Brain natriuretic peptide blood levels in the differential diagnosis of dyspnea.
OBJECTIVE
In dyspneic patients without left ventricular enlargement, it may be difficult to differentiate between obstructive lung disease and diastolic heart failure. Determination of plasma brain natriuretic peptide (BNP) levels, known to increase with ventricular stretch, may be of clinical relevance in this situation. We compared the discriminant power of BNP blood levels and of echocardiography in patients with either chronic obstructive lung disease or diastolic heart failure.


METHODS
Twenty-six New York Heart Association class III dyspneic patients with normal left ventricular systolic function were enrolled: 17 patients with chronic obstructive lung disease and 9 patients with unequivocal diastolic heart failure.


RESULTS
Echocardiographic data were unable to accurately differentiate between the two groups, whereas BNP levels were significantly and markedly higher in patients with diastolic heart failure when compared to those with obstructive lung disease (224 +/- 240 pg/mL vs 14 +/- 12 pg/mL, p < 0.0001).


CONCLUSIONS
These preliminary results warrant a prospective, large-scale evaluation of the value of BNP assay for determining diastolic dysfunction, a common cause of dyspnea in elderly patients, and differentiating it from other diagnoses such as obstructive lung disease.
Cabanes
L
L
Department of Cardiology, Cochin Hospital, René Descartes University, Paris, France. laure.cabanes@cch.ap-hop-paris.fr
Richaud-Thiriez
B
B
Fulla
Y
Y
Heloire
F
F
Vuillemard
C
C
Weber
S
S
Dusser
D
D
D000368:Aged; D003937:Diagnosis, Differential; D003971:Diastole / Q000502:physiology; D004417:Dyspnea / Q000097:blood* / Q000209:etiology; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011237:Predictive Value of Tests; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood* / Q000175:diagnosis
D020097:Natriuretic Peptide, Brain