Influence of Low-Grade Inflammation on Plasma B-type Natriuretic Peptide Levels

Inoue, Terumasa; Kikuchi, Makoto; Nakane, Tokiko; Nojiri, Ayumi; Minai, Kosuke; Komukai, Kimiaki; Ogawa, Takayuki; Hongo, Kazuhiro; Matsushima, Masato; Yoshimura, Michihiro

doi:10.2169/internalmedicine.49.4211

Cited by 14 publications

(14 citation statements)

References 56 publications

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“…The present study focused on patients with dyspnea who came to a tertiary emergency medical facility due to worsening of symptoms. Moreover, the inflammatory status was relatively high in the present population (Table 2), and inflammation has been previously reported to increase the plasma BNP levels (24). The severity of HF and the presence of inflammation may explain the higher cut-off values of the BNP levels in the present study, therefore the present findings are in line with the cut-off described in the JHFS statement.…”

Section: Cut-off Values In the Previous Studiessupporting

confidence: 88%

“…In the present study, many of the patients with respiratory disease had pneumonia and interstitial pneumonia, which causes BNP levels to rise, and this increase in BNP correlates with the level of CRP (23). Our previous report showed that inflammation increases the plasma BNP level (24). In septic patients, the severity of the illness is the main determinant of the BNP level, rather than cardiac function (25).…”

Section: Plasma Bnp Levels In Non-heart Failure Patientsmentioning

confidence: 98%

“…Several factors are involved in the regulation of the plasma BNP levels (17,24,26,27). The renal function is known to significantly affect the plasma BNP levels, therefore patients with an eGFR <30 mL/min/1.73 m 2 were excluded from the present study.…”

Section: Other Extra-cardiac Factors Affecting the Plasma Bnp Levelsmentioning

confidence: 99%

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The Optimal Cut-off Value of Plasma BNP to Differentiate Heart Failure in the Emergency Department in Japanese Patients with Dyspnea

et al. 2015

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Objective In the emergency department, it is sometimes difficult to differentiate heart failure (HF) from other diseases (e.g., respiratory diseases) in patients who develop dyspnea. The plasma B-type natriuretic peptide (BNP) levels increase in patients with HF, and various levels are associated with specific New York Heart Association classes. Although the diagnosis of HF should not be made based only on the plasma BNP levels, the identification of a cut-off value for BNP to diagnose HF would be helpful. Methods Patients admitted to the emergency department of our hospital with dyspnea between January 2010 and December 2011 were retrospectively reviewed. The patients whose estimated glomerular filtration rate was less than 30 mL/min/1.73 m 2 were excluded. Patients were divided into two groups: those with HF (n=131) and those without HF (n=138). The cut-off value for BNP was determined by the receiver-operating characteristic curve. Results The area under the curve of this curve was 0.934. The optimal cut-off point for detection of HF was 234 pg/mL. The sensitivity and specificity were 87.0% and 85.5%, respectively. The fifth and 95th percentiles of the HF group were 132.2 and 2,420.8 pg/mL, respectively. Those of the non-HF group were 9.7 and 430.2 pg/mL, respectively. Conclusion Our study suggests that a plasma BNP level cut-off value of 234 pg/mL can be used to detect HF in the emergency department.

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Section: Cut-off Values In the Previous Studiessupporting

confidence: 88%

Section: Plasma Bnp Levels In Non-heart Failure Patientsmentioning

confidence: 98%

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The Optimal Cut-off Value of Plasma BNP to Differentiate Heart Failure in the Emergency Department in Japanese Patients with Dyspnea

et al. 2015

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“…Caution must be exercised particularly for obese patients, because their plasma BNP levels can be low even in the presence of severe heart failure. Figure 6 shows an example of a clinical scenario using chest X-rays and the rapid BNP assay for the diagnosis of heart failure and other conditions (2,(12)(13)(14)22).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2012

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Objective Chest X-rays and plasma B-type natriuretic peptide (BNP) levels are useful for diagnosing congestive heart failure. However, the relationship between plasma BNP levels and pulmonary congestion on chest X-rays often seems inconsistent. Extracardiac factors can directly alter plasma BNP levels, independent of cardiac function. In the present study, we examined the clinical factors that impact the diagnosis of heart failure by using chest X-rays and plasma BNP levels. Methods and ResultsThis study comprised 459 consecutive patients who were admitted to the cardiovascular division of our hospital for any reason and in whom chest X-rays and plasma BNP levels were measured within 12 hours after admission. The approximate BNP value associated with pulmonary congestion that was detectable by chest X-rays was 143 pg/mL, but this value was influenced by renal function, age, and body mass index (BMI). Furthermore, we examined the effect of these three extracardiac factors on plasma BNP levels in each stage of pulmonary congestion. We found that renal dysfunction and advanced age increased the plasma BNP levels, whereas a high BMI decreased the levels, and that the effect of BMI on plasma BNP levels was greater for severe heart failure. Conclusion Extracardiac factors should be considered when the relationship between the plasma BNP levels and the severity of pulmonary congestion on chest X-rays seems inconsistent. In particular, low levels of plasma BNP in patients with a high BMI should be carefully considered to avoid underestimating the degree of heart failure.

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“…However, the present study identified standard contributing factors affecting changes in plasma BNP levels. 15 Serial BNP measurements are useful in evaluating acute heart failure, and we attempted to investigate improvements in acute heart failure by assessing such measurements. 9 In terms of aging, no significant differences were observed in plasma BNP levels before treatment between older and younger age groups, suggesting that the degree of acute heart failure is not related to aging in the acute phase ( Figure 2).…”

Section: Discussionmentioning

confidence: 99%

Serial measurements associated with an amelioration of acute heart failure: an analysis of repeated quantification of plasma BNP levels

Ito

Kikuchi

Nakane

et al. 2012

European Heart Journal: Acute Cardiovascular Care

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Background: The magnitude of improvement of acute heart failure achieved during treatment varies greatly among patients. We examined changes in the plasma B-type natriuretic peptide (BNP) levels of patients with acute heart failure and attempted to elucidate the clinical factors associated with amelioration of acute heart failure. Methods and results:The study population consisted of 208 consecutive patients admitted to our institution with acute heart failure. We measured plasma BNP levels before and after treatment of acute heart failure and evaluated these levels based on median age, body mass index (BMI), creatinine (Cr) level, and left ventricular ejection fraction (EF). Plasma BNP levels before treatment were equivalent between the younger and older age groups; however, plasma BNP levels after treatment were higher in the older age group (p<0.01). Plasma BNP levels before treatment were significantly high in the lower BMI group (p<0.05) and the higher Cr group (p<0.01). Similarly, plasma BNP levels after treatment were high in both the lower BMI and higher Cr groups (p<0.01 for both). In the low EF group, plasma BNP levels before treatment were significantly high (p<0.01), while plasma BNP levels after treatment were equivalent to those in the high EF group. A multiple linear regression analysis revealed that Cr was positively correlated and BMI and EF were negatively correlated with plasma BNP levels before treatment; however, the contributions of age, BMI, and Cr in reducing plasma BNP levels were more significant after treatment. Conclusions:The contributions of clinical factors working against amelioration of heart failure vary before and after treatment. Regarding plasma BNP levels, older age, very low BMI, and the presence of renal dysfunction eventually act to prevent amelioration of acute heart failure. Systolic dysfunction does not act against amelioration of acute heart failure.

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Influence of Low-Grade Inflammation on Plasma B-type Natriuretic Peptide Levels

Cited by 14 publications

References 56 publications

The Optimal Cut-off Value of Plasma BNP to Differentiate Heart Failure in the Emergency Department in Japanese Patients with Dyspnea

The Optimal Cut-off Value of Plasma BNP to Differentiate Heart Failure in the Emergency Department in Japanese Patients with Dyspnea

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

Serial measurements associated with an amelioration of acute heart failure: an analysis of repeated quantification of plasma BNP levels

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