Increased brain and atrial natriuretic peptides in patients with chronic right ventricular pressure overload: correlation between plasma neurohormones and right ventricular dysfunction

Objective-To evaluate the role of plasma neurohormones in the diagnosis of asymptomatic or minimally symptomatic right ventricular dysfunction. Setting-Tertiary cardiovascular referral centre. Methods-Plasma brain natriuretic peptide (BNP) and atrial natriuretic pepti de (ANP) concentrations were measured in 21 asymptomatic or minimally sympt omatic patients with chronic right ventricular pressure overload caused by congenital heart disease, and in seven healthy volunteers. Right ventricula r ejection fraction was determined using magnetic resonance imaging. Results-Right ventricular ejection fraction in the volunteers was higher th an in the patients (69.0 (8.2)% v 58.0(12.0)%, respectively; p < 0.006). Le ft ventricular ejection fraction was 72.3(7.8)% in volunteers and 68.1(11.0 )% in patients (NS). There was a significant difference between patients an d volunteers in the plasma concentrations of BNP (5.3 (3.5) v 2.3 (1.7) pmo l/l, respectively; p < 0.009) and ANP (7.3 (4.5) v 3.6 (1.4) pmol/l; p < 0. 05). In both patients and volunteers, mean plasma ANP was higher than mean plasma BNP Right ventricular ejection fraction was inversely correlated wit h BNP and ANP (respectively, r = 0.65; p < 0.0002 and r = 0.61; p < 0.002). There was no correlation between left ventricular ejection fraction and BN P (r = 0.2; NS) or ANP (r = 0.52; NS). Similarly, no correlation was shown between the level of right ventricular systolic pressure and either plasma BNP (r = 0.20) or plasma ANP (r = 0.07). Conclusions-There was a significant inverse correlation between right ventr icular ejection fraction and the plasma neurohormones BNP and ANP in asympt omatic or minimally symptomatic patients with right ventricular pressure ov erload and congenital heart disease. Monitoring changes in BNP and ANP may provide quantitative follow up of right ventricular dysfunction in these pa tients.