natriuretic-peptide--brain and Multiple-Sclerosis

Topics: Adult; Aged; Antineoplastic Agents; Biomarkers; Cardiomyopathies; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Heart; Humans; Male; Middle Aged; Mitoxantrone; Monitoring, Physiologic; Multiple Sclerosis; Natriuretic Peptide, Brain; Predictive Value of Tests

We present a case with a close temporal association of the first diagnosis of multiple sclerosis and stress cardiomyopathy.. A 19-year-old man experienced severe dyspnoea. The cardiac biomarkers troponin T and NT-proBNP were elevated, and transthoracic echocardiography showed basal hypokinesia. The man was diagnosed with stress cardiomyopathy after main differential diagnoses such as acute coronary syndrome, myocarditis, and pheochromocytoma were excluded. Furthermore, the patient reported vertigo and paraesthesia. Brain and spinal MRI revealed T2-hyperintense lesions with a prominent acute lesion in the pontomedullary area. Cerebrospinal fluid findings revealed a lymphocytic pleocytosis and intrathecal IgG synthesis. Serum neurofilaments were elevated. The patient was diagnosed with MS, and treatment with intravenous Methylprednisolone was initiated. The brainstem lesion due to multiple sclerosis was assumed to be the cause of stress cardiomyopathy. The patient fully recovered.. Stress cardiomyopathy may be linked with the first manifestation of multiple sclerosis in the presented case since pontomedullary lesions could affect the sympathetic nervous system. This case highlights the importance of neurological history and examination in young patients with unexplained acute cardiac complaints.

Topics: Biomarkers; Diagnosis, Differential; Echocardiography; Humans; Magnetic Resonance Imaging; Male; Multiple Sclerosis; Natriuretic Peptide, Brain; Peptide Fragments; Takotsubo Cardiomyopathy; Troponin T; Young Adult

Mitoxantrone (MTX) has been shown to reduce progression of disability and number of clinical exacerbations in patients with progressive multiple sclerosis (MS). Prolonged administration of MTX, however, is limited by the risk of cardiotoxicity. Cardiac monitoring in MTX-treated patients includes usually measurement of left ventricular ejection fraction (LVEF) by means of echocardiography. The N-terminal pro-brain natriuretic peptide (NT-proBNP) represents a novel diagnostic tool in the assessment of heart failure. This study was aimed to evaluate the usefulness of NT-proBNP for early detection of MTX-induced cardiotoxicity in MS patients.. We measured the NT-proBNP plasma levels in 45 MS patients who completed 24-month MTX therapy and in 37 MS patients of control group.. The median NT-proBNP plasma value was 15.12pg/mL. In 12 MTX-treated patients (27%), NT-proBNP plasma values were elevated, though this subgroup of patients neither clinical showed evidence of myocardial damage nor had the LVEF value <50%. In five patients with normal NT-proBNP, we observed LVEF decline >10%. We did not observe correlations between the NT-proBNP levels and patient age, MS duration, relapses index, Extended Disability Status Scale (EDSS), MTX single dose and the total cumulative dose of MTX. In 8 patients (22%) from control group, NT-proBNP plasma levels were also elevated.. The results of our study confirm that MTX therapy is safe for carefully selected and closely monitored MS patients. We believe that serial evaluation of NT-proBNP levels (before, during and after MTX therapy) can identify MS patients at high risk for MTX-induced cardiotoxicity.

Topics: Adult; Antineoplastic Agents; Biomarkers; Cardiomyopathies; Female; Heart Diseases; Heart Failure; Humans; Male; Middle Aged; Mitoxantrone; Multiple Sclerosis; Natriuretic Peptide, Brain; Peptide Fragments; Ventricular Dysfunction, Left

The cardio-neuro-endocrine axis seems to be involved in the cascade of postictal events in children. The aim of this study was to assess the relationship between childhood epilepsy and cerebrospinal fluid (CSF) or serum concentrations of the N-terminal pro B-type natriuretic peptide (NT-proBNP) interictally.. A total of seventy-four children agreed to participate in the study. Twenty-two children with epilepsy and mild developmental delay (mean+/-SD [median] age 5.8+/-4.9 [4.3] years), 15 children with newly diagnosed multiple sclerosis (MS) (15.1+/-1.4 [15.3] years) and 37 children with cryptogenic mild developmental delay (8.0+/-4.6 [7.4] years), serving as controls, were eligible.. In children with epilepsy, interictal CSF NT-proBNP concentrations were greater when compared to the MS group and to controls (mean+/-SD [median] 193.0+/-78.1 [176.0]ng/L vs. 147.8+/-60.2 [138.0]ng/L vs. 140.4+/-36.5 [134.0]ng/L; p=0.014 and p=0.009). In contrast, serum NT-proBNP concentrations and the CSF/serum NT-proBNP ratio did not differ between groups.. Greater CSF NT-proBNP concentrations in children with epilepsy may reflect an unspecific activation of the cardio-neuro-endocrine system involving endocrinological stress-response mechanisms interictally. The relationship between epilepsy and the cardio-neuro-endocrine axis may further the understanding of seizure susceptibility in children as well as influences of epilepsy on central modulation of autonomic cardiovascular control.

Topics: Adolescent; Analysis of Variance; Child; Child, Preschool; Cross-Sectional Studies; Epilepsy; Female; Humans; Immunoassay; Male; Multiple Sclerosis; Natriuretic Peptide, Brain; Patient Selection; Peptide Fragments; Spinal Puncture

The aim of this study was to evaluate the plasma level changes of B-type natriuretic peptide (BNP), biochemical marker of heart failure, and echocardiographic parameters during mitoxantrone treatment in 22 multiple sclerosis (MS) patients (8 males, 14 females, mean age 37.1+/-6.6). Mitoxantrone (after mean cumulative dose of 58.0+/-7.0 mg/m(2)) did not alter left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), posterior wall thickness (PWT) and left ventricular end-diastolic volume (LVEDV). However, mean plasma level of BNP raised from 14.53+/-3.29 pg/ml at the baseline to 16.79+/-3.05 pg/ml and 18.83+/-4.90 pg/ml (P<0.01) after mean mitoxantrone dose of 30.7+/-5.9 mg/m(2) and 58.0+/-7.0 mg/m(2), respectively. These results strongly suggest subclinical myocardial dysfunction in mitoxantrone-treated group. We assume, that low-cost, repeated BNP measurements may be a good alternative for detection of early subtle myocardial injury in MS patients during routine mitoxantrone therapy.

Topics: Adult; Analysis of Variance; Antineoplastic Agents; Biomarkers; Echocardiography; Female; Heart Injuries; Humans; Longitudinal Studies; Male; Mitoxantrone; Multiple Sclerosis; Natriuretic Peptide, Brain; Pilot Projects; Statistics, Nonparametric