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Brain Natriuretic Peptide Measurement in Patients With COPD and Cardiovascular DiseasePatients With COPD and Cardiovascular Disease FREE TO VIEW

Fayez Kheir, MD; Daniel A. Salerno, MD
Author and Funding Information

From the Department of Pulmonary Diseases, Critical Care, and Environmental Medicine, Tulane University Health Sciences Center.

Correspondence to: Daniel A. Salerno, MD, Department of Pulmonary Diseases, Critical Care, and Environmental Medicine, Tulane University Health Sciences Center, 1430 Tulane Ave, SL-9, New Orleans, LA 70112; e-mail: dsalerno@tulane.edu


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Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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Chest. 2013;144(3):1081. doi:10.1378/chest.13-0948
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To the Editor:

We read with great interest the recent article by Maclay and MacNee1 in CHEST (March 2013). The authors discussed different potential mechanisms that link COPD to an increased risk of cardiovascular disease, which will be the focus of novel therapeutic targets in the near future. We feel, however, that the relation among brain natriuretic peptide (BNP), COPD, and cardiovascular disease must be addressed.

It is well established that COPD is associated with increased cardiovascular mortality and ventricular dysfunction.2 In a 2011 prospective cohort study,2 the prevalence of ventricular dysfunction among patients with COPD was 17%, with an increased risk of mortality during the 2-year follow-up period (hazard ratio, 2.34; P = .053). BNP has been proposed as a noninvasive marker to detect previously unknown left ventricular dysfunction in patients with acute exacerbation of COPD. A 2010 prospective study in a cohort of patients with acute exacerbation of COPD found a strong correlation between levels of N-terminal pro-BNP and early mortality.3 In addition, BNP is an independent predictor of endothelial dysfunction.4 Therefore, using BNP as a surrogate marker in patients with COPD may help identify patients with underlying cardiovascular disease. The physician has to keep in mind that the natriuretic peptide level elevation in this setting is much more discrete that the one found in overt left ventricular failure.5

References

Maclay JD, MacNee W. Cardiovascular disease in COPD: mechanisms. Chest. 2013;143(3):798-807. [CrossRef] [PubMed]
 
Chang CL, Robinson SC, Mills GD, et al. Biochemical markers of cardiac dysfunction predict mortality in acute exacerbations of COPD. Thorax. 2011;66(9):764-768. [CrossRef] [PubMed]
 
Papaioannou AI, Mazioti A, Kiropoulos T, et al. Systemic and airway inflammation and the presence of emphysema in patients with COPD. Respir Med. 2010;104(2):275-282. [CrossRef] [PubMed]
 
Pauriah M, Khan F, Lim TK, et al. B-type natriuretic peptide is an independent predictor of endothelial function in man. Clin Sci (Lond). 2012;123(5):307-312. [CrossRef] [PubMed]
 
Salerno D, Marik PE. Brain natriuretic peptide measurement in pulmonary medicine. Respir Med. 2011;105(12):1770-1775. [CrossRef] [PubMed]
 

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Tables

References

Maclay JD, MacNee W. Cardiovascular disease in COPD: mechanisms. Chest. 2013;143(3):798-807. [CrossRef] [PubMed]
 
Chang CL, Robinson SC, Mills GD, et al. Biochemical markers of cardiac dysfunction predict mortality in acute exacerbations of COPD. Thorax. 2011;66(9):764-768. [CrossRef] [PubMed]
 
Papaioannou AI, Mazioti A, Kiropoulos T, et al. Systemic and airway inflammation and the presence of emphysema in patients with COPD. Respir Med. 2010;104(2):275-282. [CrossRef] [PubMed]
 
Pauriah M, Khan F, Lim TK, et al. B-type natriuretic peptide is an independent predictor of endothelial function in man. Clin Sci (Lond). 2012;123(5):307-312. [CrossRef] [PubMed]
 
Salerno D, Marik PE. Brain natriuretic peptide measurement in pulmonary medicine. Respir Med. 2011;105(12):1770-1775. [CrossRef] [PubMed]
 
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