Brain natriuretic peptide for cardiovascular events independent of left ventricular end-diastolic pressure

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To the Editor:

I read the recent publication by Rogers et al¹ with great interest. Rogers et al assessed the prognostic value of brain natriuretic peptide (BNP) for cardiovascular events independent of left ventricular end-diastolic pressure (LVEDP) and reached the conclusion that plasma BNP level was not a is not just a prognostic surrogate for elevated LV filling pressure.¹ Indeed, the clinical value of plasma BNP relating to LV function is still a topic to be studied. Recently, Oyamada et al² reported that plasma BNP value did not have a significant association with the LVEDP. Oyamada et al showed that tissue Doppler imaging combined with pulsed-wave Doppler echocardiography has a better clinical usefulness.² Indeed, the BNP has no underlying biological process relating to LVEDP. Nevertheless, the use of BNP has its limitation in laboratory concern due to the problem of false positive that can be the result of both preanalytical and analytical interferences in the laboratory process.³

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References 

1. Rogers RK, May HT, Anderson JL, et al. Prognostic value of B-type natriuretic peptide for cardiovascular events independent of left ventricular end-diastolic pressure. Am J Heart. 2009;158:777–783
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2. Oyamada 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;25:270–277
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3. Krüger S, Hoffmann R, Graf J, et al. Brain natriuretic Peptide. Diagnostic and prognostic value in chronic heart failure. Med Klin (Munich). 2003;98:562–567
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