快速测定脑钠肽在老年患者急性呼吸困难鉴别诊断中的作用

目的探讨床边快速检测脑钠肽(BNP)在老年患者急性呼吸困难鉴别诊断中的作用。方法荧光免疫测定法测定60例老年急性呼吸困难患者血浆BNP、心脏超声测定左室射血分数(EF)。结果心力衰竭引起呼吸困难患者血浆BNP水平明显高于非心力衰竭组患者[(586.4±326.3)ng/L对(65.3±36.7)ng/L,P<0.01],且随着心力衰竭程度加重,BNP水平逐渐升高。结论快速检测BNP诊断心力衰竭敏感、简便、快捷,可作为老年患者急性呼吸困难病因鉴别的一个重要检查方法。     

血浆脑钠肽水平与老年心力衰竭患者心力衰竭程度的相关性分析

目的分析血浆脑钠肽(BNP)水平与老年心力衰竭患者心力衰竭程度的关系。方法选取2012—2013年我院收治的113例老年心力衰竭患者作为研究组,采用美国纽约心脏病协会(NYHA)分级对患者进行心功能分级,其中Ⅰ级27例、Ⅱ级35例、Ⅲ级31例、Ⅳ级20例;有合并性疾病81例,无合并性疾病32例。另选取同期我院47例体检健康者作为对照组。采用酶联免疫吸附法(ELISA)测定两组受检者血浆BNP水平。结果研究组血浆BNP为(682.57±33.46)ng/L,高于对照组的(47.63±8.31)ng/L(P0.01);心功能Ⅰ级患者血浆BNP水平为(79.48±9.55)ng/L,Ⅱ级患者为(201.26±11.48)ng/L,Ⅲ级患者为(718.43±18.69)ng/L,Ⅳ级患者为(894.48±38.15)ng/L,心功能Ⅰ级患者血浆BNP水平心功能Ⅱ级患者心功能Ⅲ级患者心功能Ⅳ级患者(P0.01);有合并性疾病患者血浆BNP水平为(825.93±42.66)ng/L,高于无合并性疾病患者的(447.58±35.83)ng/L(P0.01)。结论老年心力衰竭患者血浆BNP水平明显增高,且心力衰竭程度越重血浆BNP水平越高,因此血浆BNP水平可作为判定老年心力衰竭患者心力衰竭程度的指标,但不能排除合并性疾病的干扰。     

老年心力衰竭患者B型脑钠肽测定的临床意义

目的探讨对老年心力衰竭患者测定B型脑钠肽(BNP)的临床价值。方法选取我院2014年5月~2016年5月收治的老年心力衰竭患者168例设为观察组;另选取同期于我院体检的健康老年人90例设为对照组,均测定两组BNP与左室舒张末径(LVEDD),比较上述指标水平。结果对照组BNP水平为(54.0±12.0)ng/L,低于观察组I~II级(285.0±122.6)ng/L,对比差异有统计学意义(P0.05);观察组I~II级BNP低于III~IV级(861.5±302.2)ng/L,对比差异有统计学意义(P0.05)。对照组LVEDD为(40.4±6.4)mm,短于观察组I~II级(54.3±6.2)mm与III~IV级(61.2±11.3)mm,对比差异有统计学意义(P0.05)。结论老年心力衰竭患者心功能越差BNP水平越高,临床可将BNP作为灵敏指标判断心衰严重程度。     

脑钠肽检测对急性左心力衰竭的鉴别诊断价值

目的:探讨床边即时检测脑钠肽(BNP)对急性左心力衰竭(心衰)患者的鉴别诊断价值。方法:荧光免疫法测定呼吸困难患者65例(心衰者48例、非心衰者17例)血浆BNP,心脏超声和右心漂浮导管法分别测定心脏左室射血分数(LVEF)和肺毛细血管楔压(PCWP)。结果:①急性心衰患者血浆BNP水平明显高于非心衰患者[(683±57)∶(43±6)ng/L,P<0.01];②以100ng/L为正常参考值,BNP诊断心衰的敏感性为93.8%(45/48),特异性94.1%(16/17),排除心衰的阴性预测价值93.8%(61/65);③心衰患者BNP水平与PCWP呈正相关(r=0.47,P<0.01),与LVEF呈负相关(r=-0.61,P<0.01)。结论:荧光免疫法即时检测BNP诊断心衰敏感而且特异,可作为急诊呼吸困难鉴别诊断的一个观察指标。     

心肌机能指数和血浆脑钠肽评估心力衰竭的临床研究

目的探讨超声指标——心肌机能指数(Tei)与血浆脑钠肽(BNP)水平鉴别收缩性心力衰竭(SHF)及舒张性心力衰竭(DHF)的临床应用价值。方法入选心力衰竭患者67例,按照左室射血分数(LVEF)分为SHF(LVEF<50%)及DHF组(LVEF≥50%)。32名健康者为对照组,测常规超声指标及Tei指数,并采用ELISA法测得血浆BNP水平。结果与对照组相比,DHF及SHF组Tei指数、BNP显著增高(P<0.01);心力衰竭两组相比,Tei指数、BNP在SHF组显著升高(0.63±0.11)比(0.82±0.20)ng/L,P<0.01;713.38ng/L比1345.86ng/L,P<0.05,且二者呈显著正相关(r=0.71,P<0.01)。结论Tei指数、BNP在心力衰竭患者显著升高,二者可鉴别SHF及DHF。     

心力衰竭患者血中脑钠肽水平的变化

目的：探讨脑钠肽（BNP）在心力衰竭诊断中的临床应用价值。方法：将入选患者分为心功能工组、心力衰竭组和无心脏疾病组，对这3组的血液BNP值进行统计比较及临床分析。结果：以血BNP值100ng／L作为心力衰竭判定阈值，阴性预测率为97．73％，阳性预测率为73．53％；以血BNP值400mg／L作为心力衰竭判定阈值，阴性预测率为74．63％，阳性预测率为81．82％。结论：血BNP的检测有助于诊断心力衰竭，BNP100ng／L为最佳心力衰竭诊断阈值。     

脑钠素对老年人心力衰竭诊断和预后评估的价值

目的探讨脑钠素(BNP)对老年人心力衰竭诊断和预后评估的价值。方法选择老年无症状性心力衰竭患者21例(aSHF组)和老年症状性心力衰竭患者42例(SHF组),另选18例健康老年人作为对照组,采用放射免疫分析法测定各组血浆BNP水平;比较各组血浆BNP水平和心功能状况及心血管事件发生的关系。结果血浆BNP水平在对照组、aSHF组、SHF组呈递增趋势,且随着纽约心功能分级(NYHA)增高而增加;血浆BNP为70 ng/L时,对诊断aSHF的灵敏度、特异度分别为90.48%、94.44%;根据左心室射血分数值、NYHA、BNP水平3种分级法与专家分级法符合率分别为81.9%、73.0%、85.7%;NYHAⅢ级和NYHAⅣ级患者心血管事件的发生率明显高于aSHF组和NYHAⅡ级患者,发生心血管事件患者的血浆BNP水平高于而LVEF值低于未发生心血管事件的患者。结论血浆BNP水平能反映心力衰竭的严重程度,与左心室的结构和功能相关,检测血浆BNP水平对于aSHF的诊断和鉴别诊断有重要的临床价值,且对于心力衰竭患者近期发生心血管事件具有重要的预测意义。     

三种生物学标志物在心力衰竭患者诊断中的应用

目的探讨B型钠尿肽(BNP)、N末端B型钠尿肽前体(NT-proBNP)、可溶性生长刺激表达基因2蛋白(ST2)水平在心力衰竭(心衰)患者诊断中的应用价值。方法选取在我院心内科住院的心衰患者97例为心衰组,按照心功能分级(NYHA)Ⅱ级32例,Ⅲ级36例和Ⅳ级29例,另选同期住院的非心衰患者61例为对照组,测定可溶性ST2与BNP和NT-proBNP水平,分析其对心衰的诊断价值。结果心衰组患者的BNP、NT-proBNP、可溶性ST2水平明显高于对照组,差异均有统计学意义(中位数,396.0ng/L vs 39.4ng/L,P0.01;1825.0ng/L vs215.0ng/L,P0.01;56.8μg/L vs 25.4μg/L,P0.01);且随着心功能级别增高,BNP、NT-proBNP、可溶性ST2水平逐渐增高(P0.01)。BNP、NT-proBNP、可溶性ST2诊断心力衰竭的ROC曲线下面积分别为0.874、0.891、0.842,NT-proBNP和可溶性ST2两项联合诊断心衰的ROC曲线下的面积为0.905.结论通过BNP、NT-proBNP、可溶性ST2这3种生物学标志物的检测,可帮助临床提高对心衰的诊断价值。     

N-末端脑钠肽前体对ICU老年危重病患者预后的预测价值

目的评价ICU老年危重病人N-末端脑钠肽前体(NT-pro BNP)水平与疾病预后的关系。方法选择142例年龄60岁患者,在患者入ICU的24 h内检测血浆NT-pro BNP浓度,同时记录相关生理指标,随访患者入ICU 28 d内的生存状况,并根据以上数据绘制受试者工作特征(ROC)曲线,使用Kaplan-Meier生存曲线比较不同水平NT-pro BNP浓度患者生存情况。结果 142例老年危重症患者中,存活组和死亡组NT-pro BNP水平有显著差异(P0.05);NT-pro BNP≥1 172.5 ng/L的预测价值最佳;NT-pro BNP≥1 172.5 ng/L与1 172.5 ng/L患者组相比,氧和指数、肌酐值、机械通气时间以及死亡率以及累积生存时间均有统计学差异(P0.05)。结论入ICU时NT-pro BNP水平对老年危重症患者疾病的预后有预测价值,≥1 172.5 ng/L提示预后不佳。     

肥胖对重症心力衰竭患者血浆脑钠肽水平的影响

目的探讨肥胖对重度心力衰竭患者血浆脑钠肽(BNP)水平的影响。方法纳入心功能分级为Ⅳ级的冠心病心力衰竭患者293例,采用ELISA法测定血浆BNP浓度。以体重指数(BMI)将患者分为肥胖组(BMI28 kg/m2,n=198)和非肥胖组(BMI28 kg/m2,n=95),比较两组患者BNP水平差异。结果肥胖组与非肥胖组患者比较,年龄、性别构成及左室射血分数(LVEF)、左室舒张末容积(LVEDd)水平、合并高血压病及2型糖尿病情况均差异无统计学意义(P0.05)。肥胖组血浆BNP水平(623.4±405.5 pg/ml)明显低于非肥胖组患者(948.7±607.4 pg/ml),差异具有统计学意义(P0.05)。男、女性肥胖患者、高血压、2型糖尿病肥胖患者血浆BNP水平同样低于非肥胖者,差异均具有统计学意义(P0.05)。结论心力衰竭患者BNP水平均明显增高,但肥胖患者增高程度低于非肥胖患者,临床诊断治疗中应考虑肥胖对心衰患者BNP水平的影响。     

B-type natriuretic peptide levels in obese patients with advanced heart failure.

Although recent studies show that obesity, or elevated body mass index (BMI), is associated with lower levels of B-type natriuretic peptide (BNP), it is unknown whether BMI affects the prognostic value of BNP in heart failure (HF). This study confirms the relationship between high BMI and low BNP in patients with advanced systolic HF. Despite relatively lower levels of BNP in overweight and obesity, BNP predicts worse symptoms, impaired hemodynamics, and higher mortality in HF at all levels of BMI.OBJECTIVES: This study aimed to examine the influence of obesity on the predictive value of the B-type natriuretic peptide (BNP) assay in heart failure (HF). BACKGROUND: Recent studies show that obesity, or elevated body mass index (BMI), is associated with lower circulating levels of BNP both in the general population and in patients with HF. METHODS: We analyzed data from 316 systolic HF (left ventricular ejection fraction [LVEF] < or =40%) patients [age, 53 +/- 13 years; mean LVEF, 24 +/- 7%; 48% ischemic] followed up at a university HF center. Patients were divided into categories of BMI: lean (BMI <25 kg/m2), overweight (BMI = 25 to 29.9 kg/m2), and obese (BMI > or =30 kg/m2). RESULTS: The BNP levels were significantly lower in overweight and obese compared with lean patients (p = 0.0001); median BNP (interquartile range) for the lean (n = 131), overweight (n = 99), and obese (n = 86) groups was 747 (272 to 1,300), 380 (143 to 856), and 332 (118 to 617) pg/ml, respectively. In each BMI category, elevated BNP was significantly associated with worse symptoms and higher pulmonary capillary wedge pressure. Higher BNP was also a significant independent predictor of survival independent of BMI. Optimal BNP cutoff for prediction of death or urgent transplant in lean, overweight, and obese HF patients was 590, 471, and 342 pg/ml, respectively. CONCLUSIONS: Although BNP levels are relatively lower in overweight and obese HF patients, BNP predicts worse symptoms, impaired hemodynamics, and higher mortality at all levels of BMI.     

心力衰竭并恶液质患者血清脂联素水平与BMI、脑钠肽的关系

目的探讨心力衰竭（HF）并恶液质患者血清脂联素（ADP）水平与BMI、脑钠肽（BNP）的关系。方法将80例心血管病患者分为三组,A组20例有冠心病（CHD）、HF并恶液质;B组40例有CHD史、HF,无恶液质;C组20例有CHD,无HF。另选14例查体健康者作为对照组。检测各组血清ADP、BNP、左室射血分数,计算其BMI;分析ADP水平与BMI、BNP的相关性。结果 A组血清ADP、BNP明显高于其他三组（P均〈0.01）,其ADP水平与BMI呈负相关（r=-0.47,P〈0.01）,与BNP呈正相关（r=0.55,P〈0.01）。结论 HF并恶液质患者血清ADP明显升高,提示ADP水平与HF患者发生恶液质有因果关系;ADP水平与BNP呈正相关,提示BNP可能促进血清ADP分泌。     

Relationship of B-type natriuretic peptide and anemia in patients with and without heart failure: a substudy from the Breathing Not Properly (BNP) Multinational Study

While anemia is a significant risk factor for poor outcomes in patients with heart failure (HF), it is not in defined guidelines for HF assessment. B-type natriuretic peptide (BNP) is a marker for diagnosis and management of patients with HF. We determined the incidence of anemia in patients with HF and the relationship between BNP and hemoglobin (Hgb) levels in patients with and without HF. Results from the Breathing Not Properly Multinational Trial consisted of 1,586 patients presenting to the emergency department (ED) with dyspnea. Because renal insufficiency is a confounding variable for BNP, patients with a creatinine of >or=2.0 mg/dL were excluded. The remaining data were evaluated from 620 non-HF patients (337 M, 283 F) and 547 HF patients (299 M, 248 F). The New York Heart Association (NYHA) HF classification and ejection fraction by echocardiography were assessed for HF patients. Blood was tested for Hgb, BNP, and creatinine. Using World Health Organization criteria for anemia, we observed that HF patients in NYHA class III or IV had lower mean Hgb levels (12.5 g/dL, P < 0.05) and a higher incidence of anemia (48.2%, P < 0.05) than did HF patients in class I or II (13.4 g/dL and 33.9%, respectively). There was no correlation between Hgb and log BNP for females without HF or the aggregate of all HF patients. In contrast, a significant inverse correlation was observed for males without HF (P < 0.001). Although there were differences in the BMI, age, and estimated glomerular filtration rate (eGFR) versus Hgb observed in this group, the log BNP correlation remained significant after multivariate analysis. A significant inverse correlation for log BNP and Hgb were also observed for diastolic (EF >or= 50) HF (P < 0.05) that was also not accounted for by the BMI, age, or eGFR. The presence of anemia is associated with worsening HF at ED presentation. For males without HF and diastolic HF patients of both genders, a low Hgb may be a confounding variable toward increasing BNP. Among systolic HF patients, the presence of a low hemoglobin concentration is not a factor in the interpretation of BNP results.     

BNP in overweight and obese patients with heart failure: an analysis based on the BNP-LV diastolic wall stress relationship

BackgroundSuppressed plasma B-type natriuretic peptide (BNP) levels have been reported in obese individuals with heart failure (HF). However, the precise mechanism and significance of this relationship in the clinical setting of HF are unknown. Recently, we reported a close association between BNP levels and left ventricular end-diastolic wall stress (EDWS) as the underlying mechanism of BNP secretion; therefore, we investigated the relationship between BMI and plasma BNP levels in HF while adjusting for EDWS.Methods and ResultsIn 245 consecutive patients who presented with HF, we measured plasma BNP levels and performed echocardiography and cardiac catheterization. Meridional EDWS was calculated from echocardiographic and hemodynamic parameters. The body mass index (BMI) for the total population was 22.9 ± 0.2 kg/m²; 21% were lean (BMI <20) and 27% overweight and obese (BMI ≥ 25). The correlation between plasma BNP and EDWS [r = 0.771 (P <.001)] was more robust than any other echocardiographic or hemodynamic parameter as well as any patient's characteristics. By a univariate analysis, BMI was inversely correlated with both BNP levels and EDWS (P <.001 in both). However, a multivariable regression analysis that took into account EDWS demonstrated a significant inverse association between BMI and BNP (P <.001).ConclusionThe present study demonstrates that BMI determines the BNP level in a manner that is independent of the hemodynamic load in patients with HF. Overweight and obesity should be considered to be associated with the interindividual variability of plasma BNP levels in the diagnosis and management of HF patients.     

The Influence of Body Mass Index on Clinical Interpretation of Established and Novel Biomarkers in Acute Heart Failure

BackgroundBody mass index (BMI) is a known confounder for natriuretic peptides, but its influence on other biomarkers is less well described. We investigated whether BMI interacts with biomarkers’ association with prognosis in patients with acute heart failure (AHF).Methods and ResultsB-type natriuretic peptide (BNP), high-sensitivity cardiac troponin I (hs-cTnI), galectin-3, serum neutrophil gelatinase-associated lipocalin (sNGAL), and urine NGAL were measured serially in patients with AHF during hospitalization in the AKINESIS (Acute Kidney Injury Neutrophil gelatinase-associated lipocalin Evaluation of Symptomatic Heart Failure) study. Cox regression analysis was used to determine the association of biomarkers and their interaction with BMI for 30-day, 90-day and 1-year composite outcomes of death or HF readmission. Among 866 patients, 21.2%, 29.7% and 46.8% had normal (18.5–24.9 kg/m²), overweight (25–29.9 kg/m²) or obese (≥ 30 kg/m²) BMIs on admission, respectively. Admission values of BNP and hs-cTnI were negatively associated with BMI, whereas galectin-3 and sNGAL were positively associated with BMI. Admission BNP and hs-cTnI levels were associated with the composite outcome within 30 days, 90 days and 1 year. Only BNP had a significant interaction with BMI. When BNP was analyzed by BMI category, its association with the composite outcome attenuated at higher BMIs and was no longer significant in obese individuals. Findings were similar when evaluated by the last-measured biomarkers and BMIs.ConclusionsIn patients with AHF, only BNP had a significant interaction with BMI for the outcomes, with its association attenuating as BMI increased; hs-cTnI was prognostic, regardless of BMI.     

Brain natriuretic peptide. Diagnostic value in heart failure]

BACKGROUND: Nowadays a number of diverse biochemical markers have been identified in patients with heart failure (HF) that could indicate the severity of the patients' illness. Among them, probably the most useful is brain natriuretic peptide (BNP) because it is easily obtained and because of its diagnostic and prognostic information. Our objective was to assess the association between BNP and other different associated variables previously known to be related to the evolution of HF, as well as its utility to distinguish systolic from diastolic HF. PATIENTS AND METHOD: We studied 114 patients admitted consecutively for symptomatic HF for all causes (age: 66 years, male: 60%). In all patients plasma BNP was measured, from the third day of admission, with a specific radioinmunoassay. Echocardiography was performed in 101 patients. RESULTS: BNP plasma levels increased in proportion to functional class (p = 0.01) and the degree of left ventricular dysfunction (p = 0.0001, r = 0.44). There was also an association between BNP and male sex (p = 0.008), higher plasmatic creatinine (p = 0.01, r = 0.25), Iarger ventricular diameters (p = 0.0001) and higher pulmonary systolic pressure (p = 0.001, r = 0.44). In the multivariate analysis, BNP was independently related to the rest of variables with left systolic ventricular function (p = 0.0001). Despite this association, we did not find a satisfactory cut-off value in BNP, with a good sensitivity and specificity value from the total number of patients, of which specifically systolic dysfunction as a cause of HF was detected. CONCLUSIONS: a) BNP increases proportionately to the left ventricular dysfunction and HF severity, and b) BNP is not a useful tool to distinguish systolic from diastolic HF.     

哈萨克族心力衰竭患者血浆生长分化因子15和B型利钠肽的临床意义

目的:研究血浆生长分化因子15(GDF-15)、B型利钠肽(BNP)对新疆哈萨克族(哈族)心力衰竭(HF)的意义及与其严重程度之间的关系。方法:选取新疆哈族HF患者90例(NYHAⅡ～IV级)及哈族NYHAⅠ级患者30例为研究对象,均采取空腹静脉血,测定血浆BNP及GDF-15水平,同时超声心动图测定各项心功能指标。结果:哈族HF组患者血浆GDF-15和BNP水平明显高于对照组[GDF-15(132.14±56.36)ng/L∶(34.08±10.80)ng/L;BNP(273.78±93.37)ng/ml∶(82.80±15.18)ng/ml,P<0.01],并随NYHA心功能分级的增加而升高,各组间差异均有统计学意义(均P<0.01)。哈族HF患者血浆GDF-15水平与血肌酐(Cr)、左心房前后径(LAD)、左心室舒张末期内径(LVEDd)、NYHA、BNP呈正相关(r=0.266、0.423、0.668、0.925、0.845,P<0.05);与左心室射血分数(LVEF)、左心室短轴缩短率(FS)呈显著负相关(r=-0.807、-0.733,P<0.01)。结论:哈族HF患者血浆GDF-15、BNP水平明显升高,与哈族HF程度密切相关,血浆GDF-15水平是判断哈族HF严重程度有价值的指标。     

Effect of Beta-blockade and ACE Inhibition on B-type Natriuretic Peptides in Stable Patients with Systolic Heart Failure

INTRODUCTION: The long-term effect of beta-blockade on the plasma levels of natriuretic peptides BNP and its N-terminal counterpart, NT-proBNP, as risk markers in heart failure (HF) is obscure. METHODS: Stable systolic HF patients from the CARMEN study were divided in groups matching their randomised treatment allocation: Carvedilol, enalapril or carvedilol+enalapril. Changes in BNP and NT-proBNP from baseline to 6 months maintenance visit were evaluated in each treatment arm. Furthermore, the prognostic value of BNP and NT-proBNP during monotherapy with carvedilol was assessed with univariate Cox proportional hazards models using a combined endpoint of all cause mortality and cardiovascular hospitalisation. RESULTS: NT-proBNP and BNP were significantly reduced after six months treatment with enalapril (NT-proBNP 1,303 to 857 pg/ml (P < 0.001), BNP 119 to 85 pg/ml (P < 0.001)) or carvedilol+enalapril (NT-proBNP 1,223 to 953 pg/ml (P = 0.003), BNP 117 to 93 pg/ml (P = 0.01)). In contrast, no change was observed in the carvedilol group (NT-proBNP 907 to 1,082 pg/ml (P = 0.06), BNP 114 to 130 pg/ml (P = 0.15). The prognostic value of NT-proBNP and BNP was maintained in the carvedilol group (NT-proBNP HR 1.018 95% CI (1.005-1.032), BNP 1.171 (1.088-1.260)). CONCLUSION: Treatment of HF patients with carvedilol alone does not reduce levels of natriuretic peptides, but treatment with enalapril does. Both BNP and NT-proBNP predict death and hospitalisation in HF patients treated with carvedilol for six months. The clinical implication of our results is that NT-proBNP and BNP can be used as risk markers of death and cardiovascular hospitalisations in systolic HF patients receiving carvedilol without ACE inhibition.     

Type B natriuretic peptide in the diagnosis of heart failure with preserved systolic function]

BACKGROUND: Heart failure (HF) with preserved left ventricular systolic function (LVSF) is observed in up to 50% patients with HF. There is no consensus on non-invasive diagnosis of this entity. OBJECTIVE: Evaluation of B-type natriuretic peptide (BNP) in the diagnosis of HF with preserved left ventricular systolic function. DESIGN: Prospective study. PATIENTS: One hundred and seventy-six consecutive patients with suspected HF were evaluated. Patients were classified as having HF with preserved LVSF, if they had symptoms and signs of HF, an ejection fraction greater than 40% and an abnormal Doppler pattern of the mitral inflow or atrial fibrilation and no other causes for the symptoms. All patients had a 12-lead EKG, chest roentgenogram, simple spirometry, M-mode and 2D echocardiogram with pulsed Doppler study of transmitral inflow and determination of plasma BNP levels. RESULTS: Of the 176 patients, 65 had ejection fraction greater than 40%. Of these patients 46 were classified as having HF with preserved LVSF and 19 as not having HF. Patients with HF and preserved LVSF were older, had a higher systolic blood pressure (SBP), less pathologic Q waves on ECG and higher left ventricular ejection fraction and plasma BNP than patients without HF. Multivariate analysis revealed that BNP and SBP were independently associated with the diagnosis of HF. The accuracy of BNP in the diagnosis of HF with preserved LVSF evaluated by the area under the receiver operating characteristic curve was 0.94. CONCLUSION: These results suggest that the measurement of BNP levels can help clinicians in the diagnosis of HF with preserved LVSF. Whether BNP levels might be used in clinical practice as a test for the diagnosis of HF with preserved LVSF is a question that merits further studies.     

Extremely high brain natriuretic peptide does not reflect the severity of heart failure

Brain natriuretic peptide (BNP) is important in the diagnosis and management of heart failure (HF). Sometimes, very high BNP levels encountered in clinical settings seem to be out of proportion to the severity of HF. The authors retrospectively identified 113 patients with 129 admissions with a BNP value >3000?pg/mL regardless of diagnosis. The data set was analyzed using the Student t test and bivariate analysis. Fewer than half of patients were admitted for HF. In 14 patients (10.9%), no signs of HF were found. The BNP level of those with and without HF was similar. There was no difference in BNP level in patients with and without systolic dysfunction or renal dysfunction and between different age groups. Extreme values of BNP do not necessarily correlate with the presence of HF, cardiomyopathy, or kidney dysfunction. When the magnitude of BNP elevation is very high, its clinical significance is limited.