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

Abstract

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.

Creation of mortality risk charts using123I meta-iodobenzylguanidine heart-to-mediastinum ratio in patients with heart failure: 2- and 5-year risk models

“…However, the level of this biomarker can rapidly change in response to patient conditions and treatment, indicating efficacies for tracking short-term outcomes and estimating the severity of CHF. 26 In contrast, 123 I-MIBG HMR changes more gradually during a several month period of clinical observation. 27 Thus, once BNP has stabilized, the HMR offers additional insight into the long-term prognosis, making the two tests complementary.…”

The increasing impact of a higher body mass index on the decrease in plasma B-type natriuretic peptide levels

“…It is well known that BNP is synthesized in the heart, and that plasma levels increase in parallel with cardiac dysfunction [21] and this is favorable to the failing heart. Thus, when the intrinsic response of BNP is suppressed for some reason, a disruption of the hormone balance would occur in patients with heart failure.…”

“…We also have reported that a high BMI is associated with a decrease in the plasma BNP level, whereas renal dysfunction and advanced age increase the BNP levels [20,21]. Nonetheless, it is still unclear how large the impact of the BMI is on the plasma BNP levels.…”