N-terminal pro-B-type natriuretic peptide as a marker of disease severity in patients with pericardial effusions

Abstract

Background/Aims : N-terminal pro-B-type natriuretic peptide (NT-proBNP) has recently been introduced as a useful marker in diagnosing underlying disease in patients with dyspnea and for determining the prognosis of patients with heart failure. The purpose of this study was to evaluate the value of the NT-proBNP as a marker of disease severity in patients with pericardial effusions.Methods : We enrolled 69 consecutive patients who showed moderate or large pericardial effusion with preserved left ventricular (LV) systolic function; 42 patients finally participated in the study, and 13 (31.0%) of them showed cardiac tamponade. We analyzed the etiologies, the clinical and echocardiographic variables, and the serum NT-proBNP levels in these patients.Results : The mean NT-proBNP level was 751±1002 ng/L (range 5 to 5289), and the median level was 385 ng/L (interquartile range 152 to 844). The NT-proBNP levels were higher in those patients with jugular venous distension (p=0.002), pulsus paradoxus (p=0.016), heart rate ≥100/min (p=0.006), cardiac tamponade (p=0.001), large pericardial effusion (p=0.029), exaggerated respiratory variation of the transmitral inflow (p=0.006), or plethora of the inferior vena cava (p=0.01). The NT-proBNP levels showed significant correlation with heart rate (r=0.517, p<0.001) and the diameter of the inferior vena cava (r=0.329, p=0.03).Conclusions : NT-proBNP may be useful as a marker of disease severity in patients suffering from pericardial effusion, but further prospective studies with more patients will be needed.

Cardiac tamponade causing severe reversible hyponatraemia

“…Although, rapid correction of hyponatraemia is generally considered dangerous, all cases discussed by Chang et al and the case reported by us did not suffer any significant neurological complications. Kim et al have suggested NT-pro BNP as a marker of severity of disease in cardiac tamponade 8. In our case too, there was three times elevation in BNP levels thereby suggesting increased severity.…”

The N-terminal pro-B-type natriuretic peptide as a predictor of disease progression in patients with pericardial effusion

“…The results showed that the NT-proBNP level was increased in patients with pericardial disease; they suggested that diastolic dysfunction was the cause of increased NT-proBNP levels. In our previous study, the findings showed that NT-proBNP levels might be a useful marker for disease severity in patients with PE; however, the relationship between NT-proBNP levels and diastolic dysfunction could not be determined [10]. In the current study, NT-proBNP was identified as an independent predictor of disease progression, defined as pericardial events such as constrictive pericarditis, recurrent PE, or persistent drainage, which was arbitrarily defined as the continuous drainage of an effusion through a Pig-tail catheter of more than 50 mL daily over one week.…”

“…The release of BNP serves an important regulatory role in response to these stimuli by opposing the vasoconstriction, sodium retention, and anti-diuretic effects [29,30]. In our previous study, the NT-proBNP levels were correlated with the heart rate and IVC diameter, which reflected the adrenergic and renin-angiotensin stimulation [10]. Therefore, NT-proBNP may help to predict subsequent recurrent PE and/or persistent drainage.…”

“…As described in a previous study [10], all echocardiographic studies were carried out using a standard protocol on a commercially available system (Vivid 7, GE Medical Systems, Horten, Norway). In brief, the cardiac dimensions of the walls and chambers were measured according to the American Society of Echocardiography guidelines and all of the measurements were assessed during the whole respiratory cycle and averaged over five cardiac cycles.…”

Brain natriuretic peptide and tumour markers in the diagnosis of non-malignant pericardial effusion

“…In a study, increased NT-proBNP levels in patients with cardiac tamponade were detected compared to patients without this finding [18]. It is well known that pericardial diseases lead to diastolic dysfunction [19].…”