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Aim of the Study: Heart failure is a major problem of public health in Morroco , pulmonary congestion is a key sign which can be easly detected by pulmonary sonography via interlobular septal thickening. The aim of this study was to establish a link Between kerley B lines in the lung and signs of pulmonary congestion. In addition to assess the evolution of these parameters in response to diuretic treatment. Materials and Methods: We prospectively evaluate 118 patients who presented to the emergency of IBN Rochd Hospital in Casablanca with sensation of breathlessness at baseline, 7 days, one month and 3 months for kerley B lines, NYHA Class of dyspnea and the levels of NT pro bnp. the duration of this study was 4 months. Results: Kerley B lines were present in 87.4% of patients initially, 67.6% had elevated levels of NT-probnp and 53%,30%,16% had dyspnea Class II, III and IV respectively. Diuretic treatment have shown a similar improvement of kerley B lines, levels of NT pro bnp and the class of dyspnea . In deed after a follow up of 3 month : only 7 % of patients had persistant kerley b lines, NT pro bnp levels were high in only 7.6% these findings were concordant with the clinical symptomatolgy. Hence only 7% of our patients suffered from dyspnea at moderate efforts at the end of the study. Conclusion: We demonstrated in this study a positive correlation between kerley b lines and levels of NT pro-bnp. These findings may facilitate the orientation of patients within the emergency department and help to initiate heart failure treatment rapidely.
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Background: Dyspnoeic in the emergency department with multiple co-morbidities is a diagnostic challenge. Approximately 15-20% of acute dyspneic in the Emergency Department due to ADHF (acute decompensated heart failure) are misdiagnosed. B-type peptide (BNP) and its amino-terminal fragment (NT-proBNP) accurately identify HF in dyspnoeic patients. In the general population with dyspnoea, plasma pro-BNP concentrations are increased in left ventricular dilatation, hypertrophy, systolic dysfunction, or diastolic dysfunction but are unaffected by pulmonary dysfunction. Aims and Objectives: To study the relation between NT pro-BNP & echocardiographic findings in acute dyspnoeic patients, and the relation between NT pro-BNP and In-hospital Mortality. Materials and Methods: Source of data- Patients admitted to the Emergency Room or cardiac intensive care unit with a history of acute dyspnea in a tertiary cardiac care center in south India, meeting inclusion & exclusion criteria, were studied. Results: The study population is predominantly constituted of the elderly population. The most common co-morbid condition was hypertension. The present study uses an NT pro BNP level of 900pg/ml as the cut-off level. 78 patients were positive for the test. Echocardiography showed that 58% had LV systolic dysfunction, 60% had diastolic dysfunction. 42 patients had EF >55%, 10 patients between 55-45%, 33 patients between 44-30% and 15 patients had EF < 30%. Mortality rate was 6% in the whole study population. However, Mortality was seen in only NT pro-BNP positive group it was not statistically significant (p=0.46). Conclusions: NT pro-BNP correlates well with the worsening of LV systolic function; as the EF decreases, NT pro-BNP increases. Increase in NT pro-BNP levels has to be interpreted in the clinical context, and it is not a substitute for echocardiography for assessing cardiac abnormalities and dysfunction.
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Background: To assess association of vitamin D deficiency with cardiac and pulmonary status in infants with acute bronchiolitis. Methods: Infants hospitalized with acute bronchiolitis were enrolled and classified as those with serum 25-hydroxyvitamin D (25-OHD) below or equal and above 20 ng/mL. The primary outcomes were cardiopulmonary involvement defined by elevation of NT-ProBNP, alteration of echocardiographic parameters and respiratory support requirements. The secondary outcomes were the need for PICU admission and duration of hospitalization. Results: 92 (50 males) infants with median (IQR) age of 1 (0.5-3) month were included with median (IQR) serum 25-OHD level 27.4 (11.4-40.3) ng/mL. 43 (47%) patients had serum 25-OHD level below 20 ng/mL with left ventricle dysfunction (P=0.008), right ventricle dysfunction (P=0.008) and pulmonary hypertension (P=0.007) on echocardiography more commonly than those with serum 25- OHD ?20 ng/mL. The median (IQR) serum NT-ProBNP levels were higher in those with low 25-OHD levels than normal 25-OHD levels [2232.2 (461.4-4313.3) and 830.4 (312.7- 2579.5)], respectively (P=0.003). Low 25-OHD levels were associated with increased risk for PICU admission (OR 3.9 (95% CI 1.5-10.1); P=0.004), higher rates of non-invasive ventilation (P=0.048) and mechanical ventilation (P=0.005) and longer duration of hospitalization (P=0.015). Conclusion: Low serum vitamin D level was associated with clinical severity and impaired cardiac and pulmonary status in infants with acute bronchiolitis
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Introduction: Pulmonary Embolism is a major health problemwhich is associated with significant mortality and morbidity. Itis a common and lethal condition. This study was undertakento find the association between NT-Pro-BNP levels and thelocalisation of thrombus in acute Pulmonary Embolism and toprognosticate the patients.Material and methods: Prospective study conducted ata tertiary care hospital.Thirty patients with PulmonaryEmbolism of various etiologies, confirmed with clinicalfeatures, laboratory investigations and imaging and fulfillingthe inclusion and exclusion criteria were included. Aftergetting informed consent, Blood samples for assessmentof NT-Pro-BNP levels were collected within 24 hours ofadmission.Results: In 19 patients, the thrombus was located centrally(in main pulmonary artery) whereas in 11 patients, thethrombus was located in the peripherally (in segmental andsubsegmental pulmonary arteries). 22 participants of thestudy had normal clinical outcome. 5 patients were morbid(oxygen dependant/ heart failure) whereas 3 patients died.Patients with central pulmonary embolus had higher NT-ProBNP levels whereas patients with pulmonary embolus in thesegmental or subsegmental pulmonary arteries had relativelyless NTPro-BNP levels. Patients with high NT-Pro-BNPlevels had complicated in-hospital course/ mortality whereas,patients with relatively lower NT-Pro-BNP had uncomplicatedin-hospital course.Conclusion: This study shows that higher NT-Pro-BNPlevels indicate higher probability of a more central locationof thrombus in pulmonary embolism and also right ventricularoverload. Also patients with higher NT-Pro-BNP levels had acomplicated in hospital course.
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Background: Anthracyclines represent the greatest risk for development of cardiotoxicity. Cardiotoxicity of anthracyclines may develop during the treatment (acute cardiotoxicity) and during the follow-up (chronic and late cardiotoxicity). Natriuretic peptides - Atrial Natriuretic Peptide (ANP), B-type Natriuretic Peptide (BNP) and N-terminal pro B-type natriuretic peptide (NT-pro-BNP) are released by myocardium in response to wall strain and pressure overload. The applicability of natriuretic peptides (ANP, BNP, NT-pro-BNP) as markers for Anthracycline-induced cardiotoxicity has been investigated only in a few studies and there is scarcity of data from India. Aims and Objectives: To observe correlation of NT-pro-BNP levels with cardiotoxicity in patients receiving doxorubicin. Methods and Materials: Eighty patients who were planned for treatment with Doxorubicin > 200 mg/m2 were included in this study. Each patient was assessed clinically (History, Pulse rate, Blood pressure) along with ECG, ECHO and NT-pro-BNP levels prior to initiation of chemotherapy, after completion of 200 mg/m2 of Doxorubicin, 3 months and 6 months after chemotherapy. Result: There were total of 80 patients in the study and they received a total of 384 cycles of Doxorubicin containing regimens according to respective protocols. The median number of cycles was four (range four to six cycles). The mean cumulative dose of doxorubicin was 267.75 mg/m2. As none of the patients developed any cardiac symptoms during or after the planned chemotherapy nor was there a drop in Ejection Fraction on serial ECHO, correlation with BNP levels was not possible. There were 4 patients who had very high values of NT-pro-BNP (>300 pg/ml) and 4 patients with moderate elevation of NT-pro-BNP (200-300 pg/ml) prior to the initiation of chemotherapy. 14 patients had serially increasing values of NT-pro-BNP in the 6 months follow-up. Conclusion: Based on the findings in this study it can be concluded that high upfront BNP values or increasing values of BNP does not correlate with the incidence of acute and early onset chronic cardiotoxicity. Whether or not the BNP values correlate with the incidence of late onset cardiotoxicity can be concluded only with a longer follow-up of these patients.
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@#BACKGROUND. Heart failure is public health burden in developed countries. There are currently 6.5 million adults in the US who heart failure and this number is expected to rise to more than 8 million people by 2030. AHA and ESC recommend natriuretic peptide biomarker-based screening and interventions aimed at modifying risk factors for patients at risk of developing heart failure as these can be useful in prevention of left ventricular dysfunction or new onset heart failure. OBJECTIVE: To investigate the level of NT-proBNP and its association with metabolic risk factors and possible early detection of chronic heart failure in general population. MATERIAL AND METHODS. In the study, 194 participants aged from 35 to 65 were enrolled. We measured metabolic risk factors and level of NT-proBNP of participants. The two group of participants who have positive and negative NT-proBNP results were compared by the metabolic risk factors. RESULTS. NT-proBNP results were positive in 16.49% (n=32) of the participants. The mean values of age, frequencies of hypertension, systolic and diastolic blood pressure significantly increased in participants with positive NT-proBNP results, while mean values of BMI, frequencies of diabetes, total cholesterol and LDL decreased in participants with negative NT-pro BNP results. CONCLUSION: NT-proBNP was positively related to age, arterial hypertension, sistolic and diastolic blood pressure and inversely related to body mass index, obesity, diabetes, cholesterol, LDL.BACKGROUND. Heart failure is public health burden in developed countries. There are currently 6.5 million adults in the US who heart failure and this number is expected to rise to more than 8 million people by 2030. AHA and ESC recommend natriuretic peptide biomarker-based screening and interventions aimed at modifying risk factors for patients at risk of developing heart failure as these can be useful in prevention of left ventricular dysfunction or new onset heart failure. OBJECTIVE: To investigate the level of NT-proBNP and its association with metabolic risk factors and possible early detection of chronic heart failure in general population. MATERIAL AND METHODS. In the study, 194 participants aged from 35 to 65 were enrolled. We measured metabolic risk factors and level of NT-proBNP of participants. The two group of participants who have positive and negative NT-proBNP results were compared by the metabolic risk factors. RESULTS. NT-proBNP results were positive in 16.49% (n=32) of the participants. The mean values of age, frequencies of hypertension, systolic and diastolic blood pressure significantly increased in participants with positive NT-proBNP results, while mean values of BMI, frequencies of diabetes, total cholesterol and LDL decreased in participants with negative NT-pro BNP results. CONCLUSION: NT-proBNP was positively related to age, arterial hypertension, sistolic and diastolic blood pressure and inversely related to body mass index, obesity, diabetes, cholesterol, LDL.
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@#BACKGROUND. Heart failure is the leading cause of the death among non-communicable diseases. Heart failure is a fatal disease that once its clinical symptoms appeared, five years of survival rate is 50-75%. Chronic heart failures are the main risk factors arterial hypertension, diabetes, obesity and dyslipidemia Thus, early diagnosis before its symptoms are presented and treatment with close monitoring is the most rational and effective approach for decreasing heart failure diseases and deaths caused by it. OBJECTIVE. To determine the level of NT-pro BNP in people with high risk of chronic heart failure and assess its results. METHODS. We conducted hospital-based descriptive study at State Second Central Hospital and Bayanzurkh District Medical Center. Total of 100 participants aged from 35 to 64 who had no symptom of chronic heart failure however with high risk were recruited in this study. Based on the document entitled “Heart failure prevention 2008” of the American Heart Association, old age, arterial hypertension, diabetes mellitus, heart attack and obesity were considered as higher risks of heart failure. Risk factors of heart failure were estimated by questionnaire and physical examination. The level of NT-pro BNP in plasma was determined using FIA8000 analyzer. According to the guideline produced by the European Society of Cardiology in 2016, result of the testing is considered “positive” when NT-pro BNP is higher than 125 pg/ml. Risk factors of chronic heart failure were studied in comparison with two groups which were NT-pro BNP positive and negative results and their statistically significant difference were determined. RESULTS. Of 87 participants, 51 (51%) were female and 49(49%) were male. Half of the participants (51%) were aged between 55-64. Arterial hypertension was determined in 88% of the participant, 38% were overdose drink of alcohol, therefore 55% were 1,2,3 levels obesity and 36% were diabetic. When determining the NT-pro BNP level, in 34 cases (34%) were positive. Hence, 31% of the people with arterial hypertension, 9% of the people overdose drink with alcohol, 20% of the people with obesity, 12% of the people with diabetes showed positive results of NT-pro BNP. When studying the risk factors of chronic heart failure of the compared two groups of NT-pro BNP positive and negative results, statistically significant difference (p<0.05) was increased of the with arterial hypertension and obesity. CONCLUSION. NT-pro BNP is the arterial hypertension and obesity which is increasing for people compared to the other risking factors
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Objective To investigate the relationship between the plasma NT-pro BNP level and the hear function in children pa-tients with heart failure.Methods 30 children patients with heart failure and 30 healthy children were selected as the patients group and the control group respectively.The plasma NT-pro BNP level was detected in the patients group before and after treatment and the control group.The changes of heart functional indexes and the clinical symptoms in the patients group were detected,the detec-tion results and the plasma NT-pro BNP levels were performed the correlation retrospective analysis.Results The plasma NT-pro BNP level before treatment in the patients group was significantly higher than that in the control group,there was the statistically significant difference between them(P <0.05 ).After treatment,the clinical symptoms in the patients group were obviously im-proved,the plasma NT-pro BNP level was significantly decreased and LVEF by ultrasound was also increased,the differences were statistically significant(P <0.05).The plasma NT-pro BNP level after treatment in the patients group was obviously higher than that in the control group with statistical difference between them(P <0.05).The plasma NT-pro BNP level before and after treat-ment in the patients group demonstrated a negative correlation with LVEF(r=-1.32,r=-1.78).Conclusion Detecting the plas-ma NT-pro BNP level in children patients with heart failure has the important clinical guidance significance for the diagnosis,disease condition evaluation,prognostic evaluation and cardiac function grading in the children patients with heart failure.
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El objetivo fue comparar los niveles de Pro Péptido Natriurético tipo B-N terminal (Pro-BNP-NT) basales y post reversión en pacientes con fibrilación auricular solitaria (FAS) de comienzo reciente y con función ventricular izquierda conservada. Se determinaron niveles del Pro BNP NT antes y después de su reversión en treinta pacientes con FAS de comienzo reciente y fracción de eyección de ventrículo izquierdo ≥ 50%. Basalmente, los niveles de Pro BNP NT fueron significativamente más elevados respecto a un grupo control sano: 529 pg/ml (157-1763) versus 31.5 pg/ml (24-76), p < 0.0001. Las concentraciones de Pro BNP NT descendieron significativamente luego de la cardioversión de 529 (157-1763) a 318 (98-870) pg/ml, p < 0.001. Los descensos se objetivaron tanto luego de la cardioversión eléctrica como de la obtenida por vía farmacológica, 345 (153-1151) pg/ml a 169 (86-407) pg/ml, p: 0.02 y de 1624 (541-4010) pg/ml a 856 (532-1160) pg/ml, p < 0.001, respectivamente. Este fenómeno se observó fundamentalmente en aquellos con una FAS con duración mayor a 8 horas: 1289 (338-2103) a 410 (169-905) pg/ml, p < 0.001. No se observó correlación entre los cambios de la frecuencia cardíaca y del Pro BNP NT pre y post cardioversión a ritmo sinusal. Se observaron descensos significativos de Pro BNP NT basalmente y post reversión (tanto farmacológica como eléctrica) en pacientes con FA de reciente aparición y función ventricular conservada. Estos descensos fueron más ostensibles a partir de las 8 horas de duración de la arritmia.
Our objective was to evaluate changes of N-terminal pro-BNP (NT-Pro-BNP) levels at baseline and after restoration to sinus rhythm in hemodynamic stable patients with lone atrial fibrillation (LAF) with preserved left ventricular function. NT-Pro-BNP levels were obtained before and after cardioversion in thirty hemodynamic stable patients with LAF and preserved left ventricular function. At baseline levels of NT-Pro BNP levels were significatively higher than a normal control group. NTPro-BNP levels decreased significantly following cardioversion from 529 (157-1763) to 318 (98-870) pg/ml, p < 0.0001. Decreasing of N-terminal pro-BNP concentrations was observed after any mode of cardioversion: electrical or pharmacologic, 345 (153-1151) pg/ml to 169 (86-407) pg/ml, p: 0.02 and from 1624 (541-4010) pg/ml to 856 (532-1160) pg/ml, p < 0.001, respectively. N-terminal pro-BNP decreasing was observed mainly in patients with length of LAF longer than 8 hours: 1289 (338-2103) to 410 (169-905) pg/ml, p < 0.001 but no difference was detected when such length was less than 8 hours: 274 (137-2300) to 286 (82-1440), p = NS. Our study showed that baseline levels of NT-pro-BNP decreased shortly after reversion of patients with LAF to sinus rhythm. This performance occurs predominantly in patients with LAF length of at least eight hours.
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Aged , Female , Humans , Male , Atrial Fibrillation/blood , Natriuretic Peptide, Brain/blood , Peptide Fragments/blood , Ventricular Function, Left/physiology , Atrial Fibrillation/diagnosis , Biomarkers/blood , Prospective StudiesABSTRACT
Objective To evaluate the clinical significance of the changes of plasma B-type natriuretic paprid and NT-pro BNP levels in patients with chronic heart failure(CHF).Methods 120 consecutive patients hospitalized for CHF were retrospectively studied.NT-pro BNP and LVEDD,LVESD,LVEF were measured and compared in 120 patients and 50 normal control subjects before medical treatment and on discharge.Results The plasma NT-pro BNP levels in patients with CHF were significantly higher than controls( P <0.05).The plasma NT-pro BNP levels in patients with cardiac function NYHA Ⅰ were significantly higher than controls( P < 0.05).As the cardiac function deteriorated from NYNA Ⅰ to NYNA Ⅳ,the NT-pro BNP levels increased consecutively with significant differences from each other ( P < 0.05).The plasma NT-pro BNP levels was low when CHF was cured ( P < 0.05 ).Conclusion Determination of plasma NT-pro BNP levels in patients with CHF were helpful to study the severity and prognosis of disease.
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FUNDAMENTO: O NT pro-BNP é marcador de disfunção sistólica e diastólica. OBJETIVO: Determinar os níveis de NT pro-BNP em pacientes com cardiopatia chagásica, hipertrófica, restritiva e afecções pericárdicas, e sua relação com medidas ecocardiográficas de disfunção sistólica e diastólica. MÉTODOS: Cento e quarenta e cinco pacientes foram divididos nos respectivos grupos: 1) cardiopatia chagásica (CCh) - 14 pacientes; 2) miocardiopatia hipertrófica (CMH) - 71 pacientes; 3) endomiocardiofibrose (EMF) - 26 pacientes; 4) derrame pericárdico (DP) - 18 pacientes; 5) e pericardite constritiva (PC) - 16 pacientes. Foi constituído um grupo-controle de 40 indivíduos sem doença cardíaca. O grau de acometimento miocárdico e o derrame pericárdico foram avaliados pelo ecocardiograma bidimensional e a restrição pelo Doppler pulsátil do fluxo mitral. O diagnóstico de PC foi confirmado por meio da ressonância magnética. Os níveis de NT pro-BNP foram medidos por imunoensaio com detecção por eletroquimioluminescência. RESULTADOS: O NT pro-BNP esteve aumentado (p < 0,001) na CCh (mediana 513,8 pg/ml), CMH (mediana 848 pg/ml), EMF (mediana 633 pg/ml), PC (mediana 568 pg/ml), DP (mediana 124 pg/ml), quando comparados ao grupo-controle (mediana 28 pg/ml). Não foram observadas diferenças estatisticamente significativas entre PC e EMF (p = 0,14). No grupo hipertrófico, o NT pro-BNP correlacionou-se com tamanho de átrio esquerdo (r = 0,40; p < 0,001) e relação E/Ea (p < 0,01). No grupo restritivo, houve uma tendência de correlação com pico de velocidade de onda E (r = 0,439; p = 0,06). CONCLUSÃO: O NT pro-BNP encontra-se aumentado nas diversas miocardiopatias e afecções pericárdicas, e apresenta relação com o grau de disfunção sistólica e diastólica.
BACKGROUND: NT pro-BNP is a marker of systolic and diastolic dysfunction. OBJECTIVE: 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. METHODS: 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. RESULTS: 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). CONCLUSION: NT pro-BNP is increased in the different cardiomyopathies and pericardial diseases and is correlated with the degree of systolic and diastolic dysfunction.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Cardiomyopathies/diagnosis , Natriuretic Peptide, Brain/blood , Peptide Fragments/blood , Pericarditis, Constrictive/diagnosis , Ventricular Dysfunction/diagnosis , Biomarkers/blood , Case-Control Studies , Cardiomyopathies/blood , Cardiomyopathy, Hypertrophic/diagnosis , Cardiomyopathy, Hypertrophic/physiopathology , Cardiomyopathy, Restrictive/diagnosis , Cardiomyopathy, Restrictive/physiopathology , Chagas Cardiomyopathy/diagnosis , Chagas Cardiomyopathy/physiopathology , Diastole/physiology , Magnetic Resonance Imaging , Natriuretic Peptide, Brain/physiology , Prospective Studies , Peptide Fragments/physiology , Pericardial Effusion/diagnosis , Pericardial Effusion/physiopathology , Pericarditis, Constrictive/blood , Pericardium , Systole , Ventricular Dysfunction/physiopathologyABSTRACT
PURPOSE: Misdiagnosis of congestive heart failure (CHF) is common in the emergency care setting uses clinical diagnostic tests. The utility of N-terminal probrain natriuretic peptide (NT-(pro)BNP) testing in the emergency department for differentiating between the causes of acute dyspnea and optimal cut-off points for its use are not well established. METHODS: One-hundred-nine consecutive patients with acute dyspnea, who visited our emergency medical center from December 2005 to February 2006, were prospectively recruited. Patients with acute coronary syndrome and chronic renal failure were excluded from study enrollment. The diagnosis of CHF was based on echocardiographic evidence of systolic or diastolic dysfunction. The diagnostic accuracy of NT-(pro)BNP was assessed by receiver operating characteristic curve analysis. RESULTS: The mean age was 69+/-15 years, and 41% of the patients were men. The diagnosis made in the emergency setting was incorrect in 29% of cases. The median NT(pro)BNP level among 45 patients (41%) who had acute CHF was 7739 versus 982 pg/ml for those 64 patients (59%) who did not have acute CHF(p<0.001). The area under the receiver operating characteristic curve was 0.88 (95% CI of 0.83-0.95). At a cutoff of 700pg/ml, NT-(pro)BNP had a sensitivity of 91%, a specificity of 70%, and an overall accuracy of 79% for acute CHF(p<0.001). An NT-(pro)BNP level <400pg/ml was optimal for ruling out acute CHF, which was a negative predictive value of 97%. Increased NT-(pro)BNP was the strongest independent predictor of acute CHF (odds ratio 21, 95% CI 6.1-70.0, p<0.001). CONCLUSION : NT-(pro)BNP appears to be useful as an aid in the diagnosis of CHF in acute dyspnea patients to the emergency department, however, an understanding of the cut-off points is helpful in accurate diagnosis of congestive heart failure.
Subject(s)
Humans , Male , Acute Coronary Syndrome , Diagnosis , Diagnostic Errors , Diagnostic Tests, Routine , Dyspnea , Echocardiography , Emergencies , Emergency Medical Services , Emergency Service, Hospital , Estrogens, Conjugated (USP) , Heart Failure , Kidney Failure, Chronic , Prospective Studies , ROC Curve , Sensitivity and SpecificityABSTRACT
PURPOSE: Misdiagnosis of congestive heart failure (CHF) is common in the emergency care setting uses clinical diagnostic tests. The utility of N-terminal probrain natriuretic peptide (NT-(pro)BNP) testing in the emergency department for differentiating between the causes of acute dyspnea and optimal cut-off points for its use are not well established. METHODS: One-hundred-nine consecutive patients with acute dyspnea, who visited our emergency medical center from December 2005 to February 2006, were prospectively recruited. Patients with acute coronary syndrome and chronic renal failure were excluded from study enrollment. The diagnosis of CHF was based on echocardiographic evidence of systolic or diastolic dysfunction. The diagnostic accuracy of NT-(pro)BNP was assessed by receiver operating characteristic curve analysis. RESULTS: The mean age was 69+/-15 years, and 41% of the patients were men. The diagnosis made in the emergency setting was incorrect in 29% of cases. The median NT(pro)BNP level among 45 patients (41%) who had acute CHF was 7739 versus 982 pg/ml for those 64 patients (59%) who did not have acute CHF(p<0.001). The area under the receiver operating characteristic curve was 0.88 (95% CI of 0.83-0.95). At a cutoff of 700pg/ml, NT-(pro)BNP had a sensitivity of 91%, a specificity of 70%, and an overall accuracy of 79% for acute CHF(p<0.001). An NT-(pro)BNP level <400pg/ml was optimal for ruling out acute CHF, which was a negative predictive value of 97%. Increased NT-(pro)BNP was the strongest independent predictor of acute CHF (odds ratio 21, 95% CI 6.1-70.0, p<0.001). CONCLUSION : NT-(pro)BNP appears to be useful as an aid in the diagnosis of CHF in acute dyspnea patients to the emergency department, however, an understanding of the cut-off points is helpful in accurate diagnosis of congestive heart failure.
Subject(s)
Humans , Male , Acute Coronary Syndrome , Diagnosis , Diagnostic Errors , Diagnostic Tests, Routine , Dyspnea , Echocardiography , Emergencies , Emergency Medical Services , Emergency Service, Hospital , Estrogens, Conjugated (USP) , Heart Failure , Kidney Failure, Chronic , Prospective Studies , ROC Curve , Sensitivity and SpecificityABSTRACT
BACKGROUND: Anemia is known to be one of the important risk factors in the development and the aggravation of cardiovascular diseases. This study was undertaken to evaluate the effect of anemia correction on blood NT-pro BNP level and echocardiographic parameters in ESRD patients on hemodialysis. METHODS: Recombinant human erythropoietin (rHuEPO) was administered in 20 hemodialysis patients (median age 51.5, M:F=2.3:1) with a target hemoglobin>12.0 g/dL for 3 months. All patients were subjected to a serial follow-up of hemoglobin, hematocrit, and NT-pro BNP. Echocardiographic examination was also performed before and after 3 months of therapy. RESULTS: Hemoglobin was increased at 3 months [12.3 g/dL (11.8-13.6)] compared with baseline [9.8 g/dL (9.1-10.4)] (p<0.01), and NT-pro BNP was significantly decreased at 3 months [3415 pg/mL (2717- 8160)] compared with baseline [6371 pg/mL (2338- 18269)] (p<0.05). Echocardiographic examination revealed no significant changes in left ventricular ejection fraction and left ventricular mass index. In Doppler imaging, however, there was significant decrease in E velocity [62.5 cm/sec (52.8-83.5) vs. 57.0 cm/sec (45.0-60.0), p<0.05], thereby decrement in E/E' [15.6 (13.4-25.7) vs. 14.3 (11.5-22.2), p<0.05]. CONCLUSION: Partial correction of anemia with rHuEPO in ESRD patients on hemodialysis results in the reduction of blood NT-pro BNP level and the decrease of E velocity and E/E'.
Subject(s)
Humans , Risk FactorsABSTRACT
BACKGROUND: Anemia is known to be one of the important risk factors in the development and the aggravation of cardiovascular diseases. This study was undertaken to evaluate the effect of anemia correction on blood NT-pro BNP level and echocardiographic parameters in ESRD patients on hemodialysis. METHODS: Recombinant human erythropoietin (rHuEPO) was administered in 20 hemodialysis patients (median age 51.5, M:F=2.3:1) with a target hemoglobin>12.0 g/dL for 3 months. All patients were subjected to a serial follow-up of hemoglobin, hematocrit, and NT-pro BNP. Echocardiographic examination was also performed before and after 3 months of therapy. RESULTS: Hemoglobin was increased at 3 months [12.3 g/dL (11.8-13.6)] compared with baseline [9.8 g/dL (9.1-10.4)] (p<0.01), and NT-pro BNP was significantly decreased at 3 months [3415 pg/mL (2717- 8160)] compared with baseline [6371 pg/mL (2338- 18269)] (p<0.05). Echocardiographic examination revealed no significant changes in left ventricular ejection fraction and left ventricular mass index. In Doppler imaging, however, there was significant decrease in E velocity [62.5 cm/sec (52.8-83.5) vs. 57.0 cm/sec (45.0-60.0), p<0.05], thereby decrement in E/E' [15.6 (13.4-25.7) vs. 14.3 (11.5-22.2), p<0.05]. CONCLUSION: Partial correction of anemia with rHuEPO in ESRD patients on hemodialysis results in the reduction of blood NT-pro BNP level and the decrease of E velocity and E/E'.
Subject(s)
Humans , Risk FactorsABSTRACT
Objective To study the relation between the level of serum carbohydrate antigen-125 (CA125) and heart function as well as the myocardial remodeling in patients with congestive heart failure(CHF). Methods 79 patients with CHF were divided into three groups based on the standard of New York Heart Association Classification. 25 healthy persons were served as control group. Level of CA125 was measured by MEIA. NT-proBNP was detected by Roche Cardiac Reading instrument. TNF-? was measured by radioimmunoassay. Left ventricular mass index (LVMI),left atrial volume index (LAVI) and left ventricular ejection fraction (LVEF) were detected by echocardiography. The levels of CA125,NT-proBNP,TNF-?,LVMI,LAVI and LVEF in different groups were compared.The relationship between CA125 and NT- proBNP,TNF-?,LVMI,LAVI and LVEF was evaluate.Results Levels of CA125,NT-proBNP,TNF-?,LVMI and LAVI in patients with CHF were much higher than those without CHF. The LVEF was much lower in NYHA Ⅲ and NYHA Ⅳ group than that in without CHF and NYHAⅠgroup. Conclusion CA125 was positively associated with the NT-proBNP,TNF-? and LVMI.
ABSTRACT
BACKGROUND: Dyspnea is the subjective symptom that means breathing difficulty or discomfort. Clinical evaluation to etiology of dyspnea in elderly patient may be difficult because of underlying disease and physiological change. NT-pro BNP is noted that is good clinical marker to diagnose congestive heart failure and then evaluated clinical efficiency in elderly dyspnea patients. METHODS: Medical records, echocardiogram and laboratoty result including NT-pro BNP were analysed in elderly patients who were admitted due to dyspnea from January 2004 to July 2005 that were finally diagnosed as systolic or diastolic heart failure and exacerbation of chronic obstructive lung disease. RESULTS: The patents were divided into three groups; group 1(systolic heart failure), group 2(diastolic heart failure), group 3 (exacerbation of chronic obstructive lung disease). The mean age and study number were 78.5+/-7.7 yrs(group 1; 24), 79.0+/-8.0 yrs(group 2; 22), 73.8+/-6.7 yrs(group 3; 18). The ejection fraction and left atrial size of group 1, 2, 3 were 42.9+/-7.5%, 69.7+/-9.1%. 66.19.5%(p<0.001) and 4.2+/-0.9 cm, 4.6+/-1.0 cm, 3.7+/-0.7cm(p=0.005). The value of NT-pro BNP were 12912.0+/-13179.9 pg/mL(group 1), 2842.8+/-2014.8pg/mL(group 2) and 168.2+/-148.8pg/mL(group 3)(p<0.001). CONCLUSION: NT-pro BNP can be used to evaluate etiologic disease as systolic heart failure in elderly patients who complain dyspnea as like echocardiogram although more large study is needed to evaluate clinical significance of NT-pro BNP.