From the Guidelines
Cor pulmonale does increase Brain Natriuretic Peptide (BNP) levels, although often to a lesser extent than left heart failure. This increase in BNP is due to the right ventricle becoming strained and enlarged in response to pulmonary hypertension, triggering the release of BNP from cardiac myocytes 1. The degree of BNP elevation correlates with the severity of right ventricular dysfunction and pulmonary hypertension.
Key Points to Consider
- BNP elevations in cor pulmonale are generally more modest compared to left ventricular failure because the right ventricle has less muscle mass than the left ventricle.
- Moderate elevations (typically 100-500 pg/mL) may be seen in cor pulmonale compared to the more dramatic increases often observed in left heart failure.
- Other conditions like renal dysfunction, advanced age, and acute illness can also affect BNP levels, so these factors should be considered when interpreting results 1.
- Elevated BNP can support a diagnosis of cor pulmonale, but the levels must be interpreted in context with other clinical findings.
Clinical Implications
- Clinicians should be aware that cor pulmonale can increase BNP levels, and this should be considered when evaluating patients with suspected right ventricular dysfunction or pulmonary hypertension.
- BNP levels should be interpreted in conjunction with other clinical findings, such as symptoms of heart failure, physical examination findings, and radiological evidence of pulmonary congestion 1.
- The diagnosis of cor pulmonale should be based on a comprehensive evaluation of the patient, rather than relying solely on BNP levels.
From the Research
Cor Pulmonale and Brain Natriuretic Peptide (BNP) Levels
- Cor pulmonale is associated with increased levels of Brain Natriuretic Peptide (BNP) 2, 3.
- Studies have shown that patients with cor pulmonale have higher BNP levels compared to those with chronic obstructive pulmonary disease (COPD) or healthy controls 3, 4.
- BNP levels are correlated with right ventricular pressure and are a useful marker for diagnosing and prognosticating heart failure, including cor pulmonale 3, 4.
BNP as a Biomarker for Cor Pulmonale
- Elevated BNP levels are associated with increased mortality and readmission rates in patients with cor pulmonale 2.
- BNP levels can be used to differentiate between cardiac and pulmonary causes of dyspnea, with higher levels indicating cardiac dysfunction 4.
- The area under the receiver operating characteristic curve for admission BNP levels to predict readmission in patients with cor pulmonale is 0.788, indicating a strong predictive value 2.
Hemodynamic and Endocrine Effects of BNP in Cor Pulmonale
- BNP has been shown to produce dose-related pulmonary vasodilatation in patients with cor pulmonale, without worsening oxygen saturation or affecting systemic hemodynamics 5.
- BNP also exerts favorable neurohormonal effects by suppressing aldosterone, which can contribute to its therapeutic potential in managing patients with pulmonary vascular disease 5.