Multiple factors influence brain natriuretic peptide (BNP) release in patients with heart failure. We hypothesized that extensive myocardial scarring could result in an attenuated BNP response. A total of 115 patients with New York Heart Association class III chronic heart failure and ischemic cardiomyopathy were evaluated for ischemia, hibernation, and myocardial scarring by dipyridamole-rubidium-positron emission tomographic scanning with fluorine-18, 2-fluoro-2-deoxyyglucose. Plasma BNP levels were determined within 2 weeks of the study. Left ventricular dimension and function were evaluated by echocardiography. Patients were categorized as having <33% myocardial scar (n = 67) or ≥33% myocardial scar (n = 48). BNP measurements were correlated with amount of myocardial scarring. Compared with patients with less scar, those with ≥33% scar had lower BNP levels (mean 317 ± 364 vs 635 ± 852 pg/ml, median 212 vs 357, p = 0.016). Using multiple regression analysis, presence of scarring was associated with decreased BNP response (p = 0.022). Further, patients with <33% scar in whom a higher BNP level was noted had more ischemia (51% vs 27%, p = 0.01) and greater myocardial hibernation (22 ± 14% vs 12 ± 7%, p = 0.02) compared with patients with ≥33% scar. In conclusion, in patients with chronic heart failure, a decreased BNP response indicated extensive myocardial scarring.
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine