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Clinical Cardiology logoLink to Clinical Cardiology
. 2007 Feb 14;29(10):457–461. doi: 10.1002/clc.4960291008

Relation of body fluid status to B‐type natriuretic peptide levels in patients with chronic heart failure during long‐term follow‐up

Hajime Kataoka 1,
PMCID: PMC6653972  PMID: 17063950

Abstract

Background: Little is known about the relationship of body fluid status with the levels and fluctuations of B‐type natriuretic peptide (BNP) over the long term.

Hypothesis: If BNP is to become useful for monitoring of patients with chronic heart failure (HF), the levels should reliably reflect both decompensation and improvement in the patient's condition.

Methods: Forty‐six patients with chronic HF who were stable at study entry but had previous decompensation were recruited and followed up between June 2003 and September 2005. At each visit, they were examined for BNP level and HF‐related signs of body fluid retention based on physical evaluation and pleural ultrasonography.

Results: During the study period 26 patients developed decompensation and 20 maintained a stable clinical course. In the 26 decompensated patients, BNP levels fluctuated widely (110 ±73.7 pg/ml; range 25‐290 pg/ml) even during stable periods. In all but three patients in this group, the maximum BNP level during decompensation was higher than that reached during stable periods. The BNP levels also fluctuated widely (180 ± 123 pg/ml; range 16‐489 pg/ml) in the 20 stable patients with HF. In all but one patient in this group, the BNP level was lower than the maximum BNP level obtained during the previous decompensation.

Conclusions: In patients with chronic HF with previous decompensation, there was a strong link between the appearance of clinical HF sign(s) of fluid retention and an increased BNP level despite wide intraindividual fluctuations in BNP over time. Thus, BNP levels reliably reflect both decompensation and improvement.

Keywords: B‐type natriuretic peptide, ultrasonography, heart failure, physical sign, pleural effusion

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References

  • 1. Bhalla V, Willis S, Maisel AS: B‐type natriuretic peptide: The level and the drug‐partners in the diagnosis and management of congestive heart failure. Congest Heart Fail 2004; 10 (1 suppl 1): 3–27 [DOI] [PubMed] [Google Scholar]
  • 2. Maeda K, Tsutamoto T, Wada A, Hisanaga T, Kinoshita M: Plasma brain natriuretic peptide as a biochemical maker of high left ventricular end‐dias‐tolic pressure in patients with symptomatic left ventricular dysfunction. Am Heart J 1998; 135: 825–832 [DOI] [PubMed] [Google Scholar]
  • 3. Kazanegra R, Cheng V, Garcia A, Krishnaswamy P, Gardetto N, Clopton P, Maisel A: A rapid test for B‐type natriuretic peptide correlates with falling wedge pressures in patients treated for decompensated heart failure: A pilot study. J Cardiac Fail 2001; 7: 21–29 [DOI] [PubMed] [Google Scholar]
  • 4. Lee SC, Stevens TL, Sandberg SM, Heublein DM, Nelson SM, Jougasaki M, Redfield MM, Burnett JC: The potential of brain natriuretic peptide as a biomarker for New York Heart Association class during the outpatient treatment of heart failure. J Cardiac Fail 2002; 8: 149–154 [DOI] [PubMed] [Google Scholar]
  • 5. Tang WHW, Francis GS: The difficult task of evaluating how to monitor patients with heart failure. J Cardiac Fail 2005; 11: 422–424 [DOI] [PubMed] [Google Scholar]
  • 6. Wu AHB, Smith A: Biological variation of the natriuretic peptides and their role in monitoring patients with heart failure. Eur J Heart Fail 2004; 6: 355–358 [DOI] [PubMed] [Google Scholar]
  • 7. Bruins S, Fokkema MR, Römer JWP, DeJongste MJL, van der Dijs FPL, van den Ouweland JMW, Muskiet FAJ: High intraindividual variation of B‐type natriuretic peptide (BNP) and amino‐terminal proBNP in patients with stable chronic heart failure. Clin Chem 2004; 50: 2052–2058 [DOI] [PubMed] [Google Scholar]
  • 8. Lewin J, Ledwidge M, O'Loughlin C, McNally C, McDonald K: Clinical deterioration in established heart failure: What is the value of BNP and weight gain in aiding diagnosis? Eur J Heart Fail 2005; 7: 953–957 [DOI] [PubMed] [Google Scholar]
  • 9. Kataoka H, Takada S: The role of thoracic ultrasonography for evaluation of patients with decompensated chronic heart failure. J Am Coll Cardiol 2000; 35: 1638–1646 [DOI] [PubMed] [Google Scholar]
  • 10. Jones AE, Kline JA: Pleural effusions in the critically ill: The evolving role of bedside ultrasound. Crit Care Med 2005; 33: 1874–1875 [DOI] [PubMed] [Google Scholar]
  • 11. Ghali JK, Kadakia S, Cooper R, Ferlinz J: Precipitating factors leading to decompensation of heart failure: Traits among urban blacks. Arch Intern Med 1988; 148: 2013–2016 [PubMed] [Google Scholar]
  • 12. Abdulla J, Køber L, Torp‐Pedersen C: Methods of assessing the functional status of patients with left ventricular systolic dysfunction in interventional studies. Cardiovasc Drugs Ther 2004; 18: 219–224 [DOI] [PubMed] [Google Scholar]
  • 13. Silver MA, Rosendorff C, Berkowitz R, Peacock WF IV: Current and emerging issues with B‐type natriuretic peptide. Congest Heart Fail 2005; 11: 212–214 [DOI] [PubMed] [Google Scholar]
  • 14. Tang WHW, Girod JP, Lee MJ, Starling RC, Young JB, van Lente F, Francis GS: Plasma B‐type natriuretic peptide levels in ambulatory patients with established chronic symptomatic systolic heart failure. Circulation 2003; 108: 2964–2966 [DOI] [PubMed] [Google Scholar]
  • 15. McGeoch G, Lainchbury J, Town GI, Toop L, Espiner E, Richards AM: Plasma brain natriuretic peptide after long‐term treatment for heart failure in general practice. Eur J Heart Fail 2002; 4: 479–483 [DOI] [PubMed] [Google Scholar]
  • 16. Braunschweig F, Linde C, Eriksson MJ, Hofman‐Bang C, Rydén L: Continuous haemodynamic monitoring during withdrawal of diuretics in patients with congestive heart failure. Eur Heart J 2002; 23: 59–69 [DOI] [PubMed] [Google Scholar]
  • 17. Androne AS, Hryniewicz K, Hudaihed A, Manciri D, Lamanca J, Katz SD: Relation of unrecognized hypervolemia in chronic heart failure to clinical status, hemodynamics, and patient outcomes. Am J Cardiol 2004; 93: 1254–1259 [DOI] [PubMed] [Google Scholar]
  • 18. Iwanaga Y, Nishi I, Furuichi S, Noguchi T, Sase K, Kihara Y, Goto Y, Nonogi H: B‐type natriuretic peptide strongly reflects diastolic wall stress in patients with chronic heart failure: Comparison between systolic and diastolic heart failure. J Am Coll Cardiol 2006; 47: 742–748 [DOI] [PubMed] [Google Scholar]
  • 19. Rademaker MT, Charles CJ, Kosoblou T, Protter AA, Espiner EA, Nicholls MG, Richards AM: Clearance receptors and endopeptidase: Equal role in natriuretic peptide metabolism in heart failure. Am J Physiol 1997; 273: H2372–2379 [DOI] [PubMed] [Google Scholar]
  • 20. Wang TJ, Larson MG, Levy D, Benjamin EJ, Corey D, Leip EP, Vasan RS: Heritability and genetic linkage of plasma natriuretic peptide levels. Circulation 2003; 108: 13–16 [DOI] [PubMed] [Google Scholar]
  • 21. Redfield MM, Rodeheffer RJ, Jacobsen SJ, Mahoney DW, Bailey KR, Burnett JC Jr: Plasma brain natriuretic peptide concentration: Impact of age and gender. J Am Coll Cardiol 2002; 40: 976–982 [DOI] [PubMed] [Google Scholar]

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