B-type natriuretic peptide and C-terminal-pro-endothelin-1 for the prediction of severely impaired peak oxygen consumption.

OBJECTIVE: To assess the utility of B-type natriuretic peptide (BNP) and C-terminal-pro-endothelin-1 (CT-proET-1) to predict a severely impaired peak oxygen consumption (peak VO(2), < 14 mL kg(-1) min(-1)) in patients referred for cardiopulmonary exercise testing. DESIGN: Cross-sectional study. SETTING: Tertiary care center. METHODS: Peak VO(2), BNP and CT-proET-1 were assessed in 141 consecutive patients referred for cardiopulmonary exercise testing. RESULTS: B-type natriuretic peptide [median (interquartile range) 48 (38-319) vs. 33 (15-86) pg mL(-1); P = 0.002] and CT-proET-1 [87 (76-95) vs. 60 (52-74) pmol L(-1); P < 0.001] were higher in patients with a peak VO(2) < 14 mL kg(-1) min(-1) (n = 30) than in those with a peak VO(2) > or = 14 mL kg(-1) min(-1) (n = 111). CT-pro-ET-1 had a higher area under the receiver-operator-characteristics curve (AUC) to predict a peak VO(2) < 14 mL kg(-1) min(-1) than BNP (0.79 vs. 0.68; P = 0.04). The optimal BNP cut-off of 37.2 pg mL(-1) had a sensitivity of 80% and a specificity of 56%. The optimal CT-proET-1 cut-off of 74.4 pmol L(-1) had a sensitivity of 80% and specificity of 76%. A five-item score composed of body mass index, diabetes, forced expiratory volume within the first second, alveolo-arterial oxygen pressure difference, and BNP had an AUC of 0.88 to predict a peak VO(2) < 14 mL kg(-1) min(-1). Adding CT-proET-1 to the score resulted in an AUC of 0.92. CONCLUSIONS: C-terminal-pro-endothelin-1 is superior to BNP for the prediction of a peak VO(2) < 14 mL kg(-1) min(-1) in patients referred for CPET. A score incorporating body mass index, diabetes status, spirometry, blood gases, BNP and CT-proET-1 improves the prediction of a peak VO(2) < 14 mL kg(-1) min(-1) based on single biomarkers.

Long-term prognostic value of B-type natriuretic peptide in cardiac and non-cardiac causes of acute dyspnoea.

BACKGROUND: B-type natriuretic peptide (BNP) levels significantly predict increased risk of death in heart failure. The predictive role of BNP levels in patients with non-cardiac causes of acute dyspnoea presenting to the emergency department is not well characterized. MATERIALS AND METHODS: The B-type natriuretic peptide for Acute Shortness of Breath EvaLuation (BASEL) study enrolled consecutive patients with acute dyspnoea. RESULTS: Cumulative mortality was 14.8%, 33.1% and 51.9% in 452 patients (age: 19-97 years; 58% male) within low (< 100 pg mL(-1)), intermediate (100-500 pg mL(-1)) and high (> 500 pg mL(-1)) BNP plasma levels at 18 months of follow-up. BNP classes (point estimate: 1.55, 95%CI: 1.19-2.03, P = 0.001) in addition to age, increased heart rate and diuretic use emerged as significant predictors for long-term mortality in multivariable Cox regression analyses. The BNP concentration alone had an area under the receiver operating characteristic curve of 0.71 (95%CI: 0.66-0.76; P < 0.001) for predicting 18 months mortality. BNP plasma levels independently predicted long-term risk of death in patients with non-cardiac (point estimate: 1.72, 95%CI: 1.16-2.56; P = 0.007) and with cardiac causes of acute dyspnoea (point estimate: 2.21, 95%CI: 1.34-3.64; P = 0.002). CONCLUSIONS: BNP levels are strong and independent predictors for long-term mortality in unselected dyspnoeic patients presenting to the emergency department independent from the cause of dyspnoea.

[Improving function by decortication. Functional studies with particular evaluation of lung perfusion scintigraphy]. / Funktionsverbesserung durch Dekortikation. Funktionelle Untersuchungen unter besonderer Wertung der Lungenperfusionszintigraphie.

The study presents functional and scintigraphic lung perfusion measurements before and after decortication of 9 patients treated for chronic pleural empyema with special emphasis to changes in perfusion scintigraphy. Preoperatively, the average vital capacity was 60% and the average FEV1 was 65% of the predicted. Perfusion of the affected side showed an average reduction to 22%. After decortication all functional data showed an improvement (average VC 78.5%, average FEV1 79.5%) the percentage of lung perfusion having increased to a mean of 37.8%.

Decortication in chronic pleural empyema. Investigation of lung function based on perfusion scintigraphy.

The study presents measurements in spirometry and scintigraphic lung perfusion, before and after decortication, in 9 patients treated for chronic pleural empyema with special emphasis on measuring changes by perfusion scintigraphy. Preoperatively, the average vital capacity (VC) was 60% and the average FEV1 was 65% of the predicted. Perfusion of the affected side showed an average reduction to 22%. After decortication all functional data showed an improvement (average VC 78.5%, average FEV1 79.5%) the percentage of lung perfusion having increased to a mean of 37.8%.