B-Type Natriuretic Peptide Blood Concentrations in Differential Diagnosis of Dyspnea and its Association to 6 Minute Walk

BACKGROUND AND OBJECTIVES: This study was performed to, 1) evaluate the diagnostic value of the Brain Natriuretic Peptide (BNP), which is known to be present in the heart ventricle, for patients with dyspnea for the assessing its causes;diastolic or systolic heart failure or pulmonary disease, and 2) find if the BNP is correlated with the distance walked in 6 minutes, which is known to be a prognostic indicator for heart failure. SUBJECTS AND METHODS: Fifty-seven patients who admitted to the Kangbuk Samsung Medical Center, with the chief complaint of dyspnea, were enrolled in the study. The subjects were classified into three groups according to the causes of their dyspnea, which were systolic heart failure, diastolic heart failure and chronic obstructive pulmonary disease. The plasma BNP levels were measured by a radioimmunoassay, both at admission and discharge. The BNP levels at admission were compared among the three groups. The presence of a correlation between the distance walked in 6 minutes and the BNP at discharge were also evaluated. RESULTS: The patients group with systolic heart failure had the highest mean BNP concentration of 934.6+/-386.7 pg/mL. The other two groups had significantly lower levels of BNP. The patients group with chronic obstructive pulmonary disease had significantly lower level than the group with diastolic heart failure (33.2+/-25.6 vs. 181.8+/-222.2 pg/mL). The BNP concentrations at discharge, and the distance walked in 6 minutes, between the three groups showed no statistical significance (p=0.69). CONCLUSION: This study showed that the mean plasma BNP level was highest in the group with systolic heart failure, followed by diastolic heart failure and lastly chronic obstructive pulmonary disease. These findings suggest that diagnostic value of the plasma BNP concentration in the assessment of the causes of dyspnea. Although this study has failed to show a correlation between the plasma BNP concentration at discharge and the distance walked in 6 minutes, prospective cohort studies, with larger sample sizes, need to be performed to establish the relationship, if any.

Hepatitis B virus infection and its relation to cardiovascular risk factors such as lipid profile, hsCRP in Korean adults / 대한내과학회지

BACKGROUND: Among the recent advances in understanding atherogenesis, the "infection hypothesis" is one of the most compelling but remains controversial. Recent experimental and epidemiologic findings suggest that some infectious agents play a role in the development and promotion of atherosclerosis. But very few data are available on the relation between HBV infection and atherosclerosis. We have investigated the possible association between hepatitis B virus surface antigen (HBsAg) positivity and cardiovascular risk factors including hsCRP in healthy Korean adults. METHODS: In 48,423 healthy subjects, the proportion of seropositive subjects for HBsAg and its association with cardiovascular disease risk factors were evaluated in participants in health screening program. Hepatitis B virus infection status was tested with HBsAg test with IRMA (immunoradiometric method) and serum lipid profiles, hsCRP were tested. RESULTS: Of the 48,423 study subjects, 4.5% were positive for HBsAg, indicating that they were hepatitis B virus carriers. In male, HBsAg positive group showed higher mean values for high density lipoprotein (HDL) and lower values for triglycerides, low density lipoprotein (LDL), total cholesterol. They were statistically significant (p<0.001). In female, HBsAg positive group showed higher mean values for high density lipoprotein (HDL) and lower values for triglycerides (p<0.001). In multivariate analysis of covariance (MANCOVA), adjusted by age and other variables, triglyceride, total cholesterol and low density lipoprotein were inversly associated with HBsAg seropositivity in male while only triglyceride and total cholesterol were inversly associated in female. HBsAg seropositivity and other risk factors including hsCRP level which is markers for inflammation were not correlated(p=0.055, p=0.074). CONCLSUION: The result of this study suggest no significant association between hepatitis B infection and hsCRP which is markers for inflammation but possible association with some cardiovascular risk factors such as triglyceride, total cholesterol, HDL, and LDL. Relationship between HBV infection and atherosclerosis has no definitive answer and is disputed issue therefore should stimulate the initiation of further studies to determine whether hepatitis B virus is indeed a causative factor in atherogenesis.