Plasma B-Type Natriuretic Peptide Levels in Ambulatory Patients With Established Chronic Symptomatic Systolic Heart Failure

Abstract

Background-The diagnostic and prognostic values of plasma B-type natriuretic peptide (BNP) testing are established. However, the range of plasma BNP levels present in the setting of chronic, stable systolic heart failure (HF) is unclear. Methods and Results-We followed up 558 consecutive ambulatory patients with chronic, stable systolic HF (left ventricular ejection fraction Ͻ50%) treated at a specialized outpatient HF clinic between November 2001 and February 2003. Retrospective chart review was performed to determine clinical and functional data at the time of BNP testing (Biosite Triage). The clinical characteristics of patients with plasma BNP levels Ͻ100 pg/mL and those with Ն100 pg/mL were compared. In our cohort, 60 patients were considered asymptomatic, and their plasma BNP levels ranged from 5 to 572 pg/mL (median, 147 pg/mL). Of the remaining 498 symptomatic (NYHA functional class II-III) patients, 106 (21.3%) had plasma BNP levels in the "normal" diagnostic range (Ͻ100 pg/mL). Patients in this "normal BNP" subgroup were more likely to be younger, to be female, to have nonischemic pathogenesis, and to have better-preserved cardiac and renal function and less likely to have atrial fibrillation. Conclusions-In the ambulatory care setting, both symptomatic and asymptomatic patients with chronic, stable systolic HF may present with a wide range of plasma BNP levels. In a subset of symptomatic patients (up to 21% in our cohort), plasma BNP levels are below what would be considered "diagnostic" (Ͻ100 pg/mL

Role of Biomarkers for the Prevention, Assessment, and Management of Heart Failure: A Scientific Statement From the American Heart Association

“…121 Measurement of BNP or NT-proBNP is useful for establishing prognosis in chronic HF. Elevated BNP or NTproBNP levels parallel HF disease severity, assessment by New York Heart Association (NYHA) class, elevated filling pressures, or worse hemodynamics [121][122][123][124] and are suggestive of worse clinical outcomes and mortality in chronic HF.…”

“…121 Measurement of BNP or NT-proBNP is useful for establishing prognosis in chronic HF. Elevated BNP or NTproBNP levels parallel HF disease severity, assessment by New York Heart Association (NYHA) class, elevated filling pressures, or worse hemodynamics [121][122][123][124] and are suggestive of worse clinical outcomes and mortality in chronic HF. [125][126][127][128] Further data demonstrated that each 100-pg/mL increase in BNP was associated with a 35% increase (95% confidence interval [CI], 22-49; P=0.096) in the relative risk of death.…”

Association between matrix metalloproteinase‐9 and worsening heart failure events in patients with chronic heart failure

“…Elevated MMP‐9 levels may help identify patients at risk before an increase occurs in ventricular pressure overload, which reflects ongoing ventricular remodeling. The value of BNP levels for guiding therapy in addition to clinical symptom‐based treatment seems to be limited,9, 10, 11, 21 despite the undisputed diagnostic and prognostic importance of these values 6, 7, 8. The benefits of predicting HF events may be offset by non‐HF events.…”

“…Of these, elevated plasma concentrations of brain natriuretic peptide (BNP) show notable associations with development of left ventricular dysfunction and HF 5. Although elevated BNP concentrations have diagnostic and prognostic importance,6, 7, 8 whether intense therapy for HF guided by BNP values is superior to therapy guided by clinical symptoms is unclear 9, 10, 11. BNP play important roles in maintaining cardiorenal homeostasis under physiological and pathological conditions.…”

Integration of Biomarkers Into the Practice of Treating Patients With Heart Failure: The Role of Determining the Blood Level of Natriuretic Peptides

“…Указано, что использование в качестве биомарке-ров МНУП у амбулаторных больных с хронической СН может влиять на клиническую оценку состояния боль-ного, особенно в тех случаях, когда причина развития одышки неясна [4,[20][21][22][23][24][25]. В острой ситуации резуль-таты оценки уровня НУП в качестве биомаркеров имеют более высокую чувствительность по сравнению со специфичностью и могут быть полезнее для исклю-чения СН, а не для ее подтверждения [26].…”