B-Type Natriuretic Peptide Strongly Reflects Diastolic Wall Stress in Patients With Chronic Heart Failure

Iwanaga, Yoshitaka; Nishi, Isao; Furuichi, Shinichi; Noguchi, Teruo; Sase, Kazuhiro; Kihara, Yasuki; Goto, Yoichi; Nonogi, Hiroshi

doi:10.1016/j.jacc.2005.11.030

Cited by 476 publications

(355 citation statements)

References 26 publications

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“…BNP is secreted primarily by cardiac myocytes in response to increase in LV wall stress, resulting in myocyte stretch, and the BNP level shows good correlation with LV end‐diastolic pressure. BNP levels are associated with HF severity across the spectrum of HF stages 9, 10, 11. In the current study, the BNP levels showed a significantly independent predictive value for poor prognosis in patients with HFrEF, HFpEF, and HFrlEF.…”

Section: Discussionsupporting

confidence: 54%

The prognostic value of brain natriuretic peptide in patients with heart failure and left ventricular ejection fraction higher than 60%: a sub‐analysis of the J‐MELODIC study

et al. 2017

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AimsCardiac function varies in the population of patients with heart failure (HF) with preserved left ventricular ejection fraction (LVEF; HFpEF). This study investigated the heterogeneity of clinical features associated with HF and the prognostic value of BNP levels in patients with HFpEF.Methods and resultsThe study enrolled 288 patients with stable HF and serum creatinine <1.5 mg/dL who were part of the original J‐MELODIC study cohort. They were categorized as having HF with reduced LVEF (HFrEF; EF ≤ 40%, n = 83) or as having HFpEF (EF > 40%, n = 205). Patients with HFpEF were further categorized as having relatively low LVEF (HFrlEF; EF 40–60%, n = 107) or as having relatively high LVEF (HFrhEF; EF ≥ 60%, n = 98). We defined cardiovascular death and hospitalization for HF as adverse events and evaluated the prognostic value of the BNP levels in each group. There was no significant difference in event‐free survival between HFpEF and HFrEF patients or between HFrhEF and HFrlEF patients. A multivariate Cox proportional hazards model revealed that the BNP level was an independent predictor of adverse events in HFrEF patients (hazard ratio: 4.088, 95% confidence interval: 1.178–14.179, P = 0.027) and in HFrlEF patients (hazard ratio: 14.888, 95% confidence interval: 4.969–44.608, P < 0.001) but not in HFrhEF patients (P = 0.767).ConclusionsThe BNP level has prognostic value in HFrlEF but not in HFrhEF. This indicates that HFrhEF and HFrlEF are distinct entities that may require different approaches for the management of HF.

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Section: Discussionsupporting

confidence: 54%

The prognostic value of brain natriuretic peptide in patients with heart failure and left ventricular ejection fraction higher than 60%: a sub‐analysis of the J‐MELODIC study

et al. 2017

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“…These results are consistent with the known pathophysiology of HF-PLEF where a variety of clinical conditions can ultimately lead to an increased left ventricular end diastolic wall stress. Iwanaga et al have demonstrated that BNP levels correlate very closely with left ventricular end diastolic wall stress in the setting of HF-PLEF (r 2 = 0.887) making it a good surrogate marker of worsening DD [25]. Moreover, BNP was shown to strongly correlate with pulsed wave Doppler and tissue Doppler parameters in patients with HF-PLEF [26].…”

Section: Discussionmentioning

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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“…2,3,16 It has been suggested that LV end-diastolic wall stress is the most important hemodynamic parameter regulating the levels of circulating BNP. 12,17 Of note, circulating BNP reflects the balance between BNP release and elimination. In contrast, our data suggest that LVESWS is the key loading parameter for ⌬ A-CS BNP, that is, cardiac BNP release, indicating that LV geometry and afterload rather than filling pressures are the most important mechanical determinants of cardiac BNP release.…”

Section: Discussionmentioning

confidence: 99%

“…LV end-diastolic wall stress and LV end-systolic wall stress (LVESWS) were calculated using the following formula: wall stressϭ0.334*LV pressure*LV internal diameter/(posterior wall thickness*[1ϩposterior wall thickness/LV internal diameter]), where LV internal diameter and posterior wall thickness at end diastole or end systole were used. 12 PCWP was used as a surrogate for LV end-diastolic pressure, and systolic arterial pressure was used as a substitute for LV end-systolic pressure.…”

Section: Cardiac Catheterizationmentioning

confidence: 99%

Hemodynamic Determinants of Myocardial B-Type Natriuretic Peptide Release

2010

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Abstract-Although B-type natriuretic peptide (BNP) is widely used as a biomarker for heart failure, the in vivo mechanical stimulus for its cardiac release remains poorly defined. We aimed to characterize the hemodynamic determinants of the transcardiac BNP gradient as a measure of myocardial BNP release by performing a detailed hemodynamic assessment in subjects with a broad spectrum of systolic and diastolic left ventricular dysfunction. Forty-two subjects underwent a detailed transthoracic echocardiographic study, right heart catheterization, and simultaneous BNP measurement in arterial and coronary sinus plasma. The transcardiac BNP gradient was lowest in subjects with normal left ventricular ejection fraction/high peak early diastolic annular velocity (nϭ11), intermediate in those with normal left ventricular ejection fraction/low peak early diastolic annular velocity (nϭ13), and highest in those with low left ventricular ejection fraction/low peak early diastolic annular velocity (nϭ18; 29 ng/L (range: 15 to 78 ng/L) versus 88 ng/L (range: 34 to 172 ng/L) versus 1566 ng/L (range: 624 to 2349 ng/L; PϽ0.001). Across the range of patients, left ventricular end-systolic wall stress (r 2 ϭ0.51) and peak systolic mitral annular velocity (r 2 ϭ0.47) showed the strongest correlation with higher transcardiac BNP gradient. In contrast, the transcardiac BNP gradient was weakly related to indices of diastolic load, including pulmonary capillary wedge pressure (r 2 ϭ0.27) and left ventricular end-diastolic wall stress (r 2 ϭ0.21). Across this spectrum of pathophysiology, left ventricular end-systolic wall stress appears to be the key mechanical stimulus influencing cardiac BNP release. (Hypertension. 2010;56:682-689.)

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B-Type Natriuretic Peptide Strongly Reflects Diastolic Wall Stress in Patients With Chronic Heart Failure

Cited by 476 publications

References 26 publications

The prognostic value of brain natriuretic peptide in patients with heart failure and left ventricular ejection fraction higher than 60%: a sub‐analysis of the J‐MELODIC study

The prognostic value of brain natriuretic peptide in patients with heart failure and left ventricular ejection fraction higher than 60%: a sub‐analysis of the J‐MELODIC study

BNP and NT‐proBNP predict echocardiographic severity of diastolic dysfunction

Hemodynamic Determinants of Myocardial B-Type Natriuretic Peptide Release

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