natriuretic-peptide--brain and Muscular-Diseases

Although left atrial (LA) mechanical dysfunction in heart failure with preserved ejection fraction (HFpEF) is associated with poor clinical outcomes, the influence of LA myopathy on temporal changes in cardiovascular biomarkers is unclear.. We evaluated biomarker correlates of LA myopathy, as defined by reduced LA strain, and the associations of LA strain with longitudinal changes in biomarkers among participants in the Phosphodiesterase-5 Inhibition to Improve Clinical Status and Exercise Capacity in Heart Failure with Preserved Ejection Fraction (RELAX) trial. LA speckle-tracking was performed on baseline echocardiograms of RELAX participants to measure LA reservoir and LA contractile strain. Of the 216 RELAX participants, 169 (78%) had measurable LA strain and biomarker data. Participants with LA reservoir strain below median (13.5%, interquartile range: 10%-22.5%) were older, more likely to have atrial fibrillation, and had higher jugular venous pressure (P < .05 for all). At baseline, higher levels of endothelin-1, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and troponin I were independently associated with lower LA reservoir and contractile strain (P. In HFpEF, LA myopathy is characterized by elevation in biomarkers of neurohormonal activation and myocardial necrosis. Lower LA function is associated with continued elevation in NT-proBNP over time, suggesting that LA myopathy is associated with persistent congestion in HFpEF.

Topics: Atrial Function, Left; Biomarkers; Heart Failure; Humans; Muscular Diseases; Natriuretic Peptide, Brain; Peptide Fragments; Stroke Volume

Statins are widely used drugs to reduce LDL cholesterol and risk for cardiovascular disease. Varying degrees of myopathies occur with statin use, ranging from mild myalgic symptoms alone to documented muscle damage and rhabdomyolysis. The activity of creatine kinase (CK) above a population-based reference range has been used to differentiate myalgias from documented myositic injury due to statins. However, because normal ranges for CK depend on gender, exercise, and ethnicity and are necessarily broad, it is possible for a patient to have myositic injury with a result that is within the reference range. Therefore, serial testing relative to baseline levels may be more effective in detecting mild increases in CK.. To properly interpret results of serial testing, we determined the biologic variation of CK and aldolase, another enzyme released from muscle, from biweekly blood collections for 8 weeks from 17 healthy subjects.. Using log transformation, we calculated a reference change value of about +140% and -60% for both CK and aldolase.. The use of calculated RCV could help to improve the detection of those statin side effects promoting variation in CK values, which must be determined in clinical studies. The clinical significance of detecting more cases of statin-induced myopathy must also be examined.

Topics: Adult; Algorithms; Anticholesteremic Agents; Clinical Enzyme Tests; Creatine Kinase; Creatinine; Female; Fructose-Bisphosphate Aldolase; Glomerular Filtration Rate; Humans; Male; Middle Aged; Monitoring, Physiologic; Muscular Diseases; Natriuretic Peptide, Brain; Reference Values; Simvastatin; Time Factors