ABSTRACT
As has been proven, increase of mechanical strain could result in an increase of brain natriuretic peptide (BNP) in the blood stream of implanted patient pacemakers. We measured the BNP concentration in blood due to different mode and lead implantation location of pacemaker in the time period of 3 months. The aim of this study was to investigate the changing trend of BNP level after pacemaker implantation. One hundred and three pacemaker implanted patients were monitored. Patients were in the age span of 54±12 years, including 48 men and 55 women. A group of 44 were programmed in Dual Chamber Rate Adaptive (DDDR) Pacemaker mode and a group of 59 were programmed in Ventricular Rate Modulated Pacing (VVIR) mode by the recommendation of the cardiologist. Between these two groups, the pacing levels of pacemakers was divided to under and above 50%. Some of these pacemaker leads were located at the apex of the right ventricle and the others were located in the septum wall in the right ventricle. To evaluate BNP changes during a period of 3 months, the BNPs were measured in pg/ml within 24 h of implantation (BNP1) and after 3 months (BNP2). For different classes of pacemaker implantations, the ratio of final measurement (BNP2) is divided to after implantation measurements (BNP1). Results showed that in VVIR mode, the ratio is 1.54±0.3 and in DDDR mode, the ratio is 0.38±0.17, with acceptable standard error means (<0.04). Also, comparisons are made for lead location at two modes of DDDR and VVIR separately. In the DDDR mode, the ratio for apex location is 0.49±0.12 and for septum location is 0.22±0.34, with acceptable standard error means (<0.02). In the VVIR mode, the ratio for apex location is 1.71±0.27 and for septum location is 1.28±0.09, with acceptable standard error means (<0.04). Therefore, BNP decrease in DDDR mode is more than in VVIR mode programming. In both cases of DDDR and VVIR modes, the septum location of the leads would result in a greater decrease of BNP.
ABSTRACT
To evaluate the effect of albumin serum levels and C-reactive protein (CRP) on the course of dialysis induced hypotension (DIH) in chronic hemodialysis (HD) patients, we studied 58 chronic hemodialysis patients in our center during 2007. We investigated the correlation between serum albumin, highly sensitive CRP (hs-CRP) and DIH. The mean of the serum albumin levels was 4.2 +/- 0.5 g/dL, and 32.8% of the patients revealed hypoalbuminemia. Occurrence of DIH among HD patients was 27.6%. The mean of serum albumin levels in the DIH group was significantly lower compared with the normotensive group (3.9 +/- 0.4 vs 4.3 +/- 0.5 g/dL, respectively, P= 0.008). The mean of the hs-CRP levels was significantly higher in the DIH group compared with the normotensive group (12.9 +/- 12 vs. 7.2 +/- 5.2 mg/dL, respectively, P= 0.01). We conclude that high level of CRP and hypoalbuminemia may be predictors of DIH.
