title: [Clinical characteristics of severe chronic heart failure patients with normal blood B-type natriuretic peptide].
abstract: OBJECTIVE
  To investigate the clinical features of severe chronic heart failure patients with normal B-type natriuretic peptide (BNP).
  
  
  METHODS
  A total of 57 patients with severe chronic heart failure (New York Heart Association class III and IV) were included in this prospective control study from Dec. 2002 to Oct. 2009. Group A included 13 patients with normal BNP (< 100 ng/L) and group B included 44 patients with increased BNP (> 100 ng/L). Group A patients were followup for (19.6 ± 14.7) months and group B patients for (72.5 ± 17.1) months.
  
  
  RESULTS
  The baseline clinical characteristics of two groups were comparable. Left ventricular end diastolic diameter (LVEDd) of group A was larger than group B [(70.56 ± 4.33) mm vs.(63.73 ± 3.75) mm, P < 0.05], the left ventricular ejection fraction (LVEF) of group A was lower than group B [(24.16 ± 2.50)% vs. (28.49 ± 2.63)%, P < 0.05]. The number of patents tolerating metoprolol in group A is lower than in group B (7/13 vs. 39/44, P < 0.05), and the tolerant dose of metoprolol in group A is lower than in group B [(12.5 ± 6.25) mg/d vs. (24.20 ± 11.22) mg/d, P < 0.05]. The level of BNP in group B were significantly higher at acute stages than at remission stages [(962.73 ± 165.00) ng/L vs. (876.24 ± 167.70) ng/L, P < 0.05], but remained unchanged in group A [(74.03 ± 11.18) ng/L vs. (71.38 ± 11.68) ng/L, P > 0.05]. The mortality of group A was higher than group B (11/12 vs. 6/44, P < 0.05). The binary logistic regression analysis (backward) showed that normal B-type natriuretic peptide was an independent predictor of cardiovascular mortality in patients with severe chronic heart failure (OR = 45.488, 95%CI = 5.322 - 388.791).
  
  
  CONCLUSIONS
  Normal BNP in patients with severe chronic heart failure suggests the exhaustion of BNP secretion and associated poor prognosis.
authors.affiliation: Department of Cardiology, Affiliated People's Hospital of Nanjing Medical University in Wuxi, Wuxi 214023, China. Yangzhenyu@medmail.com.cn
authors.forename: Zhen-Yu
authors.initials: ZY
authors.lastname: Yang
authors.forename: Ku-Lin
authors.initials: KL
authors.lastname: Li
authors.forename: Qiang
authors.initials: Q
authors.lastname: Wang
authors.forename: Ru-Xing
authors.initials: RX
authors.lastname: Wang
mesh_terms: D000368:Aged; D002908:Chronic Disease; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011379:Prognosis; D011446:Prospective Studies
chemical_list: D020097:Natriuretic Peptide, Brain