Blood Brain Natriuretic Peptide Levels Research Articles

Effects of long-term desmopressin treatment for nocturia in older people.

Desmopressin improves nocturia frequency; however, reports on its long-term efficacy and safety are few, and concerns regarding its effect on body composition exist. We thus investigated the efficacy and safety of long-term desmopressin administration and its effect on body composition. This retrospective study, conducted at Chikugo City Hospital between August 2020 and December 2022, involved 133 men (mean age, 77.7 years) with nocturnal and persistent nocturia, who were administered an initial dose of 50 μg desmopressin. Efficacy endpoints included nocturnal urinary frequency, nocturnal urinary volume, hours of undisturbed sleep, nocturnal polyuria index, initial nocturnal urinary volume, and daily urinary frequency in a frequency-volume chart (3 days), before treatment and at 1, 4, 12, 24, and 52 weeks after desmopressin administration. Additionally, the effects of desmopressin on body composition were examined, including blood-brain natriuretic peptide and a chest radiography, before and 52 weeks after administration. Treatment improved most efficacy endpoint evaluation parameters. Around 87.6% of patients showed improved symptoms after 52 weeks compared with those before treatment (score ≤ 3). The blood-brain natriuretic peptide level rose; however, cardiothoracic ratio was unchanged. Long-term administration of desmopressin is thus effective and safe in older people with nocturnal polyuria, with little effect on body composition.

Effect of ischemic injury characteristics on left ventricular systolic function in patients with acute myocardial infarction

Aim. To study laboratory and magnetic resonance imaging (MRI) characteristics of infarction area depending on left ventricular (LV) global systolic function in patients with acute myocardial infarction (AMI) after revascularization.Material and methods. A total of 78 patients with primary AMI were included. On days 7-10, contrast-enhanced cardiac MRI was performed. Blood brain natriuretic peptide (BNP) was analyzed. Cardiac MRI was used to determine the characteristics of scar tissue, peri-infarct zone (PIZ), microvascular obstruction (MVO), intramyocardial hemorrhage (IMH) and the global contrast index.Results. According to the MRI, patients were divided into following groups: group 1 — LV ejection fraction (LVEF) ≥50% (n=50), group 2 — LVEF 40-49% (n=21), group 3 — LVEF <40% (n=7).The BNP in groups 1, 2, 3 was 106,8 (37,5; 248), 232,6 (170,1; 337,7) and 548,5±236,4 ng/ml, respectively (p1-3<0,05). The scar tissue mass in groups 1, 2, 3 was 10,3 (2,4; 20,0), 34,7±21,3, 59,4±37,6 g, respectively (p1-2, 3<0,01). PIZ differences were found only between patients with preserved and mildly reduced EF. MVO was diagnosed in 26% of patients with LVEF ≥50%, in 47,6% of patients with LVEF of 40-49% and 85,7% with LVEF <40% (p1-3<0,01). The detection rate of IMH prevailed in the 2nd group (33,3%) compared with the 1st group (12%) (p1-2<0,05). The global contrast index was the lowest in the 1st group (14,7 (8,8; 27,9)%), intermediate in the 2nd group (33,3±12,6%), the highest in the 3th group (54,2±19,5%) (р1-2, 3; 2-3<0,05).Conclusion. The following risk factors for a decrease in LV systolic function in patients with AMI after revascularization were identified: the size of scar tissue, PIZ, MVO and IMH characteristics, global contrast index, BNP level.

Prognostic value of brain natriuretic peptide in COVID-19 with or without acute heart failure

Abstract Background Although Brain Natriuretic Peptide (BNP) provides strong prognostic information of an unfavorable outcome in patients with acute heart failure (AHF), there is little information of its relevance as a biomarker for outcomes in COVID-19 and its complications Purpose To evaluate the association of increased BNP levels with complications and in-hospital mortality in a cohort of hospitalized COVID-19 patients. Methods The study included COVID-19 patients with data on BNP levels included in the ISACS COVID-19 registry. The population was categorized according to the presence of peak BNP levels ≥100 pg/mL during hospitalization. Primary outcomes included in-hospital mortality, AHF or acute respiratory failure (ARF, defined as PiO2/FiO2<300 mmHg or need for mechanical ventilation). Calculations were conducted using age and sex-adjusted multivariable logistic regression analyses. Results were also stratified according to presence or absence of cardiovascular disease (CVD) history. Differences between subgroups were verified for statistical significance using test for interaction. Results Of the 1152 patients included in the study, 615 (53.4%) had elevated BNP levels. These subjects were older (69.9±13.8 vs 59.1±16.8, p-value<0.001), had higher rates of cardiovascular risk factors (82.9% vs 57.7%, p-value<0.001) and presented more frequently with a prior history of CVD (either ischemic heart disease, cerebrovascular disease, venous thromboembolism, atrial fibrillation or a history of revascularization) (50.1% vs 27.5%, p-value<0.001). No sex differences were observed. When considering outcomes, BNP levels ≥100 pg/mL were associated with increased rates of in-hospital mortality (32.9% vs 4.9%, p-value<0.001), even after adjustment for demographic characteristics (OR: 7.35; 95% CI: 4.75–11.40; p-value<0.001). High BNP levels were also strongly associated with an increased risk of AHF (OR 19.9; 95% CI 8.6–45.9; p-value<0.001), a correlation that persisted both in patients with and without a prior CVD history (p for interaction=0.29). Of note, patients with elevated BNP also had a higher likelihood of developing ARF (OR 2.7; 95% CI 2.1–3.6; p-value<0.001), even in absence of AHF (OR 3.00; 95% CI 2.20–4.1; p-value<0.001). Conclusions In COVID-19, blood BNP level not only appears to be predictor of in-hospital mortality and AHF but was also independently associated with an increased risk of ARF. This finding supports the routine use of BNP in all patients admitted to hospital for COVID-19, regardless of a prior history of CVD. Funding Acknowledgement Type of funding sources: None.

Associations between spleen volume and exercise capacity in advanced heart failure patients with left ventricular assist device

Abstract Background The spleen has been recognized as an important organ with several functions such as a reservoir of blood volume, and an involvement in iron metabolism by processing of aged red blood cells and recycling iron. During exercise, spleen contracts, and red blood cells pooled in the spleen are recruited into the systemic circulation. So far, we reported that spleen size changed in advanced heart failure (HF) with left ventricular assist device (LVAD). In addition, spleen volume was related to pulmonary capillary wedge pressure (PCWP) or right atrial pressure (RAP) as parameters of cardiac preload. However, it remains unclear about the relationship between spleen volume and exercise capacity in advanced HF with LVAD. Purpose The purpose of this study was to investigate the associations between spleen volume and exercise capacity in advanced HF patients with LVAD. Methods We enrolled 27 HF patients (21 males, 45±12 years) with LVAD (HeartMate II™; Abbott, Chicago, IL, USA) for use as a bridge to heart transplantation. All patients underwent blood test, echocardiography, right heart catheterization, computed tomography (CT) and cardiopulmonary exercise testing (CPET). Spleen size was measured by CT volumetry. We excluded patients with splenic infarction or aortic valve closure surgery. Results At baseline, body mass index, blood brain natriuretic peptide levels, hemoglobin levels, left ventricular ejection fraction were 21.4±3.1 kg/m2, 73.8 (51.9–165.8) pg/mL, 12.1 (10.6–13.4) g/dL, 24.8±14.7%, respectively. Total cardiac output (CO), the sum of pump flow and CO of native heart was 4.6±0.9 L/min, and spleen volume was 184.9±48.8 mL. As for parameters of CPET, peak heart rate (HR), peak VO2, and peak O2 pulse were 128±25 beats/min, 14.2±3.3 mL/kg/min, and 6.6±1.9 mL/beat. At rest, there were significant correlations between spleen volume and PCWP (r=0.382, p=0.049), RAP (r=0.406, p=0.035) or pulsatility index (r=0.384, p=0.047), despite no correlations with total CO or pump flow. During exercise, there were significant interrelations of spleen volume with peak VO2 (r=0.451, p=0.018) and peak O2 pulse (r=0.427, p=0.026). Furthermore, peak VO2 was interrelated with peak HR (r=0.481, p=0.011) or hemoglobin levels (r=0.649, p<0.001). Remarkably, spleen volume was significantly correlated with hemoglobin levels (r=0.391, p=0.043) (Figure). Interpreting these results based on Fick's formula, the proportion of native CO to total CO is very small at rest, but increases during exercise. The spleen during exercise may contribute to increased native CO, especially stroke volume. Moreover, the spleen may be related to both cardiac preload and oxygen carrying capacity, resulting in a significant association between spleen volume and peak VO2. Conclusion Spleen volume could be a useful predictor of exercise capacity in advanced HF patients with LVAD, reflecting splenic function to modulate cardiac preload and blood hemoglobin levels. Spleen volume and exercise parameters Funding Acknowledgement Type of funding source: None

Thrombus of left atrium and/or its appendage in nonvalvular atrial fibrillation: echocardiographic and laboratory risk factors, capabilities for prediction and correction

The review presents data on the feasibility of using laboratory findings to predict the presence of left atrium (LA) and/or left atrial appendage (LAA) thrombus in non-valvular atrial fibrillation (NvAF). It describes the relationship between the presence of a blood clot in the LA/LAA and a blood group, certain parameters of peripheral blood, blood brain natriuretic peptide levels, homocysteine, asymmetric D-methylarginine, uric acid and D-dimer. The authors presented data of studies to show a relationship between the presence of LA/LAA trombus and individual parameters obtained during transthoracic echocardiography: left ventricular mass index, left atrial volume index, LvEF/left atrial volume index ratio, E/e' ratio, peak systolic deformity of the left atrium. The capabilities of different scales in assessing the likelihood of the presence of LA/LAA thrombus in NvAF are evaluated. insufficient information capacity of the CHADS 2 and CHA 2 DS 2 -vASc scales is demonstrated. The article described attempts to improve the scales by adding other risk factors (CHA 2 DS 2 -VASc-MS, CHA 2 DS 2 VASc-AFR, CHA 2 DS 2 VASc-RAF scales, as well as the possible role of additional consideration of blood brain natriuretic peptide levels). It is shown that it is feasible to add information on the duration of NvAF paroxysm and glomerular filtration rate to the CHA 2 DS 2 -VASc scale. in addition, consideration of the presence of metabolic syndrome may be beneficial. Overall, approaches with addition of information on the duration of NvAF paroxysm and glomerular filtration rate to the CHA 2 DS 2 -VASc scale proved to be most successful. The authors presented the shortcomings of accumulated evidence base regarding the relationship between the studied parameters and the presence of LA/LAA thrombus, including a small number of examined patients, usually a retrospective character of the study, a search of LA/LAA thrombus before the planned catheter ablation or electropulse therapy. As a result, it is not known to what extent the studied predictors and scales may be applied to a wider contingent of patients with NvAF. In addition, most studies have been performed on the Asian population and it is unclear whether their results can be extrapolated to other ethnic groups. It was shown that thrombi do not disappear under pressure of anticoagulant therapy in at least one-third of patients.

Analysis of the Correlation between the Myocardial Expression of DPP-4 and the Clinical Parameters of Patients with Heart Failure.

Dipeptidyl peptidase-4 (DPP-4) inhibitors are widely used as antidiabetic drugs. We recently reported that DPP-4 inhibition has beneficial effects on heart failure (HF) mice model. Furthermore, we confirmed that myocardial DPP-4 activity was significantly increased in HF mice compared with non-HF mice. The aim of this study was to investigate the level of myocardial CD26 (DPP-4) expression and its association to clinical parameters in HF patients.Endomyocardial biopsy (EMB) specimens (n = 33) were obtained from HF patients who were admitted to Chiba University Hospital from June 2006 to July 2012. EMB specimens were fixed in formaldehyde and stained with Masson's trichrome staining or with anti-CD26 antibody. Patients were divided into the high CD26 density (CD26-H) or low CD26 density groups (CD26-L). DPP-4 density was compared with blood brain natriuretic peptide (BNP) level and echocardiographic parameters at one year after EMB. Although there were no significant differences in echocardiographic parameters between the CD26-H group and CD26-L group, blood BNP levels were higher in the CD26-H group than in the CD26-L group at one year after EMB. Multivariate regression analysis showed that CD26 density was also an independent determinant of blood BNP levels at one year after EMB.The level of myocardial CD26 expression might be a predictive marker of prognosis in patients with HF.

The Effects of Prolonged Acute Hypobaric Hypoxia on Novel Measures of Biventricular Performance

There are limited data on the effects of prolonged acute hypoxia on individual and global measures of biventricular function. The aim of this study was to assess its effects on conventional and novel measures of biventricular function, including the recently defined E'/(A'×S') (EAS) index, obtained using pulsed-wave tissue Doppler Imaging (PWTDI) and associated blood brain natriuretic peptide (BNP) levels. In this study, 14 healthy subjects aged 30.5 years were assessed at baseline and at >150 minutes following hypobaric hypoxia (HH) to the equivalent altitude of 4800 m for a total of 180 minutes. The combined EAS index (E'/(A' × S')) was calculated at the mitral and tricuspid annulus using data from the peak systolic (S') early (E') and late (A') diastolic filling. It was seen that HH increased resting heart rate (63.4 ± 8.4 vs. 85.2 ± 10.2/min; P < 0.0001), cardiac output (4.6 ± 0.7 L/min vs. 6.1 ± 1.2 L/min; P < 0.0001), peak pulmonary artery systolic pressure (PASP) (26.3 ± 2.0 mmHg vs. 37.2 ± 6.3 mmHg; P < 0.0001), and reduced SpO2 (98.5 ± 1.1 vs. 72.9 ± 8.1%; P < 0.0001). There was a significant reduction in mitral (0.19 ± 0.06 vs. 0.11 ± 0.03; P < 0.0001) and tricuspid (0.12 ± 0.04 vs. 0.09 ± 0.03; P = 0.03) EAS indices, but no change in left or right ventricular myocardial performance (Tei) indices, global left ventricular (LV) longitudinal systolic strain, BNP levels, or estimated filling pressures (E/E'). Only reducing SpO2 remained as an independent predictor of PASP on multivariate analysis (overall R(2) = 0.77; P < 0.0001). The right and LV EAS indices were significantly correlated (r = 0.45; 95% CI: 0.07-0.7; P = 0.02). The conclusion from this study was that acute prolonged HH does not adversely affect resting global biventricular function and there is evidence of linked right and LV responses.

MIR-27B EXPRESSION AND SIGNIFICANCE OF PULMONARY HYPERTENSION IN CONGENITAL HEART DISEASE

ObjectivesTo investigate the clinical significance of blood brain natriuretic peptide (BNP) testing in patients with acute dyspnoea due to differential due to cardiac and pulmonary.MethodsThe selected object: Select January 2011...

2．高齢者高血圧の日内変動と心血管リモデリング

Hypertension causes left ventricular hypertrophy and increases in large artery stiffness with ageing, both of which are cardiovascular risks. We studied cardiovascular remodeling in elderly hypertensive patients by measuring blood brain natriuretic peptide (BNP), left ventricular mass indices (LVMI), pulse wave velocities (PWV), and ambulatory blood pressures. We focused on ageing and sex-differences. Both LVMI and PWV correlated significantly with nocturnal blood pressures, which in turn correlated with BNP levels. Thus, BNP might be a candidate for a surrogate endpoint of target organ damage in elderly cases of hypertension. Left ventricular hypertrophy progressed with ageing more in women. Systolic blood pressures in women were shown to rise abruptly after menopause and to surpass those in men. However, more non-dippers were observed in men, suggesting that the absolute value of nocturnal blood pressure is a determinant of left ventricular hypertrophy. PWV accelerated with ageing, but it did not correlate with LVMI, suggesting that progression of cardiac remodeling with ageing was relatively independent of vascular remodeling. Finally, the greater mortality in elderly women might be associated with progressive left ventricular hypertrophy.

The use of probrain natriuretic peptide in pleural fluid for the diagnosis of pleural effusions resulting from heart failure

Natriuretic peptides are secreted by the myocardium in response to mechanical stretch and have been proposed as a possible test for assisting the diagnosis of heart failure. This article reviews the rationale for measuring N terminal probrain natriuretic peptide in pleural fluid to identify heart failure as the cause of a pleural effusion. Rapid and accurate testing of natriuretic peptides as biomarkers for heart failure is now a clinical reality. In patients presenting with dyspnea, heart failure is usually absent at blood brain natriuretic peptide levels less than 100 pg/mL, possible from 100 to 500 pg/mL, and probable at levels greater than 500 pg/mL. In evaluating natriuretic peptide assays, one needs to consider carefully laboratory and biologic variation, including gender, sex, obesity, renal function, and the assay used. Potential future applications of natriuretic peptide testing include the differential diagnosis of pleural effusion. A recent study has shown good diagnostic characteristics in cardiac pleural effusions, with likelihood ratios of 13 and a diagnostic accuracy of more than 90% for pleural fluid N terminal probrain natriuretic peptide levels > or =1500 pg/mL. Specifically, N terminal probrain natriuretic peptide pleural levels correctly categorized most cardiac effusions misclassified as exudates by standard criteria, and discriminated between cardiac and hepatic transudates. Pleural fluid N terminal probrain natriuretic peptide may help accurately differentiate cardiac from noncardiac conditions in patients presenting with pleural effusion.

Brain natriuretic peptide levels during cardiac reperfusion: comparison between percutaneous coronary angioplasty and aorto-coronaric bypass

Background: Several studies have documented brain natriuretic peptide (BNP) behavior during cardiac ischemia and after myocardial necrosis. Peptide levels have been shown to be increased during acute phase of cardiac ischemia and during late ventricular remodelling; however, there are fewer data about hormone levels during percutaneous transluminal coronary angioplasty (PTCA) and aorto-coronaric by pass (CABG). Methods: Aim of this study was to investigate plasma BNP during acute or sub-acute myocardial ischemia in patients undergoing to PTCA or CABG, taking blood samples before and after both procedures. We studied 59 consecutive subjects, 25 submitted to coronary by-pass and 34 submitted to coronary angioplasty. Blood BNP levels were measured the day before intervention and after 3, 7 and 90 days from the procedures. Results: Peptide levels were significantly different just before intervention (GABG group 118.7±81 pg/ml vs. PTCA group 34.8±15 pg/ml, p<0.01). This difference was increased after 3 days (CABG group 403.2±185 pg/ml vs. PTCA group 105.3±56 pg/ml, p<0.0001) and after 7 days (CABG group 252.2±93 pg/ml vs. PTCA group 69.8±36 pg/ml, p<0.00001). These results trend to converge after 90 days (CABG group ±93 pg/ml vs. PTCA group ±36 pg/ml, p<0.05). Conclusions: Plasma BNP shows a different behavior during and after different myocardial reperfusion procedures. PTCA causes only mild and temporary elevation of peptide levels, otherwise CABG demonstrates a more enhancing of BNP release not only in early phase but also after one week; increased levels tend to return towards the reference range after few weeks from cardiac surgery.

CORRELATION BETWEEN BRAIN NATRIURETIC PEPTIDE AND ATRIAL NATRIURETIC PEPTIDE LEVELS IN NEONATAL PLASMA

Brain natriuretic peptide (BNP), first discovered in porcine brain, is principally produced by the heart. Unlike atrial natriuretic peptide (ANP), BNP is largely derived from the ventricles. In adults plasma BNP levels, like ANP, respond to changes in blood volume and levels of 3,4-9.0 pg/ml have been reported. Fetal and cord blood BNP levels have been reported but we are not aware of further reports on BNP in neonates.We used specific radioimmunoassays (Peninsula Laboratories) to measure BNP and ANP levels in plasma from neonates with respiratory distress syndrome before and after treatment with exogenous surfactant. The cross reactivity between the two peptides in their respective assays is <0.001%.Results:Individual ANP and BNP levels were compared in 41 paired samples from babies aged 4 to 80 hours. ANP levels ranged from 87-2587 pg/ml and BNP levels ranged from 29-445 pg/ml. There was a strong correlation between the concentrations of the two peptides: R=0.76, p<0.0001 (Spearman's Rank Correlation test).Conclusions:We conclude that levels of BNP in the neonate are much higher than reported in adults and are highly correlated with ANP, although further work is needed to establish its physiological role.