title: Marked elevation of B-type natriuretic peptide in patients with heart failure and preserved ejection fraction.
abstract: Marked elevations of B-type natriuretic peptide (BNP) are not generally seen in patients with heart failure and preserved ejection fraction (HFpEF). The objective of this study was to examine the clinical and laboratory characteristics of a large cohort of patients with HFpEF and markedly elevated BNP. A retrospective examination of 421 inpatients at a university hospital admitted with a diagnosis of HFpEF was performed. Clinical and echocardiographic data in 4 groups of patients with levels of BNP ≤ 100 pg/mL, 100-400 pg/mL, 400-1,000 pg/mL and > 1,000 pg/mL were compared. Patients with HFpEF and BNP > 1,000 pg/mL (28% of the population) were characterized by impaired renal function and greater use of anti-hypertensive medications. A subset of these patients with BNP > 1,000 pg/mL had normal renal function (21%) and were significantly older, more frequently female, and tended to have lower ejection fractions. Conversely, patients with HFpEF and BNP ≤ 100 pg/mL were younger and had preserved renal function. BNP was inversely related to the likelihood of subsequent admission for heart failure, but not to myocardial infarction or death.
  
  
  CONCLUSIONS
  BNP > 1,000 pg/mL is seen in almost 1/3 of patients hospitalized with HFpEF. This elevation of BNP often reflects impaired renal function, but can also be seen in patients with preserved renal function but relatively impaired systolic function.
authors: Department of Internal Medicine, Division of Cardiovascular Medicine, University of California Davis, Davis, CA, USA.
authors: Samuel
authors: S
authors: Tate
authors: Department of Internal Medicine, Division of Cardiovascular Medicine, University of California Davis, Davis, CA, USA.
authors: Andrea
authors: A
authors: Griem
authors: Department of Public Health Sciences, Division of Biostatistics, University of California Davis, Davis, CA, USA.
authors: Blythe
authors: B
authors: Durbin-Johnson
authors: Department of Internal Medicine, Division of Cardiovascular Medicine, University of California Davis, Davis, CA, USA.
authors: Clifton
authors: C
authors: Watt
authors: Department of Internal Medicine, Division of Cardiovascular Medicine, University of California Davis, Davis, CA, USA. ; Cardiology Section, Department of Veteran Affairs, Northern California Health Care System, Mather, CA, USA.
authors: Saul
authors: S
authors: Schaefer
keywords: B-type natriuretic peptide; chronic kidney disease; diastolic heart failure