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>or=33% myocardial
scar (n=48). BNP measurements were correlated with amount of myocardial
scarring. Compared with patients with less
scar, those with >or=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 >or=33%
scar. In conclusion, in patients with chronic
heart failure, a decreased BNP response indicated extensive myocardial
scarring.