PURPOSE: To investigate the relationship of plasma brain natriuretic peptide (BNP)levels with right ventricular systolic dysfunction (RVSD) and left vetricular systolic dysfunction (LVSD) in patients admitted with dyspnea in a community hospital. Also to look at the effect of elevated creatinine on BNP levels.
METHODS: Retrospective study over 14 month period of patients admitted with worsening dyspnea. Data extracted included patient demographics, co-morbid conditions, physical findings, medications, chest radiography, 2D-echocardiographic findings including left and right ventricular functions and EKG findings. Plasma Creatinine (PCr.) and BNP levels on admission were recorded.
RESULTS: 200 charts reviewed, mean age was 68.9 years, 114 (56.7%) of them were females and 99% were African American. Patients were divided into four groups: RVSD (14.13%), LVSD (26.17%), Combined right and left ventricular dysfunction (30.8%) and those with absence of right and left ventricular dysfunction (26.17%).The mean BNP levels for different groups were 1744 pg/ml, 1281 pg/ml, 2567 pg/ml, and 723 pg/ml for RVSD, LVSD, combined ventricular dysfunction and those without right and left ventricular dysfunction respectively. Simple linear regression analysis showed significant linear relationship with BNP levels and RVSD (p-value of 0.0061). There was no significant linear relationship between BNP levels and LVSD (p=0.1130). Also Multiple logistic regression analysis showed a direct independent correlation between higher PCr. levels and BNP levels (p=0.0001).
CONCLUSION: RVSD is associated with higher levels of plasma BNP as compared to LVSD alone. Biventricular failure is associated with the highest levels of BNP. There was direct linear relationship between RVSD and plasma BNP levels which was not found with the LVSD. In addition, elevated BNP levels were found in patients with elevated PCr. irrespective of the cardiac function which could be due to decreased clearance.
CLINICAL IMPLICATIONS: In patients with worsening dyspnea; the elevation in BNP levels may not clearly predict RVSD from LVSD and echocardiography is still needed to distinguish these two entities. Also BNP levels should be cautiously interpreted in patients with renal dysfunction as they maybe falsely elevated.
DISCLOSURE: Roma Kapoor, None.