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Evaluation of impaired left ventricular ejection fraction and increased dimensions by multiple neurohumoral plasma
B A Groenning1, J C Nilsson, L Sondergaard
1Danish Research Centre of Magnetic Resonance, Section 340, H:S Hvidovre Hospital, University of Copenhagen, Kettegaard Allé 30, DK-2650, Hvidovre, Denmark. bjoerng@dadlnet.dk
Insights
Brain natriuretic peptide (BNP) is the most potent marker for assessing left ventricular (LV) dimensions and ejection fraction (LVEF) in heart failure patients. Comprehensive neurohumoral evaluation offers supplementary diagnostic insights.
Area of Science:
- Cardiology
- Biomarker Discovery
- Heart Failure Research
Background:
- Neurohumoral substances are explored as heart failure diagnostic markers.
- The superior diagnostic potential of specific markers and comprehensive evaluations remains unclear.
Purpose of the Study:
- To compare epinephrine, norepinephrine, renin activity, aldosterone, atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), arginine-vasopressin, and endothelin (ENDO) as markers for LV dimensions and LVEF.
- To determine the diagnostic value of these neurohumoral markers in systolic heart failure.
Main Methods:
- Studied 48 patients with symptomatic heart failure and 20 healthy controls.
- Utilized blood samples and magnetic resonance imaging (MRI) for comprehensive patient evaluation.
Main Results:
- Brain natriuretic peptide (BNP) demonstrated the strongest independent correlation with LV end-diastolic and end-systolic volumes, myocardial mass, and LVEF.
- Atrial natriuretic peptide (ANP) served as a supplementary marker for LV volumes, endothelin (ENDO) for myocardial mass, and aldosterone (ALDO) for LVEF when combined with BNP.
Conclusions:
- BNP is the primary neurohumoral marker for evaluating LV dimensions and LVEF in systolic heart failure.
- A comprehensive neurohumoral assessment provides additional valuable information for heart failure diagnosis.
Background:
A range of neurohumoral substances have been suggested as diagnostic markers in heart failure. It is, however, undetermined which marker has the greatest diagnostic potential, and whether additional information is gained by a comprehensive neurohumoral evaluation.
Aims:
The purpose of the study was to compare the value of epinephrine, norepinephrine, renin activity, aldosterone (ALDO), atrial (ANP) and brain (BNP) natriuretic peptides, arginine-vasopressin and endothelin (ENDO) as markers for left ventricular (LV) dimensions and ejection fraction (LVEF) in patients with systolic heart failure.
Methods:
Forty-eight patients with symptomatic heart failure were examined with blood samples and magnetic resonance imaging along with 20 age and gender-matched normal controls.
Results:
In multiple regression analyses, BNP was the strongest independent marker for LV end-diastolic (r=0.71, P<0.0001), and end-systolic (r=0.75, P<0.0001) volumes, myocardial mass (r=0.69, P<0.0001), and LVEF (r=-0.78, P<0.0001). ANP was a supplementary independent marker for LV end-diastolic (r=0.76, P<0.0001) and end-systolic (r=0.78, P<0.0001) (ANP and BNP combined) volumes, ENDO for myocardial mass [r=0.71, P<0.0001 (ENDO/BNP)], and ALDO for LVEF [r=-0.81, P<0.0001 (ALDO/BNP)].
Conclusion:
BNP is the strongest marker for LV dimensions and LVEF in patients with systolic heart failure. However, a comprehensive neurohumoral evaluation may add some information to the diagnosis.