The role of B-type natriuretic peptide in the evaluation of congestive heart failure patients in emergency department

Hao Wang, Tiffany Littleton, Sonya J. Wilson, Ferran Ros, Richard D. Robinson, Kathleen A. Delaney

Department of Emergency Medicine, JPS Health Network, Fort Worth, USA.
JPS Health Network.

DOI: 10.4236/ojcd.2012.22003                

Abstract

Aim: Congestive heart failure (CHF) is a severe cardiovascular disorder seen in the Emergency Department (ED). B-type Natriuretic Peptide (BNP) is usually ordered to evaluate the CHF severity. However, it is difficult to interpret serum BNP level when different clinical entities existed. The aim of this study is to illustrate the correlation between serum BNP level and relevant clinical variables and further determine the role of serum BNP in different CHF patients. Methods: Univariate comparisons between 26 clinical variables and serum BNP level were analyzed. In order to avoid confounding factors, potential independent clinical variables were analyzed together using multivariate regression. Results: 529 CHF patients were reviewed and divided into different groups by 26 clinical variables. Serum BNP levels were found statistically significant different by univariate compareson between groups divided by 8 clinical variables that included obesity, diastolic/systolic heart failure (HF), serum blood urea nitrogen (BUN) level, serum creatinine (Cr) level, serum sodium (Na) level, patients taking loop diuretics, history of cerebrovascular accident (CVA), and history of dementia. Among all 8 clinical variables, obesity, serum BUN, Cr level, and diastolic/systolic HF had weak-to-moderate correlation effects with serum BNP level by correlation coefficient analysis. However, only obesity and dia- stolic/systolic HF were two moderately stronger clini- cal variables that can affect the serum BNP levels by multivariate regression. Analyzing CHF patients separately by obesity and diastolic/systolic HF subsets showed longer hospitalization in diastolic HF patients with relatively higher serum Cr level. In addition, poor correlation was found between serum BNP level and length of hospitalization (LOH) as well. Conclusion: High variability of serum BNP levels exists in CHF patients with weak-to-moderate correlation effects particularly on obesity and diastolic/systolic HF.It is recommended that physicians should be cautious on interpreting BNP in different CHF populations.

Keywords

Congestive Heart Failure; B-Type Natriuretic Peptide; Clinical Variables; Emergency Department

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Omland, T. and Hagve, T.A. (2009) Natriuretic peptides: Physiologic and analytic considerations. Heart Failure Clinics, 5, 471-487. doi:10.1016/j.hfc.2009.04.005
[2]	Maisel, A. and Mehra, M.R. (2005) Understanding B-type natriuretic peptide and its role in diagnosing and monitoring congestive heart failure. Clinical Cornerstone, 7, S7-S17. doi:10.1016/S1098-3597(05)80009-2
[3]	Popescu, B.A., Popescu, A.C., Antonini-Canterin, F., Rubin, D., Cappelletti, P., Piazza, R., Ginghina, C., Dimulescu, D., Beladan, C.C. and Nicolosi, G.L. (2007) Prognostic role of left atrial volume in elderly patients with symptomatic stable chronic heart failure: Comparison with left ventricular diastolic dysfunction and B-type natriuretic peptide. Echocardiography, 24, 1035-1043. doi:10.1111/j.1540-8175.2007.00540.x
[4]	de Denus, S., Pharand, C. and Williamson, D.R. (2004) Brain natriuretic peptide in the management of heart failure: The versatile neurohormone. Chest, 125, 652-668. doi:10.1378/chest.125.2.652
[5]	Wiley, C.L., Switzer, S.P., Berg, R.L., Glurich, I. and Dart, R.A. (2010) Association of B-type natriuretic peptide levels with estimated glomerular filtration rate and congestive heart failure. Clinical Medicine Research, 8, 7-12. doi:10.3121/cmr.2009.867
[6]	Krauser, D.G., Lloyd-Jones, D.M., Chae, C.U., Cameron, R., Anwaruddin, S., Baggish, A.L., Chen, A., Tung, R. and Januzzi, J.L. Jr. (2005) Effect of body mass index on natriuretic peptide levels in patients with acute congestive heart failure: A ProBNP investigation of dyspnea in the emergency department (PRIDE) substudy. American Heart Journal, 149, 744-750. doi:10.1016/j.ahj.2004.07.010
[7]	Anwaruddin, S., Lloyd-Jones, D.M., Baggish, A., Chen, A., Krauser, D., Tung, R., Chae, C. and Januzzi, J.L. Jr. (2006) Renal function, congestive heart failure, and aminoterminal pro-brain natriuretic peptide measurement: Results from the ProBNP Investigation of dyspnea in the emergency department (PRIDE) study. Journal of the American College of Cardiology, 47, 91-97. doi:10.1016/j.jacc.2005.08.051
[8]	McCord, J., Mundy, B.J., Hudson, M.P., Maisel, A.S., Hollander, J.E., Abraham, W.T., Steg, P.G., Omland, T., Knudsen, C.W., Sandberg, K.R. and McCullough, P.A. (2004) Relationship between obesity and B-type natriuretic peptide levels. Archives of Internal Medicine, 164, 2247-2252. doi:10.1001/archinte.164.20.2247
[9]	Maeder, M.T., Mariani, J.A. and Kaye, D.M. (2010) Hemodynamic determinants of myocardial B-type natriuretic peptide release: relative contributions of systolic and diastolic wall stress. Hypertension, 56, 682-689. doi:10.1161/HYPERTENSIONAHA.110.156547
[10]	Hedley, A.A., Ogden, C.L., Johnson, C.L., Carroll, M.D., Curtin, L.R. and Flegal, K.M. (2004) Prevalence of overweight and obesity among US children, adolescents, and adults, 1999-2002. Archives of Internal Medicine, 291, 2847-2850. doi:10.1001/jama.291.23.2847
[11]	Valle, R. and Aspromonte, N. (2010) Use of brain natriuretic peptide and bioimpedance to guide therapy in heart failure patients. Contributions to Nephrology, 164, 209216. doi:10.1159/000313732
[12]	Palazzuoli, A., Gallotta, M., Quatrini, I. and Nuti, R. (2010) Natriuretic peptides (BNP and NT-ProBNP): Measurement and relevance in heart failure. Vascular Health and Risk Management, 6, 411-418. doi:10.2147/VHRM.S5789
[13]	Krupicka, J., Janota, T., Kasalová, Z. and Hradec, J. (2009) Natriuretic peptides—Physiology, pathophysiology and clinical use in heart failure. Physiological Research, 58, 171-177.
[14]	Heist, E.K. and Ruskin, J.N. (2006) Atrial fibrillation and congestive heart failure: Risk factors, mechanisms, and treatment. Progress in Cardiovascular Diseases, 48, 256269. doi:10.1016/j.pcad.2005.09.001
[15]	Lang, C.C. and Mancini, D.M. (2007) Non-cardiac comorbidities in chronic heart failure. Heart, 93, 665-671. doi:10.1136/hrt.2005.068296
[16]	Cicoira, M., Maggioni, A.P., Latini, R., Barlera, S., Carretta, E., Janosi, A., Soler Soler, J., Anand, I., Cohn, J.N. (2007) Body mass index, prognosis and mode of death in chronic heart failure: results from the Valsartan Heart Failure Trial. European Journal of Heart Failure, 9, 397402. doi:10.1016/j.ejheart.2006.10.016
[17]	Frankenstein, L., Zugck, C., Nelles, M., Schellberg, D., Katus, H.A. and Remppis, B.A. (2009) The obesity paradox in stable chronic heart failure does not persist after matching for indicators of disease severity and confounders. European Journal of Heart Failure, 11, 1189-1194. doi:10.1093/eurjhf/hfp150
[18]	Oreopoulos, A., Padwal, R., Kalantar-Zadeh, K., Fonarow, G.C., Norris, C.M. and McAlister, F.A. (2008) Body mass index and mortality in heart failure: A meta-analysis. American Heart Journal, 156, 13-22. doi:10.1016/j.ahj.2008.02.014
[19]	Stolker, J.M. and Rich, M.W. (2010) Clinical utility of B-type natriuretic peptide for estimating left ventricular filling pressures in unselected elderly patients undergoing diagnostic coronary angiography. Journal of Invasive Cardiology, 22, 107-112.
[20]	Adlam D, Silcocks P and Sparrow N. (2005) Using BNP to develop a risk score for heart failure in primary care. European Heart Journal, 26, 1086-1093. doi:10.1093/eurheartj/ehi178
[21]	Codognotto, M., Piccoli, A., Zaninotto, M., Mion, M., Plebani, M., Vertolli, U., Tona, F., Ruzza, L., Barchita, A. and Boffa, G.M. (2007) Renal dysfunction is a confounder for plasma natriuretic peptides in detecting heart dysfunction in uremic and idiopathic dilated cardiomyopathies. Clinical Chemistry, 53, 2097-2104. doi:10.1373/clinchem.2007.089656
[22]	Trimarchi, H., Muryan, A., Dicugno, M., Forrester, M., Lombi, F., Young, P., Pomeranz, V., Iriarte, R., Barucca, N., Campolo-Girard, V., Alonso, M. and Lindholm, B. (2011) In hemodialysis, adiponectin, and pro-brain natriuretic peptide levels may be subjected to variations in body mass index. Hemodialysis International, 15, 477484. doi:10.1111/j.1542-4758.2011.00562.x
[23]	Selthofer-Relati?, K., Radi?, R., Vcev, A., Steiner, R., Vizjak, V., Sram, M., Tripolski, M., Kosovi?, P., Bosnjak, I. and Selthofer, R. (2011) Low adiponectin serum level-reduced protective effect on the left ventricular wall thickness. Collegium of Antropologicum, 35, 787-791.
[24]	Clerico, A., Giannoni, A., Vittorini, S. and Emdin, M. (2012) The paradox of low BNP levels in obesity. Heart Failure Reviews, 17, 81-96.
[25]	Polak, J., Kotrc, M., Wedellova, Z., Jabor, A., Malek, I., Kautzner, J., Kazdova, L. and Melenovsky, V. (2011) Lipolytic effects of B-type natriuretic peptide 1-32 in adipose tissue of heart failure patients compared with healthy controls. Journal of the American College of Cardiology, 58, 1119-1125. doi:10.1016/j.jacc.2011.05.042
[26]	Iwanaga, Y., Kihara, Y., Niizuma, S., Noguchi, T., Nonogi, H., Kita, T. and Goto, Y. (2007) BNP in overweight and obese patients with heart failure: an analysis based on the BNP-LV diastolic wall stress relationship. Journal of Cardiac Failure, 13, 663-667. doi:10.1016/j.cardfail.2007.05.002
[27]	Niizuma, S., Iwanaga, Y., Yahata, T., Tamaki, Y., Goto, Y., Nakahama, H. and Miyazaki, S. (2009) Impact of left ventricular end-diastolic wall stress on plasma B-type natriuretic peptide in heart failure with chronic kidney disease and end-stage renal disease. Clinical Chemistry, 55, 1347-1353. doi:10.1373/clinchem.2008.121236
[28]	Tosa, S., Watanabe, H., Iino, K., Terui, G., Kosaka, T., Hasegawa, H. and Ito, H. (2009) Usefulness of plasma BNP levels as a marker of left ventricular wall stress in obese individuals. International Heart Journal, 50, 173182. doi:10.1536/ihj.50.173
[29]	Victor, B.M. and Barron, J.T. (2010) Diastolic heart failure versus diastolic dysfunction: difference in renal function. Clinical Cardiology, 33, 770-774. doi:10.1002/clc.20824
[30]	Saritas, A., Cakir, Z., Emet, M., Uzkeser, M., Akoz, A. and Acemoglu, H. (2009) Factors affecting the B-type natriuretic peptide levels in stroke patients. Annals Academy of Medicine Singapore, 39, 385-389.
[31]	Kondziella, D., G?thlin, M., Fu, M., Zetterberg, H. and Wallin, A. (2009) B-type natriuretic peptide plasma levels are elevated in subcortical vascular dementia. NeuroReport, 20, 825-827. doi:10.1097/WNR.0b013e328326f82f
[32]	Cakir, Z., Saritas, A., Emet, M., Aslan, S., Akoz, A. and Gundogdu, F. (2010) A prospective study of brain natriuretic peptide levels in three subgroups: Stroke with hypertension, stroke without hypertension, and hypertension alone. Annals of Indian Academy of Neurology, 13, 47-51. doi:10.4103/0972-2327.61277
[33]	Kerola, T., Nieminen, T., Hartikainen, S., Sulkava, R., Vuolteenaho, O. and Kettunen, R. (2010) B-type natriuretic peptide as a predictor of declining cognitive function and dementia: A cohort study of an elderly general population with a 5-year follow-up. Annals of Medicine, 42, 207-215. doi:10.3109/07853891003652542
[34]	Gunstad, J., Poppas, A., Smeal, S., Paul, R.H., Tate, D.F., Jefferson, A.L., Forman, D.E. and Cohen, R.A. (2006) Relation of brain natriuretic peptide levels to cognitive dysfunction in adults >55 years of age with cardiovascular disease. American Journal of Cardiology, 98, 538-540. doi:10.1016/j.amjcard.2006.02.062