Elevated Left Ventricular Filling Pressure after Maximal Exercise Predicts Increased Plasma B-type Natriuretic Peptide Levels in Patients with Impaired Relaxation Pattern of Diastolic Filling

Patients with an impaired relaxation pattern of Doppler left ventricular filling may have elevated or normal plasma B-type natriuretic peptide (BNP) levels. We hypothesized that elevated BNP levels occur in patients whose left atrial pressure increases after exercise. We examined the relationship between BNP levels and left ventricular filling pressure at rest and immediately after maximal exercise, estimated by Doppler tissue imaging, in 80 patients undergoing exercise echocardiography and showing impaired relaxation pattern. The ratio of early diastolic mitral inflow to annular velocities at rest did not correlate with BNP (r = 0.13, P = .23). In contrast, ratio of early diastolic mitral inflow to annular velocities after exercise correlated with BNP (r = 0.57, P < .001). Ratio of early diastolic mitral inflow to annular velocities after exercise greater than 9.9 discriminated patients with BNP greater than 100 pg/mL (n = 16) from those with BNP less than 100 pg/mL (n = 64) with a sensitivity of 75% and a specificity of 84%. In conclusion, elevated left ventricular filling pressure after maximal exercise predicts increased BNP levels in patients with impaired relaxation pattern.