In patients with severe systolic dysfunction, only brain natriuretic peptide is related to diastolic restrictive pattern

Background: In patients with severe systolic dysfunction the relationship between diastolic dysfunction and plasma levels of atrial and brain natriuretic peptide (ANP, BNP), catecholamines. renin, and aldosterone in patients with chronic heart failure (CHF) has never been investigated. Objectives: The aim of this study was to evaluate in clinically stable patients with severe systolic dysfunction whether the presence of diastolic restrictive pattern modifies neurohormonal plasma levels. Methods: Of 82 consecutive patients with stable CHF, 36 were in sinus rhythm, had an adequate ultrasound window and an ejection fraction <30%, and gave their written consent. Plasma levels of ANP, BNP, aldosterone, renin, epinephrine, and norepinephrine were assessed, and the diastolic function was evaluated by Doppler transmittal flow velocity curves. Results: Except for aldosterone, plasma levels of the other hormones were above normal range in most patients. Patients with restrictive pattern (22%) had BNP plasma levels significantly higher than patients with nonrestrictive pattern (78%): 251 +/- 196 versus 44 +/- 35 ng/L (P = .02). A BNP value of 72.6 ng/L had a sensitivity of 88%, with a specificity of 89% for detecting restrictive pattern in our population. Conclusion: In clinically stable patients with CHF and severe systolic dysfunction, BNP is the only neurohormone sensitive to the concomitant presence of a restrictive pattern.