Key result
Age, creatinine, LVEF, E/e', and markers of collagen turnover were independently associated with persistently elevated BNP levels in stable heart failure patients.
Observational (n=179)
Elevated BNP in stable heart failure is independently associated with age, renal function, systolic and diastolic dysfunction, and collagen turnover, highlighting multiple underlying pathophysiological stimuli.
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Should not yet change stable HF management; hypothesis-generating for multifactorial BNP drivers.
BACKGROUND: Persistently elevated natriuretic peptide (NP) levels in heart failure (HF) patients are associated with impaired prognosis. Recent work suggests that NP-guided therapy can improve outcome, but the mechanisms behind an elevated BNP remain unclear. Among the potential stimuli for NP in clinically stable patients are persistent occult fluid overload, wall stress, inflammation, fibrosis, and ischemia. The purpose of this study was to identify associates of B-type natriuretic peptide (BNP) in a stable HF population. METHODS: In a prospective observational study of 179 stable HF patients, the association between BNP and markers of collagen metabolism, inflammation, and Doppler-echocardiographic parameters including left ventricular ejection fraction (LVEF), left atrial volume index (LAVI), and E/e prime (E/e') was measured. RESULTS: Univariable associates of elevated BNP were age, LVEF, LAVI, E/e', creatinine, and markers of collagen turnover. In a multiple linear regression model, age, creatinine, and LVEF remained significant associates of BNP. E/e' and markers of collagen turnover had a persistent impact on BNP independent of these covariates. CONCLUSION: Multiple variables are associated with persistently elevated BNP levels in stable HF patients. Clarification of the relative importance of NP stimuli may help refine NP-guided therapy, potentially improving outcome for this at-risk population.
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Jan et al. (2013) conducted an observational in Stable heart failure (n=179). Clinical and echocardiographic variables was evaluated on Association between BNP and markers of collagen metabolism, inflammation, and Doppler-echocardiographic parameters. Age, creatinine, LVEF, E/e', and markers of collagen turnover were independently associated with persistently elevated BNP levels in stable heart failure patients.
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