Associates of an elevated natriuretic peptide level in stable heart failure patients: implications for targeted management.
BACKGROUND
Persistently elevated natriuretic peptide (NP) levels in heart failure (HF) patients are associated with impaired prognosis. Recent work suggests that NP-guided therapy can improve outcome, but the mechanisms behind an elevated BNP remain unclear. Among the potential stimuli for NP in clinically stable patients are persistent occult fluid overload, wall stress, inflammation, fibrosis, and ischemia. The purpose of this study was to identify associates of B-type natriuretic peptide (BNP) in a stable HF population.


METHODS
In a prospective observational study of 179 stable HF patients, the association between BNP and markers of collagen metabolism, inflammation, and Doppler-echocardiographic parameters including left ventricular ejection fraction (LVEF), left atrial volume index (LAVI), and E/e prime (E/e') was measured.


RESULTS
Univariable associates of elevated BNP were age, LVEF, LAVI, E/e', creatinine, and markers of collagen turnover. In a multiple linear regression model, age, creatinine, and LVEF remained significant associates of BNP. E/e' and markers of collagen turnover had a persistent impact on BNP independent of these covariates.


CONCLUSIONS
Multiple variables are associated with persistently elevated BNP levels in stable HF patients. Clarification of the relative importance of NP stimuli may help refine NP-guided therapy, potentially improving outcome for this at-risk population.
Chronic Cardiovascular Disease Management Unit, St. Vincent's Healthcare Group/St. Michael's Hospital, Dublin, Ireland.
Aftab
A
Jan
Chronic Cardiovascular Disease Management Unit, St. Vincent's Healthcare Group/St. Michael's Hospital, Dublin, Ireland.
Ian
I
Dawkins
Chronic Cardiovascular Disease Management Unit, St. Vincent's Healthcare Group/St. Michael's Hospital, Dublin, Ireland.
Niamh
N
Murphy
School of Medicine & Medical Science, UCD Conway Institute, University College Dublin, Dublin 4, Ireland.
Patrick
P
Collier
School of Medicine & Medical Science, UCD Conway Institute, University College Dublin, Dublin 4, Ireland.
John
J
Baugh
Chronic Cardiovascular Disease Management Unit, St. Vincent's Healthcare Group/St. Michael's Hospital, Dublin, Ireland.
Mark
M
Ledwidge
Chronic Cardiovascular Disease Management Unit, St. Vincent's Healthcare Group/St. Michael's Hospital, Dublin, Ireland.
Kenneth
K
McDonald
Chronic Cardiovascular Disease Management Unit, St. Vincent's Healthcare Group/St. Michael's Hospital, Dublin, Ireland ; School of Medicine & Medical Science, UCD Conway Institute, University College Dublin, Dublin 4, Ireland.
Chris J
CJ
Watson
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D003094:Collagen / Q000378:metabolism; D003404:Creatinine / Q000097:blood; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D058990:Molecular Targeted Therapy; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011379:Prognosis; D011446:Prospective Studies; D013318:Stroke Volume
D015415:Biomarkers; D020097:Natriuretic Peptide, Brain; D003094:Collagen; D003404:Creatinine