Relation of Brain Natriuretic Peptide Level to Extent of Left Ventricular Scarring in Patients With Chronic Heart Failure Secondary to Ischemic Cardiomyopathy

Multiple factors influence brain natriuretic peptide (BNP) release in patients with heart failure. We hypothesized that extensive myocardial scarring could result in an attenuated BNP response. A total of 115 patients with New York Heart Association class III chronic heart failure and ischemic cardiomyopathy were evaluated for ischemia, hibernation, and myocardial scarring by dipyridamole-rubidium-positron emission tomographic scanning with fluorine-18, 2-fluoro-2-deoxyyglucose. Plasma BNP levels were determined within 2 weeks of the study. Left ventricular dimension and function were evaluated by echocardiography. Patients were categorized as having <33% myocardial scar (n = 67) or ≥33% myocardial scar (n = 48). BNP measurements were correlated with amount of myocardial scarring. Compared with patients with less scar, those with ≥33% scar had lower BNP levels (mean 317 ± 364 vs 635 ± 852 pg/ml, median 212 vs 357, p = 0.016). Using multiple regression analysis, presence of scarring was associated with decreased BNP response (p = 0.022). Further, patients with <33% scar in whom a higher BNP level was noted had more ischemia (51% vs 27%, p = 0.01) and greater myocardial hibernation (22 ± 14% vs 12 ± 7%, p = 0.02) compared with patients with ≥33% scar. In conclusion, in patients with chronic heart failure, a decreased BNP response indicated extensive myocardial scarring.