Leg edema, ST-T abnormalities, and high BNP values are important signs of heart failure in the elderly

This study was aimed at the mechanism of the circulatory failure characteri stic of the elderly through elucidating the cause of leg edema frequently f ound in patients under treatment in health care facilities for physical or mental handicaps. ECG and measurement of atrial (ANP) and brain (BNP) natri uretic peptides were carried out on 156 patients (mostly females aged 84 ye ars on average) and echocardiographic assessment was done on 44 patients. N on-specific ST-T abnormalities were frequently found in patients with moder ate or severe leg edema (61 vs. 37% in those with slight or no edema). BNP levels were markedly increased in patients with either leg edema or ECG abn ormalities (Group B) and with both (Group C) compared with those without ei ther (Group A), with averages of 35.5 +/- 23.9. 91.3 +/- 80.1, and 184.3 +/ - 139.0 pg/ml, respectively, for Group A, B, and C. UCG examination reveale d marked regurgitation of cardiac valves, more frequently in patients with BNP over 50 pg/ml than in those with less (14/24 vs. 2/20), with a differen ce in extent of 5.7 versus 1.6 on an arbitrary scale. In addition to left v entricular hypertrophy, dilatation of the left atrium and inferior vena cav a, was frequently observed in patients with higher BNP levels. It is conclu ded that both cardiac valve regurgitation and myocardial damage represented by ST-T abnormalities on ECG result in heart failure characteristic of the elderly, and that an increase in BNP is an important sign of such heart fa ilure. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.