Serum B-type Natriuretic Peptide Levels Research Articles

Post-Transplant Trends in BNP Levels among Recipients of Heart versus Heart-Kidney Transplantation

Purpose Circulating levels of b-type natriuretic peptide (BNP) are elevated following heart transplantation (HT), peak at 1-2 months post-HT, and decline over the course of several months but rarely return to normal. We sought to determine the time course of BNP level following combined heart-kidney transplantation (HKT) compared to HT alone. Methods Between July, 2014 and August, 2017, 11 patients underwent HKT; they were matched based on age, gender, race and body mass index (BMI) to 22 patients undergoing isolated HT. Baseline demographics, serial BNP levels, and estimated glomerular filtration rate (eGFR; ml/min/1.73 m 2 ) were monitored in patients at post-transplant days 30, 60, 90, 180 and 365. Wilcoxon rank-sum test was used to compared median BNP levels at different time points between the groups. Results Average age of HKT recipients was 54±18 years (82% females, 27% black Americans, BMI 25±5 kg/m2) and that of HT recipients was 55±14 years (82% females, 27% black Americans, BMI 26±3 kg/m2). As shown in the Figure, BNP values decreased significantly among HKT recipients by 90-days, and remained significantly lower at 1-year post-transplantation (p Conclusion Unlike HT alone, BNP levels were found to be near normal in the majority of HKT recipients within a much shorter period of time and remained low up to 1-year post-transplant. This finding can potentially be explained by improved renal function with kidney transplant ; although, the effect of KT on lusitropic properties of transplanted heart cannot be ruled out.

Postoperative B-Type Natriuretic Peptide as Predictor for Postoperative Outcomes in Patients Implanted With Left Ventricular Assist Devices.

B-type natriuretic peptide (BNP) is a cardiac neurohormone known to correlate with left ventricular (LV) dilation, decreased contractility, and increased stiffness. Consequently, BNP has been used as a prognostic tool to assess the degree of LV unloading for patients supported by continuous-flow LV assist devices (LVADs). We assessed the prognostic value of changes in BNP in the 2 weeks after LVAD implantation. This retrospective study analyzed laboratory findings and outcomes of 189 LVAD patients. Patients were separated into two groups based on whether serum BNP levels had improved from preoperative levels by postoperative day 14. Group 1 had improvement in BNP levels, whereas group 2 had no improvement or worsening in BNP. There were no significant differences between the groups in age, gender, race, body mass index, or comorbidities. Group 1 had preoperative BNP 1,125 ± 1,078.3 pg/dl and postoperative BNP 440.2 ± 267.7 pg/dl (preoperative minus postoperative [ΔBNP] = -693.09 ± 942.4 pg/dl), whereas group 2 had preoperative BNP 346.0 ± 309.1 pg/dl and postoperative BNP 631.57 ± 483.4 pg/dl (ΔBNP = 289.32 ± 329.7 pg/dl). Postoperative survival in group 2 was significantly worse than in group 1. Rates of right ventricular failure (RVF) were significantly higher in group 2 (group 1: 39%, group 2: 52.7%; p = 0.01). In most patients implanted with a LVAD, BNP improves significantly in the postoperative period as the LV is unloaded. Our results indicate that lack of improvement in postoperative BNP is associated with longer length of stay, increased rates of RVF, and is an independent risk factor for reduced postoperative survival.

Increasing Age Hinders the Decline in B-Type Natriuretic Peptide Following Parathyroidectomy in Dialysis Patients

Parathyroidectomy has beneficial effects on all-cause and cardiovascular mortality in patients with uncontrolled hyperparathyroidism. B-Type natriuretic peptide (BNP) correlates with the severity of heart failure. We aimed to investigate whether parathyroidectomy modulates the BNP levels in dialysis patients. Patients who underwent surgical intervention for hyperparathyroidism were included. The serum BNP levels were determined before parathyroidectomy and during follow-up. The preoperative and postoperative BNP levels were 499±561 and 453±442 pg/ml, respectively (p=0.82). The baseline BNP level was positively correlated with weakness and headache, but not biochemical parameters. In multivariate analysis, age (odds ratio=0.837) and preoperative symptom score (odds ratio=0.935) were independent predictors for the postoperative decline in BNP levels Conclusion: The serum BNP levels may increase or decrease after parathyroidectomy. Younger age and lower symptom burden are associated with decline in BNP levels.

B-type natriuretic peptide is associated with remodeling and exercise capacity after transcatheter aortic valve replacement for aortic stenosis.

BackgroundWe aimed to assess longitudinal changes of B‐type natriuretic peptide (BNP) in aortic stenosis (AS) patients treated by transcatheter aortic valve replacement (TAVR).MethodsFrom our TAVR database, we identified 193 consecutive patients with severe symptomatic AS who underwent TAVR and were prospectively followed using serial BNP levels and echocardiography. Patients were divided into subgroups according to type of left ventricular (LV) remodeling as having normal LV mass and relative wall thickness, or showing concentric remodeling (CR), concentric hypertrophy (CH), and eccentric hypertrophy (EH).ResultsAt baseline, 30 patients (16%) had EH, 115 (60%) had CH, 37 (19%) had CR, and 11 (6%) had normal LV geometry. After TAVR, BNP decreased in the first 30 days, with further improvement during follow‐up. Patients with EH had higher BNP at baseline (P < 0.01) and a greater subsequent decrease (P < 0.001). During the median follow‐up of 1331 days (interquartile range: 632‐1678), 119 (62%) patients died. BNP showed a time‐dependent association with all‐cause mortality both in a univariable (hazards ratio [HR] 1.24, 95% confidence interval [CI]: 1.04‐1.47, P = 0.017), and in a multivariable model with Society of Thoracic Surgeons score and baseline BNP forced into the analysis (HR 1.32, 95% CI: 1.001‐1.73, P = 0.049). Elevated BNP was associated with a larger LV end‐diastolic volume index (P < 0.001) and shorter 6‐minute walk test distance (P = 0.013) throughout follow‐up.ConclusionIn patients with AS, BNP was associated with LV remodeling phenotypes and functional status before and after TAVR. Elevated BNP levels were associated with poor prognosis.

Echocardiographic and Hemodynamic Parameters Associated with Diminishing Renal Filtration among Patients with Heart Failure with Preserved Ejection Fraction

Background: Renal dysfunction is an important predictor of poor outcomes in patients with heart failure with preserved ejection fraction (HFpEF). Right ventricular (RV) dysfunction is implicated as one of the explanations for worsening renal function in cardiorenal syndrome. Novel right heart catheterization (RHC) parameters such as pulmonary artery pulsatility index (PAPi) and right atrial to pulmonary capillary wedge pressure ratio (RA:PCWP) have been found as predictors of RV dysfunction. However, most studies investigating these parameters have been done in the setting of myocardial infarction or left ventricular assist device implantation, with limited data on these metrics in patients with HFpEF. Objective: The purpose of this study was to determine whether novel RHC parameters such as RA:PCWP and PAPi correlate with long-term renal outcomes among patients with HFpEF. Methods: A retrospective single-center study of adult patients with a documented diagnosis of heart failure who had RHC was performed between January 2006 and December 2010 at Einstein Med ical Center Philadelphia. Selected patients also had a serum B-type natriuretic peptide level ≥100 pg/mL and a PCWP ≥15 mm Hg. Patients with an ejection fraction < 50%, including those with recovered ejection fraction, and end-stage renal disease were excluded. Results: A total of 81 patients with a clinical diagnosis of HFpEF were identified who met the inclusion criteria. On multivariate analysis, after adjusting for age, sex, race, diabetes, hypertension, and cardiac index, PAPi was associated with long-term estimated glomerular filtration rate (eGFR) (β = 3.43, 95% CI = 0.635–6.23, p = 0.017), and RA:PCWP showed a trend towards significance (β = 14.81, 95% CI = –0.096–29.73, p = 0.051). The results were unchanged after further adjustment for eGFR at the time of RHC. Conclusion: Novel hemodynamic indices obtained by RHC may have predictive value for long-term renal dysfunction in patients with HFpEF.

Evaluation of Brain Natriuretic Peptide, Tumor Necrosis Factor and Interleukin-6 Plasma Levels in Infants and Children with Congenital Heart Disease

Background Congenital heart disease (CHD) is the most common cause of major congenital birth defect. The aim of this study was to investigate the association of CHD with serum levels of Tumor necrosis factor-α (TNFα), Interleukin 6 (IL-6), and B-type Natriuretic Peptide (BNP) in infant and children. Materials and Methods The present study was conducted in Heshmat heart hospital and 17 Shahrivar hospital Rasht city, Iran. In 50 children, 25 with CHD and 25 age and sex-matched healthy children (were selected from companions or patients without heart disease), 3 ml vein blood samples of right hand were taken by a trained nurse and samples were sent to a private laboratory. After separation, the plasma placed at temperature of -20 °c. ELISA kits used for measuring BNP and eBioscience Bender MedSystems GmbH kit for measuring IL-6 and TNF-α. The results were entered into SPSS software (version 20.0). Results Serum levels of TNF-α and IL-6 and BNP in the healthy and patient groups were evaluated and by comparing results of the two groups there was no significant difference in serum levels of TNF-α and IL-6, but the serum levels of BNP has significant difference between two groups (80.7 ± 52.5 pg/ml vs. 455.4 ± 550.4 pg/ml, P=0.003). There was no significant relationship between BNP changes with changes in serum TNF-α, IL-6 levels. Conclusion Our study provided conclusive evidence BNP level is elevated in children with CHD; and significant relationship was observed between incidents of CHD respect to changes in serum BNP level.

Gender Differences Among Patients With Acute Pulmonary Embolism

Gender differences in patients with acute pulmonary embolism (APE) remain unclear and controversial. We aimed to understand the gender differences in patients with APE treated in the cardiovascular care units. The registry database of 1,428 patients with APE treated at the Tokyo cardiovascular care unit Network institutions from 2010 to 2014 was retrieved for analysis. In all, 795 women (55.7%) and 633 men (44.3%) were included in this study. The women were older than men (68.0 ± 16.1 vs 60.9 ± 15.6 years, p < 0.0001). Compared with men, women had more complaints of dyspnea and disturbed consciousness, lesser complaints of leg symptoms, and chest pain. Pulmonary arterial systolic pressure (51.5 ± 22.2 mm Hg vs 47.4 ± 22.4 mm Hg, p = 0.012) and the serum B-type natriuretic peptide level (180.4 [50.7 to 526.1] pg/ml vs 107.0 [25.0 to 306.8] pg/ml, p < 0.0001) on admission, was higher in women than in men. Severe cases with massive embolism were seen more in women compared with men (14.6% vs 9.2%, p = 0.0002). The use of inferior vena cava filters were lower in women than in men (31.9% vs 37.3%, p = 0.029). Furthermore, 30-day PE-related mortality was higher in women than in men significantly (5.0% vs 2.8%, p = 0.043). In conclusion, women APE patients were older with higher severity than men APE patients, resulting in poor prognosis.

Prognostic significance of ventricular late potentials in patients with pulmonary sarcoidosis

Early detection of cardiac involvement in sarcoidosis is difficult but essential to achieve optimal treatment. Signal-averaged electrocardiography (SAECG) can detect subtle cardiac electrical abnormalities termed late potentials (LPs) and would be useful for the early diagnosis of cardiac involvement. This study aims to investigate the prognostic significance of LP in patients with pulmonary sarcoidosis. We prospectively studied 74 patients with pulmonary sarcoidosis without overt electrocardiographic abnormalities. All participants underwent SAECG, cardiac echocardiography, and 24-hour ambulatory Holter monitoring. Serum angiotensin-converting enzyme and B-type natriuretic peptide levels were also evaluated. We followed these patients for the evaluation of incidence of cardiac events including cardiac death, arrhythmias, and heart failure requiring hospital admission. Of the studied population, 29 patients (39.2%) had detectable LP. During a mean follow-up period of 9.8 years, 8 patients with LPs had cardiovascular events, including development of complete atrioventricular block (n = 4), ventricular tachycardia (n = 2), and heart failure (n = 2). Meanwhile, only 1 of 45 patients without LP developed cardiac event (heart failure). Multivariate analyses revealed that LPs were associated with an increased risk of developing cardiac events (hazard ratio 9.66; 95% confidence interval 1.20-78.01; P = .033) whereas age, sex, serum angiotensin-converting enzyme and B-type natriuretic peptide levels, number of premature ventricular contractions on 24-hour Holter monitoring, and echocardiographic parameters were not associated with subsequent cardiac events. SAECG might possibly be useful for the early detection of cardiac sarcoidosis and, if independently validated, could eventually be considered as a screening test for further risk stratification.

Effects of anthracycline, cyclophosphamide and taxane chemotherapy on QTc measurements in patients with breast cancer.

AimAcute and subacute cardiotoxicity are characterized by prolongation of the corrected QT interval (QTc) and other measures derived from the QTc interval, such as QTc dispersion (QTdc) and transmural dispersion of repolarization (DTpTe). Although anthracyclines prolong the QTc interval, it is unclear whether breast cancer patients who undergo the ACT chemotherapy regimen of anthracycline (doxorubicin: A), cyclophosphamide (C) and taxane (T) may present with QTc, QTdc and DTpTe prolongation.MethodsTwenty-three consecutive patients with breast cancer were followed prospectively during ACT chemotherapy and were analyzed according to their QT measurements. QTc, QTdc and DTpTe measurements were determined by a 12-lead electrocardiogram (EKG) prior to chemotherapy (baseline), immediately after the first phase of anthracycline and cyclophosphamide (AC) treatment, and immediately after T treatment. Serum troponin and B-type natriuretic peptide (BNP) levels were also measured.ResultsCompared to baseline values, the QTc interval was significantly prolonged after the AC phase (439.7 ± 33.2 ms vs. 472.5 ± 36.3 ms, p = 0.001) and after T treatment (439.7 ± 33.2 ms vs. 467.9 ± 42.6 ms, p < 0.001). Troponin levels were elevated after the AC phase (23.0 pg/mL [min-max: 6.0–85.0] vs. 6.0 pg/mL [min-max: 6.0–22.0], p < 0.001) and after T treatment (25.0 pg/mL [min-max: 6.0–80.0] vs. 6.0 pg/mL [min-max: 6.0–22.0], p < 0.001) compared to baseline values.ConclusionIn this prospective study of patients with non-metastatic breast cancer who underwent ACT chemotherapy, significant QTc prolongation and an elevation in serum troponin levels were observed.

Changes in red blood cell volume during transition of heart failure status: a reflection of cellular hydration status?

This study examined how changes in heart failure (HF) status induce changes in the index of erythrocyte hydration based on mean red blood cell volume (MCV). Data from 47 HF patients (32% men; 78.2 ± 9.7 years) that experienced worsening and recovery of HF were analysed. Blood tests included measurements of MCV, albumin, serum solutes and b-type natriuretic peptide (BNP). Among a total of 47 worsening HF events, changes in MCV were positively correlated with changes in body weight (r = 0.31, p = .034), serum sodium (r = 0.417, p = .0036), and chloride (r = 0.457, p = .0012), and negatively correlated with changes in blood urea nitrogen (r= −0.389, p = .0069) and creatinine (r= −0.494, p = .0004). At recovery from worsening of HF by conventional diuretic therapy, change in MCV was positively correlated with the change in body weight (r = 0.457, p = .0012), serum sodium (r = 0.466, p = .001) and chloride (r = 0.484, p = .0006). Multivariate regression analysis demonstrated an independent association between the increase in serum chloride and MCV from stability to worsening of HF (odds ratio [OR] 6.02, 95% confidence interval [CI] 1.09–33.2, p = .039) and the increase or absence of change in serum chloride concentration and preserved MCV after decongestion (OR 11.5, 95% CI 1.53–85.9, p = .017). In conclusion, this study demonstrates that the changes in MCV under transition in HF status do not reflect a change that occurs in parallel with changes in HF-related markers, such as body weight and serum BNP level, but is independently associated with a change in the serum chloride concentration. Whether changes in MCV actually reflect the bodily cellular hydration status warrants further research.

Serum nitric oxide level correlates with serum brain natriuretic peptide and whole blood viscosity in hemodialysis patients

BackgroundNitric oxide (NO) is tonically synthesized by the vascular endothelium and known as a marker of vasodilatation and blood flow. As NO has a critical role in hemodynamics, NO may be associated with other hemodynamics-related factors including atrial natriuretic peptide (ANP), B-type natriuretic peptide (BNP) and whole blood viscosity (WBV). It has been reported that serum NO level increased in patients undergoing hemodialysis. However, there are few reports about the relationship between NO and hemodynamic parameters in hemodialysis patients. ObjectiveWe investigated the associations between serum levels of NO and other hemodynamics-related factors such as ANP, BNP and WBV in patients with hemodialysis. MethodsNO, ANP, and BNP levels before hemodialysis were measured using ELISA method. We measured WBV in pre- and post-dialysis. ResultsMean serum levels of NO, ANP, and BNP were 13.97 ± 10.34 μg/mL, 198.85 ± 61.56 pg/mL, and 1233.32 ± 280.81 pg/mL, respectively in patients with hemodialysis. The mean WBV values at shear rates of 1, 5, and 300 s−1 for pre-dialyses were 168.5 ± 62.5, 76.9 ± 20.6, and 33.3 ± 3.8 mP, respectively. Serum NO level was positively correlated with WBV at shear rates of 1, 5, and 300 s−1 at pre- and post-hemodialysis. There is a correlation between serum nitrite levels and the change of SBV during hemodialysis. Serum nitrite levels correlated with the serum BNP levels. ANP levels have a negative correlation with pre-dialytic WBV. However, BNP levels did not correlate with WBV during hemodialysis. ConclusionsWBV is linked to an imbalance in serum vasoactive substances in hemodialysis patients and can cause significant hemodynamic disturbance.

Correlation between B-Type Natriuretic Peptide and N-Terminal pro-B-Type Natriuretic Peptide in a Large Japanese Population at Risk of Stage A Heart Failure

Background: The measurements of B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) are useful for ruling out heart failure and as prognostic markers in not only heart failure populations but also general populations. It is not clear whether these two biomarkers are elevated in parallel or associated with demographic characteristics in large populations at risk of stage A heart failure. Here we investigated the relationship between BNP and NT-proBNP and extended the evaluation of this association to known demographic disparities in stage A heart failure. Methods: Of 4,310 ambulatory patients, we analyzed the cases of the 3,643 (mean age 65 ± 11 years, 46% male, and 79% on antihypertensive medication) patients whose serum BNP and NT-proBNP levels were both measured and who had a history of and/or risk factors for cardiovascular disease from the Japan Morning Surge-Home Blood Pressure (J-HOP) Study dataset. Results: The median (25th–75th percentiles) BNP and NT-proBNP values were 18.7 (9.3–38.5) pg/mL and 50.3 (25.5–97.4) pg/mL. There was a significant association between log-transformed BNP and log-transformed NT-proBNP (r = 818, p < 0.001). A multiple linear regression analysis showed that log-transformed NT-proBNP was significantly associated with log-transformed BNP (beta coefficient = 0.774, p < 0.001). When stratified by demographic characteristics, these associations remained (all p < 0.001). Conclusion: In a large Japanese population at risk of stage A heart failure, there was a significant association between BNP and NT-proBNP after adjustment and stratification by demographics.

The effects of the changes with serum ferritin, high sensitive C-reactive protein, troponin, B-type natriuretic peptide and low density lipoprotein in patients with acute myocardial infarction after percutaneous coronary intervention

Objective To investigate the relationships between the serum ferritin(SF), high sensitive C-reactive protein (hsCRP), troponin T(TnT), B-type natriuretic peptide(BNP), low density lipoprotein(LDL) and the acute myocardial ischemia/reperfusion injury(MI/RI). Methods The acute myocardial infarction(AMI) patients were divided into two groups based on the symptom duration: 60 emergency intervention operation patients, 60 selective operation patients and 60 normal control patients. The levels of SF, hsCRP, TnT, BNP, LDL and the ST-segment resolution(sumSTR) of all the AMI patients were detected at the time of admission and postoperative 24 h, the difference of the two groups were analyzed. Results At the time of admission, the levels of SF, BNP, hsCRP and TnT on the two groups were higher than the normal range, and the level of LDL was lower than the normal range, the difference was statistically significant(P 0.05). At postoperative 24 h, the levels of SF, BNP, LDL, hsCRP and TnT on the emergency intervention operation group were higher than the selective operation group, the difference was statistically significant (P<0.05). Conclusions After emergency intervention, the serum levels of SF, hsCRP, TnT, BNP and LDL in MI/RI were significantly different, all indicators have important significance for evaluating severity of MI/RI and preventing possible relapse. Key words: Myocardial ischemia/reperfusion injury; Serum ferritin; High sensitive C-reactive protein; Troponin T; B-type natriuretic peptide; Low density lipoprotein

B-type brain natriuretic peptide as a measure of the severity of hand-foot-mouth disease: a case-control study

BackgroundHand-foot-mouth disease (HFMD) is an acute infectious disease caused by enteroviruses, and HFMD complicated by cardiopulmonary failure has a high mortality. B type natriuretic peptide (BNP) is widely applied in monitoring cardiovascular disorders, and thus, we investigated whether this index was associated with the severity of HFMD and the outcome in severe HFMD.MethodsSerum BNP, lactate, and glucose levels as well as white blood cell (WBC) count, PaO2/FiO2, and cardiac output (CO) were analyzed in the 83 enrolled HFMD patients according to different conditions (common, severe, and critical; with and without complication; and survivors and non-survivors). The control group consisted of 29 patients with respiratory tract infections.ResultsNo significant differences in CO were observed between the groups. Serum lactate, glucose, BNP, and WBC levels in the critical group were significantly higher than those in the severe, common, and control groups (p < 0.01 or 0.05). The PaO2/FiO2 ratio was significantly lower in the critical group (214.286 ± 154.346) than in the other groups. According to logistic regression analysis, the areas under the curve for serum BNP, glucose, and PaO2/FiO2 of the patients with complications were 0.774, 0.738, and 0.75, respectively. Moreover, the BNP level was significantly higher in HFMD patients with complications and non-survivors.ConclusionOur findings indicate that BNP could be a biochemical indicator for severe (critical) HFMD and used for prognosis in terms of complications and death. Combined with Glu and PaO2/FiO2 and clinical symptoms of HFMD, the value of BNP as an indicator became more precise and specific. Our results may provide another valuable, objective biochemical indicator for severe HFMD.Trial registration numberChiCTR-DDT-14004576. Name of registry: Chinese Clinical Trial Registry. Date of registration: 2014–09-21.

Effects of Simvastatin on myocardial apoptosis and oxidative stress mechanism in immature rabbits with chronic heart failure

Objective To observe the effects of Simvastatin on myocardial apoptosis and oxidative stress mechanism in immature rabbits with chronic heart failure. Methods Thirty-six male New Zealand big-eared immature rabbits were randomly divided into 3 groups: Adriamycin(ADR)+ Simvastatin group(ADR-s group, n=12), in which ADR(1.5 mg/kg) received injection via the auricular vein of rabbits weekly, and the rabbits received oral Sim-vastatin [1.5 mg/(kg·d)] simultaneously for 12 weeks; ADR group(n=12), in which the rabbits received ADR like ADR-S group, and 9 g/L saline instead of Simvastatin; control group (CON group, n=12), which received the same amount of 9 g/L saline.Echocardiography examination was performed in 13th week.Myocardial fibrosis degree was detected by using MASSON staining, and the myocardial apoptosis was detected by using terminal deoxynucleotidyl transferase dUTP nick end labeling.Colorimetric method was used to detect the myocardial concentration superoxide dismutase (SOD) and malondialdehyde (MDA). Enzyme-linked immunosorbent assay was used to detect serum B-type brain natriuretic peptide (BNP) level. Results (1) In CON group, the immature rabbits were all alive.Four rabbits died in ADR group, and the survival rate was 66.7%, while 2 rabbits died in ADR-s group, and the survival rate was 83.3%.(2)Compared with CON group, the left ventricular end diastolic diameter (LVEDd) and left ventricular end systolic diameter (LVESd) in ADR-s group and ADR group increased [(11.90±1.09) mm, (11.34±0.92) mm vs.(10.73±0.48) mm; (9.80±0.88) mm, (8.47±1.23) mm vs.(7.31±0.36) mm]; left ventricular fractional shortening(LVFS) and left ventricular ejection fraction(LVEF) decreased [(17.65±1.70)%, (22.58±2.19)% vs.(31.79±2.58)%; (41.35±3.19)%, (49.17±3.53)% vs.(64.34±3.97)%], and all the differences were significant(all P<0.05); LVEDd and LVESd in ADR-s group were lower than those of ADR group, while LVEF and LVFS in ADR-s group were higher than those of ADR group, and the differences were significant(all P<0.05). (3) MASSON staining: compared with ADR group, there was less myocardial cell hyperplasia of fibrous tissue in ADR-s group.(4)Compared with CON group, the apoptosis index was higher in ADR and ADR-s group[(34.25±11.13)%, (24.00±6.85)% vs.(16.58±5.34)%], but ADR-s group had less than ADR group, and the diffe-rences were significant (all P<0.05). (5) Compared with ADR group, SOD activity of ADR-s group was higher[(13.40±2.68) kU/L vs.(10.66±2.99) kU/L], but MDA content was lower[(5.67±1.36) μmol/mg vs.(7.08±0.98) μmol/mg], and the differences were significant (all P<0.05). (6) Serum BNP level in ADR group and ADR-s group was higher than that of the CON group[(33.28±9.58) μg/L, (26.71±6.72) μg/L vs.(13.56±2.82) μg/L], while was higher in ADR group than that of ADR-s group, and the differences were significant (all P<0.05). Conclusions Simvastatin can protect cardiac function of immature rabbits with chronic heart failure.The possible mechanism may be the up-regulation of myocardial SOD activity, reduction of cell lipid peroxidation and inhibition of myocardial apoptosis. Key words: Simvastatin; Adriamycin; Chronic heart failure; Myocardial apoptosis; Oxidative stress

In-hospital and long-term outcomes of congestive heart failure: Predictive value of B-type and amino-terminal pro-B-type natriuretic peptides and their ratio.

Relative changes in B-type natriuretic peptide (BNP) and amino terminal pro-BNP (NT-proBNP) levels may help to assess the risk of congestive heart failure (CHF). However, whether these levels at the time of admission enable the prediction of outcomes with acute exacerbation remains unknown. The current study determined the abilities of BNP, NT-proBNP and their ratio to predict in-hospital and long-term outcomes of patients with CHF. Patients who were admitted to the cardiac care unit of Juntendo University Hospital (Tokyo, Japan) with acute CHF onset were consecutively enrolled into the present observational study. Serum levels of BNP and NT-proBNP were immediately measured on admission, and other biomarkers and clinical data were also investigated. Of 195 enrolled patients, 16 (8.2%) succumbed to CHF in hospital and 124 (69.3%) reached the endpoint of mortality or readmission following a median follow-up of 14 months. Multiple linear regression analysis revealed body mass index, low density lipoprotein cholesterol, hemoglobin, estimated glomerular filtration rate and C-reactive protein as independent predictors of the NT-proBNP/BNP ratio. BNP, NT-proBNP and their ratio were significantly higher among those who succumbed to CHF than in those who remained alive in hospital (P<0.05). Logistic regression analysis indicated that the ratio was an independent predictor for in-hospital mortality and long-term outcomes. In conclusion, the ratio of NT-proBNP to BNP more effectively predicts in-hospital outcomes than either factor alone and it may also help to predict outcomes among patients with acute exacerbation of HF.

Assessment of left ventricular function with tissue Doppler echocardiography and of B-type natriuretic peptide levels in patients undergoing transcatheter aortic valve implantation

IntroductionTranscatheter aortic valve implantation (TAVI) is an emerging minimally invasive treatment modality in high surgical risk or inoperable patients. AimThe aim of this study was to ascertain the effect of TAVI on left ventricular (LV) systolic and diastolic function and serum B-type natriuretic peptide (BNP) levels in high surgical risk or inoperable patients with severe aortic stenosis. MethodsFifty-five patients were included in our retrospective study. LV systolic and diastolic function was assessed with conventional and tissue Doppler imaging (TDI) prior to and after TAVI. Additionally, BNP was measured 24 h before and three months after the procedure. Echocardiographic controls were performed at one, three and six months and one year and mean values were taken. At the end of the study, LV systolic and diastolic function, serum BNP levels and New York Heart Association functional capacity were assessed and compared to baseline parameters. ResultsThe TAVI procedure was successful in all patients. In-hospital mortality was 1.8% (one patient). There was a substantial improvement in LV function and functional capacity at follow-up. In addition, a statistically significant decrease was detected in serum BNP levels post-TAVI (median 380 pg/ml [176.6-929.3] vs. 215 pg/ml [96.0-383.0], p=0.0001). Only one patient required a permanent pacemaker (1.8%) and there was no mortality after TAVI during follow-up. There were significant increases in LV ejection fraction and aortic valve area (51.0±13.1% vs. 58.4±9.1%, p<0.001, and 0.6±0.1 cm2 vs. 2.1±0.2 cm2, p=0.0001, respectively). At the end of the study, conventional Doppler echocardiography revealed improvement in diastolic function, with an increase in mitral E wave, a decrease in mitral A wave and an increase in E/A ratio. Deceleration time and isovolumetric relaxation time were shortened and myocardial performance (Tei) index decreased. TDI showed an increase in systolic myocardial velocity (Sm) and early diastolic velocity (Em). Septal mitral annular Sm and Em were increased, whereas MPI was reduced. ConclusionWe found that LV structural changes and diastolic dysfunction occur in patients with severe aortic stenosis and that TAVI is able to reverse these abnormalities, which we demonstrated by both conventional echocardiography and TDI. In addition, serum BNP levels were decreased after TAVI.

Assessment of left ventricular function with tissue Doppler echocardiography and of B-type natriuretic peptide levels in patients undergoing transcatheter aortic valve implantation

IntroductionTranscatheter aortic valve implantation (TAVI) is an emerging minimally invasive treatment modality in high surgical risk or inoperable patients. AimThe aim of this study was to ascertain the effect of TAVI on left ventricular (LV) systolic and diastolic function and serum B-type natriuretic peptide (BNP) levels in high surgical risk or inoperable patients with severe aortic stenosis. MethodsFifty-five patients were included in our retrospective study. LV systolic and diastolic function was assessed with conventional and tissue Doppler imaging (TDI) prior to and after TAVI. Additionally, BNP was measured 24 h before and three months after the procedure. Echocardiographic controls were performed at one, three and six months and one year and mean values were taken. At the end of the study, LV systolic and diastolic function, serum BNP levels and New York Heart Association functional capacity were assessed and compared to baseline parameters. ResultsThe TAVI procedure was successful in all patients. In-hospital mortality was 1.8% (one patient). There was a substantial improvement in LV function and functional capacity at follow-up. In addition, a statistically significant decrease was detected in serum BNP levels post-TAVI (median 380 pg/ml [176.6-929.3] vs. 215 pg/ml [96.0-383.0], p=0.0001). Only one patient required a permanent pacemaker (1.8%) and there was no mortality after TAVI during follow-up. There were significant increases in LV ejection fraction and aortic valve area (51.0±13.1% vs. 58.4±9.1%, p<0.001, and 0.6±0.1 cm2 vs. 2.1±0.2 cm2, p=0.0001, respectively). At the end of the study, conventional Doppler echocardiography revealed improvement in diastolic function, with an increase in mitral E wave, a decrease in mitral A wave and an increase in E/A ratio. Deceleration time and isovolumetric relaxation time were shortened and myocardial performance (Tei) index decreased. TDI showed an increase in systolic myocardial velocity (Sm) and early diastolic velocity (Em). Septal mitral annular Sm and Em were increased, whereas MPI was reduced. ConclusionWe found that LV structural changes and diastolic dysfunction occur in patients with severe aortic stenosis and that TAVI is able to reverse these abnormalities, which we demonstrated by both conventional echocardiography and TDI. In addition, serum BNP levels were decreased after TAVI.

Study on the diagnostic and treatment value of serum B-type natriuretic peptide levels for the chronic heart failure and its correlation with cardiac function classification

Objective To explore the diagnostic and treatment value of serum B-type natriuretic peptide(BNP) levels for the chronic heart failure and its correlation with cardiac function classification. Methods 155 patients with heart failure were selected as treatment group.According to cardiac function, grade Ⅱ in 48 cases, grade Ⅲ in 56 cases, grade Ⅳ in 51 cases.122 healthy people during the same period were selected as the control group.Retrospectively detected serum BNP levels of the subjects, and the BNP levels of the treatment group were detected before and after treatment, and its correlation with heart function was analyzed. Results The serum BNP level of the treatment group was (738.67±61.32)pg/mL, which was higher than (22.36±21.89)pg/mL of the control group, the difference was statistically significant (t=19.38, P<0.05). The serum BNP level of the treatment group after treatment was (329.58±90.74)pg/mL, which was lower than (738.67±161.32)pg/mL of the control group, the difference was statistically significant(t=19.38, P<0.05). The serum BNP levels of grade Ⅱ, grade Ⅲ and grade Ⅳ patients after treatment compared with pre-treatment, the differences were statistically significant(t=13.65, 15.18, 17.39, all P<0.05), from pre-treatment to pro-treatment, the serum BNP levels were gradually increased with increased grade, the differences were statistically significant (t=10.61, 21.33, 11.06, 16.40, all P<0.05). Conclusion The serum BNP level of chronic heart failure patients significantly increases, and it increases with the increase of cardiac function classification, and shows correlation.As the objective indicators of chronic heart failure, it has better clinical diagnosis value and treatment and prognostic significance. Key words: Heart Failure; Natriuretic Peptide, Brain; Heart Function Tests

Association of B-type natriuretic peptide with coronary plaque subtypes detected by coronary computed tomography angiography in patients with stable chest pain.

Increased B-type natriuretic peptide (BNP) level has been suggested to improve clinical predictions of coronary events and all-cause mortality. We aimed to analyze the relationship between BNP levels and coronary plaque subtypes as detected by coronary computed tomography angiography (CCTA). 402 subjects undergoing CCTA were enrolled. The relationship between increased levels of BNP and plaque subtypes was tested using multivariable linear and logistic regression analysis. Plaques were categorized into subtypes of calcified, mixed and non-calcified. Coronary plaque was observed in 93 of 402 individuals. The participants were divided into three groups according to their serum BNP levels. Compared to those with low BNP level, subgroup with high BNP level had increased prevalence of all plaque types and mixed calcified arterial plaque (MCAP). Multivariable logistic regression analysis suggested increased BNP level predicted the MCAP. Multivariable logistic regression analysis between the presence of ≥2 plaques and BNP indicated that, subgroup with high BNP level was more likely to have MCAP than low BNP level. Our study suggests that increased BNP level is associated with MCAP detected by CCTA. Increased BNP level provides additional information about coronary artery disease in patients with stable chest pain detected by CCTA.