Methods of assessing the functional status of patients with left ventricular systolic dysfunction in interventional studies: can brain natriuretic peptide measurement be used as surrogate for the traditional methods?
OBJECTIVE
To review whether brain natriuretic peptides (BNP) can be used as a surrogate for the traditional methods of assessing functional status in interventional studies of patients with left ventricular systolic dysfunction (LVSD).


RESULTS
The traditional methods for assessing functional status including New York Heart Association (NYHA) class, exercise intolerance and quality of life were reviewed in relation to BNP measurements in patients with LVSD. A meta-analysis of four studies evaluating BNP levels versus exercise peak oxygen uptake or 6-minute walking distance showed a significant correlation, but a low R-value of -0.59. Studies using BNP levels for optimisation of heart failure therapy showed conflicting results concerning the correlation between the functional improvement and changes in BNP levels. Conflicting results were also found concerning the utility of BNP levels as a surrogate to predict efficacy of the various anti-congestive therapies on heart failure outcome.


CONCLUSIONS
The results of the studies examining BNP measurement as a surrogate for functional status and drug efficacy in patients with LVSD are conflicting. Further studies are necessary to settle the place of BNP measurement as surrogate marker for exercise tolerance, NYHA classification and in assessing efficacy of different interventions in the clinical trials.
Abdulla
Jawdat
J
Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark. ja@heart.dk
Køber
Lars
L
Torp-Pedersen
Christian
C
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood*; D002227:Carbazoles / Q000627:therapeutic use; D000077261:Carvedilol; D002986:Clinical Trials as Topic / Q000379:methods / Q000706:statistics & numerical data; D003625:Data Collection / Q000379:methods; D004334:Drug Administration Schedule; D004656:Enalapril / Q000627:therapeutic use; D005080:Exercise Test / Q000379:methods / Q000706:statistics & numerical data; D017079:Exercise Tolerance / Q000502:physiology; D006304:Health Status; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology; D006801:Humans; D048289:Imidazolidines / Q000627:therapeutic use; D015201:Meta-Analysis as Topic; D008790:Metoprolol / Q000627:therapeutic use; D020097:Natriuretic Peptide, Brain / Q000097:blood* / Q000737:chemistry; D011412:Propanolamines / Q000627:therapeutic use; D011788:Quality of Life; D013223:Statistics as Topic; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000145:classification / Q000175:diagnosis* / Q000503:physiopathology
D000806:Angiotensin-Converting Enzyme Inhibitors; D015415:Biomarkers; D002227:Carbazoles; D048289:Imidazolidines; D011412:Propanolamines; D000077261:Carvedilol; D020097:Natriuretic Peptide, Brain; D004656:Enalapril; C065166:imidapril; D008790:Metoprolol