[Urinary NT-proBNP level: relationship with ventricular function parameters in heart failure]. / NT-proBNP en orina y su relación con los parámetros de la función ventricular en la insuficiencia cardiaca.

INTRODUCTION AND OBJECTIVES: The plasma N-terminal probrain natriuretic peptide (NT-proBNP) level is a sensitive marker of ventricular dysfunction. The diagnostic and prognostic value of urinary NT-proBNP measurement has been demonstrated. The objective of this study was to determine the relationship between established parameters of ventricular function and the urinary NT-proBNP level. METHODS: The study involved 74 patients with heart failure (54 male, age 66 [12] years). A Doppler echocardiographic study was performed to measure atrioventricular plane displacement (AVPD), ejection fraction, mitral flow propagation velocity, and E/A. Urinary and plasma NT-proBNP levels, and the plasma aldosterone level were measured. RESULTS: In the whole group, the plasma NT-proBNP level was 948 (961) pg/mL, the urinary NT-proBNP level was 88.7 (17.8) pg/mL, and the aldosterone level, 165 (145) pg/mL. There were correlations between urinary NT-proBNP level and AVPD (r=-0.5; P< .0001), ejection fraction (r=-0.3; P< .01), and mitral flow propagation velocity (r=-0.24; P< .05). On dividing AVPD and ejection fraction measurements into quartiles, respectively, the urinary NT-proBNP levels for these quartiles were Q1: 103 (28) pg/mL, Q2: 89 (9) pg/mL, Q3: 86 (9) pg/mL, and Q4: 78 (9) pg/mL (P< .0001) and Q1: 101 (26) pg/mL, Q2: 85 (12) pg/mL, Q3: 83 (10) pg/mL, and Q4: 85 (11) pg/mL (P< .05), respectively. Multiple linear regression analysis showed that the plasma NT-proBNP level was an independent predictor of the urinary NT-proBNP level (P< .0001). When the plasma NT-proBNP level was excluded, AVPD and ejection fraction appeared as alternative independent predictors (P< .05). CONCLUSIONS: There is a correlation between the urinary NT-proBNP level and left ventricular function parameters. This study supports the use of the urinary NT-proBNP level as a biochemical marker of ventricular function in heart failure patients.

NT-proBNP en orina y su relación con los parámetros de la función ventricular en la insuficiencia cardiaca / Urinary NT-proBNP level: relationship with ventricular function parameters in heart failure

Introducción y objetivos. La concentración plasmática de N-terminal propéptido natriurético cerebral (NT-proBNP) es un marcador sensible de disfunción ventricular. Se ha demostrado el valor diagnóstico y pronóstico de sus concentraciones urinarias. Nuestro objetivo es determinar la relación entre parámetros consolidados de la función ventricular y concentraciones urinarias de NT-proBNP. Métodos. Hemos estudiado 74 pacientes diagnosticados de insuficiencia cardiaca (54 varones, edad 66 ± 12 años). Se les realizó un estudio eco-Doppler y se determinaron el desplazamiento del plano auriculoventricular (DPAV) (mm), la fracción de eyección (FE), la velocidad de propagación del flujo mitral (Vp) (cm/s) y la relación E/A. Se midieron las concentraciones plasmáticas y urinarias de NT-proBNP y las de aldosterona (pg/ml). Resultados. Para toda la población, los valores plasmáticos de NT-proBNP fueron 948 ± 961 pg/ml, los urinarios 88,7 ± 17,8 pg/ml y los de aldosterona 165 ± 145 pg/ml. Correlacionamos las concentraciones urinarias de NT-proBNP con el DPAV (r = -0,5; p < 0,0001), la FE (r = -0,3; p < 0,01) y con Vp (r = -0,24; p < 0,05). Dividimos los valores de DPAV y FE en cuartiles y en cada uno calculamos el NT-proBNP urinario (C1: 103 ± 28, C2: 89 ± 9, C3: 86 ± 9, C4: 78 ± 9; p < 0,0001 y C1: 101 ± 26, C2: 85 ± 12, C3: 83 ± 10, C4: 85 ± 11; p < 0,05). Al realizar un análisis de regresión lineal múltiple se muestra que NT-proBNP plasmático es un factor pronóstico independiente de NT-proBNP urinario (p < 0,0001). Si excluimos el NT-proBNP plasmático surgen de manera alternativa, como factores pronóstico independientes, el DPAV y la FE (p < 0,05). Conclusiones. El NT-proBNP en la orina se correlaciona con parámetros de función del ventrículo izquierdo. Este estudio da soporte al papel del NT-proBNP urinario como marcador bioquímico de la función ventricular en pacientes con insuficiencia cardiaca (AU)

Introduction and objectives. The plasma N-terminal probrain natriuretic peptide (NT-proBNP) level is a sensitive marker of ventricular dysfunction. The diagnostic and prognostic value of urinary NT-proBNP measurement has been demonstrated. The objective of this study was to determine the relationship between established parameters of ventricular function and the urinary NT-proBNP level. Methods. The study involved 74 patients with heart failure (54 male, age 66 [12] years). A Doppler echocardiographic study was performed to measure atrioventricular plane displacement (AVPD), ejection fraction, mitral flow propagation velocity, and E/A. Urinary and plasma NT-proBNP levels, and the plasma aldosterone level were measured. Results. In the whole group, the plasma NT-proBNP level was 948 (961) pg/mL, the urinary NT-proBNP level was 88.7 (17.8) pg/mL, and the aldosterone level, 165 (145) pg/mL. There were correlations between urinary NT-proBNP level and AVPD (r=-0.5; P<.0001), ejection fraction (r=-0.3; P<.01), and mitral flow propagation velocity (r=-0.24; P<.05). On dividing AVPD and ejection fraction measurements into quartiles, respectively, the urinary NT-proBNP levels for these quartiles were Q1: 103 (28) pg/mL, Q2: 89 (9) pg/mL, Q3: 86 (9) pg/mL, and Q4: 78 (9) pg/mL (P<.0001) and Q1: 101 (26) pg/mL, Q2: 85 (12) pg/mL, Q3: 83 (10) pg/mL, and Q4: 85 (11) pg/mL (P<.05), respectively. Multiple linear regression analysis showed that the plasma NT-proBNP level was an independent predictor of the urinary NT-proBNP level (P<.0001). When the plasma NT-proBNP level was excluded, AVPD and ejection fraction appeared as alternative independent predictors (P<.05). Conclusions. There is a correlation between the urinary NT-proBNP level and left ventricular function parameters. This study supports the use of the urinary NT-proBNP level as a biochemical marker of ventricular function in heart failure patients (AU)

[8-hydroxy-2'-deoxyguanosine and lipid peroxidation in patients with heart failure]. / Valores de 8-hidroxi-2'-desoxiguanosina y de peroxidación lipídica en pacientes con insuficiencia cardiaca.

INTRODUCTION AND OBJECTIVES: Heart failure is associated with increased free radical production, which leads to a state of oxidative stress. Known markers of oxidative stress include 8-hydroxy-2'-deoxyguanosine, which reflects oxidative damage to DNA, and lipid peroxidation, which can be used to quantify damage to lipid-rich structures. The aims of this study were to compare 8-hydroxy-2'-deoxyguanosine and lipid peroxidation levels in heart failure patients and healthy subjects and to assess how these levels are influenced by heart failure etiology. METHODS: The study included 78 patients (57 male, age 64 [14] years) with heart failure and 12 control subjects. Patients completed a questionnaire and were graded according to the New York Heart Association classification. Doppler echocardiography was performed and blood samples were obtained. 8-hydroxy-2'-deoxyguanosine and lipid peroxidation levels were determined. RESULTS: Significant differences were observed between patients and control subjects in 8-hydroxy-2'-deoxyguanosine and lipid peroxidation levels, at 0.34 (0.54) ng/mL vs 0.04 (0.07) ng/mL (P<.05), and 18 (10) microM vs 8 (3) microM (P<.01), respectively. Subsequent analysis showed that heart failure etiology had a significant effect on the levels of the two markers (P<.05), which were highest in patients with hypertensive cardiomyopathy. CONCLUSIONS: Levels of 8-hydroxy-2'-deoxyguanosine and lipid peroxidation were higher in heart failure patients than in control subjects. The most significant increases were found in patients with hypertensive cardiomyopathy.

Valores de 8-hidroxi-2'-desoxiguanosina y de peroxidación lipídica en pacientes con insuficiencia cardiaca / 8-Hydroxy-2'-deoxyguanosine and lipid peroxidation in patients with heart failure

Introducción y objetivos. La insuficiencia cardiaca está asociada con un incremento en la producción de radicales libres, llegándose al estado de estrés oxidativo. Se conocen diversos marcadores de estrés oxidativo, como la 8-hidroxi-2'-desoxiguanosina, marcador del daño oxidativo en el ADN, y la peroxidación lipídica que permite cuantificar el daño en las estructuras ricas en lípidos. El propósito de este estudio es comparar los valores de 8-hidroxi-2'-desoxiguanosina y de peroxidación lipídica en pacientes con insuficiencia cardiaca y sujetos sanos, y evaluar la influencia de la etiología. Métodos. Estudiamos a 78 pacientes (57 varones, edad 64 ± 14 años) diagnosticados de insuficiencia cardiaca y a 12 controles. Los pacientes completaron un cuestionario y fueron clasificados de acuerdo con la New York Heart Association. Se les realizó un estudio eco-Doppler y extracción de sangre. Medimos las concentraciones de 8-hidroxi-2'-desoxiguanosina y de peroxidación lipídica. Resultados. Al comparar los valores de 8-hidroxi-2'-desoxiguanosina y peroxidación lipídica entre pacientes y controles obtuvimos diferencias significativas (0,34 ± 0,54 frente a 0,04 ± 0,07 ng/ml, p < 0,05 y 18 ± 10 frente a 8 ± 3 μmol/l, p < 0,01, respectivamente). Cuando comparamos las concentraciones de los 2 marcadores según la etiología de la insuficiencia cardiaca encontramos diferencias significativas en ambos (p < 0,05), que fueron mayores en la miocardiopatía hipertensiva. Conclusiones. Los valores de 8-hidroxi-2'-desoxiguanosina y peroxidación lipídica se encuentran aumentados en los pacientes con insuficiencia cardiaca al compararlos con los controles. El incremento más importante lo encontramos en pacientes con miocardiopatía hipertensiva

Introduction and objectives. Heart failure is associated with increased free radical production, which leads to a state of oxidative stress. Known markers of oxidative stress include 8-hydroxy-2'-deoxyguanosine, which reflects oxidative damage to DNA, and lipid peroxidation, which can be used to quantify damage to lipid-rich structures. The aims of this study were to compare 8-hydroxy-2'-deoxyguanosine and lipid peroxidation levels in heart failure patients and healthy subjects and to assess how these levels are influenced by heart failure etiology. Methods. The study included 78 patients (57 male, age 64 [14] years) with heart failure and 12 control subjects. Patients completed a questionnaire and were graded according to the New York Heart Association classification. Doppler echocardiography was performed and blood samples were obtained. 8-hydroxy-2'-deoxyguanosine and lipid peroxidation levels were determined. Results. Significant differences were observed between patients and control subjects in 8-hydroxy-2'-deoxyguanosine and lipid peroxidation levels, at 0.34 (0.54) ng/mL vs 0.04 (0.07) ng/mL (P<.05), and 18 (10) μM vs 8 (3) μM (P<.01), respectively. Subsequent analysis showed that heart failure etiology had a significant effect on the levels of the two markers (P<.05), which were highest in patients with hypertensive cardiomyopathy. Conclusions. Levels of 8-hydroxy-2'-deoxyguanosine and lipid peroxidation were higher in heart failure patients than in control subjects. The most significant increases were found in patients with hypertensive cardiomyopathy

[Myocardial remodeling and immunologic activation in patients with heart failure]. / Remodelado miocárdico y activación inmunitaria en pacientes con insuficiencia cardiaca.

INTRODUCTION AND OBJECTIVES: Immune response-mediated regulation of myocardial collagen remains poorly understood. Our objective was to investigate the relationship between ventricular remodeling and immunologic activation in patients with heart failure (HF) by comparing dilated and ischemic cardiomyopathy. METHODS: We studied 94 patients with HF and dilated cardiomyopathy (n=46) or ischemic cardiomyopathy (n=48). We recorded left ventricular (LV) volumes, E/A ratio, and ejection fraction. Plasma concentrations of tumor necrosis factor alpha (TNFalpha), soluble TNFa receptor I (sTNF-RI), sTNF-RII, interleukin-6 (IL-6) and IL-10 were measured. The serum procollagen type-III amino-terminal propeptide (PIIINP) level was also obtained. RESULTS: Ventricular volumes were greater in the dilated cardiomyopathy than in the ischemic cardiomyopathy group (P< .05). However, sTNF-RI, sTNF-RII and PIIINP levels were higher in the ischemic group (P< .05). In this group, there were significant correlations between ventricular volumes and IL-10 and sTNF-RII levels. There was also a significant correlation between PIIINP and sTNF-RII levels (r=0.30; P< .05). In the dilated cardiomyopathy group, there was a significant correlation between ventricular volumes and IL-10 level, and between PIIINP level and IL-6 (r=0.32; P< .05) and sTNF-RII levels (r=0.32; P< .05). Multiple linear regression analysis, which included cytokine levels, age, sex and ventricular function, showed that the sTNF-RII level was an independent predictor of the PIIINP level (adjusted r(2)=0.16; P< .0001) and of ventricular volumes (LV end-systolic volume index, adjusted r(2)=0.034; P< .05; and LV end-diastolic volume index, adjusted r(2)=.048; P< .05) in both groups. CONCLUSIONS: In HF, there is an interaction between proinflammatory cytokines and the extracellular matrix. Immunologic implications vary according to disease etiology. The elevation in proinflammatory cytokine and PIIINP levels is greater in patients with ischemic cardiomyopathy. Multiple regression analysis showed that the sTNF-RII level was an independent predictor of ventricular remodeling.

Remodelado miocárdico y activación inmunitaria en pacientes con insuficiencia cardiaca / Myocardial remodeling and immunologic activation in patients with heart failure

Introducción y objetivos. No se comprende bien la regulación del colágeno miocárdico mediada por la respuesta inmunitaria. Nuestro objetivo fue determinar las relaciones entre remodelado ventricular y activación inmunitaria en pacientes con insuficiencia cardiaca comparando miocardiopatía isquémica y dilatada. Métodos. Estudiamos a 94 pacientes con insuficiencia cardiaca: miocardiopatía dilatada (n = 46) e isquémica (n = 48). Determinamos volúmenes ventriculares, E/A y FE. Medimos las concentraciones de TNFα, sTNF-RI, sTNF-RII, IL-6 e IL-10 y calculamos los valores de PIIINP. Resultados. Los volúmenes ventriculares en la miocardiopatía dilatada fueron superiores a los del grupo isquémico (p < 0,05). Sin embargo, los valores de sTNF-RI, sTNF-RII y PIIINP fueron más elevados en el grupo isquémico (p < 0,05). En éste, los volúmenes ventriculares se correlacionaron significativamente con IL-10 y sTNF-RII. El PIIINP se correlacionó significativamente con sTNF-RII (r = 0,30; p < 0,05). En el grupo de miocardiopatía dilatada, los volúmenes ventriculares se correlacionaron significativamente con IL-10 y el PIIINP se correlacionó con IL-6 (r = 0,32; p < 0,05) y sTNF-RII (r = 0,32; p < 0,05). La regresión lineal múltiple, que incluyó citocinas, edad, sexo y función ventricular, demuestra que el sTNF-RII es un factor pronóstico independiente del PIIINP (r² ajustada = 0,16; p < 0,0001) y de los volúmenes ventriculares (IVTSVI, r² ajustada = 0,034; p < 0,05; IVTDVI, r² ajustada = 0,048; p < 0,05) en ambos grupos. Conclusiones. En la insuficiencia cardiaca hay una interacción de citocinas proinflamatorias con la matriz extracelular. La implicación inmunitaria es diferente dependiendo de la etiología. Las citocinas proinflamatorias y los valores de PIIINP son más elevados en los pacientes con miocardiopatía isquémica. La regresión múltiple demostró que el sTNF-RII es un factor pronóstico independiente de remodelado ventricular (AU)

Introduction and objectives. Immune response-mediated regulation of myocardial collagen remains poorly understood. Our objective was to investigate the relationship between ventricular remodeling and immunologic activation in patients with heart failure (HF) by comparing dilated and ischemic cardiomyopathy. Methods. We studied 94 patients with HF and dilated cardiomyopathy (n=46) or ischemic cardiomyopathy (n=48). We recorded left ventricular (LV) volumes, E/A ratio, and ejection fraction. Plasma concentrations of tumor necrosis factor α (TNFα), soluble TNFa receptor I (sTNF-RI), sTNF-RII, interleukin-6 (IL-6) and IL-10 were measured. The serum procollagen type-III amino-terminal propeptide (PIIINP) level was also obtained. Results. Ventricular volumes were greater in the dilated cardiomyopathy than in the ischemic cardiomyopathy group (P<.05). However, sTNF-RI, sTNF-RII and PIIINP levels were higher in the ischemic group (P<.05). In this group, there were significant correlations between ventricular volumes and IL-10 and sTNF-RII levels. There was also a significant correlation between PIIINP and sTNF-RII levels (r=0.30; P<.05). In the dilated cardiomyopathy group, there was a significant correlation between ventricular volumes and IL-10 level, and between PIIINP level and IL-6 (r=0.32; P<.05) and sTNF-RII levels (r=0.32; P<.05). Multiple linear regression analysis, which included cytokine levels, age, sex and ventricular function, showed that the sTNF-RII level was an independent predictor of the PIIINP level (adjusted r²=0.16; P<.0001) and of ventricular volumes (LV end-systolic volume index, adjusted r²=0.034; P<.05; and LV end-diastolic volume index, adjusted r²=.048; P<.05) in both groups. Conclusions. In HF, there is an interaction between proinflammatory cytokines and the extracellular matrix. Immunologic implications vary according to disease etiology. The elevation in proinflammatory cytokine and PIIINP levels is greater in patients with ischemic cardiomyopathy. Multiple regression analysis showed that the sTNF-RII level was an independent predictor of ventricular remodeling (AU)

Maximum longitudinal relaxation velocity of the left ventricle: its clinical value and relationship with NT-proBNP plasma levels in heart failure.

BACKGROUND: M-mode recordings of the mitral annulus to measure the maximum ascending velocity during early diastole as an expression of maximum longitudinal relaxation velocity of the left ventricle (RVm) can be used as an index of left ventricular (LV) diastolic function. The purpose of this study was to determine the relationship of RVm with LV functional parameters in patients with heart failure, with N-terminal pro-brain natriuretic peptide (NT-proBNP) plasma levels, and with their functional classification. METHODS AND RESULTS: RVm was recorded in 97 patients by M-mode echocardiography. Patients were classified according to the New York Heart Association (NYHA) and the concentration of NT-proBNP was determined. Patients with ejection fraction (EF)>40 showed a significant correlation between RVm and mitral annulus motion (MAM), mitral flow propagation velocity, E/A, age, deceleration time (DT), and NT-proBNP. In patients with EF40, though its relationship with NT-proBNP both in patients with EF>or40 it is influenced only by age. RVm values showed a significant decrease in NYHA class II and III.

Left ventricular cavity area reflects N-terminal pro-brain natriuretic peptide plasma levels in heart failure.

AIMS: N-terminal pro-brain natriuretic peptide (NT-proBNP) is useful in the diagnosis of heart failure (HF). LV two-dimensional cavity area from end-diastole (LVEDA) and end-systole (LVESA), and LV fractional area change (LVFAC) reflect changes in LV morphology and function without using geometric assumptions. In a multicenter study, we correlated LVEDA, LVESA and LVFAC with NT-proBNP, comparing patients with dilated and ischemic cardiomyopathy. METHODS AND RESULTS: We studied 106 HF patients. In the dilated group, NT-proBNP correlated with LVEDAI (r=0.6), LVESAI (r=0.7) and LVFAC (r=-0.6), all significant at p<0.001. In patients with ischemic cardiomyopathy we found LVESAI (r=0.3, p<0.05) and LVFAC (r=-0.4, p<0.01). After adjustment for age and BMI, LVFAC and LVESAI were associated in a multiple linear regression analysis with peptide levels (adjusted r(2)=0.5, p<0.001). CONCLUSIONS: In this study we found a good correlation of NT-proBNP with LV cavity areas and LVFAC. Multiple regression analysis showed that when adjusted for age and BMI, LVFAC and LVESAI are independent predictors of NT-proBNP levels in both dilated and ischemic etiologies. Patients with dilated cardiomyopathy showed better results than those with ischemic cardiomyopathy. We think LV areas are a useful and reproducible parameter, do not need geometric assumptions and reflect NT-proBNP plasma levels.

Obese subjects with heart failure have lower N-terminal pro-brain natriuretic peptide plasma levels irrespective of aetiology.

N-terminal pro-brain natriuretic peptide (NT-proBNP) may be useful in the diagnosis of heart failure and ventricular dysfunction. Obesity is an independent cardiovascular risk factor. The purpose of this study was to measure NT-proBNP plasma levels in obese and non-obese subjects with heart failure and to compare levels in subjects with ischaemic and dilated aetiology. In this study, obese subjects had 63% lower NT-proBNP plasma levels than non-obese subjects (p < 0.01). In multivariate analysis, BMI was inversely associated with NT-proBNP plasma levels (p < 0.05) and a 17% decrease in natriuretic peptide levels was attributed to obesity (p < 0.036). When we analyzed data according to the aetiology of heart failure, we found that both groups (ischaemic and dilated) had a 65% decrease in NT-proBNP plasma levels in obese subjects compared to non-obese subjects.

[Plasma concentration of big endothelin-1 and its relation with plasma NT-proBNP and ventricular function in heart failure patients]. / Relación de los valores plasmáticos de big endotelina-1 con NT-proBNP y la función ventricular de pacientes con insuficiencia cardíaca.

INTRODUCTION AND OBJECTIVES: Elevated plasma concentrations of big endothelin-1 (big ET-1) are related with severity and prognosis in patients with heart failure, and N-terminal pro-brain natriuretic peptide (NT-proBNP) is a marker of ventricular remodeling. The purpose of this study was to investigate the relationship between plasma levels of big ET-1 and NT-proBNP, and between the former and ventricular function. PATIENTS AND METHOD: We studied 103 patients with heart failure (75 men, mean age 63 [13] years). Each participant completed a questionnaire and underwent Doppler echocardiographic study to measure ejection fraction (EF), mitral flow propagation velocity (Vp) and atrioventricular plane displacement (AVPD). Blood samples were also taken to determine plasma levels of big ET-1, aldosterone and NT-proBNP. RESULTS: For the whole population big ET-1 concentration was 1.03 [0.75] fmol/m, NT-proBNP 619 (307-1328) pg/mL, aldosterone 168 [102] pg/mL, EF 37 [10], Vp 37 [11] cm/s, and AVPD 8.0 [1.7] mm. Plasma big ET-1 correlated positively with plasma NT-proBNP (r=0.50, P<.0001). However, a negative correlation was found between big ET-1 and EF (r=-0.30, P<.01), Vp, (r=-0.30, P<.01) and AVPD (r=-0.21, P<.05). When ET-1 levels were divided into quartiles and the corresponding NT-proBNP, EF, Vp and AVPD values were compared, we found significant differences (ANOVA P<.0001, P<.01, P<.05 and P<.05, respectively). CONCLUSIONS: Plasma levels of big ET-1 correlated positively with NT-proBNP levels and inversely with EF, Vp and AVPD. These findings help clarify the relationships between ventricular function and the neurohormonal activation involved in heart failure, and may aid the search for therapeutic interventions.

Relación de los valores plasmáticos de big endotelina-1 con NT-proBNP y la función ventricular de pacientes con insuficiencia cardíaca / Plasma concentration of big endothelin-1 and its relation with plasma NT-proBNP and ventricular function in heart failure patients

Introducción y objetivos. Las concentraciones elevadas de big endotelina 1 (big ET-1) se relacionan con la gravedad y el pronóstico de los pacientes con insuficiencia cardíaca (IC), mientras que N-terminal proBNP (NTproBNP) es un marcador de remodelado ventricular. El objetivo de nuestro estudio fue relacionar los valores debig ET-1 con NT-proBNP y con la función miocárdica. Pacientes y método. Estudiamos a 103 pacientes (75varones; 63 ± 13 años) diagnosticados de IC. Cada participante completó un cuestionario y fue sometido a un estudio eco-Doppler para la medición de la fracción de eyección (FE), la velocidad de propagación del flujo mitral (Vp) y el desplazamiento del plano auriculo ventricular(DPAV). Se realizó una extracción de sangre para determinarlos valores de big ET-1, aldosterona y NT-proBNP. Resultados. Para toda la población, el valor de big ET-1 fue de 1,03 ± 0,75 fmol/ml, el de NT-proBNP de 619(307-1.328) pg/ml, el de aldosterona de 168 ± 102 pg/ml,la FE de 37 ± 10, la Vp de 37 ± 11 cm/s y el DPAV de 8,0± 1,7 mm. La big ET-1 se correlacionó positivamente con el NT-proBNP (r = 0,50; p < 0,0001) e inversamente conla FE (r = -0,30; p < 0,01), la Vp (r = -0,30; p < 0,01) y elDPAV (r = -0,21; p < 0,05). Al dividir la big ET-1 en cuartiles y comparar los valores de NT-proBNP, FE, Vp y DPAV obtuvimos diferencias estadísticamente significativas(ANOVA p < 0,0001, p < 0,01, p < 0,05 y p < 0,05,respectivamente). Conclusiones. Los valores plasmáticos de big ET-1muestran una correlación positiva con los de NT-pro BNP y una correlación inversa con la FE, la Vp y el DPAV. Estos hallazgos ayudan a esclarecer las relaciones entre la función ventricular y la activación neurohormonal en la insuficiencia cardíaca y facilitan la búsqueda de nuevas intervención es terapéuticas

Introduction and objectives. Elevated plasma concentrations of big endothelin-1 (big ET-1) are related with severity and prognosis in patients with heart failure, and N-terminal pro-brain natriuretic peptide (NT-proBNP) is a marker of ventricular remodeling. The purpose of this study was to investigate the relationship between plasma levels of bigET-1 and NT-proBNP, and between the former and ventricular function. Patients and method. We studied 103 patients with heart failure (75 men, mean age 63 [13] years). Each participant completed a questionnaire and underwent Doppler echocardiographic study to measure ejection fraction(EF), mitral flow propagation velocity (Vp) and atrioventricular plane displacement (AVPD). Blood samples were also taken to determine plasma levels of big ET-1, aldosterone and NT-proBNP. Results. For the whole population big ET-1 concentration was 1.03 [0.75] fmol/m, NT-proBNP 619 (307-1328)pg/mL, aldosterone 168 [102] pg/mL, EF 37 [10], Vp 37[11] cm/s, and AVPD 8.0 [1.7] mm. Plasma big ET-1 correlated positively with plasma NT-proBNP (r=0.50,P<.0001). However, a negative correlation was found between big ET-1 and EF (r=-0.30, P<.01), Vp, (r=-0.30,P<.01) and AVPD (r=-0.21, P<.05). When ET-1 levels were divided into quartiles and the corresponding NT proBNP, EF, Vp and AVPD values were compared, we found significant differences (ANOVA P<.0001, P<.01,P<.05 and P<.05, respectively). Conclusions. Plasma levels of big ET-1 correlated positively with NT-proBNP levels and inversely with EF, Vpand AVPD. These findings help clarify the relationships between ventricular function and the neurohormonal activation involved in heart failure, and may aid the search for therapeutic interventions

[Use of sirolimus-eluting stents in complex lesions: clinical and angiographic follow-up]. / Utilización del stent recubierto de rapamicina en la revascularización de lesiones complejas: estudio con seguimiento clínico y angiográfico.

INTRODUCTION AND OBJECTIVES: The RAVEL and SIRIUS studies have demonstrated important reductions in clinical and angiographic restenosis in lesions treated with sirolimus-eluting stents. However, inclusion criteria in both studies excluded complex lesions. We studied immediate and long-term results with this stent in these complex lesions. PATIENTS AND METHOD: Prospective, observational study with clinical and angiographic follow-up of patients who met the exclusion criteria used in the RAVEL and SIRIUS studies. All patients were treated in our catheterization laboratory between June 2002 and April 2003 with the Cypher stent, and 57 patients (68 lesions) were studied in all. The most frequent lesion characteristics were excessive length 26.5%; ostial lesions 25%, bifurcations 23.5%, and severe calcifications 22.1%. Almost half (47%) of the patients had diabetes and 68% had multivessel disease. RESULTS: PTCA was successful in all patients. There was one major adverse cardiovascular event (MACE) before discharge (1 acute Q-wave myocardial infarction). Two episodes of subacute thrombosis occurred during the first week. During long-term clinical follow-up (8.7 [3.1] months) of all patients, there were 4 MACE (7%): 1 cardiac death, 1 acute myocardial infarction and 2 revascularizations of the target vessel. Intersegmental restenosis was observed by angiography in 4 lesions (8%). CONCLUSIONS: Implantation of the Cypher stent in complex lesions is safe and is associated, after 6 months of follow-up, with a low incidence of clinical events and a very low percentage of angiographic restenosis.

Utilización del stent recubierto de rapamicina en la revascularización de lesiones complejas: estudio con seguimiento clínico y angiográfico / Use of Sirolimus-Eluting stents in complex lesions: Clinical and angiographic follow-up

Introducción y objetivos. Los estudios RAVEL y SIRIUS han demostrado una importante reducción de la reestenosis clínica y angiográfica en lesiones tratadas con stent recubierto de rapamicina. Sin embargo, los criterios de selección de ambos ensayos clínicos excluyeron lesiones complejas. Estudiamos los resultados inmediatos y a medio plazo del stent de rapamicina en este tipo de lesiones complejas. Pacientes y método. Estudio prospectivo y observacional con seguimiento clínico y angiográfico de pacientes tratados en nuestro servicio entre junio de 2002 y abril de 2003 con el stent Cypher que cumplían criterios de exclusión en los estudios RAVEL y SIRIUS. Se estudió a 57 pacientes (68 lesiones). Las características más frecuentes fueron: longitud excesiva en el 26,5 por ciento, lesiones ostiales en el 25 por ciento, bifurcaciones en el 23,5 por ciento y calcificación severa en el 22,1 por ciento. El 47 por ciento de los pacientes era diabético y el 68 por ciento presentaba enfermedad multivaso. Resultados. La angioplastia coronaria transluminal percutánea se llevó a cabo con éxito en todos los casos. Hubo un evento cardíaco mayor durante el ingreso hospitalario (un infarto agudo de miocardio con onda Q) y 2 trombosis subagudas en la primera semana. Se realizó seguimiento clínico a medio plazo (8,7 ñ 3,1 meses) en el 100 por ciento de los pacientes y acontecieron 4 eventos cardíacos mayores (7 por ciento): una muerte cardíaca, un infarto agudo de miocardio y 2 revascularizaciones del vaso diana. Se objetivó reestenosis angiográfica intrasegmentaria en 4 lesiones (8 por ciento). Conclusiones. El implante del stent Cypher en lesiones complejas es seguro y se acompaña de una baja incidencia de eventos clínicos y muy bajo porcentaje de reestenosis angiográfica en el seguimiento a los 6 meses (AU)

Un caso de síndrome de Carney / A Case of Carney Complex

El síndrome de Carney es una enfermedad multisistémica, de transmisión autosómica dominante, caracterizada por la asociación de múltiples neoplasias, que incluyen el mixoma de varias localizaciones (cardíaco, cutáneo, mamario), manchas pigmentadas cutáneas, hiperactividad endocrina (síndrome de Cushing, acromegalia), tumores testiculares y schwannomas. Este trabajo recoge el caso de una mujer de 43 años que presentaba criterios diagnósticos de esta asociación que se inició con un infarto agudo de miocardio inferior, probablemente secundario a una embolización del mixoma auricular. A partir de este raro caso se realiza una breve revisión del síndrome de Carney, en el que el cribado familiar representa un punto esencial (AU)

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