title: An increased B-type natriuretic peptide in the absence of a cardiac abnormality identifies those whose left ventricular mass will increase over time.
abstract: OBJECTIVE
  The purpose of this study was to identify the relationship of B-type natriuretic peptide (BNP) with evolution of left ventricular mass (LVM) in optimally treated primary prevention patients.
  
  
  BACKGROUND
  Patients who have an elevated BNP no cardiac abnormality on echocardiography are common and at increased risk of adverse events. One hypothesis is that an elevated BNP is an early sensitive indicator of who will develop future structural abnormalities such as left ventricular (LV) hypertrophy.
  
  
  METHODS
  We identified optimally treated primary prevention patients with no cardiac abnormality at baseline. In particular, they had no myocardial ischemia, LV hypertrophy, LV dysfunction, or left atrial enlargement. They had a diverse range of plasma BNP levels and underwent cardiac magnetic resonance at baseline and 3 years later on a 3-T scanner.
  
  
  RESULTS
  Fifty patients with a diverse range of BNP were studied (with BNP ≤ 10 pg/ml in 25 patients and >10 pg/ml in 25 patients). LVM increased (+4.7 ± 3.5 g) in 24 patients and decreased (-4.9 ± 2.8 g) in 26 patients (p < 0.01). Blood pressure by 24-h monitoring was virtually identical between those whose LVM increased (systolic blood pressure 122 ± 14 mm Hg) and those whose LVM decreased (systolic blood pressure 121 ± 11 mm Hg, p = 0.77). Plasma BNP was nearly 3 times higher in those whose LVM increased versus those in whom LVM decreased (21 ± 9.6 pg/ml vs. 7.9 ± 3.9 pg/ml, p < 0.01). The c-statistic for BNP was 0.88.
  
  
  CONCLUSIONS
  In optimally treated primary prevention patients, plasma BNP levels are able to distinguish between those whose LVM will increase during the next 3 years versus those whose LVM will decrease during the next 3 years. This may explain why individuals with high BNP are at increased risk even if no cardiac abnormality can be detected initially.
authors.affiliation: Division of Cardiovascular & Diabetes Medicine, Medical Research Institute, Ninewells Hospital, Dundee, Scotland, United Kingdom. Electronic address: adnannadir@gmail.com.
authors.forename: M Adnan
authors.initials: MA
authors.lastname: Nadir
authors.affiliation: Division of Cardiovascular & Diabetes Medicine, Medical Research Institute, Ninewells Hospital, Dundee, Scotland, United Kingdom.
authors.forename: Stephen
authors.initials: S
authors.lastname: Gandy
authors.affiliation: Division of Cardiovascular & Diabetes Medicine, Medical Research Institute, Ninewells Hospital, Dundee, Scotland, United Kingdom.
authors.forename: Sheila
authors.initials: S
authors.lastname: Ireland
authors.affiliation: Division of Cardiovascular & Diabetes Medicine, Medical Research Institute, Ninewells Hospital, Dundee, Scotland, United Kingdom.
authors.forename: Tom
authors.initials: T
authors.lastname: MacDonald
authors.affiliation: Division of Cardiovascular & Diabetes Medicine, Medical Research Institute, Ninewells Hospital, Dundee, Scotland, United Kingdom.
authors.forename: Ellie
authors.initials: E
authors.lastname: Dow
authors.affiliation: Division of Cardiovascular & Diabetes Medicine, Medical Research Institute, Ninewells Hospital, Dundee, Scotland, United Kingdom.
authors.forename: Graeme
authors.initials: G
authors.lastname: Houston
authors.affiliation: Division of Cardiovascular & Diabetes Medicine, Medical Research Institute, Ninewells Hospital, Dundee, Scotland, United Kingdom.
authors.forename: Chim
authors.initials: C
authors.lastname: Lang
authors.affiliation: Division of Cardiovascular & Diabetes Medicine, Medical Research Institute, Ninewells Hospital, Dundee, Scotland, United Kingdom.
authors.forename: Allan
authors.initials: A
authors.lastname: Struthers
mesh_terms: D001794:Blood Pressure; D018450:Disease Progression; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000097:blood* / Q000175:diagnosis / Q000503:physiopathology; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D012189:Retrospective Studies; D013318:Stroke Volume; D013997:Time Factors; D016277:Ventricular Function, Left / Q000502:physiology*
chemical_list: D020097:Natriuretic Peptide, Brain
keywords: B-type natriuretic peptide; hypertension; left ventricular mass; primary prevention