The potential of brain natriuretic peptide as a biomarker for New York Heart Association class during the outpatient treatment of heart failure

• Published in: Journal of cardiac failure Vol. 8; no. 3; pp. 149 - 154
• Main Authors: Lee, Shang-Chiun, Stevens, Tracy L., Sandberg, Sharon M., Heublein, Denise M., Nelson, Susan M., Jougasaki, Michihisa, Redfield, Margaret M., Burnett, John C.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2002
• Subjects: Adult; Aged; Aged, 80 and over; Ambulatory Care; Atrial Natriuretic Factor - blood; Biomarkers - blood; Female; heart failure; Heart Failure - blood; Heart Failure - classification; Heart Failure - therapy; Humans; Male; Middle Aged; Natriuretic Peptide, Brain - blood; Natriuretic peptides; NYHA class; Peptide Fragments - blood; Protein Precursors - blood; Radioimmunoassay; Single-Blind Method; Treatment Outcome; Ventricular Dysfunction, Left - blood; heart failure; NYHA class; Natriuretic peptides
• ISSN: 1071-9164; 1532-8414
• DOI: 10.1054/jcaf.2002.125368

Background: Plasma C-terminal atrial natriuretic peptide (C-ANP), N-terminal ANP (N-ANP), and brain natriuretic peptide (BNP) have diagnostic utility in detecting left ventricular dysfunction. Their relative value in monitoring symptom status during the chronic treatment of congestive heart failure (CHF) remains undefined. Methods and Results: Ninety-eight subjects with CHF were evaluated. Baseline natriuretic peptides were measured by radioimmunoassay, left ventricular ejection fraction (LVEF) was estimated with echocardiography, and New York Heart Association (NYHA) class was determined independently by attending heart failure specialists. Forty-one subjects were restudied during a 6- to 12-month follow-up period after optimizing therapy. At baseline, all natriuretic peptides and LVEF correlated positively with NYHA class (P <.005). Plasma BNP, however, correlated best with NYHA class. At follow-up, only changes of BNP correlated to changes of NYHA class (P =.04). BNP decreased (−45% ± 12%, N = 14, P =.002) in subjects whose NYHA class improved whereas BNP remained unchanged (−1% ± 10%, N = 25, P =.95) in those whose NYHA class was stable. Conclusions: This investigation demonstrates the superiority of plasma BNP as compared to ANP and LVEF in objectively assessing NYHA class during the chronic treatment of CHF. Given that clinical assessment of CHF is subjective, plasma BNP is a useful objective biomarker in monitoring human CHF in the outpatient setting.