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Right heart dysfunction assessed with echography, B-type natriuretic peptide and cardiopulmonary test in patients with chronic heart failure

Troisi, Federica; Greco, Stefania; Brunetti, Natale Daniele; Di Biase, Matteo

Journal of Cardiovascular Medicine: July 2008 - Volume 9 - Issue 7 - p 672–676
doi: 10.2459/JCM.0b013e3282f331eb
Original articles
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Background Right ventricle (RV) impairment could influence brain natriuretic peptide (BNP) circulating levels. It is not well known whether echocardiographic parameters assessing RV function could be related to BNP levels in patients with chronic heart failure (CHF). Controversial data are available about the role played by RV dysfunction in determining exercise capacity in CHF patients.

Methods Sixty patients with CHF referred to our CHF Unit underwent blood sampling for BNP levels determination, cardiopulmonary exercise test with VO2 peak, VO2-AT and VE/VCO2 slope assessment and M-mode, two-dimensional and Doppler echocardiography with evaluation of right heart function [right atrial pressure (RAP), pulmonary artery pressure (PAP), severity of tricuspid regurgitation (TR), and tricuspid annular plane systolic excursion (TAPSE)].

Results A significant correlation was detectable between BNP levels and TAPSE (r = −0.33; P < 0.05), RAP (r = 0.34; P < 0.05), PAP (r = 0.42; P < 0.05), TR (P for trend 0.05); correlation with TAPSE remained significant even in multivariate. VO2 peak was significantly related to RAP (r = −0.38, P < 0.05) and TR (P for trend 0.05); AT with PAP (r = −0.40, P < 0.05), RAP (r = −0.50, P < 0.05), TR (P for trend 0.05). Moreover, patients with TAPSE greater than 16 mm had higher values of VO2 peak (13.68 ± 3.28 vs. 11.49 ± 2.37 ml/kg/m′, P < 0.05) and of VO2-AT (18.36 ± 1.60 vs. 10.23 ± 2.31 ml/kg/m′; P < 0.05).

Conclusion Right heart dysfunction assessed by simple echocardiographic parameters is related to neurohormonal activation featured by increased BNP levels and to a worse functional capacity in CHF patients.

University of Foggia, Cardiology Department, Foggia, Italy

Received 19 June, 2007

Revised 11 September, 2007

Accepted 10 October, 2007

Correspondence to Federica Troisi MD, PhD, ESC member, Cardiology Department, University of Foggia, Viale Pinto 1, 71100 Foggia, Italy Tel: +39 349 4539015; fax: +39 080 9905752; e-mail: federica.troisi@libero.it

© 2008 Italian Federation of Cardiology. All rights reserved.