Plasma BNP Concentration Research Articles

Kinetics of atrial and brain natriuretic peptides during hemodialysis are regulated in association with different cardiac functional changes.

The blood levels of atrial and brain natriuretic peptides (ANP and BNP) are both increased markedly in hemodialysis patients, but the kinetics of the two are not always parallel. The present study investigated the association of changes in ANP and BNP levels before and after dialysis with changes in cardiac function in hemodialysis patients. A total of 57 patients (mean age 64years, 47 males and 10 females) on maintenance hemodialysis with sinus rhythm were enrolled. Blood samples were taken at the beginning and end of dialysis, and plasma levels of ANP and BNP were measured. Changes in cardiac function during dialysis were examined by echocardiography performed just before and after dialysis. Both plasma ANP and BNP concentrations decreased significantly after hemodialysis, but the rate of decrease in BNP [mean ± SD, 555 ± 503 to 519 ± 477pg/mL (-6.4%), P = 0.011] was much smaller than that in ANP [233 ± 123 to 132 ± 83pg/mL (-43.4%), P < 0.001]. As for the relation to the changes in echocardiographic parameters before and after dialysis, the decrease in inferior vena cava diameter had a close correlation with the decrease in ANP (r = 0.528, P < 0.001), but not BNP. In contrast, the decrease in left ventricular end-diastolic volume index was correlated only with the decrease in BNP (r = 0.297, P = 0.035). The peak velocity ratio of early diastolic to atrial filling decreased with preload reduction by dialysis, and its decrease was more strongly correlated with the decrease in BNP (r = 0.407, P = 0.002) than that in ANP (r = 0.273, P = 0.040). These results demonstrated that in hemodialysis patients, the decrease in plasma ANP by a single dialysis was essentially caused by blood volume reduction, while BNP decrease was mainly induced by the reduction of left ventricular overload. Our findings indicate that the kinetics of both peptides during dialysis are regulated by different cardiac and hemodynamic factors.

Clinical value of plasma BNP combined with Tei index in evaluating left ventricular function in children with congenital heart disease before interventional therapy

Objective To explore the clinical value of combined detection of plasma BNP and Tei index in evaluating left ventricular function in children with congenital heart disease before interventional therapy. Methods From April 2017 to April 2019, a total of 60 children with congenital heart disease who were going to receive interventional therapy in Dachong Hospital of Zhongshan and Boai Hospital of Zhongshan were selected as observation subjects, and the patients were divided into cardiac function class Ⅰ group and cardiac function class Ⅱ group according to NYHA cardiac function classification, with 30 cases in each group.At the same time, 30 normal children were selected as healthy control group.The differences of plasma BNP concentration, left ventricular ejection fraction(LVEF) and left ventricular Tei index in different group were compared.The correlation between the plasma concentration and the cardiac function was investigated, and the correlation between the plasma BNP concentration and the Tei index was analyzed. Results The concentration of serum BNP[(6.8±1.2)ng/L] and the Tei index of left ventricle (0.63±0.08) in the cardiac function class Ⅱ group were significantly higher than those in the cardiac function class Ⅰ group[(5.4±1.3)ng/L, (0.48±0.11)], and the differences were statistically significant (t=1.92, 3.01, all P<0.05). These two indicators of the two groups were higher than those of the healthy control group[(3.7±1.5)ng/L, (0.33±0.09)], the differences were statistically significant(t=2.14, 2.28, 4.19, 6.14, all P<0.05). In addition, the LVEF of the cardiac function class Ⅱ group was significantly lower than that of the cardiac function class Ⅰ group(t=5.00, P<0.05), and the LVEF of the two groups were significantly lower those that of the healthy control group(t=10.32, 4.51, all P<0.05). With the increase of severity of cardiac insufficiency, the BNP and Tei index gradually increased(F=3.054, 3.491, all P<0.05), and the LVEF value decreased gradually (F=12.50, P<0.05). At the same time, the linear correlation analysis showed that the plasma BNP concentration had a positive correlation with the left ventricular Tei index(r=0.69, P<0.01). Conclusion Plasma BNP combined with Tei index can quickly and accurately assess the left ventricular function in children with congenital heart disease before intervention.As a sensitive index for clinical detection, it has clinical application value. Key words: Heart defects, congenital; Angioplasty, balloon, coronary; Preoperative period; Natriuretic peptide, brain; Ventricular function, left; Child

A porcine model of heart failure with preserved ejection fraction: magnetic resonance imaging and metabolic energetics.

AimsA significant proportion of heart failure (HF) patients have HF preserved ejection fraction (HFpEF). The lack of effective treatments for HFpEF remains a critical unmet need. A key obstacle to therapeutic innovation in HFpEF is the paucity of pre‐clinical models. Although several large animal models have been reported, few demonstrate progression to decompensated HF. We have established a model of HFpEF by enhancing a porcine model of progressive left ventricular (LV) pressure overload and characterized HF in this model including advanced cardiometabolic imaging using cardiac magnetic resonance imaging and hyperpolarized carbon‐13 magnetic resonance spectroscopy.Methods and resultsPigs underwent progressive LV pressure overload by means of an inflatable aortic cuff. Pigs developed LV hypertrophy (50% increase in wall thickness, P < 0.001, and two‐fold increase in mass compared to sham control, P < 0.001) with no evidence of LV dilatation but a significant increase in left atrial volume (P = 0.013). Cardiac magnetic resonance imaging demonstrated T1 modified Look‐Locker inversion recovery values increased in 16/17 segments compared to sham pigs (P < 0.05–P < 0.001) indicating global ventricular fibrosis. Mean LV end‐diastolic (P = 0.047) and pulmonary capillary wedge pressures (P = 0.008) were elevated compared with sham control. One‐third of the pigs demonstrated clinical signs of frank decompensated HF, and mean plasma BNP concentrations were raised compared with sham control (P = 0.008). Cardiometabolic imaging with hyperpolarized carbon‐13 magnetic resonance spectroscopy agreed with known metabolic changes in the failing heart with a switch from fatty acid towards glucose substrate utilization.ConclusionsProgressive aortic constriction in growing pigs induces significant LV hypertrophy with cardiac fibrosis associated with left atrial dilation, raised filling pressures, and an ability to transition to overt HF with raised BNP without reduction in LVEF. This model replicates many aspects of clinical HFpEF with a predominant background of hypertension and can be used to advance understanding of underlying pathology and for necessary pre‐clinical testing of novel candidate therapies.

Changes of adrenomedullin and natriuretic peptides in patients with adrenal medullary hyperplasia prior to and following pharmacological therapy and adrenalectomy.

The aim of the present study was to investigate the pathophysiological functions of adrenomedullin (ADM), atrial and brain natriuretic peptides (ANP and BNP) in patients with adrenal medullary hyperplasia (AMH). Plasma ADM, ANP and BNP concentrations were measured in 20 patients with AMH, 35 patients with essential hypertension (EH), and 40 healthy control subjects. Following effective antihypertensive therapy, the values in AMH and EH patients were measured again and laparoscopic adrenalectomy was performed for AMH patients. At 2 weeks after surgery, the three peptides were measured again. The AMH patients had higher plasma concentrations of ADM, ANP and BNP compared with the EH and control subjects. There were significant differences in the values of ADM, ANP and BNP between adrenal vein and inferior vena cava and between AMH and contralateral adrenal vein. Plasma ADM concentration was correlated with serum epinephrine and norepinephrine and urine vanillylmandelic acid, in addition to systolic and diastolic blood pressure, left ventricular ejection fraction, left ventricular mass index and ANP and BNP values in the AMH group. Following antihypertensive treatment, ADM, ANP and BNP were significantly decreased in EH patients, but remained unchanged in AMH subjects. However, these concentrations significantly decreased following surgery. Therefore, the present results suggest that ADM, ANP and BNP may be involved in regulating adrenal medulla functions.

Abstract 19088: Atrial Late Potentials and Atrial Substrate Remodeling in Patients With Atrial Fibrillation

Backgrounds: Patients with atrial fibrillation (AF) often have a low-amplitude potential in the terminal part of filtered P-wave (atrial late potential: aLP). However, it remains unknown what aLP reflects in AF patients. On the other hand, electrical remodeling of the atria can be precisely evaluated by the quantitative voltage map analysis using 3D mapping system. In this study, we hypothesized that we could substitute "non-invasive" aLP for "invasive" 3D mapping system to evaluate the atrial electrical remodeling and investigated the relationship between aLP and atrial substrate remodeling in AF patients. Methods: The P-wave single-averaged electrocardiogram (P-SAECG) was recored in 60 patients with paroxysmal AF who underwent PV isolation. Filtered P-wave duration (fPWD) and root-mean-squared voltage of the terminal 20ms of ≤2.0 μV (RMS20) were assessed by P-SAECG. The left atrial (LA) global contact mapping during sinus rhythm was performed and LA voltage zone index (LAVZI) was defined as an area with voltage &lt; 0.5mV divided by total LA surface area. Results: LAVZI showed a strong positive correlation with fPWD and a strong negative correlation with RMS20 (r=-0.82, p&lt;0.01; r=0.68, p&lt;0.01, respectively). LV volume by echocardiography was also positively correlated with fPWD and negatively correlated with RMS20 (r=0.57, p&lt;0.05; r=-0.69, p&lt;0.01, respectively). In addition, LA appendage flow was negatively correlated with fPWD (r=-0.49, p&lt;0.05). fPWD was significantly longer and RMS20 was lower in patients with AF for more than 1 year than those for less than 1 year. However, there were no significant correlations between aLP parameters and other echocardiographic findings such as left ventricular ejection fraction or plasma BNP concentration. Conclusions: aLP reflects precisely atrial substrate remodeling in AF patients. aLP might serve as non-invasive tool for monitoring the atrial substrate remodeling in patients with AF.

Exudative Pleural Effusion in Congestive Heart Failure: Thoracoscopic and Histologic Features

SESSION TITLE: Disorders of the Pleura SESSION TYPE: Original Investigation Slide PRESENTED ON: Wednesday, October 28, 2015 at 02:45 PM - 04:15 PM PURPOSE: To describe endoscopic and histopathological findings in patients with evidence of cardiac disease (BNP plasma values >500 pg/ml) and an exudative pleural effusion (PE) . METHODS: We evaluated 257 patients from January 2008 to December 2014, with undetermined exudative PE and with a BNP serum determination, who underwent medical thoracoscopy with a minimum of ten parietal pleural biopsies. Plasma BNP concentrations were measured at admission. We included only patients with BNP plasma levels > 500 pg/ml and an explorable pleural cavity. The final diagnosis of pleural disease was assessed by histological criteria. Endoscopic finding (TF) were graded as Type 1: faint pleural thickening (Fig.1) without focal lesions or change of the endoscopic pleural pattern Type2: thickening with significantly change of the pleural endoscopic pattern with or without nodules and plaques, Type 3: normal pleura. At least 10 biopsies were taken from each patient. RESULTS: Of 257 patients with exudative PE, 16 (6.2%,) had a BNP plasma level > 500 pg/ml and explorable pleural cavity. Type 1 TF were observed in 7 patients (44%), Type 2 in 9 cases (56%). All patients with Type 1 TF had an histological diagnosis of chronic pleurisy characterized by mesothelial cell hyperplasia, polymorphic flogistic infiltration with lymphocyte predominance. (Fig.2) Patients with Type 2 TF had different histological diagnosis: 2 diagnosis of pleural tuberculosis, 1 pleural localization of Small Cell Cancer, 1 Mesothelioma, 1 Eosinophilic Pleuritis associated to eosinophilic pneumonia, 4 cases of Asbestosis associated to congestive heart failure. CONCLUSIONS: A diagnosis of cardiac pleurisy is characterized by endoscopic evidence of diffuse faint pleural thickening and histopathological findings of mesothelial cell hyperplasia with polymorphic flogistic infiltration. CLINICAL IMPLICATIONS: Suggeste medical thoracoscopy in indetermined exudative pleural effusion associated to congestive heart failure (plasma BNP concentration > 500 pg/ml). DISCLOSURE: The following authors have nothing to disclose: Valentina Pinelli, Fiorenza Marugo, Donatella Intersimone, Franco Fedeli, Daniele Bertoli, Massimiliano Sivori, Pier Aldo Canessa No Product/Research Disclosure Information

Plasma concentrations of adrenomedullin and natriuretic peptides in patients with essential hypertension.

This study was designed to assess any changes in the plasma concentrations of adrenomedullin (ADM) and atrial and brain natriuretic peptide (ANP and BNP, respectively), and to investigate their pathophysiological roles in patients with essential hypertension (EH). The plasma ADM, ANP and BNP concentrations were measured in 64 patients with untreated EH and 35 normotensive control subjects. After 4 weeks of effective antihypertensive therapy with oral drugs for the hypertensive patients, the plasma concentrations of ADM, ANP and BNP in the hypertensive patients were measured again. The plasma concentrations of ADM, ANP and BNP were significantly higher in the hypertensive patients than those in the control subjects, and the concentrations increased with the clinical stage. Furthermore, the hypertensive patients exhibited increased mean arterial pressure (MAP), blood urea nitrogen (BUN), serum creatinine (Scr) and decreased glomerular filtration rates (GFRs) compared with the control subjects. The plasma ADM concentration was not only correlated with BUN, Scr and the GFR, but was also associated with the MAP and the plasma levels of ANP and BNP. Following effective antihypertensive therapy with oral medication for 4 weeks, the plasma concentrations of ADM, ANP and BNP were significantly, but not sharply, decreased. In conclusion, ADM, along with ANP and BNP, may be involved in the mechanisms acting against a further increase in blood pressure and may be useful biomarkers for the diagnosis and treatment of hypertensive patients.

Clinical usefulness of a novel program "Heart Function View" for evaluating cardiac function from gated myocardial perfusion SPECT.

To investigate clinical usefulness of a novel program "Heart Function View (HFV)" for evaluating left ventricular (LV) function from myocardial perfusion SPECT (MPS), we compared LV functional parameters (F(x)) calculated by HFV with those obtained by the other similar programs QGS and cardioGRAF or by ultrasound echocardiography (UCG) and examined their correlations with clinical markers of heart failure: plasma BNP concentrations (BNPs) and exercise capacity. Studied patients (n = 60) underwent technetium-99m tetrofosmin quantitative gated MPS including treadmill exercise for examining heart disease. Myocardial stress images were acquired 30 min after the first tracer injection during maximal exercise. Three hours later, the second tracer was injected, and resting images were acquired. LV systolic F(x) [ejection fraction (EF), peak ejection rate (PER)] and diastolic F(x) [first third filling fraction (1/3FF), first third filling rate (1/3FR), peak filling rate (PFR), time to PFR (TPF)] were analyzed, and phase standard deviation (SD) and histogram bandwidth were obtained by phase analysis. LV end-diastolic volume (EDV), end-systolic volume (ESV) and EF obtained from HFV were well correlated with those from QGS, cardioGRAF and UCG. A diastolic parameter Doppler E/e' from UCG was significantly with PFR from HFV. There were good correlations between LVEDV, LVESV, LVEF, PER, PFR, 1/3FR, TPF and 1/3FF from HFV and those from cardioGRAF. LVEF, PER, 1/3FR, and PFR were significantly correlated with plasma BNP concentrations. In patients with non-ischemic heart disease (n = 42), phase SD and histogram bandwidth were correlated negatively with exercise capacity or PFR. HFV-derived LVF(x) are correlated with LVF(x) from the other programs or UCG, or with the clinical markers of heart failure and are thus useful in the functional assessment for patients with heart disease.

SIGNIFICANCE OF BLOOD BRAIN NATRIURETIC PEPTIDE IN DIAGNOSIS OF ACUTE DYSPNOEA

ObjectivesTo explore clinical significance of differential diagnosis of plasma BNP concentration change between patients with cardiac dyspea and lung-derived dyspea.MethodsSelect Thoracic and Cardiovascular Surgery, Respiratory Medicine, Cardiology, Emergency Department in...

Efficacy and Effect on Plasma B-type Natriuretic Peptide Concentration of Losartan-hydrochlorothiazide for Hypertension Uncontrolled by Losartan-based Therapy: Subanalysis of a Multicentre Prospective Observational Study

Many patients with hypertension have difficulty achieving their target blood pressure (BP). Therefore combination therapy, for example with an angiotensin II receptor blocker (ARB) and a diuretic, may be recommended. We previously evaluated the efficacy and safety of losartan (LOS) 50 mg - hydrochlorothiazide (HCTZ) 12.5 mg, as well as its effect on the plasma concentration of B-type natriuretic peptide (BNP, a prognostic marker for cardiovascular events), in patients with hypertension uncontrolled by ≥3 months of ARB-based therapy. The present subanalysis used data from patients who received LOS-based therapy before switching to LOS-HCTZ. Efficacy, safety, and changes in blood biochemical variables including BNP were evaluated. After excluding 4 patients with protocol violations, data from 35 patients (aged 36-79 years, mean 63 years; 66% male) were used in the safety analysis. The efficacy analysis used data from the 30 patients who were followed up for 12 months. Systolic/diastolic BP decreased from 156±12/87±11 mmHg at baseline to 125±11/73±10 mmHg at 12 months (p<0.001). After 12 months, half of the patients achieved their target BP as defined by the Japanese Society of Hypertension Guidelines for the Management of Hypertension 2004. In 12 patients with baseline plasma BNP concentration ≥20 pg/mL, BNP decreased from 78.3±18.8 pg/mL to 57.3±17.7 pg/mL (p<0.01). 3 patients experienced adverse events, one of which was cardiovascular. LOS-HCTZ is efficacious, has a good safety profile, and decreases plasma BNP concentration.

PP005. Natriuretic peptide precursor B gene (TTTC)N microsatellite polymorphism and elevated BNP levels in early onset pre-eclampsia

There is a variable tandem repeat (TTTC) polymorphism in the 5(')-flanking region of the natriuretic peptide precursor B gene (NPPB), which shows association with severe pre-eclampsia. The 11-repeat carrier frequency is significantly higher in severe pre-eclamptic patients. The 11/11 genotype carriers in the pre-eclamptics has significantly higher BNP levels. Our aim was to identify this polymorphism in samples of early onset pre-eclamptic (EOP) patients, late onset pre-eclamptic patients and healthy controls. We also compared the natriuretic peptide B (BNP) concentrations. Blood samples were collected from healthy pregnant normotensive women (n=235) and women with pre-eclampsia (n=220). DNA was isolated and fluorescent PCR and DNA fragment analysis was performed for the detection of (TTTC) repeats. The plasma BNP concentration was measured by fluorescence immunoassay method using Triage BNP (Alere, San Diego). We detected 12 different repeats on the NPPB gene. The overall distribution of alleles and genotypes was significantly different between the control and pre-eclamptic groups. The 11/11 genotype carriers showed a significantly higher frequency in early onset pre-eclamptic patients than in the healthy pregnant controls (p=0.026). Calculated odds ratio (OR) was 1.694 (95% CI: 1.06-2.70). In contrast the 11/11 genotype carrier frequency was not significantly higher in the late onset pre-eclamptic group than in the control group (p=0.5308), adjusted OR 1.22 (95% CI: 0.7138-2.086). In the early onset pre-eclamptics the 11/11 genotype showed a significantly higher frequency than in the late onset group (p=0.0039) OR: 6.00. The concentration of the BNP was 9.75pg/ml in the healthy controls and 32.40pg/ml in the pre-eclamptic group (p<0.0001). The 11/11 genotype carriers had significantly higher BNP levels in the pre-eclamptic group. The early onset pre-eclamptic patients had a significantly higher BNP concentration (40.55pg/ml) than in the late onset pre-eclamptic patients (24.1pg/ml) (p=0.013). The NPPB gene (TTTC) microsatellite polymorphism in the 5(')-flanking region showed a significant difference in the distribution of alleles and genotypes between early onset and late onset pre-eclamptic patients in an ethnically homogeneous population. The concentration of the BNP was higher in early onset pre-eclamptic women, and it showed association with the genotypes.

Abstract 17732: Combination of B-Type Natriuretic Peptide and Minute Ventilation Carbon Dioxide Production Slope Improves Risk Stratification in Patients with Diastolic Heart Failure

Objectives To investigate the prognostic values of the minute ventilation/carbon dioxide production slope (VE/VCO 2 ) and peak oxygen consumption (VO 2 ) for cardiovascular and all-cause mortality in diastolic heart failure. Background Recent studies have demonstrated that VE/VCO 2 was more powerfully predicted mortality, hospitalization, or both than VO 2 in systolic heart failure. Methods and Results The outpatients previously diagnosed as diastolic heart failure were recruited from April 2006 to March 2007, and underwent cardiopulmonary exercise testing and echocardiographic examination. Plasma BNP concentration was measured. Total of 224 patients were enrolled. During a mean follow-up of 30 months, 57 patients died (36 from cardiovascular death). Univariate Cox regression analysis showed that age, New York Heart Association function class, atrial fibrillation, diabetes mellitus, left ventricular diastolic dysfunction, peak VO 2 , VE/VCO 2 , and plasma BNP were significantly associated with mortality risk. Multivariate analysis revealed that plasma BNP, VE/VCO 2 , and age remained independent predictors for both cardiovascular and all-cause mortality, with the strongest prognostic values of plasma BNP (chi square =35.9 vs 39.8; P&lt;0.001). In addition to clinical risk factors and plasma BNP, The VE/VCO 2 could provided incremental and independently prognostic information of cardiovascular (chi square =60.6 vs 51.7; P=0.009) and all-cause mortality (chi square =62.8 vs 54.2; P=0.015) with increased chi square value of Cox regression model. Conclusion In patients with diastolic heart failure, plasma BNP is the strongest predictor of mortality risk, and VE/VCO 2 , but not peak VO 2 , provides addictive independent prognostic information, which suggests that combination of plasma BNP and VE/VCO 2 can improve risk stratification.

Combination of B-type natriuretic peptide and minute ventilation/carbon dioxide production slope improves risk stratification in patients with diastolic heart failure

BackgroundRecent studies demonstrated that the minute ventilation/carbon dioxide production (VE/VCO2) slope more powerfully predicted mortality, hospitalization, or both than peak oxygen consumption (VO2) in systolic heart failure. However, the prognostic values of these two parameters in diastolic heart failure remained unclear. MethodsThe patients with diastolic heart failure were recruited from April 2006 to May 2007, and underwent cardiopulmonary exercise testing. Plasma BNP concentration was measured using Triage BNP immunoassay method. ResultsOf the 224 patients enrolled, mean values for age and New York Heart Association (NYHA) class were 68.8±9.0years and 2.38±0.53, respectively. During the mean follow-up of 30months, 57 patients died (36 from cardiovascular death). Univariate Cox regression analysis showed that age, NYHA class, atrial fibrillation, diabetes mellitus, left ventricular diastolic dysfunction, peak VO2, VE/VCO2 slope, and plasma BNP were significantly associated with mortality. Multivariate analysis revealed that plasma BNP, VE/VCO2 slope, and age remained independent predictors for cardiovascular and all-cause mortalities, with the strongest prognostic power of plasma BNP (χ2≥31.4, P<0.001). In addition to plasma BNP and clinical predictors, the VE/VCO2 slope could provide independent and incremental prognostic value of cardiovascular (χ2=60.6 vs 51.7; P=0.009) and all-cause mortalities (χ2=62.8 vs 54.2; P=0.015) with increased χ2 value of Cox regression model. ConclusionIn diastolic heart failure, plasma BNP is the strongest predictor of mortality, and VE/VCO2 slope provides independent and additive prognostic information, which suggests that combination of plasma BNP and VE/VCO2 slope can improve risk stratification.

Natriuretic peptide precursor B gene (TTTC)n microsatellite polymorphism in pre-eclampsia

BackgroundThere is a variable tandem repeat polymorphism in the 5′-flanking region of the natriuretic peptide precursor B gene (NPPB). A previous study showed association of the (TTTC) small tandem repeat (STR) variants of this gene and essential hypertension. Our aim was to identify this polymorphism in samples of pre-eclamptic patients and healthy controls. We also compared the natriuretic peptide B (BNP) concentrations. MethodsBlood samples were collected from healthy pregnant normotensive women (n=235) and women with pre-eclampsia (n=220). DNA was isolated and fluorescent PCR and DNA fragment analysis was performed for the detection of (TTTC) repeats. The plasma BNP concentration was measured by fluorescence immunoassay method. ResultsWe detected 12 different (TTTC) repeats on the NPPB gene in the studied population. The overall distribution of alleles and genotypes was significantly different between the control and pre-eclamptic groups. The number of 10-repeat genotype carriers showed significantly lower frequency in pre-eclamptics than in the healthy pregnant controls (p=0.032). After adjustment for confounding factors pre-pregnancy BMI, maternal age, primiparity and smoking, the calculated odds ratio (OR) was 0.19 (95% CI: 0.04–0.87). Similarly, the 12-repeat genotype carriers showed significantly lower frequency in pre-eclamptics than in the healthy pregnants (p=0.037; adjusted OR: 0.53 (95% CI: 0.29–0.96)). In contrast the 11-repeat genotype carrier frequency was significantly higher in the pre-eclamptic than in the healthy pregnant group (p<0.001; adjusted OR 2.91 (95% CI: 1.75–4.84)).The concentration of the BNP was 9.75pg/ml in the healthy controls and 32.40pg/ml in the pre-eclamptic group (p<0.0001). The 11/11 genotype carriers had significantly higher BNP levels in both groups. ConclusionsThe NPPB gene (TTTC) microsatellite polymorphism in the 5′-flanking region showed significant difference in the distribution of alleles and genotypes between healthy pregnant controls and pre-eclamptic patients in an ethnically homogeneous population. The concentration of the BNP was higher in pre-eclamptic women, and it showed association with the (TTTC) genotypes. We introduced an F-PCR and DNA fragment analysis method for the fast and reliable detection of this STR.

Clinical features and left ventricular (LV) dysfunction in heart failure patients with normal ejection fraction

100 inpatients with heart failure were divided into two groups: 50 with preserved LVEF and 50 with reduced LVEF. Another 50 age-matched healthy subjects served as the control group. The severity and etiology of heart failure, tissue Doppler imaging indexes (Sm;Ea;Aa;E/Ea) and plasma BNP concentrations were compared among the three groups. There was no difference in terms of NYHA classification between groups of preserved LVEF and reduced LVEF. Hypertension and DM are more common in the group of preserved LVEF. The index of Sm decreased most significantly in the group of reduced LVEF, and was negatively correlated with the BNP concentration (r = -0. 35, P ＜ 0. 05 ). The ratio of E/Ea increased gradually among the three groups, and was positively correlated with the BNP concentration ( r = 0. 728, P ＜ 0. 05 ). The LV filling index E/Ea and the BNP concentration may be helpful in the diagnosis of heart failure patients with preserved LVEF. Key words: Heart failure ; Ventricular function,Left ; Echocardiography ;

E0716 An 81-year-old Man with dizziness, fatigue and shortness of breath

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B-Type Natriuretic Peptide as a Marker of Heart Failure: New Insights From Biochemistry and Clinical Implications

The mature, biologically active 32-amino acid long B-type natriuretic peptide (BNP(1-32)), is cleaved by corin from the BNP prohormone. Recent data demonstrated that BNP(1-32) might be an ideal substrate for the endogenous aminopeptidase, dipeptidyl-peptidase (DPP) IV. DPP IV removes the two amino-terminal amino acids (Ser and Pro) from BNP(1-32) to produce BNP(3-32), which has been detected in plasma of patients with heart failure. In a canine model, intravenous BNP(3-32) infusion resulted in less natriuresis, diuresis and vasodilation compared to intravenous infusion of BNP(1-32). The clinical relevance of these observations may be important for patients with high plasma BNP concentrations, which can be measured by commercially available immunoassays. Further studies are needed to explore whether DPP IV inhibitors increase the bioavailability of BNP(1-32), delay the progression of heart failure and increase the efficacy of exogenously administered BNP(1-32) in decompensated heart failure.

Utility of Echocardiography Versus BNP Level for the Prediction of Pulmonary Arterial Pressure in Patients With Pulmonary Arterial Hypertension

Recent advances in the treatment of pulmonary arterial hypertension provide a rational basis for earlier, noninvasive diagnosis of pulmonary arterial hypertension. However, the reliability of transthoracic echocardiography, plasma BNP levels, and other parameters for the diagnosis of pulmonary arterial hypertension remains unclear. Thus, the purpose of this study was to determine the utility of these modes of investigation for the prediction of pulmonary arterial pressure as compared with the current gold standard, Swan-Ganz catheterization. Among 46 PAH patients, 37 had connective tissue diseases, while the remainder had primary pulmonary arterial hypertension, chronic pulmonary thromboembolism, and interstitial pneumonitis. Systolic pulmonary arterial pressure calculated by transthoracic echocardiography was significantly correlated with systolic pulmonary arterial pressure measured using a Swan-Ganz catheter (r = 0.51, P < 0.01). Plasma BNP concentration did not correlate with systolic pulmonary arterial pressure (r = 0.10, NS) in the overall patient population. However, when we excluded left ventricular heart failure and left ventricular hypertrophy, BNP concentration was correlated with systolic pulmonary arterial pressure (r = 0.508, P < 0.05). Among other variables tested, ECG electrical axis was correlated with pulmonary arterial pressure (r = 0.46, P < 0.05) but uric acid, lactate dehydrogenase, %DLCO, enhanced IIp sound, and pulmonary artery enlargement on chest x-ray did not correlate with pulmonary arterial pressure. These data suggest that echocardiography is the noninvasive modality of choice for the assessment of pulmonary arterial hypertension. Plasma BNP level also predicts pulmonary arterial pressure, when left ventricular heart failure and cardiac hypertrophy are excluded.

Effect of Short-Term Maximal Exercise on BNP Plasma Levels in Healthy Individuals

Many studies documented the relationship between elevated plasma concentrations of natriuretic peptides and cardiovascular diseases, especially heart failure. However, it is still uncertain whether physical exercise leads to a significant release of natriuretic peptide in healthy subjects. The aim of this study was to determine the effect of maximal physical activity on plasma BNP concentrations in healthy individuals within 3 hours after the short-term exercise. BNP plasma concentrations were measured in 15 healthy volunteers before, immediately after as well as 1 hour and 3 hours after bicycle spiroergometry. Maximal workload and exercise capacity were assessed in watts, watt-seconds, metabolic equivalents and VO(2max). Mean BNP plasma levels before, immediately after, 1 hour and 3 hours post-exercise were 19.4+/-2.5; 30.6+/-4.7; 17.9+/-2.5 and 18.7+/-3.1 pg/ml, respectively. The increase of BNP concentrations immediately after exercise was statistically significant (p=0.0017) compared to baseline values. We did not find any correlation between the post-exercise increase of BNP levels and age, body mass index, maximal workload or exercise capacity. In conclusion, short-term maximal physical exercise in healthy individuals led to a fast and transient rise of plasma BNP concentrations, which remained well within normal range and far below the cut-off value for heart failure (100 pg/ml).

Plasma levels of B-type natriuretic peptide in patients with tetralogy of Fallot after surgical repair

Objective To evaluate the utility of plasma BNP measurement in the long term follow-up of patients with surgically repaired tetralogy of Fallot (TOF). Methods From 2002 to 2008, plasma BNP concentration was measured in 130 patients with TOF at the age of mean 16.1 ± 7.1 years and mean 13.0 ± 6.5 years after surgically repair. BNP levels were compared to age and gender-specific normal values, results of exercise testing, clinical, electrocardiographic, and echocardiographic data. Results BNP was < 200 pg/ml in all and elevated in 60% of patients. Higher values were found in females ( p = 0.001), in patients waiting for pulmonary valve replacement ( p < 0.001), and in NYHA class II compared to NYHA I patients ( p = 0.012) with an inverse correlation between BNP and exercise time ( r = − 0.59, p < 0.001). BNP was correlated with right ventricular dilatation ( r = 0.29, p = 0.005) and severity of both tricuspid ( r = 0.22, p = 0.015) and pulmonary regurgitation ( r = 0.20, p = 0.029). Longitudinal data revealed increasing BNP levels before ( p = 0.04) and a BNP decrease after pulmonary valve replacement ( p = 0.03), but no change in patients without surgery. Conclusions In patients with surgically repaired TOF, plasma BNP is significantly correlated with right ventricular volume load. In clinical practice a considerable overlap limits the estimation of right ventricular volume load by BNP, but longitudinal evaluation helps to appoint the appropriate timing of pulmonary valve replacement.