natriuretic-peptide--brain and Ventricular-Dysfunction

Plasma levels of brain natriuretic peptide (BNP) and its inactive fragment N-terminal pro-BNP are recognized as reliable markers of ventricular dysfunction in adults. We aimed to verify BNP applications in children.. A review of the literature on this subject was carried out.. When dealing with paediatric patients, age and sex-related normal values must be considered. Higher BNP plasma levels are reported in children with chronic heart failure; they are related with the type of dysfunction and with prognosis. Moreover, increased BNP levels have been reported in asymptomatic children and adolescents pretreated with anthracyclines, who are at risk for ventricular dysfunction.. BNP and pro-BNP also seem to be effective markers of ventricular dysfunction in paediatric patients. Clinical use may be extended not only for the characterization of heart dysfunction, but also for monitoring asymptomatic patients at specific risk. To this purpose, wider application in clinical trials appears warranted.

Topics: Adolescent; Age Factors; Anthracyclines; Antibiotics, Antineoplastic; Biomarkers; Child; Chronic Disease; Female; Heart Defects, Congenital; Heart Failure; Humans; Male; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Prognosis; Reference Values; Risk Factors; Sex Factors; Ventricular Dysfunction

Cardioprotection is an all-encompassing term for physico-biochemical or therapeutic interventions which slow or ameliorate the progression of cardiomyocyte necrosis. There are a number of established and novel biomarkers to assess coronary artery disease at initiation, ischemia, necrosis and myocardial dysfunction. Established biomarkers such as creatine kinase-MB, cardiac troponins and natriuretic peptides have been utilized for the assessment of cardioprotection, especially during surgery. Novel markers are currently being investigated for detection and risk assessment in patients with acute coronary syndromes. Ischemia-modified albumin is used for the early detection of cardiac ischemia and could be a potential biomarker for assessing the early cardioprotective effects of damage-limiting interventional measures.

Topics: Animals; Biological Assay; Biomarkers; Creatine Kinase, MB Form; Disease Progression; Humans; Myocardial Infarction; Myocardial Ischemia; Myocytes, Cardiac; Natriuretic Peptide, Brain; Necrosis; Predictive Value of Tests; Reproducibility of Results; Serum Albumin; Treatment Outcome; Troponin I; Troponin T; Ventricular Dysfunction

A HORMONE REVEALING VENTRICULAR DYSFUNCTION: B-type natriuretic peptide or Brain natriuretic peptide (BNP) is a neurohormone secreted by the ventricular myocytes in response to volume expansion and pressure overload. It is a sensitive marker of ventricular dysfunction in symptomatic and asymptomatic patients, and its dosage is correlated with the severity of the dysfunction. INDICATION FOR ITS DOSAGE IN HEART FAILURE: Since the results of recent studies, many authors recommend its routine use in heart failure, in order to confirm the diagnosis in difficult cases, assess severity, prognosis and the efficacy of treatment. Such use requires that the results of these studies be known and that the threshold value be adapted according to the age, concomitant diseases and indication of the dosage. OTHER AFFECTIONS: Its diagnostic and prognostic interest in acute coronary syndromes and hypertension is presently being studied.

Topics: Acute Disease; Angina, Unstable; Chronic Disease; Clinical Trials as Topic; Diagnosis, Differential; Dyspnea; Emergencies; Female; Heart Diseases; Heart Failure; Humans; Hypertension; Hypertension, Pulmonary; Male; Myocardial Infarction; Natriuretic Peptide, Brain; Prognosis; Risk Factors; ROC Curve; Sensitivity and Specificity; Troponin; Ventricular Dysfunction; Ventricular Remodeling

Topics: Diastole; Drug Monitoring; Follow-Up Studies; Heart Failure; Humans; Natriuretic Peptide, Brain; Prognosis; Ventricular Dysfunction

Heart failure is emerging as a major component of the public health problem of cardiovascular disease as we move into the twenty-first century. Current statistics indicate 4.9 million US citizens are afflicted with direct treatment costs estimated to be $18.8 billion per year. These figures are expected to worsen substantially as the prevalence of heart failure continues to increase. Epidemiologic studies also point to important increases in morbidity and have identified risk factors that aid in prognosis and that may contribute to our mechanistic understanding of heart failure pathophysiology. In addition, epidemiologic results indicate that many patients with mild-to-moderate clinical heart failure are still at substantial risk for morbidity and mortality during follow-up periods of only a few years. These data highlight the importance of enhancing physician and public awareness of heart failure. New methods of molecular epidemiology will point toward better and earlier detection of this common and frequently fatal condition.

Topics: Age Distribution; Aged; Aged, 80 and over; Atrial Natriuretic Factor; Diastole; Female; Heart Failure; Humans; Incidence; Male; Middle Aged; Molecular Epidemiology; Natriuretic Peptide, Brain; Prevalence; Prognosis; Risk Factors; Severity of Illness Index; Sex Distribution; Survival Rate; Systole; United States; Ventricular Dysfunction

The natriuretic peptides are biochemical markers of heart failure (HF) severity and predictors of adverse outcomes. Smaller studies have evaluated adjusting HF therapy based on natriuretic peptide levels ("guided therapy") with inconsistent results.. To determine whether an amino-terminal pro-B-type natriuretic peptide (NT-proBNP)-guided treatment strategy improves clinical outcomes vs usual care in high-risk patients with HF and reduced ejection fraction (HFrEF).. The Guiding Evidence Based Therapy Using Biomarker Intensified Treatment in Heart Failure (GUIDE-IT) study was a randomized multicenter clinical trial conducted between January 16, 2013, and September 20, 2016, at 45 clinical sites in the United States and Canada. This study planned to randomize 1100 patients with HFrEF (ejection fraction ≤40%), elevated natriuretic peptide levels within the prior 30 days, and a history of a prior HF event (HF hospitalization or equivalent) to either an NT-proBNP-guided strategy or usual care.. Patients were randomized to either an NT-proBNP-guided strategy or usual care. Patients randomized to the guided strategy (n = 446) had HF therapy titrated with the goal of achieving a target NT-proBNP of less than 1000 pg/mL. Patients randomized to usual care (n = 448) had HF care in accordance with published guidelines, with emphasis on titration of proven neurohormonal therapies for HF. Serial measurement of NT-proBNP testing was discouraged in the usual care group.. The primary end point was the composite of time-to-first HF hospitalization or cardiovascular mortality. Prespecified secondary end points included all-cause mortality, total hospitalizations for HF, days alive and not hospitalized for cardiovascular reasons, the individual components on the primary end point, and adverse events.. The data and safety monitoring board recommended stopping the study for futility when 894 (median age, 63 years; 286 [32%] women) of the planned 1100 patients had been enrolled with follow-up for a median of 15 months. The primary end point occurred in 164 patients (37%) in the biomarker-guided group and 164 patients (37%) in the usual care group (adjusted hazard ratio [HR], 0.98; 95% CI, 0.79-1.22; P = .88). Cardiovascular mortality was 12% (n = 53) in the biomarker-guided group and 13% (n = 57) in the usual care group (HR, 0.94; 95% CI; 0.65-1.37; P = .75). None of the secondary end points nor the decreases in the NT-proBNP levels achieved differed significantly between groups.. In high-risk patients with HFrEF, a strategy of NT-proBNP-guided therapy was not more effective than a usual care strategy in improving outcomes.. clinicaltrials.gov Identifier: NCT01685840.

Topics: Aged; Biomarkers; Cardiovascular Diseases; Female; Heart Failure; Hospitalization; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Single-Blind Method; Stroke Volume; Treatment Failure; Ventricular Dysfunction

The aim of this study was to clarify the efficacy of perioperative glucose-insulin-potassium (GIK) infusion on preoperative and postoperative N-terminal (NT)-pro-brain natriuretic peptide (BNP) concentrations in patients with a low ejection fraction undergoing isolated on-pump coronary artery bypass graft (CABG) surgery.. A double-blind, randomized, controlled study.. Modarres Hospital, Tehran, Islamic Republic of Iran.. Sixty-six patients with a low ejection fraction who required coronary artery surgery were selected.. Patients were allocated to a GIK (n = 36) or a control (n = 30) group. The GIK group received GIK solution (500 mL of dextrose in water (DW) 10% + 40 U of regular insulin + 40 mEq of KCl, and 2 g of MgSO(4)) at a rate of 1 mL/kg/h for 10 hours preoperatively and until the removal of the aortic cross-clamp. The control group received half saline solution as placebo with an equivalent infusion rate during the same interval.. Serum NT-proBNP levels were measured before starting the GIK, at the time of anesthesia induction, and 24 hours after surgery. The primary outcome measures were preoperative and postoperative NT-proBNP level. The amount of elevation in postoperative NT-proBNP concentrations was less prominent in the GIK group than in the control group (2,601 ± 1,799 pg/mL v 4,732 ± 4,127 pg/mL; p = 0.02). The patients in the GIK group were extubated sooner (495 ± 92 minutes) than the control group (774 ± 224 minutes; p = 0.002). The overall extubation time was 606 ± 177 minutes. Delayed requirement for mechanical ventilation was significantly more in the controls compared with the GIK group (45.8% v 13.9%, p = 0.004).. GIK is of value in the reduction of post-cardiac surgery NT-proBNP elevation. Thus, its infusion should have a protective effect in patients with low ejection fraction undergoing CABG surgery. Further studies may prove GIK infusion benefits in high-risk CABG surgery patients optimize outcome.

Topics: Coronary Artery Bypass; Double-Blind Method; Female; Glucose; Humans; Insulin; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Perioperative Care; Postoperative Period; Potassium; Ventricular Dysfunction

Clinical trial data show that right ventricular pacing worsens cardiovascular outcomes. The underlying pathophysiology of this is undetermined. We studied the effects of right ventricular pacing on cardiac measures of vascular health (endothelial function), ventricular wall stress (B-type natriuretic peptide), and cardiac reserve (cardiac output response to exercise) in subjects with pacemakers.. Twenty-two subjects [mean age 68.4 ± 8.8 (SD) years] with dual-chamber pacemakers implanted for sino-atrial disease were studied in a randomized crossover study comparing minimal right ventricular pacing [RVP-min; pacing with long atrioventricular delay (AVD)] to maximal right ventricular pacing (RVP-max; pacing with short AVD). Endothelial function was measured with reactive hyperaemia peripheral arterial tonometry. Cardiac output at rest and during exercise was determined using an inert gas rebreathing method. Right ventricular pacing was significantly higher in RVP-max when compared with RVP-min (90 ± 16 vs. 15 ± 20%, P < 0.001). Reactive hyperaemia peripheral arterial tonometry index was significantly lower after RVP-max vs. RVP-min (1.73 ± 0.33 vs. 1.96 ± 0.37, P < 0.05). B-type natriuretic peptide was not significantly different between pacing modes (113 ± 80 vs. 104 ± 108 pg/mL, P = NS). Cardiac output at peak exercise was significantly lower during RVP-max (7.65 ± 3.15 vs. 7.05 ± 2.61 L/min, P < 0.05).. Right ventricular pacing is associated with worsened endothelial function and cardiac reserve.

Topics: Aged; Cardiac Output; Cardiac Resynchronization Therapy; Cross-Over Studies; Endothelium, Vascular; Exercise; Female; Heart Ventricles; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Pacemaker, Artificial; Prognosis; Rest; Sinoatrial Node; Ventricular Dysfunction

To compare the effects of an angiotensin receptor blocker(ARB)-based regimen versus a non-ARB based regimen on diastolic function and neurohormones in patients with hypertension and diastolic dysfunction.. 97 patients with a systolic blood pressure (SBP) > or =140 mmHg, a left ventricular ejection fraction >0.50, and echocardiographic evidence of diastolic dysfunction were randomly assignment to open-label treatment with eprosartan (with other anti-hypertensives; n = 47) or other anti-hypertensives alone (n = 50). Echocardiography, including tissue Doppler imaging (TDI), and neurohormones were done at baseline and after 6 months.. Mean age was 65 (+/-10) years and 64% was female. During 6 months of treatment, SBP decreased from 157 +/- 16 to 145 +/- 18 mmHg in the eprosartan group and from 158 +/- 17 to 141 +/- 18 mmHg in the control group (both p < 0.001; p = ns between groups). Diastolic function was unaffected in both groups and there was no correlation between changes in SBP and changes in mean TDI (r = -0.06; p = 0.58). Aldosterone levels decreased in the eprosartan group, but other neurohormones remained largely unchanged. Change in SBP was however related to the change in NT-proBNP (r = 0.26; p = 0.019).. Lowering blood pressure, either with eprosartan or other anti-hypertensives in hypertensive patients with diastolic dysfunction did not change diastolic function after 6 months of treatment, but was associated with a decrease of NT-proBNP.

Topics: Acrylates; Aged; Aldosterone; Angiotensin II Type 1 Receptor Blockers; Antihypertensive Agents; Blood Pressure; Diastole; Echocardiography; Female; Heart; Humans; Hypertension; Imidazoles; Male; Middle Aged; Natriuretic Peptide, Brain; Neurotransmitter Agents; Peptide Fragments; Peptidyl-Dipeptidase A; Stroke Volume; Thiophenes; Treatment Outcome; Ventricular Dysfunction; Ventricular Function; Ventricular Function, Left

In patients with heart failure, few data describe the neurohormonal response to nesiritide and furosemide either alone or in combination. This study systematically compared the effects of nesiritide, furosemide, and their combination on natriuresis/diuresis and plasma aldosterone in patients with chronic stable heart failure who were relatively diuretic resistant.. Natriuretic, diuretic, and neurohormonal responses to furosemide and nesiritide will differ when these agents are administered alone vs. in combination.. Twenty-eight subjects completed a multicenter, open-label, three-arm crossover study. Each subject received the following treatments in random order on alternate days: (1) furosemide, 40 mg intravenous bolus; (2) nesiritide, 2 microg/kg intravenous bolus followed by a 0.01 microg/kg/min infusion for 6 hours; (3) both furosemide and nesiritide, with furosemide given at least 15 minutes after initiation of nesiritide.. Plasma aldosterone increased by 2.2 +/- 1.6 ng/dL after furosemide alone, decreased by 3.9 +/- 1.6 ng/dL after nesiritide alone (P = 0.005 vs furosemide alone and P = 0.56 vs furosemide plus nesiritide), and decreased by 2.8 +/- 1.6 ng/dL after furosemide plus nesiritide (P = 0.02 vs furosemide alone).. Furosemide alone produced natriuresis/diuresis and a prompt rise in plasma aldosterone values. Nesiritide alone produced no significant natriuresis/diuresis, but decreased plasma aldosterone values. When furosemide was administered on a background of nesiritide infusion, the observed natriuresis/diuresis was similar to that seen with furosemide alone, without the anticipated increase in plasma aldosterone observed with furosemide alone.

Topics: Adult; Aged; Aldosterone; Biomarkers; Cross-Over Studies; Drug Resistance; Drug Therapy, Combination; Female; Furosemide; Heart Failure; Humans; Infusions, Intravenous; Injections, Intravenous; Male; Middle Aged; Natriuresis; Natriuretic Agents; Natriuretic Peptide, Brain; Sodium Potassium Chloride Symporter Inhibitors; Systole; Time Factors; Treatment Outcome; United States; Ventricular Dysfunction; Ventricular Function

Atrial synchronous right ventricular pacing (VP) may compromise ventricular function in patients undergoing pacemaker implantation for atrioventricular block. We assessed the usefulness of tissue Doppler imaging (TDI) and color M-mode echocardiography in evaluating patients with VP, and examined the long-term effects of VP on ventricular function by echocardiographic indices and B-type natriuretic peptide (BNP) measurements.. We studied 60 clinically stable elderly dual-chamber pacemaker recipients (mean age: 74 +/- 9 years) who had normal left ventricular (LV) systolic function and on the long term the same cardiac rhythm, either intrinsic normal ventricular activation (IA) (n = 20), or VP (n = 40).. Paced patients, compared to patients with IA, had decreased stroke volume (p < 0.05) and a more depressed relaxation pattern, as indicated by decreased peak early mitral velocity (E)/peak atrial contraction velocity ratio and tissue Doppler imaging (TDI)-early transmitral diastolic velocity (Ea) measures (p < 0.05). Both groups presented similar BNP levels and LV filling pressures, as assessed by E/Ea and E/early diastolic transmitral flow propagation velocity. In VP patients, age (beta = 0.31), Ea (beta = -0.28) and E/Ea (beta = 0.32) emerged as independent predictors of BNP levels.. VP is associated with reduced LV systolic function and signs of impaired relaxation. Elevated BNP levels in elderly VP patients with normal ejection fraction may be predicted by TDI signs of LV diastolic dysfunction.

Topics: Aged; Atrioventricular Block; Cardiac Pacing, Artificial; Diastole; Echocardiography, Doppler; Female; Heart Atria; Humans; Male; Natriuretic Peptide, Brain; Stroke Volume; Systole; Ventricular Dysfunction; Ventricular Function

Myocardial performance index (MPI) is an echocardiographic Doppler-derived measure of ventricular function previously validated in patients with congenital heart disease. It may be preferred over conventional noninvasive measures of ventricular function in patients with complex anatomy because it is dependent on neither geometric shape nor heart rate. Brain natriuretic peptide (BNP) is a predictor of systolic and diastolic dysfunction in anatomically correct hearts. The correlation of BNP to MPI in patients with congenital heart disease was determined. Fifty-four adults with congenital heart disease were evaluated. BNP was measured using standardized assays. Doppler echocardiography was performed within 6 months of BNP assay. There were no changes in clinical status during this interval. An experienced observer was blinded and evaluated all echocardiographic images, and MPI and ejection fraction (EF) were determined. Left ventricular (LV) or univentricular MPI was calculated in 34 patients and right ventricular (RV) MPI was calculated in 23 patients. Pearson's correlation coefficient test showed that BNP significantly correlated with LV/univentricular MPI (r = 0.461, p = 0.006) and RV MPI (r = 0.748, p <0.0001), whereas LV/univentricular EF and RVEF had no significant correlation with BNP (r = -0.189, p = 0.172; r = 0.066, p = 0.729, respectively). In patients with congenital heart disease, BNP correlated significantly with MPI, but not with LV, RV, or univentricular EF. This is particularly true in patients with geometrically variable right ventricles in which EF may be more difficult to assess. In conclusion, these findings emphasize the unique ability of both BNP and MPI to assess global ventricular function in geometrically complex hearts.

Topics: Adult; Biomarkers; Diastole; Echocardiography, Doppler, Color; Female; Heart Defects, Congenital; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Stroke Volume; Systole; Ventricular Dysfunction

Although beta-blockers improve symptoms and survival in adults with heart failure, little is known about these medications in children and adolescents.. To prospectively evaluate the effects of carvedilol in children and adolescents with symptomatic systemic ventricular systolic dysfunction.. A multicenter, randomized, double-blind, placebo-controlled study of 161 children and adolescents with symptomatic systolic heart failure from 26 US centers. In addition to treatment with conventional heart failure medications, patients were assigned to receive placebo or carvedilol. Enrollment began in June 2000 and the last dose was given in May 2005 (each patient received medication for 8 months).. Patients were randomized in a 1:1:1 ratio to twice-daily dosing with placebo, low-dose carvedilol (0.2 mg/kg per dose if weight <62.5 kg or 12.5 mg per dose if weight > or =62.5 kg), or high-dose carvedilol (0.4 mg/kg per dose if weight <62.5 kg or 25 mg per dose if weight > or =62.5 kg) and were stratified according to whether each patient's systemic ventricle was a left ventricle or not.. The primary outcome was a composite measure of heart failure outcomes in patients receiving carvedilol (low- and high-dose combined) vs placebo. Secondary efficacy variables included individual components of this composite, echocardiographic measures, and plasma b-type natriuretic peptide levels.. There was no statistically significant difference between groups for the composite end point based on the percentage of patients who improved, worsened, or were unchanged. Among 54 patients assigned to placebo, 30 improved (56%), 16 worsened (30%), and 8 were unchanged (15%); among 103 patients assigned to carvedilol, 58 improved (56%), 25 worsened (24%), and 20 were unchanged (19%). The rates of worsening were lower than expected. The odds ratio for worsened outcome for patients in the combined carvedilol group vs the placebo group was 0.79 (95% CI, 0.36-1.59; P = .47). A prespecified subgroup analysis noted significant interaction between treatment and ventricular morphology (P = .02), indicating a possible differential effect of treatment between patients with a systemic left ventricle (beneficial trend) and those whose systemic ventricle was not a left ventricle (nonbeneficial trend).. These preliminary results suggest that carvedilol does not significantly improve clinical heart failure outcomes in children and adolescents with symptomatic systolic heart failure. However, given the lower than expected event rates, the trial may have been underpowered. There may be a differential effect of carvedilol in children and adolescents based on ventricular morphology.. clinicaltrials.gov Identifier: NCT00052026.

Topics: Adolescent; Adrenergic beta-Antagonists; Carbazoles; Cardiac Output, Low; Carvedilol; Child; Child, Preschool; Double-Blind Method; Female; Humans; Infant; Male; Natriuretic Peptide, Brain; Propanolamines; Proportional Hazards Models; Prospective Studies; Systole; Ventricular Dysfunction; Ventricular Remodeling

Whether B-type natriuretic peptide (BNP) levels can be used to screen for ventricular dysfunction in patients at risk of heart failure but without overt symptoms is not known. We examined the characteristics of a BNP test for identifying systolic and diastolic dysfunction in outpatients with stable coronary disease.. In a cross-sectional study of 293 outpatients who had stable coronary disease and no history of heart failure, we compared elevations in plasma BNP levels with echocardiography for the diagnosis of systolic dysfunction (ejection fraction <55%) and diastolic dysfunction (diastolic dominant pulmonary vein flow with ejection fraction > or =55%).. A total of 48 patients (16%) had systolic dysfunction, and among the remaining 245 with preserved systolic function, 31 (13%) had diastolic dysfunction. At the standard cutpoint of >100 pg/mL, an elevated BNP level was 38% sensitive (80% specific) for systolic dysfunction and 55% sensitive (85% specific) for diastolic dysfunction. Negative likelihood ratios were 0.8 (95% confidence interval [CI]: 0.6 to 1.0) for systolic dysfunction and 0.5 (95% CI: 0.4 to 0.8) for diastolic dysfunction. Positive likelihood ratios were 1.9 (95% CI: 1.2 to 2.9) for systolic dysfunction and 3.8 (95% CI: 2.4 to 5.9) for diastolic dysfunction. Areas under the receiver operating characteristic curves were 0.59 (95% CI: 0.49 to 0.69) for systolic dysfunction and 0.79 (95% CI: 0.71 to 0.87) for diastolic dysfunction.. These data suggest that BNP is not a useful screening test for asymptomatic ventricular dysfunction in patients with stable coronary disease.

Topics: Aged; Confidence Intervals; Coronary Disease; Cross-Sectional Studies; Humans; Male; Natriuretic Peptide, Brain; Predictive Value of Tests; Ventricular Dysfunction

Carvedilol is a medication with both beta-receptor and alpha-receptor blocking properties that has been approved for the treatment of heart failure in adults. Little is known about its safety, efficacy, pharmacokinetics, and dosing profile in children.. The primary objective of this study is to evaluate the efficacy of carvedilol administered twice daily for 8 months in terms of its effect compared with placebo on a composite measure of clinical outcomes in children with symptomatic systemic ventricular systolic dysfunction and heart failure. The secondary objectives are to determine the effect of carvedilol on individual components of a composite of clinical outcomes (hospitalizations for worsening heart failure, all-cause mortality and cardiovascular hospitalizations, all cause mortality, heart failure symptoms, and patient and physician global assessment); determine the effect of carvedilol on echocardiographic indices of ventricular function and remodeling; characterize the pharmacokinetics of carvedilol in pediatric patients with heart failure; characterize the effects carvedilol on neurohormonal systems; and provide data for the selection of an optimal titration schedule and daily dose of carvedilol in children with heart failure. This study will enroll 150 children between birth and 17 years of age with chronic symptomatic heart failure caused by systemic ventricular systolic dysfunction.. This study will determine whether carvedilol improves symptoms in children with heart failure as a result of systemic ventricular systolic dysfunction. The study also will provide information on echocardiographic changes of ventricular performance and neurohormonal levels in children with heart failure before and after treatment with carvedilol, in addition to pharmacokinetics of carvedilol in children.

Topics: Adolescent; Adrenergic alpha-Antagonists; Adrenergic beta-Antagonists; Age Factors; Carbazoles; Carvedilol; Child; Child, Preschool; Drug Administration Schedule; Female; Heart Failure; Humans; Infant; Infant, Newborn; Male; Natriuretic Peptide, Brain; Placebos; Propanolamines; Prospective Studies; Treatment Outcome; Ventricular Dysfunction; Ventricular Function; Ventricular Remodeling

Recent reports have indicated that aldosterone is produced in extra-adrenal tissues in animals. The present study was designed to examine whether aldosterone is produced in human heart.. Plasma levels of aldosterone, BNP, and angiotensin-converting enzyme were measured in anterior interventricular vein (AIV), coronary sinus (CS), and aortic root (Ao), respectively, in 20 patients with left ventricular systolic dysfunction (LVSD), 25 patients with LV diastolic dysfunction (LVDD), and 23 control subjects. Aldosterone levels were significantly higher in AIV and CS than Ao in LVSD (98+/-10 versus 72+/-9 pg/mL, P:<0.001, and 97+/-11 versus 72+/-9 pg/mL, P:<0.001, respectively) and LVDD (87+/-10 versus 71+/-9 pg/mL, P:<0.01, and 84+/-10 versus 71+/-9 pg/mL, P:<0.01, respectively) groups, but no differences were observed in levels for these sites in the control group. Levels of ACE activity and BNP also were higher in AIV than Ao in both LV dysfunction groups. The difference in aldosterone levels between AIV and Ao and those in BNP and angiotensin-converting enzyme had a significant positive correlation with LVEDP and a significant negative correlation with LV ejection fraction in the LVSD group.. Production of aldosterone, angiotensin-converting enzyme, and BNP are activated in failing human ventricle in proportion to severity.

Topics: Adult; Aged; Aged, 80 and over; Aldosterone; Cardiac Catheterization; Female; Heart Function Tests; Hemodynamics; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptidyl-Dipeptidase A; Stroke Volume; Ventricular Dysfunction

Plasma levels of B-type natriuretic peptide (BNP) are markedly increased in patients with heart failure and acute myocardial infarction. The changes in plasma BNP levels in the treatment of acute myocardial infarction with angiotensin-converting enzyme inhibitors have not been examined well. This study was designed to examine the effects of early angiotensin-converting enzyme inhibitor therapy on plasma BNP levels in patients with acute myocardial infarction.. We measured the plasma levels of B-type natriuretic peptide over the time course for 2 weeks in 30 patients with acute myocardial infarction in whom either imidapril (n = 15) or placebo (n = 15) was given at random immediately after admission. Plasma BNP levels increased and reached a peak of 192 +/- 28 pg/ML 16 hours after administration; thereafter, the levels decreased and then again increased, forming the second peak of 217 +/- 38 pg/ML on the fifth day (biphasic pattern). On the other hand, plasma BNP levels increased and reached a peak level of 190 +/- 22 pg/ML 16 hours after admission and then decreased from 2 days after admission until the second week in the imidapril group (monophasic pattern). Left ventricular ejection fraction measured in the second week was significantly higher in the imidapril group than in the control group (62.2 +/- 1.1% vs 51.2 +/- 3.6%, P < .01).. It is concluded that plasma BNP levels followed a monophasic pattern after imidapril treatment, whereas a biphasic pattern was followed after placebo, and that plasma BNP levels constitute a marker of ventricular dysfunction in the treatment of acute myocardial infarction with angiotensin-converting enzyme inhibitors.

Topics: Adult; Aged; Aged, 80 and over; Angiotensin-Converting Enzyme Inhibitors; Biomarkers; Female; Hemodynamics; Humans; Imidazoles; Imidazolidines; Male; Middle Aged; Myocardial Infarction; Natriuretic Peptide, Brain; Nerve Tissue Proteins; Peptidyl-Dipeptidase A; Treatment Outcome; Ventricular Dysfunction

Atrial and brain natriuretic peptides (ANP and BNP) are produced by the heart, and their plasma concentrations are increased in human chronic congestive heart failure. Although separate studies have suggested that circulating levels of the biologically active C-terminal ANP, the biologically inactive N-terminal ANP, and BNP may have diagnostic utility in the detection of left ventricular systolic dysfunction or left ventricular hypertrophy, no studies have directly assessed the relative value of these peptides prospectively. We therefore designed this study to compare the relative ability of the different natriuretic peptides to detect abnormal left ventricular systolic and diastolic function and left ventricular hypertrophy. Using a prospective study design, we investigated 94 patients referred for cardiac catheterization and 15 age-matched normal subjects. The diagnostic abilities of elevated plasma C-terminal ANP, N-terminal ANP-(1-30), and BNP concentrations to identify systolic dysfunction (ejection fraction < 45%), diastolic dysfunction (time constant of left ventricular relaxation > 55 milliseconds, left ventricular end-diastolic pressure > 18 mm Hg), and left ventricular hypertrophy (left ventricular mass index > 120 g/m2) were objectively compared by receiver operating characteristic analysis. The areas under the receiver operating characteristic curve of BNP for detecting each of these abnormalities ranged from 0.715 to 0.908 and were significantly greater than those of C-terminal ANP or N-terminal ANP-(1-30). The sensitivity and specificity of an elevated plasma BNP, which we defined as greater than the mean + 3 SD of the 15 age-matched normal subjects, were 0.83 and 0.77, respectively, for detecting ejection fraction less than 45%, 0.85 and 0.70 for detecting the time constant of left ventricular relaxation greater than 55 milliseconds, 0.63 and 0.76 for detecting left ventricular end-diastolic pressure greater than 18 mm Hg, and 0.81 and 0.85 for detecting left ventricular mass index greater than 120 g/m2. The use of BNP and one other peptide increased sensitivity (0.90 to 0.96), albeit with lower specificity (0.56 to 0.71). An elevated plasma BNP was a more powerful marker of left ventricular systolic dysfunction, left ventricular diastolic dysfunction, and left ventricular hypertrophy than C-terminal ANP or N-terminal ANP-(1-30) in this population of patients with suspected cardiac disease. Measurement of BNP alone or in combination with C-

Topics: Aged; Atrial Natriuretic Factor; Biomarkers; Echocardiography; Female; Hemodynamics; Humans; Hypertrophy, Left Ventricular; Male; Middle Aged; Natriuretic Peptide, Brain; Nerve Tissue Proteins; Prospective Studies; ROC Curve; Sensitivity and Specificity; Ventricular Dysfunction

Many Fontan patients with and without systolic ventricular dysfunction are being treated with angiotensin-converting enzyme (ACE) inhibitors, despite its effectiveness remaining unclear. In the present study, we evaluated the short-term effect of enalapril on exercise capacity, vascular and ventricular function in pediatric Fontan patients with moderate-good systolic ventricular function. Fontan patients between 8 and 18 years with moderate-good systolic ventricular function and without previous ACE inhibitor treatment were included and were treated with enalapril for 3 months. During the first 2 weeks, the dosage was titrated according to systolic blood pressure (SBP). Exercise tests, ventricular function assessed by echocardiography, arterial stiffness measurements, and plasma levels of N-terminal pro-B-type natriuretic peptide assessed before and after a 3-month enalapril treatment period was compared. A total of 28 Fontan patients (median age 13.9 years, 6 to 15 years after Fontan operation) completed the study with a mean dosage of 0.3 ± 0.1 mg/kg/d. A total of 6 patients (21%) experienced a significant drop in SBP and 6 others (21%) experienced other adverse events. Enalapril treatment lowered the SBP (from 110 to 104 mmHg, p = 0.003) and levels of N-terminal pro-B-type natriuretic peptide (from 80 to 72 ng/L, p = 0.036). However, enalapril treatment did not improve exercise capacity, ventricular function, or arterial stiffness. In conclusion, short-term ACE inhibition has no beneficial effect in Fontan patients with moderate-good systolic ventricular function.

Topics: Adolescent; Angiotensin-Converting Enzyme Inhibitors; Blood Pressure; Child; Echocardiography; Enalapril; Exercise Test; Exercise Tolerance; Female; Fontan Procedure; Humans; Hypotension; Male; Natriuretic Peptide, Brain; Peptide Fragments; Systole; Treatment Outcome; Vascular Stiffness; Ventricular Dysfunction

Intrahepatic cholestasis of pregnancy (ICP) is associated with an increased risk of stillbirth. This study aimed to assess the relationship between bile acid concentrations and fetal cardiac dysfunction in patients with ICP who were or were not treated with ursodeoxycholic acid (UDCA).. Bile acid profiles and NT-proBNP, a marker of ventricular dysfunction, were assayed in umbilical venous serum from 15 controls and 76 ICP cases (36 untreated, 40 UDCA-treated). Fetal electrocardiogram traces were obtained from 43 controls and 48 ICP cases (26 untreated, 22 UDCA-treated). PR interval length and heart rate variability (HRV) parameters were measured in 2 behavioral states (quiet and active sleep).. In untreated ICP, fetal total serum bile acid (TSBA) concentrations (r = 0.49, p = 0.019), hydrophobicity index (r = 0.20, p = 0.039), glycocholate concentrations (r = 0.56, p = 0.007) and taurocholate concentrations (r = 0.44, p = 0.039) positively correlated with fetal NT-proBNP. Maternal TSBA (r = 0.40, p = 0.026) and alanine aminotransferase (r = 0.40, p = 0.046) also positively correlated with fetal NT-proBNP. There were no significant correlations between maternal or fetal serum bile acid concentrations and fetal HRV parameters or NT-proBNP concentrations in the UDCA-treated cohort. Fetal PR interval length positively correlated with maternal TSBA in untreated (r = 0.46, p = 0.027) and UDCA-treated ICP (r = 0.54, p = 0.026). Measures of HRV in active sleep and quiet sleep were significantly higher in untreated ICP cases than controls. HRV values in UDCA-treated cases did not differ from controls.. Elevated fetal and maternal serum bile acid concentrations in untreated ICP are associated with an abnormal fetal cardiac phenotype characterized by increased NT-proBNP concentration, PR interval length and HRV. UDCA treatment partially attenuates this phenotype.. The risk of stillbirth in intrahepatic cholestasis of pregnancy (ICP) is linked to the level of bile acids in the mother which are thought to disrupt the baby's heart rhythm. We found that babies of women with untreated ICP have abnormally functioning hearts compared to those without ICP, and the degree of abnormality is closely linked to the level of harmful bile acids in the mother and baby's blood. Babies of women with ICP who received treatment with the drug UDCA do not have the same level of abnormality in their hearts, suggesting that UDCA could be a beneficial treatment in some ICP cases, although further clinical trials are needed to confirm this.

Topics: Adult; Alanine Transaminase; Bile Acids and Salts; Biomarkers; Cholagogues and Choleretics; Cholestasis, Intrahepatic; Correlation of Data; Electrocardiography; Female; Fetal Blood; Fetal Heart; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Pregnancy; Pregnancy Complications; Risk Assessment; Stillbirth; Treatment Outcome; Ursodeoxycholic Acid; Ventricular Dysfunction

Preeclampsia and fetal growth restriction share some pathophysiologic features and are both associated with placental insufficiency. Fetal cardiac remodeling has been described extensively in fetal growth restriction, whereas little is known about preeclampsia with a normally grown fetus.. To describe fetal cardiac structure and function in pregnancies complicated by preeclampsia and/or fetal growth restriction as compared with uncomplicated pregnancies.. This was a prospective, observational study including pregnancies complicated by normotensive fetal growth restriction (n=36), preeclampsia with a normally grown fetus (n=35), preeclampsia with fetal growth restriction (preeclampsia with a normally grown fetus-fetal growth restriction, n=42), and 111 uncomplicated pregnancies matched by gestational age at ultrasound. Fetal echocardiography was performed at diagnosis for cases and recruitment for uncomplicated pregnancies. Cord blood concentrations of B-type natriuretic peptide and troponin I were measured at delivery. Univariate and multiple regression analysis were conducted.. Pregnancies complicated by preeclampsia and/or fetal growth restriction showed similar patterns of fetal cardiac remodeling with larger hearts (cardiothoracic ratio, median [interquartile range]: uncomplicated pregnancies 0.27 [0.23-0.29], fetal growth restriction 0.31 [0.26-0.34], preeclampsia with a normally grown fetus 0.31 [0.29-0.33), and preeclampsia with fetal growth restriction 0.28 [0.26-0.33]; P<.001) and more spherical right ventricles (right ventricular sphericity index: uncomplicated pregnancies 1.42 [1.25-1.72], fetal growth restriction 1.29 [1.22-1.72], preeclampsia with a normally grown fetus 1.30 [1.33-1.51], and preeclampsia with fetal growth restriction 1.35 [1.27-1.46]; P=.04) and hypertrophic ventricles (relative wall thickness: uncomplicated pregnancies 0.55 [0.48-0.61], fetal growth restriction 0.67 [0.58-0.8], preeclampsia with a normally grown fetus 0.68 [0.61-0.76], and preeclampsia with fetal growth restriction 0.66 [0.58-0.77]; P<.001). Signs of myocardial dysfunction also were observed, with increased myocardial performance index (uncomplicated pregnancies 0.78 z scores [0.32-1.41], fetal growth restriction 1.48 [0.97-2.08], preeclampsia with a normally grown fetus 1.15 [0.75-2.17], and preeclampsia with fetal growth restriction 0.45 [0.54-1.94]; P<.001) and greater cord blood B-type natriuretic peptide (uncomplicated pregnancies 14.2 [8.4-30.9] pg/mL, fetal growth restriction 20.8 [13.1-33.5] pg/mL, preeclampsia with a normally grown fetus 31.8 [16.4-45.8] pg/mL and preeclampsia with fetal growth restriction 37.9 [15.7-105.4] pg/mL; P<.001) and troponin I as compared with uncomplicated pregnancies.. Fetuses of preeclamptic mothers, independently of their growth patterns, presented cardiovascular remodeling and dysfunction in a similar fashion to what has been previously described for fetal growth restriction. Future research is warranted to better elucidate the mechanism(s) underlying fetal cardiac adaptation in these conditions.

Topics: Adult; Cardiomegaly; Echocardiography; Female; Fetal Blood; Fetal Growth Retardation; Fetal Heart; Gestational Age; Humans; Natriuretic Peptide, Brain; Pre-Eclampsia; Pregnancy; Pregnancy Trimester, Third; Prospective Studies; Spain; Troponin I; Ventricular Dysfunction; Ventricular Remodeling

Topics: Aged; Aged, 80 and over; Aortic Valve Stenosis; Biomarkers; Echocardiography; Feasibility Studies; Female; Follow-Up Studies; Humans; Kaplan-Meier Estimate; Male; Natriuretic Peptide, Brain; Preoperative Period; Prognosis; Prospective Studies; Reference Values; Risk Assessment; Severity of Illness Index; Transcatheter Aortic Valve Replacement; Treatment Outcome; Troponin I; Ventricular Dysfunction; Ventricular Function, Left

The objective is to examine the correlation between plasma levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) and tissue Doppler imaging (TDI) echocardiographic parameters in the first 28 days of life in very-low-birth-weight infants (VLBWI). VLBWI admitted to the Neonatal Intensive Care Unit (NICU) at Hospital Puerta del Mar, Spain, from January 2015 to January 2017 were prospectively enrolled. Weekly determination of plasma NT-proBNP (pg/mL), and echocardiograms were done during the first 28 days of life. 101 preterm infants with a mean GA of 28.85 weeks (± 1.85 SD) and mean birth weight of 1152 g (± 247.4 SD) were included. A total of 483 echocardiograms and 139 NT-proBNP determinations were performed. We found a negative correlation between plasma NT-proBNP levels and diastolic velocities: mitral A' (ρ = - 0.15, p = 0.04), mitral E' (ρ = - 0.17, p = 0.02), tricuspid A' (ρ = - 0.20, p = 0.006), tricuspid E' (ρ = - 0.24, p = 0.0009). In the first 24 h of life, NT-proBNP levels were strongly correlated with mitral A' and E' velocities in patients with no patent ductus arteriosus (PDA) (ρ = - 0.75, p = 0.04). In preterm patients, elevated NT-proBNP levels are related to worse diastolic myocardial function. In the first 24 h, this correlation is much stronger in the absence of PDA.

Topics: Biomarkers; Echocardiography, Doppler; Female; Humans; Infant; Infant, Premature; Infant, Premature, Diseases; Infant, Very Low Birth Weight; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prospective Studies; Spain; Ventricular Dysfunction

The purpose of this study was to investigate the associations between clinical factors and cardiac function as measured by pressure-volume loops (PVLs) in a pediatric heart transplant cohort.. Patients (age < 20 years) who underwent heart transplantation presenting for a clinically indicated catheterization were enrolled. PVLs were recorded using microconductance catheters (CD Leycom. A total of 18 patients were enrolled. Median age was 8.7 years (IQR 5-14 years). There were ten males and eight females. Six patients had a history of rejection and ten had positive donor-specific antibodies. There was no transplant coronary artery disease. Median BNP was 100 pg/mL (IQR 46-140). Time from transplant to PVL obtained during catheterization procedure was 4.1 years (IQR 1.7-7.8 year). No single clinical characteristic was statistically significant when correlated with PVL data. However, longer ischemic time was associated with worse Beta (r = 0.49, p = 0.05).. Our study found that longer ischemic times are associated with increased left ventricular stiffness. No other single clinical variable is associated with cardiac dysfunction as determined by PVL analysis.

Topics: Adolescent; Biomarkers; Cardiac Catheterization; Child; Child, Preschool; Female; Heart Transplantation; Heart Ventricles; Humans; Male; Myocardial Ischemia; Natriuretic Peptide, Brain; Primary Graft Dysfunction; Risk Factors; Time Factors; Ventricular Dysfunction; Ventricular Function

Perturbed hemodynamic function complicates severe malaria. The Fluid Expansion as Supportive Therapy trial demonstrated that fluid resuscitation, involving children with severe malaria, was associated with increased mortality, primarily due to cardiovascular collapse, suggesting that myocardial dysfunction may have a role. The aim of this study was to characterize cardiac function in children with severe malaria.. A prospective observational study with clinical, laboratory, and echocardiographic data collected at presentation (T0) and 24 hours (T1) in children with severe malaria. Cardiac index and ejection fraction were calculated at T0 and T1. Cardiac troponin I and brain natriuretic peptide were measured at T0. We compared clinical and echocardiographic variables in children with and without severe malarial anemia (hemoglobin < 5 mg/dL) at T0 and T1.. Mbale Regional Referral Hospital.. Children 3 months to 12 years old with severe falciparum malaria.. Usual care.. We enrolled 104 children, median age 23.3 months, including 61 children with severe malarial anemia. Cardiac troponin I levels were elevated (> 0.1 ng/mL) in n equals to 50, (48%), and median brain natriuretic peptide was within normal range (69.1 pg/mL; interquartile range, 48.4-90.8). At T0, median Cardiac index was significantly higher in the severe malarial anemia versus nonsevere malarial anemia group (6.89 vs 5.28 L/min/m) (p = 0.001), which normalized in both groups at T1 (5.60 vs 5.13 L/min/m) (p = 0.452). Cardiac index negatively correlated with hemoglobin, r equals to -0.380 (p < 0.001). Four patients (3.8%) had evidence of depressed cardiac systolic function (ejection fraction < 45%). Overall, six children died, none developed pulmonary edema, biventricular failure, or required diuretic treatment.. Elevation of cardiac index, due to increased stroke volume, in severe malaria is a physiologic response to circulatory compromise and correlates with anemia. Following whole blood transfusion and antimalarial therapy, cardiac index in severe malarial anemia returns to normal. The majority (> 96%) of children with severe malaria have preserved myocardial systolic function. Although there is evidence for myocardial injury (elevated cardiac troponin I), this does not correlate with cardiac dysfunction.

Topics: Anemia; Biomarkers; Blood Transfusion; Child; Child, Preschool; Echocardiography; Female; Fluid Therapy; Humans; Infant; Malaria, Falciparum; Male; Natriuretic Peptide, Brain; Prospective Studies; Troponin I; Uganda; Ventricular Dysfunction; Ventricular Function

N-Terminal pro B-type natriuretic peptide (NT-proBNP) is widely used as a marker of ventricular dysfunction. However, data regarding the association of NT-proBNP with blood pressure (BP) and pulse pressure (PP) in the elderly population are limited.Methods and Results:The present cross-sectional study involved 6,529 participants, aged ≥70 years, without cardiovascular disease (CVD), who underwent general health examinations. Serum NT-proBNP concentrations were determined, with high NT-proBNP concentrations defined as those ≥125 pg/mL. Subjects were divided into five groups based on PP (<50, ≥50 to <60, ≥60 to <70, ≥70 to <80, and ≥80 mmHg). NT-proBNP was positively associated with systolic BP, whereas a U-shaped association was found between diastolic BP and NT-proBNP. The odds ratios for high NT-proBNP concentrations in the PP ≥80 and ≥70 to <80 mmHg groups (OR 1.83 [P<0.001] and 1.40 [P<0.005], respectively) were significantly higher than in the PP <50 mmHg group. All data were adjusted for age, sex, body mass index, hemoglobin concentration, serum creatinine, pulse rate, smoking, alcohol intake, and antihypertensive medication intake, and the presence of diabetes and dyslipidemia.. The results suggest that NT-proBNP concentrations may be a marker of not only ventricular dysfunction, but also arterial stiffness in the elderly population without CVD.

Topics: Aged; Biomarkers; Blood Pressure; Cross-Sectional Studies; Diastole; Female; Humans; Male; Natriuretic Peptide, Brain; Odds Ratio; Peptide Fragments; Systole; Vascular Stiffness; Ventricular Dysfunction

The pathophysiology of cardio-renal syndrome (CRS) is complex. Hydronephrosis caused by urolithiasis may cause cytokine release and lead to cardiac dysfunction. The aim of this study was to evaluate cardiac function changes observed in patients who received double J placement using feasible biomarkers and echocardiography. This was a prospective, single-center study. Eighty-seven patients who presented with acute unilateral hydronephrosis and received ureteroscope stone manipulation were enrolled. Echocardiography and cytokines were measured on the day of the operation and 24 hours after the procedure. Changes before and after surgery were assessed by the paired t-test and Wilcoxon test. Correlation analyses between echocardiographic diastolic indices and cytokine levels were performed using Pearson's correlation coefficients. Patients with hydronephrosis showed a higher left atrium volume index (LAVI), decreased E', and increased E/ E' ratio, which indicated diastolic dysfunction. Patients with hydronephrosis also exhibited decreased global strain rates during isovolumetric relaxation (SRIVR) and E/ SRIVR, which confirmed the diastolic dysfunction. Significant reductions in LAVI, increases in SRIVR and decreases in E/ SRIVR were observed after the operation. Biomarkers, such as TGF-β and serum NT-proBNP, were significantly decreased after surgery. In addition, a significant correlation was observed between the post-surgical decrease in TGF-β1 and increase in SRIVR. Unilateral hydronephrosis causes cardiac diastolic dysfunction, and relieving hydronephrosis could improve diastolic function. Improvements in cardiac dysfunction can be evaluated by echocardiography and measuring cytokine levels. The results of this study will inform efforts to improve the early diagnosis of CRS and prevent further deterioration of cardiac function when treating patients with hydronephrosis.

Topics: Adult; Aged; Biomarkers; Cardio-Renal Syndrome; Diastole; Echocardiography; Female; Humans; Hydronephrosis; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Stents; Transforming Growth Factor beta1; Ventricular Dysfunction; Ventricular Dysfunction, Left

The purpose of this study was to investigate the relationship between the accessory pathway location and brain natriuretic peptide (BNP) level in patients with Wolff-Parkinson-White (WPW) syndrome.. We divided 102 WPW syndrome patients with normal left ventricular systolic function into four groups: those with manifest right (MR, n = 14), manifest septal (MS, n = 11), manifest left (ML, n = 30), and concealed (C, n = 47) accessory pathways. BNP level and electrophysiological properties, including difference in timing of the ventricular electrogram between the His bundle area and the distal coronary sinus area (His-CS delay), which indicate intraventricular dyssynchrony, were compared.. BNP levels (pg/dl) were higher in the MR and MS groups than in the ML and C groups (MR, 64 ± 58; MS, 55 ± 45; ML, 17 ± 15; C, 25 ± 21; P < 0.001). AV intervals (ms) were shorter in the MR and MS groups than in the ML and C groups (MR, 76 ± 16; MS, 83 ± 6; ML, 101 ± 19; C, 136 ± 20; P < 0.001). His-CS delay (ms) was longer in the MR group than in the other groups (MR, 50 ± 15; MS, 21 ± 7; ML, 23 ± 10; C, 19 ± 8; P < 0.001). The AV interval (P < 0.01) and the His-CS delay (P < 0.001) were negatively and positively correlated, respectively, with the BNP level.. Anterograde conduction with a right or septal accessory pathway increased the BNP level in WPW syndrome patients with normal cardiac function.

Topics: Accessory Atrioventricular Bundle; Biomarkers; Electrocardiography; Female; Humans; Male; Natriuretic Peptide, Brain; Reproducibility of Results; Sensitivity and Specificity; Ventricular Dysfunction; Wolff-Parkinson-White Syndrome

Although nesiritide has been used in adults with left heart failure, the experience in the paediatric population is limited. We reviewed and analysed our experience with continuous nesiritide infusion as adjunct therapy in children with biventricular dysfunction due to diverse aetiologies and suffering from oliguria despite intravenous diuretics and inotropic therapies for heart-failure management.

Topics: Adolescent; Child; Critical Illness; Heart Failure; Humans; Infant; Male; Natriuretic Agents; Natriuretic Peptide, Brain; Oliguria; Ventricular Dysfunction

The aim of the study was to investigate serum NT-proBNP levels in adult patients with transposition of the great arteries (d-TGA) corrected by atrial switch procedures (Mustard or Senning) operation and to assess the relationship with ventricular impairment and NYHA class.. Serum NT-proBNP levels were measured in a group of 81 consecutive adult patients (59 males, mean age 27 years and 22 females, mean age 28 years) with transposition of the great arteries (TGA) after surgical correction in childhood, and in a control group of 25 healthy individuals (16 males, mean age 32 years, and 9 females, mean age 29 years). Age-matched correlation of NT-proBNP concentrations in TGA patients after Mustard or Senning correction was performed, but this correlation was considered not significant (p=0.08).. Concentrations of NT-proBNP in patients with TGA were significantly elevated compared to the control group of healthy individuals (203 ng/L vs. 41 ng/L, p<0.0001). Patients after the Mustard repair had significantly higher NT-proBNP values than patients after the Senning operation (234 ng/L vs. 148 ng/L, p=0.0023). NT-proBNP correlated negatively with the systemic right ventricular ejection fraction with the greatest significance in patients after Mustard correction (r=-0.32, p<0.0001). The concentration of NT-proBNP was also associated with NYHA functional class (p=0.0035) with the greatest significance in patients with Mustard correction (p=0.028).. Elevated levels of NT-proBNP appear to be a useful tool in assessing heart failure in patients with transposition of the great arteries after atrial switch correction.

Topics: Adult; Arterial Switch Operation; Female; Humans; Male; Natriuretic Peptide, Brain; Peptide Fragments; Transposition of Great Vessels; Ventricular Dysfunction

In children, elevated amino-terminal pro-B-type natriuretic peptide levels are associated with impaired heart function. The predictive value of serial monitoring of amino-terminal pro-B-type natriuretic peptide levels in acute decompensated heart failure is unclear.. Prospective observational study.. Single, tertiary referral pediatric critical care unit.. Patients aged 0-21 years with primary myocardial dysfunction and acute decompensated heart failure.. Amino-terminal pro-B-type natriuretic peptide levels were obtained on enrollment, day 2, and day 7. Clinical, laboratory, and imaging data were collected on enrollment. Adverse cardiovascular outcome was defined as heart transplant, ventricular assist device placement, extracorporeal membrane oxygenation, or death at 1 year after admission. Aminoterminal pro-B-type natriuretic peptide levels and the percent change from day 0 to day 2 and day 0 to day 7 were calculated and compared between those with and without adverse cardiovascular outcome.. Sixteen consecutive patients were enrolled. Adverse cardiovascular outcome occurred in six patients (37.5%, four heart transplant and two ventricular assist device). In patients with an adverse cardiovascular outcome, median amino-terminal pro-B-type natriuretic peptide levels at day 7 were significantly higher (7,365 vs 1,196 pg/mL; p = 0.02) and the percent decline in amino-terminal pro-B-type natriuretic peptide was significantly smaller (28% vs 73%; p = 0.02) compared with those without an adverse cardiovascular outcome. Receiver operating curve analysis revealed that a less than 55% decline in amino-terminal pro-B-type natriuretic peptide levels at day 7 had a sensitivity and specificity of 83% and 90%, respectively, in predicting an adverse cardiovascular (area under the curve, 0.86; 95% CI, 0.68-1.0; p = 0.02).. In conclusion, children with primary myocardial dysfunction and acute decompensated heart failure, a persistently elevated amino-terminal pro-B-type natriuretic peptide, and/or a lesser degree of decline in amino-terminal pro-B-type natriuretic peptide during the first week of presentation were strongly associated with adverse cardiovascular outcome. Serial amino-terminal pro-B-type natriuretic peptide monitoring may allow the early identification of children at risk for worse outcome.

Topics: Acute Disease; Adolescent; Child; Child, Preschool; Extracorporeal Membrane Oxygenation; Female; Follow-Up Studies; Heart Failure; Heart Transplantation; Heart-Assist Devices; Humans; Male; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Prospective Studies; ROC Curve; Ventricular Dysfunction

Few prospective data are available regarding long-term outcomes after surgical closure of a ventricular septal defect (VSD).. The objective of this study was to investigate clinical outcomes>30 years after surgical VSD closure.. Patients who underwent surgical VSD closure during childhood between 1968 and 1980 were reexamined every 10 years. In 2012, we invited eligible patients to undergo another examination, which included electrocardiography, Holter monitoring, echocardiography, bicycle ergometry, measurement of N-terminal pro-B-type natriuretic peptide, and subjective health assessment.. Cumulative survival was 86% at 40 years. Causes of mortality were arrhythmia, heart failure, endocarditis, during valvular surgery, pulmonary hypertension, noncardiac causes, and unknown causes. Cumulative event-free survival after surgery was 72% at 40 years. Symptomatic arrhythmias occurred in 13% of patients and surgical or catheter-based reinterventions in 12%. Prevalence of impaired right ventricular systolic function increased from 1% in 2001 to 17% in 2012 (p=0.001). Left ventricular systolic function was impaired but stable in 21% of patients. Aortic regurgitation occurred more often in the last 20 years (p=0.039), and mean exercise capacity decreased (p=0.003). N-terminal pro-B-type natriuretic peptide (median: 11.6 pmol/l [interquartile range: 7.0 to 19.8 pmol/l]) was elevated (>14 pmol/l) in 38% of patients. A concomitant cardiac lesion, for example, patent ductus arteriosus, and aortic cross-clamp time were determinants of late events (hazard ratio: 2.84 [95% confidence interval: 1.23 to 6.53] and hazard ratio: 1.47 per 10 min [95% confidence interval: 1.22 to 1.99], respectively). Patients rated their subjective health status significantly better than a reference population.. Survival up to 40 years after successful surgical VSD closure is slightly lower than in the general Dutch population. Morbidity is not negligible, especially in patients with a concomitant cardiac lesion.

Topics: Adult; Aortic Valve Insufficiency; Arrhythmias, Cardiac; Echocardiography; Exercise Tolerance; Female; Health Status; Heart Septal Defects, Ventricular; Humans; Longitudinal Studies; Male; Natriuretic Peptide, Brain; Patient Outcome Assessment; Peptide Fragments; Prospective Studies; Self Report; Ventricular Dysfunction

Topics: Adult; Anemia, Sickle Cell; Cardiac Output, High; Diastole; Echocardiography, Doppler; Humans; L-Lactate Dehydrogenase; Male; Natriuretic Peptide, Brain; Peptide Fragments; Ventricular Dysfunction

High sensitivity troponin T (hsTnT) assays enable us to detect chronic heart failure (CHF). Adult congenital heart disease (ACHD) patients are classified as being in at least stage B of CHF. The purpose of the study was to assess hsTnT levels in ACHD patients and determine its clinical significance.. This is a prospective cross-sectional study. We assessed hsTnT in 131 ACHD patients and in 30 healthy controls. All ACHD patients underwent routine clinical and echocardiographic evaluation and had hsTnT and N-terminal brain natriuretic peptide (NT-pro-BNP) level measurements.. The cut-off value defining an abnormal hsTnT level was established as >0.005 ng/mL. 35.1% (n=46) of ACHD patients had abnormal hsTnT compared to 6.7% (n=2) of healthy controls (p=0.002). The prevalence of elevated hsTnT did not differ between simple and complex and between non-cyanotic and cyanotic congenital heart disease (CHD). The sensitivity and specificity of hsTnT for the detection of moderate or severe (significant) systemic ventricular dysfunction was 78.6% and 69.8%, respectively (OR 8.49; CI 95% 2.23-32.30; p<0,0001) whereas for significant pulmonary ventricular dysfunction it was 66.7% and 68.2%, respectively (OR 4.29; CI 95% 1.56-11.79; p=0.003). In multivariate logistic regression models elevated hsTnT, but not NT-pro-BNP, was independently associated with both significant systemic ventricular dysfunction (p=0.004) and significant pulmonary ventricular dysfunction (p=0.011).. A troponin leak is observed in a substantial number of ACHD patients and is associated with significant systemic and pulmonary ventricular impairment. Compared to NT-pro-BNP, hsTnT is a more specific independent predictor of ventricular dysfunction in ACHD.

Topics: Adult; Biomarkers; Cross-Sectional Studies; Female; Heart Defects, Congenital; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prospective Studies; Sensitivity and Specificity; Troponin T; Ultrasonography; Ventricular Dysfunction; Young Adult

Prognosis of heart failure patients has been defined in hospital-based or retrospective studies. This study aimed to characterize prognosis of outpatients with new-onset preserved or reduced ejection fraction heart failure; to explore the role of collagen turnover biomarkers (MMP2, MMP9, TIMP1) in predicting prognosis; and to analyse their relationship with echocardiographic parameters and final diagnosis.. This is an observational, prospective, longitudinal study. Outpatients with new-onset heart failure symptoms referred to a one-stop clinic were included. Echocardiography and biomarkers plasma levels determination were performed at the inclusion. A prospective follow-up was conducted to report cardiovascular events. The discriminant analysis was applied to identify the parameters related to cardiovascular outcomes.. A total of 172 patients (75 ± 9 years) were included, 67% with heart failure (64% preserved and 36% with reduced ejection fraction). During follow-up (median 34.5 months), 32.6% had at least one cardiovascular event and 9.9% died. Heart failure groups showed no differences in cardiovascular outcomes with a higher rate of events than nonheart failure patients. MMP2 and TIMP1 were correlated with diastolic dysfunction (Rho 0.349 and 0.294, P < 0.001). In the discriminant analysis, the combination of biomarkers with clinical, biochemical and echocardiographic parameters was useful to predict cardiovascular outcomes (AUC ROC 0.806, Wilks lambda 0.7688, P < 0.001).. Prognosis of outpatients with new-onset heart failure symptoms is comparable between heart failure with preserved or reduced subgroups. The addition of biomarkers specially MMP2 and high sensitive troponin I to other clinical, biochemical and echocardiographic variables can predict cardiovascular prognosis at the time of diagnosis.

Topics: Aged; Aged, 80 and over; Ambulatory Care; Biomarkers; Collagen; Discriminant Analysis; Echocardiography; Female; Heart Failure; Humans; Longitudinal Studies; Male; Matrix Metalloproteinase 2; Matrix Metalloproteinase 9; Natriuretic Peptide, Brain; Prognosis; Prospective Studies; Stroke Volume; Tissue Inhibitor of Metalloproteinase-1; Troponin I; Ventricular Dysfunction

The failure to wean from mechanical ventilation is related to worse outcomes after cardiac surgery. The aim of this study was to evaluate whether the serum level of B-type natriuretic peptide is a predictor of weaning failure from mechanical ventilation after cardiac surgery.. We conducted a prospective, observational cohort study of 101 patients who underwent on-pump coronary artery bypass grafting. B-type natriuretic peptide was measured postoperatively after intensive care unit admission and at the end of a 60-min spontaneous breathing test. The demographic data, hemodynamic and respiratory parameters, fluid balance, need for vasopressor or inotropic support, and length of the intensive care unit and hospital stays were recorded. Weaning failure was considered as either the inability to sustain spontaneous breathing after 60 min or the need for reintubation within 48 h.. Of the 101 patients studied, 12 patients failed the weaning trial. There were no differences between the groups in the baseline or intraoperative characteristics, including left ventricular function, EuroSCORE and lengths of the cardiac procedure and cardiopulmonary bypass. The B-type natriuretic peptide levels were significantly higher at intensive care unit admission and at the end of the breathing test in the patients with weaning failure compared with the patients who were successfully weaned. In a multivariate model, a high B-type natriuretic peptide level at the end of a spontaneous breathing trial was the only independent predictor of weaning failure from mechanical ventilation.. A high B-type natriuretic peptide level is a predictive factor for the failure to wean from mechanical ventilation after cardiac surgery. These findings suggest that optimizing ventricular function should be a goal during the perioperative period.

Topics: Adult; Age Factors; Aged; Biomarkers; Cardiac Surgical Procedures; Epidemiologic Methods; Female; Hemodynamics; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Postoperative Period; Predictive Value of Tests; Respiratory Function Tests; Risk Assessment; Sex Factors; Time Factors; Treatment Failure; Ventilator Weaning; Ventricular Dysfunction

Elevated levels of B-type natriuretic peptides among patients with exacerbations of chronic obstructive pulmonary disease (COPD) are associated with higher mortality. The pathophysiology is unclear. To establish if elevated levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) are due to right or left heart dysfunction, we performed echocardiograms in 18 patients admitted to hospital with COPD. Elevated levels of NT-proBNP were associated with both right and left heart dysfunction and indicate that these patients have biventricular dysfunction rather than isolated right ventricular compromise.

Topics: Aged; Aged, 80 and over; Biomarkers; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Pulmonary Disease, Chronic Obstructive; Ventricular Dysfunction

Topics: Adult; Arginine; Female; Heart Atria; Humans; Male; Natriuretic Peptide, Brain; Peptide Fragments; Postoperative Complications; Transposition of Great Vessels; Ventricular Dysfunction

The association between HCV infection and myocardial disorders remains unclear. This study aimed to assess whether or not HCV infection influences myocardial dysfunction by the use of NT-proBNP, a sensitive marker of myocardial dysfunction. A total of 198 participants [99 patients with chronic HCV infection (aged 46-68 years) and 99 anti-HCV-negative sex and age matched controls] were examined. Serum HCV-RNA level and HCV genotype were tested and liver biopsy was done only for the patient group. The NT-proBNP concentration of the HCV patients (mean 71.6 ± 79.1 pg/ml; median 46.0 pg/ml, range 5.0-400.0) was significantly higher than that of the controls (mean 39.8 ± 24.4 pg/ml; median 35.8 pg/ml, range 7.0-108.0) (P < 0.05). 20.0 % of the HCV patients and 0.6 % of the controls had high NT-proBNP (higher than 125 pg/ml; the single cut off point for patients under 75 years of age) (P < 0.05). Stepwise multiple regression analysis revealed that chronic HCV infection was independently correlated with NT-proBNP level after adjustment for parameters that might influence NT-proBNP (P = 0.005). Our data suggest that chronic HCV infection is associated with increased NT-proBNP, indicating that chronic HCV infection might induce myocardial dysfunction.

Topics: Aged; Biomarkers; Biopsy; Cross-Sectional Studies; Female; Heart Ventricles; Hepacivirus; Hepatitis C Antibodies; Hepatitis C, Chronic; Humans; Japan; Liver; Male; Middle Aged; Molecular Typing; Myocarditis; Natriuretic Peptide, Brain; Peptide Fragments; RNA, Viral; Up-Regulation; Ventricular Dysfunction

Topics: Adult; Atherosclerosis; Biomarkers; Disability Evaluation; Female; Heart Failure; Humans; Longitudinal Studies; Lupus Erythematosus, Systemic; Male; Natriuretic Peptide, Brain; Peptide Fragments; Severity of Illness Index; Ventricular Dysfunction

Measurement of natriuretic peptides may be recommended prior to echocardiography in patients with suspected heart failure. Cut-off point for heart failure diagnosis in primary care is not well established. We aimed to assess the optimal diagnostic cut-off value of N-terminal pro-B-type natriuretic peptide on a community population attended in primary care.. Prospective diagnostic accuracy study of a rapid point-of-care N-terminal pro-B-type natriuretic peptide test in a primary healthcare centre. Consecutive patients referred by their general practitioners to echocardiography due to suspected heart failure were included. Clinical history and physical examination based on Framingham criteria, electrocardiogram, chest X-ray, N-terminal pro-B-type natriuretic peptide measurement and echocardiogram were performed. Heart failure diagnosis was made by a cardiologist blinded to N-terminal pro-B-type natriuretic peptide value, using the European Society of Cardiology diagnosis criteria (clinical and echocardiographic data).. Of 220 patients evaluated (65.5% women; median 74 years [interquartile range 67-81]). Heart failure diagnosis was confirmed in 52 patients (23.6%), 16 (30.8%) with left ventricular ejection fraction <50% (39.6 [5.1]%). Median values of N-terminal pro-B-type natriuretic peptide were 715 pg/mL [interquartile range 510.5-1575] and 77.5 pg/mL [interquartile range 58-179.75] for patients with and without heart failure respectively. The best cut-off point was 280 pg/mL, with a receiver operating characteristic curve of 0.94 (95% confidence interval, 0.91-0.97). Six patients with heart failure diagnosis (11.5%) had N-terminal pro-B-type natriuretic peptide values <400 pg/mL. Measurement of natriuretic peptides would avoid 67% of requested echocardiograms.. In a community population attended in primary care, the best cut-off point of N-terminal pro-B-type natriuretic peptide to rule out heart failure was 280 pg/mL. N-terminal pro-B-type natriuretic peptide measurement improve work-out diagnoses and could be cost-effectiveness.

Topics: Aged; Aged, 80 and over; Area Under Curve; Comorbidity; Confidence Intervals; Cost-Benefit Analysis; Echocardiography, Doppler; Electrocardiography; Female; Heart Failure; Humans; Male; Natriuretic Peptide, Brain; Peptide Fragments; Point-of-Care Systems; Predictive Value of Tests; Primary Health Care; ROC Curve; Ventricular Dysfunction

We studied relationship between structure-functional parameters of left and right cardiac chambers and N-terminal pro-brain natriuretic peptide (NT-proBNP) level in 118 patients with arterial hypertension (AH) (35 men, 83 women) and 17 healthy volunteers. Methods comprised 24-hour arterial pressure monitoring (APM), two-dimensional echocardiography (echoCG), Doppler echoCG, and tissue echoCG of mitral and tricuspid atrioventricular annuli, treadmill test, 6-min walk test, and measurement of NT-proBNP level in blood plasma. In patients with AH blood plasma NT-proBNP level was significantly higher than in a group of healthy persons of similar age. Elevation of this biochemical marker was accompanied by significant change of characteristics of remodeling of left and right parts of the heart, abnormalities of left ventricular diastolic function according to transmitral blood flow, disturbances of left ventricular diastolic and systolic function according to tissue Doplerography data. Comparative analysis of structure-functional parameters of the heart and NT-proBNP level in patients with AH allowed to reveal more significant changes of parameters of diastolic and systolic remodeling, local and global diastolic and systolic left ventricular function in patients with NT-proBNP levels more than 306 mol/ml. Factors determining NT-proBNP level in patients with AH were age, free right ventricular wall thickness, and body mass index.

Topics: Adult; Biomarkers; Body Mass Index; Echocardiography, Doppler; Exercise Test; Female; Heart Ventricles; Humans; Hypertension; Hypertrophy, Right Ventricular; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Research Design; Statistics as Topic; Ventricular Dysfunction; Ventricular Function, Left; Ventricular Function, Right; Ventricular Remodeling

It is still unclear whether circulating levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) reflect cardiac filling and function in the critically ill patient, particularly during sepsis and a proinflammatory response that may induce NT-proBNP release from the heart.. We prospectively evaluated the value of NT-proBNP as a marker of cardiac loading, function, and response to fluid loading in 18 septic and 68 nonseptic, critically ill patients in the intensive care unit of a university medical center. Transpulmonary thermal dilution and pressure measurements were done, and plasma NT-proBNP was determined before and after colloid fluid loading.. Compared with nonseptic patients, NT-proBNP plasma levels were higher and systolic cardiac function indices were lower in patients with sepsis than those without sepsis. N-terminal pro-B-type natriuretic peptide best related, from all hemodynamic parameters before and after fluid loading, to systolic cardiac function (rather than diastolic filling) variables, independently of confounders such as renal dysfunction (judged from serum creatinine). In addition, a high NT-proBNP (>3467 pg/mL) predicted absence of fluid responsiveness in sepsis only.. Our data suggest that an increased circulating NT-proBNP plasma level is an independent marker of greater systolic cardiac dysfunction, irrespective of filling status, and is a better predictor of fluid nonresponsiveness in septic vs nonseptic, critically ill patients.

Topics: Academic Medical Centers; Adult; Aged; Biomarkers; Critical Illness; Female; Fluid Therapy; Humans; Intensive Care Units; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Prospective Studies; Sepsis; Systole; Treatment Outcome; Ventricular Dysfunction; Young Adult

Although oxidative stress is considered to promote arrhythmogenic substrates in diseased model animals, it is difficult to evaluate its primary role. In this study, we evaluated the promotion of arrhythmogenic substrates in the primary hyperoxidative state.. Sprague-Dawley rats were treated with L-buthionine-sulfoximine (BSO, 30 mmol · L(-1) · day(-1)) for 14 days. On day 7 or 14, the serum levels of derivatives of reactive oxygen metabolites (d-ROM) were measured, and immune staining of 8-hydroxy-2'-deoxyguanosine (8O HdG) was performed to assess oxidative stress. The ventricular effective refractory period (ERP), monophasic action potential duration (MAPD), and the inducibility of ventricular arrhythmia were also evaluated. BSO rats exhibited higher serum d-ROM and clearer 8OHdG staining than the controls. The inducibility of ventricular arrhythmia was higher in the BSO rats than in the controls. The ERP was shorter in the BSO rats than the control (day 14, 32 ± 1 vs. 36 ± 1 ms, P<0.05), whereas the MAPD(90) was longer in the BSO rats (day 14, 76 ± 5 vs. 55 ± 4 ms, P<0.05). The mRNA levels of Kv4.2, erg, and SERCA2a were downregulated in the BSO rats (P < 0.05), and Western blot analysis exhibited the downregulation of erg and SERCA2 expression in the BSO rats (P < 0.05).. Systemic oxidative stress might be one of the primary factors promoting cardiac electrophysiological remodeling and increasing the inducibility of arrhythmia independently of major organ disorders.

Topics: 8-Hydroxy-2'-Deoxyguanosine; Action Potentials; Analysis of Variance; Animals; Arrhythmias, Cardiac; Blood Pressure; Blotting, Western; Buthionine Sulfoximine; Cardiac Pacing, Artificial; Cytokines; Deoxyguanosine; Disease Models, Animal; Disease Progression; Ether-A-Go-Go Potassium Channels; Glutathione; Hydrogen Peroxide; Immunohistochemistry; Myocardium; Natriuretic Peptide, Brain; Oxidative Stress; Rats; Rats, Sprague-Dawley; Reverse Transcriptase Polymerase Chain Reaction; RNA, Messenger; Sarcoplasmic Reticulum Calcium-Transporting ATPases; Shal Potassium Channels; Time Factors; Ventricular Dysfunction; Ventricular Remodeling

Cytokines such as tumor necrosis factor-alpha (TNF) contribute to cardiac dysfunction in chronic heart failure (CHF). Brain natriuretic peptide (BNP) and atrial natriuretic peptide (ANP) are thought to reflect cardiac functional and structural damage.. To study the relationship between BNP, ANP, and TNF, these parameters were measured in fasting venous blood samples of 25 CHF patients (age 66+/-2 years, pVO(2) 17.4+/-2.1 mL/kg/min, NYHA class 2.8+/-0.2, all mean+/-SEM) and 8 healthy controls (age 71+/-2 years). Patients with CHF had higher plasma levels of BNP (p<0.05), ANP (p<0.05), norepinephrine (p<0.01), and echocardiographic left ventricular end-diastolic diameter (LVEDD, p<0.05) compared to controls, whereas TNF and epinephrine were not significantly different. There were significant correlations between natriuretic peptides and markers of inflammation and myocardial dysfunction in CHF patients: BNP vs. TNF (r=0.64, p=0.0006), vs. LVEDD (r=0.59, p=0.0025); ANP vs. TNF (r=0.60, p=0.0016), vs. LVEDD (r=0.65, p=0.0006); TNF vs. LVEDD (r=0.57, p=0.004). After adjustment for NYHA, creatinine clearance, and age TNF correlated with BNP (all p=0.01) and ANP (all p<0.002). The cachectic CHF patients (n=7,>6% weight loss) had the highest BNP (p<0.001 vs. controls, p<0.05 vs. non-cachectic CHF) and ANP levels (p=0.01 vs. controls). Concentrations of uric acid, epinephrine, and norepinephrine also correlated with ANP and BNP.. In CHF, TNF is closely related to BNP and ANP (independently of CHF severity and ventricular dysfunction), particularly in patients with cardiac cachexia. TNF may causally contribute to intrinsic cardiac dysfunction thereby stimulating BNP and ANP secretion.

Topics: Age Factors; Aged; Atrial Natriuretic Factor; Biomarkers; Cachexia; Female; Heart Failure; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Severity of Illness Index; Tumor Necrosis Factor-alpha; Ventricular Dysfunction

Patients after the Fontan procedure are at risk for suboptimal functional health status, and associations with laboratory measures are important for planning interventions and outcome measures for clinical trials.. Parents completed the generic Child Health Questionnaire for 511 Fontan Cross-Sectional Study patients 6 to 18 years of age (61% male). Associations of Child Health Questionnaire Physical and Psychosocial Functioning Summary Scores (FSS) with standardized measurements from prospective exercise testing, echocardiography, magnetic resonance imaging, and measurement of brain natriuretic peptide were determined by regression analyses. For exercise variables for maximal effort patients only, the final model showed that higher Physical FSS was associated only with higher maximum work rate, accounting for 9% of variation in Physical FSS. For echocardiography, lower Tei index (particularly for patients with extracardiac lateral tunnel connections), lower indexed end-systolic volume, and the absence of atrioventricular valve regurgitation for patients having Fontan procedure at age <2 years were associated with higher Physical FSS, accounting for 14% of variation in Physical FSS. For magnetic resonance imaging, ratio of lower mass to end-diastolic volume and midquartiles of indexed end-systolic volume (nonlinear) were associated with higher Physical FSS, accounting for 11% of variation. Lower brain natriuretic peptide was significantly but weakly associated with higher Physical FSS (1% of variation). Significant associations for Psychosocial FSS with laboratory measures were fewer and weaker than for Physical FSS.. In relatively healthy Fontan patients, laboratory measures account for a small proportion of the variation in functional health status and therefore may not be optimal surrogate end points for trials of therapeutic interventions.

Topics: Adolescent; Cardiac Volume; Child; Cross-Sectional Studies; Echocardiography; Exercise Test; Exercise Tolerance; Female; Fontan Procedure; Health Status; Heart Defects, Congenital; Humans; Magnetic Resonance Imaging; Male; Natriuretic Peptide, Brain; Postoperative Complications; Surveys and Questionnaires; Ventricular Dysfunction

Diastolic dysfunction as demonstrated by tissue Doppler imaging (TDI), particularly E/e' (peak early diastolic transmitral/peak early diastolic mitral annular velocity) is common in critical illness. In septic shock, the prognostic value of TDI is undefined. This study sought to evaluate and compare the prognostic significance of TDI and cardiac biomarkers (B-type natriuretic peptide (BNP); N-terminal proBNP (NTproBNP); troponin T (TnT)) in septic shock. The contribution of fluid management and diastolic dysfunction to elevation of BNP was also evaluated.. Twenty-one consecutive adult patients from a multidisciplinary intensive care unit underwent transthoracic echocardiography and blood collection within 72 hours of developing septic shock.. Mean +/- SD APACHE III score was 80.1 +/- 23.8. Hospital mortality was 29%. E/e' was significantly higher in hospital non-survivors (15.32 +/- 2.74, survivors 9.05 +/- 2.75; P = 0.0002). Area under ROC curves were E/e' 0.94, TnT 0.86, BNP 0.78 and NTproBNP 0.67. An E/e' threshold of 14.5 offered 100% sensitivity and 83% specificity. Adjustment for APACHE III, cardiac disease, fluid balance and grade of diastolic function, demonstrated E/e' as an independent predictor of hospital mortality (P = 0.019). Multiple linear regression incorporating APACHE III, gender, cardiac disease, fluid balance, noradrenaline dose, C reactive protein, ejection fraction and diastolic dysfunction yielded APACHE III (P = 0.033), fluid balance (P = 0.001) and diastolic dysfunction (P = 0.009) as independent predictors of BNP concentration.. E/e' is an independent predictor of hospital survival in septic shock. It offers better discrimination between survivors and non-survivors than cardiac biomarkers. Fluid balance and diastolic dysfunction were independent predictors of BNP concentration in septic shock.

Topics: Adult; Aged; Aged, 80 and over; APACHE; Biomarkers; Echocardiography, Doppler; Female; Forecasting; Heart; Heart Ventricles; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Outcome Assessment, Health Care; Peptide Fragments; Proportional Hazards Models; Prospective Studies; Shock, Septic; Survival Analysis; Troponin T; Ventricular Dysfunction; Young Adult

Depression is a common comorbidity in heart failure (HF); however, the mechanisms related to a poorer outcome of depressed patients with HF remain unclear.. To evaluate the role of severe depression in the outcome of patients with decompensated HF.. A total of 43 patients with advanced HF, EF < 40.0%, and hospitalized for cardiac compensation were consecutively studied. After history taking and physical examination, the patients underwent laboratory tests including BNP determination. After the diagnosis of depression was made, the Hamilton-D scale was applied. Severe depression was defined by a score equal to or greater than 18. The clinical and laboratory variables according to the presence or absence of severe depression were analyzed using logistic regression. The ROC curve defined the cut-off point for BNP.. Severe or very severe depression was identified in 24 (55.8%) patients. Severely depressed patients did not differ from non-depressed patients as regards age, gender and renal function, but showed less cardiac impairment (EF 23.4 ± 7.2% vs 19.5 ± 5.2%; p = 0.046) and higher BNP levels (2,582.8 ± 1,596.6 pg/ml vs 1,206.6 ± 587.0 pg/ml; p < 0.001). However, patients with BNP levels higher than 1,100 pg/ml had a 12.0-fold higher chance (odds ratio [95% CI] = 2.61 - 55.26) of developing severe depression.. Patients with severe depression showed a higher degree of neurohormonal stimulation despite their lower degree of ventricular dysfunction. The pathophysiological changes related to depression, leading to increased neurohormonal stimulation and cytokines, probably contributed to this more intense clinical manifestation even in the presence of less cardiac damage.

Topics: Biomarkers; Depression; Epidemiologic Methods; Female; Heart Failure; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Reference Values; Ventricular Dysfunction

Ventricular dysfunction (VnD) after primary coronary artery bypass grafting is associated with increased hospital stay and mortality. Natriuretic peptides have compensatory vasodilatory, natriuretic, and paracrine influences on myocardial failure and ischemia. The authors hypothesized that natriuretic peptide system gene variants independently predict risk of VnD after primary coronary artery bypass grafting.. A total of 1,164 patients undergoing primary coronary artery bypass grafting with cardiopulmonary bypass at two institutions were prospectively enrolled. After prospectively defined exclusions, 697 patients of European descent (76 with VnD) were analyzed. VnD was defined as need for at least 2 new inotropes and/or new mechanical ventricular support after coronary artery bypass grafting. A total of 139 haplotype-tagging single nucleotide polymorphisms (SNPs) within 7 genes (NPPA, NPPB, NPPC, NPR1, NPR2, NPR3, CORIN) were genotyped. SNPs univariately associated with VnD were entered into logistic regression models adjusting for clinical covariates predictive of VnD. To control for multiple comparisons, permutation analyses were conducted for all SNP associations.. After adjusting for clinical covariates and multiple comparisons within each gene, seven NPPA/NPPB SNPs (rs632793, rs6668352, rs549596, rs198388, rs198389, rs6676300, rs1009592) were associated with decreased risk of postoperative VnD (additive model; odds ratios 0.44-0.55; P = 0.010- 0.036) and four NPR3 SNPs (rs700923, rs16890196, rs765199, rs700926) were associated with increased risk of postoperative VnD (recessive model; odds ratios 3.89-4.28; P = 0.007-0.034).. Genetic variation within the NPPA/NPPB and NPR3 genes is associated with risk of VnD after primary coronary artery bypass grafting. Knowledge of such genotypic predictors may result in better understanding of the molecular mechanisms underlying postoperative VnD.

Topics: Adult; Aged; Aged, 80 and over; Atrial Natriuretic Factor; Coronary Artery Bypass; Data Collection; Europe; Female; Genes; Genetic Variation; Genotype; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Polymorphism, Single Nucleotide; Prospective Studies; Receptors, Atrial Natriuretic Factor; Risk Factors; Serine Endopeptidases; Troponin I; Ventricular Dysfunction; Young Adult

It was aimed to compare urine B-type natriuretic peptide (BNP) according to left ventricular systolic dysfunction and to investigate its diagnostic value in heart failure (HF) patients.. A total of 90 HF outpatients (61 men, age 66 +/- 12) and 30 age- and gender-matched controls were studied.. An increase in urine BNP was observed in patients with EF 40% (p < 0.0001), and controls (p < 0.0001). Significant correlations between urinary BNP and left ventricular functional parameters were obtained. A multivariate regression analysis was performed and the best model associated with urine BNP included plasma BNP (p < 0.0001), EF (p = 0.02) and LV volume indexes (p < 0.0001). The ROC for detection of EF

Topics: Aged; Case-Control Studies; Female; Heart Failure; Humans; Male; Natriuretic Peptide, Brain; Prospective Studies; Ventricular Dysfunction

Our aim was further to clarify the diagnostic usefulness of N-terminal pro-B-type natriuretic peptide for detecting ventricular dysfunction in children, and its correlation with myocardial performance index and New York University Pediatric Heart Failure Index score. We also hypothesized that the level of this natriuretic peptide in the serum could predict the severity of diastolic abnormalities in children with cardiac failure. We enrolled 99 patients, aged from 3 months to 16 years, who had been referred for echocardiography to evaluate ventricular function. Echocardiographic evidence of left ventricular systolic and diastolic dysfunction was found in 20 and 42 patients, respectively. We classified these patients as having impaired relaxation, seen in 12 patients, pseudonormal patterns seen in 19 patients, and restrictive-like patterns of filling seen in 11 patients. The mean of the log-transformed values for N-terminal pro-B-type natriuretic peptide increased significantly according to the severity of diastolic dysfunction (p = 0.003, p = 0.022, p < 0.0001). A value of 178 pg/ml had a sensitivity of 88% and specificity of 81% for detecting abnormal diastolic function (p < 0.0001). Furthermore, the log-transformed values correlated with myocardial performance index (p < 0.0001) in a positive manner, and the levels increased significantly according to New York University Pediatric Heart Failure Index score, showing a linear correlation with a robust r value for regression (r = 0.89, p < 0.0001). Our findings suggest that higher levels of the peptide, having a good correlation with New York University Pediatric Heart Failure Index score and myocardial performance index, might be a suitable marker to rule out ventricular diastolic dysfunction in children.

Topics: Adolescent; Analysis of Variance; Area Under Curve; Biomarkers; Child; Child, Preschool; Diastole; Echocardiography; Female; Humans; Infant; Linear Models; Male; Natriuretic Peptide, Brain; Predictive Value of Tests; Prospective Studies; ROC Curve; Sensitivity and Specificity; Ventricular Dysfunction

Assess the use of N terminal pro brain natriuretic peptide (NT-pro BNP) to early diagnose ventricular dysfunction in doxorubicin-administered children.. Fifty-five cancer patients who received accumulative dose of doxorubicin <300 mg/m2 (group 1), 49 cases with accumulative dose > or = 300 mg/m2 (group 2) and 52 cases as a control group (group 3) were included in the study. Electrocardiogram, chest roentgenogram, echocardiogram, and serum NT-pro BNP were studied.. At age 1-10 years, there were significantly higher NT-pro BNP in group 2 than group 1 (384 +/- 291 vs. 92.2 +/- 89 pg/ml; p = 0.001), and than group 3 (79 +/- 92 pg/ml; p = 0.001). Patients with NT-pro BNP level > 1 SD of the control group were more likely to have abnormal > or = 2 echocardiographic parameters of left ventricular diastolic dysfunction than patients with NT-pro BNP < or = 1 SD (OR = 3.8, 95% CI 1.18-12.5). Patients in group 2 were more likely to have abnormal > or = 2 parameters of left ventricular diastolic dysfunction than patients in group 1 (OR = 2.8, 95% CI 1.07-7.7) and more likely to have NT-pro BNP >1 SD than group 1 (OR = 8, 95% CI 1.96-38.4). There were association of NT-pro BNP > 1 SD, accumulative dose of doxorubicin > or = 300 mg/m2, and early left ventricular diastolic dysfunction by echocardiogram.. Serum NT-pro BNP > 1 SD has a high probability to diagnose early doxorubicin-induced cardiomyopathy in patient 1-10 years old.

Topics: Analysis of Variance; Antibiotics, Antineoplastic; Biomarkers; Child; Cross-Sectional Studies; Doxorubicin; Echocardiography; Electrocardiography; Female; Heart Function Tests; Humans; Male; Natriuretic Peptide, Brain; Radiography, Thoracic; Statistics, Nonparametric; Ventricular Dysfunction

Heart failure has a serious prognosis. However, among elderly patients the panorama of concomitant diseases makes it difficult to implement the results from epidemiological studies. The aim of this study was to evaluate the influence of different clinical variables on cardiovascular mortality during a long-term follow-up.. In all, 474 elderly patients (age 65-82 years) in primary health care were evaluated and followed during a 10 year period. All patients had symptoms associated with heart failure and were examined by a cardiologist. Blood samples including NT-proBNP were analyzed, and ECG and Doppler echocardiography were assessed. Both the systolic and diastolic function was evaluated. Functional capacity was evaluated according to the NYHA classification. During the 10 years of follow-up those with the highest quartile of plasma concentration of NT-proBNP had almost four times increased risk of cardiovascular mortality. Impaired systolic function, diabetes and reduced functional capacity were all markers of increased risk of cardiovascular mortality. All variables were also evaluated after 5 years, with higher risk ratios for a majority of variables.. In this study 474 patients with symptoms of heart failure were followed during 10 years. High plasma concentration of NT-proBNP could predict almost four times increased risk of cardiovascular mortality up to 10 years. Also, impaired cardiac function according to echocardiography, and reduced functional capacity as well as diabetes all had influence on risk of cardiovascular mortality up to 10 years.

Topics: Aged; Aged, 80 and over; Biomarkers; Cardiovascular Diseases; Diabetes Complications; Female; Follow-Up Studies; Heart Failure; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Prognosis; Risk Factors; Ventricular Dysfunction

NT pro-BNP is a marker of systolic and diastolic dysfunction.. To determine NT pro-BNP levels in patients with chagasic, hypertrophic, and restrictive heart diseases, as well as with pericardial diseases, and their relation to echocardiographic measurements of systolic and diastolic dysfunction.. A total of 145 patients were divided into the following groups: 1) Chagas' heart disease (CHD)--14 patients; 2) hypertrophic cardiomyopathy (HCM)--71 patients; 3) endomyocardial fibrosis (EMF)--26 patients; 4) pericardial effusion (PE)--18 patients; and 5) constrictive pericarditis (CP)--16 patients. The control group was comprised of 40 individuals with no heart disease. The degree of myocardial impairment and pericardial effusion were assessed by two-dimensional echocardiography and the degree of restriction by pulsed Doppler transmitral flow. The diagnosis of CP was confirmed through magnetic resonance imaging. NT pro-BNP levels were determined through electrochemiluminescence immunoassay.. NT pro-BNP was increased (p < 0.001) in CHD (median = 513.8 pg/ml), HCM (median = 848 pg/ml), EMF (median = 633 pg/ml), CP (median = 568 pg/ml), and PE (median = 124 pg/ml), when compared with the control group (median = 28 pg/ml). No statistically significant differences were found between CP and EMF (p = 0.14). In the hypertrophic group, NT pro-BNP was correlated with left atrial size (r = 0.40; p < 0.001) and with E/Ea ratio (p < 0.01). In the restrictive group, there was a trend of correlation with E-wave peak velocity (r = 0.439; p = 0.06).. NT pro-BNP is increased in the different cardiomyopathies and pericardial diseases and is correlated with the degree of systolic and diastolic dysfunction.

Topics: Adult; Biomarkers; Cardiomyopathies; Cardiomyopathy, Hypertrophic; Cardiomyopathy, Restrictive; Case-Control Studies; Chagas Cardiomyopathy; Diastole; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Pericardial Effusion; Pericarditis, Constrictive; Pericardium; Prospective Studies; Systole; Ultrasonography; Ventricular Dysfunction

Elevated B-type natriuretic peptide is associated with increased morbidity and mortality in ambulatory patients with congestive heart failure or acute coronary syndromes. Its utility in predicting adverse cardiac surgical outcomes is less certain. We hypothesized that preoperative plasma B-type natriuretic peptide would independently predict in-hospital postoperative ventricular dysfunction, hospital stay, and up to 5-year mortality after primary coronary artery bypass grafting.. This is a prospective, longitudinal study of 1023 patients at two institutions undergoing primary coronary artery bypass grafting with cardiopulmonary bypass. Ventricular dysfunction was defined as requirement for at least two inotropes or new intra-aortic balloon pump or ventricular assist device support after coronary artery bypass grafting. Multivariable analyses assessed independent roles of preoperative B-type natriuretic peptide in predicting postoperative ventricular dysfunction, hospital stay, and 5-year all-cause mortality.. Preoperative plasma B-type natriuretic peptide concentration predicted ventricular dysfunction, hospital stay, and mortality in univariate and multivariable analyses. Logistic regression demonstrated preoperative B-type natriuretic peptide to independently predict ventricular dysfunction (odds ratio 1.92, 95% confidence interval 1.12-3.29, P = .018), after adjustment for preoperative left ventricular ejection fraction, congestive heart failure severity, and other clinical predictors. Multivariable Cox proportional hazards models showed preoperative B-type natriuretic peptide to independently predict hospital stay (hazard ratio 1.42, 95% confidence interval 1.18-1.72, P = .0002) and mortality (hazard ratio 1.89, 95% confidence interval 1.08-3.33, P = .026).. Preoperative plasma B-type natriuretic peptide independently predicted in-hospital ventricular dysfunction, hospital stay, and up to 5-year all-cause mortality after primary coronary artery bypass grafting.

Topics: Adult; Aged; Aged, 80 and over; Assisted Circulation; Biomarkers; Cardiotonic Agents; Coronary Artery Bypass; Female; Humans; Length of Stay; Male; Middle Aged; Natriuretic Peptide, Brain; Postoperative Care; Postoperative Complications; Survival Rate; Ventricular Dysfunction

Serum cobalamin (vitamin B12), bound to transcobalamin II, is taken up by the endothelium of the hepatic vasculature via a receptor-mediated membrane transport process. We hypothesized hepatic congestion is associated with elevated serum B12 without hepatocyte necrosis.. Serum B12, aspartate and alanine transaminases, alkaline phosphatase, bilirubin (Bili), and brain natriuretic peptide (BNP) were monitored at the time of admission in 91 hospitalized patients: (a) 38 with decompensated biventricular failure having systemic venous distention, tricuspid regurgitation (TR), and echocardiographic evidence of inferior vena cava dilation and moderate to marked TR; (b) 18 with acute left heart failure having a myocardial infarction, an ischemic cardiomyopathy, or hypertensive heart disease; and (c) 35 without clinical evidence of failure despite myocardial infarction, pericarditis, or atrial arrhythmia. Serum cobalamin (normal 180-600 pg/mL) was elevated with biventricular failure (861.4 +/- 53.0 pg/mL) compared with (P < 0.0001) left heart or no failure, where B12 remained normal. Serum aspartate, alanine, and alkaline phosphatase were normal in each group whereas Bili was increased (1.8 +/- 0.2 mg/dL; P < 0.05) with biventricular failure. Plasma BNP was elevated in each group.. Elevated cobalamin and Bili are respective biomarkers of hepatocellular dysfunction and cholestasis in patients having decompensated biventricular failure with systemic venous distention and TR without hepatocyte necrosis vis-à-vis left heart failure or in the absence of clinical failure. Elevated plasma BNP did not distinguish between the presence or absence of systemic venous congestion.

Topics: Adult; Aged; Female; Heart Failure; Humans; Liver; Male; Middle Aged; Natriuretic Peptide, Brain; Ventricular Dysfunction; Vitamin B 12; Vitamin B Complex; Young Adult

Debates about adverse effects of ventricular- vs. atrial-based pacing have never ended, especially regarding cardiovascular outcomes in common pacemaker populations.. To investigate the contribution of right ventricular apical pacing to the left ventricular negative remodeling, we measured the inter- and intraventricular mechanical dyssynchrony by echocardiography as well as plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) level in 116 consecutive patients of symptomatic bradyarrhythmias including sinus node dysfunction (SND) in 80 and atrioventricular block in 36. Dual-chamber rate-modulated pacing (DDDR) pacemakers were implanted in 76 patients (SND, 40), and single-chamber ventricular rate-modulated pacing (AAIR) pacemakers in 40 (all SND). Clinical manifestations were retrospectively correlated.. After 3.5 years of pacing, DDDR pacemaker patients demonstrated higher plasma NT-proBNP concentration (503 +/- 111 pg/ml) than AAIR patients (194 +/- 42 pg/ml, p = 0.002) despite similar cardiovascular function at baseline. Multivariate regression analysis revealed that the only predictor of the highest quartile of plasma NT-proBNP, i.e. >or=386 pg/ml, was the interventricular contraction time difference (p = 0.01). Reprogramming to minimize ventricular pacing percentage in 8 patients of SND caused parallel reduction of plasma NT-proBNP.. Interventricular mechanical dyssynchrony, imposed mostly by right ventricular apical pacing, could lead to abnormal heightening of plasma NT-proBNP concentration after chronic DDDR pacing in common pacemaker patients with normal baseline left ventricular function.

Topics: Adult; Aged; Aged, 80 and over; Bradycardia; Cardiac Pacing, Artificial; Echocardiography; Female; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Sick Sinus Syndrome; Ventricular Dysfunction

Tachycardia-induced cardiomyopathy is characterized by ventricular systolic dysfunction and congestive heart failure resulting from persistent or highly frequent tachyarrhythmias with uncontrolled heart rate. While reversible and often considered benign, few studies have examined the outcome of the disorder. The clinical characteristics, treatment, and long-term outcomes of 12 consecutive patients with tachycardia-induced cardiomyopathy (9 men, age, 51.9 +/- 17.6 years) were studied. The mean period between the occurrence of tachyarrhythmias and the development of congestive heart failure was 26.0 +/- 34.3 days. The mean heart rate on admission was 156.3 +/- 28.7 beats/min. All patients had severe heart failure with a NYHA functional class of 2.3 +/- 0.5, left ventricular ejection fraction of 0.32 +/- 0.10, and brain natriuretic peptide level of 505.7 +/- 449.1 pg/mL. In all patients, cardiac dysfunction recovered after 53.5 +/- 61.3 days. During the follow-up of 53 +/- 24 months, 2 patients had a recurrence of heart failure with uncontrolled tachyarrhythmia and 1 patient died suddenly. In tachycardia-induced cardiomyopathy, recurrent heart failure with uncontrollable tachyarrhythmia and sudden death were observed after recovery from cardiac dysfunction. A substrate for heart failure and/or life-threatening arrhythmia might persist, and careful, long-term follow-up seems required.

Topics: Adult; Aged; Cardiomyopathies; Death, Sudden, Cardiac; Female; Heart Failure; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Recurrence; Stroke Volume; Tachycardia; Treatment Outcome; Ventricular Dysfunction

Natriuretic peptide levels B (BNP) and A (ANP) have been described in children with different diagnose of congenital heart defects (CHD). However, the impact of the type of cardiac load per se on natriuretic peptide levels, irrespective of diagnosis, has not been reported. The aim of the present study was to evaluate the levels of BNP and ANP in children with congenital and acquired heart disease according to different types of cardiac load. Plasma BNP and ANP were analysed in 137 children with CHD/heart disease, median age 2.9 (0.3-16.7) years. Haemodynamic load was classified as: no overload, pressure overload, volume overload of right and/or left ventricle and systolic ventricular dysfunction. Twenty-three children without heart disease served as controls for the natriuretic peptide measurements. The highest BNP and ANP values were observed in the systolic dysfunction, 613 ng l(-1) (81.8-3910) and 431 (43.8-1990), and volume groups, 29.8 (5.5-352) and 93.0 (15.9-346), respectively, whereas the values in the pressure, 17.9 (0.7-315) and 51.9 (8.7-210), and no overload groups, 10.3 (0.2-28.1) and 28.6 (8.6-105), respectively, were only slightly higher than those in the controls 4.7 (0.0-17.7) and 32.9 (11.7-212.2), respectively. The highest BNP and ANP values were seen in children with systolic dysfunction, while volume overload in the absence of heart failure resulted in higher levels than pressure overload.

Topics: Adolescent; Atrial Natriuretic Factor; Blood Pressure; Cardiac Output; Case-Control Studies; Child; Child, Preschool; Female; Heart Defects, Congenital; Hemodynamics; Humans; Infant; Male; Natriuretic Peptide, Brain; Systole; Ventricular Dysfunction

B-type natriuretic peptide (BNP) is a blood test which detects ventricular wall stretch and is being increasingly used in primary care on limited evidence.. To assess the practical implications and potential clinical benefit of measuring BNP to identify and guide the treatment of undiagnosed or under-treated ventricular dysfunction in at-risk patients.. Screening study with single-arm intervention.. A total of 1918 patients with diabetes mellitus or ischaemic heart disease aged > or =65 years registered with 12 general practices were invited; 76 patients with elevated BNP underwent BNP-guided treatment titration.. Eligible patients were invited to attend for a blood test at their own practice; those with a persistently elevated plasma BNP concentration (>43.3 pmol/l) after repeat measurement were offered initiation or up-titration of treatment guided by remeasurement of BNP with a target concentration of <36 pmol/l.. Seven-hundred and fifty-nine patients (40%) attended for screening; 76 (10% of 759) commenced treatment titration. Of these 76 patients, 64 (84%) were asymptomatic or had only mild breathlessness. Maximum titration effect was achieved by the second visit when 27 (36%) had achieved the BNP target concentration and the mean reduction was 10.8 pmol/l (P<0.001). The most effective therapeutic step was a switch in beta-blocker to carvedilol or bisoprolol (P<0.001).. About 10% of patients with diabetes or cardiovascular disease on GP morbidity registers have a persistently raised plasma BNP concentration. Simple adjustment of their drug treatment may reduce their BNP and associated mortality risk, but further up-titration against BNP is only possible if the within-person biological variability of measurement can be reduced.

Topics: Adrenergic beta-Antagonists; Aged; Biomarkers; Diabetic Angiopathies; Family Practice; Feasibility Studies; Heart Failure; Humans; Myocardial Ischemia; Natriuretic Peptide, Brain; Risk Factors; Ventricular Dysfunction

Serum brain natriuretic peptide (BNP) has been reported to indicate ventricular dysfunction, however, in children it has not been studied yet in our country.. 157 BNP tests were performed in 107 children, on the one hand, to evaluate its clinical value, to assess LV or systemic RV function in patients with transposition of great arteries after Senning operation, on the other hand, to prove the relation between BNP, MRI and echocardiographic ventricular function parameters. PATIENTS' AGE: 4 months-20 years, mean 12.5 yrs. Group I: Senning patients, Groups II and III: patients with dilated or hypertrophic cardiomyopathy, Group IV: patients with aortic insufficiency.. BNP was determined using the electrochemiluminesce method (Elycsys-10 Roche). During the functional MRI Mass- Medis software RV LV EF, end-diastolic, end-systolic volumes were calculated. Echo M-mode, TEI index were calculated.. BNPs were significantly as higher compared to normal in each group of patients. Group I: 318 +/- 285 pg/ml, p < 0.01, Group II: 7262 +/- 10970 pg/ml, p < 0.01, Group III: 1558 +/- 2765 pg/ml, p < 0.01, Group IV: 1076 +/- 2791 pg/ml, p < 0.00l, vs 58 +/- 31 pg/ml. BNP were negatively correlated with MRI RV EF (r: -0.51, p < 0.05) and showed good correlation with TEI index (0.43 +/- 0.18, p < 0.05). After 3 weeks of medical or surgical treatment BNP decreased significantly. 4 patients died during the follow-up period, these had the highest BNP levels in each patients group.. BNP is a useful, prognostically valuable method in children to monitor ventricular function. BNP levels reflect the severity of the impairment of systemic RV function in Senning patients in whom a complex RV geometry is present causing the assessment of RV function more difficult, so we recommend BNP measurements as a longitudinal test in this patient group.

Topics: Adolescent; Adult; Biomarkers; Child; Child, Preschool; Echocardiography; Female; Humans; Infant; Luminescent Measurements; Magnetic Resonance Imaging; Male; Natriuretic Peptide, Brain; Predictive Value of Tests; Severity of Illness Index; Ventricular Dysfunction

Excessive fibrosis contributes to an increase in left ventricular stiffness. The goal of the present study was to investigate the role of connective tissue growth factor (CCN2/CTGF), a profibrotic cytokine of the CCN (Cyr61, CTGF, and Nov) family, and its functional interactions with brain natriuretic peptide (BNP), an antifibrotic peptide, in the development of myocardial fibrosis and diastolic heart failure. Histological examination on endomyocardial biopsy samples from patients without systolic dysfunction revealed that the abundance of CTGF-immunopositive cardiac myocytes was correlated with the excessive interstitial fibrosis and a clinical history of acute pulmonary congestion. In a rat pressure overload cardiac hypertrophy model, CTGF mRNA levels and BNP mRNA were increased in proportion to one another in the myocardium. Interestingly, relative abundance of mRNA for CTGF compared with BNP was positively correlated with diastolic dysfunction, myocardial fibrosis area, and procollagen type 1 mRNA expression. Investigation with conditioned medium and subsequent neutralization experiments using primary cultured cells demonstrated that CTGF secreted by cardiac myocytes induced collagen production in cardiac fibroblasts. Further, G protein-coupled receptor ligands induced expression of the CTGF and BNP genes in cardiac myocytes, whereas aldosterone and transforming growth factor-beta preferentially induced expression of the CTGF gene. Finally, exogenous BNP prevented the production of CTGF in cardiac myocytes. These data suggest that a disproportionate increase in CTGF relative to BNP in cardiac myocytes plays a central role in the induction of excessive myocardial fibrosis and diastolic heart failure.

Topics: Aged; Animals; Cardiomegaly; Cells, Cultured; Connective Tissue Growth Factor; Elasticity; Endomyocardial Fibrosis; Fibrosis; Gene Expression; Humans; Immediate-Early Proteins; Intercellular Signaling Peptides and Proteins; Male; Myocardium; Myocytes, Cardiac; Natriuretic Peptide, Brain; Nephroblastoma Overexpressed Protein; Rats; Rats, Wistar; RNA, Messenger; Stimulation, Chemical; Stroke Volume; Transcription, Genetic; Ventricular Dysfunction

Continuously elevated B-type natriuretic peptide B (BNP) levels are associated with adverse prognosis in heart failure, but this has been less well established in heart transplantation, where medium- to long-term studies are lacking. The purpose of this study was to determine whether BNP levels determined in the first year of transplant have prognostic implications for subsequent outcome.. A retrospective case-control study was carried out in 71 heart transplant patients with a total of 488 biopsies and BNP determinations. Determinations that might raise BNP levels (rejection, high lung pressures, renal dysfunction, depressed ventricular function and graft vascular disease) and those obtained in the first 4 months were excluded. The final analysis included 56 patients with 155 BNP determinations spread over Months 5, 7, 9 and 12. Two groups were made according to the presence of major events after the first year (death, late rejection and ventricular dysfunction associated or not with graft vascular disease): group with events: 13 patients, 37 determinations; group without events: 43 patients, 118 determinations.. There were no differences in the clinical profile of the patients. Mean follow-up was 6 years. Mean BNP was higher in the events group for determinations at Month 5 [event: 140 (95), no events: 68 (68); p = 0.01], Month 7 [event: 174 (32), no event: 66 (65); p = 0.002], Month 9 [event: 143 (37), no event: 58 (54); p = 0.002] and Month 12 [event: 126 (55), no event: 48 (37); p = 0.001]. The receiver-operator characteristic (ROC) curve showed that a BNP value of 100 pg/ml classified patients with a sensitivity of 80% and a specificity of 75% (p = 0.0001).. BNP values determined in the first year of transplant might help to distinguish a sub-group of patients with a higher rate of significant complications in long-term follow-up.

Topics: Adult; Case-Control Studies; Female; Follow-Up Studies; Graft Rejection; Heart Diseases; Heart Transplantation; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Postoperative Period; Predictive Value of Tests; Prognosis; Retrospective Studies; ROC Curve; Sensitivity and Specificity; Time Factors; Ventricular Dysfunction

Topics: Biomarkers; Heart Failure; Heart Valve Diseases; Humans; Natriuretic Peptide, Brain; Peptide Fragments; Protein Precursors; Ventricular Dysfunction

Although tetralogy of Fallot (TOF) can be repaired surgically, residual lesions that cause abnormal ventricular load can eventually lead to heart failure. Subclinical biventricular dysfunction in these patients may be detected only by using suitably sensitive indexes. The Tei index determined by the pulsed Doppler method enables the measurement of left ventricular (LV) and right ventricular (RV) function. This study was designed to evaluate the biventricular Tei indexes in adults with operated congenital heart disease and to correlate these indexes with cardiopulmonary capacity and neurohormonal activation. Fifty-nine patients with surgically corrected TOF and 52 patients with operated left-to-right-shunt defects were included in the study. Patients with TOF showed significantly greater LV and RV Tei indexes than those with left-to-right-shunt defects (LV Tei index 0.50 +/- 0.09 vs 0.34 +/- 0.05, RV Tei index 0.37 +/- 0.1 vs 0.25 +/- 0.06; p <0.0001). Peak oxygen uptake was significantly reduced in the patients with TOF (25 +/- 6 vs 32 +/- 6 ml x kg(-1) x min(-1), p <0.0001) and was correlated inversely with the LV Tei index (r = -0.61, p <0.0001). N-terminal-pro-brain natriuretic peptide was significantly increased in patients with TOF (150 +/- 141 vs 57 +/- 39 pg/ml, p <0.0001). In conclusion, in asymptomatic or minimally symptomatic patients with TOF, biventricular dysfunction is detected by the Tei index. Further indexes for heart failure in these patients are increased circulating plasma N-terminal-pro-brain natriuretic peptide and impaired peak oxygen uptake. The combined determinations of these 3 variables enable the identification of congenital heart disease with impaired cardiac function before they become clinically symptomatic.

Topics: Adult; Echocardiography, Doppler, Pulsed; Exercise Tolerance; Female; Heart Failure; Heart Ventricles; Humans; Male; Multivariate Analysis; Myocardial Contraction; Natriuretic Peptide, Brain; Oxygen Consumption; Peptide Fragments; Prospective Studies; Pulmonary Valve Insufficiency; Sensitivity and Specificity; Stroke Volume; Tetralogy of Fallot; Ventricular Dysfunction

Adiponectin, which is a collagen-like plasma protein produced by adipose tissue, has anti-atherogenic and anti-inflammatory effects. Plasma adiponectin levels in patients with congestive heart failure (CHF) were determined, as well as relationships between the plasma levels of adiponectin and other hormones.. The study group comprised 90 patients with CHF and 20 control subjects, who were divided into 4 subgroups according to New York Heart Association (NYHA) functional class. Plasma levels of adiponectin, tumor necrosis factor (TNF)-alpha and brain natriuretic peptide (BNP) and cardiac hemodynamics were determined. Plasma adiponectin levels were significantly increased according to the severity of NYHA class in the patients with CHF; control: 6.2+/-1.0; NYHA I: 8.5+/-1.9, NYHA II: 12.0+/-2.2, NYHA III: 13.0+/-2.7, NYHA IV: 14.9+/-2.7 microg/ml (p=0.0008). Similarly, plasma BNP levels were significantly increased in accordance with the NYHA class. Plasma adiponectin levels correlated positively with BNP (r=0.40, p=0.0002) and TNF-alpha (r=0.49, p=0.0001), and correlated negatively with cardiac index (r=-0.27, p=0.05). In 24 of 46 patients in the NYHA III and IV subgroups, according to the prompt improvement in cardiac function, levels of both plasma adiponectin and BNP were significantly reduced (p<0.0001).. Plasma adiponectin levels increased according to the severity of CHF and, moreover, they correlated with the plasma levels of BNP and TNF-alpha. These results indicate that augmented release of adiponectin is involved in the pathogenesis of CHF and further study is needed to elucidate its exact role.

Topics: Adiponectin; Aged; Female; Heart Failure; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Tumor Necrosis Factor-alpha; Ventricular Dysfunction

The usefulness of B-type natriuretic peptide (BNP) levels to assess ventricular dysfunction in children and the congenital heart disease population remains largely unknown. We retrospectively analyzed 62 patients with or without known heart disease who had plasma BNP measured for the investigation of new or severity grading of known ventricular dysfunction. BNP levels were significantly higher in patients with ventricular dysfunction (mean 623 +/- 146 pg/ml, range 5 to 5,000) than in patients without ventricular dysfunction (mean 22 +/- 5 pg/ml, range 5 to 63; p <0.01). Using a cutoff of 40 pg/ml, BNP levels detected heart disease associated with ventricular dysfunction at a sensitivity of 85%, specificity of 81%, positive predictive value of 92%, and negative predictive value of 68%. The degree of BNP elevation was also associated with the severity of heart failure and high ventricular filling pressures. Plasma BNP elevation can be a reliable test in children and young adults with various kinds of congenital heart disease resulting in ventricular dysfunction.

Topics: Adolescent; Adult; Biomarkers; Case-Control Studies; Child; Child, Preschool; Female; Heart Defects, Congenital; Humans; Infant; Male; Natriuretic Peptide, Brain; Predictive Value of Tests; Retrospective Studies; Sensitivity and Specificity; Severity of Illness Index; Ventricular Dysfunction

N-terminal brain natriuretic peptide (NT-proBNP) improves emergency room diagnosis of acutely decompensated heart failure. Less evidence is available on the usefulness of NT-proBNP as a prognostic marker after hospitalization for acute heart failure. The percentage of NT-proBNP reduction during admission and its prognostic significance were studied.. This was a prospective study of 74 patients in the emergency department who were diagnosed with acute heart failure and who had follow-up evaluation for 6 and 12 months after admission. Plasma NT-proBNP concentrations were measured on admission, at 24 hours, at day 7, and at 6 and 12 months. Eighteen patients died during the 12-month follow-up; 12 deaths were from cardiovascular causes. NT-proBNP concentrations were significantly higher in the emergency department and at 24 hours than those concentrations that were found at day 7 and beyond (P < .001). During admission, the NT-proBNP concentration fell a mean of 15% in patients who died of cardiovascular causes during the 1-year follow-up evaluation, in 75% in those patients who died of non-cardiovascular causes, and in 50% in survivors (P = .004). The area under the receiver operator characteristic curve for NT-proBNP reduction percentage to predict cardiovascular death was 0.78 (95% CI, 0.66-0.90; P = .002). A 30% NT-proBNP reduction percentage cutoff value had 75% accuracy for the identification of high-risk patients and was the only variable that was associated with cardiovascular death in multivariate analysis (odds ratio, 4.4; 95% CI, 1.12-17.4; P = .03).. NT-proBNP reduction percentage during admission for acutely decompensated heart failure appeared to be the best predictor of cardiovascular death during the follow-up period. A <30% NT-proBNP reduction percentage identified a subgroup of high-risk patients.

Topics: Aged; Biomarkers; Cause of Death; Cohort Studies; Emergency Service, Hospital; Female; Follow-Up Studies; Heart Failure; Humans; Male; Multivariate Analysis; Natriuretic Peptide, Brain; Patient Admission; Peptide Fragments; Predictive Value of Tests; Prognosis; Prospective Studies; ROC Curve; Ventricular Dysfunction

For a further depiction of exercise-induced cardiac dysfunction, N-terminal pro-brain natriuretic peptide (NT-pro-BNP) and cardiac troponin T (cTnT) were measured in recreational cyclists (n = 29) during the Otztal Radmarathon 2004. In all subjects, NT-pro-BNP significantly increased from 28 +/- 21 to 278 +/- 152 ng/L immediately after the race (p <0.001), decreased again on the following day, and returned to baseline values 1 week later. The mean percentage increase in NT-pro-BNP was 1,128 +/- 803%. CTnT, negative in all subjects before the race, increased transiently in 13 athletes (45%), with levels ranging from 0.043 to 0.224 mug/L in 8 of them (28%). One day after competition, cTnT had normalized in all athletes. Because of the typical release of kinetics, the deflection of NT-pro-BNP is considered to be the adequate volume regulatory response of a hemodynamically stressed heart to prolonged strenuous exercise. The observed kinetics of cTnT substantiate a release from the free cytoplasmatic pool due to the half-life of cytosolic cTnT. In healthy cyclists, transient increases in NT-pro-BNP and cTnT are more likely to reflect cardiac fatigue than injury.

Topics: Adult; Bicycling; Biomarkers; Humans; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Reference Values; Retrospective Studies; Troponin T; Ventricular Dysfunction

Measurement of brain natriuretic peptide (BNP) has become a potent diagnostic aid as a means of identifying patients with systolic or diastolic dysfunction. Due to better stability in circulating blood, we reasoned that measurement of N-terminal proBNP (NT-proBNP) may be a more discerning marker for the detection and evaluation of chronic heart failure.. The relationships between plasma concentrations of NT-proBNP and BNP, and aetiology, New York Heart Association (NYHA) classification, and left ventricular ejection fraction (LVEF) were analyzed in 105 patients with chronic heart failure. Sixty-seven healthy volunteers were studied as the controls.. Both NT-proBNP and BNP showed progressive increases (P<0.001) in proportion to the NYHA classification; the increment of NT-proBNP was larger than that of BNP. Elevated NT-proBNP significantly correlated with BNP (r=0.737, P<0.001). Receiver operating characteristics analysis to detect LVEF<40% showed similar values (area under the curve, AUC: NT-proBNP 0.754 vs. BNP 0.770), however, AUC to detect LVEF<50% tended to be greater for NT-proBNP than that for BNP (NT-proBNP 0.820 vs. BNP 0.794).. NT-proBNP may be a more discerning marker for the detection and evaluation of heart failure than BNP.

Topics: Aged; Aged, 80 and over; Biomarkers; Female; Heart Failure; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Nerve Tissue Proteins; Peptide Fragments; Predictive Value of Tests; Ventricular Dysfunction

To evaluate the utility of NT-proBNP in the emergency diagnosis and in-hospital monitoring of patients with acute dyspnoea and ventricular dysfunction.. Misdiagnosis of heart failure (HF) is common in the urgent care setting using clinical diagnostic tests. Reports show that BNP is useful to diagnose HF in patients with acute dyspnoea.. Prospective study of 100 patients attending the Emergency Department (ED) for acute dyspnoea. Final diagnosis was determined on the basis of ED data sheets, echocardiography and pulmonary function tests. NT-proBNP levels were obtained on admission, at 24 h and at day 7.. Patients with ventricular dysfunction were sub-classified into decompensated HF and masked HF, defined as HF with concomitant signs of pulmonary disease. Decompensated and masked HF patients had significantly higher NT-proBNP values than patients with non-cardiac dyspnoea (normal ventricular function) (920+/-140 and 978+/-363 vs. 50+/-15 pmol/L; P<0.001 and P<0.01, respectively). The mean area under the ROC curve for NT-proBNP was 0.957 (95% CI, 0.918 to 0.996, P<0.001). In multiple logistic-regression analysis NT-proBNP>115 pmol/l was the strongest independent predictor of ventricular dysfunction (odds ratio 45.4; 95% CI: 4.5-452.3). At day 7, a significant and similar reduction in NT-proBNP was observed in the two groups of patients with ventricular dysfunction (P<0.001 vs. admission values), but complete clinical resolution was less frequent in masked HF patients (P<0.05 vs. decompensated HF).. NT-proBNP is a new candidate marker for the detection and exclusion of ventricular dysfunction in patients attending the ED for acute dyspnoea. NT-proBNP may also serve to monitor outcome during hospitalization.

Topics: Adult; Aged; Aged, 80 and over; Biomarkers; Critical Care; Dyspnea; Emergency Service, Hospital; Female; Hospitalization; Humans; Male; Middle Aged; Monitoring, Physiologic; Natriuretic Peptide, Brain; Nerve Tissue Proteins; Peptide Fragments; Predictive Value of Tests; Sensitivity and Specificity; Troponin T; Ventricular Dysfunction

Preserved systolic function among heart failure patients is a common finding, a fact that has only recently been fully appreciated. The aim of the present study was to examine the value of NT-proBNP to predict mortality in relation to established risk factors among consecutively hospitalised heart failure patients and secondly to characterise patients in relation to preserved and reduced systolic function.. At the time of admission 2230 consecutively hospitalised patients had their cardiac status evaluated through determinations of NT-proBNP, echocardiography, clinical examination and medical history. Follow-up was performed 1 year later in all patients.. 161 patients fulfilled strict diagnostic criteria for heart failure (HF). In this subgroup of patients 1-year mortality was approximately 30% and significantly higher as compared to the remaining non-heart failure population (approx. 16%). Using univariate analysis left ventricular ejection fraction (LVEF), New York Heart Association classification (NYHA) and plasma levels of NT-proBNP all predicted mortality independently. However, regardless of systolic function, age and NYHA class, risk-stratification was provided by measurements of NT-proBNP. Having measured plasma levels of NT-proBNP, LVEF did not provide any additional prognostic information on mortality among heart failure patients (multivariate analysis).. The results show that independent of LVEF, measurements of NT-proBNP add additional prognostic information. It is concluded that NT-proBNP is a strong predictor of 1-year mortality in consecutively hospitalised patients with heart failure with preserved as well as reduced systolic function.

Topics: Adult; Aged; Aged, 80 and over; Biomarkers; Female; Heart Failure; Hospitalization; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Nerve Tissue Proteins; Peptide Fragments; Prognosis; Risk Factors; Stroke Volume; Survival Analysis; Ventricular Dysfunction; Ventricular Function

Topics: Atrial Natriuretic Factor; Heart Failure; Humans; Natriuretic Peptide, Brain; Ventricular Dysfunction

We investigated the relationship between the urinary levels of biopyrrins and the severity of heart failure (HF).. Oxidative stress is evident in heart disease and contributes to the development of ventricular dysfunction in patients with HF. Biopyrrins, oxidative metabolites of bilirubin, have been discovered as potential markers of oxidative stress.. We measured the levels of urinary biopyrrins and plasma B-type natriuretic peptide (BNP) in 94 patients with HF (59 men; mean age 65 years) and 47 control subjects (30 men; mean age 65 years). Urine and blood samples were taken after admission in all subjects. Further urine samples were obtained from 40 patients after treatment of HF.. The urinary biopyrrins/creatinine levels (micromol/g creatinine) were the highest in patients in New York Heart Association (NYHA) class III/IV (n = 26; 17.05 [range 7.85 to 42.91]). The urinary biopyrrins/creatinine levels in patients in NYHA class I (n = 35; 3.46 [range 2.60 to 5.42]) or II (n = 33; 5.39 [range 3.37 to 9.36]) were significantly higher than those in controls (2.38 [range 1.57 to 3.15]). There were significant differences in urinary biopyrrins/creatinine levels among each group. The treatment of HF significantly decreased both urinary biopyrrins/creatinine levels (from 7.43 [range 3.84 to 17.05] to 3.07 [range 2.21 to 5.71]) and NYHA class (from 2.5 +/- 0.1 to 1.7 +/- 0.1). Log biopyrrins/creatinine levels were positively correlated with log BNP levels (r = 0.650, p < 0.001).. These results indicate that urinary biopyrrins levels are increased in patients with HF and are elevated in proportion to its severity.

Topics: Aged; Bilirubin; Biomarkers; Female; Heart Failure; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Oxidative Stress; Severity of Illness Index; Ventricular Dysfunction

Preclinical systolic or diastolic dysfunction is associated with increased morbidity and mortality. We postulated that plasma brain natriuretic peptide (BNP) might serve as a biomarker for preclinical ventricular dysfunction (PCVD) but that the discriminatory values for BNP may vary with age and sex.. We measured BNP, systolic and diastolic ventricular function, and clinical parameters in 2042 randomly selected residents of Olmsted County, Minn, aged 45 years or older. For preclinical systolic dysfunction, the areas under the receiver operating characteristics curve were higher for those with more severe (0.82 to 0.92) than any (0.51 to 0.74) systolic dysfunction and were similar in men and women and in younger and older persons. For preclinical diastolic dysfunction, the areas under the receiver operating characteristics curve were higher for those with moderate-to-severe (0.74 to 0.79) than any (0.52 to 0.68) diastolic dysfunction and were similar regardless of age or sex. Optimal discriminatory values of BNP varied with age and sex. Considering the prevalence of preclinical systolic or diastolic dysfunction and the predictive characteristics observed, using BNP to screen for PCVD would necessitate echo in 10% to 40% of those screened, with most confirmatory echocardiograms being negative, and would miss 10% to 60% of those affected.. BNP is a suboptimal screening test for PCVD in the population.

Topics: Age Factors; Aged; Aged, 80 and over; Area Under Curve; Biomarkers; Diastole; Early Diagnosis; False Negative Reactions; False Positive Reactions; Female; Humans; Male; Mass Screening; Middle Aged; Minnesota; Natriuretic Peptide, Brain; Predictive Value of Tests; Risk; ROC Curve; Sampling Studies; Sensitivity and Specificity; Sex Factors; Systole; Ultrasonography; Ventricular Dysfunction; Ventricular Function

The aims of this study were to measure the N-terminal fragment of pro-brain natriuretic peptide (proBNP) in plasma in medical conditions commonly found in primary care and to evaluate the utility of these measurements in identifying impaired cardiac function in elderly patients with symptoms associated with heart failure.. We studied 415 patients (221 men and 194 women; mean age, 72 years) who had contacted a primary healthcare center for dyspnea, fatigue, and/or peripheral edema. One cardiologist evaluated the patients in terms of history, physical examination, functional capacity, electrocardiography, and suspicion of heart failure. Plasma N-terminal proBNP was measured by an in-house RIA. An ejection fraction < or =40% by Doppler echocardiography was regarded as reduced cardiac function. Abnormal diastolic function was defined as an abnormal mitral inflow defined as reduced ratio of peak early diastolic filling velocity to peak filling velocity at atrial contraction (E/A ratio), or as abnormal pulmonary venous flow pattern.. Patients with impaired functional capacity, impaired systolic function, and/or impaired renal function had significantly increased N-terminal proBNP concentrations. By multiple regression analysis, N-terminal proBNP concentrations were also influenced by ischemic heart disease, cardiac enlargement, and certain medications but not by increased creatinine. No gender differences were observed. Patients with isolated diastolic dysfunction attributable to relaxation abnormalities had lower concentrations than those with normal cardiac function, whereas those with pseudonormal E/A ratios or restrictive filling patterns had higher concentrations.. Plasma N-terminal proBNP concentrations increase as a result of impaired systolic function, age, impaired renal function, cardiac ischemia and enlargement, and certain medications. Values are high in diastolic dysfunction with pseudonormal patterns, but not in patients with relaxation abnormalities. An increase in plasma N-terminal proBNP might be an earlier sign of abnormal cardiac function than abnormalities identified by currently used echocardiographic measurements.

Topics: Aged; Aged, 80 and over; Cardiomegaly; Diastole; Echocardiography, Doppler; Edema; Family Practice; Female; Heart Failure; Humans; Kidney; Male; Myocardial Ischemia; Natriuretic Peptide, Brain; Protein Precursors; Radiography; ROC Curve; Systole; Ventricular Dysfunction

Cardiac troponin I (cTnI), a sensitive and specific marker of myocardial cell injury, is useful in diagnosing and assessing prognosis in acute coronary syndromes. Small studies report that cTnI is elevated in severe heart failure (HF) and may predict adverse outcomes.. The present study evaluated 238 patients with advanced HF referred for cardiac transplantation evaluation who had cTnI assay drawn at the time of initial presentation. Patients with acute myocardial infarction or myocarditis were excluded from analysis. cTnI was detectable (cTnI > or =0.04 ng/mL) in serum of 117 patients (49.1%). Patients with detectable cTnI levels had significantly higher B-type natriuretic peptide (BNP) levels (P<0.001) and more impaired hemodynamic profiles, including higher pulmonary wedge pressures (P=0.002) and lower cardiac indexes (P<0.0001). A significant correlation was found between detectable cTnI and progressive decline in ejection fraction over time. Furthermore, detectable cTnI was associated with increased mortality risk (RR, 2.05; 95% CI, 1.22 to 3.43). After adjustment for other factors associated with adverse prognosis including age, sex, ejection fraction, and coronary artery disease, cTnI remained a significant predictor of death. cTnI used in conjunction with BNP further improved prognostic value.. cTnI is associated with impaired hemodynamics, elevated BNP levels, and progressive left ventricular dysfunction in patients with HF. cTnI may be a novel, useful tool in identifying patients with HF who are at increased risk for progressive ventricular dysfunction and death.

Topics: Academic Medical Centers; Atrial Natriuretic Factor; California; Chronic Disease; Cohort Studies; Comorbidity; Disease Progression; Female; Heart Failure; Hemodynamics; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Predictive Value of Tests; Prognosis; Risk Assessment; Survival Rate; Troponin I; Ventricular Dysfunction

Brain natriuretic peptide (BNP), a neurohormone secreted from the ventricular myocardium in response to hemodynamic load/wall stress, in congestive heart failure (CHF). This study was performed to evaluate the correlation between BNP level and clinical presentations and hemodynamic parameters obtained by echo-Doppler (echo-Doppler) analysis, and its relation with disease severity and ventricular load/wall stress. CHF patients (n=246) were subgrouped by clinical presentations and echo-Doppler findings into 4 groups: diastolic HF only, chronic HF, acute HF, and chronic HF with acute exacerbation. A BNP level of 81.2 pg/ml showed a sensitivity/ specificity of 53.3%/98.4% for detecting CHF (AUC, 0.882; p < 0.0001), and was found to be closely related with the NYHA classification (p < 0.0001). Log BNP was related with LVEF (r2=0.3015, p < 0.0001) and the Meridional wall stress index (r2=0.4052, p < 0.0001). The difference between the BNP levels of the subgroups and BNP control was significant (p < 0.0001), except between the HF group and the controls; control (n=114, 20.9 +/- 31.4 pg/ml), only diastolic HF (n=84, 89.8 +/- 117.6 pg/ml), chronic HF (n=60, 208.2 +/- 210.2 pg/ml), acute HF (n=28, 477.9 +/- 498.4 pg/ml), chronic HF with acute exacerbation (n= 74, 754.1 +/- 419.2 pg/ml). The BNP level was significantly higher in the only diastolic HF group than in the asymptomatic control group with diastolic dysfunction (89.8 +/- 12.8 vs. 22.8 +/- 5.1 pg/ml, p < 0.0001). BNP may be a good indicator for the differential diagnosis of a broad spectrum of heart failures. And, elevated BNP might help to diagnose diastolic HF in patients with diastolic dysfunction.

Topics: Adult; Aged; Atrial Natriuretic Factor; Echocardiography; Female; Heart Failure; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Prognosis; Ventricular Dysfunction

Topics: Acute Disease; Atrial Natriuretic Factor; Electrocardiography; Heart Failure; Humans; Natriuretic Agents; Natriuretic Peptide, Brain; Physical Examination; Protein Precursors; Ventricular Dysfunction

Topics: Atrial Natriuretic Factor; Biomarkers; Cardiac Output, Low; Humans; Myocardium; Natriuretic Peptide, Brain; Protein Precursors; Ventricular Dysfunction

To investigate the usefulness of measuring plasma concentrations of B type natriuretic peptide in the diagnosis of left ventricular systolic dysfunction in an unselected group of elderly people.. Observational study.. General practice with four centres in Poole, Dorset.. 155 elderly patients aged 70 to 84 years.. Diagnostic characteristics of plasma B type natriuretic peptide measured by radioimmunoassay as a test for left ventricular systolic dysfunction assessed by echocardiography.. The median plasma concentration of B type natriuretic peptide was 39.3 pmol/l in patients with left ventricular systolic dysfunction and 15.8 pmol/l in those with normal function. The proportional area under the receiver operator curve was 0.85. At a cut-off point of 18.7 pmol/l the test sensitivity was 92% and the predictive value 18%.. Plasma concentration of B type natriuretic peptide could be used effectively as an initial test in a community screening programme and, possibly, using a low cut-off point, as a means of ruling out left ventricular systolic dysfunction. It is, however, not a good test to "rule in" the diagnosis, and access to echocardiography remains essential for general practitioners to diagnose heart failure early.

Topics: Aged; Aged, 80 and over; Area Under Curve; Biomarkers; Echocardiography; Humans; Natriuretic Peptide, Brain; Predictive Value of Tests; Radioimmunoassay; Sensitivity and Specificity; Ventricular Dysfunction

A diagnosis of heart failure (HF) can be difficult, especially in patients with mild symptomatology. The purpose of this study was to evaluate the significance of brain natriuretic peptide (BNP) in the diagnosis of HF with systolic or isolated diastolic ventricular dysfunction. One hundred patients and 9 controls were included in the study. Eighty-five patients were diagnosed with HF, based on clinical and echocardiographic findings. BNP levels were accurate for the diagnosis of HF, with an area under the receiver operating characteristic (ROC) curve (AUC) of 0.92. In addition, BNP levels showed an excellent accuracy for the diagnosis of isolated diastolic HF (AUC = 0.89). These data suggest that the measurement of BNP levels may be helpful in the diagnosis of HF and in selecting patients for further evaluation. Furthermore, BNP measurement can play an important role in the diagnosis of isolated diastolic HF.

Topics: Aged; Biomarkers; Blood Flow Velocity; Diagnosis, Differential; Echocardiography, Doppler, Pulsed; Female; Heart Failure; Humans; Male; Middle Aged; Myocardial Contraction; Natriuretic Peptide, Brain; Radioimmunoassay; Reproducibility of Results; Ventricular Dysfunction