Attenuation of Compensation of Endogenous Cardiac Natriuretic Peptide System in Chronic Heart Failure

Tsutamoto, Takayoshi; Wada, Atsuyuki; Maeda, Keiko; Hisanaga, Tomoko; Maeda, Yusaku; Fukai, Daisuke; Ohnishi, Masato; Sugimoto, Yukihiko; Kinoshita, Masahiko

doi:10.1161/01.cir.96.2.509

Cited by 872 publications

(282 citation statements)

References 35 publications

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“…In a similar way, BNP has been shown to provide prognostic information in adults with chronic heart failure or after acute myocardial infarction [18,19].…”

Section: Resultsmentioning

confidence: 91%

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B‐type natriuretic peptide levels in patients with functionally univentricular hearts after total cavopulmonary connection

Koch

Zink

Singer

et al. 2008

European J of Heart Fail

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Aims: To assess plasma B-type natriuretic peptide (BNP) levels in patients with univentricular hearts late after volume unloading by total cavopulmonary connection (TCPC). Methods: Plasma BNP was measured by sandwich immunoassay in 67 patients after a modified Fontan procedure. BNP levels were compared with age and sex-specific normal values, clinical and echocardiographic data, and results of exercise testing. Results: BNP had a wide range of 5-290 pg/ml, but was normal in 81% of patients, and median BNP was only 13 pg/ml. There was no difference between males and females, between patients with left or right ventricular morphology, and no correlation was found between BNP and age, post-operative follow-up period, maximum exercise capability, peak oxygen uptake, or blood oxygen saturation. New York Heart Association class I patients had lower BNP than class II patients (p = 0.04). Plasma BNP concentration was positively correlated to the number of specific sequelae (r = 0.59, p b 0.001), and to severity of atrioventricular regurgitation (r = 0.38, p = 0.002). 5/13 patients with elevated BNP died during follow-up. Conclusion: BNP plasma concentration was normal in the majority of patients up to 15 years after TCPC. Elevated and increasing BNP levels were associated with increased morbidity and late mortality.

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“…In a similar way, BNP has been shown to provide prognostic information in adults with chronic heart failure or after acute myocardial infarction [18,19].…”

Section: Resultsmentioning

confidence: 91%

“…There was no difference in BNP between male and female patients (14 [IQR 6-33] vs. 13 [IQR 7-25] pg/ml), nor between patients with left or right ventricular morphology (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) vs. 14 [IQR 7-41] pg/ml).…”

Section: Resultsmentioning

confidence: 99%

B‐type natriuretic peptide levels in patients with functionally univentricular hearts after total cavopulmonary connection

Koch

Zink

Singer

et al. 2008

European J of Heart Fail

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“…Two cut offs for NT-proBNP were selected before the analyses, 300 pg/ml and 600 pg/ml, with a value of less than 300 pg/ml shown to be optimal for ruling out HF [18]. BNP was determined using the Shionoria immunoradiometric assay kit [19]. These cut off values determined to be optimal for ruling out HF were selected to test the most conservative association with the presence of HF-PLEF.…”

Section: Nt-probnp and Bnpmentioning

confidence: 99%

BNP and NT‐proBNP predict echocardiographic severity of diastolic dysfunction

Grewal

McKelvie

Lonn

et al. 2008

European J of Heart Fail

108

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Aims: To evaluate the best combination of clinical parameters and brain natriuretic peptide (BNP) or N-terminal pro-BNP (NT-proBNP), to predict diastolic dysfunction (DD) in heart failure with preserved left ventricular ejection fraction (HF-PLEF) as determined by Dopplerechocardiography. Methods and Results: HF patients with EF N 40% in the CHARM Echocardiographic Substudy were included and classified to have normal diastolic function, or mild, moderate or severe diastolic dysfunction. Plasma BNP and NT-proBNP levels were measured and relevant clinical characteristics recorded. 181 participants were included in this analysis, 72 (40%) had moderate to severe DD. A model including age, sex, BNP, body mass index, history of atrial fibrillation, coronary artery disease, diabetes mellitus, hypertension and left atrial volume was highly predictive of moderate to severe DD; AUC 0.81 (0.73-0.88; p b 0.0001). Similarly, substitution of BNP with NT-proBNP resulted in an AUC 0.79 (0.72-0.87; p b 0.0001). In these models; BNP N 100 pg/ml (OR 6.24 CI 2.42-16.09, p = 0.0002), history of diabetes (OR 3.52 CI 1. 43-8.70, p = 0.006) and NT-proBNP N 600 pg/ml , p = 0.0004), history of diabetes mellitus (OR 2.75 CI 1.12-6.76, p = 0.03) respectively remained independent predictors of DD in HF-PLEF. Conclusions: Natriuretic peptides were the strongest independent predictors of DD, as determined by Doppler-echocardiography, in HF-PLEF.

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“…BNP is a truly ventricular hormone, and responds to changes in LV filling pressure. BNP may be a more sensitive and specific indicator of ventricular disorders than other natriuretic peptides (26,27). BNP level provides prognostic information independent of other variables previously associated with mortality and sudden death in patients with chronic heart failure, and is more useful than ANP or norepinephrine for predicting a poor prognosis (27,28).…”

Section: Discussionmentioning

confidence: 99%

“…Cheung and Kumana (34) suggested that the BNP level reflects the long-term intravascular volume, rather than the momentary volume. On the other hand, Tsutamoto et al (27), Cheng et al (35) and Nakagawa et al (36) considered BNP to be an emergency hormone, responding instantaneously to ventricular volume overload. Unfortunately, we have little information on the stability or reproducibility of BNP levels measured over time in heart failure patients who have a stable course (37,38).…”

Section: Discussionmentioning

confidence: 99%

Usefulness of the brain natriuretic peptide to atrial natriuretic peptide ratio in determining the severity of mitral regurgitation

Shimamoto

Kusumoto

Sakai

et al. 2007

Canadian Journal of Cardiology

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I n chronic mitral regurgitation (MR), increased preload and reduced afterload due to unloading from the left ventricle (LV) into the left atrium (LA) leads to compensatory dilation of the LV and facilitates LV ejection. Although this response initially maintains cardiac output, myocardial decompensation eventually results in heart failure symptoms and an increased risk of sudden death. In addition, backflow into the LA results in enlargement of the LA, atrial fibrillation and elevated pulmonary pressures. In some patients, LV contractility is irreversibly impaired in the absence of symptoms (1-3). Thus, deferring surgical intervention often leads to irreversible postoperative LV dysfunction. Valve replacement or valvuloplasty is essential before the myocardial damage becomes irreversible.Early valvuloplasty conducted when heart failure is mild has been reported to improve prognosis (4). In clinical practice, however, it remains difficult to decide the timing of surgery defined by mild heart failure symptoms and preserved cardiac function.Some reports have shown that preoperative LV function (LV end-diastolic diameter [LVDd], LV end-systolic diameter BACKGROUND: Atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) levels were characterized in subjects with mitral regurgitation (MR). METHODS: Sixty-two cases of moderate or severe chronic MR were studied. The blood levels of neurohormonal factors were stratified by the known MR prognostic factors of New York Heart Association (NYHA) functional class, left ventricular end-diastolic diameters, left ventricular end-systolic diameter (LVDs), ejection fraction (EF), left atrial diameter and presence of atrial fibrillation (AF). RESULTS: ANP levels were higher in NYHA class II and lower in classes I and III/IV (P=0.0206). BNP levels were higher in NYHA class II than class I (P=0.0355). The BNP/ANP ratio was significantly higher in NYHA classes II and III/IV than in class I (P=0.0007). To differentiate between NYHA classes I/II and III/IV, a cut-off BNP/ANP ratio of 2.97 produced a sensitivity of 78% and specificity of 87%. Compared with subjects in sinus rhythm, patients with AF had an enlarged left atrium and lower ANP levels. The BNP/ANP ratio correlated significantly with left atrial diameter, LVDs and EF (r=0.429, P=0.0017; r=0.351, P=0.0117; and r=-0.349, P=0.0122; respectively), and was significantly higher among all the known operative indications for MR tested (LVDs 45 mm or more, EF 60% or less, NYHA class II or greater and AF; P=0.0073, P=0.003, P=0.0102 and P=0.0149, respectively). CONCLUSIONS: In chronic MR, levels of ANP and BNP, and the BNP/ANP ratio are potential indicators of disease severity.

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Attenuation of Compensation of Endogenous Cardiac Natriuretic Peptide System in Chronic Heart Failure

Cited by 872 publications

References 35 publications

B‐type natriuretic peptide levels in patients with functionally univentricular hearts after total cavopulmonary connection

B‐type natriuretic peptide levels in patients with functionally univentricular hearts after total cavopulmonary connection

BNP and NT‐proBNP predict echocardiographic severity of diastolic dysfunction

Usefulness of the brain natriuretic peptide to atrial natriuretic peptide ratio in determining the severity of mitral regurgitation

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