title: B-type natriuretic peptide for diagnosis and treatment of congestive heart failure.
abstract: BACKGROUND
  Prognostic classification of congestive heart failure (CHF) is difficult and only possible with the help of additional diagnostic tools. B-type natriuretic peptide (BNP) has been used as a diagnostic and prognostic marker for patients (pts) with CHF. In this study, the clinical value of BNP for stratification and treatment of pts with CHF was evaluated.
  
  
  METHODS
  33 out-pts with CHF (age 57 +/- 12 years) were included. Left-ventricular (LV) ejection fraction (EF) was 27 +/- 8% (mean +/- SD) and NYHA-class 2.4 +/- 0.7. Following parameters were measured: BNP and sodium from blood samples, exercise performance from 6-minute walking test (6MWT, meters) (n = 18), LV end-diastolic diameter (LVEDD) and LV mass (LVM) from 2D-echocardiography (n = 33), as well as LV end-diastolic pressure (LVEDP, n = 23) and systemic vascular resistance (SVR, n = 20) from heart-catheterisation. Ten pts were hospitalised in the preceding 6 months because of worsening CHF or for optimisation of medical therapy. BNP was measured at the beginning and end of the hospital-stay. Follow-up was for 1 year.
  
  
  RESULTS
  Pts with a high NYHA-class had a higher BNP (pg/ml) than those with a low NYHA- class: NYHA I 51 +/- 20, II 281 +/- 223, III 562+/-346 and IV 1061 +/- 126 pg/ml (p = 0.002). BNP correlated with LVEDP (r = 0.50, p <0.02), SVR (r =0.49, p <0.03) and inversely with 6MWT (r =-0.60, p <0.009), LVEF (r = -0.49, p <0.004) and sodium (r = -0.36, p = 0.04). In the hospitalised pts, mean BNP (pg/ml) was 881 +/- 695 at admission,and 532 +/- 435 at discharge (n.s.). Decrease in BNPduring hospitalisation paralleled weight-loss and was significantly greater in patients with >1000 pg/ml BNP at admission (n = 5) as compared to the 5 patients with BNP <1000 (p <0.03). Patients with an adverse event during 1-year follow-up had significantly higher BNP both at steady-state (603 +/-359 pg/ml) and at time of decompensation than patients with a favourable outcome (227 +/- 218 pg/ml,p <0.001).
  
  
  CONCLUSIONS
  BNP correlates well with the clinical severity of CHF (NYHA-class) and is directly related to filling pressure (LVEDP), LV function(LVEF) and exercise performance (6 MWT). Furthermore, BNP has prognostic impact with regard to adverse clinical events.
authors.affiliation: Swiss Cardiovascular Center, Institute of Clinical Chemistry, University Hospital, Bern, Switzerland.
authors.forename: Gabriela M
authors.initials: GM
authors.lastname: Kuster
authors.forename: Hildegard
authors.initials: H
authors.lastname: Tanner
authors.forename: Gert
authors.initials: G
authors.lastname: Printzen
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Suter
authors.forename: Paul
authors.initials: P
authors.lastname: Mohacsi
authors.forename: Otto M
authors.initials: OM
authors.lastname: Hess
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D009320:Atrial Natriuretic Factor / Q000097:blood* / Q000627:therapeutic use*; D002316:Cardiotonic Agents / Q000097:blood* / Q000627:therapeutic use*; D015331:Cohort Studies; D005080:Exercise Test; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000188:drug therapy* / Q000503:physiopathology; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain; D017063:Outcome Assessment, Health Care; D019095:Point-of-Care Systems; D015203:Reproducibility of Results; D018570:Risk Assessment; D012720:Severity of Illness Index
chemical_list: D002316:Cardiotonic Agents; D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor