatinine, and 4) macroalbuminuria: UACR ≥ 300 mg/g creatinine. The prevalence values of CKD, advanced CKD, microalbuminuria, and macroalbuminuria were 27.4％, 2.5%, 31.4%, and 9.3%, respectively. Highest BNP (≥ 39.2 ng/ml) was independently positively associated with microalbuminuria and macroalbuminuria (adjusted ORs, 2.61 [95% CI: 1.53-4.49] and 3.45 [95% CI: 1.46-8.72], respectively). High BNP was not associated with advanced CKD or CKD. There was a statistically significant positive exposure-response relationships between the BNP level and advanced CKD, microalbuminuria, and macroalbuminuria (p for trend = 0.047, 0.001, and 0.003, respectively). BNP level may be independently positively associated with advanced CKD, microalbuminuria, and macroalbuminuria but not CKD in Japanese patients with type 2 diabetes mellitus.

Plasma B-type natriuretic peptide concentration is independently associated with kidney function decline in Japanese patients with chronic kidney disease.

The relationship between B-type natriuretic peptide (BNP) concentration and renal outcomes in patients with chronic kidney disease (CKD) remains unclear; therefore, it has not been determined whether BNP is related to renal outcomes, independent of cardiac parameters. This study was designed to clarify whether BNP concentration is associated with renal outcomes in CKD patients, independent of cardiac functional and structural alterations. This prospective observational study included 372 consecutive patients with CKD. The renal endpoint was the composite of doubling of serum creatinine concentration and end-stage renal disease requiring dialysis. BNP concentrations were divided into quartiles. A Cox proportional hazards model was utilized to determine the risk factors for poor renal outcomes. During a median follow-up of 23.1 months, the renal endpoint was observed in 124 patients, including 14, 18, 37 and 55 patients in the first through fourth BNP quartiles, respectively. After adjustment for covariates, including cardiac parameters such as left atrial diameter, left ventricular mass index, left ventricular ejection fraction, and left ventricular hypertrophy, the hazard ratios (HRs) for renal outcomes became progressively higher for the second [HR, 1.50; 95% confidence interval (CI), 0.70-3.30), third (HR, 2.29; 95% CI, 1.11-4.91), and fourth (HR, 4.29; 95% CI, 2.05-9.39) BNP quartiles when compared with the lowest BNP quartile. Higher BNP levels were associated with adverse renal outcomes, independent of cardiac structure and function, suggesting that BNP may be a useful biomarker for exploring factors associated with kidney disease progression.

Decrease in B-Type Natriuretic Peptide Levels and Successful Catheter Ablation for Atrial Fibrillation in Patients with Heart Failure.

Little is known about the association between B-type natriuretic peptide (BNP) levels and catheter ablation of atrial fibrillation (AF) in patients with heart failure. This study aimed to examine the impact of elimination of AF by catheter ablation on BNP levels in patients with left ventricular systolic dysfunction. Fifty-four AF patients with left ventricular ejection fraction (LVEF) ≤ 50%, who underwent radiofrequency catheter ablation therapy of AF, were included. BNP sampling was performed at baseline, 3 days, and 1 month after ablation. After a follow-up period of 6 months, the BNP levels decreased significantly in the nonrecurrence group (n = 35; median 126.3 [interquartile 57.2-206.5] pg/mL, 63.5 [23.9-180.2] pg/mL, and 45.9 [21.9-160.3] pg/mL, P < 0.001, respectively), but not in the recurrence group (n = 19; 144.7 [87.1-217.3] pg/mL, 88.8 [12.9-213.2] pg/mL, and 118.5 [51.6-298.2] pg/mL, P = 0.368, respectively). The patients in the nonrecurrence group had a higher percentage relative reduction in BNP levels from baseline to 1 month after ablation than those in the recurrence group (56.5 [-9.0-77.4]% vs -2.4 [-47.1-60.9]%, P = 0.027). Additionally, a relative reduction in BNP levels significantly correlated with an increase in LVEF after ablation (r = 0.486, P < 0.001). Plasma BNP levels decreased significantly with successful catheter ablation of AF in patients with impaired LVEF. The decrease in BNP levels might be associated with early recovery of cardiac function and subsequent maintenance of sinus rhythm at follow-up.

Evaluation of left ventricular functions in patients with pseudoexfoliation syndrome using tissue Doppler echocardiography and its association with plasma BNP levels.

Pseudoexfoliation syndrome (PES) is a systemic disorder that involves various visceral organs. In this observational cross-sectional study we aimed to investigate the left ventricular functions in patients with PES by using tissue Doppler imaging and correlations between B-type natriuretic peptide (BNP) levels and cardiac functions. The study enrolled 22 patients with PES (9 male, 41%), aged 57.0 ± 8.8 years, and 23 control subjects (9 male, 39%), aged 52.8 ± 4.9 years. Patients with any cardiovascular disease were excluded. Fasting blood samples were taken and tissue Doppler imaging was performed at the mitral annulus with echocardiographic examination. The independent t and Mann-Whitney U tests were used. The Em velocities at the basal septum and lateral annulus were significantly lower in patients with PES showing decreased diastolic functions (7.6 ± 2.0 versus 9.1 ± 1.6 cm/s, p=0.01 and 9.3 ± 3.5 versus 11.5 ± 3.1 cm/s, p=0.04 respectively). While global left ventricular systolic function assessed by ejection fraction was not significantly different between patients with PES and controls, the septum S-wave velocities of PES patients were lower (7.6 ± 1.3 versus 8.5 ± 1.2 cm/s, p=0.03). Total plasma BNP levels were significantly higher in PES patients (129.04 ± 99.38 pg/mL versus 59.64 ± 53.69 pg/mL; p=0.005) and there was a negative correlation between plasma BNP concentration and mitral annulus average Em velocities (r=-0.554, p=0.009). E/Em ratio was also significantly higher in PES patients (7.85 ± 2.01 versus 6.64 ± 1.48, p=0.03). In this study we showed decreased left ventricular diastolic functions correlated with plasma BNP levels in PES patients. Although further studies needed, evaluation and follow-up of PES patients in terms of left ventricular functions will be useful.

The correlation of ECHO findings of right cardiac pathologies with BNP, uric acid, and CRP in OSAS.

Right cardiac pathologies develop in patients with obstructive sleep apnea syndrome (OSAS) and in most patients there are no symptoms in the early stages of right cardiac disorders. We aimed to evaluate a possible relationship between B-type natriuretic peptide (BNP), blood uric acid, C-reactive protein (CRP), and the right cardiac pathologies in patients with OSAS, and the role of these parameters in the management of patients with OSAS. A total of 98 subjects, 31 (31.6%) controls and 67 (68.4%) with OSAS, were included in the study. All the subjects underwent polysomnography, and standard and tissue Doppler echocardiography (ECHO) examinations. BNP, CRP, and blood uric acid levels were measured in all patients. Upon evaluating the relationship between BNP and ECHO parameters, BNP levels were found to positively correlate with such ECHO parameters as pulmonary artery pressure. As for the association between CRP and ECHO findings, RV diameter exhibited a statistically significant positive correlation with them. Moreover, uric acid was found to statistically correlate positively with right atrium dimensions. BNP, CRP, and blood uric acid levels can be used as adjunctive parameters in the early diagnosis and follow-up of right heart pathologies in patients with OSAS.

B-Type Natriuretic Peptide and Survival in Hypertrophic Cardiomyopathy

The aim of this study was to determine the relationship between B-type natriuretic peptide (BNP) and survival in patients with hypertrophic cardiomyopathy. Natriuretic peptides are released in response to neurohormonal activation, myocardial stretch, and wall tension and therefore reflect hemodynamic derangements. A total of 772 patients with hypertrophic cardiomyopathy had BNP obtained in conjunction with echocardiography and clinical evaluation, inclusive of cardiopulmonary exercise evaluation in 429 patients (56%). Survival free of all-cause mortality was lower across increasing levels of BNP (log-rank test, p= 0.002). Three-year survival by tertile was 99.2% (95% confidence interval: 94.3% to 99.9%; BNP level≤98 pg/ml), 94.8% (95% confidence interval: 88.2% to 97.8%; BNP level, >98 to<298 pg/ml), and 89.9% (95% confidence interval: 82.0% to 94.5%; BNP level≥298 pg/ml). Compared with patients in the first tertile, the hazard ratios for death in the second and third tertiles were 4.88 (p= 0.006) and 6.98 (p= 0.0003), respectively. This relationship persisted inpatients without resting obstructive physiology (n= 497, p= 0.01). BNP levels were related to New York HeartAssociation functional status (p< 0.0001) and the subsequent need for septal reduction therapy in follow-up(p= 0.04). In this large cohort of patients with hypertrophic cardiomyopathy, BNP was an independent predictor of morbidity and mortality.

Evaluation of Right Ventricular Functions and B-Type Natriuretic Peptide Levels by Cardiopulmonary Exercise Test in Patients with Pulmonary Regurgitation After Repair of Tetralogy of Fallot

Impairment of right ventricular functions, especially due to chronic pulmonary regurgitation (PR), is a well-known entity in patients with tetralogy of Fallot (ToF) after repair. The aim of this study was to examine the relation between B-type natriuretic peptide (BNP) levels and right ventricular dysfunction by cardiopulmonary exercise test (ET) in patients after repair of ToF. Twenty-five patients with a mean age of 14.1 +/- 4.4 years at follow-up who underwent repair of ToF at a mean age of 4.9 +/- 5.1 years and 29 age- and sex-matched healthy children at a mean age of 13.1 +/- 2.8 years were enrolled in this study. Plasma BNP levels were measured at baseline and at maximal exercise. The volume of right ventricle (RV) and the degree of PR were assessed by two-dimensional echocardiography and color Doppler. Plasma BNP levels were significantly higher in patients with ToF than in controls (28.3 +/- 24.1 vs 7.4 +/- 2.3 pg/mL, p = 0.0001). Exercise was associated with increased plasma BNP levels in both groups. A greater increase in BNP was noted in patients with ToF than in controls (37.6 +/- 27.5 vs 11.3 +/- 4.5 pg/mL, p = 0.0001). Forced vital capacity (FVC%) (84.9 +/- 16.9 vs 98.4 +/- 18.2, p = 0.01) and forced expiratory volume during the 1st second (FEV1%) (91.5 +/- 19.3 vs 103.8 +/- 16.1, p = 0.02) were decreased, exercise duration (ED) (10.1 +/- 1.9 vs 11.4 +/- 1.7 min, p = 0.02), maximum heart rate (HRmax) (171.2 +/- 18.9 vs 186.4 +/- 13.9 /min, p = 0.004), and maximum oxygen uptake (VO(2)max) (1.56 +/- 0.53 vs 2.1 +/- 0.6 L/min, p = 0.007) were lower in patients with ToF. There were significant correlations between the degree of PR and ED (r =-0.3, p = 0.009), HRmax (r =-0.4, p = 0.001), and VO(2)max (r =-0.4, p = 0.001). The correlations were significant both before and after exercise, being more pronounced after exercise between BNP level and the degree of PR (r = 0.6, p = 0.0001). As a result, the severity of PR has a negative influence on right ventricular functions and there is significant relation between right ventricular functions and exercise capacity after repair of tetralogy of Fallot.

Prognostic Value of B-Type Natriuretic Peptides in Patients With Stable Coronary Artery Disease: The PEACE Trial

The purpose of this study was to assess the association between B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) and the incidence of specific cardiovascular events in low-risk patients with stable coronary disease, the incremental prognostic information obtained from these two biomarkers compared with traditional risk factors, and their ability to identify patients who may benefit from angiotensin-converting enzyme (ACE) inhibition. The prognostic value of BNPs in low-risk patients with stable coronary artery disease remains unclear. Baseline plasma BNP and NT-proBNP concentrations were measured in 3,761 patients with stable coronary artery disease and preserved left ventricular function participating in the PEACE (Prevention of Events With Angiotensin-Converting Enzyme Inhibition) study, a placebo-controlled trial of trandolapril. Multivariable Cox regression was used to assess the association between natriuretic peptide concentrations and the incidence of cardiovascular mortality, fatal or nonfatal myocardial infarction, heart failure, and stroke. The BNP and NT-proBNP levels were strongly related to the incidence of cardiovascular mortality, heart failure, and stroke but not to myocardial infarction. In multivariable models, BNP remained associated with increased risk of heart failure, whereas NT-proBNP remained associated with increased risk of cardiovascular mortality, heart failure, and stroke. By C-statistic calculations, BNP and NT-proBNP significantly improved the predictive accuracy of the best available model for incident heart failure, and NT-proBNP also improved the model for cardiovascular death. The magnitude of effect of ACE inhibition on the likelihood of experiencing cardiovascular end points was similar, regardless of either BNP or NT-proBNP baseline concentrations. In low-risk patients with stable coronary artery disease and preserved ventricular function, BNPs provide strong and incremental prognostic information to traditional risk factors.

Admission B-Type Natriuretic Peptide Levels and In-Hospital Mortality in Acute Decompensated Heart Failure

This study was designed to determine whether admission B-type natriuretic peptide (BNP) levels are predictive of in-hospital mortality in acute decompensated heart failure (HF). Levels of BNP have been demonstrated to facilitate the diagnosis of HF and predict mortality in chronic systolic HF. B-type natriuretic peptide levels within 24 h of presentation were obtained in 48,629 (63%) of 77,467 hospitalization episodes entered in ADHERE (Acute Decompensated Heart Failure National Registry). In-hospital mortality was assessed by BNP quartiles in the entire cohort and in patients with reduced (n = 19,544) as well as preserved (n = 18,164) left ventricular systolic function using chi-square and logistic regression models. Quartiles (Q) of BNP were Q1 (<430), Q2 (430 to 839), Q3 (840 to 1,729), and Q4 (> or =1,730 pg/ml). The BNP levels were <100 pg/ml in 3.3% of the total cohort. Patients in Q1 versus Q4 were younger, more likely to be women, and had lower creatinine and higher left ventricular ejection fraction. There was a near-linear relationship between BNP quartiles and in-hospital mortality: Q1 (1.9%), Q2 (2.8%), Q3 (3.8%), and Q4 (6.0%), p < 0.0001. B-type natriuretic peptide quartile remained highly predictive of mortality even after adjustment for age, gender, systolic blood pressure, blood urea nitrogen, creatinine, sodium, pulse, and dyspnea at rest, Q4 versus Q1 (adjusted odds ratio 2.23 [95% confidence interval 1.91 to 2.62, p < 0.0001]). The BNP quartiles independently predicted mortality in patients with reduced and preserved systolic function. An elevated admission BNP level is a significant predictor of in-hospital mortality in acute decompensated HF with either reduced or preserved systolic function, independent of other clinical and laboratory variables. (Registry for Acute Decompensated Heart Failure Patients; http://www.clinicaltrials.gov/show/NCT00366639; NCT00366639).

Relation of Left Atrial Volume to B-Type Natriuretic Peptide Levels in Patients With Stable Chronic Heart Failure

This study assessed the relation between B-type natriuretic peptide (BNP) and echocardiographic indexes of left ventricular (LV) filling pressure in 53 patients with stable heart failure and without significant valvular dysfunction. Left atrial volume indexed to body surface area (LAVi), an indicator of chronic LV filling pressure, was correlated with BNP (r = 0.692, p <0.001) and was the strongest independent predictor of elevated levels in this cohort. LAVi was also the best predictor of BNP >or=100 pg/ml, with an area under the receiver-operating characteristic curve of 0.85 (95% confidence interval 0.74 to 0.96, p <0.001). Using the optimal cutoff of >31 ml/m(2), LAVi had a sensitivity of 92% and a specificity of 65% for BNP >or=100 pg/ml. Patients with LAVi >31 ml/m(2) had a median BNP of 122 pg/ml, compared with 21 pg/ml in patients with LAVi <or=31 ml/m(2) (p <0.001). These findings suggest that in patients with stable heart failure, BNP levels are related to chronic LV filling pressures. This may help explain the relatively modest correlation between BNP and acute measures of LV filling and the heterogeneity in BNP levels in patients with stable heart failure.

Prognostic value of B-type natriuretic peptide levels on admission in patients with acute ST elevation myocardial infarction

Objective — To assess the relation between B-type natriuretic peptide (BNP) levels on admission in ST elevation myocardial infarction (STEMI) and short-term, all-cause mortality.Methods and results — Blood samples for BNP determination were obtained on admission in 88 patients (mean age 60.6 ± 10.7 years old) with STEMI. In a 15-minute period, BNP was measured by using simple bedside test for rapid quantification of BNP. Thirty days follow-up was performed. During the period of follow-up 12 (13.6%) patients died. Mean BNP was 228.74 ± 269.98 pg/ml.The lowest value was 5 pg/ml, the highest value 1300 pg/ml due to limitations of the method.The baseline level of BNP was higher among patients who died than among those who were alive at 30 days (mean, 545.6 vs. 178.7 pg/ml; P = 0.001). Mortality increased among patients in increasing quartiles (p = 0.009). The unadjusted odds ratio for 30-day risk of death in the fourth quartile was 5.6 (95 percent confidence interval, 1.6 to 20.5; P < 0.001).When BNP was added to a multivariate Cox regression model including clinical and electrocardiographic variables, BNP levels were independently associated with the prognosis.Conclusions — BNP levels obtained on admission are a powerful, independent indicator of shortterm mortality in patients with STEMI. Rapid tests for BNP assay seem to be a new tool in risk stratification of patients with STEMI.

B-Type Natriuretic Peptide Levels in Patients in the Emergency Department With Possible Heart Failure and Previous Stable Angina Pectoris and/or Healed Myocardial Infarction

We examined the relation between B-type natriuretic peptide (BNP) levels and a history of stable angina pectoris and/or healed myocardial infarction in 1,240 patients who were evaluated in the emergency department for possible heart failure. In patients who had heart failure, there was no relation between BNP levels and previous stable angina pectoris and/or healed myocardial infarction. However, in patients who did not have heart failure, there was a relation between BNP levels and previous stable angina pectoris and/or healed myocardial infarction but no significant independent relation in multiple regression analysis.

B-Type Natriuretic Peptide Is Related to Left Ventricular Mass in Hypertensive Patients but Not in Athletes

A positive correlation has been previously documented between B-type natriuretic peptide (BNP) levels and left ventricular mass index (LVMI) in hypertensive patients. We evaluated 8 cycling athletes, 8 healthy age-matched controls; 17 hypertensive patients and 7 age-matched controls. LVMI was significantly higher in athletes and hypertensive patients than in their controls. Plasma levels of BNP in hypertensive patients were significantly higher than in athletes and their age-matched controls. No significant difference was found between athletes and their controls. Cycling athletes had significantly larger LVMI than hypertensive patients and controls, without elevated BNP levels. These results suggest that BNP levels are elevated in patients with increased LVM due to hypertension but not in physiologically increased LVM. Whether elevated BNP levels in athletes is a sign of structural heart disease merits further investigation.