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Clinical Research in Cardiology
Erschienen in: Clinical Research in Cardiology 1/2011

01.01.2011 | Original Paper

Influence of acute and chronic myocardial loading conditions, function, structural changes and extracardiac factors on NT-proBNP in asymptomatic patients with preserved ejection fraction

verfasst von: Olaf Schulz, Andre Rudolph, Sarah Scheiner, Helena Mut, Jeanette Schulz-Menger, Gunnar Berghoefer, Ricarda Bensch, Jochen Kraemer, Ingolf Schimke

Erschienen in: Clinical Research in Cardiology | Ausgabe 1/2011

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Abstract

Background

We compared the effect of different loading conditions, parameters of structural heart disease and extracardiac confounders on NT-proBNP to validate the application of NT-proBNP for a characterisation of loading conditions and clinical course of patients with chronic heart diseases.

Methods

NT-proBNP was measured in 15 controls and 34 patients with preserved ejection fraction and chronic pressure (by aortic stenosis) or volume overload (by aortic or mitral regurgitation) before and after physical as well as dobutamine stress. Myocardial fibrosis was evaluated by contrast-enhanced cardiovascular magnetic resonance.

Results

In patients with elevated NT-proBNP due to chronic pressure or volume overloaded ventricles, physical and dobutamine stress were associated with only marginal nonsignificant additional NT-proBNP responses. Univariate analyses showed that myocardial fibrosis has the greatest effect on NT-proBNP (P < 0.01). Forward regression analyses revealed left ventricular filling, systolic function, the presence of valvular heart disease, serum creatinine and responses to dobutamine stress as independent determinants of NT-proBNP (P < 0.05 each).

Conclusion

NT-proBNP cannot be used simply to characterise intensity of ventricular load. Character and duration of loading conditions, cardiac structure and function, as well as confounders should be considered when NT-proBNP is used for clinical follow-up assessment.
Literatur
1.
Anand IS, Fisher LD, Chiang YT et al (2003) Changes in brain natriuretic peptide and norepinephrine over time and mortality and morbidity in the Valsartan Heart Failure Trial (Val-HeFT). Circulation 107:1278–1283CrossRefPubMed
2.
Maisel A (2010) Natriuretic peptide-guided therapy for heart failure. Ready for “battle” or too “scarred” by the challenges of trial design? J Am Coll Cardiol 55:61–64CrossRef
3.
Berger R, Moertl D, Peter S et al (2010) N-terminal pro-B-type natriuretic peptide-guided intensive patient management in addition to multidisciplinary care in chronic heart failure. A 3-arm, prospective, randomized pilot study. J Am Coll Cardiol 55:645–653CrossRefPubMed
4.
Ogawa T, Linz W, Stevenson M et al (1996) Evidence for load-dependent and load-independent determinants of cardiac natriuretic peptide production. Circulation 93:2059–2067PubMed
5.
Magga J, Vuolteenaho O, Tokola H, Marttila M, Ruskoaho H (1997) Involvement of transcriptional and posttranscriptional mechanisms in cardiac overload-induced increase of B-type natriuretic peptide gene expression. Circ Res 81:694–702PubMed
6.
Tang WH, Girod JP, Lee MJ et al (2003) Plasma B-type natriuretic peptide levels in ambulatory patients with established chronic symptomatic systolic heart failure. Circulation 108:2964–2966CrossRefPubMed
7.
O’Neill JO, Bott-Silverman CE, McRae AT 3rd et al (2005) B-type natriuretic peptide levels are not a surrogate marker for invasive hemodynamics during management of patients with severe heart failure. Am Heart J 149:363–369CrossRefPubMed
8.
Goetze JP, Mogelvang R, Maage L et al (2006) Plasma pro-B-type natriuretic peptide in the general population: screening for left ventricular hypertrophy and systolic dysfunction. Eur Heart J 27:3004–3010CrossRefPubMed
9.
Zoghbi WA, Enriquez-Sarano M, Foster E et al (2003) Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 16:777–802CrossRefPubMed
10.
Vahanian A, Baumgartner H, Bax J et al (2007) Guidelines on the management of valvular heart disease: the Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology. Eur Heart J 28:230–268PubMed
11.
Ganau A, Devereux RB, Roman MJ et al (1992) Patterns of left ventricular hypertrophy and geometric remodeling in essential hypertension. J Am Coll Cardiol 19:1550–1558CrossRefPubMed
12.
Diez J, Querejeta R, Lopez B, Gonzalez A, Larman M, Martinez Ubago JL (2002) Losartan-dependent regression of myocardial fibrosis is associated with reduction of left ventricular chamber stiffness in hypertensive patients. Circulation 105:2512–2517CrossRefPubMed
13.
Ommen SR, Nishimura RA, Appleton CP et al (2000) Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: a comparative simultaneous Doppler-catheterization study. Circulation 102:1788–1794PubMed
14.
Moller JE, Sondergaard E, Seward JB, Appleton CP, Egstrup K (2000) Ratio of left ventricular peak E-wave velocity to flow propagation velocity assessed by color M-mode Doppler echocardiography in first myocardial infarction: prognostic and clinical implications. J Am Coll Cardiol 35:363–370CrossRefPubMed
15.
Nagueh SF, Middleton KJ, Kopelen HA, Zoghbi WA, Quinones MA (1997) Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures. J Am Coll Cardiol 30:1527–1533CrossRefPubMed
16.
Reichek N, Wilson J, St John Sutton M, Plappert TA, Goldberg S, Hirshfeld JW (1982) Noninvasive determination of left ventricular end-systolic stress: validation of the method and initial application. Circulation 65:99–108PubMed
17.
Kalra DK, Ramchandani M, Zhu X et al (2002) Relation of tissue Doppler-derived myocardial velocities to serum levels and myocardial gene expression of tumor necrosis factor-alpha and inducible nitric oxide synthase in patients with ischemic cardiomyopathy having coronary artery bypass grafting. Am J Cardiol 90:708–712CrossRefPubMed
18.
Rudolph A, Abdel-Aty H, Bohl S et al (2009) Noninvasive detection of fibrosis applying contrast-enhanced cardiac magnetic resonance in different forms of left ventricular hypertrophy relation to remodeling. J Am Coll Cardiol 53:284–291CrossRefPubMed
19.
Wu AH (2006) Serial testing of B-type natriuretic peptide and NTpro-BNP for monitoring therapy of heart failure: the role of biologic variation in the interpretation of results. Am Heart J 152:828–834CrossRefPubMed
20.
Kuhn M (2003) Structure, regulation, and function of mammalian membrane guanylyl cyclase receptors, with a focus on guanylyl cyclase-A. Circ Res 93:700–709CrossRefPubMed
21.
Shelton RJ, Clark AL, Goode K, Rigby AS, Cleland JG (2006) The diagnostic utility of N-terminal pro-B-type natriuretic peptide for the detection of major structural heart disease in patients with atrial fibrillation. Eur Heart J 27:2353–2361CrossRefPubMed
22.
Letsas KP, Filippatos GS, Pappas LK et al (2009) Determinants of plasma NT-pro-BNP levels in patients with atrial fibrillation and preserved left ventricular ejection fraction. Clin Res Cardiol 98:101–106CrossRefPubMed
23.
Simon T, Becker R, Voss F et al (2008) Elevated B-type natriuretic peptide levels in patients with nonischemic cardiomyopathy predict occurrence of arrhythmic events. Clin Res Cardiol 97:306–309CrossRefPubMed
24.
Sabatine MS, Morrow DA, de Lemos JA et al (2004) Acute changes in circulating natriuretic peptide levels in relation to myocardial ischemia. J Am Coll Cardiol 44:1988–1995CrossRefPubMed
25.
McCullough PA, Omland T, Maisel AS (2003) B-type natriuretic peptides: a diagnostic breakthrough for clinicians. Rev Cardiovasc Med 4:72–80PubMed
26.
Dutka DP, Donnelly JE, Palka P, Lange A, Nunez DJ, Nihoyannopoulos P (2000) Echocardiographic characterization of cardiomyopathy in Friedreich’s ataxia with tissue Doppler echocardiographically derived myocardial velocity gradients. Circulation 102:1276–1282PubMed
27.
Weber M, Arnold R, Rau M et al (2004) Relation of N-terminal pro-B-type natriuretic peptide to severity of valvular aortic stenosis. Am J Cardiol 94:740–745CrossRefPubMed
28.
Eimer MJ, Ekery DL, Rigolin VH, Bonow RO, Carnethon MR, Cotts WG (2004) Elevated B-type natriuretic peptide in asymptomatic men with chronic aortic regurgitation and preserved left ventricular systolic function. Am J Cardiol 94:676–678CrossRefPubMed
29.
Sutton TM, Stewart RA, Gerber IL et al (2003) Plasma natriuretic peptide levels increase with symptoms and severity of mitral regurgitation. J Am Coll Cardiol 41:2280–2287CrossRefPubMed
30.
Delagardelle C, Feiereisen P, Vaillant M et al (2008) Reverse remodelling through exercise training is more pronounced in non-ischemic heart failure. Clin Res Cardiol 97:865–871CrossRefPubMed
31.
Kjaer A, Appel J, Hildebrandt P, Petersen CL (2004) Basal and exercise-induced neuroendocrine activation in patients with heart failure and in normal subjects. Eur J Heart Fail 6:29–39CrossRefPubMed
32.
McNairy M, Gardetto N, Clopton P et al (2002) Stability of B-type natriuretic peptide levels during exercise in patients with congestive heart failure: implications for outpatient monitoring with B-type natriuretic peptide. Am Heart J 143:406–411CrossRefPubMed
33.
Steele IC, McDowell G, Moore A et al (1997) Responses of atrial natriuretic peptide and brain natriuretic peptide to exercise in patients with chronic heart failure and normal control subjects. Eur J Clin Invest 27:270–276CrossRefPubMed
34.
Tosa S, Watanabe H, Iino K et al (2009) Usefulness of plasma BNP levels as a marker of left ventricular wall stress in obese individuals. Int Heart J 50:173–182CrossRefPubMed
Metadaten
Titel
Influence of acute and chronic myocardial loading conditions, function, structural changes and extracardiac factors on NT-proBNP in asymptomatic patients with preserved ejection fraction
verfasst von
Olaf Schulz
Andre Rudolph
Sarah Scheiner
Helena Mut
Jeanette Schulz-Menger
Gunnar Berghoefer
Ricarda Bensch
Jochen Kraemer
Ingolf Schimke
Publikationsdatum
01.01.2011
Verlag
Springer-Verlag
Erschienen in
Clinical Research in Cardiology / Ausgabe 1/2011
Print ISSN: 1861-0684
Elektronische ISSN: 1861-0692
DOI
https://doi.org/10.1007/s00392-010-0210-2

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