Left ventricular dysfunction, natriuretic peptides, and mortality in an urban population

Abstract

Objective-To report the mortality of left ventricular systolic dysfunction (LVD), assessed objectively by echocardiography, and its association with natriuretic peptide hormones in a random sample of 1640 men and women aged 25-74 years from a geographical, urban population. Methods-Left ventricular function was measured by echocardiography in 1640 attendees studied in 1992-3. LVD was defined as a left ventricular ejection fraction (LVEF) < 30%. Plasma concentrations of N-terminal atrial natriuretic peptide (N-ANP) and brain natriuretic peptide (BNP) were measured by standard radioimmunoassays. Mortality was documented at four years. Results-The four year all cause mortality rate in the whole cohort was 4.9% (80 deaths). It was 21% (nine deaths) in those with an LVEF < 30% and 4% in those whose LVEF was > 30% (p < 0.001). The median (interquartile range) BNP concentration in those who died was 16.9 pg/ml (8.8-27) and 7.8 pg/ml (3.4-13) in survivors (p < 0.0001). Similarly, N-ANP had a median concentration of 2.35 ng/ml (1.32-3.36) in those with a fatal outcome and 1.27 ng/ml (0.9-2.0) in those alive at four years (p < 0.0001). Subjects with an LVEF < 40% also had a significant mortality rate of 17% if they also had a BNP concentration > 17.9 pg/ml compared with 6.8% if their BNP was below this concentration (p = 0.013). Multivariate analysis revealed the independent predictors of four year all cause mortality to be increasing age (p < 0.001), a BNP concentration > 17.9 pg/ml (p = 0.006), the presence of ischaemic heart disease (p = 0.03), and male sex (p = 0.04). Conclusions-LVD is associated with a considerable mortality rate in this population. BNP also independently predicts outcome. In addition to its role as a diagnostic aid in chronic heart failure and LVD, it provides prognostic information and clarifies the meaning of a given degree of LVD.

Intrathoracic impedance monitoring to detect chronic heart failure deterioration: Relationship to changes in NT‐proBNP

“…Prior investigations have established BNP and its precursor NT-proBNP as markers for the diagnosis [10,11] and prognosis [12] of CHF. BNP and NT-proBNP are released in response to myocyte stretch [13], and are elevated in asymptomatic as well as symptomatic CHF [14,15]. The concentration of the peptide hormone increases with the severity of CHF, but threshold values have not yet been defined [5,16,17].…”

The epidemiology of left ventricular hypertrophy in type 2 diabetes mellitus

“…It is well established that various left ventricular abnormalities strongly promote cardiac death, in particular left ventricular hypertrophy (LVH) [9][10][11][12][13] and left ventricular systolic dysfunction (LVSD) [14,15]. Impaired long axis contraction of the left ventricle may also be associated with increased mortality [16].…”

Therapy of Ischemic Cardiomyopathy With the Immunomodulating Agent Pentoxifylline

“…The aim of the present study was therefore to determine whether the addition of pentoxifylline to standard therapy in patients with ischemic left ventricular dysfunction would result in improvement in ventricular function and plasma levels of the inflammatory markers C-reactive protein (CRP) and TNF-␣ and Fas/Apo-1. Because plasma brain natriuretic peptide (NT-pro BNP), which is released from the heart in response to elevations in transmural pressures and wall stress, appears to be a powerful predictor of prognosis 11 and is a rational surrogate end point for the efficacy of treatment in heart failure, we also evaluated whether any hemodynamic benefits of pentoxifylline were associated with reductions in plasma concentrations of NT-pro BNP.…”