Influence of Low-Grade Inflammation on Plasma B-type Natriuretic Peptide Levels

Abstract

Objective B-type natriuretic peptide (BNP) is a cardiac hormone. The results of previous in vitro studies suggest that neurohumoral factors, and not only hemodynamic factors, may cause BNP secretion. In this study, we examined the impact of serum C-reactive protein (CRP) levels on the relationship between echocardiographic parameters and plasma BNP levels in patients with cardiovascular diseases. Methods and PatientsThe study population comprised 417 patients who visited our cardiovascular unit with a problem. Both blood sampling and echocardiography were performed within one month. Results Multiple regression analysis showed that plasma BNP levels were negatively correlated with male gender, body mass index, and estimated glomerular filtration rate, and positively correlated with serum CRP levels and left ventricular end-systolic dimension (LVDs). The study population was divided into two groups based on the 75th percentile of the serum CRP levels. Single regression analysis showed that a regression line between LVDs and plasma BNP levels was steeper in the group of patients with CRP levels above the 75th percentile. Multiple regression analysis revealed that the interaction term (LVDs × CRP) was significant, which means LVDs had more impact on plasma BNP levels at higher CRP levels. Conclusion Plasma BNP levels increased with respect to the severity of cardiac dysfunction and serum CRP levels, and should therefore be considered a collective or total marker for life-threatening conditions including systemic inflammation, and not simply as a marker of cardiac dysfunction in patients with cardiovascular diseases.

The Optimal Cut-off Value of Plasma BNP to Differentiate Heart Failure in the Emergency Department in Japanese Patients with Dyspnea

“…The present study focused on patients with dyspnea who came to a tertiary emergency medical facility due to worsening of symptoms. Moreover, the inflammatory status was relatively high in the present population (Table 2), and inflammation has been previously reported to increase the plasma BNP levels (24). The severity of HF and the presence of inflammation may explain the higher cut-off values of the BNP levels in the present study, therefore the present findings are in line with the cut-off described in the JHFS statement.…”

“…In the present study, many of the patients with respiratory disease had pneumonia and interstitial pneumonia, which causes BNP levels to rise, and this increase in BNP correlates with the level of CRP (23). Our previous report showed that inflammation increases the plasma BNP level (24). In septic patients, the severity of the illness is the main determinant of the BNP level, rather than cardiac function (25).…”

“…Several factors are involved in the regulation of the plasma BNP levels (17,24,26,27). The renal function is known to significantly affect the plasma BNP levels, therefore patients with an eGFR <30 mL/min/1.73 m 2 were excluded from the present study.…”

Contribution of Extracardiac Factors to the Inconsistency Between Plasma B-type Natriuretic Peptide Levels and the Severity of Pulmonary Congestion on Chest X-rays in the Diagnosis of Heart Failure

“…Caution must be exercised particularly for obese patients, because their plasma BNP levels can be low even in the presence of severe heart failure. Figure 6 shows an example of a clinical scenario using chest X-rays and the rapid BNP assay for the diagnosis of heart failure and other conditions (2,(12)(13)(14)22).…”

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

“…However, the present study identified standard contributing factors affecting changes in plasma BNP levels. 15 Serial BNP measurements are useful in evaluating acute heart failure, and we attempted to investigate improvements in acute heart failure by assessing such measurements. 9 In terms of aging, no significant differences were observed in plasma BNP levels before treatment between older and younger age groups, suggesting that the degree of acute heart failure is not related to aging in the acute phase ( Figure 2).…”