Amino-terminal Pro-brain Natriuretic Peptide Levels Research Articles

Analysis of the correlation between amino-terminal pro-brain natriuretic peptide levels and prognosis of patients with off-pump coronary artery bypass grafting

IntroductionThis study aims to investigate the correlation between the postoperative changes in serum amino-terminal pro-brain natriuretic peptide (NT-proBNP) levels and the prognosis of patients with off-pump coronary artery bypass grafting. MethodsThe patients were divided into two groups according to the left ventricular ejection fraction (LVEF) value of their cardiac ultrasound 48 h after surgery: the study group, those with early postoperative cardiac dysfunction (LVEF ≤45%, 36 cases), and the control group, those without early postoperative cardiac dysfunction (LVEF >45%, 60 cases). The serum NT-proBNP levels at 24 h and 48 h after surgery and before discharge were measured in the two groups, and any major postoperative adverse events were observed to analyze the relationship between the NT-proBNP levels and early postoperative cardiac dysfunction and prognosis. ResultsThe serum NT-proBNP levels in the study group were significantly higher than in the control group at 24 h and 48 h after surgery (p < 0.05). However, there was no significant difference between the two groups in the serum NT-proBNP levels before discharge (p > 0.05). The main adverse events of the study group during hospitalization were significantly higher than in the control group (p < 0.05). The area under the curve of NT-proBNP in predicting early postoperative cardiac dysfunction was 0.850 (95% CI: 0.826–0.903) (p < 0.001). The best diagnostic value was 5653.95 pg/ml, the sensitivity was 87.8%, and the specificity was 83.6%. ConclusionThe postoperative NT-proBNP level is closely related to early cardiac dysfunction and major adverse events after off-pump coronary artery bypass grafting.

Correlation between amino-terminal pro-brain natriuretic peptide levels and the maximum vasoactive-inotropic score in the first 24 h post-intervention of cardiac surgery

Correlation between amino-terminal pro-brain natriuretic peptide levels and the maximum vasoactive-inotropic score in the first 24 h post-intervention of cardiac surgery

TISSUE DOPPLER IMAGING IN DETECTION OF RIGHT VENTRICULAR SYSTOLIC AND DIASTOLIC FUNCTION IN VARIOUS FORMS OF PULMONARY HYPERTENSION: PP.8.342

The Aim: To evaluate the possibilities of Tissue Doppler Imaging (TDI) in detection of early myocardial functional changes in different forms of pulmonary hypertension (PH). Materials and Methods: 29 pts with idiopathic pulmonary hypertension (IPH), 15 pts with chronic thromboembolic disease (CTD), 18 pts with PH, associated with systemic scleroderma (SS), 13 pts with PH, associated with chronic obstructive respiratory disease (CORD),15 pts with PH, associated with congenital heart disease (CHD), 12 pts with residual PH with FC I-III (WHO) and 21 healthy volunteers in control group (CG) were included in the study. Echocardiography, complete conventional and TDI, were operated (Vivid 7, G.E.). Plasma amino-terminal pro-brain natriuretic peptide levels (NT-proBNP) were measured (Elecsys 2010, Roche). Results: IPH and CHD pts were characterized by the most marked heart remodeling accordingly to elevated SPAP (table 1). CORD and RPH pts have the least enlarged right heart chambers and SPAP. Parameters Em RV in CTD and SS pts were rather small while E/Em RV were large and comparable with E/Em RV in IPH pts. Table 1. Echocardiographic parameters and NT-proBNP levels in groups with PH and in controls.We found the higher prevalence of TDI-findings of early RV diastolic dysfunction (DD) as compared with traditional echocardiographic measurements in different forms of PH (89,7% versus 58,6% in IPH, 86,7% vs 46,7% in CTD, 77,8% vs 55,6% in SS, 100% vs 27,3% in CORD, 86,7% vs 26,7% in CHD, 41,7% vs 16,7% in RPH pts). Conclusion: Tissue Doppler Imaging can be a useful tool for detection early features of DD in different forms of PH as compared with traditional echocardiography. CTD and SS pts with moderate systolic echocardiographic parameters and SPAP but high NTpro-BNP levels have marked DD of RV by TDI measuring. Quantity of pts with DD of RV revealed by traditional Doppler measuring was significantly less than detected by TDI in all PH groups.

High Lipoprotein(a) Levels are Associated With Long-Term Adverse Outcomes in Acute Myocardial Infarction Patients in High Killip Classes

Background and ObjectivesAn elevated concentration of lipoprotein(a) {Lp(a)} is associated with an increased prevalence and increased severity of coronary artery disease. However, the relationship between Lp(a) levels and outcomes after acute myocardial infarction (AMI) is unclear.Subjects and MethodsBetween October 2005 and June 2007, we measured serum Lp(a) levels in 832 consecutive AMI patients (age, 62.8±12.4 years, 600 men) on admission. They were divided into tertiles according to their serum Lp(a) levels {Tertile 1 (n=276), Lp(a)<13.8 mg/dL; Tertile 2 (n=279), Lp(a)=13.8-30.6 mg/dL; Tertile 3 (n=277), Lp(a)>30.6 mg/dL}.ResultsThere were no differences in baseline clinical characteristics among Tertiles 1, 2, and 3, except for proportions of Killip class III-IV patients (5.8% vs. 10.0% vs. 18.8%, respectively, p<0.001). There were significant differences in left ventricular ejection fractions (57.3±11.4% vs. 55.9±12.3% vs. 53.1±13.1%, p<0.001). Among the laboratory findings, there were significant differences in total cholesterol (173.3±37.2 vs. 183.5±38.9 vs. 185.3±43.8 mg/dL, p=0.001), low density lipoprotein-cholesterol (111.3±34.3 vs. 122.9±34.7 vs. 123.3±39.4 mg/dL, p<0.001), apolipoprotein B (92.8±25.4 vs. 100.8±26.0 vs. 101.9±28.8 mg/dL, p<0.001), and amino-terminal pro-brain natriuretic peptide levels (1805.2±4343.3 vs. 2607.9±5216.3 vs. 3981.5±7689.7 pg/mL, p<0.001). After adjusting for multiple variables in the high Killip class (III-IV) subgroup, the risk estimate for major adverse cardiovascular events (MACE) at 1-year follow-up was significantly higher in Tertile 3 than in Tertiles 1 or 2 (hazard ratio 6.723, 95% confidence interval 1.037-43.593, p=0.046).ConclusionIn patients in high Killip classes, high serum levels of Lp(a) were significantly associated with long-term adverse outcomes after AMI.

Umbilical cord blood amino-terminal pro-brain natriuretic peptide levels according to the mode of delivery

To evaluate cord blood amino-terminal pro-brain natriuretic peptide (NT-proBNP) levels according to the mode of delivery. Between 1 March and 31 May 2007, 106 blood samples were drawn from the umbilical vein at the time of delivery. Eighty-four NT-proBNP levels [63 term (34 cesarean sections and 29 vaginal deliveries) and 21 preterm births] were analyzed with respect to gestational age, birth weight, Apgar score, newborn gender, and cord blood pH. There was no statistical significance on comparison of the mean NT-proBNP values between the cesarean and vaginal delivery groups (801.9+/-537.7 vs. 724.3+/-542.4 pg/ml, respectively; P=0.572). The correlation of NT-proBNP with gestational age, birth weight, and cord blood pH was -0.616, -0.585, and -0.202, respectively. The mean values for NT-proBNP levels were compared according to the newborn gender (male vs. female; P=0.926), and Apgar score at 1 min [>6 (N=71) vs. <or=6 (N=13); P=0.001]. Vaginal delivery did not result in increased cord blood NT-proBNP levels reflecting cardiovascular stress to the fetal heart. NT-proBNP was inversely correlated with gestational age. Low Apgar score and umbilical cord blood pH appeared to induce the fetus to produce increased amounts of NT-proBNP.

Aminoterminal brain-type natriuretic peptide levels correlate with heart failure in patients with bidirectional Glenn anastomosis and with morbidity after the Fontan operation

The aims of this study were to generate normal values of aminoterminal pro-brain natriuretic peptide in children with a bidirectional Glenn anastomosis without congestive heart failure and to test the hypothesis that plasma levels of aminoterminal pro-brain natriuretic peptide correlate with the clinical severity of congestive heart failure and morbidity after the Fontan operation. Aminoterminal pro-brain natriuretic peptide plasma levels of 78 patients after the bidirectional Glenn operation with a median age of 3.2 years and a median follow-up time of 3 years were measured by using an automated enzyme immunoassay. The severity of heart failure was quantified by using the New York University Pediatric Heart Failure Index. The 97.5th percentile of aminoterminal pro-brain natriuretic peptide level in patients without congestive heart failure was 339 pg/mL. Aminoterminal pro-brain natriuretic peptide levels strongly correlated with the New York University Pediatric Heart Failure Index score (P < .001). In patients with congestive heart failure (31/78), the aminoterminal pro-brain natriuretic peptide levels were significantly higher (median, 670 pg/mL) than in patients without congestive heart failure (median, 171 pg/mL). In 41 patients who underwent the Fontan operation, the time to removal of chest tubes and the length of hospital stay positively correlated with the preoperative value of aminoterminal pro-brain natriuretic peptide. In children with a bidirectional Glenn anastomosis without signs of heart failure, aminoterminal pro-brain natriuretic peptide levels were within the normal range and correlated with the severity of congestive heart failure. Further studies are needed to determine whether aminoterminal pro-brain natriuretic peptide levels can aide clinicians in the early detection of congestive heart failure in this patient group.

Combined Use of Amino Terminal-Pro-Brain Natriuretic Peptide Levels and QRS Duration to Predict Left Ventricular Systolic Dysfunction in Patients With Dyspnea

The combination of elevated amino-terminal pro-brain natriuretic peptide levels and wide QRS duration was highly sensitive and specific for the prediction of impaired left ventricular systolic function among a group of patients presenting with dyspnea to the emergency department. This strategy can be used to predict depressed function and target more formal evaluation with echocardiography in patients with dyspnea.