ABSTRACT
Natriuretic peptides, in particular, brain or B-type, are useful for the assessment of patients presenting with dyspnea to the medical office or emergency department. Levels of natriuretic peptides are useful for assessing prognosis of heart failure or coronary syndrome patients. Less is known about serial peptide measurements for guiding treatment strategies in heart failure. The authors review the uses, pitfalls, and practical points for using natriuretic peptides clinically.
Subject(s)
Cardiac Output, Low/drug therapy , Cardiovascular Agents/therapeutic use , Natriuretic Peptide, Brain/blood , Biomarkers/blood , Cardiac Output, Low/diagnosis , Drug Monitoring/methods , Female , Humans , Male , Natriuretic Peptide, Brain/physiology , Sensitivity and Specificity , Sex Factors , Ventricular Dysfunction, Left/diagnosisABSTRACT
Brain natriuretic peptide (BNP) is a diagnostic marker for left ventricular dysfunction. Sepsis and septic shock are increasing in incidence and mortality. Myocardial dysfunction frequently accompanies severe sepsis and septic shock. Although previously described as a preterminal event, ventricular dysfunction with reduced ejection fraction and biventricular dilatation is present in most patients with severe sepsis and septic shock. In survivors, this depression in cardiac function is reversible over the course of seven to ten days. Even though some prognostic factors have been identified in patients with sepsis-induced myocardial dysfunction, their measurement often includes costly and cumbersome techniques. Thus, there is a need for an inexpensive, simple, rapid and readily available marker to predict mortality in septic shock. At present, a relationship between BNP with myocardial dysfunction in septic shock has not been evaluated. However, growing evidence supports the hypothesis that BNP could be an early predictor of mortality in septic shock. If proven, the hypothesis would have important clinical and public health implications.
Subject(s)
Biomarkers/blood , Natriuretic Peptide, Brain/blood , Shock, Septic/mortality , Ventricular Dysfunction, Left/diagnosis , HumansABSTRACT
The brain natriuretic peptide (BNP) assay is a new, relatively inexpensive, and simple test that has the potential to be an early, cost-effective, and reliable marker for HIV-related cardiomyopathy. We report 1 case of HIV-related cardiomyopathy and 10 cases of of HIV infection with unknown heart disease in which we measured BNP levels and performed echocardiography. We found a significant inverse relationship between BNP and left ventricular function in these patients. Further basic and epidemiologic research on BNP measurement for the detection of HIV-related cardiomyopathy is needed to support these findings, which if confirmed, could have important clinical and public health implications.
Subject(s)
Cardiomyopathies/diagnosis , HIV Infections/complications , Natriuretic Peptide, Brain/blood , Adult , Biomarkers/blood , Cardiomyopathies/blood , Cardiomyopathies/etiology , Case-Control Studies , Echocardiography , Female , Humans , Male , Middle AgedABSTRACT
The use of Human Immunodeficiency Virus (HIV) protease inhibitors as part of the Highly Active Antiretroviral Therapy (HAART) is associated with atherogenic dyslipoproteinemia, insulin resistance, hypertension and endothelial dysfunction, all of which contribute to premature coronary heart disease. These abnormalities appear to be associated with an increase in cardiovascular events in HIV-infected patients. Beneficial metabolic effects of anti-diabetic agents used in HIV-infected patients have been reported. The thiazolidinediones (TZDs), a new group of antidiabetic drugs, may modulate the proliferative and inflammatory cascades involved in atherosclerosis. Thus, an increasing totality of evidence suggests that TZDs may represent a unique and powerful research tool to find a common denominator underlying the pathophysiology and treatment of the metabolic cardiovascular risk factors associated with HIV infection.
Subject(s)
Coronary Disease/drug therapy , Endothelium, Vascular/drug effects , HIV Infections/drug therapy , Thiazoles/therapeutic use , Thiazolidinediones , Animals , Coronary Disease/complications , Coronary Disease/physiopathology , Endothelium, Vascular/physiopathology , HIV Infections/complications , HIV Infections/physiopathology , Humans , Patients/statistics & numerical data , Risk Factors , Thiazoles/pharmacologyABSTRACT
One of the most common and life-threatening cardiovascular complications of HIV-infection is severe global left ventricular dysfunction due to primary heart muscle disease. At present, there is no single, cost-effective and reliable method of identifying the highly prevalent HIV-related cardiac dysfunction. Nonetheless, growing evidence supports the hypothesis that brain natriuretic peptide measurement has the potential to detect patients who develop HIV-related cardiomyopathy. If true, this hypothesis would have important clinical and public health implications.
