B-Type Natriuretic Peptide Concentrations and Myocardial Dysfunction in Critical Illness

Sturgess, DJ; Marwick, Thomas H.; Joyce, Chris; Venkatesh, Balasubramanian

doi:10.1177/0310057x0603400218

Cited by 6 publications

(9 citation statements)

References 96 publications

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“…This is potentially explained by the magnitude of potential confounders on plasma biomarker concentrations in the critically ill [3]. Furthermore, TDI offers more direct evaluation of myocardial function.…”

Section: Discussionmentioning

confidence: 99%

“…In general, BNP is a peptide hormone secreted by the ventricular myocardial in response to wall stress [3]. Its principal clinical use is the diagnosis of heart failure [56].…”

Section: Discussionmentioning

confidence: 99%

“…Whilst impaired systolic function has been identified as the major culprit, the contribution of diastolic dysfunction (and hence ventricular filling) to cardiovascular morbidity and mortality in septic shock is not fully understood. Investigation of left ventricular (LV) diastolic function at the bedside is challenging, but techniques such as echocardiography and biomarkers such as B-type natriuretic peptide (BNP) are increasingly supported by current literature [3-5]. In particular, recent application of non-invasive, bedside technologies, such as tissue Doppler imaging (TDI), offer fresh insight [6].…”

Section: Introductionmentioning

confidence: 99%

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Prediction of hospital outcome in septic shock: a prospective comparison of tissue Doppler and cardiac biomarkers

et al. 2010

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IntroductionDiastolic dysfunction as demonstrated by tissue Doppler imaging (TDI), particularly E/e' (peak early diastolic transmitral/peak early diastolic mitral annular velocity) is common in critical illness. In septic shock, the prognostic value of TDI is undefined. This study sought to evaluate and compare the prognostic significance of TDI and cardiac biomarkers (B-type natriuretic peptide (BNP); N-terminal proBNP (NTproBNP); troponin T (TnT)) in septic shock. The contribution of fluid management and diastolic dysfunction to elevation of BNP was also evaluated.MethodsTwenty-one consecutive adult patients from a multidisciplinary intensive care unit underwent transthoracic echocardiography and blood collection within 72 hours of developing septic shock.ResultsMean ± SD APACHE III score was 80.1 ± 23.8. Hospital mortality was 29%. E/e' was significantly higher in hospital non-survivors (15.32 ± 2.74, survivors 9.05 ± 2.75; P = 0.0002). Area under ROC curves were E/e' 0.94, TnT 0.86, BNP 0.78 and NTproBNP 0.67. An E/e' threshold of 14.5 offered 100% sensitivity and 83% specificity. Adjustment for APACHE III, cardiac disease, fluid balance and grade of diastolic function, demonstrated E/e' as an independent predictor of hospital mortality (P = 0.019). Multiple linear regression incorporating APACHE III, gender, cardiac disease, fluid balance, noradrenaline dose, C reactive protein, ejection fraction and diastolic dysfunction yielded APACHE III (P = 0.033), fluid balance (P = 0.001) and diastolic dysfunction (P = 0.009) as independent predictors of BNP concentration.ConclusionsE/e' is an independent predictor of hospital survival in septic shock. It offers better discrimination between survivors and non-survivors than cardiac biomarkers. Fluid balance and diastolic dysfunction were independent predictors of BNP concentration in septic shock.

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Section: Discussionmentioning

confidence: 99%

“…In general, BNP is a peptide hormone secreted by the ventricular myocardial in response to wall stress [3]. Its principal clinical use is the diagnosis of heart failure [56].…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prediction of hospital outcome in septic shock: a prospective comparison of tissue Doppler and cardiac biomarkers

et al. 2010

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“…BNP is generally released by cardiac myocytes in response to ventricular strain 14 . It follows that by diagnosing ventricular failure (plateau of Frank Starling curve), elevated BNP should exclude a fluid responsive state.…”

Section: Discussionmentioning

confidence: 99%

A Comparison of Transcutaneous Doppler Corrected Flow Time, B-Type Natriuretic Peptide and Central venous Pressure as Predictors of Fluid Responsiveness in Septic Shock: A Preliminary Evaluation.

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Pascoe

Scalia

et al. 2010

Anaesth Intensive Care

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Aortic corrected flow time (FTc) is easily measured by Doppler techniques. Recent data using transoesophageal Doppler suggest that it may predict fluid responsiveness in critical care. This use of FTc has not previously been evaluated in septic shock, nor have any studies incorporated transcutaneously measured FTc. Furthermore, no comparison has been made between FTc, plasma B-type natriuretic peptide concentration (BNP) or central venous pressure. The aim of this preliminary study was to compare FTc, BNP and central venous pressure as predictors of fluid responsiveness in septic shock patients without cardiac dysrhythmia. This was a prospective study of 10 consecutive adult septic shock patients (in sinus rhythm; 60% mechanically ventilated) treated with intravenous fluid challenge (4% albumin 250 ml over 15 minutes) in a mixed medical/ surgical tertiary intensive care unit. Mean ± SD Acute Physiological and Chronic Health Evaluation II score was 21.8±12.7. Haemodynamic assessment incorporating transcutaneous aortic Doppler (USCOM ®) occurred before and five minutes after fluid challenge. Concurrent with initial assessment, blood samples were collected for BNP assay (ADIVA Centaur ®). Four patients demonstrated an increase in stroke volume ≥15% (responders). Percent change in stroke volume strongly correlated with baseline FTc (r=-0.81, P=0.004) but not BNP (r=-0.3, P=0.4) or central venous pressure (r=-0.4, P=0.2). Baseline FTc <350 ms discriminated responders from non-responders (P=0.047). Our data support FTc as a better predictor of fluid responsiveness than either BNP or central venous pressure in septic shock. Transcutaneous aortic Doppler FTc offers promise as a simple, completely non-invasive predictor of fluid responsiveness and should be evaluated further.

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“…Plasma B-type natriuretic peptide concentration (BNP) is a marker of cardiac dysfunction [1]. It is unclear why extremely high concentrations have been reported in sepsis with preserved systolic function [2].…”

Section: Introductionmentioning

confidence: 99%

Sepsis-associated diastolic dysfunction without elevated plasma B-type natriuretic peptide

et al. 2008

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B-Type Natriuretic Peptide Concentrations and Myocardial Dysfunction in Critical Illness

Cited by 6 publications

References 96 publications

Prediction of hospital outcome in septic shock: a prospective comparison of tissue Doppler and cardiac biomarkers

Prediction of hospital outcome in septic shock: a prospective comparison of tissue Doppler and cardiac biomarkers

A Comparison of Transcutaneous Doppler Corrected Flow Time, B-Type Natriuretic Peptide and Central venous Pressure as Predictors of Fluid Responsiveness in Septic Shock: A Preliminary Evaluation.

Sepsis-associated diastolic dysfunction without elevated plasma B-type natriuretic peptide

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