Plasma brain natriuretic peptide level as a biochemical marker of morbidity and mortality in patients with asymptomatic or minimally symptomatic leftventricular dysfunction - Comparison with plasma angiotensin II and endothelin-1

Aims To evaluate the level of plasma brain natriuretic peptide as a predict or of morbidity and mortality in patients with asymptomatic or minimally sy mptomatic left ventricular dysfunction. Methods We measured plasma levels of atrial natriuretic peptide, brain natr iuretic peptide, norepinephrine, angiotensin II, and endothelin-1 and monit ored haemodynamic parameters in 290 consecutive patients with asymptomatic or minimally and newly symptomatic left Ventricular dysfunction (functional classes I-II, mean left ventricular ejection fraction=37%). All patients w ere followed up for a median period of 812 days. The Cox proportional hazar ds model was used to assess the association of variables with mortality and morbidity. Results At the end of the follow-up, 24 patients had suffered cardiac death and 25 had been hospitalized for worsening heart failure during the follow -up period. Among 21 variables such as clinical characteristics, treatment, haemodynamics, and neurohumoral factors, high levels of plasma brain natri uretic peptide (P<0.0001), norepinephrine (P=0.042), left ventricular end-d iastolic volume index (P=0.0035), and left Ventricular end-diastolic pressu re (P=0.033) were shown to be independent predictors of mortality and morbi dity by stepwise multivariate analysis. Moreover, only a high level of plas ma brain natriuretic peptide (P<0.0001) was shown to be an independent pred ictor of mortality in these patients. Conclusions These results indicate that a high plasma brain natriuretic pep tide level provides information about mortality and morbidity in patients w ith asymptomatic or minimally symptomatic left ventricular dysfunction. (Eu r Heart J 1999; 20: 1799-1807) (C) 1999 The European Society of Cardiology.