Relationship between the plasma NT-ProBNP concentration and characteristics of heart failure and premature ventricular complexes in stable ischemic heart disease

Journal OF MILITARY PHARMACO - MEDICINE N⁰4 - 2021

RELATIONSHIP BETWEEN THE PLASMA NT-proBNP

CONCENTRATION AND CHARACTERISTICS OF HEART

FAILURE AND PREMATURE VENTRICULAR COMPLEXES

IN STABLE ISCHEMIC HEART DISEASE

Doan Thinh Truong^1,2, Nguyen Oanh Oanh², Nguyen Quang Toan³

SUMMARY

Objectives: To investigate the relationship between plasma NT-proBNP levels and

characteristics of heart failure and premature ventricular complexes (PVCs) in patients with

chronic ischemic heart disease.

Subjects and methods: A cross-sectional descriptive study on 136 patients with chronic

heart failure who were diagnosed as stable ischemic heart disease at Military Hospital 103 and

Hanoi Heart Hospital from October 2016 to January 2021. Participants were eligible for

inclusion and exclusion criteria. NT-proBNP was taken at the admission and after treatment.

Medical statistical algorithm was used to determine the correlation between symptoms of heart

failure, PVCs and plasma NT-proBNP.

Results: Patients’ median age was 70.0 10.483. NT-proBNP concentrations pre- and post -

treatment were 2540.846 470.484 and 1162.268 178.840 pg/mL. Patient's age, heart rate,

and creatinine levels were positively correlated with NT-proBNP concentration whereas left

ventricular systolic function (EF%) was inversely correlated with NT-proBNP levels (r = -0.315,

p < 0.001). There was a positive correlation between NT-proBNP concentrations and heart

failure degree according to New York Heart Association (NYHA) (r = 0.406, p < 0.001). The

severity of the post-treatment PVCs significantly decreased, with significant difference (p = 0.027).

But there was no correlation between PVCs and the plasma NT-proBNP concentrations.

Conclusion: Plasma NT-proBNP concentrations are correlated with several features of

heart failure. But there is no correlation between PVCs and plasma NT-proBNP concentrations

in patients with heart failure due to ischemic heart disease.

* Keywords: NT-proBNP; Heart failure; Premature ventricular complexes; Stable ischemic

heart disease.

INTRODUCTION

surgery/intervention. When the atheroma

progresses, the coronary is narrowed

significantly [2]. According to the

statistics, cardiovascular diseases cause

4 million deaths annually in Europe and

1.9 million deaths in the European Union,

Chronic ischemic heart disease or

chronic coronary syndrome is a condition

that relates to the stability of atherosclerotic

plaques, when there is not sudden

rupture or after the acute phase or post -

¹Hoai Duc General Hospital, Hanoi

²Military Hospital 103, Vietnam Military Medical University

³Thai Nguyen National General Hospital

Corresponding author: Doan Thinh Truong (bsdoanthinhtruong@gmail.com)

Date received: 20/02/2020

Date accepted: 25/4/2021

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Journal OF MILITARY PHARMACO - MEDICINE N⁰4 - 2021

mainly due to coronary artery disease Hanoi Heart Hospital from October 2016

(CHD) [3]. Myocadial ischemia in chronic to January 2021

coronary syndrome leads to functional

* Selection criteria:

impairment of an area of the left

Patients with a diagnosis or a history of

ventricular heart muscle, disorders of left

acute myocardial infarction; Patients with

ventricular

increased passive stiffness promotes

diastolic filling, hypertrophy

relaxation,

and

then

significant coronary lesions (one coronary

artery stenosis of at least 50% by

coronary angiography at the time of the

study or before; Patients undergoing

coronary revascularization or without

intervention; Patients undergoing coronary

bypass surgery; Patients with stable angina

or unstable angina.

and

myocardial fibrosis. Cardiac ischemia in

cardiovascular

disease

can

trigger

and

electrophysiological

arrhythmias.

changes

When myocardial ischemia and

hypoxia occur, the release of NT-proBNP

is stimulated. Other factors in myocardial

ischemia include increased heart rate,

- Patient was diagnosed with heart

failure by ESC 2016 [6].

* Exclusion criteria:

proinflammatory

neurotransmitters

vasoconstriction,

cytokines

such

and

as

Patients had chronic kidney disease,

severe arrhythmia, pericardial disease,

antidiuretic,

rapidly

myocarditis,

infectious

endocarditis,

increasing left ventricular pressure and

cell proliferation. Birth also stimulates NT-

proBNP synthesis [4]. Studies show that

NT-proBNP test plays a pivotal role in

screening, diagnosing, and predicting

cardiovascular events such as heart

failure, arrhythmia, etc. in patients with

chronic coronary syndrome [5].

or other severe chronic disease, or those

who did not agree to participate in

the study.

2. Method

A cross-sectional descriptive study.

* Sampling method:

Convenient sample, including all patients

who met the inclusion criteria.

Therefore, we conducted this project

with the following objectives: To investigate

the relationship between NT-proBNP

levels and characteristics of heart failure

and PVCs in patients with chronic ischemic

heart disease.

* Research target:

Age, sex, clinical symptoms (blood

pressure, pulse, breathing rate, edema,

heart failure degree according to NYHA,

degree of chest pain according to CCS, ...),

subclinical features (plasma NT-ProBNP,

EF, Dd, ...).

SUBJECTS AND METHODS

1. Subjects

136 patients with chronic heart failure

were diagnosed as ischemic heart

disease at Military Hospital 103 and

* Data processing: By SPSS statistical

software version 21.0. The statistical

significance level is 95% with p < 0.05.

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Journal OF MILITARY PHARMACO - MEDICINE N⁰4 - 2021

RESULTS

Through a study on 136 heart failure patients with chronic ischemic heart disease,

we obtained the following results:

Table 1: General characteristics of study subjects.

Characteristics

Parameters

34 (25.0)

Females (n, %)

Age ( SD)

70.0 10.483

X

Hypertension (n, %)

Smoke (n, %)

105 (77.2)

25 (18.4)

Chest pain (n, %)

Edema (n, %)

118 (86.8)

19 (3.7)

Rale in the lungs (n, %)

25 (18.4)

Enlarged liver, jugular vein (n, %)

5 (3.7)

88.49 25.212

Diastolic blood pressure (mmHg) (

X

SD)

135.10 25.568

Systolic blood pressure (mmHg) (

X

Ejection fraction (%)

54.689 17.839

2540.846 5486.735

NT-proBNP before treatment (pg/mL) (

NT-proBNP after treatment (pg/mL) (

X

SD)

1162.268 2085.617

X

Male/female ratio: 3/1. Hypertension accounted for the highest percentage (77.2%).

The mean age was 70.0 10.483. Mean values of NT-proBNP pre- and post-treatment

were different.

Table 2: Relationship between plasma NT-proBNP concentrations and heart failure

characteristics.

Before treatment

Correlation index

r

p

Age

0.195

-0.065

0.108

0.141

-0.083

0.302

0.322

-0.315

0.023

0.454

0.209

0.102

0.335

< 0.001

Gender

Body mass index (BMI)

Edema

Chest pain

Heart rate

Creatinine

Ejection fraction (%)

Patient's age, heart rate, creatinine level were positively correlated with NT-proBNP

concentration, left ventricular systolic function (EF%) was inversely correlated with

NT-proBNP concentration. In this study, we found no correlation between gender, BMI,

chest pain level, edema and NT-proBNP levels.

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Table 3: Correlation between NT-proBNP and heart failure by NYHA classification

NYHA classification

NT-proBNP pre-treatment (

1235.36 4118.46

4552.371 8280.329

4167.684 5811.875

2453.262 2820.500

0.02

SD)

X

NYHA I

NYHA II

NYHA III

NYHA IV

p (medium)

r

0.406

p (correlation )

< 0.001

Plasma NT-proBNP concentration differs based on the severity of heart failure

according to NYHA. The higher the NYHA level, the higher NT-proBNP concentration,

the difference was significant with p = 0.02. There was a moderately positive

correlation between plasma NT-proBNP concentrations and NYHA-based heart failure

levels with r = 0.406 (p < 0.001).

Table 4: Characteristics of ventricular premature complex on the 24-hour Holter

monitoring by Lown grading system.

24-hour Holter

Lown 0

Before treatment n (%)

68 (50.0)

After treatment n (%)

69 (50.7)

50 (36.8)

6 (4.4)

p

Lown 1

Lown 2

Lown 3

Lown 4

Lown 5

34 (25.0)

9 (6.6)

0.027

7 (5.1)

2 (1.5)

18 (13.2)

9 (6.6)

0 (0.0)

There was a dramatical change between the ratio ofPVCs pre- and post-treatment, the

number of Lown 3-4 PVCs decreased significantly after treatment, the difference was

statistically significant, p < 0.05.

Table 5: Correlation between NT-proBNP and premature ventricular complex.

Pre-treatment NT-proBNP

SD

Post-treatment NT-proBNP

SD

Lown

p

X

Lown 0

2132.715 4244.692

4370.759 8862.632

1652.645 2234.545

1675.567 1194.475

988.613 1738.441

1670.962 3129.067

890.963 1042.746

756.012 820.785

0.008

0.013

0.256

0.084

Lown 1

Lown 2

Lown 3

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Lown 4-5

p (medium)

r

1647.107 1787.532

1151.074 1459.703

0.048

0.251

0.046

0.595

0.578

0.048

0.583

p (correlation)

The plasma NT-proBNP concentration according to Lown grading system for PVCs

did not differ between groups (p > 0.05). There was also no correlation for plasma

NT-proBNP concentrations between the groups of PVCs as classified by Lown.

2. Relationship between NT-proBNP

DISCUSSION

and characteristics of heart failure and

1. General characteristics of the patient

premature ventricular complex

Patients’ median age was 70.0 10.483.

Clinical manifestations of heart failure

Previous studies showed that men had a

include chest pain, edema and enlarged

higher risk of ischemic heart disease,

liver with the corresponding rates of

stroke and other cardiovascular diseases

than women. In our study, male

accounted for 75.0%, female only 25.0%.

The pathogenesis of later development of

atherosclerosis in women is due to the

protective role hormone estrogen [7].

86.8%, 3.7% and 3.7%. The incidence of

edema in our study was lower because

these patients were followed up regularly

at an outpatient clinic.

In this study, we found no correlation

between sex, BMI, chest pain level,

edema and NT-proBNP levels. According

to Nguyen Thi Thu Dung et al, when

studying 202 heart failure patients by

stages, there was no correlation between

NT-proBNP and BMI, glomerular filtration

rate, hemoglobin, and left ventricular

systolic [1].

The mean values of plasma NT-proBNP

concentrations pre- and post- treatment

were 2540.846 470.484 and 1162.268

178.840. The study by Nuria Farre et al.

on 3,580 chronic heart failure patients, of

whom ischemic heart disease was the

leading cause with the rate of 44.7% and

mean NT-proBNP concentration was

1.638 pg/mL [8]. It is suggested that the

group of heart failure patients with chronic

ischemic heart disease had higher plasma

NT-proBNP concentrations than those

with chronic heart failure due to other

causes, and myocardial ischemia contributes

to increase the levels of NT-proBNP.

Patient's age, heart rate, and creatinine

level were positively correlated with

NT-proBNP levels (mean

r

>

0.3).

It means that the older the patients are,

the faster the heart rate is, leading to an

increased NT-proBNP levels. When

tachycardia causes myocardial ischemia

resulting in an increased myocardial

contractility, which, in turn, stimulates

release of NT-proBNP. Left ventricular

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Journal OF MILITARY PHARMACO - MEDICINE N⁰4 - 2021

systolic function (EF%) had a moderately

The degree of PVCs according to

negative correlation with the NT-proBNP Lown's classification on 24-hour Holter

pre- and post-treatment was significantly

different (p = 0.027). It means that after

treatment, the number and the degree of

severe PVCs decreased significantly

compared to pre-treatment. However,

there was no significant correlation between

plasma NT-proBNP concentrations in the

Lown-classified PVCs, indicating that

NT-proBNP levels did not vary significantly

between PVCs according to Lown

classification with p (correlation) > 0.05

and p (general) > 0.05. Lucian M. studied

40 neuropathic patients undergoing

24-hour electrocardiographic Holter to

detect PVCs, the results revealed an

NT-proBNP < 125 pg/mL in 16 patients

and NT-proBNP > 125 pg/mL in 24 patients.

The results showed that there was a great

number of patients with PVCs in the

NT-proBNP group, the presence of PVC

was positively correlated with NT-proBNP

with r = 0.445 (p = 0.006) [10].

concentration with r = -0.315 (p < 0.001).

It means that when left ventricular systolic

function decreases, the concentration of NT-

proBNP increases, when left ventricular

function decreases, ventricular relaxation,

myocardial atony loss increases, leading

to the release of NT-proBNP. In this

study, we found no correlation between

sex, BMI, chest pain level, and edema

with NT-proBNP concentration (table 3).

According to Richards M's study on 1,049

patients with heart failure undergoing

coronary intervention in Australia - New

Zealand (ANZ), the author revealed that

there was

correlation

a

moderately positive

between NT-proBNP

concentration and age r = 0.44 (p < 0.001),

and moderately negative correlation with

left ventricular systolic function r = -0.46

(p < 0.001) [9].

The plasma NT-proBNP concentration

differs according to NYHA classification of

heart failure, the higher the NYHA level,

the higher the NT-proBNP concentrations,

the difference was significant (p = 0.02).

Our study found no association

between NT-proBNP levels and the

presence of PVCs, which may be due to

high degree of heart failure among our

patients. Because NT-proBNP is elevated,

we do not define NT-proBNP's cut-off for

ventricular arrhythmias.

There was

a

moderately positive

correlation between plasma NT-proBNP

concentrations and NYHA-based heart

failure levels with r = 0.406 (p < 0.001).

Nguyen Thi Thu Dung et al studied on

202 heart failure patients in different

stages, the study results showed that

there was a fairly strong correlation

between the concentration of NT-proBNP

and the degree of heart failure according

to NYHA with r = 0.67 (p < 0.0001) [1].

CONCLUSION

Plasma NT-proBNP concentrations in

patients with chronic ischemic heart was

correlated with several clinical and

subclinical features of heart failure. But

there was no correlation between plasma

NT-proBNP levels and the presence

of PVCs.

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Journal OF MILITARY PHARMACO - MEDICINE N⁰4 - 2021

acute and chronic heart failure: The task force

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