Diagnostic value of BNP in suspected perimyocarditis--a preliminary report

Diagnosis of perimyocarditis is often very challenging. Clinical presentation includes chest pain and ECG changes which are difficult to interpret. Clinical course is usually mild, however, some patients develop heart failure symptoms and require aggressive treatment. Plasma b-type natriuretic peptide (BNP) is a marker of the hemodynamical impairment of the heart. Its diagnostic role in patients with acute perimyocarditis has not yet been examined.

To assess the usefulness of BNP measurement in the diagnosis of perimyocarditis.

The study group consisted of 14 consecutive patients (13 males, mean age 32.1+/-12.4 years) with suspected perimyocarditis (history of influenza, typical symptoms, ECG and echocardiographic results as well as myocardial necrotic markers). Plasma BNP was assessed at bedside at the time of admission.

Plasma BNP, measured in 12 patients, was 163+/-154 pg/mL (max. 519 pg/mL) and exceeded upper normal level in 6 (50%) patients. When normal levels were adjusted for age and gender, 9 (80%) patients had elevated BNP. One patient had heart failure symptoms and a BNP level of 205 pg/mL. In all 4 patients who had transient myocardial contractility disturbances, detected by echocardiography, BNP level exceeded 100 pg/mL.

BNP level is increased in some patients with acute perimyocarditis. BNP elevation is probably associated with hemodynamical stress caused by transient contractility abnormalities. Diagnostic and prognostic role of BNP in acute perimyocarditis requires further studies.