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(Circulation. 1997;96:509-516.)
© 1997 American Heart Association, Inc.
Articles |
Attenuation of Compensation of Endogenous Cardiac Natriuretic Peptide System in Chronic Heart Failure
Prognostic Role of Plasma Brain Natriuretic Peptide Concentration in Patients With Chronic Symptomatic Left Ventricular Dysfunction
From the First Department of Internal Medicine, Shiga University of Medical Science, Tsukinowa, Seta, Otsu 520-21, Japan.
Correspondence to Takayoshi Tsutamoto, MD, The First Department of Internal Medicine, Shiga University of Medical Science Tsukinowa, Seta, Otsu 520-21, Japan.
Background Patients with congestive heart failure (CHF) have high plasma levels of atrial natriuretic peptide (ANP), mainly from the atrium, and brain natriuretic peptide (BNP), mainly from the ventricle. We examined the prognostic role of plasma BNP in chronic CHF patients in comparison with plasma ANP and other variables previously known to be associated with high mortality. We also evaluated the relationship between mortality and plasma cGMP, a biological marker of ANP and BNP.
Methods and Results The study subjects were 85 patients with chronic CHF (left ventricular ejection fraction <0.45) who were followed for 2 years. The plasma levels of ANP, BNP, cGMP, and norepinephrine increased with the severity of CHF. Among plasma levels of ANP, BNP, cGMP, and norepinephrine and clinical and hemodynamic parameters, only high levels of plasma BNP (P<.0001) and pulmonary capillary wedge pressure (P=.003) were significant independent predictors of the mortality in patients with CHF by Cox proportional hazard analysis. Although plasma levels of ANP and BNP were threefold or fivefold higher in nonsurvivors than in survivors, there was no difference in plasma cGMP level between nonsurvivors and survivors.
Conclusions These findings indicate that plasma BNP is more useful than ANP for assessing the mortality in patients with chronic CHF and that the plasma levels of BNP provide prognostic information independent of other variables previously associated with a poor prognosis. Our findings also suggest that the compensatory activity of the cardiac natriuretic peptide system is attenuated as mortality increases in chronic CHF patients with high plasma levels of ANP and BNP.
Key Words: natriuretic peptides • heart failure • atrial natriuretic factor • prognosis
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B. Meyer, D. Mortl, K. Strecker, M. Hulsmann, V. Kulemann, T. Neunteufl, R. Pacher, and R. Berger Flow-Mediated Vasodilation Predicts Outcome in Patients With Chronic Heart Failure: Comparison With B-Type Natriuretic Peptide J. Am. Coll. Cardiol., September 20, 2005; 46(6): 1011 - 1018. [Abstract] [Full Text] [PDF]
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A. M. Duncan, E. Lim, D. G. Gibson, and M. Y. Henein Effect of Dobutamine Stress on Left Ventricular Filling in Ischemic Dilated Cardiomyopathy: Pathophysiology and Prognostic Implications J. Am. Coll. Cardiol., August 2, 2005; 46(3): 488 - 496. [Abstract] [Full Text] [PDF]
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M. Kupari, H. Turto, J. Lommi, M. Makijarvi, and H. Parikka Transcardiac gradients of N-terminal B-type natriuretic peptide in aortic valve stenosis Eur J Heart Fail, August 1, 2005; 7(5): 809 - 814. [Abstract] [Full Text] [PDF]
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S. Isobe, H. Izawa, M. Iwase, M. Nanasato, M. Nonokawa, A. Ando, S. Ohshima, K. Nagata, K. Kato, T. Nishizawa, et al. Cardiac 123I-MIBG Reflects Left Ventricular Functional Reserve in Patients with Nonobstructive Hypertrophic Cardiomyopathy J. Nucl. Med., June 1, 2005; 46(6): 909 - 916. [Abstract] [Full Text] [PDF]
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Authors/Task Force Members, K. Swedberg, Writing Committee:, J. Cleland, H. Dargie, H. Drexler, F. Follath, M. Komajda, L. Tavazzi, O. A. Smiseth, et al. Guidelines for the diagnosis and treatment of chronic heart failure: executive summary (update 2005): The Task Force for the Diagnosis and Treatment of Chronic Heart Failure of the European Society of Cardiology Eur. Heart J., June 1, 2005; 26(11): 1115 - 1140. [Full Text] [PDF]
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R. Valle, N. Aspromonte, S. Barro, C. Canali, E. Carbonieri, V. Ceci, M. Chinellato, G. Gallo, P. Giovinazzo, R. Ricci, et al. The NT-proBNP assay identifies very elderly nursing home residents suffering from pre-clinical heart failure Eur J Heart Fail, June 1, 2005; 7(4): 542 - 551. [Abstract] [Full Text] [PDF]
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T. Kishi, Y. Hirooka, A. Masumoto, K. Ito, Y. Kimura, K. Inokuchi, T. Tagawa, H. Shimokawa, A. Takeshita, and K. Sunagawa Rho-Kinase Inhibitor Improves Increased Vascular Resistance and Impaired Vasodilation of the Forearm in Patients With Heart Failure Circulation, May 31, 2005; 111(21): 2741 - 2747. [Abstract] [Full Text] [PDF]
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D. Detaint, D. Messika-Zeitoun, J.-F. Avierinos, C. Scott, H. Chen, J. C. Burnett Jr, and M. Enriquez-Sarano B-Type Natriuretic Peptide in Organic Mitral Regurgitation: Determinants and Impact on Outcome Circulation, May 10, 2005; 111(18): 2391 - 2397. [Abstract] [Full Text] [PDF]
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C. Kistorp, I. Raymond, F. Pedersen, F. Gustafsson, J. Faber, and P. Hildebrandt N-Terminal Pro-Brain Natriuretic Peptide, C-Reactive Protein, and Urinary Albumin Levels as Predictors of Mortality and Cardiovascular Events in Older Adults JAMA, April 6, 2005; 293(13): 1609 - 1616. [Abstract] [Full Text] [PDF]
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R. S. Gardner, V. Chong, I. Morton, and T. A. McDonagh N-terminal brain natriuretic peptide is a more powerful predictor of mortality than endothelin-1, adrenomedullin and tumour necrosis factor-{alpha} in patients referred for consideration of cardiac transplantation Eur J Heart Fail, March 2, 2005; 7(2): 253 - 260. [Abstract] [Full Text] [PDF]
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S. Kasama, T. Toyama, H. Kumakura, Y. Takayama, S. Ichikawa, T. Suzuki, and M. Kurabayashi Effects of candesartan on cardiac sympathetic nerve activity in patients with congestive heart failure and preserved left ventricular ejection fraction J. Am. Coll. Cardiol., March 1, 2005; 45(5): 661 - 667. [Abstract] [Full Text] [PDF]
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R. Jarai, N. Iordanova, R. Jarai, A. Raffetseder, W. Woloszczuk, M. Gyongyosi, G. Geyer, J. Wojta, and K. Huber Risk assessment in patients with unstable angina/non-ST-elevation myocardial infarction and normal N-terminal pro-brain natriuretic peptide levels by N-terminal pro-atrial natriuretic peptide Eur. Heart J., February 1, 2005; 26(3): 250 - 256. [Abstract] [Full Text] [PDF]
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J. Hogenhuis, A. A. Voors, T. Jaarsma, H. L. Hillege, F. Boomsma, and D. J. van Veldhuisen Influence of age on natriuretic peptides in patients with chronic heart failure: a comparison between ANP/NT-ANP and BNP/NT-proBNP Eur J Heart Fail, January 1, 2005; 7(1): 81 - 86. [Abstract] [Full Text] [PDF]
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S. Kasama, T. Toyama, H. Kumakura, Y. Takayama, S. Ichikawa, S. Tange, T. Suzuki, and M. Kurabayashi Dobutamine Stress 99mTc-Tetrofosmin Quantitative Gated SPECT Predicts Improvement of Cardiac Function After Carvedilol Treatment in Patients with Dilated Cardiomyopathy J. Nucl. Med., November 1, 2004; 45(11): 1878 - 1884. [Abstract] [Full Text] [PDF]
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P. Bettencourt, A. Azevedo, J. Pimenta, F. Frioes, S. Ferreira, and A. Ferreira N-Terminal-Pro-Brain Natriuretic Peptide Predicts Outcome After Hospital Discharge in Heart Failure Patients Circulation, October 12, 2004; 110(15): 2168 - 2174. [Abstract] [Full Text] [PDF]
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V. M. Conraads, P. Beckers, J. Vaes, M. Martin, V. Van Hoof, C. De Maeyer, N. Possemiers, F. L. Wuyts, and C. J. Vrints Combined endurance/resistance training reduces NT-proBNP levels in patients with chronic heart failure Eur. Heart J., October 2, 2004; 25(20): 1797 - 1805. [Abstract] [Full Text] [PDF]
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A. P. Patrianakos, F. I. Parthenakis, E. A. Papadimitriou, G. F. Diakakis, P. G. Tzerakis, D. Nikitovic, and P. E. Vardas Restrictive filling pattern is associated with increased humoral activation and impaired exercise capacity in dilated cardiomyopathy Eur J Heart Fail, October 1, 2004; 6(6): 735 - 743. [Abstract] [Full Text] [PDF]
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F. Hartmann, M. Packer, A. J.S. Coats, M. B. Fowler, H. Krum, P. Mohacsi, J. L. Rouleau, M. Tendera, A. Castaigne, S. D. Anker, et al. Prognostic Impact of Plasma N-Terminal Pro-Brain Natriuretic Peptide in Severe Chronic Congestive Heart Failure: A Substudy of the Carvedilol Prospective Randomized Cumulative Survival (COPERNICUS) Trial Circulation, September 28, 2004; 110(13): 1780 - 1786. [Abstract] [Full Text] [PDF]
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T. Omland Heart failure in the emergency department: Is B-type natriuretic peptide a better prognostic indicator than clinical assessment? J. Am. Coll. Cardiol., September 15, 2004; 44(6): 1334 - 1336. [Full Text] [PDF]
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