PURPOSE: If brain natriuretic peptide (BNP) is to become useful for monitoring of patients with chronic heart failure (HF), the levels should reliably reflect both decompensation and improvement in the patient’s condition. This study examined the longitudinal relation between clinically-determined body fluid status and BNP levels in chronic HF patients.
METHODS: Forty-six chronic HF patients that were stable at study entry but had previous decompensation were recruited and followed-up between June 2003 and September 2005. At each visit, they were examined for BNP level and HF-related signs of body fluid retention based on physical evaluation and pleural ultrasonography.
RESULTS: During the study period, 26 patients developed decompensation and 20 maintained a stable clinical course. In the 26 decompensated patients, BNP levels fluctuated widely (mean [± SD], 110 ± 73.7 pg/ml; range 25 to 290 pg/ml), even during stable periods. In all but three patients in this group, the maximum BNP level during decompensation was higher than that reached during stable periods. The BNP levels also fluctuated widely (180 ± 123 pg/ml; range 16 to 489 pg/ml) in the 20 stable HF patients. In all but one patient in this group, the BNP level was lower than the maximum BNP level obtained during the previous decompensation.
CONCLUSION: In chronic HF patients with previous decompensation, there was a strong link between the appearance of clinical HF-sign(s) of fluid retention and an increased BNP level, despite wide intra-individual fluctuations in BNP over time. Thus, BNP levels reliably reflect both decompensation and improvement.
CLINICAL IMPLICATIONS: This study examined the longitudinal relation between clinically-determined body fluid status and BNP level in chronic HF patients, and explored the intra-individual fluctuations in plasma BNP levels over time and determined whether the levels reliably reflect both decompensation and improvement in the individual patient’s condition.
DISCLOSURE: Hajime Kataoka, None.