Korean Circ J.  2010 Mar;40(3):141-142. 10.4070/kcj.2010.40.3.141.

High Plasma Levels of the B-type Natriuretic Peptide in Patients Without Heart Failure: Is There Clinical Significance?

• Yu LH
• Kim MH
• Park JS
• Cha KS
• Park TH
• Kim YD

• KMID: 2094075
• DOI: http://doi.org/10.4070/kcj.2010.40.3.141

Abstract

We report a case of a 19-year-old female with an elevated plasma B-type natriuretic peptide (BNP) level, but without evidence of heart failure (HF). She presented with non-specific chest pain and a high level of the B-type natriuretic peptide, despite having unremarkable findings on physical examination, laboratory analysis, electrocardiogram, echocardiogram, chest X-ray, chest computed tomography, whole body scan, and coronary angiography. We attribute this finding to a genetic variation in the synthesis and cleavage of the natriuretic peptides.

Keyword

Natriuretic peptide; Heart failure

MeSH Terms

Chest Pain
Coronary Angiography
Electrocardiography
Female
Genetic Variation
Heart
Heart Failure
Humans
Natriuretic Peptide, Brain
Natriuretic Peptides
Physical Examination
Plasma
Thorax
Whole Body Imaging
Young Adult
Natriuretic Peptide, Brain
Natriuretic Peptides

Figure

• 

  Fig. 1 The B-type natriuretic peptide (BNP) levels were checked six times during the previous clinical follow-up. The 3rd and 5th BNP measurements had a lower level, which may reflect continuous medications with diltiazem and a diuretic. The 4th and 6th BNP measurements were elevated and may reflect non-compliance with therapy.

Reference

1. Horio T, Kawano Y. Bio-molecular markers for cardiovascular disease: significance of natriuretic peptides and adrenomedullin. Korean Circ J. 2008. 38:507–513.

2. Yasue H, Yoshimura M, Sumida H, et al. Localization and mechanism of secretion of B-type natriuretic peptide in comparison with those of A-type natriuretic peptide in normal subjects and patients with heart failure. Circulation. 1994. 90:195–203.

3. Hunt PJ, Yandle TG, Nicholls MG, Richards AM, Espiner EA. The amino-terminal portion of pro-brain natriuretic peptide (Pro-BNP) circulates in human plasma. Biochem Biophys Res Commun. 1995. 214:1175–1183.

4. Lainchbury JG, Campbell E, Frampton CM, Yandle TG, Nicholls MG, Richards AM. Brain natriuretic peptide and N terminal brain natriuretic peptide in the diagnosis of heart failure in patients with acute shortness of breath. J Am Coll Cardiol. 2003. 42:728–735.

5. Nishikimi T, Yoshihara F, Morimoto A, et al. Relationship between left ventricular geometry and natriuretic peptide levels in essential hypertension. Hypertension. 1996. 28:22–30.

6. Troughton RW, Prior DL, Pereira JJ, et al. Plasma B-type natriuretic peptide levels in systolic heart failure: importance of left ventricular diastolic function and right ventricular systolic function. J Am Coll Cardiol. 2004. 43:416–422.

7. Baggish AL, van Kimmenade RR, Januzzi JL Jr. The differential diagnosis of an elevated amino-terminal pro-B-type natriuretic peptide level. Am J Cardiol. 2008. 101:43–48.

8. Wang TJ, Larson MG, Levy D, et al. Heritability and genetic linkage of plasma natriuretic peptide levels. Circulation. 2003. 108:13–16.