Is Portable Cardiopulmonary Ultrasound the Future of Heart Failure Diagnosis?

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.

2D Echocardiographic Findings, NT-ProBNP Levels, and Outcomes in Dyspnoeic Patients: Results from the Pro-BNP Investigation of Dyspnoea in the Emergency Department- a Single Centre Experience

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.

Vitamin D Levels and Cardiopulmonary Status in Infants With Acute Bronchiolitis

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

N-terminal pro brain natriuretic peptide as a marker of myocardial dysfunction in newborns with perinatal asphyxia

Background: Perinatal asphyxia refers to a condition during first and second stage of labour in which impaired gas exchange leads to foetal hypoxemia. Perinatal asphyxia causes cardiac dysfunction in 24 to 60 percent of the cases. The reduced cardiovascular reserve is associated with hypoxic brain damage and has high impact on neonatal mortality and adverse neurological outcomes. It has been challenging to diagnose myocardial dysfunction in resource constraint setting. Aim and objective of this study was to Determine N-Terminal Pro BNP concentrations in perinatal asphyxia and correlate with modified Sarnat stages of hypoxic ischemic encephalopathy.Methods: Among 120 Neonates admitted in neonatal intensive care unit with diagnosis of perinatal asphyxia were considered for the study. 2mL of venous blood drawn within 48hours of life was analyzed for quantitative N-Terminal Pro BNP and was correlated with modified Sarnat stages of hypoxic ischemic encephalopathy.Results: A Total of 120 cases of perinatal asphyxia were considered for the study, among which 44 cases had HIE stage 1, 48 had HIE stage 2 and rest 28 had HIE stage 3. The mean and standard deviation of N-Terminal Pro BNP concentrations in stage 1 was 1,502.86'3,581.170 pg/mL, stage 2 was 4,916.31'8,001.674 pg/mL and stage 3 was 8,912.41'13,927.152 pg/mL with significant p value of 0.003.Conclusions: Early N-Terminal Pro BNP concentrations may provide a useful marker for the anticipated severity of myocardial dysfunction.

Association of N-terminal-Pro-B-type Natriuretic Peptide with Localization of Thrombus and Clinical Outcome in Acute Pulmonary Embolism

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.

Changes of serum NT-pro BNP and Lp (a) levels in patients with acute mocardial infarction after emergency PCI and their clincal significances / 吉林大学学报(医学版)

Objective: To investigate the changes of the levels of amino-terminal pro-brain natriuretic peptide (NT-pro BNP) and lipoprotein a [Lp (a)], and to clarify the relationships between the severity of coronary artery lesions and the prognosis in the patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCD. Methods: A total of 316 AMI patients underwent emergency PCI were selected. According to the number of stenosed coronary vessels, the patients were divided into single-vessel disease group (n=135), double-vessel disease group (n= 99) and three-vessel disease group (n=82). According to the Gensini score, there were 79 cases in 83. 00 group. The patients' general data, biochemical parameters, echocardiography results, and coronary angiography findings were recorded, and the major adverse cardiovascular events (MACE) were also recorded during a 12-month folow-up. The relationships between the serum NT-pro BNP and Lp (a) levels of the AMI patients in different lesion counts and Gensini scores, and the recent Accurrence of MACE were analyzed. The receiver operating characteristic (ROC) curve was drawn to investigate the values of NT-pro BNP and Lp (a) levels on predicting the recent MACE in the patients with AMI. Results: The serum NT-pro BNP levels of the patients in three-vessel disease group and double-vessel disease group were higher than that in single-vessel disease group (P< 0.01); the serum Lp (a) level of the patients in three-vessel disease group was higher than that in single-vessel disease group (P<0.05). According to Spearman correlation analysis, there were positive correlations between the serum NT-pro BNP level, Lp (a) level of the AMI patients and the number of coronary vessels (r=0.285, P< 0.01; r=0.144, P=0.010); there were positive correlation between the serum NT-pro BNP level, Lp (a) level and Gensini score of coronary lesions (r=0.156, P=0.006; r=0.164, P=0.003). The serum NT-pro BNP and Lp (a) levels of the patients with MACE during follow-up were higher than those in the patients without MACE. The ROC curve showed that the area under the curve (AUC) of the levels of serum NT-pro BNP and Lp (a) was 0.747 (95%CI: 0.679-0.814). Conclusion: The serum NT-pro BNP and Lp (a) levels have the certain relationships with the severity of coronary artery lesions in the AMI patients after PCI. The simultaneous detection A serum NT-pro BNP and Lp (a) levels has certain predictive value for the recent Accurrence of MACE in the AMI patients underwent emergency PCI.

The correlation of doxorubicin related cardiotoxicity with B-type natriuretic peptide levels in South Indian population

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.

Study of cardiac manifestations in patients with chronic liver disease

Background: Chronic liver disease is a common cause of mortality and morbidity worldwide. This has pathological effects on various systems in the body including cardiovascular system which usually is unnoticed. In majority of cases of chronic liver disease, cardiovascular complications develop as a subclinical condition which manifests only during stressful situations. Hence early detection of cirrhotic cardiomyopathy by echocardiography and 2D-ECHO studies in all patients of chronic liver disease helps in reducing the morbidity and mortality.Methods: 100 cases of chronic liver disease were included in the study. Data was collected through a prepared proforma. All patients were subjected to cardiac evaluation by ECG and Echocardiography. Serum pro-BNP levels were done for selected patients. Severity of the liver disease was assessed by using Child-Pugh score. Cardiac abnormalities were noted and correlated with the severity of the liver disease.Results: Out of 100 patients studied, 83% were males. 80% of the patients had history of alcoholism. 59% of the patients had abnormal ECG finding. 40% of them had QT prolongation and was related to the severity of liver disease. 60% of the total patients studied had positive pro-BNP values in patients with significant cardiac dysfunction. 46% of the patients had normal echocardiographic finding; most common abnormal finding was diastolic dysfunction (43%) and positively correlated with severity of liver disease.Conclusions: In chronic liver disease patient’s QT prolongation is the most common ECG abnormality. Most common Echocardiographic finding was diastolic dysfunction which had strong correlation with the severity of the liver disease.

N-TERMINAL PRO-BRAIN NATRIURETIC PEPTIDE AND METABOLIC RISK FACTORS / Шинэ санаа Шинэ нээлт

@#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.

Effects of Super-Ultramarathon Races (622 km) on Cardiac Bio-Markers and Markers of Muscle Damage / 대한스포츠의학회지

PURPOSE: Changes in serum biomarkers of cardiac and muscle damage have been studied in ultra-marathon runners for distances up to 308 km. We investigated these biomarker changes following a 622-km super-ultramarathon race. METHODS: A group of men with a mean age of 52.7±4.8 years participated. Blood samples were obtained pre-race, during the race, and post-race, to analyze the aforementioned biomarkers. RESULTS: Creatine kinase and creatine kinase-MB (CK-MB) levels increased during the race, and both steadily declined post-race with CK-MB declining at a slower rate. Lactic acid dehydrogenase levels overall were increased over pre-race levels. White blood cell counts increased during the race. Red blood cell decreased from pre-race to 300 km and 622 km. Platelet increased only in the recovery period. High-sensitivity C-reactive protein levels were increased throughout the race and at day 3 compared to pre-race levels. Cardiac troponin I (cTnI) levels increased during the race. N-terminal pro b-type natriuretic peptide (NT-proBNP) levels increased during the race. CONCLUSION: The rise in cTnI was not clinically significant, and highly elevated NT-proBNP levels during the race indicates that myocardial burden rose linearly as running distance increased. However, no clinical risk was found as most of the markers returned to normal range during the recovery.

НАТРИ ХӨӨГЧ ПЕПТИД БА ЗҮРХНИЙ АРХАГ ДУТАГДЛЫН ЗАРИМ ЭРСДЭЛТ ХҮЧИН ЗҮЙЛСИЙН ХАМААРАЛ / Шинэ санаа Шинэ нээлт

@#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

Clinical outcomes of tetralogy of Fallot with restrictive right ventricle physiology after repair / 中国小儿急救医学

Objective To evaluate the risk factors,diagnostic index of the restrictive right ventricle physiology(rRV) and the impact of the mid-term outcome of the patients.Methods Eighty patients(30 in rRV group and 50 in non-rRV group) undergoing TOF repair admitted in our department from Oct 2011 to May 2012 were studied.Perioperative clinical data were collected and echo data were recorded after operation.Mixed linear regression for repeated measures was used to compare the variables and analyze the correlations.Results Patients in rRV group were younger with longer cardiopulmonary bypass(CPB) time,aortic cross clamp time,ventilation time,intensive care unit and hospital stay compared with those in non-rRV group(P<0.01,respectively).The younger patients with longer CPB time had high risk of rRV by logistic regression analysis.Within 7 days post operation,the increase of saturation of venous oxygenation and decrease of oxygen extraction ration were slower in rRV group than those in non-rRV group(P<0.05,respectively).Lactate decreased in both groups,but was higher in rRV group throughout the 7 days(P=0.03).NT-proBNP was higher in rRV group throughout the 7 days than that in non-rRV group.NT-proBNP≥4750pg/ml often indicated the patients in the state of rRV.CRP slightly increased in 1-2 days post operation,and decreased thereafter,and the decrease was slower in rRV group(P=0.08).With regard to the mid-term outcome,there was no significant differences in the incidences of the obstruction of the right ventricle outflow and main pulmonary artery,the stenosis of the branch of pulmonary artery and the degree of the pulmonary valve regurgitation.Conclusion rRV is associated with significantly higher levels of NT-proBNP and CRP.The incidence of rRV correlates with age on operation and positively correlates with CPB time.NT-proBNP would be regarded as an indicator of the incidence of rRV.The study indicated the rRV would have impact on the early outcome of the patients but there was no significant effect on mid-term outcome.

Study on correlation between plasma NT-pro BNP level and heart function in children with heart failure / 国际检验医学杂志

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.

Surrogates of Poor Prognostic Sign in Adult Patients with Homozygous Sickle Cell Disease: An Echocardiographic Study.

Background: Pulmonary Arterial hypertension (PAH) is a late complication in adult patients with homozygous sickle cell Anaemia (SCA). The early identification of PAH may be of paramount importance. Aim: This study is aimed at evaluating the usefulness of NT pro BNP in the assessment of diastolic function of RV in adult patients with sickle cell disease. It is also aimed at the assessment of the predictive risk of serum level of NT pro BNP hormone and ferritin with other pulsed and tissue Doppler indices for the development of pulmonary hypertension in patients with SCA. In addition, we measured the usefulness of tissue Doppler velocity of lateral annulus of tricuspid valve in the assessment of diastolic function of RV in adult patients with SCD. Method: In this cross sectional prospective study, 103 patients with homozygous SCD were studied and compared with age and gender matched healthy control. Every patient had a clinical assessment, pulsed and tissue Doppler evaluation. Blood samples were withdrawn for the level of haemoglobin, ferritin and NT pro BNP hormone. The mean Original Research Article British Journal of Medicine & Medical Research, 4(26): 4431-4443, 2014 4432 difference between the two groups for echo Doppler and biometric variables were assessed. Multiple regression analysis applied for measuring the odds ratio of different biometric and Doppler variables for risk of PAH in SCD. Results: The study group consist of 103 patients with SCA, mean age of 28.52±14.11 year, (range 14-42), with 68 male (66.0%) Patients with SCA compared with control had a significantly low diastolic pressure, lower haemoglobin level but high serum level ferritin and pro BNP hormone. Further, there was a significant increment in the left atrium area (LA), higher right ventricle (RV) wall thickness and diameter. The RV tricuspid annular systolic excursion (TAPSE) was high of 1.42±0.21 vs. 1.11±0.23, P<0.05. RV Pulsed Doppler data showed restrictive filling pattern with significant higher E wave velocity, higher early diastolic filling wave (E)/ atria wave velocity (A) ratio and short Deceleration Time (DT). Further, the ratio of upper pulmonary vein for systolic/diastolic Doppler velocity was significantly lower 1.5±0.12 vs.2.4±0.11, p<0.05. The tissue Doppler of lateral annulus of tricuspid valve in SCA patients showed a significantly lower S wave of 6.7±1.7 vs 11.3±1.9, p<0.01, higher pulsed early velocity( E)/ early Tissue velocity (E-) ratio and lower atria wave velocity (A). The incidence of pulmonary hypertension in SCD patients via tricuspid valve velocity defined as ≥2.5 m/s was 28%. There were positive correlation between the serum level of ferritin, NT pro BNP hormone and tricuspid valve velocity of (r= 0.38) and (r=0.43) respectively. The odds ratio for development of PAH was 3.1 for E/E- ratio ≥13, 2.5 for DT of <160msec, 2.2 for Left ventricle mass Index (LVMI)>121 gm/M2, 1.9 for ferritin ≥600g/l, 1.6cm for left atrial area ≥20cm, 1.3 for pro- BNP ≥150Pmol/L. Conclusion: Adult patients with SCA have normal Systolic function but increase of LV mass and restrictive diastolic dysfunction. RV has increase wall thickness, systolic and diastolic dysfunction of restrictive pattern. The prevalence of pulmonary hypertension in SCA is 28% with positive correlation between ferritin, pro BNP level and tricuspid valve velocity on echo. The risk of PAH in SCA patients is higher if the patient had on echo DT <160msec, LVMI >121gm/M2, cm, E/E- ratio ≥13 or RV wall thickness >3mm.

Association of levels of N-terminal-pro-B-type natriuretic peptide with localisation of thrombus in acute pulmonary embolism.

Background and objectives. Brain-natriuretic peptide (BNP) is a potent natriuretic, diuretic hormone that is released from heart into the circulation. We aimed to investigate whether N-terminal-pro-BNP (pro-BNP) could predict localisation of thrombus in patients with acute pulmonary embolism. Methods. Emergency patients found to have thrombosis in the pulmonary artery on helical computed tomography were enrolled. The thrombi which were localised in the main/right or left pulmonary artery were classified as central and those at segmentary/sub-segmentary levels as peripheral. The patients were evaluated by an echocardiogram and pro-BNP levels were measured. Results. Forty-nine patients were enrolled. The thrombus was unilateraly located in 63.3 percent patients and peripherally in 81.6 percent. The difference in pro-BNP levels between those with central and peripheral thrombi was significant (p<0.05). Pro-BNP levels of patients with and without evidence of right ventricular overload (pulmonary hypertension, right heart dilatation, interventricular septal hypokinaesia) were also significantly different (respectively, p<0.001, p<0.01, p<0.01). The pro-BNP levels of patients who were followed up in the intensive care unit and needed thrombolytic treatment were significantly higher (respectively p<0.001, p<0.01). Conclusions. Higher pro-BNP levels indicate higher probability of more central location of thrombus, resulting in a more adverse clinical course. Further studies are needed to determine the predictive values of pro-BNP levels for localisation of pulomnary embolus.

Descenso de los niveles de propéptido natriurético de tipo B-N terminal luego de la reversión de pacientes con fibrilación auricular y función ventricular conservada / NT-Pro-BNP levels performance before and after reversion to sinus rhythm in patients with preserved ventricular function

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.

Valne of BNP and NT-Pro BNT testing in diagwsis of heart failure / 中国基层医药

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.

Cardiac response to exercise in mild-to-moderate chronic obstructive pulmonary disease / 老年心脏病学杂志（英文版）

Objective Chronic obstructive pulmonary disease (COPD) increases the risk of cardiovascular problem.The symptom of dyspnea on exertion may be associated with pulmonary dysfunction or heart failure, or both. The study objective was to determine whether cardiac dysfunction adds to the mechanism of dyspnea caused mainly by impaired lung function in patients with mild-to-moderate COPD. Methods Patients with COPD and healthy controls performed incremental and constant work rate exercise testing. Venous blood samples were collected in 19 COPD patients and 10 controls before and during constant work exercise for analysis of N-terminal-pro-BNP (NT-pro-BNP). Results Peak oxygen uptake and constant work exercise time (CWET) were significantly lower in COPD group than in control group (15.81±3.65 vs 19.19a±6.16 ml/min kg, P=0.035 and 7.78±6.53 rain vs 14.77±7.33 min, P=0.015, respectively). Anaerobic threshold, oxygen pulse and heart rate reserve were not statistically significant between COPD group and control group. The NT-pro-BNP levels both at rest and during constant work exercise were higher in COPD group compared to control group, but without statistical significance. The correlations between CWET and NT-proBNP at rest or during exercise in patients with COPD were not statistically significant. Conclusions Heart failure does not contribute to exercise intolerance in mild-to-moderate COPD.

Níveis séricos de NT pro-BNP: relação com função sistólica e diastólica nas miocardiopatias e pericardiopatias / Serum NT pro-BNP: relation to systolic and diastolic function in cardiomyopathies and pericardiopathies

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.

Elevated radial arterial augmentation index in hypertensive patients with diastolic dysfunction / 老年心脏病学杂志（英文版）

Objective To investigate the correlation between augmentation index (AI) of the radial artery and diastolic heart function in patients with hypertension.Methods Echocardiographs were obtained for 305 patients with hypertension.AI,pulse wave velocity (PWV) of peripheral arteries and serum pro-brain natriuretic peptide (proBNP) levels were determined.Correlations and receiver operating characteristic (ROC) curves were drawn between AI values and impaired diastolic function.Results AI levels were significantly increased in patients with impaired diastolic function diagnosed by ultrasound.Assessment of diastolic heart function based on proBNP levels revealed that AI and aortic pulse wave velocity were significantly elevated in patients with impaired diastolic function.The operating curve indicated that AI may be a more accurate and efficient index for the evaluation of impaired diastolic function compared to pWV.Correlation analysis also showed that proBNP levels had altered in parallel with changes in AI and PWV.After adjusting for various factors including age,gender,blood pressure and blood lipid,a positive correlation was observed between proBNP and AI with a correlation coefficient of 0.3697 (P =0.003).However,no correlation between proBNP and aortic PWV was seen after adjustment.Conclusions Changes in radial AI levels may reflect parallel changes in diastolic cardiac function in patients with hypertension,suggesting that AI may be utilized as a non-invasive clinical indicator of diastolic heart function.