Myocardial stiffness is an important determinant of the plasma brain natriuretic peptide concentration in patients with both diastolic and systolic heart failure

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Abstract
Aims Plasma brain natriuretic peptide (BNP) concentration increases in proportion to heart failure (HF) severity. Although plasma BNP decreases to a certain level by optimal treatment, there is significant heterogeneity in the baseline value among individuals. The underlying mechanism of the steady-state plasma BNP levels remains still controversial. We investigated the hypothesis that myocardial stiffness (Km) is a major determinant of the plasma BNP level. Methods and results In 19 patients with diastolic HF [DHF; left ventricular ejection fraction (LVEF)≥45%], 18 with systolic HF (SHF; LVEFP=0.010), pulmonary capillary wedge pressure (P=0.030), end-diastolic pressure (P=0.006), time constant of the LV isovolumic-pressure decline (P=0.049), end-diastolic stress (P=0.012), and Km (P=0.004), respectively. In SHF, a significant correlation was observed between plasma BNP and end-diastolic stress (P=0.036), chamber stiffness (P=0.048), and Km (P=0.003), respectively. Conclusion In stable conditions, Km may be the most important determinant of the plasma BNP production in patients with both DHF and SHF.