Nishimura, K; Nishimura, T; Onishi, K; Oga, T; Hasegawa, Y; Jones, PW
(2014)
Changes in plasma levels of B-type natriuretic peptide with acute exacerbations of chronic obstructive pulmonary disease.
International Journal of Chronic Obstructive Pulmonary Disease, 9.
155 - 162.
ISSN 1176-9106
https://doi.org/10.2147/COPD.S55143
SGUL Authors: Jones, Paul Wyatt
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Abstract
Background:
Elevated plasma B-type natriuretic peptide (BNP) levels and their association with heart failure have been reported in subjects with acute exacerbations of chronic obstructive
pulmonary disease (AECOPD).
Purpose:
To examine and compare plasma BNP levels and diastolic and systolic dysfunction in subjects with AECOPD and s
table chronic obstructive pulmonary disease (COPD).
Methods:
In all,87 unselected consecutive hospitalizations due to AECOPD in 61 subjects and a total of 190 consecutive subjects with stable COPD were recruited. Plasma BNP levels were compared cross-sectionally and longitudinally. Transthoracic echocardiographic examinations
were also performed in the hospitalized subjects.
Results:
In the hospitalized subjects, the median plasma BNP level (interquartile range) was 55.4 (26.9–129.3) pg/mL and was higher than that of patients with stable COPD: 18.3 (10.0–45.3)for Global Initiative for Chronic Obstructive Lung Disease grade I; 25.8 (11.0–53.7) for grade II; 22.1 (9.1–52.6) for grade III; and 17.2 (9.6–22.9) pg/mL for grade IV, all P,0.001.
In 15 subjects studied prospectively, the median plasma BNP level was 19.4 (9.8–32.2) pg/mL before AECOPD, 72.7 (27.7–146.3) pg/mL during AECOPD, and 14.6 (12.9–39.0) pg/mL
after AECOPD (P,0.0033 and P,0.0013, respectively). Median plasma BNP levels during AECOPD were significantly higher in ten unsuccessfully discharged subjects 260.5 (59.4–555.0)
than in 48 successfully discharged subjects 48.5(24.2–104.0) pg/mL (P=0.0066). Only 5.6%
of AECOPD subjects were associated with systolic dysfunction defined as a left ventricular ejection fraction (LVEF),50%; a further 7.4% were considered to have impaired relaxation defined as an E/A wave velocity ratio,0.8 and a deceleration time of E.240 ms. BNP levels were weakly correlated with the E/peak early diastolic velocity of the mitral annulus (Ea) ratio (Spearman’s rank correlation coefficient =0.353,P =0.018), but they were not correlated with the LVEF (Spearman’s rank correlation coefficient =−0.221,P = 0.108).
Conclusion:
A modest elevation of plasma BNP is observed during AECOPD. It appears that AECOPD may have an impact on plasma BNP levels that is not attributable to heart failure.
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