title: Relation of brain natriuretic peptide level to extent of left ventricular scarring in patients with chronic heart failure secondary to ischemic cardiomyopathy.
abstract: Multiple factors influence brain natriuretic peptide (BNP) release in patients with heart failure. We hypothesized that extensive myocardial scarring could result in an attenuated BNP response. A total of 115 patients with New York Heart Association class III chronic heart failure and ischemic cardiomyopathy were evaluated for ischemia, hibernation, and myocardial scarring by dipyridamole-rubidium-positron emission tomographic scanning with fluorine-18, 2-fluoro-2-deoxyyglucose. Plasma BNP levels were determined within 2 weeks of the study. Left ventricular dimension and function were evaluated by echocardiography. Patients were categorized as having <33% myocardial scar (n=67) or>or=33% myocardial scar (n=48). BNP measurements were correlated with amount of myocardial scarring. Compared with patients with less scar, those with >or=33% scar had lower BNP levels (mean 317+/-364 vs 635+/-852 pg/ml, median 212 vs 357, p=0.016). Using multiple regression analysis, presence of scarring was associated with decreased BNP response (p=0.022). Further, patients with <33% scar in whom a higher BNP level was noted had more ischemia (51% vs 27%, p=0.01) and greater myocardial hibernation (22+/-14% vs 12+/-7%, p=0.02) compared with patients with >or=33% scar. In conclusion, in patients with chronic heart failure, a decreased BNP response indicated extensive myocardial scarring.
authors.affiliation: University of Rochester Medical Center, Cardiology Department, Rochester, New York, USA. Mehmet_Aktas@urmc.rochester.edu
authors.forename: Mehmet Kemal
authors.initials: MK
authors.lastname: Aktas
authors.forename: Drew
authors.initials: D
authors.lastname: Allen
authors.forename: Wael A
authors.initials: WA
authors.lastname: Jaber
authors.forename: Hsuan-Hung
authors.initials: HH
authors.lastname: Chuang
authors.forename: David O
authors.initials: DO
authors.lastname: Taylor
authors.forename: Mohamad H
authors.initials: MH
authors.lastname: Yamani
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D002921:Cicatrix / Q000473:pathology; D004452:Echocardiography; D005260:Female; D019788:Fluorodeoxyglucose F18; D006333:Heart Failure / Q000097:blood* / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood* / Q000000981:diagnostic imaging / Q000473:pathology; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D019275:Radiopharmaceuticals; D012044:Regression Analysis; D012189:Retrospective Studies; D014055:Tomography, Emission-Computed / Q000379:methods; D018487:Ventricular Dysfunction, Left / Q000097:blood* / Q000000981:diagnostic imaging / Q000473:pathology
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D020097:Natriuretic Peptide, Brain