Predictive Value of NT-proBNP in Vascular Surgery Patients with COPD and Normal Left Ventricular Systolic Function

ABSTRACT N-terminal pro-B-type natriuretic peptide (NT-proBNP) is commonly used to identify a cardiac cause of dyspnoea. However, patients with chronic obstructive pulmonary disease (COPD) may also have increased plasma NT-proBNP levels because of right-sided myocardial stress caused by pulmonary hypertension. We investigated the relationship between COPD and elevated NT-proBNP levels as well as the impact of elevated NT-proBNP levels on mortality in vascular surgery patients with normal left ventricular systolic function. Prior to vascular surgery, NT-proBNP levels, pulmonary function and left ventricular ejection fraction (LVEF) were assessed in 376 patients. Only patients with a LVEF > 40%% were included; n == 261. Elevated NT-proBNP levels were defined as ≥500 pg/ml. Firstly, we assessed the relationship between COPD and NT-proBNP levels. Secondly, we investigated the association between elevated NT-proBNP levels and one-year mortality. COPD was independently associated with elevated NT-proBNP levels (OR 3.36, 95%%CI 1.30–8.65) with significant associations found for mild and severe COPD. Elevated NT-proBNP levels were associated with increased one-year mortality in patients with (HR 7.73, 95%%CI 1.60–37.43) and without COPD (HR 3.44, 95%%CI 1.10–10.73). COPD was associated with elevated NT-proBNP levels in patients with a normal LVEF undergoing vascular surgery. Elevated NT-proBNP levels independent of other well-established risk factors were associated with increased one-year mortality. NT-proBNP may be useful biomarker to risk stratify patients with COPD.

[1]  Jeroen J. Bax,et al.  Plasma N-terminal pro-B-type natriuretic peptide as a predictor of perioperative and long-term outcome after vascular surgery. , 2009, Journal of vascular surgery.

[2]  D. Muthu,et al.  Rapid Measurement of B-Type Natriuretic Peptide in the Emergency Diagnosis of Heart Failure , 2009 .

[3]  M. Christ-Crain,et al.  Use of B-type natriuretic peptide in the risk stratification of acute exacerbations of COPD. , 2008, Chest.

[4]  S. Jelić,et al.  Obstructive Pulmonary Disease and Chronic Heart Failure Diagnostic and Therapeutic Challenges in Patients With Coexistent Chronic , 2008 .

[5]  P. Poole‐Wilson,et al.  Prognostic importance of plasma NT‐pro BNP in chronic heart failure in patients treated with a β‐blocker: Results from the Carvedilol Or Metoprolol European Trial (COMET) trial , 2007, European journal of heart failure.

[6]  F. Rutten,et al.  Comparison of B‐type natriuretic peptide assays for identifying heart failure in stable elderly patients with a clinical diagnosis of chronic obstructive pulmonary disease , 2007, European journal of heart failure.

[7]  A. Cohen-Solal,et al.  Plasma brain natriuretic peptide-guided therapy to improve outcome in heart failure: the STARS-BNP Multicenter Study. , 2007, Journal of the American College of Cardiology.

[8]  D. Feeny,et al.  Effects of nocturnal noninvasive mechanical ventilation on heart rate variability of patients with advanced COPD. , 2007, Chest.

[9]  T. L. Le Jemtel,et al.  Diagnostic usefulness of B-type natriuretic peptide and functional consequences of muscle alterations in COPD and chronic heart failure. , 2006, Chest.

[10]  J. Behr,et al.  Brain natriuretic peptide is a prognostic parameter in chronic lung disease. , 2006, American journal of respiratory and critical care medicine.

[11]  C. Berry,et al.  Predictive value of plasma brain natriuretic peptide for cardiac outcome after vascular surgery , 2005, Heart.

[12]  M. Vogeser,et al.  Characterization of brain natriuretic peptide in long-term follow-up of pulmonary arterial hypertension. , 2005, Chest.

[13]  E. Bozkanat,et al.  The Significance of Elevated Brain Natriuretic Peptide Levels in Chronic Obstructive Pulmonary Disease , 2005, The Journal of international medical research.

[14]  Patrick Lebecque,et al.  Comparison of spirometric reference values , 2004, Pediatric pulmonology.

[15]  C. Frampton,et al.  Brain natriuretic peptide and n-terminal brain natriuretic peptide in the diagnosis of heart failure in patients with acute shortness of breath. , 2003, Journal of the American College of Cardiology.

[16]  H. Büller,et al.  Brain Natriuretic Peptide as a Predictor of Adverse Outcome in Patients With Pulmonary Embolism , 2003, Circulation.

[17]  L. Fisher,et al.  Changes in Brain Natriuretic Peptide and Norepinephrine Over Time and Mortality and Morbidity in the Valsartan Heart Failure Trial (Val-HeFT) , 2003, Circulation.

[18]  E. E. van der Wall,et al.  Increased brain and atrial natriuretic peptides in patients with chronic right ventricular pressure overload: correlation between plasma neurohormones and right ventricular dysfunction , 2001, Heart.

[19]  M. Kinoshita,et al.  Effect of spironolactone on plasma brain natriuretic peptide and left ventricular remodeling in patients with congestive heart failure. , 2001, Journal of the American College of Cardiology.

[20]  H. Naruse,et al.  Plasma concentration of brain natriuretic peptide as a biochemical marker for the evaluation of right ventricular overload and mortality in chronic respiratory disease. , 2000, Clinica chimica acta; international journal of clinical chemistry.

[21]  E F Cook,et al.  Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. , 1999, Circulation.

[22]  M. Bando,et al.  Elevated plasma brain natriuretic peptide levels in chronic respiratory failure with cor pulmonale. , 1999, Respiratory medicine.

[23]  S. Kuribayashi,et al.  Plasma brain natriuretic peptide levels increase in proportion to the extent of right ventricular dysfunction in pulmonary hypertension. , 1998, Journal of the American College of Cardiology.

[24]  S. Rich,et al.  Neurohormonal activation in patients with right ventricular failure from pulmonary hypertension: relation to hemodynamic variables and endothelin levels. , 1995, Journal of the American College of Cardiology.

[25]  J. Roca,et al.  Standardization of the measurement of transfer factor (diffusing capacity). Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society. , 1993, The European respiratory journal. Supplement.

[26]  J E Cotes,et al.  Lung volumes and forced ventilatory flows , 1993, European Respiratory Journal.

[27]  J E Cotes,et al.  Lung volumes and forced ventilatory flows. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society. , 1993, The European respiratory journal. Supplement.

[28]  B. Lipworth,et al.  Elevated levels of brain natriuretic peptide in acute hypoxaemic chronic obstructive pulmonary disease. , 1992, Clinical science.

[29]  N. Reichek,et al.  Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. , 1989, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.