Causes of cardiovascular and noncardiovascular death in the ISCHEMIA trial.

BACKGROUND: The International Study of Comparative Health Effectiveness with Medical and Invasive Approaches trial demonstrated no overall difference in the composite primary endpoint and the secondary endpoints of cardiovascular (CV) death/myocardial infarction or all-cause mortality between an initial invasive or conservative strategy among participants with chronic coronary disease and moderate or severe myocardial ischemia. Detailed cause-specific death analyses have not been reported. METHODS: We compared overall and cause-specific death rates by treatment group using Cox models with adjustment for pre-specified baseline covariates. Cause of death was adjudicated by an independent Clinical Events Committee as CV, non-CV, and undetermined. We evaluated the association of risk factors and treatment strategy with cause of death. RESULTS: Four-year cumulative incidence rates for CV death were similar between invasive and conservative strategies (2.6% vs 3.0%; hazard ratio [HR] 0.98; 95% CI [0.70-1.38]), but non-CV death rates were higher in the invasive strategy (3.3% vs 2.1%; HR 1.45 [1.00-2.09]). Overall, 13% of deaths were attributed to undetermined causes (38/289). Fewer undetermined deaths (0.6% vs 1.3%; HR 0.48 [0.24-0.95]) and more malignancy deaths (2.0% vs 0.8%; HR 2.11 [1.23-3.60]) occurred in the invasive strategy than in the conservative strategy. CONCLUSIONS: In International Study of Comparative Health Effectiveness with Medical and Invasive Approaches, all-cause and CV death rates were similar between treatment strategies. The observation of fewer undetermined deaths and more malignancy deaths in the invasive strategy remains unexplained. These findings should be interpreted with caution in the context of prior studies and the overall trial results.

Clinical outcomes vary between the Shuttle Walk Test and Stress Test in patients with coronary artery disease.

Purpose: The purpose of this study was to determine if the Incremental Shuttle Walk Test (ISWT) can elicit similar patient responses as a treadmill stress test in patients with coronary artery disease (CAD). Methods: Both the stress test and the ISWT were performed by 172 participants, aged 60.67±10.23 years. We screened participants for unstable angina, severe aortic stenosis, uncontrolled hypertension, and excluded if unable to walk on a treadmill. Outcome measures (signs and symptoms) included: i) patient-reported chest pain; ii) patient-reported breathlessness/exhaustion and not being able to keep up with test protocol; and iii) able to reach target HRmax. Additionally, EKG changes during the stress test were monitored for ST changes or arrhythmias. Results: During the stress test, 15 participants reported chest pain, 23 participants reached target HRmax. No participants reported chest pain and 2 participants reached target HRmax during the ISWT. Participants reporting chest pain had a higher mean BMI and significant difference in METS (p < 0.001) during the stress test and walking distance (p = 0.03) when compared with patients who did not report chest pain during the stress test. Breathlessness and not being able to keep up with protocol were the most commonly reported in both tests. Changes in EKG were observed in 38 participants in the stress test. Conclusion: A maximal effort stress test is better at eliciting ischemic signs and symptoms and a superior tool for diagnosis of progression or severity of CAD than the ISWT. Appropriate selection of exercise tests is important in the clinical setting.

Consenso de expertos en la asistencia multidisciplinaria y el abordaje integral de la insuficiencia cardiaca. Desde el alta hospitalaria hasta la continuidad asistencial con primaria / Expert consensus on multidisciplinary management and integrated approaches in heart failure. Continuity of care from hospital discharge to primary care

La insuficiencia cardiaca es una enfermedad que precisa un tratamiento multidisciplinario, dadas la diversidad de causas y entornos clínicos implicados que las tratan y las diferentes estrategias terapéuticas que precisan la participación indispensable de diversas disciplinas. La presencia en los servicios de cardiología de unidades de insuficiencia cardiaca centradas en el tratamiento de los pacientes con esta afección y unidades de rehabilitación cardiaca que, entre sus indicaciones para la reducción de la morbimortalidad, también están implicadas en la atención de esos mismos pacientes puede causar dificultades de coordinación y pérdida de una atención integral centrada en el paciente. Por estos motivos, en el presente documento se plantea una estrategia de coordinación entre las diferentes unidades implicadas en el tratamiento de los pacientes dentro de los servicios de cardiología y la continuidad asistencial con atención primaria, tanto tras haber conseguido la estabilidad como la interrelación para una coordinación posterior más efectiva

Heart failure is a condition that requires a multidisciplinary approach to treatment because of the wide range of causes and clinical contexts that may be involved and because the diverse treatment strategies used necessitate the participation of multiple disciplines. In cardiology departments, the presence of both heart failure units that focus on the treatment of affected patients and cardiac rehabilitation units that, as well as targeting reductions in morbidity and mortality, are also involved in caring for the same patients can create difficulties for coordination and can result in the loss of comprehensive patient-centered care. For these reasons, this paper presents a strategy for coordinating the different units involved in patient management in cardiology departments and for ensuring continuity of care in primary care, both immediately after achieving stabilization and subsequently, when these interactions are important for effective coordination

The use of multisite left ventricular pacing via quadripolar lead improves acute haemodynamics and mechanical dyssynchrony assessed by radial strain speckle tracking: initial results.

AIMS: The objective of the present study was to evaluate the effect of multipoint pacing (MPP) on acute haemodynamics, cardiac contractility, and left ventricle (LV) dyssynchrony, in comparison with conventional cardiac resynchronization therapy (CRT). METHODS AND RESULTS: An open-label, non-randomized, single-centre, prospective study was designed. Twenty-seven consecutive patients were included. Evaluation of pacing configurations was performed in a random order. Transthoracic echocardiography was used to obtain haemodynamic and dyssynchrony parameters. Left ventricular ejection fraction (LVEF) was significantly superior in MPP compared with baseline (38.4 ± 1.8% vs. 26.1 ± 2.2%; P < 0.001), and in conventional pacing configuration compared with baseline (33.2 ± 1.8% vs. 26.1 ± 2.2%; P = 0.007). Cardiac index (CI) was increased by 21.8 ± 5.4% and 34.7 ± 5.1% in conventional and MPP configurations, respectively (P = 0.19). Percentage of acute responders (CI increase ≥10%) was 62.9 and 85.2% in conventional and MPP, respectively (P < 0.001). LV dyssynchrony was defined by radial strain rate parameters. Baseline anteroseptal-to-posterior wall time delay was 168 ± 21 ms. It was reduced until 70.4 ± 29 ms in conventional and -6.6 ± 11 ms in MPP (conventional vs. baseline P = 0.04; MPP vs. conventional P = 0.05). Standard deviation of the time-to-peak radial strain of the 6 LV basal segments was 101 ± 9.7, 80.3 ± 9.2, and 66 ± 8.03 ms in baseline, conventional, and MPP configurations, respectively (MPP vs. basal P = 0.012). Finally, we observed a positive correlation (r = 0.69) between reduction in dyssynchrony and CI increase (P < 0.0001). CONCLUSION: MPP showed a further reduction in LV dyssynchrony compared with conventional biventricular pacing. Moreover, MPP resulted in an additional improvement in LVEF and in CI, and this was translated into a higher number of acute responders to CRT.

Valor pronóstico a largo plazo de los valores séricos y urinarios del fragmento N-terminal del péptido natriurético tipo B y del filtrado glomerular en pacientes con insuficiencia cardíaca / Long-term prognosis of serum and urine n-terminal proBNP levels and glomerular filtration rate in heart failure patients

Fundamento y objetivo: El amino-terminal pro-brain natriuretic peptide (NT-proBNP, ‘fragmento N terminal del péptino natriurético tipo B’) y el filtrado glomerular renal (eFGR) están relacionados con el pronóstico a corto plazo en la insuficiencia cardíaca (IC). Este estudio evalúa el poder predictivo de los valores NT-proBNP séricos y urinarios, así como del eFGR en pacientes con IC en un seguimiento a 60 meses. Pacientes y método: Se estudiaron 93 pacientes diagnosticados de IC (66 varones, edad: 65±12 años). El episodio primario fue muerte cardiovascular y el episodio combinado fue mortalidad o ingreso de origen cardíaco. Resultados: Solamente los valores séricos de NT-proBNP tuvieron un área bajo la curva significativa para la presencia de mortalidad cardíaca y episodios combinados: 0,70 (p=0,004) y 0,67 (p=0,019), respectivamente. El NT-proBNP urinario y el eFGR no obtuvieron áreas bajo la curva significativas. Los pacientes con altos valores de NT-proBNP en suero tuvieron una peor supervivencia (44 [IC del 95%: 38–50] versus 56 [IC del 95%: 53–59] meses; p=0,0006) y pronóstico para episodios (33 [IC del 95%: 28–38] versus 42 [IC del 95%: 28–38] meses; p=0,027). Al englobar la concentración del péptido y la disfunción renal, los pacientes con NT-proBNP sérico alto y bajo eFGR tuvieron la peor supervivencia (42 [IC del 95%: 33–52] meses; p=0,010). Por último, sólo los valores de NT-proBNP séricos mayores de 933pg/ml y de 550pg/ml predicen muerte cardiovascular (hazard ratio=2,81; p=0,033) y episodios (hazard ratio=1,79; p=0,049), respectivamente. Conclusiones: Los valores de NT-proBNP séricos fueron un factor predictivo de mortalidad y episodios cardiovasculares a 60 meses, superior a los valores urinarios de NT-proBNP y eFGR, en pacientes diagnosticados de insuficiencia cardíaca con disfunción renal moderada (AU)

Background and objective: The amino-terminal pro-brain natriuretic peptide (NT-proBNP) and estimated glomerular filtration rate (eGFR) values are related to short prognosis in patients with heart failure (HF). This study evaluates the prognostic power of serum and urinary NT-proBNP levels, and eGFR values, in HF patients during a 60-month follow-up. Patients and Methods: We studied 93 HF outpatients (66 males, age 65±12). Primary endpoint was defined as cardiovascular mortality and secondary endpoint as cardiovascular mortality or admissions. Results: Only serum NT-proBNP levels had a significant area under the curve for the prognosis of 60-month mortality and combined events, 0.70 (p=0.004) and 0.67 (p=0.019), respectively. Urinary NT-proBNP and eGFR did not have statistical significant areas under the curve. Patients with high serum NT-proBNP had the highest risk of cardiovascular death [44 (IC 95% 38–50) vs. 56 (IC 95% 53–59) months, p=0.0006] and combined events [33 (IC 95% 28–38) vs. 42 (IC 95% 28–38) months; p=0.027]. After the integration of serum NT-proBNP and renal function, patients with high peptide levels and low eGFR had the worst survival [42 (IC 95% 33–52) months; p=0.010]. Finally, only serum NT-proBNP concentration above 933pg/mL was a predictor of poor survival (hazard ratio=2.81, p=0.033) and NT-proBNP above 550pg/mL for combined events (hazard ratio=1.79, p=0.049). Conclusions: Serum NT-proBNP levels were superior to urine NT-proBNP and eGFR values for predicting 60-month cardiovascular death and combined events in HF patients (AU)

[Long-term prognosis of serum and urine n-terminal proBNP levels and glomerular filtration rate in heart failure patients]. / Valor pronóstico a largo plazo de los valores séricos y urinarios del fragmento N-terminal del péptido natriurético tipo B y del filtrado glomerular en pacientes con insuficiencia cardíaca.

BACKGROUND AND OBJECTIVE: The amino-terminal pro-brain natriuretic peptide (NT-proBNP) and estimated glomerular filtration rate (eGFR) values are related to short prognosis in patients with heart failure (HF). This study evaluates the prognostic power of serum and urinary NT-proBNP levels, and eGFR values, in HF patients during a 60-month follow-up. PATIENTS AND METHODS: We studied 93 HF outpatients (66 males, age 65+/-12). Primary endpoint was defined as cardiovascular mortality and secondary endpoint as cardiovascular mortality or admissions. RESULTS: Only serum NT-proBNP levels had a significant area under the curve for the prognosis of 60-month mortality and combined events, 0.70 (p=0.004) and 0.67 (p=0.019), respectively. Urinary NT-proBNP and eGFR did not have statistical significant areas under the curve. Patients with high serum NT-proBNP had the highest risk of cardiovascular death [44 (IC 95% 38-50) vs. 56 (IC 95% 53-59) months, p=0.0006] and combined events [33 (IC 95% 28-38) vs. 42 (IC 95% 28-38) months; p=0.027]. After the integration of serum NT-proBNP and renal function, patients with high peptide levels and low eGFR had the worst survival [42 (IC 95% 33-52) months; p=0.010]. Finally, only serum NT-proBNP concentration above 933 pg/mL was a predictor of poor survival (hazard ratio=2.81, p=0.033) and NT-proBNP above 550 pg/mL for combined events (hazard ratio=1.79, p=0.049). CONCLUSIONS: Serum NT-proBNP levels were superior to urine NT-proBNP and eGFR values for predicting 60-month cardiovascular death and combined events in HF patients.

Urinary NT-proBNP. A valuable marker in the assessment of patients with essential hypertension.

The aim was to evaluate the usefulness of urinary N-terminal fragment of B-type natriuretic peptide (NT-proBNP) measurement for predicting the presence of left ventricular hypertrophy (LVH) in 160 asymptomatic patients with essential hypertension. The urinary NT-proBNP/creatinine ratio was higher in patients with LVH than in either those without LVH (P< .0001) or control subjects (P< .0001). Multivariate linear regression analysis identified age (P=.034), left ventricular mass index (P=.026) and serum NT-proBNP level (P=.001) as predictors of the urinary peptide level. The area under the curve for the NT-proBNP/creatinine ratio was 0.71+/-0.04 (P< .0001) for identifying LVH. Logistic regression analysis showed that the NT-proBNP: creatinine ratio was a predictor of LVH (odds ratio=4.074; P=.009). In conclusion, the urinary NT-proBNP concentration is a new marker that could be useful for identifying LVH in subjects with essential hypertension.

NT-proBNP urinario. Su valor en la caracterización de pacientes con hipertensión esencial / Urinary NT-proBNP. A valuable marker in the assessment of patients with essential hypertension

El objetivo fue evaluar el poder predictivo para diagnosticar hipertrofia del ventrículo izquierdo (HVI) de la concentración urinaria del fragmento N-terminal del propéptido natriurético tipo B (NT-proBNP) en 160 pacientes asintomáticos diagnosticados de hipertensión esencial (HT). Las concentraciones urinarias de NT-proBNP/creatinina estuvieron incrementadas en pacientes con HVI al compararlos con no hipertróficos (p < 0,0001) y controles (p < 0,0001). El análisis de regresión lineal múltiple mostró que la edad (p = 0,034), el índice de masa del ventrículo izquierdo (IMVI) (p = 0,026) y el NT-proBNP sérico (p = 0,001) predicen la concentración urinaria del péptido. El área bajo la curva de NT-proBNP/creatinina fue 0,71 ± 0,04 (p < 0,0001) para la detección de HVI, y el análisis de regresión logística mostró que NT-proBNP urinario/ creatinina predice la HVI (odds ratio = 4,074; p = 0,009). En conclusión, la concentración de NT-proBNP en orina es un nuevo marcador que puede ser de utilidad para detectar HVI en sujetos con HT esencial (AU)

The aim was to evaluate the usefulness of urinary N-terminal fragment of B-type natriuretic peptide (NT-proBNP) measurement for predicting the presence of left ventricular hypertrophy (LVH) in 160 asymptomatic patients with essential hypertension. The urinary NT-proBNP/creatinine ratio was higher in patients with LVH than in either those without LVH (P < .0001) or control subjects (P < .0001). Multivariate linear regression analysis identified age (P=.034), left ventricular mass index (P=.026) and serum NT-proBNP level (P=.001) as predictors of the urinary peptide level. The area under the curve for the NT-proBNP/creatinine ratio was 0.71±0.04 (P < .0001) for identifying LVH. Logistic regression analysis showed that the NT-proBNP: creatinine ratio was a predictor of LVH (odds ratio=4.074; P=.009). In conclusion, the urinary NT-proBNP concentration is a new marker that could be useful for identifying LVH in subjects with essential hypertension (AU)

Valor pronóstico de big endotelina-1 en pacientes con insuficiencia cardíaca y clase funcional moderadamente sintomática / Prognostic value of big endothelin-1 prognostic value in patients with heart failure and moderately symptomatic functional class

Fundamento y objetivo: Existen estudios sobre el papel de la big endotelina 1 (big ET-1) como marcador de mortalidad en pacientes con insuficiencia cardíaca (IC) grave. Sin embargo, no se ha encontrado valor pronóstico en pacientes con clase funcional moderadamente sintomática. Nuestro objetivo fue evaluar, en un seguimiento a 24 meses, el poder pronóstico de big ET-1 en pacientes con IC y clase funcional moderadamente deteriorada. Material y método: Se determinaron los valores de big ET-1 en una cohorte de 90 pacientes ambulatorios (edad media [desviación estándar] de 64 [13] años, 70% varones) con IC. Se clasificó a los pacientes funcionalmente según la clasificación de la New York Heart Association (NYHA). Resultados: Obtuvimos un valor mediano de big ET-1 de 0,86 (extremos 0,61 1,20)fmol/ml. Evaluamos su poder para la detección de mortalidad cardiovascular y obtuvimos un área bajo la curva (ABC) de 0,68 (0,08) (p=0,02), punto de corte óptimo 0,98fmol/ml (sensibilidad del 69%, especificidad del 75%). En el análisis de regresión logística, la big ET-1 resultó también un predictor independiente de mortalidad (odds ratio [OR]=5,851; p=0,009). Conclusiones: La determinación de la big ET-1 tiene valor para la predicción de mortalidad cardiovascular en pacientes con IC y clase funcional moderadamente sintomática (AU)

Background and objective: Several studies have analyzed big endothelin-1 as a marker of mortality in patients with severe heart failure (HF). However, it has not proven prognostic value in patients with moderately symptomatic functional class. Our objective was to evaluate, in a 24 months follow-up, the prognostic power of big endothelin-1 in patients with HF and moderately deteriorated functional class. Material and method: Big endothelin-1 levels were measured in a cohort of 90 outpatients (age 64 (13), 70% males) diagnosed with HF. Patients were functionally classified (NYHA).Results: For the whole population, big endothelin-1 was 0.86 (0.61 1.20)fmol/ml. We evaluated its predictive value in detecting cardiovascular mortality, obtaining an AUC of 0.68 (0.08) (P=.02), and a cut-off value of 0.98fmol/ml (sensitivity 69%, specificity 75%). When a logistic regression analysis was performed, big endothelin-1 was also an independent predictor of mortality (OR=5.851, P=.009). Conclusions: Big endothelin-1 predicts cardiovascular mortality in patients diagnosed of HF and moderately symptomatic functional class (AU)

[Prognostic value of big endothelin-1 prognostic value in patients with heart failure and moderately symptomatic functional class]. / Valor pronóstico de big endotelina-1 en pacientes con insuficiencia cardíaca y clase funcional moderadamente sintomática.

BACKGROUND AND OBJECTIVE: Several studies have analyzed big endothelin-1 as a marker of mortality in patients with severe heart failure (HF). However, it has not proven prognostic value in patients with moderately symptomatic functional class. Our objective was to evaluate, in a 24 months follow-up, the prognostic power of big endothelin-1 in patients with HF and moderately deteriorated functional class. MATERIAL AND METHOD: Big endothelin-1 levels were measured in a cohort of 90 outpatients (age 64 (13), 70% males) diagnosed with HF. Patients were functionally classified (NYHA). RESULTS: For the whole population, big endothelin-1 was 0.86 (0.61-1.20)fmol/ml. We evaluated its predictive value in detecting cardiovascular mortality, obtaining an AUC of 0.68 (0.08) (P=.02), and a cut-off value of 0.98 fmol/ml (sensitivity 69%, specificity 75%). When a logistic regression analysis was performed, big endothelin-1 was also an independent predictor of mortality (OR=5.851, P=.009). CONCLUSIONS: Big endothelin-1 predicts cardiovascular mortality in patients diagnosed of HF and moderately symptomatic functional class.

[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

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.

[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

Ventricular hypertrophy increases NT-proBNP in subjects with and without hypertension.

BACKGROUND: It has been published that hypertension (HT) must be taken into account when using NT-proBNP, but left ventricular (LV) hypertrophy without HT could be a cause of NT-proBNP elevation. In a population study we compared NT-proBNP in subjects with hypertrophy, with and without diagnosis of HT. METHODS: We studied 215 subjects from a random sample of 432 people who had declared to suffer from dyspnea. These 432 subjects were referred to their hospital where blood samples were taken, an echo-Doppler study was performed and a specific questionnaire was completed. We got a positive answer from 215, and 52 (24%) have LV hypertrophy. RESULTS: When we compared NT-proBNP in non-hypertrophic population, 148 +/- 286 pg/ml, with NT-proBNP in LV hypertrophic population, 202 +/- 209 pg/ml, we found P < 0.001. In the hypertrophic group, when we compared NT-proBNP (199 +/- 201 pg/ml) in normotensive subjects (LV mass index 170 +/- 70 g/m2, Vp 50 +/- 18 cm/s, LVEF 62 +/- 8) with NT-proBNP (205 +/- 220 pg/ml) in subjects with diagnosis of HT (LV mass index 169 +/- 37 g/m2, Vp 55 +/- 20 cm/s, LVEF 64 +/- 10), we found NS. CONCLUSIONS: This population study shows that NT-proBNP is elevated in patients with LV hypertrophy with or without HT. In LV hypertrophy the presence of HT does not influence the peptide levels significantly.