PLASMA BRAIN NATRIURETIC PEPTIDE AS A BIOCHEMICAL MARKER OF HIGH LEFT-VENTRICULAR END-DIASTOLIC PRESSURE IN PATIENTS WITH SYMPTOMATIC LEFT-VENTRICULAR DYSFUNCTION

Background Plasma atrial natriuretic peptide (ANP), mainly from the at rium, brain natriuretic peptide (BNP), mainly from the ventricle, nore pinephrine (NE), and endothelin-1 (ET-1) levels are increased with the severity of congestive heart Failure (CHF). Although a close correlat ion between the left ventricular end-diastolic pressure (LVEDP) and pl asma ANP in patients with left ventricular dysfunction has been report ed, it is not yet known which cardiac natriuretic peptide is a better predictor of high LVEDP in patients with CHF. Methods To investigate t he biochemical predictors of the high LVEDP in patients with left vent ricular dysfunction, we measured plasma ANP, BNP, NE, and ET-1 levels and the hemodynamic parameters in 72 patients with symptomatic left ve ntricular dysfunction. Stepwise multivariate regression analyses were also used to determine whether the plasma levels of ANP, BNP, NE, and ET-1 could predict high LVEDP. Results Although significant positive c orrelations were found among the plasma levels of ANP, BNP, ET-1, and NE and the LVEDP, only BNP (p = 0.0001) was an independent and signifi cant predictor of high LVEDP in patients with CHF. In all eight patien ts with severe CHF measured for hemodynamics before and after the trea tments, the plasma BNP levels decreased in association with the decrea se of LVEDP, whereas other factors increased in some patients despite the decrease of LVEDP. Conclusions These findings suggest that plasma BNP is superior to ANP as a predictor of high LVEDP in patients with s ymptomatic left ventricular dysfunction.