Plasma Brain Natriuretic Peptide Levels Research Articles

The study of diagnostic value about plasma brain natriuretic peptide level in chronic heart failure

Objective To study the diagnostic value about plasma brain natriureticpeptide level in chronic heart failure in order to provide evidence for the diagnostic obout chronic heart failure. Methods 56examples with chronic heart failure patients from August 2007 to March 2009 in my courtyard treatment were divided into A group( 28 examples)and B group(28 examples)based on NYHA. 50 normal healthy person exam-ples were selected as the control group( C group). The plasma brain natriuretic peptide level of the three groups were compared and studied. Results After the comparative study, we found that the plasma brain natriuretic peptide level of A group and B group was higher that of C group,P ＜0.01 ,there was significant difference between thethree group. And the plasma brain natriuretic peptide level between the A group and B group were compared,P ＜ 0.05, the difference has statistical significance. Conclusion The diagnostic value about plasma brain natriuretic peptide level in chronic heart failure was obviously bigger. It can provide evidence for the diagnostic obout chronic heart failure, and is worth further studying. Key words: Plasma brain natriuretic peptide level; Chronic heart failure; Diagnostic value

Effects of atorvastatin calcium on chronic heart failure and plasma brain natriuretic peptide levels

Objective To observe the effects of atorvastatin calcium on chronic heart failure (CHF) and plasma brain natriuretic peptide levels. Methods 110 cases of CHF were randomly divided into two groups:control group( 54 cases)of heart failure in patients received conventional treatment, such as salt restriction, rest, under the condition chosen diuretics, angiotensin converting enzyme inhibitors, β-blocker, spironolactone, nitrates and other substances,if necessary, the application of digitalis-like illness, stress and other positive inotropic drugs, antibiotics. Treatment group(56 cases)received atorvastatin calcium 20 mg based on the control group, take 1 before each dinner. Two groups were treated for 6 months. Results After 6 months, The efficiency of the treatment group was significantly higher than that of the control group( P < 0. 05 ); the LVEF of the treatment group increased significantly than that of the control group ( P < 0. 01 ); The plasma BNP levels of the treatment group decreased significantly than the control group ( P < 0. 01 ). Conclusion The patients of CHF can significantly reduce plasma BNP levels, increase LVEF, improve cardiac function at the same time in the conventional treatment plus atorvastatin calcium treatment. Key words: Chronic heart failure; Atorvastatin calcium; Brain natriuretic peptide; Left ventricular ejection fraction

Cardiac resynchronization therapy; the importance of evaluating cardiac metabolism

Cardiac resynchronization therapy; the importance of evaluating cardiac metabolism

Brain natriuretic peptide and the athlete’s heart: a pilot study

The role of brain natriuretic peptide (BNP) in differentiating the athlete's heart from maladaptive cardiac hypertrophy is unclear. To address this issue, an integrated M mode, two-dimensional B mode and Doppler echocardiographical study were performed and plasma BNP levels were measured in 25 strength athletes, 25 patients with established hypertrophic cardiomyopathy (HCM) and 25 healthy volunteers. Among athletes, BNP levels correlated negatively with the total training time (r = -0.79, p = 0.002) and positively with ejection fraction (r = 0.58, p = 0.049) and fractional shortening (r = 0.57, p = 0.049). A BNP cut-off value of 11.8 pg/ml had 88% specificity and 74% negative predictive value for the exclusion of HCM. Brain natriuretic peptide might be useful as a preparticipation screening test in athletes.

Brain natriuretic peptide as a predictor of delayed atrial fibrillation after ischaemic stroke and transient ischaemic attack

We investigated whether the brain natriuretic peptide (BNP) level can serve as a predictive biological marker of delayed atrial fibrillation (AF). Two hundred and thirty seven consecutive patients admitted to our institution with acute ischaemic stroke or transient ischaemic attack (TIA) within 24 h of onset were enrolled. The patients were classified according to the presence or absence of AF upon admission [AF and sinus rhythm (SR) groups]. The SR group was subdivided based on the development of AF after admission (new- and non-AF groups). We compared the characteristics between the AF and SR groups, and between the new- and non-AF groups. The factors associated with new-AF were investigated by multivariate logistic regression analysis. Amongst the enrolled patients, 72 (30.4%) had AF upon admission (AF group), and 13 (5.5%) developed AF thereafter (new-AF group). The plasma BNP level was significantly higher in the AF, than in the SR group (401.7 vs. 92.1 pg/ml, P < 0.001). Moreover, the plasma BNP level was significantly higher in the new-, than in the non-AF group (184.7 vs. 84.1 pg/ml, P < 0.001). The optimal cutoff BNP level required to distinguish new-, from non-AF groups was 85.0 pg/ml, and the sensitivity and specificity was 83.3% and 76.2%, respectively. On multivariate logistic regression analysis, plasma BNP level >85.0 pg/ml (odds ratio, 7.20; 95% confidence interval, 1.71 to 30.43, P = 0.007) was an independent factor associated with new-AF. High plasma BNP level should be a strong predictor of delayed AF after ischaemic stroke or TIA.

Relationship of natriuretic peptide and transthoracic echocardiographic findings in 135 subjects with muscular dystrophy

<h2>Abstract</h2><h3>Purpose</h3> To examine the usefulness of plasma atrial (ANP) and brain natriuretic peptide (BNP) levels and transthoracic echocardiogram (TTE) findings in predicting left ventricular (LV) dysfunction in muscular dystrophies (MD). <h3>Materials and methods</h3> 135 MD subjects (83 Duchenne MD (DMD), all males, mean age 22±7years, 20 Becker MD (BMD), all males, 45±16years, 21 limb-girdle MD (LGMD), 14 males, 52±13years, and 11 facioscapulohumeral MD (FSHD), all males, 58±13years) underwent TTE and measurement of BNP and ANP. <h3>Results</h3> In DMD, TTE revealed asynergy of the LV posterior-wall (72%), interventricular septum (IVS) (29%) and LV apex-wall (24%); in BMD subjects: TTE revealed asynergy of LV posterior-wall (50%) and IVS (25%); in LGMD and FSHD subjects: TTE revealed asynergy of LV posterior-wall (33 and 27%, respectively). LV end-diastolic (LVDdI) and end-systolic diameter index (LVDsI) were significantly larger in DMD than FSHD, and LV ejection fraction (LVEF) was significantly lower in DMD than LGMD and FSHD. In DMD, when LVEF was >=35%, BNP and ANP levels remained low, but when LVEF<35%, BNP and ANP levels showed steep increase. Relationship between LVEF and BNP or ANP levels was curvilinear (<i>R</i>²=0.69 and 0.55, respectively, <i>p</i><0.001) using following equation: BNP=673491×EF^−2.897, ANP=5716.6×EF^−1.422, respectively. When LVDdI>=40mm/m² or LVDsI>=35mm/m², LVEF<=35%, plasma BNP and ANP levels increased steeply and the relationship between LVDdI, LVDsI, or LVEF and plasma BNP or ANP levels was curvilinear. <h3>Conclusion</h3> In DMD, LVEF was significantly lower, asynergy of LV posterior-wall was more frequent and BNP and ANP levels were dramatically higher when LVDdI>=40mm/m², LVDsI>=35mm/m² or LVEF<35%.

Angiotensin converting enzyme 2 gene expression increased compensatory for left ventricular remodeling in patients with end-stage heart failure

It has been reported that angiotensin converting enzyme (ACE) 2, a homologue of ACE, has direct effects on cardiac function. However, the role of ACE2 in the development of human heart failure is not fully understood. We evaluated the expression of the ACE2 gene by means of real-time RT-PCR in myocardium from 14 patients with end-stage heart failure. The amount of ACE2 mRNA positively correlated with left ventricular (LV) end-diastolic diameter (r(2)=0.56, p<0.01) but did not significantly correlate with LV ejection fraction or plasma brain natriuretic peptide levels. In conclusion, our data show that the up-regulation of the ACE2 gene in the LV myocardium of patients with severe heart failure was associated with the degree of LV dilatation and may thereby constitute an important adaptive mechanism to retard the progression of adverse LV remodeling.

The prognostic value of plasma brain natriuretic peptide in patients with acute pulmonary embolism

The aim of the study is to investigate the prognostic value of plasma brain natriuretic peptide (BNP) in patients with acute pulmonary embolism. Plasma BNP concentrations were measured in 47 cases with acute pulmonary embolism. Plasma BNP levels in massive or sub-massive pulmonary embolism were higher than those in no-massive pulmonary embolism (P = 0. 001,0. 048) ; BNP levels in survival cases were higher than those in fatal cases ( P = 0. 027 ). The incidence of massive or sub-massive pulmonary embolism in patients with BNP >400 pg/ml was higher than that with BNP≤400 pg/ml ( 100% vs. 75%,P = 0. 023 ). Results indicate that plasma BNP concentration might be associated with risk stratification and prognosis of the disease. Key words: Pulmonary embolism; Natriuretic peptide; brain

117 Long-axis Dysfunction Is Related to Symptomatic Status and Brain Natriuretic Peptide Level in Aortic Stenosis

Introduction In aortic stenosis (AS), the left ventricular (LV) ejection fraction is classically maintained within the normal range despite the presence of decreased longitudinal function. Tissue Doppler imaging (TDI) assessment of myocardial velocities is a sensitive method to detect long-axis dysfunction. However, in AS, data are limited and no studies have correlated the symptomatic status and the level of plasma brain natriuretic peptide (BNP) with the severity of long axis dysfunction. Method and results A comprehensive 2D echocardiogram including TDI of LV was performed in 40 consecutive patients with severe AS (age, 71±13 years, 62% of male, AVA, 0.67±0.2cm 2 , mean transaortic pressure gradient, 44±14mmHg, LV mass, 162±49 g/m 2 ). Concomitantly, plasma BNP level was measured. Peak systolic (Sa) and diastolic tissue velocities (Ea and Aa) were measured in septal, lateral, inferior and anterior position. Sa (mean, 5.4±1.4cm/s, range 2.5 to 8.8 cm/s) was significantly correlated with aortic valve area (AVA) (r=0.53, p=0.0004), LV ejection fraction (r=0.55, p=0.02) and septal E/Ea ratio (r=0.45, p=0.008). Consistently, patients with AVA ≤0.7cm 2 (n=19, 47.5%) had lower Sa (4.8±1.3 vs. 5.9±1.3cm/s, p=0.016). Sa was lower even in patients with preserved LV ejection fraction (Sa=5.6±1.2cm/s). Interestingly, Sa was also correlated with BNP (r=0.48, p=0.004). Patients with low Sa (≤5.4cm/s, n=16, 40%) had significantly higher BNP (570±190 vs. 271±167pg/ml, p=0.03). Moreover, symptomatic patients (n=29, 73%) had lower Sa (5±1.3 vs. 6.5±1.1cm/s, p=0.02) and higher septal E/Ea ratio (28±16 vs. 13±17, p=0.007). Conclusion In patients with AS and preserved LV ejection fraction, the decrease in long-axis function is directly correlated to symptoms and BNP levels. Further studies are needed to evaluate the role of subclinical LV dysfunction in the management of patients with severe aortic stenosis.

170 Left Ventricular Longitudinal Function is a Determinant of Plasma Brain Natriuretic Peptide in Degenerative Mitral Regurgitation

In organic mitral regurgitation (OMR), brain natriuretic peptide (BNP) may be used as a surrogate marker of MR consequences on LV. The use of tissue Doppler imaging (TDI) and 2-D speckle-tracking (2DSt) to assess longitudinal strain improve the detection of subclinical LV dysfunction. However, whether decreased longaxis function is a determinant of BNP has never been examined. Transthoracic echocardiography including Doppler, TDI and 2DSt quantification were performed in 56 consecutive patients (61±15 years, 54% of male) with moderate to severe OMR. Peak annulus velocity and time-to-peak velocity (TP) were measured using TDI for Ea-, Aa- and Sa-wave. 2DSt was used to evaluate global longitudinal strain (GLS). Simultaneously to echocardiography, blood sample was drawn and plasma BNP level was measured. Patients were separated into 2 groups according to the median of BNP level (≥26pg/ml). Patients with BNP ≥26pg/ml were significantly older (65±13 vs. 56±16 yrs, p=0.03) and had higher LV systolic diameter (37±5 vs. 33±7mm, p=0.03), lower GLS (19±4 vs. 22±3%, p=0.0016) and slower TP-Ea (480±49 vs. 456±45ms, p=0.03). By contrast, there was no significant difference between the 2 groups with regard to LV volume and ejection fraction and MR severity. Plasma BNP was correlated with age (r=0.29, p=0.04), LV systolic diameter (r=0.29, p=0.04), TP-Ea (r=0.37, p=0.004) and GLS (r=-0.57, p<0.0001). On multivariate analysis, after adjustment for age, sex and LV systolic diameter, only TP-Ea (r 2 =0.10, p=0.004) and GLS (r 2 =0.32, p<0.0001) were independently associated with BNP. Interestingly, for 1% decrease in GLS, BNP raise of 2.6pg/ml. In addition, GLS was an independent predictor of BNP ≥26pg/l (odds-ratio=1.3, 95%CI: 1.05-1.56, p=0.005). In OMR, BNP release is rather related to LV longitudinal and filling function than severity of MR. Consequently, BNP may be used to unmask subclinical LV dysfunction and to improve the clinical management of patients with OMR.

183 Determinants of Plasma Brain Natriuretic Peptide Release in Aortic Stenosis

Brain natriuretic peptide (BNP) is released by the left ventricle (LV) in response to increase LV wall stress and is associated with symptoms and outcome in aortic stenosis (AS). However, the relation between BNP, LV filling pressure and left atrial (LA) volume has been poorly examined in AS. This study was undertaken to assess the determinants of BNP level in AS. Two-dimensional, tissue Doppler imaging and Doppler transthoracic echocardiography were performed in 34 consecutive patients with severe AS (72±12 years, 62% of male, aortic valve area (AVA), 0.67±0.2 cm 2 , mean gradient, 45±13mmHg). Concomitantly, plasma BNP level was measured. Mean plasma level BNP was 325±572pg/ml. BNP was significantly higher in patients with reduced LV systolic function (LV ejection fraction ≤ 60%, n=22; 595±869 vs. 178±235pg/ml, p=0.04), increased indexed LA volume (≥ 40ml/m 2 , n=21; 454±686 vs. 125±210pg/ml, p=0.026) and increased LV filling pressure (E/Ea ratios: septal ≥ 15, n=17, 562±738 vs. 108±117pg/ml, p=0.004; lateral ≥ 11, n=14, 626±800 vs. 137±139, p=0.02). There were good correlations between BNP and LV and LA ejection fraction, (r=-0.40, p=0.0035 and r=-0.45, p=0.01), indexed LA volume (r=0.48, p=0.0049) and with septal and lateral E/Ea ratios (r=0.69, p<0.0001 and r=0.50, p=0.0054). However, there was lower correlation between BNP and AVA (r=0.33, p=0.047). After adjustment for age and LV ejection fraction, multivariate analysis showed that E/Ea septal (p=0.0005) or lateral (p=0.048) ratios and indexed LA volumes (p=0.006) remained associated with BNP. Furthermore, symptomatic patients (n=24) had significantly higher BNP level (427±654 vs.78±112pg/ml, p=0.009) and E/Ea septal (25±14 vs. 12±7, p=0.01) and lateral ratios (15±7 vs. 10±5, p=0.01) than asymptomatic patients. This study shows that BNP release is mainly determined by both LV and LA function in patients with AS. In this population, BNP level reflects the ventricular and atrial consequences of increased afterload rather than the severity of stenosis.

Intra-aortic balloon counterpulsation in patients with acute myocardial infarction complicated by cardiogenic shock: The prospective, randomized IABP SHOCK Trial for attenuation of multiorgan dysfunction syndrome*

Patients undergoing percutaneous coronary intervention (PCI) for acute myocardial infarction with cardiogenic shock (CS) are often treated with intra-aortic balloon pump counterpulsation (IABP), even though the evidence to support this is limited. We determined whether IABP as an addition to PCI-centered therapy ameliorates multiorgan dysfunction syndrome (MODS) in patients with acute myocardial infarction complicated by CS. A prospective, randomized, controlled, open-label clinical trial recruiting patients between March 2003 and June 2004 (ClinicalTrials.gov ID NCT00469248). Tertiary care university hospital. Forty-five consecutive patients with AMI and CS undergoing PCI were randomized to treatment with or without IABP. Acute Physiology and Chronic Health Evaluation (APACHE) II scores (primary outcome measure), hemodynamic values, inflammatory markers, and plasma brain natriuretic peptide (BNP) levels (secondary outcomes) were collected over 4 days from randomization. The prospective hypothesis was that adding IABP therapy to "standard care" would improve CS-triggered MODS. The addition of IABP to standard therapy did not result in a significant improvement in MODS (measured by serial APACHE II scoring over 4 days). IABP use had no significant effect on cardiac index or systemic inflammatory activation, although BNP levels were significantly lower in IABP-treated patients. Initial and serial APACHE II scoring correlated with mortality better than cardiac index, systemic inflammatory state, and BNP levels in this group of patients. Nonsurvivors had significantly higher initial APACHE II scores (29.9 +/- 2.88) than survivors (18.1 +/- 1.66, p < .05). Nevertheless, discrepancies among patients within the groups cannot be ruled out and might interfere with our results. In this randomized trial addressing addition of IABP in CS patients, mechanical support was associated only with modest effects on reduction of APACHE II score as a marker of severity of disease, improvement of cardiac index, reduction of inflammatory state, or reduction of BNP biomarker status compared with medical therapy alone. However, the limitations of our present trial preclude any definitive conclusion, but request for a larger prospective, randomized, multicentered trial with mortality as primary end point.

EFFECTS OF ORAL SUPPLEMENTATION OF L-ARGININE IN THE TREATMENT OF PULMONARY HYPERTENSION SECONDARY TO PULMONARY EMBOLISM: A CASE REPORT

We tried L-arginine for the treatment of pulmonary hypertension secondary to pulmonary embolism. The plasma brain natriuretic peptide (BNP) level inversely correlated with the plasma concentration of L-arginine. After oral supplementation of L-arginine, patient's symptoms (shortness of breath and general malaise), state of congestive heart failure, and exercise capacity all improved. L-arginine may be effective in the treatment of pulmonary hypertension secondary to pulmonary embolism.

A prospective study of brain natriuretic peptide levels in three subgroups: Stroke with hypertension, stroke without hypertension, and hypertension alone

Aim:To study brain natriuretic peptide (BNP) levels in three subgroups: patients having stroke with hypertension (HT), those having stroke without HT, and those with HT alone. We also tried to identify whether BNP levels predict the length of stay in hospital and mortality.Materials and Methods:The groups were formed by patients who had been admitted to the emergency department in the first 4–12 h after the onset of symptoms. There were 30 stroke patients with a history of HT (group I), 30 stroke patients without a history of HT (group II), and 20 HT patients without stroke (group III). Patients with congestive heart failure, chronic cor pulmonale, severe valvular heart disease, chronic renal failure, liver insufficiency, diabetes mellitus, atrial fibrillation, and those with a history of stroke were excluded from the study since these diseases can affect the plasma BNP levels.Results:The demographic characteristics, except the age distribution, were similar among the groups. The mean BNP levels in the three groups were 168.8 ± 223.9 pg/ml, 85.0 ± 75.1 pg/ml, and 84.8 ± 178.3 pg/ml, respectively. The differences between the groups were statistically significant.Conclusion:The mean BNP levels were affected by HT and/or stroke. The simultaneous presence of HT and stroke results in a more significant increase BNP than the presence of either stroke or HT alone. When diseases that can affect the plasma BNP levels are excluded, the BNP levels in stroke patients without a history of HT are similar to the levels seen in patients with only HT.

174 Is Left Ventricular Longitudinal Function a Determinant of Plasma Brain Natriuretic Peptide during Exercise in Patients with Organic Mitral Regurgitation?

Plasma brain natriuretic peptide (BNP) may be used for risk stratification in patients with organic mitral regurgitation (OMR). Whether exercise can induce changes in BNP in patients with OMR has never been investigated. Resting and exercise transthoracic echocardiography including Doppler, tissue Doppler imaging (TDI) and 2-D speckle-tracking (2DSt) quantification were performed in 56 consecutive patients (61±15 yrs, 54% of male) with moderate to severe OMR. Peak velocity and time-to-peak velocity (TP) were measured using TDI for Ea-, Aa- and Sa-wave. 2DSt was use to evaluate global LV longitudinal strain (GLS). Blood samples were drawn at rest and 5 min after peak exercise to measure plasma BNP level. BNP increases during exercise (from 27±18 to 35±24pg/ml, p<0.001) and peak exercise BNP was correlated to exercise LV ejection fraction (EF) (r=-0.36, p=0.007) and to exercise Sa velocity (r=-0.41, p<0.001), TP-Sa (r=0.32, p=0.02) and TP-Ea (r=0.39, p=0.004). The best correlation with peak BNP was found with peak GLS (r=-0.58, p<0.0001). In addition, there were significant associations between the changes in BNP and the changes in LVEF (r=-0.35, p=0.009), Sa velocity (r=-0.37, p=0.005), TP-Ea (r=0.35, p=0.01), and GLS (r=-0.44, p=0.0001). On multivariate analysis, after adjustment for age, sex and LVEF, only peak GLS and TP-Ea were independently associated with peak BNP (r 2 =0.34, p<0.0001 and r 2 =0.11, p=0.003, respectively). Furthermore, only changes in Sa velocity (r 2 =0.23, p=0.0004) and in GLS (r 2 =0.17, p=0.03) were independently associated, after adjustment, with the changes in BNP. Exercise and exercise-induced changes in LV longitudinal function are the major determinants of both exercise and changes in BNP during exercise, in patients with OMR. These results suggest that LV longitudinal function should be systematically quantified during stress echocardiography to detect latent subclinical LV dysfunction.

The combination of elevated BNP and AF as a predictor of no early recanalization after IV-t-PA in acute ischemic stroke

Background and purpose In acute stroke patients treated with intravenous tissue plasminogen activator (t-PA), early recanalization can improve patient outcome. Heart failure may result in reduction of brain perfusion, which limits the ability of the blood stream to wash out emboli. Brain natriuretic peptide (BNP) is used as a biological marker of heart failure. Most stroke patients with atrial fibrillation (AF) have elevated BNP levels. We investigated the relationships of plasma BNP levels before t-PA infusion and AF with early recanalization after t-PA infusion. Methods Patients with a major brain artery occlusion were studied prospectively. MRAs were performed before and within 60 min after t-PA infusion. The relationship between BNP levels before t-PA infusion and the presence of AF with early recanalization was examined. Results Seventy-nine patients (49 men; mean age, 75.5 ± 10.4 years; ICA occlusion in 25 patients, M1 in 32, M2 in 13, PCA in 3, and BA in 6) were enrolled. Follow-up MRA within 60 min after t-PA infusion revealed recanalization in 35 (44.3%) patients and no recanalization in 44 (55.7%). Patients with AF (57.1% vs. 75.0%, P = 0.0294) and BNP > 150 pg/dl (39.0% vs. 73.7%, P = 0.0019) less frequently had early recanalization than those without AF and with BNP ≤ 150 pg/dl. The combination of AF and BNP > 150 pg/ml was a useful predictor for no early recanalization (positive predictive value, 79.4%; negative predictive value, 62.2%; sensitivity, 61.4%; specificity, 80.0%). Conclusion The presence of AF and elevated BNP was associated with no early recanalization after IV-t-PA therapy. We should need further study to ascertain its predictive ability.

Serum interleukin-6 and C-reactive protein are markedly elevated in acute decompensated heart failure patients with left ventricular systolic dysfunction

Cytokines play important roles in heart failure (HF). We examined whether cytokine levels are different in acute decompensated heart failure (ADHF) patients between with left ventricular systolic dysfunction (LVSDF) and with preserved LV ejection function (PLVEF). We studied 81 HF patients who were admitted to our hospital with acute decompensation. They were divided into two groups: LVSDF (LVEF)<45% and PLVEF (LVEF45%). Serum interleukin-6 (IL-6), highly sensitive C-reactive protein (hsCRP), tumor necrosis factor alpha (TNF-alpha), and IL-18 and plasma brain natriuretic peptide (BNP) were measured on admission and at discharge. On admission, IL-6 and hsCRP were higher in LVSDF than in PLVEF. IL-6 and hsCRP decreased after treatment in LVSDF, but not in PLVEF, while plasma BNP levels decreased in both HF with treatment. There was no difference in TNF-alpha or in IL-18 level between LVSDF and PLVEF, and they did not change after treatment in either group. In conclusion, cytokine profiles were different in ADHF between those with LVSDF and PLVEF. Activation of IL-6-hsCRP pathway may play a specific role in ADHF with LVSDF.

Circadian Rhythms and Effects of Anesthesia on Plasma Natriuretic Peptide Levels in Rats

Atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) are circulating hormones secreted predominantly in patients with hypertension or congestive heart failure. To obtain background data on plasma ANP and BNP levels in rats, we investigated the circadian rhythms and effects of anesthesia on these peptides. To determine the circadian rhythms, plasma samples from thirty rats were collected by non-anesthesia (decapitation) at six time points every fourth hour. To determine the effects of anesthesia, plasma samples from thirty-two rats were collected under diethyl ether, pentobarbital or urethane anesthesia. The plasma ANP and BNP levels were determined using a radioimmunoassay. The plasma ANP levels were high from the evening to early morning, while the plasma BNP levels were relatively low at 2:30 AM. The difference in the BNP levels was statistically significant. The plasma BNP levels were relatively high when the rats were anesthetized using urethane. These results suggest that blood collection should be performed between 10:30 AM to 2:30 PM to determine plasma ANP and BNP. The use of pentobarbital is also recommended for toxicological studies in rats.

Value of Estimated Right Ventricular Filling Pressure in Predicting Cardiac Events in Chronic Pulmonary Arterial Hypertension

Right ventricular (RV) filling pressure can be estimated using tissue Doppler imaging (TDI) from the tricuspid lateral annulus, but few data are available on the usefulness of Doppler-derived RV filling pressure in predicting the prognosis of chronic pulmonary arterial hypertension (PAH). In 50 consecutive patients with PAH, TDI was performed within 24 hours of right-sided catheterization to measure early diastolic myocardial velocity at the tricuspid lateral annulus (E(a)) and early diastolic tricuspid inflow (E). The tricuspid E/E(a) ratio was calculated and compared with the invasive hemodynamic variables. Cardiac events were defined as cardiac death or rehospitalization due to RV failure. Mean right atrial pressure (RAP) averaged 6 +/- 5 mm Hg (range, 1-25 mm Hg). E/E(a) correlated positively with mean RAP (r = 0.80, P < .001), irrespective of RV systolic function. We divided patients into group A with cardiac events (n = 19) and group B without events (n = 31) in a mean follow-up period of 14 months. Plasma brain natriuretic peptide level and E/E(a) were significantly higher in group A than in group B (349 +/- 310 pg/dL vs 129 +/- 136 pg/dL, P = .001; 7.0 +/- 3.2 vs 4.5 +/- 1.9, P = .004, respectively), whereas mean pulmonary artery pressure did not differ significantly. In a multivariate model, E/E(a) remained predictive for cardiac events (hazard ratio 1.227; 95% confidence interval, 1.042-1.444; P = .014). An E/E(a) cutoff value of 6.8 discriminated cases with cardiac events with a sensitivity of 42% and specificity of 97% (area under the curve 0.71). The tricuspid E/E(a) ratio provides a reliable estimation of RV filling pressure and predicts cardiac events in patients with PAH.

Effect of simvastatin vs. rosuvastatin on adiponectin and haemoglobin A1c levels in patients with non‐ischaemic chronic heart failure

To compare the effects of lipophilic simvastatin and hydrophilic rosuvastatin on plasma adiponectin and glycated haemoglobin A1c (HbA1c) levels in patients with non-ischaemic chronic heart failure (NICHF). Seventy-one stable outpatients with NICHF, who were already receiving standard therapy for CHF, were randomized to simvastatin (n = 35) or rosuvastatin (n = 36). Plasma levels of brain natriuretic peptide (BNP), total adiponectin, high-sensitive C-reactive protein, HbA1c, and oxidized low-density lipoprotein (oxLDL), a marker of oxidative stress, were measured before and 4 months after treatment with simvastatin or rosuvastatin. There was no difference in the baseline characteristics including left ventricular ejection fraction (LVEF) and biochemical parameters between the two groups. In both groups, plasma BNP levels and LVEF did not change after 4 months. Plasma levels of adiponectin and oxLDL did not change and HbA1c level was slightly increased (6.0 +/- 0.9 vs. 6.1 +/- 0.9%, P = 0.053) in the simvastatin group. In contrast, plasma adiponectin level was significantly increased (12.3 +/- 7.3 vs. 14.0 +/- 8.2 microg/mL, P = 0.012) concomitant with a significant reduction in oxLDL and HbA1c (oxLDL: 8.8 +/- 4.7 vs. 7.6 +/- 4.7 U/mL, P = 0.0059; HbA1c: 6.0 +/- 0.7 vs. 5.9 +/- 0.7%, P = 0.002) in the rosuvastatin group. These findings suggest that hydrophilic rosuvastatin but not lipophilic simvastatin increases adiponectin and decreases HbA1c levels in patients with NICHF.