Brain natriuretic peptide is a reliable indicator of ventilatory abnormalities during cardiopulmonary exercise test in heart failure patients.
BACKGROUND
Whether brain natriuretic peptide (BNP), a neurohormone marker of ventricular dysfunction, correlates with an enhanced ventilatory response (EVR) during cardiopulmonary exercise test, a well-known predictor of prognosis, in systolic heart failure (HF) is currently unknown.


METHODS
Resting BNP was measured in 134 consecutive stable outpatients aged 69 +/- 11 years with mild to moderate HF and LV ejection fraction (LVEF) < 40% who performed a maximal exercise test. EVR was assessed as the slope of the relation between minute ventilation and carbon dioxide production (VE/VCO2 slope) > or = 35.


RESULTS
LVEF averaged 33 +/- 7%, BNP 350 +/- 396 pg/ml, and the VE/VCO2 slope 36 +/- 8. Fifty-six of 123 patients (45%) had EVR. BNP correlated with VE/VCO2 slope (r = 0.453; p < 0.01). By multivariate logistic regression, plasma BNP was the only independent predictor of EVR (RR: 1.004 per unit increment, 95% CI: 1.002-1.006, p < 0.0001). A BNP > or = 160 pg/ml had 86% sensitivity, 67% specificity, and 76% overall accuracy for the prediction of EVR (chi square: 37.4, RR 12.2, 95% CI: 4.96-30.3, p < 0.0001, AUC 0.815 (95%CI. 0.738-0.892)).


CONCLUSIONS
In systolic HF, plasma BNP is related to an enhanced ventilatory response to exercise and offers a simple and reliable alternative to the cardiopulmonary exercise test in patients with inability or contraindications to exercise.
Scardovi
Angela Beatrice
AB
Cardiology Department, S. Spirito Hospital, Rome, Italy. ab.scardovi@libero.it
De Maria
Renata
R
Colettat
Claudio
C
Aspromonte
Nadia
N
Perna
Silvia
S
Infusino
Tommaso
T
D'Errigo
Paola
P
Rosato
Stefano
S
Greggi
Manuela
M
Di Giacomo
Tiziana
T
Riccio
Roberto
R
Cec
Vincenzo
V
D000368:Aged; D000075202:Contraindications; D005080:Exercise Test / Q000379:methods; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011379:Prognosis; D012131:Respiratory Insufficiency / Q000097:blood / Q000503:physiopathology; D012143:Respiratory Physiological Phenomena
D020097:Natriuretic Peptide, Brain