Author + information
- Received April 4, 2003
- Revision received June 12, 2003
- Accepted July 29, 2003
- Published online January 7, 2004.
- Hitoshi Yamaguchi, MD, PhD*,‡,
- Junichi Yoshida, MD†,‡,
- Kazuhiro Yamamoto, MD, PhD, FACC†,* (, )
- Yasushi Sakata, MD, PhD†,
- Toshiaki Mano, MD, PhD†,
- Noriyuki Akehi, MD†,
- Masatsugu Hori, MD, PhD, FACC†,
- Young-Jae Lim, MD, PhD*,
- Masayoshi Mishima, MD, PhD* and
- Tohru Masuyama, MD, PhD, FACC†
- ↵*Reprint requests and correspondence:
Dr. Kazuhiro Yamamoto, Department of Internal Medicine and Therapeutics (A8), Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita 565-0871, Japan.
Objectives We tested a hypothesis that elevation of the plasma level of brain natriuretic peptide (BNP) is one of the characteristics of patients with diastolic heart failure (DHF) independent of left ventricular (LV) hypertrophy.
Background The clinical characteristics of DHF are not well acknowledged, although DHF has become a great social burden. Such a lack of clinical information leads to inaccuracy in the diagnosis of DHF. We have demonstrated enhancement of ventricular production of BNP with progression of maladaptive ventricular hypertrophy, but not with development of compensatory hypertrophy in an animal DHF model.
Methods Of 372 patients who presented to the emergency department because of acute pulmonary congestion without acute coronary syndrome between January 1996 and May 2002, those with an ejection fraction ≥45% upon admission, who were stably controlled at least for a year in our outpatient clinics, comprised the DHF group (n = 19). A control group consisted of 22 hypertensive patients with a LV mass index greater than or equal to its minimum value of the DHF group and an ejection fraction ≥45%, in whom cardiac symptoms had not occurred.
Results Despite a similar distribution of LV mass index, the BNP level was higher in the DHF group than in the control group (149 ± 38 vs. 31 ± 5 pg/ml, p < 0.01). There was no difference in LV cavity size or parameters derived from pulsed Doppler transmitral flow velocity curves.
Conclusions An elevation of BNP may be a hallmark of patients with or at risk of DHF among subjects with preserved systolic function independent of LV hypertrophy.
↵‡ Drs. Yamaguchi and Yoshida contributed equally to this work.
☆ This study was supported in part by grants from the Ministry of Health, Labor, and Welfare; the Japanese Society for the Promotion of Science; the Osaka Heart Club; and the Salt Science Research Foundation (no. 0343). Gottlieb C. Friesinger, II, MD, acted as Guest Editor of the article.
- Received April 4, 2003.
- Revision received June 12, 2003.
- Accepted July 29, 2003.
- American College of Cardiology Foundation