Hemodynamic Determinants of Myocardial B-Type Natriuretic Peptide Release

Abstract

Abstract-Although B-type natriuretic peptide (BNP) is widely used as a biomarker for heart failure, the in vivo mechanical stimulus for its cardiac release remains poorly defined. We aimed to characterize the hemodynamic determinants of the transcardiac BNP gradient as a measure of myocardial BNP release by performing a detailed hemodynamic assessment in subjects with a broad spectrum of systolic and diastolic left ventricular dysfunction. Forty-two subjects underwent a detailed transthoracic echocardiographic study, right heart catheterization, and simultaneous BNP measurement in arterial and coronary sinus plasma. The transcardiac BNP gradient was lowest in subjects with normal left ventricular ejection fraction/high peak early diastolic annular velocity (nϭ11), intermediate in those with normal left ventricular ejection fraction/low peak early diastolic annular velocity (nϭ13), and highest in those with low left ventricular ejection fraction/low peak early diastolic annular velocity (nϭ18; 29 ng/L (range: 15 to 78 ng/L) versus 88 ng/L (range: 34 to 172 ng/L) versus 1566 ng/L (range: 624 to 2349 ng/L; PϽ0.001). Across the range of patients, left ventricular end-systolic wall stress (r 2 ϭ0.51) and peak systolic mitral annular velocity (r 2 ϭ0.47) showed the strongest correlation with higher transcardiac BNP gradient. In contrast, the transcardiac BNP gradient was weakly related to indices of diastolic load, including pulmonary capillary wedge pressure (r 2 ϭ0.27) and left ventricular end-diastolic wall stress (r 2 ϭ0.21). Across this spectrum of pathophysiology, left ventricular end-systolic wall stress appears to be the key mechanical stimulus influencing cardiac BNP release. (Hypertension. 2010;56:682-689.)

Effects of nicorandil on the reduction of BNP levels in patients with chronic kidney disease

“…Therefore, we applied BNP, not NT-proBNP, as a prognostic surrogate marker in this study. It is reported that left ventricular end-systolic wall stress is the key mechanical stimulus for cardiac BNP release [34]. Our data demonstrated that the change in BNP levels is correlated to the changes in AI and cPP.…”

Renal Function Trajectories and Clinical Outcomes in Acute Heart Failure

“…33 However, tools for assessing congestion in AHF, including biomarkers and noninvasive devices, remain limited. 34,35 Implantable hemodynamic monitors, if approved, should provide important new understanding of the relationship among filling pressures, renal function, and outcomes in AHF. 36 These tools may also help to explain a negative impact of improved renal function [29][30][31] by identifying patients in whom WRF occurred before admission.…”

Brain Natriuretic Hormone Predicts Stress Induced Alterations in Diastolic Function

“…The likely explanation is that exercise causes increase in venous return leading to atrial stretch causing increase release of natriuretic peptides. Other determinant factors of pro-BNP include age, left ventricular hypertrophy, ventricular dysfunction (i.e., decreased ejection fraction and/or increased left ventricular end diastolic pressure) and subclinical myocardial injury and ischemia 21,[27][28][29] .…”