© 2004 European Society of Cardiology
Is plasma N-BNP a good indicator of the functional reserve of failing hearts? The FRESH-BNP study
a Academic Unit of Molecular Vascular Medicine, University of Leeds, Martin Wing, Leeds General Infirmary Leeds LS1 3EX, UK
b Department of Medicine and Therapeutics, University of Leicester Leicester, UK
c Department of Mathematical Sciences, University of Liverpool Liverpool, UK
* Corresponding author. Tel.: +44-113-392-5401; Fax: +44-113-392-5395
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Abstract |
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Aims: Whether plasma N-terminal brain natriuretic peptide (N-BNP) is useful in the diagnosis of heart failure (HF) depends traditionally on whether it is as good as the putative ‘gold-standard’, left ventricular ejection fraction (LVEF), in indicating cardiac dysfunction. However, since HF is primarily an impairment of function of the cardiac pump, we explored the relationship between N-BNP and direct and indirect indicators of cardiac pump dysfunction.
Methods and Results: Eighty-six HF patients (mean age 56 years) with a range of LVEF's (mean 36.9±15.2%, range 15–66%) and 10 age-matched healthy controls were recruited into the study and had resting N-BNP measured. Cardiopulmonary exercise testing was performed to assess peak oxygen consumption (VO2). A subgroup of 23 subjects underwent further exercise haemodynamic assessment to evaluate peak cardiac power output (CPO). The CHF group had significantly higher N-BNP (median [interquartile range]) levels (299 [705] fmol/ml) than the control group (7 [51] fmol/ml, P<0.005). Significant correlations between N-BNP and peak VO2, and N-BNP and peak CPO were observed (R
0.5, P<0.005). Although significant correlation was observed between N-BNP and LVEF (R=0.34, P=0.01), the correlations between LVEF and peak VO2 or peak CPO (all R<0.3, P>0.3) were not significant. Multivariate analysis identified plasma N-BNP and NYHA class, but not LVEF, as independent predictors of peak VO2.
Conclusions: We have found that N-BNP was surprisingly good as a simple indicator of cardiac pump dysfunction. Since heart failure is an inadequacy of function, these results strongly support the notion that N-BNP is a useful blood test in estimating the extent of cardiac pump dysfunction and helpful in establishing positive diagnosis of heart failure.
Key Words: Chronic heart failure • Brain natriuretic peptide • Peak oxygen consumption • Cardiac power output • Left ventricular ejection fraction • Cardiac pump function
Received December 17, 2003; Revised February 16, 2004; Accepted March 13, 2004
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