Independent effects of both right and left ventricular function on plasma brain natriuretic peptide.
BACKGROUND
Brain natriuretic peptide (BNP) is increased in heart failure; however, the relative contribution of the right and left ventricles is largely unknown.


OBJECTIVE
To investigate if right ventricular function has an independent influence on plasma BNP concentration.


METHODS
Right (RVEF), left ventricular ejection fraction (LVEF), and left ventricular end-diastolic volume index (LVEDVI) were determined in 105 consecutive patients by first-pass radionuclide ventriculography (FP-RNV) and multiple ECG-gated equilibrium radionuclide ventriculography (ERNV), respectively. BNP was analyzed by immunoassay.


RESULTS
Mean LVEF was 0.51 (range 0.10-0.83) with 36% having a reduced LVEF (<0.50). Mean RVEF was 0.50 (range 0.26-0.78) with 43% having a reduced RVEF (<0.50). The mean LVEDVI was 92 ml/m2 with 22% above the upper normal limit (117 ml/m2). Mean BNP was 239 pg/ml range (0.63-2523). In univariate linear regression analysis LVEF, LVEDVI and RVEF all correlated significantly with log BNP (p<0.0001). In a multivariate analysis only RVEF and LVEF remained significant. The parameter estimates of the final adjusted model indicated that RVEF and LVEF influence on log BNP were of the same magnitude.


CONCLUSIONS
BNP, which is a strong prognostic marker in heart failure, independently depends on both left and right ventricular systolic function. This might, at least in part, explain why BNP holds stronger prognostic value than LVEF alone.
Vogelsang
Thomas Wiis
TW
Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen, Denmark. tvogelsang@mfi.ku.dk
Jensen
Ruben J
RJ
Monrad
Astrid L
AL
Russ
Kaspar
K
Olesen
Uffe H
UH
Hesse
Birger
B
Kjaer
Andreas
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D018487:Ventricular Dysfunction, Left / Q000097:blood*; D018497:Ventricular Dysfunction, Right / Q000097:blood*
D015415:Biomarkers; D020097:Natriuretic Peptide, Brain