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.

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.

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.

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.

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.