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Changes in plasma levels of B-type natriuretic peptide with acute exacerbations of chronic obstructive pulmonary disease.

Nishimura K, Nishimura T, Onishi K, Oga T, Hasegawa Y, Jones PW - Int J Chron Obstruct Pulmon Dis (2014)

Bottom Line: Plasma BNP levels were compared cross-sectionally and longitudinally.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Pulmonary Medicine, National Center for Geriatrics and Gerontology, Obu, Japan.

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 stable 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 I V, 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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Cross-sectional comparisons of plasma BNP levels (means ± standard deviation) in 61 subjects first hospitalized with AECOPD, in 65 subjects at GOLD grade I with stable COPD, in 65 subjects at grade II, in 40 subjects at grade III, and in 20 subjects at grade IV.Notes: Plasma BNP levels were not statistically different among the GOLD grades (P=0.53), but the plasma BNP levels measured in 61 subjects first hospitalized with AECOPD were statistically higher than in subjects with stable COPD at each GOLD grade (P<0.001).Abbreviations: AECOPD, acute exacerbations of chronic obstructive pulmonary disease; COPD, chronic obstructive pulmonary disease; BNP, B-type natriuretic peptide; GOLD, Global Initiative for Chronic Obstructive Lung Disease.
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f1-copd-9-155: Cross-sectional comparisons of plasma BNP levels (means ± standard deviation) in 61 subjects first hospitalized with AECOPD, in 65 subjects at GOLD grade I with stable COPD, in 65 subjects at grade II, in 40 subjects at grade III, and in 20 subjects at grade IV.Notes: Plasma BNP levels were not statistically different among the GOLD grades (P=0.53), but the plasma BNP levels measured in 61 subjects first hospitalized with AECOPD were statistically higher than in subjects with stable COPD at each GOLD grade (P<0.001).Abbreviations: AECOPD, acute exacerbations of chronic obstructive pulmonary disease; COPD, chronic obstructive pulmonary disease; BNP, B-type natriuretic peptide; GOLD, Global Initiative for Chronic Obstructive Lung Disease.

Mentions: The median plasma BNP level was 55.4 (26.9–129.3) pg/mL at the first hospitalization with AECOPD during the study period, and in the stable patients, it was 21.5 (10.3–47.5) pg/mL (Table 2). This difference was statistically significant at P<0.0001. On the other hand, for stable COPD, median plasma BNP levels did not differ significantly (P=0.53) across GOLD grades: 18.3 (10.0–45.3) for GOLD 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 (Figure 1).


Changes in plasma levels of B-type natriuretic peptide with acute exacerbations of chronic obstructive pulmonary disease.

Nishimura K, Nishimura T, Onishi K, Oga T, Hasegawa Y, Jones PW - Int J Chron Obstruct Pulmon Dis (2014)

Cross-sectional comparisons of plasma BNP levels (means ± standard deviation) in 61 subjects first hospitalized with AECOPD, in 65 subjects at GOLD grade I with stable COPD, in 65 subjects at grade II, in 40 subjects at grade III, and in 20 subjects at grade IV.Notes: Plasma BNP levels were not statistically different among the GOLD grades (P=0.53), but the plasma BNP levels measured in 61 subjects first hospitalized with AECOPD were statistically higher than in subjects with stable COPD at each GOLD grade (P<0.001).Abbreviations: AECOPD, acute exacerbations of chronic obstructive pulmonary disease; COPD, chronic obstructive pulmonary disease; BNP, B-type natriuretic peptide; GOLD, Global Initiative for Chronic Obstructive Lung Disease.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3921082&req=5

f1-copd-9-155: Cross-sectional comparisons of plasma BNP levels (means ± standard deviation) in 61 subjects first hospitalized with AECOPD, in 65 subjects at GOLD grade I with stable COPD, in 65 subjects at grade II, in 40 subjects at grade III, and in 20 subjects at grade IV.Notes: Plasma BNP levels were not statistically different among the GOLD grades (P=0.53), but the plasma BNP levels measured in 61 subjects first hospitalized with AECOPD were statistically higher than in subjects with stable COPD at each GOLD grade (P<0.001).Abbreviations: AECOPD, acute exacerbations of chronic obstructive pulmonary disease; COPD, chronic obstructive pulmonary disease; BNP, B-type natriuretic peptide; GOLD, Global Initiative for Chronic Obstructive Lung Disease.
Mentions: The median plasma BNP level was 55.4 (26.9–129.3) pg/mL at the first hospitalization with AECOPD during the study period, and in the stable patients, it was 21.5 (10.3–47.5) pg/mL (Table 2). This difference was statistically significant at P<0.0001. On the other hand, for stable COPD, median plasma BNP levels did not differ significantly (P=0.53) across GOLD grades: 18.3 (10.0–45.3) for GOLD 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 (Figure 1).

Bottom Line: Plasma BNP levels were compared cross-sectionally and longitudinally.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Pulmonary Medicine, National Center for Geriatrics and Gerontology, Obu, Japan.

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 stable 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 I V, 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.

Show MeSH
Related in: MedlinePlus