title: Different implication of elevated B-type natriuretic peptide level in patients with heart failure with preserved ejection fraction and in those with reduced ejection fraction.
abstract: BACKGROUND
  There have been no reports that show significant direct relationship between echocardiographic parameters and B-type natriuretic peptide (BNP) level. This could be due to the heterogeneous pathophysiology of heart failure and a lack of appropriate echocardiographic parameters. We sought to determine the best echocardiographic parameter that described elevated BNP level in patients with heart failure with and without systolic dysfunction.
  
  
  RESULTS
  We studied 111 consecutive heart failure patients. They were divided into patients with heart failure and preserved ejection fraction (HFPEF, n = 61) and that with heart failure and reduced ejection fraction (HFREF, n = 50). Conventional and new echocardiographic parameters including myocardial strains were measured. BNP did not reflect any single echocardiographic parameter in patients with heart failure in total. The ratio of early diastolic transmitral flow velocity and mitral annular velocity had strong positive correlation with BNP level in the HFPEF group but not in the HFREF group. In the group of HFREF, global longitudinal and circumferential strains were positively correlated. Multivariate analysis revealed that predicted factors for BNP value in HFPEF and in HFREF were different.
  
  
  CONCLUSIONS
  High BNP level may indicate high filling pressure when ejection fraction is preserved and may indicate myocardial dysfunction when it is reduced.
authors.affiliation: Department of Health Sciences, Division of Functional Diagnostics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan; Department of Clinical Laboratory Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan.
authors.forename: Takako
authors.initials: T
authors.lastname: Ishigaki
authors.forename: Takashi
authors.initials: T
authors.lastname: Yoshida
authors.forename: Hiromi
authors.initials: H
authors.lastname: Izumi
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Fujisawa
authors.forename: Shoko
authors.initials: S
authors.lastname: Shimizu
authors.forename: Kasumi
authors.initials: K
authors.lastname: Masuda
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Asanuma
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Okabe
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nakatani
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D004452:Echocardiography / Q000379:methods; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000150:complications / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D015854:Up-Regulation; D018487:Ventricular Dysfunction, Left / Q000097:blood* / Q000000981:diagnostic imaging* / Q000209:etiology; D055815:Young Adult
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain
keywords: B-type natriuretic peptide; echocardiography; heart failure with preserved ejection fraction; heart failure with reduced ejection fraction