natriuretic-peptide--brain and Aortic-Aneurysm

This review discusses the role of biomarkers for both diagnoses and disease monitoring before, during, and after treatment of aortic dissection.

Topics: Aortic Aneurysm; Aortic Dissection; Biomarkers; C-Reactive Protein; Calcium-Binding Proteins; Calponins; Elastin; Endothelin-1; Fibrin Fibrinogen Degradation Products; Humans; Microfilament Proteins; Natriuretic Peptide, Brain; Peptide Fragments; Peptidyl-Dipeptidase A; Receptors, Notch; Smooth Muscle Myosins; Transforming Growth Factor beta

Natriuretic peptides have been shown to improve renal blood flow and stimulate natriuresis. In a recent retrospective trial, we documented that prophylactic use of nesiritide was associated with a 66% reduction in the odds for dialysis or in-hospital mortality at 21 days in patients undergoing high-risk cardiac surgery; therefore, we designed a prospective trial.. This prospective, randomized, clinical trial included 94 patients undergoing high-risk cardiac surgery comparing a 5-day course of continuous nesiritide (at a dose of 0.01 microg x kg(-1) x min(-1) started before surgery) versus placebo. The primary end point was dialysis and/or all-cause mortality within 21 days; secondary end points were incidence of acute kidney injury, renal function, and length of stay.. Nesiritide did not reduce the primary end point of incidence of dialysis and/or all-cause mortality through day 21 (6.6% vs 6.1%; P = .914). Fewer patients receiving nesiritide had acute kidney injury (defined as an absolute increase in serum creatinine > or = 0.3 mg/dL from baseline or a percentage increase in serum creatinine > or = 50% from baseline within 48 hours) compared with controls (2.2% vs 22.4%; P = .004), and mean serum creatinine was lower in the immediate postoperative period in the nesiritide group (1.18 +/- 0.41 mg/dL vs 1.45 +/- 0.74 mg/dL; P = .028). However, no difference in length of stay was noted (nesiritide 20.73 +/- 3.05 days vs control 21.26 +/- 4.03 days; P = .917).. These results do not demonstrate a benefit for prophylactic use of nesiritide on the incidence of dialysis and/or death in patients undergoing high-risk cardiac surgery. Although nesiritide may provide some renal protection in the immediate postoperative period, no effect on length of stay was observed.

Topics: Acute Kidney Injury; Aged; Aortic Aneurysm; Cardiac Surgical Procedures; Cause of Death; Creatinine; Double-Blind Method; Female; Glomerular Filtration Rate; Heart Valve Prosthesis Implantation; Humans; Kidney; Length of Stay; Male; Middle Aged; Natriuretic Agents; Natriuretic Peptide, Brain; Postoperative Complications; Renal Dialysis; Risk Factors

Marfan syndrome (MFS) is an inherited connective tissue disorder characterized by ectopia lentis, aortic root dilation and dissection and specific skeletal features. Obstructive sleep apnea (OSA) in MFS has been described earlier but the prevalence and its relation with the cardiovascular risk is still controversial. This study aimed to further investigate these aspects.. In this prospective longitudinal study, we performed an attended polysomnography in 40 MFS patients (60% women, 37 ± 12.8 years) and evaluated several cardiovascular parameters through echocardiography, resting electrocardiogram, 24 hr-Holter monitoring and serum NT-ProBNP measurements.. We found that OSA was present in 42.5% of the patients and that higher body mass index was the most important factor associated with the presence of OSA. We observed that overweight was present in 27.5% of the patients in the whole cohort and in 55.6% if >40 years. Furthermore, when evaluating the impact of OSA on the cardiovascular system, we observed that patients with OSA tended to have higher systolic blood pressure, larger distal aortic diameters and a higher prevalence of ventricular arrhythmia. These differences were, however, not significant after adjusting for confounders.. Our study shows a high prevalence of OSA and a high prevalence of overweight in MFS patients. We found some trends between OSA and cardiovascular features but we could not establish a solid association. Our study, however might be underpowered, and a multicenter collaborative study could be very useful to answer some important open questions.

Topics: Adult; Aortic Aneurysm; Aortic Dissection; Arrhythmias, Cardiac; Blood Pressure; Body Mass Index; Cardiovascular Diseases; Electrocardiography; Female; Fibrillin-1; Genetic Association Studies; Humans; Male; Marfan Syndrome; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Polysomnography; Prevalence; Prospective Studies; Risk Factors; Sleep Apnea Syndromes; Sleep Apnea, Obstructive; Young Adult

Topics: Aortic Aneurysm; Aortic Dissection; Aortic Valve Insufficiency; Biomarkers; Blood Vessel Prosthesis Implantation; Dyspnea; Heart Failure, Diastolic; Heart Murmurs; Heart Valve Prosthesis Implantation; Humans; Hypertension; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments

Placental growth factor (PlGF), a member of the vascular endothelial growth factor (VEGF) family, has recently emerged as a predictor of survival and cardiovascular risk. Along with others, we have shown an independent association between PlGF and cardiovascular events in CKD patients, but not much is known about patients receiving dialysis.. We studied 205 dialysis patients undergoing cardiac catheterization at the Nara Medical University between April 1, 2004, and December 31, 2012. Serum levels of PlGF and VEGF were measured with ELISA in all the patients.. During a median follow-up of 20 months, 121 participants died from any cause or experienced a cardiovascular event. In the fully adjusted analysis, having an above-median PlGF or VEGF level was associated with a hazards ratio for adverse outcomes of 2.55 (1.72-3.83) and 1.39 (0.95-2.04), respectively. Using a multimarker strategy in a model with age, serum albumin, history of coronary artery disease, brain natriuretic peptide and PlGF, patients with 2, 3 and 4 positive markers had a 3.82-, 5.77- and 6.59-fold higher risk of mortality or a cardiovascular event, respectively, compared to those with no positive markers. The model with PlGF had a significantly higher c-statistic, integrated discrimination improvement index and category-free net reclassification improvement index than the model without PlGF.. PlGF is independently associated with mortality and cardiovascular events, but the association between VEGF and adverse events was attenuated with covariate adjustment. The addition of PlGF to models with established clinical predictors provides additional useful prognostic information in patients receiving dialysis.

Topics: Aged; Aortic Aneurysm; Aortic Diseases; Aortic Dissection; Aortic Rupture; Cardiovascular Diseases; Coronary Artery Disease; Female; Humans; Kidney Failure, Chronic; Male; Middle Aged; Mortality; Natriuretic Peptide, Brain; Peripheral Arterial Disease; Placenta Growth Factor; Pregnancy Proteins; Prognosis; Proportional Hazards Models; Renal Dialysis; Stroke; Vascular Endothelial Growth Factor A

Endothelin-1 (ET-1) and B-type natriuretic peptide (BNP) have been reported to be involved in numerous cardiovascular diseases. The study aim was to monitor the circulating plasma levels of these peptides in patients affected by aortic disease, and to identify any changes in such levels after surgical treatment.. A total of 81 patients (52 males, 29 females; mean age 64 +/- 11 years) with aortic disease underwent surgery. The conditions included aortic valve stenosis (n=36), aortic valve regurgitation (n=11), ascending aortic aneurysm (n=6), and combined ascending aortic aneurysm and valvulopathy (n=28). Circulating plasma levels of ET-1 and BNP were measured in all patients before and at 12 months after surgery.. Compared to the preoperative situation, significant decreases were found postoperatively in plasma levels of ET-1 (4.2 +/- 0.1 versus 3.1 +/- 0.1 pM; p < 0.001) and BNP (0.071 versus 0.017 ng/ml; p < 0.001), combined with an increased cardiac function and decreased ventricular dimensions. The preoperative levels of both peptides were similar in all patient groups, and were decreased to a similar extent regardless of the diagnosis. Basal levels of ET-1 were higher in the trileaflet aortic valve compared to the bicuspid valve (4.0 +/- 0.1 versus 3.6 +/- 0.1 pM; p = 0.04).. Circulating plasma levels of ET-1 and BNP were decreased after surgery for aortic valve disease. The decrease was unrelated to the presence of ascending aortic aneurysm, and most likely represents a response to cardiac remodeling and the improved functional status of the patients.

Topics: Adult; Aged; Aged, 80 and over; Aortic Aneurysm; Aortic Valve Insufficiency; Aortic Valve Stenosis; Biomarkers; Blood Vessel Prosthesis Implantation; Down-Regulation; Endothelin-1; Female; Heart Valve Prosthesis Implantation; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Prospective Studies; Recovery of Function; Stroke Volume; Sweden; Time Factors; Treatment Outcome; Ventricular Function, Left; Ventricular Remodeling

Early diagnosis and treatment are pivotal for patients with acute aortic dissection (AAD). D-dimer is a rule-out diagnostic test for pulmonary embolism but there is evidence that it may also be applicable to AAD. We evaluated plasma D-dimer, white cell blood count (WBC), C-reactive protein (CRP) and N-terminal pro-B-type natriuretic peptide (BNP) in 18 consecutive patients with established AAD, 21 consecutive patients with dilated ascending aortas scheduled for elective surgery and 8 normal subjects. Patients with AAD had significantly higher elevated D-dimer, compared to chronic aneurysms and normal controls (p<0.0001). D-dimer level higher than 700 ng/ml had a sensitivity of 94% and specificity of 59% for diagnosis of AAD. The WBC count was also significantly increased compared to the other groups (p<0.01). CRP and BNP values were significantly higher compared to normal controls but these parameters did not distinguish between AAD and chronic aneurysms. D-dimer can be used as a 'rule-out' test in patients with suspected AAD and seems useful in the discrimination between AAD and chronic uncomplicated aneurysms, unlike CRP and BNP plasma levels.

Topics: Acute Disease; Acute-Phase Reaction; Adolescent; Adult; Aged; Aortic Aneurysm; Aortic Dissection; C-Reactive Protein; Chronic Disease; Female; Fibrin Fibrinogen Degradation Products; Humans; Leukocyte Count; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prospective Studies; Sensitivity and Specificity