A rapid B-type natriuretic peptide assay accurately diagnoses left ventricular dysfunction and heart failure: A multicenter evaluation

Aims: To assess plasma B-type natriuretic peptide (BNP) levels in patients with univentricular hearts late after volume unloading by total cavopulmonary connection (TCPC). Methods: Plasma BNP was measured by sandwich immunoassay in 67 patients after a modified Fontan procedure. BNP levels were compared with age and sex-specific normal values, clinical and echocardiographic data, and results of exercise testing. Results: BNP had a wide range of 5-290 pg/ml, but was normal in 81% of patients, and median BNP was only 13 pg/ml. There was no difference between males and females, between patients with left or right ventricular morphology, and no correlation was found between BNP and age, post-operative follow-up period, maximum exercise capability, peak oxygen uptake, or blood oxygen saturation. New York Heart Association class I patients had lower BNP than class II patients (p = 0.04). Plasma BNP concentration was positively correlated to the number of specific sequelae (r = 0.59, p b 0.001), and to severity of atrioventricular regurgitation (r = 0.38, p = 0.002). 5/13 patients with elevated BNP died during follow-up. Conclusion: BNP plasma concentration was normal in the majority of patients up to 15 years after TCPC. Elevated and increasing BNP levels were associated with increased morbidity and late mortality.

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“…According to age-and sex-specific reference values [11,12], BNP was increased in only 13/67 patients.…”

Section: Resultsmentioning

confidence: 94%

B‐type natriuretic peptide levels in patients with functionally univentricular hearts after total cavopulmonary connection

Koch

Zink

Singer

et al. 2008

European J of Heart Fail

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“…Conversely, the finding that BNP levels were within the normal range in a minority of HCM patients with severe heart failure is similar to recent observations in congestive heart failure caused by coronary artery disease. 1,26 This observation may be explained by episodic BNP secretion but also raises the possibility that such normal BNP values ultimately imply better prognosis.…”

Section: Maron Et Al Bnp In Hypertrophic Cardiomyopathy 987mentioning

confidence: 99%

“…1,26 Indeed, almost 50% of our HCM patients who were asymptomatic nevertheless showed elevated BNP values exceeding the generally recommended cutoff value for normality of 100 pg/mL. 26,27 Although the significance of such elevated plasma BNP levels in the absence of symptoms is uncertain, it is possible that they represent a preclinical prognostic marker for impending heart failure and clinical decompensation or even a useful (albeit insensitive) test for detecting HCM in phenotype-negative family members who carry a mutant gene for the disease. 12 However, we have used a cross-sectional study design, and therefore, predictions of clinical outcome over time with serial BNP measurements are beyond the scope of this investigation.…”

Section: Maron Et Al Bnp In Hypertrophic Cardiomyopathy 987mentioning

confidence: 99%

Usefulness of B-Type Natriuretic Peptide Assay in the Assessment of Symptomatic State in Hypertrophic Cardiomyopathy

et al. 2004

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Background-Hypertrophic cardiomyopathy (HCM) has a diverse clinical spectrum that often includes progressive heart failure symptoms and disability. Assessment of symptom severity may be highly subjective, encumbered by the heterogeneous clinical presentation. Plasma B-type natriuretic peptide (BNP) has been used widely as an objective marker for heart failure severity and outcome, predominantly in coronary heart disease with ventricular dilatation and systolic dysfunction. Methods and Results-We prospectively assessed plasma BNP as a quantitative clinical marker of heart failure severity in 107 consecutive HCM patients. BNP showed a statistically significant relationship to magnitude of functional limitation, assessed by New York Heart Association (NYHA) functional class: I, 136Ϯ159 pg/mL; II, 338Ϯ439 pg/mL; and III/IV, 481Ϯ334 pg/mL (PϽ0.001). Multivariable analysis showed that BNP was independently related to NYHA class as well as age and left ventricular wall thickness (each with a value of Pϭ0.0001). BNP Ն200 pg/mL was the most reliable predictor of heart failure symptoms, with positive and negative predictive values of 63% and 79%, respectively. BNP power in distinguishing patients with or without heart failure symptoms was less than that for differentiating between no (or only mild) and severe symptoms (area under receiver operating characteristic curveϭ0.75 and 0.83, respectively). Conclusions-Plasma BNP is independently related to the presence and magnitude of heart failure symptoms in patients with HCM. As a clinical marker for heart failure, BNP is limited by considerable overlap in values between categories of heart failure severity as well as confounding variables of left ventricular wall thickness and age.

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“…11 BNP concentrations have been shown to be an excellent screening tool for differentiating cardiac from noncardiac causes of dyspnea in adults, with sensitivities and specificities that are reported to surpass those of clinical and radiological methods. [12][13][14][15] Numerous studies suggest that elevated BNP concentrations may be useful for detecting the presence of a PDA in premature neonates. [16][17][18][19][20][21][22] Recently, several authors have suggested that by using BNP measurements to monitor changes in PDA shunt magnitude, the need for repeated echocardiography may be obviated.…”

Section: Introductionmentioning

confidence: 99%

How useful are B-type natriuretic peptide measurements for monitoring changes in patent ductus arteriosus shunt magnitude?

2010

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Objective: Although B-type natriuretic peptide (BNP) concentrations seem to be useful for detecting the presence of patent ductus arteriosus, there is no information about their usefulness for monitoring changes in PDA shunt magnitude. Study Design:We performed a retrospective analysis of paired BNPechocardiogram measurements (obtained from infants (24 to 32 weeks gestation) with clinical suspicion of PDA).Result: Individual BNP concentrations (n ¼ 146, from 88 infants) were significantly related to shunt magnitude at the time of measurement and had good discriminating power for detecting a moderate-or-large shunt (area under receiver-operator characteristic curves (ROC-AUC) ¼ 0.85). In total, 36 infants had serial BNP-echocardiogram pairs (n ¼ 91) measured during their hospitalization. Changes (either increases or decreases) in BNP concentrations over time had only fair discriminating power (ROC-AUC ¼ 0.76) for detecting increases or decreases, respectively, in shunt magnitude. Conclusion:The high degree of variability in the BNP measurements made them less useful for monitoring changes in magnitude.

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A rapid B-type natriuretic peptide assay accurately diagnoses left ventricular dysfunction and heart failure: A multicenter evaluation

Cited by 166 publications

References 26 publications

B‐type natriuretic peptide levels in patients with functionally univentricular hearts after total cavopulmonary connection

B‐type natriuretic peptide levels in patients with functionally univentricular hearts after total cavopulmonary connection

Usefulness of B-Type Natriuretic Peptide Assay in the Assessment of Symptomatic State in Hypertrophic Cardiomyopathy

How useful are B-type natriuretic peptide measurements for monitoring changes in patent ductus arteriosus shunt magnitude?

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