Serum BNP Research Articles

Serum BNP levels are associated with malignant pericardial effusion

IntroductionThe development of malignant pericardial effusion indicates a poor prognosis and is the leading cause of cardiac tamponade. The objectives of the study were to examine the levels of BNP in traumatic, malignant and non-malignant pericardial effusion etiologies, and to assess the value of serum and pericardial fluid BNP levels in the prognosis of malignant pericardial effusion. MethodsA of 56 patients with clinical and echocardiographic diagnosis of pre-tamponade or tamponade who required pericardiocentesis were included in the study. BNP levels were assessed in the serum and within the pericardial fluid. The diagnostic value of BNP levels in discriminating between malignant and non- malignant etiology of pericardial effusion was examined using a receiver-operating characteristic (ROC). ResultsPericardial fluid BNP levels were similar across all etiology groups. In patients with malignant etiology, the amount of pericardial fluid was high and their serum BNP levels were relatively low. BNP levels were strong predictors of malignant pericardial effusion, and the cut-off point of BNP ≤ 250 pg/ml demonstrated the highest sensitivity (90.0%) for malignant etiology. ConclusionsLow serum BNP levels were significantly associated with malignancy in patients undergoing pericardiocentesis for pericardial effusions. Serum BNP levels <250 pg/ml may trigger more extensive diagnostic testing for malignant pericardial effusion in patients with small pericardial effusion who are not considered for pericardiocentesis due to small effusion, in whom the etiology is unclear.

Distinct contribution of Rac1 expression in cardiomyocytes to anthracycline-induced cardiac injury

Cardiotoxicity is the dose limiting adverse effect of anthracycline-based anticancer therapy. Inhibitor studies point to Rac1 as therapeutic target to prevent anthracycline-induced cardiotoxicity. Yet, supporting genetic evidence is still missing and the pathophysiological relevance of different cardiac cell types is unclear. Here, we employed a tamoxifen-inducible cardiomyocyte-specific rac1 knock-out mouse model (Rac1flox/flox/MHC-MerCreMer) to investigate the impact of Rac1 expression in cardiomyocytes on cardiac injury following doxorubicin treatment. Distinctive stress responses resulting from doxorubicin treatment were observed, including upregulation of systemic markers of inflammation (IL-6, IL-1α, MCP-1), cardiac damage (ANP, BNP), DNA damage (i.e. DNA double-strand breaks (DSB)), DNA damage response (DDR) and cell death. Measuring the acute doxorubicin response, the serum level of MCP-1 was elevated, cardiac mRNA expression of Hsp70 was reduced and cardiac DDR was specifically enhanced in Rac1 deficient mice. The frequency of apoptotic heart cells remained unaffected by Rac1. Employing a subactue model, the number of doxorubicin-induced DSB was significantly reduced if Rac1 is absent. Yet, the doxorubicin-triggered increase in serum ANP and BNP levels remained unaffected by Rac1. Overall, knock-out of rac1 in cardiomyocytes confers partial protection against doxorubicin-induced cardiac injury. Hence, the data provide first genetic evidence supporting the view that pharmacological targeting of Rac1 is useful to widen the therapeutic window of anthracycline-based anticancer therapy by alleviating acute/subacute cardiomyocyte damage. Furthermore, considering published data obtained from the use of pharmacological Rac1 inhibitors, the results of our study indicate that Rac1-regulated functions of cardiac cell types others than cardiomyocytes additionally influence the adverse outcomes of anthracycline treatment on the heart.

Potential biomarkers of acute myocardial infarction based on weighted gene co-expression network analysis

BackgroundAcute myocardial infarction (AMI) is the common cause of mortality in developed countries. The feasibility of whole-genome gene expression analysis to identify outcome-related genes and dysregulated pathways remains unknown. Molecular marker such as BNP, CRP and other serum inflammatory markers have got the notice at this point. However, these biomarkers exhibit elevated levels in patients with thyroid disease, renal failure and congestive heart failure. In this study, three groups of microarray data sets (GES66360, GSE48060, GSE29532) were collected from GEO, a total of 99, 52 and 55 samples, respectively. Weighted gene co-expression network analysis (WGCNA) was performed to obtain a classifier which composed of related genes that best characterize the AMI.ResultsHere, this study obtained three groups of microarray data sets (GES66360, GSE48060, GSE29532) on AMI blood samples, a total of 99, 52 and 24 samples, respectively. In all, 4672 genes, 3185 genes, 3660 genes were identified in GSE66360, GSE48060, GSE60993 modules, respectively. We preformed WGCNA, GO and KEGG pathway enrichment analysis on these three data sets, finding function enrichment of the differential expression gene on inflammation and immune response. Transcriptome analysis were performed in AMI patients at four time points compared to CAD patients with no history of MI, to determine gene expression profiles and their possible changes during the recovery from myocardial infarction.ConclusionsThe results suggested that three overlapping genes (FGFBP2, GFOD1 and MLC1) between two modules could be a potential use of gene biomarkers for the diagnose of AMI.

Influence of percutaneous coronary intervention on homocysteine and galection-3 in serum of patients with coronary heart disease and correlation analysis

Objective To discuss the influence of percutaneous coronary intervention(PCI) on the serum concentration of homocysteine(Hcy) and galectin-3 in patients with coronary heart disease(CHD). Methods From September 2016 to October 2017, 70 patients in Ji'nan Central Hospital were selected.According to the results of coronary angiography(CAG), they were divided into observation group with drug-eluted stents(n=47, including 25 cases with type A CHD and 22 cases with type B CHD) and control group without abnormal CAG(n=23). Serial venous blood samples were obtained 1 day before PCI as well as 1 day and 7 days after PCI.Plasma concentrations of Hcy, BNP and galectin-3 were measured and compared.The postoperative patients with PCI were tracked for 1 year to observe the influence of serum Hcy and galectin-3 on the severity of CHD and the quality after PCI. Results The plasma Hcy levels of type A[(16.52±5.41)μmol/L]and type B[(19.32±6.35)μmol/L]after PCI were significantly higher than those of the type A[(11.66±3.25)μmol/L]and the type B[(15.87±5.20)μmol/L]before PCI(t=2.375, P<0.05, t=2.97, P<0.01). Meanwhile, the plasma galectin-3 levels of type A[(0.86±0.11)μg/L] and type B[(1.15±0.48)μg/L]after PCI were also higher than those of the type A[(0.32±0.53)μg/L]and the type B[(0.46±0.19)μg/L]before PCI(t=2.178, P<0.05, t=4.269, P<0.01). Furthermore, levels of the plasma Hcy and galectin-3 were positively associated with the severity of CHD. Conclusion The higher blood levels of serum Hcy, BNP and galectin-3 after PCI indicate that the balloon inflation and implantation of stent can affect the level of plasma Hcy, BNP and galectin-3.Therefore, the levels of serum Hcy and galectin-3 are helpful to diagnose CHD and evaluate the degree of CHD. Key words: Coronary artery disease; Percutaneous coronary intervention; Cysteine; Brain natriuretic peptide; Galectin-3; Coronary angiography; Serum; Degree of the lesion

AdipoRon prevents l-thyroxine or isoproterenol-induced cardiac hypertrophy through regulating the AMPK-related pathway.

Cardiac hypertrophy is a risk factor which can intrigue heart failure. In the present study, we explored whether AdipoRon attenuates isoprenaline (ISO) or l-thyroxine-induced cardiac hypertrophy in Sprague-Dawley (SD) rats and whether the anti-hypertrophy effect is mediated by AMPK-related pathway. Here, cardiac hypertrophy was induced by injection of l-thyroxine or ISO in SD rats. In the treatment group, AdipoRon was co-administered. We examined the effects of AdipoRon on cardiac hypertrophy and hypertrophy signaling pathway. The weight of SD rats was recorded every day. Rats were killed for collection of blood and heart under anesthesia. The left heart weight and heart weight were weighed. Paraffin-embedded heart tissue regions (4 μm) were stained with hematoxylin and eosin or Masson to detect left heart hypertrophy and myocardial fibrosis. The serum BNP levels were determined by using an enzyme-linked immunosorbent assay. The mRNA levels of ANP, BNP, PGC-1α, and ERRα were evaluated by real-time PCR analysis. The protein expression levels of PGC-1α, ERRα, and pAMPK/AMPK were determined by western blot analysis. The results showed that AdipoRon significantly reversed heart weight (HW)/body weight (BW) ratio, left ventricular (LV)/BW ratio, serum BNP level and the mRNA level of ANP and BNP induced by ISO or l-thyroxine. ISO or l-thyroxine reduced both the mRNA level and protein level of ERRα and PGC-1α, and also reduced the protein level of pAMPK/AMPK. However, AdipoRon reversed ISO or l-thyroxine-induced changes of pAMPK/AMPK, ERRα, and PGC-1α. Our data indicated that the effects of AdipoRon are mediated partly by activating AMPK-related pathway, and AdipoRon plays a potential role in the prevention of cardiac hypertrophy.

1866. Adverse Outcomes Associated with Potentially Inappropriate Antibiotic Use in Heart Failure Admissions

BackgroundHospital admissions due to acute decompensated heart failure (ADHF) are common, and the clinical presentation can be confused with other conditions such as pneumonia. Hospitalized ADHF patients often receive antibiotic therapy even when the clinical suspicion for pneumonia is low, and intravenous (IV) antibiotics are commonly used. We hypothesized the additional fluid and sodium content of potentially unnecessary antibiotic therapy could worsen outcomes and complicate management of ADHF patients.MethodsWe conducted a retrospective cohort analysis of adult patients with a diagnosis of ADHF. Patients were excluded if chest radiography suggested pneumonia, if they were continuing a prior antibiotic regimen, if they were diagnosed with a proven infection during admission, or if serum BNP level was not elevated. Patients who received antibiotics were compared with those who did not with respect to diuretic requirements, length of stay, sodium and fluid load attributable to antibiotic treatment, and readmission rate.ResultsThree hundred thirty-seven patients were screened for inclusion of which 153 were enrolled, 89 in the nonantibiotic arm compared with 64 in the antibiotic arm. Median length of stay in the antibiotic arm was 6.5 days as opposed to 3.25 days in the nonantibiotic arm (P < 0.001). The antibiotic group received a median dosage of 1,000 mg of furosemide compared with 400 mg in the nonantibiotic arm (P < 0.001). Patients who received antibiotics were 2.51 times more likely to be readmitted compared with patients who did not receive antibiotics (P = 0.04). On average, each patient in the antibiotic arm received approximately 970 mg of sodium daily and 1.6 L of volume attributed to antibiotic infusions.ConclusionPatients who received IV antibiotics during treatment for ADHF without evidence of infection had significantly longer lengths of stay, received significantly higher doses of furosemide, and were more likely to be readmitted compared with patients with the same diagnosis who were not exposed to intravenous antibiotics. Additional studies are needed to determine factors contributing to potential overprescribing in this population, and ADHF patients are a promising target of antibiotic stewardship interventions.Disclosures All authors: No reported disclosures.

Clinical observation of Wutou-Chishizhi decoction combined with conventional medicine for treatment for ischemic cardiomyopathy and heart failure

Objective To explore clinical efficacy and safety of Wutou-Chishizhi decoction combined with conventional medicinefor treatment for ischemic cardiomyopathy and heart failure. Methods A total of 103 patients with ischemic cardiomyopathy and heart failure were divided into control group (n=51) and treatment group (n=52). Patients of control group were treated with conventional medicine, while treatment groupwere treated Wutou-Chishizhi decoction combined with conventional medicine. The two groups were treated for 28 days. Clinical curative effect was evaluated after treatment. The score of quality of life of the two groups were compared. The LVEDD, LVESD, LVEF, VEGF, hs-CRP, BNP and cTNⅠ of the two groups were compared. The adverse reactions of the two groups during the treatment were compared. Results Total effective rate of the treatment group was 94.23%(49/52), which was significantly higher than the control group 76.47% (39/51), and the difference was statistically significant (χ2=6.527, P=0.011). After treatment, the LVEDD (50.25 ± 6.82 mm vs. 57.12 ± 7.33mm, t=4.926) and LVESD (44.13 ± 3.63 mm vs. 46.20 ± 4.05 mm, t=2.733) in the treatment group were significantly lower than those in the control group (P<0.05). The LVEF (45.57% ± 7.30% vs. 41.14% ± 6.22%, t=3.312) in the treatment group was significantly higher than that in the control group (P<0.05). After treatment, the VEGF in the treatment group was significantly higher than that in the control group (P<0.05). And the hs-CRP (2.11 ± 0.41 mg/L vs. 3.05 ± 0.63 mg/L, t=8.992), BNP (82.02 ± 21.13 pg/L vs. 122.35 ± 30.52 pg/L, t=7.810) and cTNⅠ (0.25 ± 0.08 μg/L vs. 0.37 ± 0.10 μg/L, t=6.732) in the treatment group were significantly lower than those in the control group (P<0.05). There were no serious adverse reactions of the two groups during treatment. Conclusions The Wutou-Chishizhi decoction combined with conventional medicine for treatment of ischemic cardiomyopathy and heart failure has a good efficacy and low adverse reactions, can improve the cardiac function and quality of life, reduce the serum hs-CRP, BNP and cTNⅠ levels, improve the serum VEGF level, and it was worthy clinical application. Key words: Myocardial ischemia; Heart failure; Wutou-Chishizhi decoction; Cardiac function; Quality of life; Clinical study

17\u03b2-estradiol preserves right ventricular function in rats with pulmonary arterial hypertension: an echocardiographic and histochemical study

Pulmonary arterial hypertension (PAH) is more prevalent in females. Paradoxically, female patients have better right ventricular (RV) function and higher survival rates than males. However, the effects of 17β-estradiol (E2) on RV function in PAH has not been studied. Twenty-four male rats were exposed to monocrotaline (MCT) to induce experimental PAH, while treated with E2 or vehicle respectively. Together with eight control rats, thirty-two rats were examined by echocardiography 4 weeks after drug administration. Echocardiographic measurement of RV function included: tricuspid annular plane systolic excursion (TAPSE), RV index of myocardial performance (RIMP), RV fractional area change (RVFAC) and tricuspid annular systolic velocity (s′). RV free wall longitudinal strain (RVLSFW) and RV longitudinal shortening fraction (RVLSF) were also used to quantify RV function. RV morphology was determined by echocardiographic and histological analysis. TAPSE, RVFAC and s′ were reduced, and RIMP was elevated in the MCT-treated group and vehicle-treated group, when compared with control group (P < 0.01). TAPSE, RVFAC and s′ in the E2 group were higher, while RIMP was lower than those in the MCT-treated group and vehicle-treated group (P < 0.01). Myocardial functional parameters (RVLSFW and RVLSF) were also higher in the E2 group. Enhanced serum E2 levels were closely correlated with the improvement in RV functional parameters and enhancement of serum BNP levels (P < 0.01 for all groups). RV function decreased significantly in male rats with MCT-induced PAH, while E2 exhibited a protective effect on RV function, suggesting that E2 is a critical modulator of sex differences in PAH.

Association between typical electrocardiographic abnormalities and NT-proBNP elevation in a large cohort of patients with Chagas disease from endemic area

Chagas cardiomyopathy is the most harmful complication of Chagas disease. The electrocardiogram is a well-studied exam and has been considered an important tool for detection and evaluation of Chagas cardiomyopathy since the first years of its description. Many of its abnormalities have been described as associated with a worse prognosis. Serum BNP levels were described as inversely related to the left ventricular ejection fraction and as an independent predictor of death. It was not reported how electrocardiographic alterations correlate to NT-proBNP and its analog. The present study aims to describe the baseline electrocardiograms of a large cohort of patients with Chagas disease from endemic area and to establish an association between the number of electrocardiogram alterations and high levels of NT-ProBNP in Chagas disease patients. This study selected 1959 Chagas disease patients in 21 municipalities within a limited region in the northern part of the State of Minas Gerais (Brazil), 1084 of them had Chagas cardiomyopathy. NT-proBNP levels were suggestive of heart failure in 11.7% of this population. One or more electrocardiographic alterations have an Odds Ratio of 9.12 (CI 95% 5.62–14.80) to have NT-proBNP elevation. Considering the association between the number of 1, 2, and 3 or more alterations in electrocardiogram and NT-proBNP elevation, the ORs were 7.11 (CI 95% 4.33–11.67); 16.04 (CI 95% 9.27–27.77) and 47.82 (CI 95% 17.98–127.20), respectively. The presence and the number of typical electrocardiographic alterations of Chagas disease are independently associated with the severity of the cardiomyopathy.

Advanced interatrial block is an electrocardiographic marker for recurrence of atrial fibrillation after electrical cardioversion

BackgroundEarly recurrence of atrial fibrillation (AF) is common following a successful electrical cardioversion (ECV). The purpose of this study was to investigate the hypothesis that AF recurrence is related to atrial electrical inhomogeneity, which may influence the P wave characteristics. MethodsTwo hundred ninety-one consecutive persistent AF patients who underwent ECV were enrolled, and evaluated for AF recurrences one month after the ECV. Patients with open-heart surgery, a history of catheter ablation, and an unsuccessful ECV were excluded. The P wave duration, dispersion and P wave morphology were evaluated by 12‑lead ECGs 30 min after the ECV. ResultsIn total, 141 patients were investigated. One month after the ECV, 60 (43%) patients maintained sinus rhythm. The advanced interatrial block (aIAB; P wave duration >120 ms and biphasic P waves in the inferior leads) (Hazard ratio [HR], 4.51; 95% confidence interval [CI] 1.45–14.01, P = 0.009), P wave dispersion (HR, 1.06; 95%CI 1.02–1.09, P = 0.001), and duration of AF per month (HR, 1.03; 95%CI 1.01–1.04, P = 0.004) were independent predictors of AF recurrence. An aIAB was not associated with structural parameters such as the left atrial volume index or right atrial area. There were no differences in the serum BNP level and frequency of administering anti-arrhythmic drugs between the patients with and without recurrence. ConclusionsThe risk of AF recurrence after the ECV can be predicted by the P wave characteristics. A longer P wave dispersion and the duration of AF also had a tendency for recurrence.

Berberine inhibits cardiac remodeling of heart failure after myocardial infarction by reducing myocardial cell apoptosis in rats.

The effects of berberine on cardiac function of heart failure after myocardial infarction and its possible mechanism were investigated. The anterior descending branches of 50 female Wistar rats were ligatured to establish the model of heart failure after myocardial infarction. At 4 weeks after successful modeling, the rats were randomly divided into two groups receiving 4-week gavage with saline (Sal group) and berberine (Ber group), while the sham-operation group (Sham group) was set up. After 4 weeks, the hemodynamics and serum BNP in rats were measured. The hearts of rats were taken to detect the degree of myocardial fibrosis. The myocardial cell apoptosis was detected. The expressions and changes in myocardial apoptosis-related proteins, including Bcl-2, Bax and caspase-3, were detected. The expression and changes in GRP78, CHOP and caspase-12 in myocardial tissue were detected. The results showed that Berberine improved the cardiac function of rats after myocardial infarction. After myocardial infarction, myocardial fibrosis and apoptosis were observed around the infarction area, berberine improved the myocardial fibrosis and reduced cell apoptosis. Furthermore, berberine alleviated endoplasmic reticulum stress (ERS) after myocardial infarction. In conclusion, Berberine can inhibit the myocardium cell apoptosis of heart failure after myocardial infarction, and its mechanism may be realized by affecting the ERS in myocardial tissue of heart failure after myocardial infarction and CHOP and caspase-12 apoptotic signaling pathway, upregulating Bcl-2/Bax expression and downregulating caspase-3 expression, thus inhibiting the cardiac remodeling and protecting the cardiac function.

Determinants of in-hospital clinical outcome in patients with sub-massive pulmonary embolism

IntroductionThere is limited data regarding in hospital determinants of clinical deterioration and outcome in sub massive pulmonary embolism (PE). We aimed to evaluate these determinants by comparing biomarkers, CT pulmonary angiogram echocardiography, electrocardiography variables. Methods57 patients of sub massive PE diagnosed on CT pulmonary angiogram were included. All patients received UFH on admission and were divided into two groups based on their clinical course. Group 1 comprised of patients who remained stable, group 2 of patients who showed signs of clinical deterioration. ResultsThere were 34(59.6%) patients in group 1 and 23(40.4%) patients in group 2. No significant difference in age, gender, BMI. 59.37% had sub massive PE, 5.26% had mortality and 40.4% had clinical deterioration. Intravenous UFH infusion given to 59.6%, systemic thrombolysis 22.8%, catheter directed mechanical breakdown 14%, surgical embolectomy in 3.5% patients. S1Q3T3, new onset RBBB, T wave inversion > 1.63 mm, Basal RV size > 40 mm, RV: LV ratio > 1.2, Global RV longitudinal strain <−10.75% and RVSP > 39 mmHg profiled high risk group. Serum BNP and CT pulmonary angiogram derived scores didn’t differ significantly although CT findings helped to exclude low risk patients (specificity 88%, sensitivity 95%). ConclusionsPhysicians should be aware that patients who have ECG and Echocardiography changes suggestive of right ventricular strain and dysfunction above the cut off values and have documented thrombus in Proximal branches (RPA/LPA) or in distal portion of main pulmonary artery may require aggressive management with systemic/catheter based thrombolysis besides routine anticoagulation with heparin to prevent clinical deterioration.

Assessment of left ventricular systolic synchrony and cardiac function in patients with ischemic heart disease by echocardiography.

To investigate the correlation between left ventricular systolic synchrony and cardiac function in patients with ischemic heart diseases of different degrees by echocardiography. 84 cases of patients with ischemic heart diseases were consecutively selected including 28 cases of asymptomatic heart failure, 40 cases of mild to moderate heart failure, and 16 cases of severe and refractory heart failure. Interventricular synchrony was evaluated by echocardiography, and the result was expressed by interventricular mechanical delay (IVMD). The ventricular systolic synchrony was evaluated by the standard deviation of systole tmax (Ts-SD), cardiac function indexes included left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter (LVEDd), and BNP and QRS wave duration. IVMD, Ts-SD and QRS wave duration increased gradually following the exacerbation of heart failure; differences were statistically significant (p < 0.05). The ratio of the QRS wave duration that was equal to or greater than 120 ms among three groups showed no statistical difference (p = 0.593). In patients with QRS wave durations equal to or greater than 120 ms compared to patients with durations less than 120 ms, the levels of IVDM, Ts-SD, LVEDd, and serum BNP were increased (p < 0.05) while levels of LVEF were decreased (p < 0.05). There were no significant linear correlations among values of IVMD, Ts-SD with LVEF, LVEDd, BNP and QRS wave duration (p > 0.05). Left ventricular systole synchrony was different in patients with different degrees of ischemic heart diseases, and a comprehensive assessment of the combination of ventricular systole synchrony with cardiac function is needed.

The impact of aerobic exercise training with vascular occlusion in patients with chronic heart failure.

AimsThis study aimed to evaluate the impact of aerobic exercise training with vascular occlusion in patients with chronic heart failure.Methods and resultsThirty patients with post‐infarction heart failure were randomized to an interventional exercise group (IG; n = 15) or a control exercise group (CG; n = 15). Exercise was performed at an intensity of 40–70% of the peak VO2/W for 6 months. Patients in the IG remained seated on the saddle of the cycle ergometer with their feet on the pedals. Pneumatic tourniquets were applied to the proximal ends of their thighs with appropriate pressure resulting in a 40–80 mmHg increase in the systolic blood pressure that is required for vascular occlusion (208.7 ± 7.4 mmHg). We evaluated the safety and efficacy of the intervention and its effect on exercise capacity and serum BNP levels. There were no significant differences between the IG and CG in patient characteristics at study entry. Peak VO2/W in the IG significantly increased compared with that in the CG; the change in the serum BNP levels was significantly larger in the IG than in the CG.ConclusionsThese results suggest that aerobic exercise training with vascular occlusion can improve exercise capacity and serum BNP levels in patients with chronic heart failure.

Effect of intravenous nitrate treatment on serum BNP level and 30-day follow-up events in decompensated systolic heart failure

Effect of intravenous nitrate treatment on serum BNP level and 30-day follow-up events in decompensated systolic heart failure

The Correlation of NT-Pro BNP with Echocardiographic Indices Including 3D Vena Contracta Width in the Assessment of Severity of Mitral Regurgitation

Introduction: Mitral regurgitation (MR) is a common valvular disease that causes significant morbidity and mortality. The use of multiple echocardiographic indices and hormonal parameters in combination can provide an accurate assessment of MR severity and LV dysfunction in most cases. Aim of study: The aim of this study was to correlate the levels of serum NT-pro BNP with various echocardiographic parameters including 3D vena contracta width in patients with MR. Methods: 74 Patients diagnosed with primary mitral regurgitation in sinus rhythm with no conduction disturbance were included in the study. 2D and Doppler echocardiography indices were calculated. A full-volume 3D color Doppler acquisition was obtained and 3D vena contracta width was calculated and serum BNP levels were obtained. Results: NT-pro BNP levels were increased with symptoms in patients with mitral regurgitation (NYHAI: 4.48 ± 0.06, NYHAII: 5.54 ± 0.78, NYHAIII: 6.68 ± 1.21 pg/ml, p 0.01). NT-pro BNP plasma levels were significantly correlated with MPI (r = 0.945, p 0.01), LVESV (r = 0.706, p 0.01), LVESVI (r = 0.677, p 0.01), LAVI (r = 0.709, p 0.01), MR 2D VC (r = 0.430, p 0.01), 3D VC (r = 0.441, p 0.01), PISA (r = 0.440, p 0.01) and negative correlation with LV ejection fraction (r = 0.846, p 0.01), dp/dt (r = 0.795, p BNP plasma level and LA jet area ratio (P = 0.33). It was observed that there was a significant correlation between 3D VC and PISA levels in patients of mitral regurgitation. However correlation is better in MR with central jet compared to eccentric jet in moderate and severe MR (r = 0.807, 0.817 vs r = 0.617, 0.572). Conclusion: This study showed that NT-pro BNP measurement has the same sensitivity and specificity as echocardiographic indices. Three-dimensional VCA may provide a reliable measurement of ROA, independent of geometric and flow assumptions.

Early detection of impaired left ventricular function in hemodialysis patients

Chronic kidney disease (CKD) is a worldwide public health problem associated with increased morbidity and cardiovascular diseases. Our aim was to investigate left ventricular (LV) myocardial function throughout the cardiac cycle with speckle tracking echocardiography (STE) in end-stage renal disease (ESRD) patients undergoing chronic hemodialysis (HD). The study population consisted of 30 maintenance HD patients. These patients were examined just before and after HD. LV global longitudinal (GLS), circumferential (GCS) and radial (GRS) peak systolic strain was measured with 2D-STE and 3D-STE. BNP levels were measured before and after HD. Increased LV mass index (LVMi) and a decreased E/A ratio were found in hemodialysis patients. LV global longitudinal and radial peak systolic strain was decreased in the study group population. Strain values improved in longitudinal and radial directions after HD [pre-HD vs. post-HD; GLS: −16.43 (1.7) vs. −18.49 (1.9) %, P < 0.001, GRS: 23.94 (9.2) vs. 30.41 (10.4) %, P < 0.001, GCS: −20.23 (3.4) vs. −21.46 (4.9) %, P = 0.1]. LVMi was inversely related to pre-HD GLS ( r = −0.418, P = 0.02) and post-HD GLS ( r = −0.406, P = 0.03). Serum BNP levels were also inversely correlated with pre-HD GLS ( r = −0.433, P < 0.05) and post-HD GLS ( r = −0.456, P < 0.05). STE may be used to identify early abnormalities in patients with ESRD undergoing hemodialysis with preserved LV ejection fraction. HD treatment results in immediate improvement in all strain directions. LV hypertrophy may play a role in the deterioration of LV mechanics in patients with ESRD.

Correlation analysis of serum BNP, Hcy, hs-CRP and thyroid hormone levels in patients with acute myocardial infarction

Objective To analyze the correlation between the serum of patients with acute myocardial infarction in BNP, Hcy, hs-CRP and thyroid hormone levels. Methods A total of 80 patients with acute myocardial infarction (AMI group) were selected from March 2013 to March 2015, and 80 healthy volunteers with normal cardiac function were selected as the control group.Compared with the two groups of patients with thyroid hormone, serum BNP, Hcy and hs-CRP levels.At the same time, the correlation between different types of patients with different types of thyroid, and the BNP levels in different infarction, different parts of the infarct and the number of infarction were compared. Results The patients with acute myocardial infarction of the thyroid hormone levels of T3 and TSH value was significantly lower than that in normal healthy subjects; STEMI and NSTEMI compared with patients with thyroid hormone levels in the two groups, STEMI of T3 was significantly lower than that of NSTEMI (P 0.05); the infarction site of different BNP levels had no statistically significant difference(P>0.05); infarction number comparison, reinfarction, BNP levels was significantly higher than those of the patients with first infarction BNP, the data of the two groups had no statistically significant difference(P>0.05). Conclusion The serum of patients with acute myocardial infarction in BNP, Hcy, hs-CRP values will appear significantly increasing and the BNP levels can also determine the initial type of infarction, and the number of BNP occurred in myocardial infarction has certain correlation.At the same time, the level of thyroid hormone in patients with acute myocardial infarction will be significantly reduced, and can be determined by the level of T3 content, to determine the severity of myocardial infarction patients. Key words: Acute myocardial infarction; Brain natriuretic peptide; Homo cysteine; High sensitivity C-reactive protein; Thyroid hormone

The APEX trial: Effects of allopurinol on exercise capacity, coronary and peripheral endothelial function, and natriuretic peptides in patients with cardiac syndrome X

This study was a randomized, double-blind, placebo-control crossover trial. Nineteen patients (mean age 59±10years, 11 women and 8 men) with cardiac syndrome X were randomized to a 6-week treatment with either allopurinol (600mg/day) or placebo. After 4weeks of washout period, they were crossed over to the other arm. Outcomes measured at baseline and after treatment were maximum exercise time (ET) derived from Bruce protocol exercise treadmill test, serum BNP measurement, coronary flow reserve (CFR) as assessed by measuring the response of flow velocity in the left anterior descending artery to adenosine, and flow-mediated vasodilatation of the brachial artery (FMD). Allopurinol significantly reduced serum uric acid levels when compared with placebo (-48±24% vs 1.9±11%, P<.001). There was no significant difference in maximum ET, CFR, and FMD between allopurinol and placebo. However, there was a trend that allopurinol reduced serum BNP when compared to placebo (-8% [interquartile range -22% to 65%] vs 44% [interquartile range -18% to 140%]; P=.07). In patients with cardiac syndrome X, high-dose allopurinol did not improve exercise capacity, and coronary or peripheral endothelial function.

Diagnostic Value of NT-pro BNP Biomarker and Echocardiography in Cardiac Involvements in Beta-thalassemia Patients

Background N-terminal pro–B-type natriuretic peptide (NT-proBNP) is a marker to evaluate the cardiac involvement in thalassemia. We aimed to evaluate conventional and tissue Doppler echocardiography findings and its relation to plasma NT-pro BNP, Ferritin and Iron levels in beta-thalassemia patients. Materials and Methods This study performed on 164 participants equal of major beta- thalassemia patients (n=82), and controls (82 healthy children with normal cardiovascular status). The patients collected from outpatients after applied exclusion criteria. Blood samples were taken from participants in fasting to measure NT- pro BNP, Ferritin and Iron serum. Participants were under echocardiography by Pediatric cardiologist. The level of error considered as 0.05 for data analysis by SPSS version 20.0. Results NT- pro BNP, Iron, Ferritin, left S', left A', right A', EF, FS, left and right A/A'; right and left MPI were significantly different in patients group (P 10 years, and FS had different values significantly in lower levels. In lower level of left E/E' resulted that FS was significantly higher in the age group < 10 years. Right peak E velocity was significantly higher in younger’s in higher level of left E/E'. Right E/E' was significantly higher in elders in lower level of left E/E' (P<0.05). Conclusion The study confirmed that NT-pro BNP increases in thalassemia and association with age and LV diastolic dysfunction. NT-pro BNP with E/E' and S' were shown diastolic and systolic dysfunction in thalassemia. Therefore, an increased level of ferritin and NT-pro BNP can be used as a marker for the intensification of iron chelation therapy, which reverses iron-induced cardiomyopathy.