Study objectives: In dyspneic patients without left
ventricular enlargement, it may be difficult to differentiate between
obstructive lung disease and diastolic heart failure. Determination of
plasma brain natriuretic peptide (BNP) levels, known to increase with
ventricular stretch, may be of clinical relevance in this situation. We
compared the discriminant power of BNP blood levels and of
echocardiography in patients with either chronic obstructive lung
disease or diastolic heart failure.
Twenty-six New York Heart Association class III dyspneic patients with
normal left ventricular systolic function were enrolled: 17 patients
with chronic obstructive lung disease and 9 patients with unequivocal
diastolic heart failure.
data were unable to accurately differentiate between the two groups,
whereas BNP levels were significantly and markedly higher in patients
with diastolic heart failure when compared to those with obstructive
lung disease (224 ± 240 pg/mL vs 14 ± 12 pg/mL,
p < 0.0001).
Conclusions: These preliminary results
warrant a prospective, large-scale evaluation of the value of BNP assay
for determining diastolic dysfunction, a common cause of dyspnea in
elderly patients, and differentiating it from other diagnoses such as
obstructive lung disease.