Relationship Between Brain Natriuretic Peptide, Myocardial Wall Stress, and Ventricular Arrhythmia Severity

Abstract

SUMMARYWe previously demonstrated that the severity of arrhythmias is reflected by circulating brain natriuretic peptide (BNP) concentrations in patients without signs of congestive heart failure. In the present study, we evaluated the relationships between the severity of the arrhythmia, BNP concentration, and echocardiographic findings.The subjects consisted of 52 patients with ventricular premature contractions (VPC) but no manifestations of heart failure and no digoxin or beta-blocker therapy. Patients underwent Holter monitoring, plasma sampling for BNP measurement, and transthoracic echocardiography (TTE). We scored the motion of 16 left ventricular segments, deriving a wall-motion score index (WMSI) by totaling the scores and dividing by the number of segments scored.Twenty-three patients with Lown grade I to II arrhythmias constituted group A while group B consisted of 29 Lown III to IV patients. Group B had BNP concentrations triple those in group A (57.2 versus 18.1 pg/mL, P < 0.01). Left ventricular ejection fraction (LVEF) was similar in groups A and B (65.2% versus 62.1%, NS). Although left ventricular end-diastolic dimension (LVEDD) was normal in both groups, group B exhibited a larger LVEDD than group A (50 versus 46 mm, P < 0.005). The correlation (r) between BNP and interventricular septum thickness (IVST) was 0.27 (P = 0.013) in group A and 0.37 (P < 0.0001) in group B. Between BNP and posterior wall thickness (PWT), the correlation was 0.23 (P = 0.014) in group A versus 0.33 (P < 0.0001) in group B. The WMSI in group B was higher than in group A (1.34 versus 1.11, P < 0.05).We believe that besides the changes in echocardiographic parameters, the BNP elevation in group B could be a response to abnormal wall stress from the severe ventricular arrhythmias. (Jpn Heart J 2004; 45: 771-777)

Exposure to chronic alcohol accelerates development of wall stress and eccentric remodeling in rats with volume overload

“…Indeed, in patients with essential hypertension, both ANP and BNP levels are positively correlated with posterior wall thickness (LVPW) [29]. In patients with premature ventricular contractions, BNP levels are positively correlated with LVPW [30]. Consistent with this, we found a significant positive correlation between BNP expression and LVPW.…”

Relationship Between the Plasma Levels of Brain Natriuretic Peptide and Left Ventricular Ejection Fraction in Asymptomatic Patients With Previous Myocardial Infarction

“…Plasma BNP is also a useful index of therapeutic outcome during drug treatment for heart failure 7) and a response to abnormal wall stress from severe ventricular arrhythmias. 8) Some investigations in Japanese subjects have shown that plasma BNP is useful as an independent factor for estimation of the outcome and prediction of sudden death. 9,10) On the other hand, plasma BNP has been reported to increase with increases in the grade of severity of heart disease according to the NYHA classification in a way similar to the plasma levels of ANP, cGMP, and norepinephrine.…”

Time course of B-type natriuretic peptides changes after ventricular fibrillation: Relationships with cardiac syncope

“…Increases in both BNP and NT-proBNP plasma levels have been observed in association with cardiac myocyte stretching, and in arrhythmias [2][3][4]. B-type natriuretic peptides have therefore recently gained attention as biomarkers of cardiac arrhythmic syncope [5,6].…”

“…The present study analysed a subgroup of patients from the APACE ongoing cohort [3] with final adjudicated diagnosis of UA or NSTEMI who had coronary angiograms during the course of hospitalization.…”