N-terminal pro-brain natriuretic peptide is a useful marker to identify latent heart failure patients in older adults in a rural outpatient clinic.

AIM: Although measurement of natriuretic peptides including N-terminal pro-brain natriuretic peptide (NT-proBNP) has been recommended for identifying heart failure (HF) patients, the prevalence of elderly patients with latent HF who are attending an outpatient clinic is unknown. METHODS: We measured NT-proBNP levels in 393 patients (aged 75 ± 9 years) in a rural outpatient clinic. Patients with a diagnosis of heart disease were excluded. The patients were divided into two groups by the values of NT-proBNP: high NT-proBNP group (>400 pg/mL) and low NT-proBNP group (≤400 pg/mL) according to Japanese guidelines. Patients with a high NT-proBNP value underwent echocardiography including tissue Doppler examination. RESULTS: A total of 43 (11%) patients had high NT-proBNP values. Those patients were older, and larger percentages of those patients were male, had atrial fibrillation, history of stroke and dementia. Echocardiography was carried out in 39 of the 43 patients with high NT-proBNP values, and there were four patients with left ventricular systolic dysfunction, two with hypertrophic cardiomyopathy and one with aortic regurgitation. In the remaining 32 patients, 27 patients had diastolic HF in accordance with Japanese guidelines. A diagnosis of HF according to the guidelines was finally made in 34 (87 %) of the 39 patients. CONCLUSIONS: A large number of elderly patients without a diagnosis of HF who were attending an outpatient clinic showed high levels of NT-proBNP, and measurement of NT-proBNP is useful to identify patients with latent HF. Geriatr Gerontol Int 2017; 17: 1648-1653.

Abdominal visceral fat thickness measured by ultrasonography predicts the presence and severity of coronary artery disease.

Abdominal visceral fat plays a critical role in the pathogenesis of metabolic syndrome, which is a risk factor for coronary artery disease (CAD). Ultrasonography (US) distinctively quantifies visceral fat and subcutaneous fat. We measured the maximum preperitoneal visceral fat thickness (Vmax) and the minimum subcutaneous fat thickness (Smin) by US in 185 patients who underwent coronary angiography. Although the 144 patients with CAD had larger Vmax (8.8 ± 3.6 vs. 6.4 ± 2.8 mm; p < 0.001) than those without, there was no difference in Smin. Vmax of 6.9 mm or higher was an independent predictor of CAD (odds ratio, 3.710, p = 0.008) by multiple logistic regression analysis. Vmax significantly correlated with the number of diseased vessels. Assessment of abdominal visceral fat by US gives us incremental information beyond conventional risk factors for predicting CAD in routine clinical practice.

[Severe pulmonary hypertension and congestive heart failure in an elderly patient with Basedow's disease].

An 83-year-old woman was admitted to our hospital with dyspnea. A chest X-ray showed cardiomegaly and pulmonary congestion. An echocardiogram revealed severe tricuspid regurgitation and markedly elevated transtricuspid pressure gradient of 103 mmHg. There was no left ventricular systolic or diastolic dysfunction. Laboratory evaluation revealed elevated free T4 and suppressed TSH levels. Serum level of anti-TSH receptor antibody was significantly elevated. A thyroid echogram demonstrated increased internal flow pattern in the thyroid gland. As a result of these findings, she was given a diagnosis of Basedow's disease associated with severe pulmonary hypertension and congestive heart failure. After treatment for hyperthyroidism with thiamazole, propranolol, furosemide, and warfarin, she made good recovery with gradual resolution of pulmonary hypertension. The severity of pulmonary hypertension in this case was significantly higher than that in previous reports, possibly because of concomitant minor pulmonary embolism, thiamine deficiency and anemia. In summary, we report a rare case of Basedow's disease with severe and reversible pulmonary hypertension that appeared in very old age.