Differential atrial and ventricular expression of myocardial BNP during evolution of heart failure
Andreas LuchnerTracy L. StevensDaniel D. BorgesonMargaret M. RedfieldChi-Ming WeiJ G PorterJohn C. Burnett
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Abstract:
Although brain natriuretic peptide (BNP) of myocardial origin is important in cardiovascular and renal function and as a marker of cardiac dysfunction, the expression of BNP in atrial and ventricular myocardium remains controversial both under normal conditions and in heart failure. We therefore determined left atrial and left ventricular (LV) gene expression and tissue concentration as well as circulating BNP during the evolution of rapid ventricular pacing-induced congestive heart failure (CHF) in the dog. Early LV dysfunction after 10 days of pacing was characterized by impaired LV function but maintained arterial pressure, and overt CHF after 38 days of pacing was characterized by further impaired LV function and decreased systemic arterial pressure. Under normal conditions, cardiac BNP mRNA and cardiac tissue BNP were of atrial origin. In early LV dysfunction, BNP mRNA and tissue BNP were markedly increased in the left atrium in association with an increase in circulating BNP but remained below or at the limit of detection in the LV. In overt CHF, BNP mRNA was further increased in the left atrium and first increased in the LV, together with an increase in LV tissue BNP and a further increase in circulating BNP. In the progression of CHF, early LV dysfunction is characterized by a selective increase in atrial BNP expression in association with increased circulating BNP. Overt CHF is characterized by an additional recruitment of ventricular BNP expression and a further increase in circulating BNP. These studies provide important new insight into the local and temporal regulation of cardiac BNP gene expression during the progression of heart failure and underscore the predominant endocrine role of atrial myocardium under normal conditions and in early LV dysfunction.Keywords:
Brain natriuretic peptide
Objective To investigate the value of a B-type natriuretic peptide(BNP) rapid assay in the diagnosis of congestive heart failure(CHF). Methods Plasma BNP was measured in 174 patients with acute breathe difficulty. 103 patients among them were examined for left ventricular ejection fraction(LVEF) and left ventricular diastolic dimension (LVDD) by echocardiography. Results BNP levels of 140 patients with CHF and 34 patients with pulmonary breathe difficulty were 245 ng/L(5～4 500 ng/L) and (30.8±27.1) ng/L respectively. In patients with CHF, BNP levels were related with the New York Heart Association classification. The plasma BNP levels increased when LVEF reduced and LVDD dilated. The plasma BNP levels of NYHA class Ⅲ and Ⅳ were markedly higher than NYHA class Ⅰ and Ⅱ. Conclusions BNP can reflect the change of left ventricular function, and it might be useful for early diagnosis and prognosis of CHF.
Brain natriuretic peptide
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To investigate the correlation between brain natriuretic peptide (BNP) and the cardiac function in patients with heart failure(HF), the plasma level of BNP was determined by IRMA and the left cardiac function parameters were measured on echocardiogram in patients with different grade of HF. The results showed that the plasma level of BNP elevated with the worsening of heart failure (NYHA classification). The plasma levels of BNP were negatively correlated with left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVDd). The plasma level of BNP increases significantly along with the severity of HF classified by NYHA, and might be a biochemical parameter for evaluating the left ventricular function.
Brain natriuretic peptide
Ventricular Function
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The aim of this study was to assess the value of the radioimmunometric determination of natriuretic peptide type-B (brain natriuretic peptide, BNP) in the diagnosis and prognosis of heart failure, and to study the association between BNP and the clinical, analytical and echocardiographic variables associated with the evolution of heart failure. The study group included 169 patients (74 women and 95 men; mean, 66 years) with heart failure of different causes, admitted consecutively to our hospital. BNP levels were measured with a radioimmunometric assay (Shionora BNP Cis ) after day 3 of admission. Patients were also studied by echocardiography. A significant association between the cause of heart failure and the BNP concentration was found (patients with ischaemic disease had the highest BNP values). Systolic function was worse in patients with ischaemic disease or dilated cardiomyopathy. High BNP values were also associated with advanced functional class and male sex. Plasma creatinine correlated positively with plasma BNP. However, we found no significant association with the other clinical variables evaluated. Of the echocardiographic variables analysed, BNP correlated positively with the ventricular diameter and pulmonary artery systolic pressure, and inversely with the shortening fraction; patients with severely impaired systolic function had the highest BNP values. It can be concluded that BNP levels (by radioimmunometric assay) are increased in patients with heart failure, and increase in relation to left ventricular dysfunction and the severity of heart failure. The strong independent association of plasma BNP with the left ventricular ejection fraction, its stability and the low cost of measurement suggest that plasma BNP assay could become a routine test. BNP assay could be included as an important factor in clinical and therapeutic decision making, as it complements the information provided by other variables used in the diagnosis of heart failure.
Brain natriuretic peptide
Dilated Cardiomyopathy
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Objective To investigate the relationship of brain natriuretic peptide(BNP) and cardiac function in congestive heart failure patients and the role of BNP in diagnosis,prognosis assessment in congestive heart failure. Methods Eighty-two congestive heart failure patients and 30 normal subjects were collected.Cardiac left ventricular ejection fraction was assessed by cardiac color Doppler ultrasound;plasma BNP levels was measured by fluorescence immunoassay;the patients were followed up for 2 years and survival analysis was performed.Results The plasma BNP levels in patients with heart failure is far higher than that in the normal healthy subjects(P 0.05),and BNP negatively related to cardiac function;survival analysis showed that BNP levels was closely related to two end-point events. Conclusion BNP levels and cardiac function is related,and BNP can be used for diagnosis and the prognosis assessment of congestive heart failure patients.
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Objective To investigate the relationship between brain natriuretic peptide(BNP) level and left ventricular remodeling and prognostic value in chronic heart failure(CHF) patients.Methods The plasma BNP concentrations of 126 CHF patients were measured quickly by luminoimmunoassay.The main adverse cardiac events(MACE,including cardiavarscular death,recurrent heart failure/readmission for HF worsening) were analyzed at inhospital and 30 days and 6 months.Results With the higher BNP values in CHF group gradually,LVMI and LVIDdI increasing,and LVEF decreasing distinctly with the higher incidence of MACE.After adjustment for clinical prognostic factors,such as ages,LVMI,LVIDdI,and LVEF in CHF groups,BNP level remained significantly independent predictor for MACE at 30 days(r=0.769,P0.01) and 6 months(r=0.831,P0.01) by multivariate logistic regression analysis.The Area under receiver operating characteristic(ROC) curve was 0.851(95%CI 0.778-0.924,P0.01) for incidence of MACE at 6 months.Conclusion Plasma BNP level is related with left ventricular remodeling,and it is a significantly independent predictor for MACE in patients with CHF.
Mace
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Ventricular remodeling
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Objective:To explore the relation between brain natriuretic peptide (BNP) and cardiac function in patients with congestive heart failure (CHF).Methods:The study subjects were divided into two groups: CHF group and normal heart function group(control group).The BNP was detected by ELISA. When cardiac function of CHF group was corrected the BNP was detected again.Results:BNP level of CHF group was higher than that of control group(P0.01),and declined with cardiac function improvement(P0.05).Conclusion:BNP level has a relation with cardiac function and it may be a good biomarker in diagnosing CHF and evaluating cardiac function.
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Objective To evaluate the significance of brain natriuretic peptide(BNP) in patients with chronic congestive heart failure. Methods The plasma brain natriuretic peptide level of 120 chronic heart failure patients and 110 controls were measured with ELISA method in admition,two weeks later.LVdD,left ventricular rejection fraction and cardiac index were detected with color Doppler.Correlation analysis was done between plasma level of brain natriuretic peptide and LVdD,left ventricular rejection fraction, cardiac index in chronic heart failure patients.Results The plasma brain natriuretic peptide level in chronic heart failure group was much higher than that in the controls(P0.01),which was positively correlated with NYHA class and LVdD,and negatively with left ventricular rejection fraction and cardiac index.After regular treatment,with the improving of heart function,the level of brain natriuretic peptide declined obviously(P0.05).Conclusion The plasma level of brain natriuretic peptide is correlated with the cardiac function in patients with chronic heart failure,and it has some clinical value in the diagnosis and evaluation of the condition on the patients with chronic heart failure.
Brain natriuretic peptide
Cardiac index
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Objective: To investigate the correlative relationship among the level of brain/b-type natriuretic peptide (BNP) , and the severity of heart failure (HF) , left ventricular function in old patients with heart failure. Methods: BNP levels of 79 patients with heart failure were measured by ELlSA; Colored Doppler echocardiography was performed to measure the left ventricular function. Results: BNP levels increased with increment of NYHA classification, and this was negatively correlated left ventricular ejection fraction (P0. 05). Conclusion: BNP level increase with the degree of severity of heart failure and can better reflect the left ventricular function.
Brain natriuretic peptide
Ventricular Function
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Objective To study the relationship between level of brain natriuretic peptide and the cardiac function in the patients with chronic heart failure and to investigate the value of brain natriuretic peptide in the diagnosis and illness evaluation on chronic heart failure.Methods The plasma brain natriuretic peptide level of 134 chronic heart failure patients and 102 controls were measured with ELISA method.Left ventricular ejection fraction and cardiac index were detected with color Doppler.Correlation analysis was done between plasma level of brain natriuretic peptide and left ventricular ejection fraction,cardiac index in chronic heart failure patients.Results The plasma brain natriuretic peptide level in chronic heart failure group was much higher than that in the controls(P0.01),which was positively correlated with NYHA class,and negatively with left ventricular ejection fraction and cardiac index.After regular treatment,with the improving of heart function,the level of brain natriuretic peptide declined obviously(P0.05).Brain natriuretic peptide level in the patients without improved heart function was significantly higher than that in the patients with improved heart function(P0.01).Conclusion The plasma level of brain natriuretic peptide is correlated with the cardiac function in patients with chronic heart failure,and it has some clinical value in the diagnosis and evaluation of the condition on the patients with chronic heart failure.
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Cardiac index
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Objective To demonstrate the relations of the serume brain natriuretic peptide(BNP) concentration with cardiac function in patients with chronic heart failure . Methods The serume brain natriuretic peptide(BNP) concentration were measured with ELISA methods in 62 heart failure patients and 20 healthy persons as control. Doppler echocardiography was performed to determine left ventricular ejection fraction (LVEF), left ventricular fractional shortening(FS) and left ventricular end diastolic diameters (LVEDD).Observe the correlation of BNP with LVEF?FS?LVEDD. Results The serume BNP concentration was significantly increased in patients with chronic heart failure as compared with healthy subjects(P0.01=,BNP levels were significantly increased in heart function classes according to NYHA. BNP concentration had a significant negative correlation with LVEF(r=-0.62, P0.01=, FS(r=-0.59, P0.01=and positively correlated with LVEDD in patients with heart failure(r=0.67, P0.01=. Conclusion The serume BNP concentration was good marker used to reflect cardiac function and had a close relationship with left ventricular structure.
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