Elevated plasma brain natriuretic peptide levels in chronic respiratory failure with cor pulmonale

Abstract

Elevated plasma brain natriuretic peptide (BNP) levels have been described in patients with congestive heart failure and acute myocardial infarction. We measured plasma BNP levels in patients with chronic respiratory failure to evaluate the correlation between plasma BNP levels and pulmonary haemodynamics. Plasma BNP levels were measured in 28 patients with chronic respiratory failure accompanied by three underlying diseases [14 with chronic obstructive pulmonary disease (COPD), seven with sequelae of pulmonary tuberculosis (sequelae Tbc) and seven with diffuse panbronchiolitis (DPB)] by immunoradiometric assay methods (IRMA). Twenty-one of 28 patients had already received oxygen supplementation and 16 of 21 patients were treated as outpatients with home oxygen therapy. Plasma BNP levels were significantly elevated in patients with chronic respiratory failure complicated by cor pulmonale (81.5 +/- 13.1 pg ml-1) compared to patients without cor pulmonale (13.3 +/- 2.7 pg ml-1, P < 0.001). As controls, plasma BNP levels in 10 patients with primary lung cancer were studied, and the results (3.5 +/- 1.0 pg ml-1) were not significantly different from those of patients with chronic respiratory failure without cor pulmonale. Plasma BNP levels in 12 healthy subjects were also studied, and the results (7.2 +/- 1.0 pg ml-1) were not significantly different from those of the control subjects. Plasma BNP levels showed a weak linear correlation with systolic pulmonary arterial blood pressure, estimated by Doppler echocardiography (r = 0.43; P = 0.068), but there was no significant correlation between BNP levels and the degree of hypoxaemia (r = 0.30; P = 0.138). Plasma atrial natriuretic peptide (ANP) levels in patients with chronic respiratory failure were also measured using the same samples. Plasma ANP levels were also significantly elevated in patients with chronic respiratory failure complicated by cor pulmonale (80.8 +/- 12.1 pg ml-1) compared to patients without cor pulmonale (26.1 +/- 4.4 pg ml-1, P = 0.003). A significant correlation was found between plasma BNP and ANP levels (r = 0.68; P < 0.001). Our results suggest that the plasma BNP or ANP level may be a useful indicator for detecting the presence of cor pulmonale in patients with chronic respiratory failure.

Prevalence and misdiagnosis of chronic heart failure in nursing home residents: the role of B-type natriuretic peptides

“…NT-proBNP and BNP were influenced by age and renal dysfunction in accordance with other studies. [16][17][18][19] In contrast with other studies, they were not influenced by gender nor by the use of renin-angiotensin system blockers. [20][21][22] A limitation of the study is the small population of 103 nursing home residents, in one centre, which could lead to a selection bias in arriving at the prevalence of CHF of 23%.…”

COPD and PE: A clinical dilemma

“…Such elevations are usually smaller than those appreciated in left ventricular heart failure and negligible or absent in uncomplicated COPD exacerbation (Bando et al 1999).…”

Effects of right ventricular dysfunction on exercise capacity and quality of life and associations with serum NT-proBNP levels in COPD: an observational study

“…In the present study we determined significant negative correlations between serum NT-proBNP with FEV 1 , FVC, IC and VC as well. Chi et al (25) determined positive correlation between PAP with NT-proBNP in COPD patients and Bando et al (27) found higher serum BNP levels in COPD patients with PH than COPD patients without PH. Leuchte et al (23) showed significant correlation between serum BNP levels with PAP in COPD patients with PAP>35 mm Hg at right heart catheterization.…”