N-terminal Pro B-type Natriuretic Peptide and the Evaluation of Cardiac Dysfunction and Severity of Disease in Cirrhotic Patients

Abstract

PurposeCardiac dysfunction and hyperdynamic systemic circulation may be present in patients with cirrhosis. The purpose of this study was to identify relations between plasma levels of N-terminal-proBNP (NT-proBNP), reflecting early ventricular dysfunction, and the severity of liver disease and cardiac dysfunction in cirrhotic patients.Materials and MethodsSixty-three cirrhotic patients and 15 controls (group 1) were enrolled in this study. Plasma levels of NT-proBNP were determined in echocardiographically examined patients, which were allocated to 1 of 3 groups according to Child-Pugh classification or into 2 groups, i.e., a compensated group without ascites (group 2) and decompensated group with ascites (group 3).ResultsPlasma NT-proBNP levels were significantly higher in cirrhotic patients (groups 2 and 3) than in age-matched controls (155.9 and 198.3 vs. 40.3 pg/mL, respectively, p < 0.05). NT-proBNP levels were significantly increased in Child class C patients than in classes B and A (250.0 vs. 168.6 and 119.6 pg/mL, respectively, p < 0.05). Left atrial dimension, wall thickness of left ventricle, and EF or E/E' were significantly increased, and EDT was prolonged in cirrhotic patients than in controls. Increased LVMI and decreased E/A ratio were noted in the group of patients with ascites as compared with the other groups.ConclusionPlasma NT-proBNP levels were high in cirrhotic patients and are likely to be related to the severity of disease. Advanced cirrhosis is associated with advanced cardiac dysfunction, and NT-proBNP levels has predictive value for concomitant cardiac dysfunction and cirrhosis progression.

N-Terminal Pro-Brain Natriuretic Peptide: Prognostic Potential in End Stage Liver Cirrhosis in a Cohort Free of Heart Failure; an Egyptian Insight

“…In the present study, our results were comparable to several studies [8,10,11], where NT-proBNP levels were raised in cirrhotic patients in comparison to non-cirrhotic, non-cardiac age matched healthy controls. In addition, we noticed that these levels were positively correlated with Child-Pugh and MELD scores as demonstrated in the reported studies [11,17,18].…”

“…Previous studies revealed increased NP concentrations in patients with cirrhosis suggesting cardiac dysfunction [8,10,11]. However, few studies had demonstrated NP significance in prognosis of liver cirrhosis.…”

B-type natriuretic peptide and cirrhosis progression

“…However, high levels of BNP also have been found in congestive states such as heart and renal failure and in chronic liver disease (Passino et al, 2008). Previous studies have shown increased plasma concentrations of BNP in some patients with cirrhosis (Woo et al, 2008;Pimenta et al, 2010), which suggested that cardiac dysfunction might also be present. Recently, several studies have documented that BNP levels were related to the severity of disease in these patients, indicating its predictive value for concomitant cardiac dysfunction and cirrhosis progression (Yildiz et al, 2005).…”

Brain Natriuretic Peptide in Cirrhosis

“…The levels of plasma BNP in cirrhosis has been investigated, but its role as prognostic marker of the disease has not been fully explored [27,28]. It is only used as a marker of decompensated cirrhotic cardiomyopathy, indicating the level of cardiac abnormalities, not the level of cirrhosis [21].…”