Elsevier

The Lancet

Volume 360, Issue 9331, 10 August 2002, Pages 461-462
The Lancet

Research Letters
Brain natriuretic peptide and left ventricular dysfunction in Chagas' disease

https://doi.org/10.1016/S0140-6736(02)09638-1Get rights and content

Summary

Left ventricular dysfunction in Chagas' disease is common but can be difficult to detect. We investigated whether measurement of plasma brain natriuretic peptide (BNP) could identify patients with left ventricular dysfunction who need further investigation or treatment. Among patients with an abnormal electrocardiogram or chest radiograph, a BNP concentration of 60·7 pmol/L or higher has a sensitivity and positive predictive value of 80%, and specificity and negative predictive value of 97%. Measurement of plasma BNP concentration could be a useful method to screen patients with Chagas' disease.

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    Both peptides are strong predictors of mortality, and are some of the most well characterized markers for assessing early cardiac damage and predicting heart failure outcome. Measurement of BNP levels has also been suggested for the prognosis of patients presenting left ventricular systolic dysfunction, one of the typical signs of cardiac Chagas disease [22,25–27]. The use of natriuretic peptides in the context of Chagas disease has also been studied in combination with other host-derived molecules.

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    Also, some variables with known prognostic implications were not systematically collected: left ventricular ejection fraction —strongly associated with cardiovascular mortality—was not available for inclusion in the multivariable mortality models. We believe, however, that the results remain valid, once we used the BNP levels—with marked inverse correlation with left ventricular ejection fraction and mortality in cardiomyopathies28,29—as a reliable surrogate for left ventricular function. Finally, only baseline data were available for most variables, including ECG and laboratory results.

  • Chagas Disease Diagnostic Applications: Present Knowledge and Future Steps

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    Alternatively, several groups attempted to identify biochemical markers of cardiac damage and/or inflammation such as TNF-α (Talvani et al., 2004a), angiotensin-converting enzyme 2 (ACE2) (Wang et al., 2010), brain and atrial natriuretic peptides (BNP and ANP, respectively) (Garcia-Alvarez et al., 2010; Heringer-Walther et al., 2005; Ribeiro et al., 2002) as candidates for disease prognosis (Table 1). In particular, the concentrations of BNP and ANP in serum were systematically studied as markers of heart damage in Chagasic patients (Garcia-Alvarez et al., 2010; Heringer-Walther et al., 2005; Ribeiro et al., 2002) since they had been previously related with cardiovascular diseases (Wang et al., 2006; Wondergem et al., 2001). Increased concentrations of BNP and ANP strongly correlated with the severity of Chagas-associated cardiac damage, being BNP more sensitive than ANP (Fernandes et al., 2007; Heringer-Walther et al., 2005; Talvani et al., 2004b).

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