ATTENUATION OF COMPENSATION OF ENDOGENOUS CARDIAC NATRIURETIC PEPTIDESYSTEM IN CHRONIC HEART-FAILURE - PROGNOSTIC ROLE OF PLASMA BRAIN NATRIURETIC PEPTIDE CONCENTRATION IN PATIENTS WITH CHRONIC SYMPTOMATIC LEFT-VENTRICULAR DYSFUNCTION

Background Patients with congestive heart failure (CHF) have high plas ma levels of atrial natriuretic peptide (ANP), mainly from the atrium, and brain natriuretic peptide (BNP), mainly from the ventricle. We ex amined the prognostic role of plasma BNP in chronic CHF patients in co mparison with plasma ANP and other variables previously known to be as sociated with high mortality. We also evaluated the relationship betwe en mortality and plasma cGMP, a biological marker of ANP and BNP. Meth ods and Results The study subjects were 85 patients with chronic CHF ( left ventricular ejection fraction <0.45) who were followed for 2 year s. The plasma levels of ANP, BNP, cGMP, and norepinephrine increased w ith the severity of CHF. Among plasma levels of ANP, BNP, cGMP, and no repinephrine and clinical and hemodynamic parameters, only high levels of plasma BNP (P<.0001) and pulmonary capillary wedge pressure (P=.00 3) were significant independent predictors of the mortality in patient s 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 no nsurvivors and survivors. Conclusions These findings indicate that pla sma BNP is more useful than ANP for assessing the mortality in patient s with chronic CHF and that the plasma levels of BNP provide prognosti c information independent of other variables previously associated wit h a poor prognosis. Our findings also suggest that the compensatory ac tivity of the cardiac natriuretic peptide system is attenuated as mort ality increases in chronic CHF patients with high plasma levels of ANP and BNP.