NT Pro BNP Plasma Level and Atrial Volume Are Linked to the Severity of Liver Cirrhosis

Abstract

Background and AimsPlasma levels of NT-pro-BNP, a natriuretic peptide precursor, are raised in the presence of fluid retention of cardiac origin and can be used as markers of cardiac dysfunction. Recent studies showed high levels of NT pro BNP in patients with cirrhosis. We assessed NT pro-BNP and other parameters of cardiac dysfunction in patients with cirrhosis, with or without ascites, in order to determine whether the behaviour of NT pro BNP is linked to the stage of liver disease or to secondary cardiac dysfunction.MethodsFifty eight consecutive hospitalized patients mostly with viral or NAFLD-related cirrhosis were studied. All underwent abdominal ultrasound and upper GI endoscopy. Cardiac morpho-functional changes were evaluated by echocardiography and NT-pro-BNP plasma levels determined upon admission. Twenty-eight hypertensive patients, without evidence of liver disease served as controls.ResultsFifty eight cirrhotic patients (72% men) with a median age of 62 years (11% with mild arterial hypertension and 31% with type 2 diabetes) had a normal renal function (mean creatinine 0.9 mg/dl, range 0.7–1.06). As compared to controls, cirrhotic patients had higher NT pro-BNP plasma levels (365.2±365.2 vs 70.8±70.6 pg/ml; p<0.001). Left atrial volume (LAV) (61.8±26.3 vs 43.5±14.1 ml; p = 0.001), and left ventricular ejection fraction (62.7±6.9 vs. 65.5±4%,; p = 0.05) were also altered in cirrhotic patients that in controls. Patients with F2-F3 oesophageal varices as compared to F0/F1, showed higher e' velocity (0.91±0.23 vs 0.66±0.19 m/s, p<0.001), and accordingly a higher E/A ratio (1.21±0.46 vs 0.89±0.33 m/s., p = 0.006).ConclusionNT-pro-BNP plasma levels are increased proportionally to the stage of chronic liver disease. Advanced cirrhosis and high NT-pro-BNP levels are significantly associated to increased LAV and to signs of cardiac diastolic dysfunction. NT pro-BNP levels could hence be an useful prognostic indicators of early decompensation of cirrhosis.

Clinical implications of the hyperdynamic syndrome in cirrhosis

“…A marker of initial cardiac damage has been indentified and proven in analysis of NT pro-brain natriuretic peptide (BNP), a pro hormone of the BNP, commonly used to screen patients with cardiac dyspnea. NT pro BNP is a sensitive marker of myocardial injury, and has been found at high levels in both compensated and decompensated cirrhosis [82]. In fact, it has been recently correlated with the severity of cirrhosis (Child-Pugh class, HVPG and serum albumin), degree of cardiac dysfunction (plasma volume, heart rate and QT interval) and myocardiac hypertrophy.…”

Ocena kardiologiczna pacjentów z niewydolnością wątroby w ramach kwalifikacji do operacji przeszczepienia wątroby

“…Wzrost stężenia NT-proBNP zależy od stopnia zaawansowania niewydolności wątroby, dlatego jest ono najwyższe u chorych w klasie C według klasyfikacji Child-Pugh, z wysoką punktacją w skali MELD (Model of End-Stage Liver Disease) oraz u pacjentów z wodobrzuszem [16]. Nieprawidłowe stężenie NT-proBNP może być przydatne w identyfikacji pacjentów obarczonych podwyższonym ryzykiem sercowo--naczyniowym, a tym samym -gorszym rokowaniem.…”

Cirrhotic cardiomyopathy: we already know. What comes next?

“…However, its clinical usage is still being evaluated [12,13]. Natriuretic peptide are secreted by the cardiomyocytes in response to volume or pressure overload, or myocardial ischemia, to compensate RAAS effect in sodium and water balance [14,15]. BNP may be one of the most available biomarkers which allows an early recognition of cardiac involvement [16,17].…”