Skip to main content
NCBI home page
Heart logoLink to Heart
. 2001 Jul;86(1):21–26. doi: 10.1136/heart.86.1.21

Left ventricular dysfunction, natriuretic peptides, and mortality in an urban population

T McDonagh 1, A Cunningham 1, C Morrison 1, J McMurray 1, I Ford 1, J Morton 1, H Dargie 1
PMCID: PMC1729832  PMID: 11410555

Abstract

OBJECTIVE—To report the mortality of left ventricular systolic dysfunction (LVD), assessed objectively by echocardiography, and its association with natriuretic peptide hormones in a random sample of 1640 men and women aged 25-74 years from a geographical, urban population.
METHODS—Left ventricular function was measured by echocardiography in 1640 attendees studied in 1992-3. LVD was defined as a left ventricular ejection fraction (LVEF) ⩽ 30%. Plasma concentrations of N-terminal atrial natriuretic peptide (N-ANP) and brain natriuretic peptide (BNP) were measured by standard radioimmunoassays. Mortality was documented at four years.
RESULTS—The four year all cause mortality rate in the whole cohort was 4.9% (80 deaths). It was 21% (nine deaths) in those with an LVEF ⩽ 30% and 4% in those whose LVEF was > 30% (p < 0.001). The median (interquartile range) BNP concentration in those who died was 16.9 pg/ml (8.8-27) and 7.8 pg/ml (3.4-13) in survivors (p < 0.0001). Similarly, N-ANP had a median concentration of 2.35 ng/ml (1.32-3.36) in those with a fatal outcome and 1.27 ng/ml (0.9-2.0) in those alive at four years (p < 0.0001). Subjects with an LVEF ⩽ 40% also had a significant mortality rate of 17% if they also had a BNP concentration ⩾ 17.9 pg/ml compared with 6.8% if their BNP was below this concentration (p = 0.013). Multivariate analysis revealed the independent predictors of four year all cause mortality to be increasing age (p < 0.001), a BNP concentration ⩾ 17.9 pg/ml (p = 0.006), the presence of ischaemic heart disease (p = 0.03), and male sex (p = 0.04).
CONCLUSIONS—LVD is associated with a considerable mortality rate in this population. BNP also independently predicts outcome. In addition to its role as a diagnostic aid in chronic heart failure and LVD, it provides prognostic information and clarifies the meaning of a given degree of LVD.


Keywords: epidemiology; left ventricular dysfunction; natriuretic peptides

Full Text

The Full Text of this article is available as a PDF (159.9 KB).

Figure 1  .

Figure 1  

Open in a new tab

Kaplan-Meier survival curves for left ventricular ejection fraction (LVEF) categories (> 40%, ⩽ 40%, ⩽ 35%, and ⩽ 30%). The p values above and below the respective LVEF cut off points were as follows: LVEF ⩽ and > 40%, p < 0.0001; LVEF ⩽ and > 35%, p < 0.0001; LVEF ⩽ and > 30%, p < 0.001. The number of subjects in each ejection fraction category was as follows: LVEF > 40% = 1194; LVEF ⩽ 40% = 273; LVEF ⩽ 35% = 113; LVEF ⩽ 30% = 43. 

Figure 2  .

Figure 2  

Open in a new tab

Kaplan-Meier survival curves for various categories of brain natriuretic peptide (BNP) concentrations (< 10 pg/ml, 10 ⩽ BNP < 20 pg/ml, 20 ⩽ BNP < 30 pg/ml, and BNP ⩾ 30 pg/ml). The actual mortality rates % (n) for these categories were 2% (16), 6.7% (23), 12.5% (10), and 18% (12), respectively. The log rank statistic was 53, p < 0.0001.    

Figure 3  .

Figure 3  

Open in a new tab

Kaplan-Meier survival curves for BNP, dichotomised at a concentration of 17.9 pg/ml. There were 33 deaths/1067 (3.1%) in those with BNP < 17.9 pg/ml and 28 deaths/188 at risk (14.9%) in those with an increased BNP concentration (p < 0.0001, log rank statistic 49.5).

Figure 4  .

Figure 4  

Open in a new tab

Kaplan-Meier survival curves for those with a left ventricular ejection fraction categories of ⩽ 40% stratified by a BNP concentration < 17.9 or ⩾ 17.9 pg/ml. The p value was 0.013. There were 12 deaths/175 (6.8%) in those with a BNP < 17.9 pg/ml and 12 deaths/70 at risk (17%) in those with an increased BNP concentration.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Clarkson P. B., Wheeldon N. M., MacFadyen R. J., Pringle S. D., MacDonald T. M. Effects of brain natriuretic peptide on exercise hemodynamics and neurohormones in isolated diastolic heart failure. Circulation. 1996 Jun 1;93(11):2037–2042. doi: 10.1161/01.cir.93.11.2037. [DOI] [PubMed] [Google Scholar]
  2. Eriksson H., Svärdsudd K., Larsson B., Ohlson L. O., Tibblin G., Welin L., Wilhelmsen L. Risk factors for heart failure in the general population: the study of men born in 1913. Eur Heart J. 1989 Jul;10(7):647–656. doi: 10.1093/oxfordjournals.eurheartj.a059542. [DOI] [PubMed] [Google Scholar]
  3. Hall C., Rouleau J. L., Moyè L., de Champlain J., Bichet D., Klein M., Sussex B., Packer M., Rouleau J., Arnold M. O. N-terminal proatrial natriuretic factor. An independent predictor of long-term prognosis after myocardial infarction. Circulation. 1994 May;89(5):1934–1942. doi: 10.1161/01.cir.89.5.1934. [DOI] [PubMed] [Google Scholar]
  4. Ho K. K., Anderson K. M., Kannel W. B., Grossman W., Levy D. Survival after the onset of congestive heart failure in Framingham Heart Study subjects. Circulation. 1993 Jul;88(1):107–115. doi: 10.1161/01.cir.88.1.107. [DOI] [PubMed] [Google Scholar]
  5. Iivanainen A. M., Tikkanen I., Tilvis R., Heikkilá J., Helenius T., Kupari M. Associations between atrial natriuretic peptides, echocardiographic findings and mortality in an elderly population sample. J Intern Med. 1997 Apr;241(4):261–268. doi: 10.1046/j.1365-2796.1997.113124000.x. [DOI] [PubMed] [Google Scholar]
  6. Kohno M., Horio T., Yokokawa K., Murakawa K., Yasunari K., Akioka K., Tahara A., Toda I., Takeuchi K., Kurihara N. Brain natriuretic peptide as a cardiac hormone in essential hypertension. Am J Med. 1992 Jan;92(1):29–34. doi: 10.1016/0002-9343(92)90011-y. [DOI] [PubMed] [Google Scholar]
  7. Lang C. C., Choy A. M., Turner K., Tobin R., Coutie W., Struthers A. D. The effect of intravenous saline loading on plasma levels of brain natriuretic peptide in man. J Hypertens. 1993 Jul;11(7):737–741. doi: 10.1097/00004872-199307000-00009. [DOI] [PubMed] [Google Scholar]
  8. McDonagh T. A., Morrison C. E., Lawrence A., Ford I., Tunstall-Pedoe H., McMurray J. J., Dargie H. J. Symptomatic and asymptomatic left-ventricular systolic dysfunction in an urban population. Lancet. 1997 Sep 20;350(9081):829–833. doi: 10.1016/S0140-6736(97)03033-X. [DOI] [PubMed] [Google Scholar]
  9. McDonagh T. A., Robb S. D., Murdoch D. R., Morton J. J., Ford I., Morrison C. E., Tunstall-Pedoe H., McMurray J. J., Dargie H. J. Biochemical detection of left-ventricular systolic dysfunction. Lancet. 1998 Jan 3;351(9095):9–13. doi: 10.1016/s0140-6736(97)03034-1. [DOI] [PubMed] [Google Scholar]
  10. McKee P. A., Castelli W. P., McNamara P. M., Kannel W. B. The natural history of congestive heart failure: the Framingham study. N Engl J Med. 1971 Dec 23;285(26):1441–1446. doi: 10.1056/NEJM197112232852601. [DOI] [PubMed] [Google Scholar]
  11. Omland T., Aakvaag A., Bonarjee V. V., Caidahl K., Lie R. T., Nilsen D. W., Sundsfjord J. A., Dickstein K. Plasma brain natriuretic peptide as an indicator of left ventricular systolic function and long-term survival after acute myocardial infarction. Comparison with plasma atrial natriuretic peptide and N-terminal proatrial natriuretic peptide. Circulation. 1996 Jun 1;93(11):1963–1969. doi: 10.1161/01.cir.93.11.1963. [DOI] [PubMed] [Google Scholar]
  12. Pacher R., Stanek B., Hülsmann M., Koller-Strametz J., Berger R., Schuller M., Hartter E., Ogris E., Frey B., Heinz G. Prognostic impact of big endothelin-1 plasma concentrations compared with invasive hemodynamic evaluation in severe heart failure. J Am Coll Cardiol. 1996 Mar 1;27(3):633–641. doi: 10.1016/0735-1097(95)00520-x. [DOI] [PubMed] [Google Scholar]
  13. Pfeffer M. A., Braunwald E., Moyé L. A., Basta L., Brown E. J., Jr, Cuddy T. E., Davis B. R., Geltman E. M., Goldman S., Flaker G. C. Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. Results of the survival and ventricular enlargement trial. The SAVE Investigators. N Engl J Med. 1992 Sep 3;327(10):669–677. doi: 10.1056/NEJM199209033271001. [DOI] [PubMed] [Google Scholar]
  14. Pitt B., Cohn J. N., Francis G. S., Kostis J. B., Packer M., Pfeffer M. A., Swedberg K., Yusuf S. The effect of treatment on survival in congestive heart failure. Clin Cardiol. 1992 May;15(5):323–329. doi: 10.1002/clc.4960150504. [DOI] [PubMed] [Google Scholar]
  15. Pousset F., Isnard R., Lechat P., Kalotka H., Carayon A., Maistre G., Escolano S., Thomas D., Komajda M. Prognostic value of plasma endothelin-1 in patients with chronic heart failure. Eur Heart J. 1997 Feb;18(2):254–258. doi: 10.1093/oxfordjournals.eurheartj.a015228. [DOI] [PubMed] [Google Scholar]
  16. Richards A. M., Nicholls M. G., Yandle T. G., Frampton C., Espiner E. A., Turner J. G., Buttimore R. C., Lainchbury J. G., Elliott J. M., Ikram H. Plasma N-terminal pro-brain natriuretic peptide and adrenomedullin: new neurohormonal predictors of left ventricular function and prognosis after myocardial infarction. Circulation. 1998 May 19;97(19):1921–1929. doi: 10.1161/01.cir.97.19.1921. [DOI] [PubMed] [Google Scholar]
  17. Rodeheffer R. J., Jacobsen S. J., Gersh B. J., Kottke T. E., McCann H. A., Bailey K. R., Ballard D. J. The incidence and prevalence of congestive heart failure in Rochester, Minnesota. Mayo Clin Proc. 1993 Dec;68(12):1143–1150. doi: 10.1016/s0025-6196(12)60063-9. [DOI] [PubMed] [Google Scholar]
  18. Schocken D. D., Arrieta M. I., Leaverton P. E., Ross E. A. Prevalence and mortality rate of congestive heart failure in the United States. J Am Coll Cardiol. 1992 Aug;20(2):301–306. doi: 10.1016/0735-1097(92)90094-4. [DOI] [PubMed] [Google Scholar]
  19. Senni M., Tribouilloy C. M., Rodeheffer R. J., Jacobsen S. J., Evans J. M., Bailey K. R., Redfield M. M. Congestive heart failure in the community: a study of all incident cases in Olmsted County, Minnesota, in 1991. Circulation. 1998 Nov 24;98(21):2282–2289. doi: 10.1161/01.cir.98.21.2282. [DOI] [PubMed] [Google Scholar]
  20. Wallén T., Landahl S., Hedner T., Nakao K., Saito Y. Brain natriuretic peptide predicts mortality in the elderly. Heart. 1997 Mar;77(3):264–267. doi: 10.1136/hrt.77.3.264. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Wei C. M., Heublein D. M., Perrella M. A., Lerman A., Rodeheffer R. J., McGregor C. G., Edwards W. D., Schaff H. V., Burnett J. C., Jr Natriuretic peptide system in human heart failure. Circulation. 1993 Sep;88(3):1004–1009. doi: 10.1161/01.cir.88.3.1004. [DOI] [PubMed] [Google Scholar]
  22. Wu C. F., Bishopric N. H., Pratt R. E. Atrial natriuretic peptide induces apoptosis in neonatal rat cardiac myocytes. J Biol Chem. 1997 Jun 6;272(23):14860–14866. doi: 10.1074/jbc.272.23.14860. [DOI] [PubMed] [Google Scholar]

Articles from Heart are provided here courtesy of BMJ Publishing Group

RESOURCES