Plasma activity of B-type natriuretic peptide in patients with biventricular heart failure versus those with right heart failure due to chronic obstructive pulmonary disease.

Background: Plasma B-type natriuretic peptide (BNP) is an established prognostic indicator in patients with left ventricular systolic heart failure (LHF). However, no efficient data exist regarding the differences in plasma BNP activity between patients with biventricular heart failure and those with right heart failure (RHF) due to chronic obstructive pulmonary disease (COPD).

Objective: This study investigates BNP in RHF due to COPD in comparison to RHF due to LHF, and estimates the relation of BNP levels with clinical and echocardiographic parameters.

Methods: We evaluated plasma BNP in 88 patients admitted to hospital with acutely decompensated chronic heart failure (31 with RHF due to LHF, 30 with RHF due to COPD without left heart disease, and 27 with LHF without right ventricular involvement). All patients underwent echocardiography examination and blood samples were collected to determine BNP and routine blood chemistry measurements.

Results: Plasma BNP levels were significantly higher in RHF due to LHF compared with RHF due to COPD (P <0.001). Plasma BNP did not appear to differ between RHF due to LHF and LHF alone (P = 0.802). In multiple linear regression analysis, tissue Doppler imaging e(LV) (B: -0.053, P = 0.002) and e(RV) (B: -0.079, P = 0.007) had an independent negative association with BNP, whereas logUrea (B: 0.635, P < 0.001) and hematocrit (B: 0.014, P = 0.005) showed an independent positive association with BNP levels in the group of RHF due to COPD.

Conclusion: BNP levels were significantly lower in RHF due to COPD compared with RHF due to LHF and were independently predicted by indices of left ventricular and right ventricular diastolic function, renal function, and anemia.