title: Myocardial stiffness is an important determinant of the plasma brain natriuretic peptide concentration in patients with both diastolic and systolic heart failure.
abstract: OBJECTIVE
  Plasma brain natriuretic peptide (BNP) concentration increases in proportion to heart failure (HF) severity. Although plasma BNP decreases to a certain level by optimal treatment, there is significant heterogeneity in the baseline value among individuals. The underlying mechanism of the steady-state plasma BNP levels remains still controversial. We investigated the hypothesis that myocardial stiffness (K(m)) is a major determinant of the plasma BNP level.
  
  
  RESULTS
  In 19 patients with diastolic HF [DHF; left ventricular ejection fraction (LVEF) > or =4 5%], 18 with systolic HF (SHF; LVEF < 45%), and 12 controls, left ventricular (LV) performance variables and the results of the stress-strain analyses were obtained by the combined simultaneous measurement of echocardiographic and haemodynamic data, and compared with the plasma BNP level. In DHF, a significant correlation was observed between plasma BNP and fractional shortening (P = 0.010), pulmonary capillary wedge pressure (P = 0.030), end-diastolic pressure (P = 0.006), time constant of the LV isovolumic-pressure decline (P = 0.049), end-diastolic stress (P = 0.012), and K(m) (P = 0.004), respectively. In SHF, a significant correlation was observed between plasma BNP and end-diastolic stress (P = 0.036), chamber stiffness (P = 0.048), and K(m) (P = 0.003), respectively.
  
  
  CONCLUSIONS
  In stable conditions, K(m) may be the most important determinant of the plasma BNP production in patients with both DHF and SHF.
authors.affiliation: Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe University, Graduate School of Medicine, Chuo-ku, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Watanabe
authors.forename: Junya
authors.initials: J
authors.lastname: Shite
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Takaoka
authors.forename: Toshiro
authors.initials: T
authors.lastname: Shinke
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Imuro
authors.forename: Toru
authors.initials: T
authors.lastname: Ozawa
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Otake
authors.forename: Daisuke
authors.initials: D
authors.lastname: Matsumoto
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ogasawara
authors.forename: Oscar Luis
authors.initials: OL
authors.lastname: Paredes
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Yokoyama
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D009202:Cardiomyopathies / Q000097:blood* / Q000503:physiopathology; D003971:Diastole / Q000502:physiology; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D013318:Stroke Volume / Q000502:physiology; D013599:Systole / Q000502:physiology
chemical_list: D020097:Natriuretic Peptide, Brain