Plasma surfactant protein-B: A novel biomarker in chronic heart failure

Carmine G. De Pasquale, Leonard F. Arnolda, Ian R. Doyle, Philip E. Aylward, Derek P. Chew, Andrew D. Bersten

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39 Citations (Scopus)


Background - in chronic heart failure (CHF), elevated pulmonary microvascular pressure (Pmv) results in pulmonary edema. Because elevated Pmv may alter the integrity of the alveolocapillary barrier, allowing leakage of surfactant protein-B (SP-B) from the alveoli into the circulation, we aimed to determine plasma levels of SP-B in CHF and their relation to clinical status. Methods and Results - Fifty-three outpatients with CHF had plasma SP-B and N-terminal proBNP (NT-proBNP) assayed, in addition to a formalized clinical assessment at each clinic review over a period of 18 months. The control group comprised 19 normal volunteers. Plasma SP-B was elevated in CHF (P<0.001), and levels increased with New York Heart Association classification (P<0.001). SP-B correlated with objective clinical status parameters and NT-proBNP. During follow-up, major cardiovascular events occurred in patients with higher plasma SP-B (P<0.01) and NT-proBNP (P<0.05). Furthermore, on conditional logistic regression analysis, only SP-B was independently associated with CHF hospitalization (P=0.005). The 53 patients underwent a total of 210 outpatient visits. When the diuretic dosage was increased on clinical grounds, SP-B had increased 39% (P<0.001) and NT-proBNP had increased 32% (P<0.001). Conversely, at the next visit, SP-B fell 12% (P<0.001), whereas NT-proBNP fell 39% (P<0.001). Conclusions - Plasma SP-B is increased in CHF, and levels are related to clinical severity. Furthermore, within individual patients, SP-B levels vary with dynamic clinical status and NT-proBNP levels. Because plasma SP-B is independently associated with CHF hospitalization, it may, by virtue of its differing release mechanism to NT-proBNP, be a clinically useful biomarker of the pulmonary consequences of raised Pmv.

Number of pages6
Issue number9
Publication statusPublished - 31 Aug 2004


  • Edema
  • Heart failure
  • Lung
  • Natriuretic peptides
  • Proteins

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

De Pasquale, C. G., Arnolda, L. F., Doyle, I. R., Aylward, P. E., Chew, D. P., & Bersten, A. D. (2004). Plasma surfactant protein-B: A novel biomarker in chronic heart failure. Circulation, 110(9), 1091-1096.