Author response: B-type natriuretic peptide for cardiovascular events independent of left ventricular end-diastolic pressure

Refers to article:

Brain natriuretic peptide for cardiovascular events independent of left ventricular end-diastolic pressure
Viroj Wiwanitkit
American Heart Journal
March 2010 (Vol. 159, Issue 3, Page e15)
Full Text | Full-Text PDF (44 KB)

Article Outline

• References

• Copyright

Dear Dr Wiwanitkit:

Thank you for your interest in our study. We agree that the clinical application of B-type natriuretic peptide (BNP) as a prognostic marker is still evolving. We do believe that the body of evidence supports a relationship between BNP and left ventricular end-diastolic pressure in adults with left ventricular dysfunction.1, 2, 3, 4, 5, 6, 7, 8, 9, 10 The lack of such a relationship in the study by Oyamada et al11 may instead be related to their unique study population of infants with ventricular septal defects. The issue of false positives as a limitation to BNP testing is acknowledged but may be more germane to the use of BNP as a diagnostic, rather than a prognostic, marker and reinforces that the strength of BNP as a diagnostic test is its high negative predictive value. Nonetheless, implementation of BNP into clinical practice as a prognostic marker will be facilitated by better understanding and adjustment for clinical covariates that affect BNP levels.12, 13

References

1. 1Richards AM, Crozier IG, Yandle TG, et al. Brain natriuretic factor: regional plasma concentrations and correlations with haemodynamic state in cardiac disease. Br Heart J. 1993;69:414–417. MEDLINE | CrossRef

2. 2Joung B, Ha JW, Ko YG, et al. Can pro-brain natriuretic peptide be used as a noninvasive predictor of elevated left ventricular diastolic pressures in patients with normal systolic function?. Am Heart J. 2005;150:1213–1219. Abstract | Full Text | Full-Text PDF (273 KB) | CrossRef

3. 3Iwanaga Y, Nishi I, Furuichi S, et al. B-type natriuretic peptide strongly reflects diastolic wall stress in patients with chronic heart failure: comparison between systolic and diastolic heart failure. J Am Coll Cardiol. 2006;47:742–748. Abstract | Full Text | Full-Text PDF (336 KB) | CrossRef

4. 4O'Neill JO, Bott-Silverman CE, McRae AT, et al. B-type natriuretic peptide levels are not a surrogate marker for invasive hemodynamics during management of patients with severe heart failure. Am Heart J. 2005;149:363–369. Abstract | Full Text | Full-Text PDF (163 KB) | CrossRef

5. 5Maeda K, Tsutamoto T, Wada A, et al. Plasma brain natriuretic peptide as a biochemical marker of high left ventricular end-diastolic pressure in patients with symptomatic left ventricular dysfunction. Am Heart J. 1998;135:825–832. Abstract | Full Text | Full-Text PDF (182 KB) | CrossRef

6. 6Taylor JA, Christenson RH, Rao K, et al. B-type natriuretic peptide and N-terminal pro B-type natriuretic peptide are depressed in obesity despite higher left ventricular end diastolic pressures. Am Heart J. 2006;152:1071–1076. Abstract | Full Text | Full-Text PDF (200 KB) | CrossRef

7. 7Tschope C, Kasner M, Westermann D, et al. The role of NT-proBNP in the diagnostics of isolated diastolic dysfunction: correlation with echocardiographic and invasive measurements. Eur Heart J. 2005;26:2277–2284. CrossRef

8. 8Murakami Y, Shimada T, Inoue S, et al. New insights into the mechanism of the elevation of plasma brain natriuretic polypeptide levels in patients with left ventricular hypertrophy. Can J Cardiol. 2002;18:1294–1300.

9. 9Yamamoto K, Burnett JC, Jougasaki M, et al. Superiority of brain natriuretic peptide as a hormonal marker of ventricular systolic and diastolic dysfunction and ventricular hypertrophy. Hypertension. 1996;28:988–994.

10. 10Ndrepepa G, Braun S, Mehilli J, et al. Plasma levels of N-terminal pro-brain natriuretic peptide in patients with coronary artery disease and relation to clinical presentation, angiographic severity, and left ventricular ejection fraction. Am J Cardiol. 2005;95:553–557. Abstract | Full Text | Full-Text PDF (115 KB) | CrossRef

11. 11Oyamada J, Toyono M, Shimada S, et al. Noninvasive estimation of left ventricular end-diastolic pressure using tissue Doppler imaging combined with pulsed-wave Doppler echocardiography in patients with ventricular septal defects: a comparison with the plasma levels of the B-type natriuretic Peptide. Echocardiography. 2008;25(3):270–277. CrossRef

12. 12Rogers RK, Stehlik J, Stoddard, GJ, et al. Adjusting for clinical covariates improves the ability of BNP to distinguish cardiac from non-cardiac dyspnea: a sub-study of HEARD-IT.

13. 13Rogers RK, Stoddard GJ, Greene T, et al. Adjusting for clinical covariates improves the ability of B-type natriuretic peptide to distinguish cardiac from non-cardiac dyspnea. Am J Cardiol. 2009;104:1165–1170. Abstract | Full Text | Full-Text PDF (296 KB) | CrossRef

Division of Cardiology, University of Colorado Health Sciences Center, Campus Box B132, Aurora, CO 80045

PII: S0002-8703(09)00959-4

doi:10.1016/j.ahj.2009.12.005

31 of 33