title: Plasma B-type natriuretic peptide levels in systolic heart failure: importance of left ventricular diastolic function and right ventricular systolic function.
abstract: OBJECTIVE
  This study was designed to characterize the importance of echocardiographic indexes, including newer indexes of diastolic function, as determinants of plasma B-type natriuretic peptide (BNP) levels in patients with systolic heart failure (SHF).
  
  
  BACKGROUND
  Plasma BNP levels have utility for diagnosing and managing heart failure. However, there is significant heterogeneity in BNP levels that is not explained by left ventricular size and function alone.
  
  
  METHODS
  In 106 patients with symptomatic SHF (left ventricular ejection fraction [LVEF] <0.35), we measured plasma BNP levels and performed comprehensive echocardiography with assessment of left ventricular diastolic function, including color M-mode (CMM) and tissue Doppler imaging (TDI), and of right ventricular (RV) function.
  
  
  RESULTS
  Median plasma BNP levels were elevated and increased with greater severity of diastolic dysfunction. We found significant correlations (p < 0.001 for all) between BNP and indexes of myocardial relaxation (early diastolic velocity: r = -0.26), compliance (deceleration time: r = -0.55), and filling pressure (early transmitral to early annular diastolic velocity ratio: r = 0.51; early transmitral flow to the velocity of early left ventricular flow propagation ratio: r = 0.41). In multivariate analysis, overall diastolic stage, LVEF, RV systolic dysfunction, mitral regurgitation (MR) severity, age and creatinine clearance were independent predictors of BNP levels (model fit r = 0.8, p < 0.001).
  
  
  CONCLUSIONS
  Plasma BNP levels are significantly related to newer diastolic indexes measured from TDI and CMM in SHF. Heterogeneity of BNP levels in patients with SHF reflects the severity of diastolic abnormality, RV dysfunction, and MR in addition to LVEF, age, and renal function. These findings may explain the powerful relationship of BNP to symptoms and prognosis in SHF.
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA.
authors.forename: Richard W
authors.initials: RW
authors.lastname: Troughton
authors.forename: David L
authors.initials: DL
authors.lastname: Prior
authors.forename: Jeremy J
authors.initials: JJ
authors.lastname: Pereira
authors.forename: Maureen
authors.initials: M
authors.lastname: Martin
authors.forename: Annette
authors.initials: A
authors.lastname: Fogarty
authors.forename: Annitta
authors.initials: A
authors.lastname: Morehead
authors.forename: Timothy G
authors.initials: TG
authors.lastname: Yandle
authors.forename: A Mark
authors.initials: AM
authors.lastname: Richards
authors.forename: Randall C
authors.initials: RC
authors.lastname: Starling
authors.forename: James B
authors.initials: JB
authors.lastname: Young
authors.forename: James D
authors.initials: JD
authors.lastname: Thomas
authors.forename: Allan L
authors.initials: AL
authors.lastname: Klein
mesh_terms: D000368:Aged; D003971:Diastole; D015150:Echocardiography, Doppler; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D013599:Systole; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right
chemical_list: D020097:Natriuretic Peptide, Brain