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Relationship between CT Findings and the Plasma Levels of Brain Natriuretic Peptide in 29 Patients with Acute Cardiogenic Pulmonary Edema

Posted Jun 30, 2012 Updated Apr 10, 2023
By Kosaku Komiya MD , Hiroshi Ishii MD PhD , Junji Murakami MD PhD , Hidehiko Yamamoto MD PhD , Fumito Okada MD PhD , Katashi Satoh MD PhD , Osamu Takahashi MD MPH PhD , Takeshi Johkoh MD PhD , Jun-ichi Kadota MD PhD
7 min read

Rationale and Objectives

Brain natriuretic peptide (BNP) is a useful biomarker for the assessment of cardiogenic pulmonary edema. This study evaluated the relationship between computed tomography (CT) findings and plasma BNP levels in patients with cardiogenic pulmonary edema.

Materials and Methods

Twenty-nine consecutive outpatients with severe respiratory failure from cardiogenic edema presenting to emergency departments were enrolled. They underwent chest CT and plasma BNP levels were measured in the emergency room. CT findings were independently evaluated by two radiologists who were unaware of the patients’ clinical information.

Results

The plasma BNP levels only correlated with the volume of pleural effusion in each side (right: r s = 0.519, P = .004; left: r s = 0.460, P = .012). No significant correlation was observed between the BNP levels and the findings of lung parenchyma or cardiovascular enlargement.

Conclusion

Estimating the pleural effusion volume with CT may be a feasible method as well as measuring the plasma BNP level in the assessment of acute cardiogenic pulmonary edema.

The plasma level of brain natriuretic peptide (BNP) is a sensitive diagnostic marker of dyspnea from cardiac causes , and a prognostic marker after an episode of acute coronary syndrome and in patients with chronic heart failure .

Computed tomography (CT) is increasingly used in emergency departments and is thought to have advantages in the diagnosis of patients with severe acute respiratory failure, including acute respiratory distress syndrome (ARDS), cardiogenic pulmonary edema, and pulmonary embolism . However, the correlation between plasma BNP levels and radiological findings has not been fully evaluated in patients with acute cardiogenic pulmonary edema, except in patients with a mild pulmonary embolism . This study, therefore, compared chest CT findings with the plasma BNP levels, to determine whether chest CT was a useful auxiliary tool in the assessment of acute cardiogenic pulmonary edema.

Materials and methods

Setting and Patients

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Measurement of BNP

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Evaluation of CT Findings

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Statistical Analyses

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Results

Patient Characteristics

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Table 1

Baseline Patient Characteristics

Low BNP High BNP_n_ = 29n = 14n = 15P Value Female 13 (45) 4 (29) 9 (60) .091 Age, y 81 (11) 79.5 (9.5) 84 (12.5) .297 GFR, mL/min 47.2 (16.3) 47.9 (16) 46 (12.8) .295 Systolic blood pressure, mm Hg 138 (36) 146 (33.8) 135 (40.5) .429 Diastolic blood pressure, mm Hg 86 (35) 91.5 (43) 77 (24) .596 Body temperature, °F 98.1 (33.1) 97.7 (33.1) 98.2 (33.5) .166 P/F ratio 106 (86) 95.4 (76.3) 112 (104.1) .171 History of bronchial asthma 1 (3) 1 (7) 0 (0) .482 History of diabetes mellitus 8 (28) 2 (14) 6 (40) .128

BNP, brain natriuretic peptide; GFR, glomerular filtration rate; P/F, partial pressure of oxygen in arterial blood/fraction of inspired oxygen.

Data are expressed as the number (%) or median (interquartile range).

Cutoff level of plasma BNP: 830 pg/mL.

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Chest CT Findings

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Figure 1, Bland-Altman plots of two observers’ results for the contidnuous variables; transverse diameter of SVC, longitudinal diameter of IVC, transverse diameter of RV and LV, and pleural effusion in each side. The x-axis is the average of two observers’ results, and y-axis is the difference between them. The continuous line ( center ) represents the means of the difference. The top and bottom dotted lines represent the upper and lower limits of agreement (mean difference ± 1 SD), respectively. Mean difference ± 1 SD represents the limit of agreement of the Bland-Altman analysis. IVC, inferior vena cava; LV, left ventricle; RV, right ventricle; SVC, superior vena cava.

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Table 2

Chest CT Features in Acute Cardiogenic Pulmonary Edema According to Plasma BNP Levels

Low BNP High BNP_n_ = 29n = 14n = 15P Value Ground-glass attenuation 29 (100) 14 (100) 15 (100) N/A Airspace-consolidation 28 (97) 13 (93) 15 (100) .482 Subpleural sparing 8 (28) 3 (21) 5 (33) .383 Thickening of bronchovascular bundle 26 (90) 14 (100) 12 (80) .124 Air-bronchogram 3 (10) 0 (0) 3 (20) .124 Transverse diameter of SVC (mm) 21 (4) 20 (4) 21 (4) .238 Longitudinal diameter of IVC (mm) 24 (7) 25 (7.8) 23 (4.5) .285 RV/LV 0.88 (0.28) 0.87 (0.24) 0.91 (0.26) .558 Right-sided pleural effusion (mL) 2861 (2064) 1978 (2039) 3188 (2025) .035 Left-sided pleural effusion (mL) 940 (927) 566 (596) 1223 (1573) .047

BNP, brain natriuretic peptide; IVC, inferior vena cava; N/A, not available; RV/LV, right ventricle/left ventricle; SVC, superior vena cava.

Data are expressed as the number (%) or median (interquartile range).

Cutoff level of plasma BNP: 830 pg/mL.

Figure 2, Chest computed tomography images of patients with acute cardiogenic pulmonary edema according to the plasma brain natriuretic peptide (BNP) levels. The calculated volume of pleural effusion was: (a) 1413 mL ( right side ), 225 mL ( left side ) in a 72-year-old female (plasma BNP level; 411 pg/mL). (b) A total of 3338 mL ( right side ), 683 mL ( left side ) in a 62-year-old female (plasma BNP level; 1167 pg/mL). (c) A total of 7710 mL ( right side ), 2499 mL ( left side ) in a 73-year-old male (plasma BNP level; 1997 pg/mL).

Figure 3, Plots of the volume of pleural effusion in the right side (a) and in the left side (b) , according to the plasma brain natriuretic peptide levels.

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Discussion

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Academic Radiology, Volume 19, Issue 7
Journals General Radiology
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