Brain Natriuretic Peptide Reduction Research Articles

#510 Evaluating tolvaptan as a protective agent for cardiac insufficiency in peritoneal dialysis patients

Abstract Introduction Peritoneal dialysis serves as a highly effective renal replacement therapy, offering prolonged preservation of residual renal function, improved blood pressure regulation, and enhanced quality of life. While diuretics are generally considered safe and beneficial in this context, their efficacy may be limited in certain cases. Background and Aims The rationale behind investigating the potential benefits of tolvaptan in peritoneal dialysis stems from existing studies in Asia, where the use of tolvaptan has been approved in this population. These studies, conducted on patients undergoing peritoneal dialysis, indicate notable improvements in urine output and key heart failure indicators such as Left Ventricular Mass Index (LVMI) and Brain Natriuretic Peptide (BNP). Materials & Methods Recognizing the significance of these findings, a recent meta-analysis was conducted to comprehensively assess the collective data. The meta-analysis encompassed data from five pertinent studies involving a total of 70 peritoneal dialysis patients, with an average age of 66.1 ± 15 years. Participants received tolvaptan in doses of up to 15 mg, and the mean follow-up period was 8.2 ± 3.9 months. Results Results from the meta-analysis revealed a significant increase in urine volume in two out of four instances (Mean Difference [MD]= +554.5 cc [379,730], I²=61.5). While most studies did not indicate substantial changes in body weight or renal kt/V, a notable reduction in Left Ventricular Mass Index was evident in two studies (MD= -43.28 [-84.9,-1.6], I²=80.6%). Additionally, a substantial reduction in BNP was reported in one study, with no documented adverse events across the studies. Conclusion As an adjunct therapy, tolvaptan exhibits potential benefits in volume control, potentially contributing to improved cardiac function in peritoneal dialysis patients. The findings of this study align with existing research, highlighting the positive impact of tolvaptan on heart failure markers. Nevertheless, further high-quality studies are imperative to consolidate and validate these observed benefits in the peritoneal dialysis population.

Development and validation of a clinical prediction model for early ventilator weaning in post-cardiac surgery

BackgroundWeaning patients from mechanical ventilation is a critical clinical challenge post cardiac surgery. The effective liberation of patients from the ventilator significantly improves their recovery and survival rates. This study aimed to develop and validate a clinical prediction model to evaluate the likelihood of successful extubation in post-cardiac surgery patients. MethodA predictive nomogram was constructed for extubation success in individual patients, and receiver operating characteristic (ROC) and calibration curves were generated to assess its predictive capability. The superior performance of the model was confirmed using Delong's test in the ROC analysis. A decision curve analysis (DCA) was conducted to evaluate the clinical utility of the nomogram. ResultsAmong 270 adults included in our study, 107 (28.84%) experienced delayed extubation. A predictive nomogram system was derived based on five identified risk factors, including the proportion of male patients, EuroSCORE II, operation time, pump time, bleeding during operation, and brain natriuretic peptide (BNP) level. Based on the predictive system, five independent predictors were used to construct a full nomogram. The area under the curve values of the nomogram were 0.880 and 0.753 for the training and validation cohorts, respectively. The DCA and clinical impact curves showed good clinical utility of this model. ConclusionDelayed extubation and weaning failure, common and potentially hazardous complications following cardiac surgery, vary in timing based on factors such as sex, EuroSCORE II, pump duration, bleeding, and postoperative BNP reduction. The nomogram developed and validated in this study can accurately predict when extubation should occur in these patients. This tool is vital for assessing risks on an individual basis and making well-informed clinical decisions.

Biomarkers of hemodynamic status in patients with moderate and severe COVID-19

Aim. To assess laboratory markers of hemodynamic status in patients with moderate to severe COVID-19.Materials and Methods. Here we examined 15 patients with moderate COVID-19 and 16 critically ill COVID-19 patients. The control group consisted of 20 healthy volunteers. The levels of endothelin-1, brain natriuretic peptide (BNP), and N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured by enzyme-linked immunosorbent assay. The amounts of nitrites (NO2) and nitrates (NO3) were measured by a Griess test (an enzymatic conversion of nitrates to nitrites) with a following colorimetric analysis.Results. Measurements of endothelin-1, nitrites, and nitrates showed high variability. The levels of NT-proBNP were reduced by 65% and 50% in patients with moderate and severe COVID-19, respectively (p < 0.05). In contrast, the levels of BNP were elevated by 472% and 548% in these patient categories (p < 0.05). These results indicated increased left ventricular load and suggested a heart failure.Conclusion. Progressive increase of BNP and concurrent reduction of NT-proBNP indicate affected hemodynamics in patients with moderate and severe COVID-19.

Effects of luseogliflozin on estimated plasma volume in patients with heart failure with preserved ejection fraction.

AimsSodium glucose co‐transporter 2 inhibitors have diuretic effects in both patients with glycosuria and with natriuresis. We sought to assess the effect of luseogliflozin on estimated plasma volume (ePV) in patients with type 2 diabetes and heart failure with preserved ejection fraction (HFpEF).Methods and resultsThis study was a post‐hoc analysis of the MUSCAT‐HF trial (UMIN000018395), a multicentre, prospective, open‐label, randomized controlled trial that assessed the effect of 12 weeks of luseogliflozin (2.5 mg, once daily, n = 83) as compared with voglibose (0.2 mg, three times daily, n = 82) on the reduction in brain natriuretic peptide (BNP) in patients with type 2 diabetes and HFpEF. The analysis compared the change in ePV calculated by the Straus formula from baseline to Weeks 4, 12, and 24, using a mixed‐effects model for repeated measures. We also estimated the association between changes in ePV and changes in other clinical parameters, including BNP levels. Luseogliflozin significantly reduced ePV as compared to voglibose at Week 4 {adjusted mean group‐difference −6.43% [95% confidence interval (CI): −9.11 to −3.74]}, at Week 12 [−8.73% (95%CI: −11.40 to −6.05)], and at Week 24 [−11.02% (95%CI: −13.71 to −8.33)]. The effect of luseogliflozin on these parameters was mostly consistent across various patient clinical characteristics. The change in ePV at Week 12 was significantly associated with log‐transformed BNP (r = 0.197, P = 0.015) and left atrial volume index (r = 0.283, P = 0.019).ConclusionsLuseogliflozin significantly reduced ePV in patients with type 2 diabetes and HFpEF, as compared with voglibose. The reduction of intravascular volume by luseogliflozin may provide clinical benefits to patients with type 2 diabetes and HFpEF.

Aliskiren and L-carnitine attenuate isoproterenol-induced cardiac hypertrophy via targeting IL-6/JAK2/STAT3/SOCS3 signaling pathway

This research was designed to assess the inhibitory action of aliskiren, L-carnitine, and their combined treatment on JAK2/STAT3/SOCS3 signaling pathway in cardiac hypertrophy induced by isoproterenol injection in rats. Wistar rats were injected with isoproterenol (5 mg/kg/day) for 15 days for induction of cardiac hypertrophy. Hypertrophied animals were concurrently treated daily with aliskiren (50 mg/kg) and/or L-carnitine (200 mg/kg). Either L-carnitine or aliskiren treatment significantly reduced the elevated relative heart weight with a concomitant reduction in brain natriuretic peptide, creatine kinase-MB, and troponin T in isoproterenol treated animals. Additionally, L-carnitine and/or aliskiren treatment significantly reduced myocardial interleukin-6, lipid peroxidation, and markedly increased glutathione content. Aliskiren and/or L-carnitine treatment also attenuated myocardial fibrosis as evidenced by the significant decrease in myocardial collagen I and transforming growth factor-β1. The biochemical results were further confirmed by the improvement in myocardial histopathological architecture. Interestingly, aliskiren and L-carnitine treatment down-regulated the expression of JAK2, STAT3, and SOCS3 in hypertrophied animals. Conclusively, aliskiren/L-carnitine regimen may ameliorate cardiac hypertrophy induced by isoproterenol through mitigating oxidative stress, inflammation, and IL-6/JAK2/STAT3/SOCS3 pathway.

Comparative effects of furosemide and other diuretics in the treatment of heart failure: a systematic review and combined meta-analysis of randomized controlled trials.

Diuretics have an essential role in the management of heart failure (HF). However, each drug has its own benefit and side effect. Side effects include fluid, electrolyte abnormalities, and acid-base disturbance. These adverse effects of diuretics predispose patients to serious cardiac arrhythmias and may increase the risk of arrhythmic mortality. Herein, we aim to summarize the relative efficacy and safety of all available diuretics used in the treatment of patients with HF. In June 2017, a systematic electronic database search was conducted in nine databases. All randomized controlled trials (RCTs) comparing the different diuretics used in HF were included for meta-analysis. The protocol was registered in Prospero with CRD42018084819. Among the included 54 studies (10,740 patients), 34 RCTs were eligible for quantitative network meta-analysis (NMA) and traditional meta-analysis while the other 20 studies were qualitatively analyzed. Our results showed that azosemide and torasemide caused a significant reduction in brain natriuretic peptide (BNP) level. Torasemide also caused a significant decrease in collagen volume fraction (CVF) and edema. No significant difference between the agents concerning glomerular filtration rate (GFR), water extraction, and sodium excretion was demonstrated. Regarding side effects, no significant difference among diuretics was observed in terms of hospital readmission and mortality rates. Diuretics are the main treatment of hypervolemia in HF patients. The choice of appropriate diuretic is essential for successful management and is mainly guided by patient clinical situations and the presence of other co-morbidities.

BNP as a New Biomarker of Cardiac Thyroid Hormone Function.

BackgroundCardiac re-expression of fetal genes in patients with heart failure (HF) suggests the presence of low cardiac tissue thyroid hormone (TH) function. However, serum concentrations of T3 and T4 are often normal or subclinically low, necessitating an alternative serum biomarker for low cardiac TH function to guide treatment of these patients. The clinical literature suggests that serum Brain Natriuretic Peptide (BNP) levels are inversely associated with serum triiodo-L-thyronine (T3) levels. The objective of this study was to investigate BNP as a potential serum biomarker for TH function in the heart.MethodsTwo animal models of thyroid hormone deficiency: (1) 8-weeks of propyl thiouracil-induced hypothyroidism (Hypo) in adult female rats were subsequently treated with oral T3 (10 μg/kg/d) for 3, 6, or 14 days; (2) HF induced by coronary artery ligation (myocardial infarction, MI) in adult female rats was treated daily with low dose oral T3 (5 μg/kg/d) for 8 or 16 wks.ResultsSix days of T3 treatment of Hypo rats normalized most cardiac functional parameters. Serum levels of BNP increased 5-fold in Hypo rats, while T3 treatment normalized BNP by day 14, showing a significant inverse relationship between serum BNP and free or total T3 concentrations. Myocardial BNP mRNA was increased 2.5-fold in Hypo rats and its expression was decreased to normal values by 14 days of T3 treatment. Measurements of hemodynamic function showed significant dysfunction in MI rats after 16 weeks, with serum BNP increased by 4.5-fold and serum free and total T3 decreased significantly. Treatment with T3 decreased serum BNP while increasing total T3 indicating an inverse correlation between these two biologic factors (r2 = 0.676, p < 0.001). Myocardial BNP mRNA was increased 5-fold in MI rats which was significantly decreased by T3 over 8 to 16 week treatment periods.ConclusionsResults from the two models of TH dysfunction confirmed an inverse relationship between tissue and serum T3 and BNP, such that the reduction in serum BNP could potentially be utilized to monitor efficacy and dosing of T3 treatment. Thus, serum BNP may serve as a reliable biomarker for cardiac TH function.

Impact of brain natriuretic peptide reduction on the worsening renal function in patients with acute heart failure.

AimsThe prognostic impact of worsening renal function (WRF) in patients with acute heart failure (AHF) remains under debate. Successful decongestion might offset the negative impact of WRF, but little is known about indicators of successful decongestion in the very acute phase of AHF. We hypothesized that decongestion as evaluated by the percent reduction in brain natriuretic peptide (BNP) could identify relevant prognostic implications of WRF in the very acute phase of AHF.Methods and resultsData on 907 consecutive hospitalized patients with AHF in the REALITY-AHF study (age: 78±12 years; 55.1% male) were analyzed. Creatinine and BNP were measured at baseline and 48 hours from admission. WRF was defined as an increase in creatinine >0.3 mg at 48 hours from admission. The primary endpoint was 1-year all-cause mortality. Patients were divided into four groups according to the presence/absence of WRF and a BNP reduction higher/lower than the median: no-WRF/higher-BNP-reduction (n = 390), no-WRF/lower-BNP-reduction (n = 397), WRF/higher-BNP-reduction (n = 63), and WRF/lower-BNP-reduction groups (n = 57). Kaplan-Meier curve analysis showed that the WRF/lower-BNP-reduction group had a worse prognosis than the other groups. In a Cox regression analysis, only the WRF/lower-BNP-reduction group had higher mortality compared to the no-WRF/higher-BNP-reduction group (hazard ratio: 3.34, p<0.001).ConclusionIn the very acute phase of AHF, BNP reduction may aid in identifying relevant prognostic significance of WRF.

Abstract P126: Statines Reduce Cardiac Dysfunction After Preeclamptic Pregnancy

Introduction: Former preeclamptic women have an increased risk of cardiovascular disease in later life. However, the underlying functional and structural mechanisms are still unknown. Objective: We tested the hypothesis that pravastatin has a beneficial effect on the remodeling of the maternal heart after preeclamptic pregnancy and thus reduces the long-term cardiovascular risk. Methods: Female rats harboring the human angiotensinogen gene [TGR(hAogen)L1623] developed a preeclamptic phenotype during pregnancy when mated with male rats carrying the human renin gene [TGR(hRen)L10J], but behaved physiologically normal postpartum. To investigate a possible intervention, we treated preeclamptic dams with pravastatin for four weeks after birth, which was started already during pregnancy. Cardiac structure and function was compared by speckle tracking echocardiography, gene expression analysis, and immune staining of the maternal heart. Results: Due to pravastatin treatment, former preeclamptic rats reduced signs of cardiac hypertrophy (perimeter cardiomyocytes 65.3±0.3 vs. 60.5±0.5 μm), fibrosis (fibronectin 3.9±0.3 vs. 1.8±0.2 %) and improved cardiac microcirculation (CD31+ cells 219.0±4.7 vs. 269.1±8.6). In addition, cardiac output was increased postpartum by statin treatment (ejection fraction 57.2±1.2 vs. 61.0±1.9; global longitudinal strain -14.5±0.6 vs. -19.8±1.0 %; heartrate 355.0±8.7 vs. 328.6±8.3 bpm). Analysis of maternal blood serum showed a reduction of brain natriuretic peptide (BNP 0.39±0.05 vs. 0.33±0.01 ng/ml) and soluble fms-like tyrosine kinase 1 (sFlt1 0.69±0.02 vs. 0.51±0.02 ng/ml) even four weeks after birth. Fetuses at the time of birth also benefited from treatment (brain liver ratio 0.93±0.03 vs. 0.82±0.01; heart body ratio 7.14±0.09 vs. 6.80±0.12). Discussion: Former preeclamptic rats showed significant cardiac hypertrophy in combination with fibrosis and capillary rarefaction. These irreversible structural changes can be reduced by pravastatin treatment. We could not detect any harmful influence of statins on the fetus. Values mean±SEM, PE vs. PE+pravastatin

Baseline and Serial Brain Natriuretic Peptide Level Predicts 5-Year Overall Survival in Patients With Pulmonary Arterial Hypertension: Data From the REVEAL Registry

Plasma brain natriuretic peptide (BNP) level is a prognostic biomarker in pulmonary arterial hypertension (PAH). Its impact on long-term overall survival (OS) was investigated in the Registry to Evaluate Early and Long-term Pulmonary Arterial Hypertension Disease Management (REVEAL), a 5-year observational, multicenter, US registry of patients with PAH. Patients were≥ 18 years of age, met right heart catheterization criteria at rest, had World Health Organization group I PAH, and had BNP measurement at enrollment. Optimal BNP threshold was obtained via receiver operating characteristic curve analysis. OS was compared in patients with low (≤ 340 pg/mL) vshigh (> 340 pg/mL) BNP at baseline; changes between baseline and last assessment were also examined. Patients were categorized based on baseline (low or high) and follow-up (low or high) BNP values; hazard ratios (HRs) for OS were estimated and compared using Cox regression. Overall, 1,426 patients were analyzed. Mortality risk was significantly higher in patients with baseline high vslow BNP (HR, 3.6; 95%CI, 3.0-4.2). BNP change analysis at≤ 1 year postenrollment demonstrated that the low-low group had the lowest and the high-high group had the highest 5-year mortality risk (HR, 0.23; 95%CI, 0.19-0.27). Changes in BNP score also correlated with change of risk of death. Baseline BNP threshold of 340 pg/mL strongly predicted survival up to 5 years in patients with PAH. A BNP reduction at 1 year since enrollment was associated with decreased mortality risk, whereas an increase in BNP at 1 year was associated with an increased mortality risk, supporting BNP as a surrogate marker of PAH survival.

Predictors of Hospitalization for Heart Failure Decompensation in 18-months Follow-up After Index Hospitalization for Acute Heart Failure.

Introduction:Heart failure (HF) has very high rate of repeat hospitalizations due to HF decompensation (HHFD), sometimes very shortly after discharge for acute HF.Aim:The aim of this paper is to investigate rate of HHFD and to identify their possible predictors.Patients and Methods:Total amount of 222 patients hospitalized at Clinic for heart and vessel disease and rheumatism in acute HF were followed for next 18 months for occurrence of HHFD. During hospitalization were collected demographic data, risk factors, routine laboratory tests and admission BNP (brain natriuretic peptide), discharge BNP, percentage change of BNP during hospitalization, high sensitive troponin I, CA125 (cancer antigen125) and cystatin C.Results:In next 18 months 129 patients (58.11%) reached end-point HHFD- mean time of its occurrence was 2.2 (95% CI=1.67-2.7) months. Patients with HHFD had more often arterial hypertension (HTA) (p=0.006), had higher BMI (p=0.035) and had higher values of bilirubin, admission BNP (p=0.031), discharge BNP (p <0.001), CA125 (p=0.023) and cystatin C (p=0.028). There was no difference in troponin values (p=0.095), while % reduction of BNP during hospitalization was lower (p<0.001) in group with HHFD. In univariate Cox hazard analysis HTA was positively and BMI negatively correlated with HHFD, while in multivariate Cox hazard analysis independent predictors were HTA (HR 1.6; 95% CI=1.1-2.2; p=0.018) and BMI<25 (HR 1.6; 95% CI=1.1-2.3; p=0.007). In univariate Cox hazard analysis admission BNP, discharge BNP, rise of BNP during hospitalization, CA125 and bilirubin were positively correlated, while sodium was negatively correlated with HHFD. In multivariate Cox hazard analysis there was only one independent predictor of HHFD - discharge BNP (HR 6.05; 95% CI=1.89-19.4; p=0.002). Conclusion: Arterial hypertension, BMI>25 and discharge BNP are independent predictors of HHFD. This could help us to identify high-risk patients for readmission who should be monitored more frequently and treated with sophisticated drug and device therapy.

The Salutary Influence of Forest Bathing on Elderly Patients with Chronic Heart Failure.

The aim of the current study was to test the hypothesis that forest bathing would be beneficial for elderly patients with chronic heart failure (CHF) as an adjunctive therapy. Two groups of participants with CHF were simultaneously sent to the forest or an urban control area for a four-day trip, respectively. Subjects exposed to the forest site showed a significant reduction of brain natriuretic peptide (BNP) in comparison to that of the city group and their own baseline levels. The values for the cardiovascular disease related pathological factors, including endothelin-1 (ET-1), and constituents of the renin-angiotensin system (RAS), including renin, angiotensinogen (AGT), angiotensin II (ANGII), and ANGII receptor type 1 or 2 (AT1 or AT2) in subjects exposed to the forest environment were lower than those in the urban control group. Obviously, a decreased level of inflammatory cytokines and improved antioxidant function was observed in the forest group rather than in the city group. The assessment of the profile of mood states (POMS) indicated that the negative emotional mood state was alleviated after forest bathing. As anticipated, a better air quality in the forest site was observed according to the detection of PM2.5 (particulate matter <2.5 μm) and negative ions. These results provided direct evidence that forest bathing has a beneficial effect on CHF patients, and thus may pave the way for potential development of forest bathing as an effective adjunctive therapy on cardiovascular disorders.

Different trajectories and significance of B-type natriuretic peptide, congestion and acute kidney injury in patients with heart failure.

The exact relationship existing among congestion status, brain natriuretic peptide (BNP) changes and acute kidney injury (AKI) has not been elucidated in patients with acute heart failure (AHF). The aims of this study are: to investigate the relation and prognostic role of BNP, AKI and clinical congestion after discharge; to define the exact BNP cut off value or a BNP in-hospital reduction to identify patients with higher risk during vulnerable post-discharge phase. We consecutively enrolled 157 patients with a diagnosis of AHF. BNP and creatinine were measured in all patients, and degree of failure was assessed. AKI was defined as a creatinine increase ≥0.3mg/dL or eGFR reduction ≥20% during hospitalization. All patients were followed for 1 and 3months. Of 146 included patients, 110 patients (75%) displayed effective decongestion, 116 (79%) showed a BNP decrease ≥30%, and 28 (19%) developed in-hospital AKI. BNP in-hospital decrease ≥30% was found more often in patients who showed good decongestion in comparison to patients in persistent failure (63 vs 22%; p<0.001). The ROC curve analyses at 3months show that both BNP reduction of 30% between admission and discharge and decongestion at discharge identifies patients with a reduced incidence of cardiovascular events (AUC=0.79, confidence interval 0.68-0.90, sensibility 90%, sensitivity 50% p<0.001). Kaplan-Meier survival plots show a better outcome in patients with a BNP decrease ≥30% and good decongestion at discharge (p=0.03). BNP reduction in AHF is associated with decongestion. BNP reduction associated with decongestion at discharge is a favorable prognostic indicator at 90-day survival irrespective of the AKI occurrence.

Abstract 397: Brain natriuretic peptide (BNP) as molecular marker for bladder, ovarian, and glioblastoma cancers

Abstract Background: BNP has been reported as molecular marker for ovarian cancer. This study evaluated BNP as a molecular marker for bladder, ovarian, glioblastoma, and pancreatic cancers. Methods: Serum samples collected at the time of diagnosis were tested using rapid and quantitative point-of-care (POC) devices for BNP blood biomarkers and the data was evaluated using JMP® 11.2.1 statistical analysis software. Samples were collected from bladder cancer patients (48 transitional cell carcinoma of the bladder), glioblastoma patients (51), pancreatic cancer patients (39 adenocarcinoma, 1 mucinous adenocarcinoma), ovarian cancer patients (24 serous adenocarcinoma, 20 serous papillary adenocarcinoma, 7 endometrioid adenocarcinoma, 3 clear cell carcinoma, 1 endometrial adenocarcinoma, 1 endometrioid papillary carcinoma, 1 serous papillary carcinoma), and normal subjects (n = 60). Results: Compared to normal subjects, bladder patients are more likely to be smokers (p = 0.0064). All four patient groups were more likely to be hypertensive (bladder, p = 0.0165; glioblastoma, p&amp;lt;0.0001, ovarian, p = 0.0002; pancreatic, p &amp;lt; 0.0001). No significant differences among the groups versus normal for weight were observed. Significant differences between the groups versus normal for BMI (ovarian, p = 0.0061), age (bladder, p = 0.0006; pancreatic = 0.0085), BNP (ovarian, p = 0.0012; glioblastoma, p = 0.0016; bladder, p = 0.0112) were noted. There was positive correlation between age and BNP level among all four cancer groups (bladder, p = 0.0133; glioblastoma, p = 0.0629; ovarian, p = 0.0304; pancreatic, p = 0.0172); whereas there was a negative correlation between age and BNP level among normal controls (p = 0.0109). Age-adjusted BNP level was highly significant different versus normal (bladder, p &amp;lt;0.0001; ovarian, p = 0.0013; glioblastoma, p = 0.0047). Neither BNP nor age-adjusted BNP level was significantly different from normal for pancreatic cancer patients. Hypertensive condition had no impact on BNP or age-adjusted BNP. Conclusions: Bladder, ovarian, and glioblastoma cancers are associated with significant reduction in BNP and age-adjusted BNP blood levels. Pancreatic cancer was an exception. BNP level could be useful in the monitoring of treatment efficacy in which the BNP POC device described here would be highly appropriate due to its ease in deployment at the patient's home or doctor's office. Citation Format: Cynthia Lee, William Yeh, Dongwoon Lee, Samuel Dixon, Vuong Trieu. Brain natriuretic peptide (BNP) as molecular marker for bladder, ovarian, and glioblastoma cancers. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 397.

An Investigation of the Effects of Aerobic Exercise on Serum Brain Natriuretic Peptide and C-Reactive Protein in women with Cardiovascular Diseases

A B S T R A C T Article type: Original Article Introduction: The aim of this study was to evaluate the effects of aerobic exercise on brain natriuretic peptide (BNP) and C-reactive protein (CRP) levels in women with cardiovascular diseases. Materials and Methods: In this semi experimental study, thirty female patients with at least one coronary artery stenosis (more than70%) were chosen and divided into two groups of aerobic training (n=15) and control (n=15). Blood samples were obtained at the beginning and end of the study to measure brain natriuretic peptide (BNP) and C-reactive protein (CRP) levels. The aerobic group cycled on a stationary ergometer for three sessions per week (period of eight weeks). The control group did not receive any exercise. Each exercise session included a10-minute warm-up, a 15-minute or more aerobic training program and a 5-minute cool-down. In the warm-up and cool-down stages, running, walking and stretching activities were used. During the first week of training, subjects exercised for 15 minutes at 55-60% of their target heart rates. Each week, exercise duration extended by five minutes, while the intensity was unchanged. Results: Results indicated that 8 weeks of aerobic training had a significant effect on decreasing the BNP and CRP levels in females with Cardiovascular Diseases (P=0.005 and P=0.017 , respectively). Moreover, a significant Difference was seen between the control and experimental groups in mean BNP and CRP values (P=0.0001 and P=0.001 respectively), while no significant difference were seen between the pre and post tests in the Control group for BNP (P=0.21) and CRP (P= 0.28). There were significant reduction in BNP (p<0. 05) and CRP levels (p<0.01) after 8 weeks aerobic exercise in experimental group, But no change was seen in the control group in both BNP and CRP levels. Conclusion: Aerobic exercise can attenuate BNP and CRP levels in females with cardiovascular diseases; hence it can be used as a part of treatment.

Efficacy of positive airway pressure on brain natriuretic peptide in patients with heart failure and sleep-disorder breathing: a meta-analysis of randomized controlled trials.

Positive airway pressure (PAP) has been recognized as an effective therapeutic option for sleep-disordered breathing (SDB) in patients with heart failure (HF), and it can improve left ventricular function. Whether PAP can ameliorate serum brain natriuretic peptide (BNP) levels, a biomarker of HF, is controversial. The purpose of the present study was to quantitatively assess the efficacy of PAP on BNP in patients with HF and SDB. A systematic search of PubMed, Embase, Web of Science and Cochrane library identified six randomized controlled trials (RCTs), in which PAP was compared with medical therapy, subtherapeutic PAP or different types of PAP. The data of BNP were extracted and pooled into meta-analysis using STATA 12.0. Totally 6 RCT studies (7 cohorts) with 222 patients were enrolled into analysis. The quality of each study was high and the heterogeneity (I(2) = 58.1%) was noted between studies. A significant reduction of BNP was observed after PAP treatment in patients with HF and SDB (SMD -0.517, 95% CI -0.764 to -0.270, z = 4.11, p = 0.000). Our meta-analysis of RCTs demonstrated that PAP elicits significant reduction of BNP in patients with HF and SDB.

Effects of cilnidipine on sympathetic nerve activity and cardiorenal function in hypertensive patients with type 2 diabetes mellitus: Association with BNP and aldosterone levels

AimsHypertension stimulates the sympathetic nervous system and this phenomenon is exacerbated by diabetes mellitus. We investigated the effects of cilnidipine, an N/L-type calcium channel blocker, on aspects of this system in patients with type 2 diabetes mellitus. MethodsIn 33 hypertensive patients with type 2 diabetes mellitus treated with a calcium channel blocker other than cilnidipine, we evaluated the influence of switching to cilnidipine on blood pressure, heart rate, catecholamine, plasma renin and aldosterone concentration, brain natriuretic peptide, urine liver-type fatty acid binding protein, and urinary albumin excretion ratio in the same patients by a cross-over design. Other biochemical parameters were also evaluated. ResultsSwitching to cilnidipine did not change blood pressure but caused reduction in catecholamine concentrations in blood and urine and plasma aldosterone concentration, accompanied by significant reduction in brain natriuretic peptide, urine liver-type fatty acid binding protein, and albumin excretion ratio. These parameters other than brain natriuretic peptide were significantly increased after cilnidipine was changed to the original calcium channel blocker. ConclusionsIn 33 hypertensive patients with type 2 diabetes mellitus, compared to other calcium channel blockers, cilnidipine suppressed sympathetic nerve activity and aldosterone, and significantly improved markers of cardiorenal disorders. Therefore, cilnidipine may be an important calcium channel blocker for use in combination with renin–angiotensin–aldosterone system inhibitors when dealing with hypertension complicated with diabetes mellitus.

Effectiveness of Bumetanide Infusion in Treatment of Generalized Edema and Congestive Heart Failure

Generalized edema (anasarca) is common in nephrotic syndrome which rarely produces shortness of breath. Increased shortness of breath associated with rapid weight gain and generalized edema signify congestive heart failure (CHF). Loop diuretics consisting of furosemide (Lasix&#174), bumetanide (Bumex&#174), torsemide (Demadex&#174) or ethacrynic acid (Edecrin) are effective diuretics to treat anasarca. However, efficacy varies depending on the renal function. Loop diuretic given orally or by intravenous boluses produce good urine output but overall response in reducing edema or shortness of breath as in CHF is less than optimum. Although literature information is very limited, continuous bumetanide infusion for 72 to 96 hours is found to be very effective in producing subjective relief of shortness of breath as well as objective improvement such as reduction in brain natriuretic peptide in CHF and improved kidney function, so that diuresis is sustained even after discontinuation of the infusion. Decrease in kidney function and electrolytes and acid-base imbalance are common but they are reversible with prompt replacement therapy. They pose no threat to life.

The influence of different dosages of atorvastatin in acute coronary syndrome female patients on vascular endothelial growth factor and brain natriuretic peptide

Objective To study the influence of different dosages of atorvastatin in acute coronary syndrome female patients on vascular endothelial growth factor(VEGF) and brain natriuretic peptide(BNP).Methods 60 female cases of ACS patients were divided into A and B group.30 patients in the A group were given atorvastatin 20mg per night,while the other 30 patients in the B group were taken 40mg per night.The patients were followed four weeks by evaluating serum VEGF and BNP concentration.Results After treatment for four weeks,the patients in the two groups showed significant reduction in VEGF and BNP,however,the therapeutic group showed significant difference between the two groups.Additionally,the B group further showed significant reduction in VEGF and BNP.Conclusion Using high-dose atorvastatin lowers VEGF and BNP significantly,which could reduce female cardiovascμlar events. Key words: Coronary disease; Vascular endothelial growth factor; Brain natriuretic peptide; Female

Effect of Short-Term Infusive Dobutamine Therapy on Thyroid Hormone Profile and Hemodynamic Parameters in Patients With Acute Worsening Heart Failure and Low-Triiodothyronine Syndrome

ObjectivesLow-triiodothyronine syndrome (LT3S) is a condition characterized by decreased total serum T3 and free T3 (fT3) with normal levels of thyroxine (fT4) and thyrotropin (TSH). Experimental studies have shown that...