Brain natriuretic peptide for prediction of Cheyne-Stokes respiration in heart failure patients

Christ, Michael; Sharkova, Yulia; Fenske, Hendrik; Rostig, Sven; Herzum, Ileana; Becker, Heinrich F.; Mueller, Christian; Grimm, Wolfram

doi:10.1016/j.ijcard.2006.03.031

Cited by 33 publications

(25 citation statements)

References 36 publications

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“…43 However, in this study the mean age was 55 years, 77% of patients had NYHA class I-II HF, the frequency of CSA was low, a nonstandard defi nition of CSA was used, and only 35% of patients were treated with b -blockers, raising concerns regarding the generalizability of the fi ndings. A more recent report 44 described similar observations, although this latter study relied on unat- Figure 1. A, Men with heart failure (HF) and CSA had signifi cantly higher mean ANP concentrations (4,336 pg/mL vs 2,510 pg/mL, P 5 .03) compared with patients with HF without CSA, although considerable overlap between patient groups is present.…”

Section: Limitationssupporting

confidence: 52%

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Relation of Natriuretic Peptide Concentrations to Central Sleep Apnea in Patients With Heart Failure

Calvin

Somers

Walt

et al. 2011

Chest

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Background: Central sleep apnea (CSA) is frequent among patients with heart failure (HF) and associated with increased morbidity and mortality. Elevated cardiac fi lling pressures promote CSA and atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) secretion. We hypothesized that circulating natriuretic peptide concentrations predict CSA. Methods: Consecutive patients with HF (n 5 44) with left ventricular ejection fraction (LVEF) Յ 35% underwent polysomnography for detection of CSA. CSA was defi ned as an apnea-hypo pnea index Ն 15 with Ն 50% central apneic events. The relation of natriuretic peptide concentrations to CSA was evaluated by estimation of ORs and receiver operator characteristics (ROCs). Results: Twenty-seven subjects (61%) had CSA, with men more frequently affected than women (73% vs 27%; OR, 7.1; P 5 .01); given that only three women had CSA, further analysis was restricted to men. Subjects with CSA had higher mean ANP (4,336 pg/mL vs 2,510 pg/mL, P 5 .03) and BNP concentrations (746 pg/mL vs 379 pg/mL, P 5 .05). ANP and BNP concentrations were signifi cantly related to CSA (OR, 3.7 per 3,000 pg/mL, P 5 .03 and OR, 1.5 per 200 pg/mL, P 5 .04, respectively), whereas age, LVEF, and New York Heart Association functional class were not. Abbreviations: ANP 5 atrial natriuretic peptide; AUC 5 area under the curve; BNP 5 brain natriuretic peptide; CSA 5 central sleep apnea; eGFR 5 estimated glomerular fi ltration rate; HF 5 heart failure; LVEF 5 left ventricular ejection fraction; NYHA 5 New York Heart Association; OSA 5 obstructive sleep apnea; PSG 5 polysomnography; ROC 5 receiver-operator characteristic; T90% 5 time with arterial oxygen saturation , 90%

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Section: Limitationssupporting

confidence: 52%

“…Accordingly, our data support the concept that the main usefulness of natriuretic peptide testing may be the exclusion of CSA as has been previously suggested. 43,44 Larger studies are needed to confirm these findings in a broader population of patients with HF, including larger numbers of women.…”

Section: Discussionmentioning

confidence: 96%

Relation of Natriuretic Peptide Concentrations to Central Sleep Apnea in Patients With Heart Failure

Calvin

Somers

Walt

et al. 2011

Chest

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“…20 Our finding that CSB is significantly associated with NT-proBNP, a direct marker of pressure overload, supports the concept that pressure overload is an important part of CSB. 21 There are several possible mechanisms for the association between CSB events and mortality, which was demonstrated in the current study. It has been shown before that CSB is associated with oscillations in both heart rate and blood pressure.…”

Section: Discussionsupporting

confidence: 54%

“…20 We believe that our current results support the notion that CSB is an important signal in HF and suggest that CSB is a cause rather than a reflection of HF severity. 21 Although we cannot claim that CSB is a direct cause of mortality in HF patients, it is conceivable that repeated episodes of CSB may deteriorate HF disease over time. 5,25 Several study limitations should be noted.…”

Section: Discussionmentioning

confidence: 95%

Implications of Cheyne‐Stokes Breathing in Advanced Systolic Heart Failure

Amir

Reisfeld²,

Sberro³

et al. 2010

Clinical Cardiology

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Background: Cheyne-Stokes breathing (CSB) has been associated with heart failure (HF) patients for many years; however, its true prevalence and its prognostic implications are still obscure. Hypothesis: The goal of this study was to investigate the prevalence and the possible prognostic implications of nocturnal CSB in advanced heart failure patients. Methods: We performed single night full polysomonography ambulatory sleep studies in 71 HF patients. We analyzed the patients' sleep studies, clinical and laboratory data, and 6 month mortality. Results: A total of 71 chronic systolic HF patients were analyzed, 60 males, 11 females, age 65±13 years. Mean left ventricular ejection fraction was 27%±11%. Short episodes of CSB (at least 3 min duration) were present in all patients,and mean CSB duration was 1 hour. CSB duration was associatedsignificantly with both high serum levels of N-terminal prohormone brain natriuretic peptide (NT-proBNP) as well as with 6 month mortality. Log CSB time had a significant correlation with log NT-proBNP (r = 0.5, P<.0001). Based on median CSB duration, the Kaplan-Meier survival curve analysis showed significant association with 6 month mortality (P = .03). Conclusions: CSB prevalence in advanced HF patients is higher than previously reported and is associated with increased serum levels of NT-proBNP and higher 6 month mortality. IntroductionCheyne-Stokes breathing (CSB) has been associated with heart failure for more than 2 centuries and yet its incidence and clinical implications are still being debated. Therefore, we conducted ambulatory sleep studies in 71 advanced systolic heart failure (HF) patients in order to assess the prevalence and consequences of CSB. To evaluate the possible prognostic implications of CSB in HF, we analyzed sleep study results, clinical data, laboratory parameters, and followed patient mortality for 6 months.

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“…Similarly, BNP plasma concentration is increased in patients with worse CHF and is indicative of a poorer prognosis [88]. Thus the significantly higher plasma BNP levels seen in CHF patients with central SDB compared to those without central SDB [89,90] may mean that central SDB is just a functional indicator of the severity of cardiac dysfunction. Alternatively, its presence in the setting of CHF may lead to adverse cardiac effects.…”

Section: Adverse Effects Of Central Sleep Disordered Breathing In Chrmentioning

confidence: 99%

Sleep disordered breathing in chronic heart failure

Freedman

2008

Heart Fail Rev

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Heart failure is a growing problem, placing an increasing burden on public health resources and continuing to exert a high toll in mortality and morbidity. Sleep disordered breathing (SDB) is also a major public health problem and is associated with an increased risk of fatal and non-fatal cardiovascular events. Current evidence suggests SDB, particularly central SDB, is more prevalent in patients with chronic heart failure (CHF) than in the general population, but is under-diagnosed as SDB symptoms are less prevalent in CHF. This is further hampered by the absence of a simple and accurate screening tool and limited access to sleep facilities to diagnose SDB in the large numbers of patients with CHF. The presence of SDB in patients with CHF imposes increased haemodynamic burdens and results in autonomic abnormalities. Central SDB is an independent marker of worse prognosis, and evidence is increasing that obstructive SDB is also associated with higher mortality in patients with CHF. Optimal treatment of central SDB in these patients remains uncertain. While evidence of efficacy of positive pressure ventilation is stronger in obstructive SDB, improvement in survival for patients with both CHF and SDB awaits definitive trials. This paper summarizes our current understanding of the pathophysiology of SDB in CHF, and the cardiovascular consequences, and reviews the evidence for the beneficial effects of treatment of SDB in patients with CHF.

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Brain natriuretic peptide for prediction of Cheyne-Stokes respiration in heart failure patients

Cited by 33 publications

References 36 publications

Relation of Natriuretic Peptide Concentrations to Central Sleep Apnea in Patients With Heart Failure

Relation of Natriuretic Peptide Concentrations to Central Sleep Apnea in Patients With Heart Failure

Implications of Cheyne‐Stokes Breathing in Advanced Systolic Heart Failure

Sleep disordered breathing in chronic heart failure

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