1. Relationship Between B-Type Natriuretic Peptides and Pulmonary Capillary Wedge Pressure in the Intensive Care Unit
- Author
-
Edward P. Shapiro, Paul R. Forfia, Kerry J. Stewart, Stanley Watkins, and J. Eduardo Rame
- Subjects
Male ,medicine.medical_specialty ,Critical Care ,medicine.drug_class ,Population ,Statistics as Topic ,Cardiac index ,Hemodynamics ,Nerve Tissue Proteins ,Pulmonary Edema ,Kidney Function Tests ,Ventricular Dysfunction, Left ,Catheters, Indwelling ,Predictive Value of Tests ,Internal medicine ,Natriuretic Peptide, Brain ,Natriuretic peptide ,medicine ,Humans ,Pulmonary Wedge Pressure ,cardiovascular diseases ,Pulmonary wedge pressure ,education ,Aged ,education.field_of_study ,Ejection fraction ,business.industry ,Middle Aged ,Brain natriuretic peptide ,Prognosis ,Peptide Fragments ,Cardiology ,Female ,business ,Cardiology and Cardiovascular Medicine ,Biomarkers ,hormones, hormone substitutes, and hormone antagonists ,Blood sampling ,Glomerular Filtration Rate - Abstract
ObjectivesWe examined whether B-type natriuretic peptides (BNP) can serve as noninvasive markers of pulmonary capillary wedge pressure (PCWP) in the setting of critical illness.BackgroundThe BNP and N-terminal pro-B-type natriuretic peptide (NT-proBNP) are highly correlated with left ventricular (LV) filling pressures in patients with depressed LV systolic function. However, their relationship to PCWP in a heterogeneous intensive care unit (ICU) population has not been established.MethodsWe prospectively studied 40 patients in the ICU requiring invasive hemodynamic monitoring. Hemodynamics were recorded simultaneously with blood sampling for BNP and NT-proBNP.ResultsThe BNP (median 420 pg/ml) and NT-proBNP (median 3,304 pg/ml) levels were markedly elevated, but weakly correlated with PCWP (BNP, r = 0.40, NT-proBNP, r = 0.32) and other cardiac parameters. Peptide levels were approximately four-fold greater in patients with impaired (estimated glomerular filtration rate [eGFR] 60 ml/min) renal function, despite similar PCWP, cardiac index, and LV ejection fraction. In addition, both BNP and NT-proBNP showed stronger correlations with PCWP in patients with preserved (BNP, r = 0.58, NT-proBNP, r = 0.73) versus impaired renal function (BNP, r = 0.48, NT-proBNP, r = 0.34). Interaction terms between eGFR and BNP (p = 0.06) and NT-proBNP (p = 0.04) suggest that eGFR modulates the relationship of these peptides to filling pressures.ConclusionsThe BNPs are markedly elevated, yet show only weak correlations to PCWP in ICU patients requiring invasive hemodynamic monitoring. Thus, a single value for BNP or NT-proBNP may not be a clinically useful noninvasive marker of filling pressures in the critically ill patient. This appears to be especially true in patients with impaired renal function.
- Full Text
- View/download PDF