Chest computed tomography features predictive of elevated b-type natriuretic peptide independent of renal function: Diagnostic implications for evaluation of congestive heart failure

OBJECTIVE: B-type natriuretic peptide (BNP), commonly evaluated in patients suspected of congestive heart failure, is also elevated in patients with renal insufficiency. The objective of our study was to identify chest computed tomography features that correlate with BNP levels independent of renal function. MATERIALS AND METHODS: A total of 162 (of which 76 had normal BNP and 86 had elevated BNP) patients with chest computed tomography and serum BNP levels measured within 24 hours were evaluated for the presence of ground-glass opacities, interlobular septal thickening, mediastinal lymphadenopathy, mosaic perfusion, peribronchovascular thickening, pericardial effusion, and pleural effusion. Both univariate and multivariate analysis were used to correlate these features with the serum BNP. Multiple logistic regression was used to identify statistically significant correlates of BNP controlling for the glomerular filtration rate. RESULTS: Ground-glass opacity, interlobular septal thickening, pericardial effusion, and left-and right-sided pleural effusion were statistically significant predictors of elevated BNP on separate logistic regression incorporating the glomerular filtration rate. After multiple logistic regression, interlobular septal thickening (odds ratio, 5.69) and pleural effusion (odds ratio, 3.88) remained significant predictors of BNP independent of the glomerular filtration rate. CONCLUSIONS: Interlobular septal thickening and pleural effusion appear to be independent predictors of BNP, and this may be useful in the evaluation of patients for congestive heart failure in the setting of renal insufficiency.