Increased circulating pro-brain natriuretic peptide (PROBNP) and brain natriuretic peptide (BNP) in patients with cirrhosis. Relation to cardiovascular dysfunction and severity of disease

Abstract

Background and aims: Cardiac dysfunction may be present in patients with cirrhosis. This study was undertaken to relate plasma concentrations of cardiac peptides reflecting early ventricular dysfunction (pro-brain natriuretic peptide (proBNP) and brain natriuretic peptide (BNP)) to markers of severity of liver disease, cardiac dysfunction, and hyperdynamic circulation in patients with cirrhosis. Patients and methods: Circulating levels of proBNP and BNP were determined in 51 cirrhotic patients during a haemodynamic investigation. Results: Plasma proBNP and BNP were significantly increased in cirrhotic patients (19 and 12 pmol/l, respectively) compared with age matched controls (14 and 6 pmol/l; p,0.02) and healthy subjects (,15 and ,5.3 pmol/l; p,0.002). Circulating proBNP and BNP were closely correlated (r = 0.89, p,0.001), and the concentration ratio proBNP/BNP was similar to that of control subjects (1.8 v 2.3; NS). Circulating proBNP and BNP were related to severity of liver disease (Child score, serum albumin, coagulation factors 2, 7, and 10, and hepatic venous pressure gradient) and to markers of cardiac dysfunction (QT interval, heart rate, plasma volume) but not to indicators of the hyperdynamic circulation. Moreover, in multiple regression analysis, proBNP and BNP were also related to arterial carbon dioxide and oxygen tensions. The rate of hepatic disposal of proBNP and BNP was not significantly different in cirrhotic patients and controls. Conclusion: Elevated circulating levels of proBNP and BNP in patients with cirrhosis most likely reflects increased cardiac ventricular generation of these peptides and thus indicates the presence of cardiac dysfunction, rather than being caused by the hyperdynamic circulatory changes found in these patients.

Pathophysiological and Clinical Approach to Cirrhotic Cardiomyopathy

“…Moreover, these correlate with the stage of the liver disease and may show the severity of myocardial dysfunction and ventricular hypertrophy. Despite these favorable features BNP and pro-BNP may not be able to indicate the hyperdynamic circulation [56,57]. These biomarkers have also been shown to be helpful in the screening of CCM [58].…”

Cirrhotic cardiomyopathy

“…Abbreviations: IVRT, isovolumic relaxation time, which is the time period during which the mitral and aortic valves are both closed. The left ventricle begins to relax, but before left ventricular filling occurs; DDT, diastolic deceleration time, which is the time period from the peak of the early diastolic filling velocity to the end of the E wave cardiomyopathy as the cause of this electrophysiological abnormality [26].…”

“…Henriksen and colleagues [26] found that both pro-BNP (a propeptide of BNP) and BNP elevations correlated with the severity of cirrhosis as well as the degree of cardiac dysfunction. Yildiz et al [30] also reported a significant correlation between the BNP levels and the Child-Pugh score.…”

N-Terminal Pro-Brain Natriuretic Peptide: Prognostic Potential in End Stage Liver Cirrhosis in a Cohort Free of Heart Failure; an Egyptian Insight

“…Ventricles become an important source of NPs, particularly Brain-Type Natriuretic Peptide (BNP) in response to myocardial ischaemia and stretch by volume and pressure overload [6]. N-terminal-proBNP (NT-proBNP) resulting from cleavage of ProBNP (a precursor of BNP) is more stable with longer half-life, it has been shown to be superior in predicting morbidity and mortality or hospitalization for chronic heart failure and an even better indicator of early cardiac dysfunction than BNP [8,9].…”

“…Previous studies revealed increased NP concentrations in patients with cirrhosis suggesting cardiac dysfunction [8,10,11]. However, few studies had demonstrated NP significance in prognosis of liver cirrhosis.…”