Plasma B-type Natriuretic Peptide Levels In Patients Research Articles

Sleep-disordered breathing is independently associated with elevated natriuretic peptide levels in patients with cardiovascular diseases

Sleep disorders and sleep duration have attracted considerable attention as potential modifiable risk factors for the development and progression of heart failure (HF). However, whether these sleep behaviors could aggravate the underlying cardiac condition remains ambiguous. We evaluated the associations between the levels of plasma B-type natriuretic peptide (BNP) and sleep-disordered breathing (SDB), sleep quality and quantity, or daytime sleepiness in cardiovascular diseases (CVD) patients. A total of 1717 consecutive patients with CVD [median age, 66years (55-74years); female, 27.5%] were enrolled. SDB was screened by nocturnal pulse oximetry; sleep quality and quantity were determined by Pittsburg Sleep Quality Index, and daytime sleepiness was examined by Epworth Sleepiness Scale. The median plasma BNP level was 54.9pg/ml (23.5-146.4pg/ml). Multiple regression analyses showed that the BNP level in the highest quintile (BNP > 181.8pg/ml) was associated with SDB (severe: OR, 5.88; 95% CI 3.17-10.88; moderate: OR, 3.62; 95% CI 2.17-6.02; mild: OR, 2.22: 95% CI 1.42-3.47). There were no significant associations between other sleep parameters and higher BNP levels. The relationship between SDB and BNP levels was unchanged regardless of the previous history of symptomatic HF. SDB was independently associated with the elevated plasma BNP level in patients with a variety of CVD.

Clinical implication of LAVI over A′ ratio in patients with acute coronary syndrome

PurposeThe ratio of the left atrial volume index (LAVI) and late diastolic mitral annular velocity (A′) is a useful echocardiographic index for identifying advanced left ventricular (LV) diastolic dysfunction in...

Improvement in the Quality of Life and Exercise Performance in Relation to the Plasma B-Type Natriuretic Peptide Level After Catheter Ablation in Patients With Asymptomatic Persistent Atrial Fibrillation.

Efficacy of catheter ablation (CA) of asymptomatic persistent atrial fibrillation (AF) remains unclear. We assessed the quality of life (QOL), exercise performance (EP), and plasma B-type natriuretic peptide (BNP) levels following CA in patients with asymptomatic AF.Methods and Results:We enrolled 34 patients with asymptomatic persistent AF. QOL, was assessed by 2 questionnaires: the Short Form-36 (SF-36) and a QOL questionnaire specific for AF (AFQLQ). The QOL, EP, and plasma BNP level were examined before and 6 months after CA. In the SF-36 survey 5 of 8 components and all 3 subsets of the AFQLQ significantly improved in the patients without recurrences (30 patients, 88%), but there were no differences in those with recurrences. In patients without recurrences, there was an increase in the metabolic equivalents of task (10.2±2.3 vs. 11.6±2.3 METs, P<0.0001), duration of maximal exercise (476±144 vs. 605±143 s, P<0.0001), and plasma BNP decrease (146.6±124.3 vs. 33.8±35.6 pg/dL, P<0.0001), with a linear correlation in the increased duration of exercise and plasma BNP decrease (R=0.620, P<0.0001). Maintenance of sinus rhythm after successful CA improved the QOL, EP, and plasma BNP level in patients with asymptomatic persistent AF. CA may be primarily applicable in such patients with previously unrecognized impairment in their QOL and EP.

Correlation between microvascular dysfunction and B-type natriuretic peptide levels in non-ischemic heart failure patients with cardiac fibrosis

BackgroundsThe relationship between microvascular dysfunction and plasma B-type natriuretic peptide (BNP) levels remains unclear in heart failure (HF) patients with cardiac fibrosis. MethodsThis study evaluated 55 consecutive non-ischemic HF patients in an effort to determine the relationship between endothelial independent coronary microvascular dysfunction and plasma BNP levels, as well as whether each measure is correlated with myocardial fibrosis. We evaluated plasma BNP levels in patients with stable HF. We used cardiac catheterization to measure trans-cardiac BNP release levels, measuring from the coronary sinus and the aortic root, and coronary flow reserve (CFR). Patients also underwent cardiac magnetic resonance imaging to evaluate for the presence of late gadolinium enhancement (LGE), as an indicator of cardiac fibrosis. ResultsCFR in cardiac catheterization was significantly and inversely correlated with plasma BNP levels (r=0.336, p=0.012) and trans-cardiac BNP release levels (r=0.347, p=0.041). Thirty-three patients were LGE-positive. CFR was significantly correlated with plasma BNP levels in the LGE-positive group (r=0.349, p=0.046), but this correlation was not significant in the LGE-negative group. (r=0.338, p=0.125). Multivariate logistic regression analysis revealed that a plasma BNP levels >180pg/ml at stable HF condition was significant and independent predictor of CFR<2.5 in all patients (p=0.035, odds ratio: 5.2, 95% confidence interval: 1.1–29.0), and in the LGE-positive group (p=0.040, odds ratio: 5.4, 95% confidence interval: 1.1–27.2). ConclusionsIn non-ischemic HF patients especially those with cardiac fibrosis, endothelial independent microvascular dysfunction is closely correlated with plasma BNP levels, and ventricular wall tension.

Factors responsible for elevated plasma B-type natriuretic peptide levels in severe aortic stenosis: Comparison between elderly and younger patients

BackgroundElevated plasma B-type natriuretic peptide (BNP) is a predictor of outcome and helpful for risk stratification in aortic stenosis (AS). However, left ventricular (LV) diastolic dysfunction progresses with aging and may also influence plasma BNP levels in elderly patients. We hypothesized that plasma BNP levels may be influenced by age in severe AS, and that factors that affect the elevation of plasma BNP levels may be different between elderly and younger patients with AS. MethodsWe performed echocardiography in 341 patients with severe AS [aortic valve area (AVA)<1.0cm2] and classified them into two groups by age (elderly ≥75 years old, n=201; younger patients <75 years old, n=140). We used multivariate linear regression analysis to assess the factors that determine plasma BNP levels in both groups. ResultsAge was found to be one of the independent determinants of plasma BNP levels in all patients (β=0.135, p=0.005). Although AVA was similar in the two groups, plasma BNP levels and E/e′ were significantly higher in elderly than younger patients [133.0 (IQR, 73.3–329.7)pg/dl vs 92.8 (IQR, 40.6–171.8)pg/dl, p<0.01; 20±8 vs 16±6, p<0.01, respectively). In multivariate stepwise linear regression analysis, AVA index, LV ejection fraction, mass index, E/e′, estimated systolic pulmonary artery pressure (eSPAS), and the presence of atrial fibrillation were independent determinants of plasma BNP levels in younger patients. In contrast, the independent determinants of plasma BNP levels in elderly patients were LV ejection fraction, mass index, E/e′, eSPAS, the presence of atrial fibrillation, age, and hemoglobin levels, but not AVA index. ConclusionsThere may be differences in the factors that influence plasma BNP levels between elderly and younger patients with severe AS. In elderly patients, plasma BNP levels may be influenced more by these factors than AS severity compared with younger patients.

Abstract 9451: Determinant Factors of Elevated Plasma B-type Natriuretic Peptide Level in Severe Aortic Stenosis

Background: Elevated plasma B-type natriuretic peptide (BNP) level reflects left ventricular (LV) dysfunction and is associated with poor outcome in aortic stenosis (AS). We aimed to determine the echocardiographic and clinical factors that are associated with elevated plasma BNP level in patients with severe AS. Methods: We performed echocardiography in 142 patients (age 72±10 years) with severe AS (aortic valve area (AVA) &lt; 1.0cm 2 ). We excluded patients with chronic renal failure and other significant valvular disease. We used multivariate linear regression analysis to evaluate factors that are associated with the plasma BNP levels in these patients. Results: Mean AVA was 0.77±0.16cm 2 . The factors associated with plasma BNP levels were left ventricular (LV) ejection fraction, E/A, E/e’, left atrial diameter, estimated systolic pulmonary artery pressure (SPAP), AVA, LV mass index, e’, systolic systemic blood pressure and the presence of atrial fibrillation (Table). In multivariate stepwise linear regression analysis, LV ejection fraction was the strongest independent determinants of plasma BNP level. In addition, estimated SPAP, and E/e’, and AVA were also found to be independently associated with plasma BNP level. Conclusions: In patients with severe AS, plasma BNP levels mainly correlates with LV systolic dysfunction. However, LV diastolic dysfunction, elevated pulmonary hypertension, and AS severity are also independently associated with elevated plasma BNP levels in severe AS.

Cardiac tamponade as an independent condition affecting the relationship between the plasma B-type natriuretic peptide levels and cardiac function

Plasma B-type natriuretic peptide (BNP) is finely regulated by the cardiac function and several extracardiac factors. Therefore, the relationship between the plasma BNP levels and the severity of heart failure sometimes seems inconsistent. The purpose of the present study was to investigate the plasma BNP levels in patients with cardiac tamponade and their changes after pericardial drainage. This study included 14 patients with cardiac tamponade who underwent pericardiocentesis. The cardiac tamponade was due to malignant diseases in 13 patients and uremia in 1 patient. The plasma BNP levels were measured before and 24-48 h after drainage. Although the patients reported severe symptoms of heart failure, their plasma BNP levels were only 71.2 ± 11.1 pg/ml before drainage. After appropriate drainage, the plasma BNP levels increased to 186.0 ± 22.5 pg/ml, which was significantly higher than that before drainage (P = 0.0002). In patients with cardiac tamponade, the plasma BNP levels were low, probably because of impaired ventricular stretching, and the levels significantly increased in response to the primary condition after drainage. This study demonstrates an additional condition that affects the relationship between the plasma BNP levels and cardiac function. If inconsistency is seen in the relationship between the plasma BNP levels and clinical signs of heart failure, the presence of cardiac tamponade should therefore be considered.

The role of brain natriuretic peptide and serum triiodothyronine in the diagnosis and prognosis of chronic heart failure

Objective The objective of this paper was to investigate the diagnostic and prognostic value of plasma B type natriuretic peptide (BNP) and serum triiodothyronine (T3) in chronic congestive heart failure (CHF).Methods 156 cases of CHF patients and 75 cases of cardiac function I patients hospitalized over the same period were utilized in this study. On admission, the patient’s BNP and T3 plasma concentrations were measured. The correlation analysis of plasma BNP and T3 in CHF patients with cardiac function classification was conducted.Results According to the NYHA grading systems, the plasma BNP levels in patients with II, III, and IV grade CHF were significantly higher than those with cardiac function I (P < 0.05); BNP levels and NYHA grading of cardiac function correlated positively. The BNP concentrations increased with CHF progression (P < 0.01). The T3 level and NYHA grading of cardiac function correlated negatively. The T3 level decreased as the degree of heart failure increased. Using CHF in combination with BNP to predict the occurrence of CHF had a sensitivity value of 90.8% with 95.5% specificity, 86.3% accuracy, and a negative predictive value of 87.7%.Conclusions Plasma BNP was more sensitive than T3 in the diagnosis of CHF. The T3 was more meaningful than the BNP in the prognosis of CHF. The BNP and T3 combination detection was more valuable in determining the severity of CHF and prognosis.

Influence of Low-Grade Inflammation on Plasma B-type Natriuretic Peptide Levels

B-type natriuretic peptide (BNP) is a cardiac hormone. The results of previous in vitro studies suggest that neurohumoral factors, and not only hemodynamic factors, may cause BNP secretion. In this study, we examined the impact of serum C-reactive protein (CRP) levels on the relationship between echocardiographic parameters and plasma BNP levels in patients with cardiovascular diseases. The study population comprised 417 patients who visited our cardiovascular unit with a problem. Both blood sampling and echocardiography were performed within one month. Multiple regression analysis showed that plasma BNP levels were negatively correlated with male gender, body mass index, and estimated glomerular filtration rate, and positively correlated with serum CRP levels and left ventricular end-systolic dimension (LVDs). The study population was divided into two groups based on the 75th percentile of the serum CRP levels. Single regression analysis showed that a regression line between LVDs and plasma BNP levels was steeper in the group of patients with CRP levels above the 75th percentile. Multiple regression analysis revealed that the interaction term (LVDs×CRP) was significant, which means LVDs had more impact on plasma BNP levels at higher CRP levels. Plasma BNP levels increased with respect to the severity of cardiac dysfunction and serum CRP levels, and should therefore be considered a collective or total marker for life-threatening conditions including systemic inflammation, and not simply as a marker of cardiac dysfunction in patients with cardiovascular diseases.

B-Type Natriuretic Peptide in Isolated Severe Tricuspid Regurgitation: Determinants and Impact on Outcome

BackgroundThe plasma B-type natriuretic peptide (BNP) level is a useful prognostic marker in heart failure and valvular heart disease. In patients with isolated severe tricuspid regurgitation (TR), little is known about the determinants of plasma BNP levels and the correlation with future outcome. The purpose of this study was to identify the determinants of plasma BNP levels in patients with isolated severe TR and the value of the BNP level in predicting postoperative outcomes after corrective surgery.MethodsWe prospectively enrolled 39 patients with isolated, severe TR undergoing corrective surgery. A plasma BNP assay and cardiac magnetic resonance (CMR) imaging were performed before surgery. The combined end-point was the occurrence of cardiac death or readmission due to heart failure.ResultsLinear regression analysis showed that the left ventricular ejection fraction and right ventricular end systolic volume were the most important determinants of the BNP levels (p = 0.002, R2 = 0.315). Based on the receiver operating characteristics (ROC) curve, we were able to derive an optimal cutoff value (200 pg/mL) to predict postoperative cardiac death with a sensitivity of 80% and a specificity of 85%. The one-year survival rate was 96% in patients with a BNP < 200 pg/mL and 53% in patients with a BNP ≥ 200 pg/dL (p = 0.001).ConclusionAn elevation in the BNP level is determined by the functional status of the right and left ventricles in patients with isolated, severe TR. An elevated BNP predicts adverse events after corrective surgery. Therefore, the BNP level should be included in the clinical evaluation and risk stratification of patients with isolated TR.

Determinant factors of plasma B-type natriuretic peptide levels in patients with persistent nonvalvular atrial fibrillation and preserved left ventricular systolic function

Plasma B-type natriuretic peptide (BNP) levels are determined by several factors. The presence of atrial fibrillation (AF) is one of these factors. Meanwhile, plasma BNP levels are well correlated with left ventricular (LV) filling pressure in patients with sinus rhythm. Furthermore, LV filling pressure can be estimated by the ratio of early diastolic transmitral velocity to early diastolic mitral annular velocity (E/e' ratio) in patients with sinus rhythm or with AF. However, it is still unclear if elevated plasma BNP levels reflect increases in LV filling pressure in patients with AF, especially with preserved LV systolic function. This study was designed to examine which factors determine plasma BNP levels in patients with persistent nonvalvular AF and preserved LV systolic function. We examined 195 clinically stable outpatients with persistent nonvalvular AF and preserved LV systolic function. They underwent comprehensive 2-dimensional and Doppler echocardiography, plasma BNP and creatinine levels, clinical history, and heart rate were determined. Then we statistically analyzed the correlation between plasma BNP levels and several variables including E/e' ratio. On univariate analyses, plasma BNP levels were significantly correlated with age, LV diastolic diameter (LVDd), E/e' ratio, and mitral E wave deceleration time. In addition, plasma BNP levels were significantly higher in males and in patients with a history of congestive heart failure and those who had been administered a ß-blocker. On multiple linear regression analyses, E/e' ratio, age, LVDd, and administration of ß-blocker were independent determinant factors of plasma BNP levels. Plasma BNP levels in patients with persistent AF and preserved LV systolic function are affected by E/e' ratio, age, LVDd, and administration of ß-blockers.

Utility of tissue Doppler imaging to predict exercise capacity in hypertrophic cardiomyopathy: Comparison with B-type natriuretic peptide

Recent reports suggest that left ventricular diastolic function assessed by tissue Doppler imaging (TDI) and plasma B-type natriuretic peptide (BNP) levels can relate to functional status in patients with hypertrophic cardiomyopathy (HCM). However, it is unclear which is more useful to predict the exercise capacity in HCM patients without systolic impairment and/or atrial fibrillation, TDI or BNP levels. The present study directly compared the clinical relevance of assessing diastolic function using TDI and measuring the plasma BNP level in patients with HCM. We evaluated diastolic function using TDI as well as plasma BNP levels in 31 patients (52.2+/-16.9 years of age; 20 males) with HCM and examined the relationship of these values to exercise capacity (peak O(2) consumption (VO(2))) measured by cardiopulmonary exercise tests. Average peak VO(2) was 18.5+/-4.7 ml/(kg min). Although the E/A ratio by transmitral flow was not correlated with peak VO(2), the lateral E/E(a) ratio assessed by TDI was significantly correlated with peak VO(2) (r=-0.52, p=0.003). On the other hand, plasma BNP level was not significantly related to peak VO(2) but NYHA class. Assessment of diastolic function using TDI, not plasma BNP levels, is more useful for predicting objective exercise capacity in HCM patients without systolic impairment and/or atrial fibrillation.

B-type natriuretic peptide levels in patients with COPD and normal right ventricular function

Evidence suggests that elevated plasma levels of B-type natriuretic peptide (BNP) are found in patients with chronic obstructive pulmonary disease (COPD) and right ventricular dysfunction. We examined the effects of exercise on plasma BNP levels in patients with COPD who have normal right ventricular function Seventeen patients with a diagnosis of COPD and normal right ventricular function demonstrated by radionuclide ventriculography, and 17 age-and sex-matched healthy subjects underwent a treadmill exercise test. Plasma BNP levels were measured sequentially before, immediately after, and 1 hour after the exercise test The mean plasma BNP+/-standard deviation levels of the COPD and control groups before exercise were 21.3+/-16 pg/ml and 13.4+/-11 pg/ml, respectively (P>0.05). Mean plasma BNP level measured immediately after exercise was 37.9+/-31 pg/ml in the COPD group, reflecting a statistically significant increase when compared with the initial value (P<0.05). The control group did not show any significant change in plasma BNP levels after the exercise test Exercise induces an increase in plasma BNP levels in patients with COPD who do not have right ventricular dysfunction at rest. Measurement of exercise-induced BNP levels may be a useful alternative to pulmonary artery catheterisation in identifying the patients who are likely to benefit from long-term oxygen therapy.

Daily dialyses decrease plasma levels of brain natriuretic peptide (BNP), a biomarker of left ventricular dysfunction

Brain natriuretic peptide or B-type natriuretic peptide (BNP) is a sensitive marker of heart disease. Plasma levels of BNP increase in left ventricular failure and determination of plasma BNP has become a useful tool in the diagnosis of heart failure. Hemodialysis (HD) patients may have elevated plasma levels of BNP, particularly predialysis, that correlate with echocardiographic signs of left ventricular dysfunction. High BNP levels are also a strong predictor of mortality in both nonrenal and HD patients. We studied plasma BNP levels in patients who changed from conventional thrice-weekly dialysis to daily dialysis 6 times a week while maintaining a total weekly time on dialysis of 12 hr. Twelve HD patients, mean age 55 years, had 4 hr of conventional thrice-weekly treatment for 4 weeks. Predialysis and postdialysis blood samples were obtained at the last dialysis. Patients were then dialyzed for 2 hr, 6 times weekly, for 4 weeks (daily dialysis). Again, predialysis and postdialysis blood samples were collected at the last HD. Brain natriuretic peptide plasma concentrations were determined by immunoradiometric assay. Predialysis BNP levels decreased from 194+/-51 ng/L (68+/-19 pmol/L; mean+SE) during thrice-weekly HD to 113+/-45 ng/L (41+/-18 pmol/L; p = 0.001) after 4 weeks on daily dialysis. With thrice-weekly HD, predialysis BNP levels were higher than postdialysis levels: 120+/-26 ng/L (39+/-8 pmol/L; p = 0.059). With daily dialysis, predialysis BNP levels did not differ significantly from postdialysis levels. Elevated predialysis plasma levels of BNP, considered sensitive and early markers of left ventricular dysfunction, decreased when patients were changed from conventional thrice-weekly HD to daily dialysis maintaining total hours of dialysis per week constant. Given the accumulated evidence that BNP is a biomarker of left ventricular dysfunction and can be used for risk stratification and guidance in pharmacotherapy of heart failure, daily dialysis appears to lead to less cardiac distress.

Blood haemoglobin is an independent predictor of B-type natriuretic peptide (BNP)

BNP (B-type natriuretic peptide) and anaemia are both associated with adverse outcome in patients with chronic heart failure. Whether low haemoglobin levels are independently predictive of elevated BNP levels in subjects without heart failure is unknown. In the present study, we examined the relationship between haemoglobin and BNP levels in 234 patients with suspected coronary heart disease without a history of chronic heart failure, adjusting for known predictors of BNP levels. By univariate analysis, haemoglobin levels were inversely related to logarithmically transformed BNP values (r = -0.30, P < 0.0001). After adjustment for patient age, gender, body mass index, history of myocardial infarction, use of diuretics, angiotensin-converting enzyme inhibitors and beta-blockers, estimated creatinine clearance rate, extent of coronary disease, left ventricular ejection fraction and left ventricular end-diastolic pressure, blood haemoglobin remained an independent predictor of plasma BNP (standardized beta-coefficient = -0.253, P < 0.0001). A similar relationship was observed between haematocrit and BNP (standardized beta-coefficient -0.215, P < 0.0001). We conclude that haemoglobin levels are independently predictive of plasma BNP levels in patients with suspected coronary heart disease without heart failure. Anaemia may contribute to elevated BNP levels in the absence of heart failure, and may represent an important confounder of the relationship between BNP, cardiac function and prognosis.

Bedside tests of B‐type natriuretic peptide in the diagnosis of left ventricular diastolic dysfunction in hypertensive patients

To investigate the value of B-type natriuretic peptide (BNP) in diagnosing left ventricular diastolic dysfunction in patients with hypertension. The left ventricular diastolic function and plasma BNP levels were assessed prospectively in 135 hypertensive patients. The plasma BNP in patients with (n=61) and without (n=74) diastolic dysfunction was 122+/-105 and 18+/-16 pg/ml, respectively (p<0.001). Increased BNP levels were associated with systolic blood pressure (p<0.05), left ventricular mass index (p<0.001), the E/A ratio of transmitral flow (p<0.01) and the isovolumic relaxation time (p<0.01). A receiver-operator characteristic curve showing the sensitivity and specificity of BNP against the echocardiography diagnosis of diastolic dysfunction revealed an area under the curve (accuracy) of 0.904 (p<0.01). Using a cut-off value of >40 pg/ml, the sensitivity and specificity of plasma BNP in diagnosing left ventricular diastolic dysfunction were 79% and 92%, respectively. The plasma BNP levels in patients with hypertension are closely related to left ventricular hypertrophy and filling impairment. Plasma BNP may be used to facilitate the diagnosis of left ventricular diastolic dysfunction.

Clinical implications of elevated plasma b-type natriuretic peptide in cardiac arrest

Study objectives: Plasma B-type natriuretic peptide (BNP) is a useful diagnostic and prognostic biomarker for patients with congestive heart failure. In victims with cardiac arrest, plasma BNP level might reflect the presence of congestive heart failure before the occurrence of cardiac arrest. Influence of cardiac arrest on plasma BNP level remains to be investigated. The aim of this study is to know whether the occurrence of cardiac arrest influences plasma BNP level and to define clinical significance of increased plasma BNP level in patients with cardiac arrest. Methods: Seventy patients (mean age 63±16 years, 49 male patients) with out-of-hospital cardiac arrest were enrolled in this study. Blood samples for BNP testing were obtained on arrival (time 0), 30 minutes after initiation of cardiopulmonary resuscitation (CPR) (time 1), and 3 hours (time 2) and 12 hours (time 3) after restoration of spontaneous circulation. Patients were grouped by plasma BNP level as normal BNP group (<100 pg/mL) and high BNP group (≥100 pg/mL). Results: Plasma BNP was not changed along elapsed time from cardiac arrest (482±866 pg/mL at time 0, 484±396 at time 1, 510±959 at time 2, 587±599 at time 3, <i>P</i>>.01). Mean plasma BNP was 41±29 pg/mL in the normal BNP group (n=33) and 876±1,049 pg/mL in the high BNP group (n=37). Plasma BNP was elevated in 24 (75%) of 32 patients with presumed cardiac etiology and 13 (34%) of 38 patients with noncardiac etiology (<i>P</i>=.01). Mean plasma BNP of the patients with presumed cardiac etiology was higher than that of patients with noncardiac etiology during CPR (709±924 pg/mL versus 292±777 pg/mL at time 0, <i>P</i>=.067; 438±463 versus 101±180 pg/mL at time 1, <i>P</i>=.001; 701±561 versus 382±1,151 pg/mL at time 2, <i>P</i>=.878; 974±623 versus 290±381 pg/mL at time 3, <i>P</i>=.122). There was no difference in plasma BNP level according to initial presenting cardiac rhythm or resuscitation outcome. Conclusion: Plasma BNP is not affected by occurrence of cardiac arrest or performing CPR. Elevated plasma BNP in patients with cardiac arrest suggests presence of preexisting heart disease.

Plasma B-type natriuretic peptide reflects left ventricular hypertrophy and diastolic function in hypertension

Background: Hypertension is associated with changes in concentrations of vasoactive peptides and procollagen propeptides, but their relationships with left ventricular hypertrophy and cardiac function are unclear. Methods: We measured plasma levels of atrial natriuretic peptide (ANP), its amino terminal propeptide (NT-proANP), B-type natriuretic peptide (BNP), endothelin-1 (ET-1), and serum levels of the aminoterminal propeptide of type I procollagen (PINP) and the aminoterminal propeptide of type III procollagen (PIIINP) and echocardiographic parameters in 97 patients with hypertension in the Anglo-Scandinavian Cardiac Outcomes Trial. Results: Median values (reference values) of the peptides were: ANP 11.2 (6.9–14.9) pmol/l, NT-proANP 351 (143–311) pmol/l, BNP 1.1 (0.4–7.2) pmol/l, ET-1 8.7 (1.2–5.0) pmol/l, PIIINP 2.8 (1.7–4.2) μg/l and PINP 29 (19–84) μg/l. Plasma BNP levels in patients with left ventricular hypertrophy (1.2 pmol/l) and patients with echocardiographic signs of diastolic dysfunction (1.5 pmol/l) were greater than those in patients without hypertrophy (0.7 pmol/l) and normal diastolic parameters (0.9 pmol/l) ( p<0.05). BNP was the only biochemical parameter that independently predicted interventricular septal diastolic diameter ( p<0.05), left ventricular mass index ( p<0.01) and ratio of the velocity–time integrals of the E and A waves of the mitral inflow in a stepwise logistic regression analysis ( p<0.05). Conclusions: The results show that BNP reflects the remodelling process in hypertension.

Effects of angiotensin-converting enzyme inhibitor on plasma b-type natriuretic peptide levels in patients with acute myocardial infarction

Background: Plasma levels of B-type natriuretic peptide (BNP) are markedly increased in patients with heart failure and acute myocardial infarction. The changes in plasma BNP levels in the treatment of acute myocardial infarction with angiotensin-converting enzyme inhibitors have not been examined well. This study was designed to examine the effects of early angiotensin-converting enzyme inhibitor therapy on plasma BNP levels in patients with acute myocardial infarction. Methods and Results: We measured the plasma levels of B-type natriuretic peptide over the time course for 2 weeks in 30 patients with acute myocardial infarction in whom either imidapril (n = 15) or placebo (n = 15) was given at random immediately after admission. Plasma BNP levels increased and reached a peak of 192 ± 28 pg/ML 16 hours after admission; thereafter, the levels decreased and then again increased, forming the second peak of 217 ± 38 pg/ML on the fifth day (biphasic pattern). On the other hand, plasma BNP levels increased and reached a peak level of 190 ± 22 pg/ML 16 hours after admission and then decreased from 2 days after admission until the second week in the imidapril group (monophasic pattern). Left ventricular ejection fraction measured in the second week was significantly higher in the imidapril group than in the control group (62.2 ± 1.1% vs 51.2 ± 3.6%, P < .01). Conclusions: It is concluded that plasma BNP levels followed a monophasic pattern after imidapril treatment, whereas a biphasic pattern was followed after placebo, and that plasma BNP levels constitute a marker of ventricular dysfunction in the treatment of acute myocardial infarction with angiotensin-converting enzyme inhibitors.