Brain Natriuretic Peptide and Diastolic Dysfunction in the Elderly: Influence of Gender

Chanwit Roongsritong, MD; Ahmad Qaddour, MD; S. Lane Cox, MD; Safaa Labib, MD; Charles A. Bradley, PhD

Disclosures

CHF. 2005;11(2):65-67. 

In This Article

Abstract and Introduction

Diastolic heart failure is common in the elderly, particularly women. Previous studies on the value of brain natriuretic peptide in diastolic dysfunction have been largely limited to male subjects. The authors found that female gender, in addition to diastolic function, is an independent predictor of brain natriuretic peptide levels in the elderly without systolic ventricular dysfunction. The authors' data indicate that an optimal threshold of brain natriuretic peptide for detecting diastolic dysfunction should be gender-specific.

Heart failure (HF) is a major health problem in the elderly. The prevalence of diastolic HF increases with age.[1] It is estimated that diastolic dysfunction is the cause of HF in 35% and 40% of patients between 60 and 70 years of age and in 50% of those 70 years or older.[2] The definitive diagnosis of diastolic HF usually requires a combination of clearcut symptoms and signs of HF in the presence of normal left ventricular (LV) systolic function and objective evidence of LV diastolic dysfunction.[3]

Brain natriuretic peptide (BNP) has recently been shown to reliably detect the presence of diastolic dysfunction on echocardiography in the subjects referred for an evaluation of LV function. [4,5] The populations in these studies were predominantly male with less than 10% female subjects. However, diastolic HF is more common in women than in men.[6,7] Influence of gender on BNP levels in elderly remains inconclusive. A significant impact of gender on BNP levels was demonstrated among all-aged groups in a population-based study of subjects without known cardiovascular disease or cardiac dysfunction.[8] This particular study also found the optimal discriminatory value of BNP for detecting LV systolic dysfunction to be higher in women than in men. More recently, a comparable level of BNP has, however, been reported in elderly (over 70 years of age) with non-systolic HF.[9] We evaluated the importance of gender on the BNP levels and its diagnostic value for isolated diastolic dysfunction in the elderly in relation to other factors known to alter BNP levels.

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