title: N-terminal pro-brain natriuretic protein levels in takotsubo cardiomyopathy.
abstract: Takotsubo cardiomyopathy (TTC) is characterized by reversible left ventricular (LV) systolic dysfunction independent of fixed coronary disease or coronary spastic pathogenesis. A number of investigators have documented marked elevation of natriuretic peptide levels at presentation in such patients. We sought to determine the pattern, extent, and determinants of the release of N-terminal pro-B type natriuretic peptide/B type natriuretic peptide (NT-proBNP/BNP) in patients with TTC. We evaluated NT-proBNP/BNP release acutely and during the first 3 months in 56 patients with TTC (96% women, mean age 69 ± 11 years). The peak plasma NT-proBNP levels were compared to the pulmonary capillary wedge pressure and measures of regional and global LV systolic dysfunction (systolic wall stress, wall motion score index, and LV ejection fraction) as potential determinants of NT-proBNP/BNP release. In patients with TTC, the plasma concentrations of NT-proBNP (median 4,382 pg/ml, interquartile range 2,440 to 9,019) and BNP (median 617 pg/ml, interquartile range 426 to 1,026) were substantially elevated and increased significantly during the first 24 hours after the onset of symptoms (p = 0.001), with slow and incomplete resolution during the 3 months thereafter. The peak NT-proBNP levels exhibited no significant correlation with either pulmonary capillary wedge pressure or systolic wall stress. However, the peak NT-proBNP level correlated significantly with the simultaneous plasma normetanephrine concentrations (r = 0.53, p = 0.001) and the extent of impairment of LV systolic function, as measured by the wall motion score index (r = 0.37, p = 0.008) and LV ejection fraction (r = -0.39, p = 0.008). In conclusion, TTC is associated with marked and persistent elevation of NT-proBNP/BNP levels, which correlated with both the extent of catecholamine increase and the severity of LV systolic dysfunction.
authors.affiliation: Queen Elizabeth Hospital, Adelaide, Australia.
authors.forename: Thanh Ha
authors.initials: TH
authors.lastname: Nguyen
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Neil
authors.forename: Aaron L
authors.initials: AL
authors.lastname: Sverdlov
authors.forename: Gnanadevan
authors.initials: G
authors.lastname: Mahadavan
authors.forename: Yuliy Y
authors.initials: YY
authors.lastname: Chirkov
authors.forename: Angela M
authors.initials: AM
authors.lastname: Kucia
authors.forename: Jeanette
authors.initials: J
authors.lastname: Stansborough
authors.forename: John F
authors.initials: JF
authors.lastname: Beltrame
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Selvanayagam
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Zeitz
authors.forename: Allan D
authors.initials: AD
authors.lastname: Struthers
authors.forename: Michael P
authors.initials: MP
authors.lastname: Frenneaux
authors.forename: John D
authors.initials: JD
authors.lastname: Horowitz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000032:analysis; D004452:Echocardiography; D005260:Female; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D009647:Normetanephrine / Q000097:blood; D010446:Peptide Fragments / Q000097:blood*; D011446:Prospective Studies; D011669:Pulmonary Wedge Pressure / Q000502:physiology; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology; D013599:Systole / Q000502:physiology; D054549:Takotsubo Cardiomyopathy / Q000097:blood*; D018487:Ventricular Dysfunction, Left / Q000473:pathology / Q000503:physiopathology
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D009647:Normetanephrine; D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein