Utility of plasma n-terminal pro brain natriuretic peptide in the assessment of left ventricular systolic dysfunction

The diagnosis of heart failure [HF] is difficult, with both overdiagnosis and underdiagnosis occurring commonly in practice. Echocardiography is a standard technique in the evaluation of left ventricular function. Natriuretic peptides have been proposed as useful markers of left ventricular dysfunction. The aim of the study was to evaluate the utility of plasma amino-terminal pro-brain natriuretic peptide [NT-proBNP] for the detection of left ventricular systolic dysfunction. We measured NT-proBNP in 70 patients referred for cardiac and echocardiographic evaluation due to known symptomatic HF in 20 and high risk for HF in 50 patients. Left ventricular ejection fraction [LVEF] was determined by echocardiography and patients were categorized into 2 groups, patients with LVEF >45% and patients with LVEF<45%. There were 39 patients with LVEF >45% [31 men and 8 women with a mean age of 53 +/- 5.1 years] and 31 patients with LVEF <45% [29 men and 2 women with a mean age of 59 +/- 6.1]. There were no differences between groups regarding age or body mass index. The mean NT-proBNP concentration in patients with LVEF <45% was significantly higher than that in patients with LVEF >45% [1025 +/- 697.5 pg/ml vs. 55 +/- 30.3 pg/ml, p<0.0001]. All patients with LVEF <45% had NT-proBNP value >100 pg/ml and 36 of 39 patients with LVEF >45% had NT-proBNP value <100 pg/ml. Using this cut-off value the NT proBNP was 100% sensitive and 92% specific with negative predictive value of 92% and positive predictive value of 94% for detection of patients with LVEF <45%. Our results suggest that measurement of NT-proBNP with a commercially available diagnostic kit can be reliable for detection of left ventricular systolic dysfunction as indicated by LVEF <45%

Value of thoracic aortic atherosclerosis detected by multiplane transesophageal echocardiography in detection of significant coronary disease

Aortic atherosclerosis [AA] is associated with an increased risk for recurrent ischemic stroke and cardiovascular death and can be diagnosed by transesophageal echocardiography [TEE]. This study was designed to examine whether the detection of AA by multiplane TEE could predict the presence or absence of significant coronary artery disease [CAD]. The study included 64 patients [56 men and 8 women; mean age 55 +/- 11 years] examined by TEE and in whom coronary angiography was performed within 1 month of TEE. All patients were assessed for the identification of AA and the severity of the lesions was graded as follows: grade I = normal when the internal surface was smooth and without lumen irregularities or increased echogenecity; grade II = intimal thickening with increased echodensity but without lumen irregularity; grade III = increased echodensity of the intima with well defined atheroma extending <5 mm in the aorta; grade IV = atheroma >5mm; and grade V = protruding mobile plaques. AA was defined as a lesion with grade III-V changes. Twenty three of the 64 patients [36%] had significant coronary stenosis and 41 [64%] had normal coronary arteries. Twenty nine of 64 patients [45%] had grade IIl-V atherosclerotic lesions in the thoracic aorta. TEE detected grade III-IV atherosclerotic lesions in the thoracic aorta in 19 of the 23 [83%] patients with CAD and in 10 of the 41 patients [24%] without CAD [p<0.01]. Identification of grade III-V AA on TEE had a sensitivity of 83% and a specificity of 76% for detection of CAD. The positive and negative predictive values were 89% and 66% respectively. This study suggests that detection of significant atherosclerotic lesions in the thoracic aorta by multiplane transesophageal echocardiography is useful in identification of significant coronary artery disease and deserves further investigation

Left ventricular structural alterations in treated hypertensives with or without nocturnal fall in blood pressure

The lack of the normal nocturnal fall in blood pressure in hypertensive patients has been suggested to augment target organ damage. The aim of our study was to assess the effects of dipper and non-dipper BP profiles, in treated hypertensives on left ventricular structural alterations. This study included 85 patients with treated hypertension. They were divided into 2 groups, group I included 26 patients with controlled clinic BP and group II, included 59 patients with ucontrolled and resistant BP. All patients underwent 24-hour ambulatory blood pressure [BP] monitoring and echocardiographic examination. Using ambulatory BP measurements patients were classified into dipper and non-dippers in each group. Using echocardiographic measurements of left ventricular [LV] dimensions, LV mass was calculated and indexed for body surface area to obtain the left ventricular mass index [LVMI]. LV hypertrophy [LVH] was diagnosed when LVMI was >110g/m2 in women and >134g/m2 in men. LV relative wall thickness [LVRWT] was calculated with values <0.45 were considered normal for both sexes. LV geometric pattern was estimated according to the relation between LVMI and relative wall thickness. The prevalence of non-dippers was significantly higher in group II [53%] than in group I [31%]. There were no differences in the demographic and metabolic characteristics as well as mean 24-h BP values in dippers and non-dippers in both groups. There was higher prevalence of LVH in group II [37%] compared to group I [19%]. However, the prevalence of LVH was similar in dippers and non-dippers in group I [16% and 25%, respectively] and group II [61% and 65%, respectively]. LVM, LVMI, LVRWT and LV fractional shortening were similar in dippers and non-dippers in both groups. Most patients in group I had normal LV geometry with only 2 patients of each of the dippers and non-dippers showing eccentric LVH. Group II patients had higher incidence of concentric LVH both in dippers and non-dippers [39% and 42 and respectively]. Our results indicate that the non-dipping BP profile, diagnosed on the basis of a single ABPM, in treated hypertensives with or without BP control is not associated with an increase prevalence of LVH or LV geometric alterations

Plasma adrenomedullin levels in patients with non-insulin dependent diabetes mellitus with and without complications

The present study was undertaken to determine plasma adrenomedullin [ADM] levels in patients with non-insulin dependent diabetes mellitus [NIDDM] to elucidate the potential involvement in the pathogenesis of diabetic complications. The patients were 31 males and 29 females with age ranging from 46-72 years [M +/- SD 57 +/- 12], the study were done at Al-Azhar University Hospitals and National Institute of Diabetes and Endocrinology between March 2000 and August 2000. Plasma ADM levels were 49.3 +/- 5.7 pg/ml in control subjects, 54.3 +/- 7.5 pg/ml in NIDDM patients without complications and 65.5 +/- 7.1 pg/ml in NIDDM with complications. Plasma ADM levels were significantly higher in NIDDM patients without complications than controls and in complicated vs non-complicated patients and their levels were not affected by plasma glucose concentrations. Plasma ADM levels increased dependently on the severity of diabetic complications and positively correlated with systolic blood pressure, serum creatinine, urinary excretion of albumin and fall in systolic blood pressure on standing up [sympathetic function]. In contrast, plasma ADM levels were reversely correlated with R-R interval on standing up 30:15 ratio [parasympathetic function] and conduction velocities of left ulnar nerves [peripheral neuropathy]. The results indicated that the increase in plasma ADM levels were closely related to diabetic complications, which may depend on the development of microangiopathy and play a certain role in protection against microvascular disturbance in diabetic patients

Agreement between wall motion abnormalities on echocardiography and perfusion defects on thallium-201 scintigraphy in patients with acute myocardial infarction

This study aimed to compare between wall motion abnormalities detected by echocardiography and myocardial perfusion abnormalities detected by thallium-201 scintigraphy in patients undergoing these investigations after uncomplicated acute myocardial infarction. The study included 20 patients [14 males and six females] who survived acute myocardial infarction. Technically satisfactory echocardiograms and scintigraphic images were obtained in all patients. Resting wall motion abnormalities were detected on echocardiography in 18/20 patients, whereas myocardial perfusion defects on thallium-201 scintigraphy were found in all patients