natriuretic-peptide--brain and Respiration-Disorders

Topics: Biomarkers; Chronic Disease; Diagnostic Imaging; Edema; Heart Failure; Humans; Natriuretic Peptide, Brain; Norepinephrine; Pleural Effusion; Renin-Angiotensin System; Respiration Disorders; Stroke Volume; Ventricular Remodeling

We sought to evaluate the associations of high-sensitivity troponin T (Hs-TnT), N-terminal pro-brain natriuretic peptide (NT-proBNP), and high sensitivity C-reactive protein (Hs-CRP) with mortality from any cause, cardiovascular disease (CVD), coronary heart disease (CHD), stroke, cancer, and respiratory disease in the Atherosclerosis Risk in Communities cohort.. We included 11,193 participants aged 54 to 74 years, initially free of the conditions being studied, and who had biomarkers measured. Participants were followed for a mean of 9.9 years.. Hazard ratios (HR), adjusted for multiple risk factors, for mortality in participants in the highest Hs-TnT category compared with those with undetectable levels were: Total 3.42 (95% confidence interval [CI], 2.75-4.26); CVD, 7.34 (95% CI, 4.64-11.6); CHD, 6.06 (95% CI, 2.91-12.6); stroke, 3.31 (95% CI, 1.26-8.66); cancer, 1.60 (95% CI, 1.08-2.38); and respiratory, 3.85 (95% CI, 1.39-10.7). Comparing the highest NT-proBNP quintile with those in the lowest quintile, the adjusted HRs for mortality were: Total, 3.05 (95% CI, 2.46-3.77); CVD, 7.48 (95% CI, 4.67-12.0); CHD, 4.07 (95% CI, 2.07-7.98); and stroke, 10.4 (95% CI, 2.26-47.7). Comparing extreme Hs-CRP quintiles, the adjusted HRs for mortality were: Total, 1.61 (95% CI, 1.32-1.97); CVD, 1.76 (95% CI, 1.19-2.62); and respiratory, 3.36 (95% CI, 1.34-8.45). Having multiple markers elevated simultaneously greatly increased cause-specific mortality risks.. Greater levels of Hs-TnT, NT-proBNP and Hs-CRP are associated with increased risk of death, not just from CVD, but also from some noncardiovascular causes.

Topics: Aged; Biomarkers; C-Reactive Protein; Cardiovascular Diseases; Female; Humans; Male; Middle Aged; Mortality; Natriuretic Peptide, Brain; Neoplasms; Population Surveillance; Predictive Value of Tests; Prevalence; Proportional Hazards Models; Prospective Studies; Respiration Disorders; Risk Factors; Surveys and Questionnaires; Troponin T

To determine if serum natriuretic peptide (NP) concentrations could distinguish cardiac from non-cardiac causes of respiratory distress (RD) in cats.. Seventy-four cats from 1 university hospital were used.. Serum NP concentrations were measured in 41 cats with non-cardiac respiratory distress (RD-NC) and compared to 33 cats with RD due to congestive heart failure (RD+CHF) using sandwich enzyme immunoassays (ELISA).. RD-NC cats had lower (P=0.0001) median NT-proANP and NT-proBNP concentrations (614 and 45 fmol/mL, respectively) than RD+CHF cats (1690 and 523 fmol/mL, respectively). The area under the curve was 0.88 and 0.96 for the receiver operating curve analysis of the diagnostic accuracy of NT-proANP and NT-proBNP concentrations to discriminate RD+CHF from RD-NC cats (P=0.036). An optimum cut-off concentration of 986 fmol/mL for NT-proANP and 220 fmol/mL for NT-proBNP accurately discriminated RD-NC from RC+CHF cats with a sensitivity of 93.8% and 93.9% and a specificity of 80.3% and 87.8%, respectively.. Serum NP concentrations were different in RD+CHF cats compared to RD-NC cats. Evaluation of circulating NP concentrations may be helpful in the initial approach to cats presenting with respiratory distress, particularly if advances in ELISA technology result in a rapid cage-side test.

Topics: Animals; Atrial Natriuretic Factor; Biomarkers; Case-Control Studies; Cat Diseases; Cats; Confidence Intervals; Diagnosis, Differential; Enzyme-Linked Immunosorbent Assay; Female; Heart Failure; Male; Natriuretic Peptide, Brain; Peptide Fragments; Protein Precursors; Respiration Disorders; ROC Curve; Sensitivity and Specificity

Circulating plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) concentration facilitates emergency diagnosis of congestive heart failure (CHF) in people. Its utility to discriminate between dyspneic cats with CHF vs. primary respiratory disease requires further assessment. Our objectives were to determine if NT-proBNP (1) differentiates dyspneic cats with CHF vs. primary respiratory disease; (2) increases with renal insufficiency; (3) correlates with left atrial dimension, radiographic cardiomegaly, and estimated left ventricular filling pressure (E/E(a)).. NT-proBNP was measured in 167 dyspneic cats (66 primary respiratory disease, 101 CHF) to evaluate (1) relationship with clinical parameters; (2) ability to distinguish CHF from primary respiratory disease; (3) optimal cut-off values using receiver operating characteristic (ROC) curve analysis.. NT-proBNP (1) was higher (median and inter-quartile [25th-75th] percentile) in CHF (754 pmol/L; 437, 1035 pmol/L) vs. primary respiratory disease (76.5 pmol/L; 24, 180 pmol/L) cohorts (P<0.001); (2) positively correlated in CHF cats with increased inter-ventricular septal end-diastolic thickness (rho=0.266; P=0.007) and LV free wall thickness (rho=0.218; P=0.027), but not with radiographic heart size, left atrial size, left ventricular dimensions, E/E(a) ratio, BUN, creatinine, or thyroxine; (3) distinguished dyspneic CHF cats from primary respiratory disease at 265 pmol/L cut-off value with 90.2% sensitivity, 87.9% specificity, 92% positive predictive value, and 85.3% negative predictive value (area under ROC curve, 0.94).. NT-proBNP accurately discriminated CHF from respiratory disease causes of dyspnea.

Topics: Animals; Biomarkers; Case-Control Studies; Cat Diseases; Cats; Diagnosis, Differential; Dyspnea; Female; Heart Failure; Male; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Prospective Studies; Renal Insufficiency; Respiration Disorders; ROC Curve

We measured plasma BNP and hANP levels and studied the relationship to echocardiographic findings in 49 patients who visited or admitted in our hospital due to dyspnea (25 with chronic obstructive pulmonary disease (COPD), 8 with interstitial pneumonia, 16 with sequelae of tuberculosis). The age in the interstitial pneumonia group was lower and the arterial blood partial pressure of CO2 was higher in the sequelae of tuberculosis group. Plasma BNP and hANP levels were similar in the three groups. Plasma BNP level did not correlate with the pressure gradient measured from tricuspid valve regurgitation. Some patients had pulmonary hypertension despite having low plasma BNP levels. Hypoxemia was more severe in the higher BNP level group than in the lower BNP level group. Plasma BNP levels did not reflect pulmonary hypertension unless these was left ventricular failure or valvular diseases in these groups.

Topics: Aged; Aged, 80 and over; Atrial Natriuretic Factor; Female; Humans; Hypertension, Pulmonary; Lung Diseases, Interstitial; Male; Middle Aged; Natriuretic Peptide, Brain; Pulmonary Disease, Chronic Obstructive; Respiration Disorders

B-type natriuretic peptide (BNP) is an established tool for the diagnosis of acute congestive heart failure in patients presenting with dyspnea. Some patients have moderately elevated BNP levels (ie, 100 to 500 pg/mL) in the absence of acute congestive heart failure. The objective of the current study was to identify independent predictors of elevated BNP concentrations in the absence of congestive heart failure.. We studied 781 patients without acute congestive heart failure and BNP levels 0 to 500 pg/mL drawn from a cohort of 1,586 patients with acute dyspnea who had BNP levels measured on emergency department arrival. Two cardiologists blinded to BNP results reviewed all clinical data and categorized patients according to whether they had acute congestive heart failure or not.. Independent predictors of elevated BNP levels (ie, >100 pg/mL) were a medical history of atrial fibrillation, radiographic cardiomegaly, decreased blood hemoglobin concentration, decreased body mass index, and increased age.. Knowledge of these commonly obtained variables should aid clinicians in the interpretation of moderately elevated BNP results in patients presenting with acute dyspnea in the emergency department.

Topics: Aged; Arrhythmias, Cardiac; Biomarkers; Chronic Disease; Comorbidity; Dyspnea; Female; Heart Failure; Humans; Male; Middle Aged; Multivariate Analysis; Natriuretic Peptide, Brain; Predictive Value of Tests; Pulmonary Embolism; Respiration Disorders; Retrospective Studies

Diagnosis of acute left ventricular failure (LVF) is often difficult in the prehospital setting. Brain natriuretic peptide (BNP) is a marker of LVF. The object of this study was to evaluate the feasibility of BNP measurement during the prehospital management of patients with dyspnoea.. Prospective feasibility study, in the Paris Emergency Medical Service (SAMU).. All patients, aged 50 years and over, presenting with acute dyspnoea were included in the study, unless the dyspnoea was of circumstantial origin. Bedside BNP assays were conducted in parallel with the usual clinical management. For each patient, three diagnoses (cardiac, respiratory or uncertain) were established: firstly, according to the usual clinical criteria (diagnosis 1); secondly (diagnosis 2) according to the result of BNP measurement. When the diagnoses 1 and 2 were not in agreement, patients were entered into a category labeled "diagnostic correction".. Fifty-two patients were included in the study. Twenty-one patients had clinically obvious LVF (diagnosis 1' = cardiac). For seven other patients, the clinical variables suggested a respiratory cause (diagnosis 1 = respiratory). For 24 patients dyspnoea was due to a non-identified cause (diagnosis 1 = uncertain). BNP levels were measured in 51 out of 52 patients (one failure). Only nine patients had a BNP level lower than the threshold value of 100 pg ml(-1). In 71% the diagnosis 1 was corrected after BNP estimation. Only two of 27 patients with marked bronchospasm had a BNP level lower than 100 pg ml(-1).. Estimation of BNP is both feasible and easy in prehospital care, and can confirm the cardiac origins of atypical acute dyspnoea. In elderly patients LVF appears to be clinically underestimated. BNP assay may produce improvements in prehospital management of patients with dyspnoea.

Topics: Acute Disease; Aged; Aged, 80 and over; Diagnosis, Differential; Dyspnea; Emergency Medical Services; Feasibility Studies; Female; Heart Diseases; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Prospective Studies; Respiration Disorders