Contribution of Extracardiac Factors to the Inconsistency Between Plasma B-type Natriuretic Peptide Levels and the Severity of Pulmonary Congestion on Chest X-rays in the Diagnosis of Heart Failure

Nakane, Tokiko; Kikuchi, Makoto; Komukai, Kimiaki; Kayama, Yosuke; Matsuo, Seiichiro; Nagoshi, Tomohisa; Minai, Kosuke; Date, Taro; Ogawa, Takayuki; Yagi, Hideki; Yoshimura, Michihiro

doi:10.2169/internalmedicine.51.6206

Cited by 15 publications

(18 citation statements)

References 22 publications

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“…However, the BMI-related change observed in the present study population was relatively small. If heart failure becomes advanced, then the influence of obesity on the plasma BNP level may become stronger (24).…”

Section: Relationship Between the Plasma Bnp Levels And Bmimentioning

confidence: 99%

Determination of the B-type Natriuretic Peptide Level as a Criterion for Abnormalities in Japanese Individuals in Routine Clinical Practice: The J-ABS Multi-center Study (Japan Abnormal BNP Standard)

et al. 2013

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Objective The present study was undertaken to establish a useful range for the B-type natriuretic peptide (BNP) level, with the ultimate goal of determining a cut-off BNP level that will make it possible to identify patients with clinically important organic heart disorders among patients encountered in clinical practice. Methods A total of 11,967 outpatients were evaluated for this study, and, after applying the exclusion criteria, 361 patients were finally recruited for the analysis. Compared to the factors of gender and body mass index, aging was considered to be an indispensable factor in this analysis. The 'median' plasma BNP level was found to increase slowly with age, but remained lower than 30 pg/mL, even in patients aged 60 years or older. In contrast, the overall '95th percentile' of the plasma BNP level in the patients younger than 60 years was 41 pg/mL, which increased to 139.8 pg/mL in the patients aged 60 years or older. Conclusion These findings suggest that the lower range of the BNP level allowing for identification of patients with clinically important organic heart disorders increases with age; however, it might be appropriate to adopt a level of approximately 40 pg/mL, even in elderly patients, in order to avoid any possible age-related effects of diastolic dysfunction or other factors.

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Section: Relationship Between the Plasma Bnp Levels And Bmimentioning

confidence: 99%

Determination of the B-type Natriuretic Peptide Level as a Criterion for Abnormalities in Japanese Individuals in Routine Clinical Practice: The J-ABS Multi-center Study (Japan Abnormal BNP Standard)

et al. 2013

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“…In addition, the multiple regression analysis clearly showed for the first time that IHD per se is an independent determinant of the plasma BNP level, in addition to other known factors, such as age, male gender, low BMI, s-Cr, low LVEF and AF [26]–[31]. Furthermore, when the total study population was divided by gender, significant differences were identified between females and males.…”

Section: Discussionmentioning

confidence: 75%

The Plasma B-Type Natriuretic Peptide Levels Are Low in Males with Stable Ischemic Heart Disease (IHD) Compared to Those Observed in Patients with Non-IHD: A Retrospective Study

et al. 2014

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ObjectiveAlthough the plasma B-type natriuretic peptide (BNP) level is a marker of heart failure, it is unclear whether BNP per se plays a pivotal role for pathogenic mechanisms underlying the development of ischemic heart disease (IHD). In this study, we retrospectively examined the plasma BNP levels in stable patients with IHD and compared to stable patients with cardiovascular diseases other than IHD.MethodsThe study population was 2088 patients (1698 males and 390 females) who were admitted to our hospital due to IHD (n = 1,661) and non-IHD (n = 427) and underwent cardiac catheterization. Measurements of the hemodynamic parameters and blood sampling were performed.ResultsThe plasma BNP levels were significantly lower in the IHD group than in the non-IHD group (p<0.001). The multiple regression analysis examining the logBNP values showed that age, a male gender, low left ventricular ejection fraction, low body mass index, serum creatinine, atrial fibrillation and IHD per se were significant explanatory variables. When the total study population was divided according to gender, the plasma BNP levels were found to be significantly lower in the IHD group than in the non-IHD group among males (p<0.001), but not females (p = NS). Furthermore, a multiple logistic regression analysis of IHD showed the logBNP value to be a significant explanatory variable in males (regression coefficient: −0.669, p<0.001), but not females (p = NS).ConclusionsThe plasma BNP levels were relatively low in stable patients with IHD compared with those observed in stable patients with non-IHD; this tendency was evident in males. Perhaps, the low reactivity of BNP is causally associated with IHD in males. We hope that this study will serve as a test of future prospective studies.

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“…obesity, renal insufficiency and anaemia) that dramatically reduce their significance. 13,16 Those confounding variables were not considered in our analysis. Also, in order to achieve a sufficient study population, we included laboratory values from dates up to 60 days from the CT examinations and did not differentiate between acute and chronic left heart failure.…”

Section: Discussionmentioning

confidence: 99%

Dual-energy CT pulmonary angiography in patients with suspected pulmonary embolism: value for the detection and quantification of pulmonary venous congestion

Thieme¹,

Meinel²,

Graef³

et al. 2014

BJR

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CT pulmonary angiography in patients with suspected pulmonary embolism: value for the detection and quantification of pulmonary venous congestion. Br J Radiol 2014;87:20140079. FULL PAPER Dual-energy CT pulmonary angiography in patients with suspected pulmonary embolism: value for the detection and quantification of pulmonary venous congestion S F THIEME, F G MEINEL, A GRAEF, A D HELCK, M F REISER and T RC JOHNSON Results: No significant difference of PBV but significant differences of mean PA and LA enhancement and individual enhancement differences (PA 2 LA) were found between the populations. PA 2 LA was higher in patients with elevated BNP and proBNP and was positively correlated with these values. Receiver operating characteristic analysis revealed a moderate discriminatory power of the PA 2 LA difference for the presence of cardiac biomarker elevations. Conclusion: PBV in DE-CTPA is not altered in patients with signs of congestive heart failure. However, differences in enhancement values in the pre-and postpulmonary vessels were found in comparison with the control population. Advances in knowledge: Altered pulmonary vascular haemodynamics in pulmonary venous congestion are not reflected in dual-energy-derived PBV maps. In the diagnosis of left heart failure in patients with chest pain and dyspnoea, density measurements in the pulmonary artery and in the left atrium in CTPA images may be a helpful diagnostic tool.In the diagnostic algorithms for patients with acute dyspnoea, CT pulmonary angiography (CTPA) plays a major role, specifically in cases when pulmonary embolism (PE) is suspected. Whenever no PE can be detected, radiologists face the challenge to detect alternative pathological thoracic findings. An undiagnosed acute or chronic left heart failure with pulmonary congestion can be an alternative cause of acute dyspnoea. Although there are some direct and indirect CT criteria that suggest the diagnosis of congestive heart failure with pulmonary venous hypertension (e.g. dilated pulmonary veins with a blurry appearance of the vessel walls, thickening of the interlobular septal lines, ground-glass opacities/alveolar oedema, pleural effusions and an enlargement of the left atrium and/or ventricle), the diagnosis of left heart failure on the basis of CT findings is often equivocal and rather rater dependent. For suspected left heart failure, chest radiography represents the primary diagnostic tool rather than CT. Still, if CTPA is performed in chest pain workup, an improved, more objective diagnosis of congestive heart failure would be desirable. Dual-energy CTPA (DE-CTPA) can quantify the iodinerelated pulmonary beam absorption and thus allow an automated, reader-independent, software-based quantification of the pulmonary content of iodinated contrast material [termed "perfused blood volume" (PBV)].1 Based on the assumption that an impaired left heart function leads to variances in the pulmonary blood content and in the dynamics of the pulmonary passage of the contrast bolus, we tried to find out if ...

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Contribution of Extracardiac Factors to the Inconsistency Between Plasma B-type Natriuretic Peptide Levels and the Severity of Pulmonary Congestion on Chest X-rays in the Diagnosis of Heart Failure

Cited by 15 publications

References 22 publications

Determination of the B-type Natriuretic Peptide Level as a Criterion for Abnormalities in Japanese Individuals in Routine Clinical Practice: The J-ABS Multi-center Study (Japan Abnormal BNP Standard)

Determination of the B-type Natriuretic Peptide Level as a Criterion for Abnormalities in Japanese Individuals in Routine Clinical Practice: The J-ABS Multi-center Study (Japan Abnormal BNP Standard)

The Plasma B-Type Natriuretic Peptide Levels Are Low in Males with Stable Ischemic Heart Disease (IHD) Compared to Those Observed in Patients with Non-IHD: A Retrospective Study

Dual-energy CT pulmonary angiography in patients with suspected pulmonary embolism: value for the detection and quantification of pulmonary venous congestion

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