Contribution of Extracardiac Factors to the Inconsistency Between Plasma B-type Natriuretic Peptide Levels and the Severity of Pulmonary Congestion on Chest X-rays in the Diagnosis of Heart Failure

Tokiko Nakane; Makoto Kawai; Kimiaki Komukai; Yosuke Kayama; Seiichiro Matsuo; Tomohisa Nagoshi; Kosuke Minai; Taro Date; Takayuki Ogawa; Hidenori Yagi; Michihiro Yoshimura

doi:10.2169/internalmedicine.51.6206

ORIGINAL ARTICLES

Contribution of Extracardiac Factors to the Inconsistency Between Plasma B-type Natriuretic Peptide Levels and the Severity of Pulmonary Congestion on Chest X-rays in the Diagnosis of Heart Failure

Tokiko Nakane, Makoto Kawai, Kimiaki Komukai, Yosuke Kayama, Seiichiro Matsuo, Tomohisa Nagoshi, Kosuke Minai, Taro Date, Takayuki Ogawa, Hidenori Yagi, Michihiro Yoshimura

Author information

Tokiko Nakane
Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Japan
Makoto Kawai
Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Japan
Kimiaki Komukai
Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Japan
Yosuke Kayama
Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Japan
Seiichiro Matsuo
Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Japan
Tomohisa Nagoshi
Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Japan
Kosuke Minai
Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Japan
Taro Date
Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Japan
Takayuki Ogawa
Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Japan
Hidenori Yagi
Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Japan
Michihiro Yoshimura
Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Japan

Keywords: aging, body mass index, congestion grade, estimated glomerular filtration rate, obesity, renal failure

JOURNAL OPEN ACCESS

2012 Volume 51 Issue 3 Pages 239-248

DOI https://doi.org/10.2169/internalmedicine.51.6206

Details

Abstract

Objective Chest X-rays and plasma B-type natriuretic peptide (BNP) levels are useful for diagnosing congestive heart failure. However, the relationship between plasma BNP levels and pulmonary congestion on chest X-rays often seems inconsistent. Extracardiac factors can directly alter plasma BNP levels, independent of cardiac function. In the present study, we examined the clinical factors that impact the diagnosis of heart failure by using chest X-rays and plasma BNP levels.
Methods and Results This study comprised 459 consecutive patients who were admitted to the cardiovascular division of our hospital for any reason and in whom chest X-rays and plasma BNP levels were measured within 12 hours after admission. The approximate BNP value associated with pulmonary congestion that was detectable by chest X-rays was 143 pg/mL, but this value was influenced by renal function, age, and body mass index (BMI). Furthermore, we examined the effect of these three extracardiac factors on plasma BNP levels in each stage of pulmonary congestion. We found that renal dysfunction and advanced age increased the plasma BNP levels, whereas a high BMI decreased the levels, and that the effect of BMI on plasma BNP levels was greater for severe heart failure.
Conclusion Extracardiac factors should be considered when the relationship between the plasma BNP levels and the severity of pulmonary congestion on chest X-rays seems inconsistent. In particular, low levels of plasma BNP in patients with a high BMI should be carefully considered to avoid underestimating the degree of heart failure.

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