Brain Natriuretic Hormone Predicts Stress-Induced Alterations in Diastolic Function

Background:Mental stress (MS) reduces diastolic function (DF) and may lead to congestive heart failure with preserved systolic function. Whether brain natriuretic hormone (brain natriuretic peptide [BNP]) mediates the relationship of MS with DF is unknown. Methods:One hundred sixty individuals aged 30 to 50 years underwent 2-hour protocol of 40-minute rest, videogame stressor and recovery. Hemodynamics, pro-BNP samples and DF indices were obtained throughout the protocol. Separate regression analyses were conducted using rest and stress E/A, E′ and E/E′ as dependent variables. Predictor variables were entered into the stepwise regression models in a hierarchical fashion. At the first level, age, sex, race, height, body mass index, pro-BNP and left ventricular mass (LVM) were permitted to enter the models. The second level consisted of systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR). The final level contained cross-product terms of race by SBP, DBP and HR. Results:E/A ratio was lower during stress compared to rest and recovery (P < 0.01). Resting E/A ratio was predicted by a regression model of age (−0.31), pro-BNP (0.16), HR (−0.40) and DBP (−0.23) with an R2 = 0.33. Stress E/A ratio was predicted by age (−0.24), pro-BNP (0.08), HR (−0.38) and SBP (−0.21) with total R2 = 0.22. Resting E′ model consisted of age (−0.22), pro-BNP (0.26), DBP (−0.27) and LVM (−0.15) with an R2 = 0.29. Stress E′ was predicted by age (−0.18), pro-BNP (0.35) and LVM (−0.18) with an R2 = 0.18. Resting E/E′ was predicted by race (0.17, B > W) and DBP (0.24) with an R2 = 0.10. Stress E/E′ consisted of pro-BNP (−0.36), height (−0.26) and HR (−0.21) with an R2 = 0.15. Conclusions:pro-BNP predicts both resting and stress DF, suggesting that lower BNP during MS may be a marker of diastolic dysfunction in apparently healthy individuals.

[1]  M. Drazner,et al.  Impact of Body Mass and Body Composition on Circulating Levels of Natriuretic Peptides: Results From the Dallas Heart Study , 2005, Circulation.

[2]  S. Seto,et al.  Impaired left ventricular filling in borderline hypertensive patients without cardiac structural changes. , 1993, American heart journal.

[3]  H. Anisman,et al.  Impact of acute and chronic stressor experiences on heart atrial and brain natriuretic peptides in response to a subsequent stressor , 2010, Hormones and Behavior.

[4]  G. Fonarow,et al.  B-type natriuretic peptide levels in obese patients with advanced heart failure. , 2006, Journal of the American College of Cardiology.

[5]  J. Sanderson,et al.  Diastolic dysfunction and natriuretic peptides in systolic heart failure. Higher ANP and BNP levels are associated with the restrictive filling pattern. , 1996, European heart journal.

[6]  A. Steptoe,et al.  Systematic review of mental stress-induced myocardial ischaemia. , 2003, European heart journal.

[7]  B. Massie,et al.  Correlates of diastolic filling abnormalities in hypertension: a Doppler echocardiographic study. , 1990, American heart journal.

[8]  L. Fatti.  Perspex specimen-boxes. , 1947, Lancet.

[9]  E. Mesquita,et al.  Cardiac function during mental stress: cholinergic modulation with pyridostigmine in healthy subjects. , 2003, Clinical science.

[10]  T. Ishimitsu,et al.  Relationship between left ventricular geometry and natriuretic peptide levels in essential hypertension. , 1996, Hypertension.

[11]  C. Palombo,et al.  Casual, ambulatory and stress blood pressure: relationships with left ventricular mass and filling. , 1991, International Journal of Cardiology.

[12]  J. Hollander,et al.  Impact of age, race, and sex on the ability of B-type natriuretic peptide to aid in the emergency diagnosis of heart failure: results from the Breathing Not Properly (BNP) multinational study. , 2003, American heart journal.

[13]  J. Mariani,et al.  Hemodynamic Determinants of Myocardial B-Type Natriuretic Peptide Release: Relative Contributions of Systolic and Diastolic Wall Stress , 2010, Hypertension.

[14]  C. Kumana,et al.  Natriuretic peptides--relevance in cardiovascular disease. , 1998, JAMA.

[15]  D. Reda,et al.  Importance of obesity, race and age to the cardiac structural and functional effects of hypertension. The Department of Veterans Affairs Cooperative Study Group on Antihypertensive Agents. , 1994, Journal of the American College of Cardiology.

[16]  Bert N. Uchino,et al.  Autonomic cardiac control. III. Psychological stress and cardiac response in autonomic space as revealed by pharmacological blockades. , 1994, Psychophysiology.

[17]  B. Falkner,et al.  Cardiovascular Response to Mental Stress in Normal Adolescents with Hypertensive Parents: Hemodynamics and Mental Stress in Adolescents , 1979, Hypertension.

[18]  J. Gardin,et al.  Relationship of cardiovascular risk factors to echocardiographic left ventricular mass in healthy young black and white adult men and women. The CARDIA study. Coronary Artery Risk Development in Young Adults. , 1995, Circulation.

[19]  R. Kronmal,et al.  Differences in the incidence of congestive heart failure by ethnicity: the multi-ethnic study of atherosclerosis. , 2008, Archives of internal medicine.

[20]  R. Soufer,et al.  Effects of mental stress on left ventricular and peripheral vascular performance in patients with coronary artery disease. , 1998, Journal of the American College of Cardiology.

[21]  D. Levy,et al.  Impact of age and sex on plasma natriuretic peptide levels in healthy adults. , 2002, The American journal of cardiology.

[22]  A. L'Abbate,et al.  Coronary dynamics and mental arithmetic stress in humans. , 1991, Circulation.

[23]  Y. Kihara,et al.  BNP in overweight and obese patients with heart failure: an analysis based on the BNP-LV diastolic wall stress relationship. , 2007, Journal of cardiac failure.

[24]  D. Berman,et al.  Mental stress and the induction of silent myocardial ischemia in patients with coronary artery disease. , 1988, The New England journal of medicine.

[25]  J. Gottdiener,et al.  Mental Stress Hemodynamic Responses and Myocardial Ischemia: Does Left Ventricular Dysfunction Alter These Relationships? , 2007, Psychosomatic medicine.

[26]  G. Harshfield,et al.  Gender Differences in Diastolic Function Among Youth , 2007, Pediatric Cardiology.

[27]  N. Nahman,et al.  Nocturnal blood pressure in treated hypertensive African Americans Compared to treated hypertensive European Americans. , 1996, Journal of the American Society of Nephrology : JASN.

[28]  A. Folsom,et al.  Heart failure incidence and survival (from the Atherosclerosis Risk in Communities study). , 2008, The American journal of cardiology.

[29]  K. George,et al.  Cardiac fatigue following prolonged endurance exercise of differing distances. , 2000, Medicine and science in sports and exercise.

[30]  G. Harshfield,et al.  Relationship of body composition to stress-induced pressure natriuresis in youth. , 2004, American journal of hypertension.

[31]  R. Soufer,et al.  Role of behavioral and psychological factors in mental stress-induced silent left ventricular dysfunction in coronary artery disease. , 1993, Journal of the American College of Cardiology.

[32]  M. Abe,et al.  N‐terminal fragment of pro‐brain natriuretic peptide (NT‐proBNP) for predicting silent myocardial ischaemia in type 2 diabetes mellitus independent of microalbuminuria , 2010, Diabetes/metabolism research and reviews.

[33]  A. Richards,et al.  Correlates of plasma atrial natriuretic factor in health and hypertension. , 1987, Hypertension.

[34]  Y. Kokubo,et al.  Association of plasma B-type natriuretic peptide levels with obesity in a general urban Japanese population: the Suita Study. , 2010, Endocrine journal.

[35]  J. Gottdiener,et al.  Induction of silent myocardial ischemia with mental stress testing: relation to the triggers of ischemia during daily life activities and to ischemic functional severity. , 1994, Journal of the American College of Cardiology.

[36]  M. Drazner,et al.  Increased prevalence of concentric left ventricular hypertrophy in African-Americans: Will an epidemic of heart failure follow? , 2006, Heart Failure Reviews.

[37]  K. Yano,et al.  Effect of mental stress on hemodynamics and left ventricular diastolic function in patients with ischemic heart disease. , 1998, Japanese circulation journal.

[38]  S. Gottlieb,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. , 2006, American heart journal.

[39]  A. Khera,et al.  Relation of coronary atherosclerosis determined by electron beam computed tomography and plasma levels of n-terminal pro-brain natriuretic peptide in a multiethnic population-based sample (the Dallas Heart Study). , 2005, The American journal of cardiology.

[40]  A. Shore,et al.  RAISED CIRCULATING LEVELS OF ATRIAL NATRIURETIC PEPTIDES IN ESSENTIAL HYPERTENSION , 1986, The Lancet.

[41]  J. Mair,et al.  Relationship between natriuretic peptides and hemodynamics in patients with heart failure at rest and after ergometric exercise. , 1999, Clinica chimica acta; international journal of clinical chemistry.