B-type Natriuretic Peptide Values Research Articles

B-type natriuretic peptide and plasma hemoglobin levels following transfusion of shorter-storage versus longer-storage red blood cells: Results from the TOTAL randomized trial

Prior studies have suggested that transfusion of stored red blood cells (RBCs) with increased levels of cell-free hemoglobin might reduce the bioavailability of recipient nitric oxide (NO) and cause myocardial strain. Ugandan children (ages 6-60 months) with severe anemia and lactic acidosis were randomly assigned to receive RBCs stored 1-10 days versus 25-35 days. B-type natriuretic peptide (BNP), vital signs, renal function test results, and plasma hemoglobin were measured. Most children had either malaria or sickle cell disease and were thus at risk for reduced NO bioavailability. Seventy patients received RBCs stored 1-10 days, and 77 received RBCs stored 25-35 days. The median (interquartile range) cell-free hemoglobin was nearly 3 times higher in longer-storage RBCs (26.4 [15.5-43.4] μmol/L) than in shorter-storage RBCs (10.8 [7.8-18.6] μmol/L), P < .0001. Median (interquartile range) BNP 2 hours posttransfusion was 156 (59-650) pg/mL (shorter storage) versus 158 (59-425) pg/mL (longer storage), P = .76. BNP values 22 hours posttransfusion were 110 (46-337) pg/mL (shorter storage) versus 96 (49-310) pg/mL (longer storage), P = .76. Changes in BNP within individuals from pretransfusion to 2 hours (or 22 hours) posttransfusion were not significantly different between the study groups. BNP change following transfusion did not correlate with the concentration of cell-free hemoglobin in the RBC supernatant. Blood pressure, blood urea nitrogen, creatinine, and change in plasma hemoglobin were not significantly different in the 2 groups. In a randomized trial among children at risk for reduced NO bioavailability, we found that BNP, blood pressure, creatinine, and plasma hemoglobin were not higher in patients receiving RBCs stored for 25-35 versus 1-10 days.

Plasma B-type natriuretic peptide levels are poorly related to the occurrence of ischemia or ventricular arrhythmias during symptom-limited exercise in low-risk patients.

IntroductionThe usefulness of B-type natriuretic peptide (BNP) as a marker of ischemia is controversial. BNP levels have predicted arrhythmias in various settings, but it is unknown whether they are related to exercise-induced ischemic ventricular arrhythmias.Material and methodsWe analyzed in 63 patients (64 ±14 years, 65% male, 62% with known coronary disease) undergoing exercise stress single-photon emission computed tomography (SPECT) the association between plasma BNP values (before and 15 min after exercise) and the occurrence of ischemia or ventricular arrhythmias during the test.ResultsExercise test (8.1 ±2.7 min, 7.4 ±8.1 metabolic equivalents, 82 ±12% of maximal predicted heart rate) induced reversible perfusion defects in 23 (36%) patients. Eight (13%) patients presented significant arrhythmias (≥ 7 ventricular premature complexes/min, couplets, or non-sustained ventricular tachycardia during exercise or in the first minute of recovery). Median baseline BNP levels were 17.5 (12.4–66.4) pg/ml in patients developing scintigraphic ischemia and 45.6 (13.2–107.4) pg/ml in those without ischemia (p = 0.137). The BNP levels increased after exercise (34.4 (15.3–65.4)% increment over baseline, p < 0.001), but the magnitude of this increase was not related to SPECT positivity (35.7 (18.8–65.4)% vs. 27.9 (5.6–64.0)% in patients with and without ischemia, respectively, p = 0.304). No significant association was found between BNP values (at baseline or their change during the test) and ventricular arrhythmias.ConclusionsPlasma BNP values – at baseline or after exercise – were not associated with myocardial ischemia or with ventricular arrhythmia during exercise SPECT. These results highlight the limited usefulness of this biomarker to assess acute ischemia.

Gestational and postnatal age influence B-type natriuretic peptide level used in diagnosis of a hemodynamically significant patent ductus arteriosus in preterm infants

Objective: To determine a cutoff value for B-type natriuretic peptide (BNP) level above which suggests a hemodynamically significant patent ductus arteriosus (hsPDA) and evaluate whether gestational age influences BNP production. Subjects and Methods: This was a prospective, observational study on infants of 24 0/7-31 6/7 weeks gestation. Up to 5 BNP levels were drawn within the first 2 weeks of life. An echocardiogram was done within the first 5 days in conjunction with the second BNP level. A patent ductus arteriosus (PDA) was graded as no, nonsignificant, or hemodynamically significant. Kruskal-Wallis test and Mann-Whitney U-test were used for statistical analyses. Result: There were 135 BNP-echocardiogram pairs in 95 patients. BNP levels were significantly different between PDA groups, P < 0.0001. Based on our receiver operating characteristic curve, a BNP level of 276 pg/ml or above on the day of life (DOL) 5 was suggestive of an hsPDA. Gestational age had a significant effect on BNP production. Conclusion: A cutoff BNP level of 276 pg/ml on DOL 5 is suggestive of an hsPDA in preterm infants of <32 weeks gestation. Gestational age has a significant impact on the ability of a preterm infant to produce BNP in response to an hsPDA, and therefore, different cutoff values based on gestational age may be appropriate.

Change of Serum BNP Between Admission and Discharge After Acute Decompensated Heart Failure Is a Better Predictor of 6-Month All-Cause Mortality Than the Single BNP Value Determined at Admission.

BackgroundB-type natriuretic peptide (BNP) is regarded as a reliable predictor of outcome in patients with acute decompensated heart failure (ADHF). However, according to some scholars, a single isolated measurement of serum BNP at the time of hospital admission would not be sufficient to provide reliable prognostic information.MethodsA retrospective study was carried out on patients hospitalized for ADHF, who had then undergone follow-up of at least 6 months, in order to see if there was any difference in midterm mortality among patients with rising BNP at discharge as compared to those with decreasing BNP at discharge. Medical records had to be carefully examined to divide the case records into two groups, the former characterized by an increase in BNP during hospitalization, and the latter showing a decrease in BNP from the time of admission to the time of discharge.ResultsUltimately, 177 patients were enrolled in a retrospective study. Among them, 53 patients (29.94%) had increased BNPs at the time of discharge relative to admission, whereas 124 (70.06%) exhibited decreases in serum BNP during their hospital stay. The group with patients who exhibited BNP increases at the time of discharge had higher degree of congestion evident in the higher frequency of persistent jugular venous distention (odds ratio: 3.72; P = 0.0001) and persistent orthopnea at discharge (odds ratio: 2.93; P = 0.0016). Moreover, patients with increased BNP at the time of discharge had a lower reduction in inferior vena cava maximum diameter (1.58 ± 2.2 mm vs. 6.32 ± 1.82 mm; P = 0.001 (one-way ANOVA)). In contrast, there was no significant difference in weight loss when patients with increased BNP at discharge were compared to those with no such increase. A total of 14 patients (7.9%) died during the 6-month follow-up period. Cox proportional hazard analysis revealed that BNP increase at the time of discharge was an independent predictor of 6-month all-cause mortality after adjustment for age, sodium at discharge, creatinine at discharge and New York Heart Association (NYHA) class at discharge (hazard ratio 34.49; 95% confidence intervals: 4.55 - 261.06; P = 0.001).ConclusionsAmong patients with recent ADHF, increased BNP at the time of discharge from the hospital entailed a higher grade of congestion and higher 6-month mortality.

The value of B-type natriuretic peptide as a predictor of mortality in patients with constrictive pericarditis undergoing pericardiectomy

The value of B-type natriuretic peptide as a predictor of mortality in patients with constrictive pericarditis undergoing pericardiectomy

Abstract 11462: The Clinical Significance of Pulse Pressure in Patients With Heart Failure With Preserved Ejection Fraction

Background: Although pulse pressure (PP) has been recognized as a risk factor for various cardiovascular diseases, its association with cardiovascular outcomes in patients with heart failure (HF) with preserved ejection fraction (HFpEF) remains uncertain. This study aimed to assess the relationship between PP and cardiovascular outcomes in HFpEF patients. Methods: We enrolled 317 consecutive HFpEF patients, admitted to Kumamoto University Hospital from 2007 to 2013. We measured blood pressure (BP) by using ankle brachial index (ABI) form on admission. PP values higher than 65 mmHg were defined as high-PP as reported previously. Results: PP had a significant positive correlation with pulse wave velocity (PWV) (r=0.50, p&lt;0.001), and negative correlations with estimated glomerular filtration rate (eGFR) (r=0.32, p&lt;0.001) and hemoglobin levels (r=0.27, p&lt;0.01) in HFpEF patients. In multivariate logistic-regression analysis, age, hemoglobin, eGFR and the presence of diabetes mellitus were independently associated with high-PP. PP also had strong and significant correlations with eGFR, PWV and hemoglobin level. In multivariate-Cox-proportional hazard analysis, high-PP (p=0.01), the presence of ischemic heart disease (p=0.01), and B-type natriuretic peptide (BNP) values (p=0.01) were independently associated with the occurrence of cardiovascular events (CVE). In Kaplan-Meier analysis, HFpEF patients with high-PP had a significant higher risk of CVE and HF-related events (both, log-lank test, p&lt;0.01). Multivariate-Cox-hazard analysis identified that high-PP, but not high-systolic BP (SBP), as an independent predictor of both CVE (hazard ratio [HR]: 2.15, p=0.01) and HF-related events (HR: 4.37, p&lt;0.01).We further stratified patients into four groups combined with PP and BNP values, HFpEF patients with both high-PP and high-BNP(cutoff:100pg/dL) had the highest risk of HF-related events and CVE (both, log-rank test, p&lt;0.001), indicating their usefulness in risk prediction in HFpEF patients. Conclusion: High-PP, rather than high-SBP, was closely associated with the prognosis of patients with HFpEF. PP is the useful marker for risk stratification in HFpEF.

Abstract 13459: Usefulness of B-Type Natriuretic Peptide and High-Sensitivity Cardiac Troponin for Risk Stratification in Low Flow, Low Gradient Aortic Stenosis -A Substudy of the TOPAS Study

Background: B-type natriuretic peptide (BNP) and troponin T (TNT) have been shown to be associated with outcome in several clinical conditions. However the prognostic value of these 2 biomarkers combined together remains unclear. We aimed to explore the prognostic value of combined BNP and high-sensitivity TNT (hsTNT) in patients with low flow low gradient aortic stenosis (LGLG AS). Methods: Ninety eight patients (74±10 year; 75% men) with LFLG AS (LVEF &lt;50% and/or SVi&lt;35 ml/m2, mean gradient&lt;40 mmHg, AVAi&lt;0.6 cm2/m2) were prospectively enrolled in the TOPAS study and included in this analysis. The cohort was divided into three groups according to BNP and hsTNT plasma levels: Group A, patients with BNP&lt;550 pg/mL and undetectable TNT (hsTNT&lt;0.015 ng/mL); Group B, with BNP≥550 pg/mL or hsTNT≥0.015 ng/mL and Group C, patients with BNP≥550 pg/mL and hsTNT≥0.015 ng/mL. The primary endpoint was all-cause mortality. Results: Among the 98 patients, 32 (33%) were in Group A, 39 (40%) in Group B and 24 (27%) in Group C. During a median follow up of 2.8 [IQR=1.1-4.1] years, 55 patients died. Patients in Group C were older and had lower LVEF (all p&lt;0.05). Two-year mortality was higher in Group C (41±9%) than in Group B (23±7) and Group A (5±4%) (p=0.0019). In Group B, there was no significant difference in 2-year mortality rates between the subgroup with hsTNT≥0.015 ng/mL versus that with BNP≥550 pg/mL (26±9% vs. 11±10%, respectively, p=0.21). In multivariable analysis adjusted for age, type of treatment (AVR vs. conservative), coronary artery disease and LVEF, Group C remained independently associated with increased risk of mortality (HR= 4.25; p=0.023), and Group B tended to have higher mortality (HR=3.63; p=0.058) as compared to Group A. Conclusion: The results of this study demonstrate the usefulness of combined measures of BNP and hsTNT to enhance risk stratification in patients with LFLG AS. Patients having activation of both BNP and hsTNT have a 4-fold increase risk of mortality.

Effects of ivabradine therapy on heart failure biomarkers.

Heart rate (HR) reduction is associated with improved outcomes in patients with heart failure (HF) and biomarkers can be a valuable diagnostic tool in HF management. The primary aim of our study was to evaluate the short-term (6 months) effect of ivabradine on N-terminal pro B-type natriuretic peptide (NT-proBNP), CA-125, and cystatin-C values in systolic HF outpatients, and secondary aim was to determine the relationship between baseline HR and the NT-proBNP, CA-125, cystatin-C, and clinical status variation with ivabradine therapy. Ninety-eight patients (mean age: 65.81 ± 10.20 years; 33 men), left ventricular ejection fraction < 35% with Simpson method, New York Heart Association (NYHA) class II-III, sinus rhythm and resting HR > 70/min, optimally treated before the study were included. Among them, two matched groups were formed: the ivabradine group and the control group. Patients received ivabradine with an average (range of 10-15) mg/day during 6 months of follow-up. Blood samples for NT-proBNP, CA-125, and cystatin-C were taken at baseline and at the end of a 6-month follow-up in both groups. There was a significant decrease in NYHA class in the ivabradine group (2.67 ± ± 0.47 vs. 1.85 ± 0.61, p < 0.001). When ivabradine and control groups were compared, a significant difference was also found in NHYA class 6 months later (p = 0.013). A significant decrease was found in HR in the ivabradine and control groups (84.10 ± 8.76 vs. 68.36 ± ± 8.32 bpm, p = 0.001; 84.51 ± 10 vs. 80.40 ± 8.3 bpm, p = 0.001). When both groups were compared, a significant difference was also found in HR after 6 months (p = 0.001). A significant decrease was found in cystatin-C (2.10 ± 0.73 vs. 1.50 ± 0.44 mg/L, p < 0.001), CA-125 (30.09 ± 21.08 vs. 13.22 ± 8.51 U/mL, p < 0.001), and NT-proBNP (1,353.02 ± 1,453.77 vs. 717.81 ± 834.76 pg/mL, p < 0.001) in the ivabradine group. When ivabradine and control groups were compared after 6 months, a significant decrease was found in all HF parameters (respectively; cystatin-C: p = 0.001, CA-125: p = 0.001, NT-proBNP: p = 0.001). Creatinine level was significantly decreased and glomerular filtration rate (GFR) was significantly increased in the ivabradine group (1.02 ± 0.26 vs. 0.86 ± 0.17, creatinine: p = 0.001; 79.26 ± 18.58 vs. 92.48 ± 19.88, GFR: p = 0.001). There was no significant correlation between NYHA classes (before and after ivabradine therapy) and biochemical markers, or HR. In the outpatients with systolic HF, persistent resting HF > 70/min with optimal medical therapy, the NT-proBNP, CA-125, and cystatin-C reductions were obtained with ivabradine treatment. Measurement of NT-proBNP, CA-125, and cystatin-C may prove to be useful in biomarker panels evaluating ivabradine therapy response in HF patients.

How B-Type Natriuretic Peptide (BNP) and Body Weight Changes Vary in Heart Failure With Preserved Ejection Fraction Compared With Reduced Ejection Fraction: Secondary Results of the HABIT (HF Assessment With BNP in the Home) Trial

BackgroundHeart failure is a common cause of hospitalization and can be divided into types with preserved and reduced ejection fraction (HFpEF and HFrEF, respectively). In this subanalysis of the HABIT (Heart Failure Assessment With BNP in the Home) trial, we examined the differences between home B-type natriuretic peptide (BNP) testing and weight monitoring in patients with HFpEF and with HFrEF before decompensation. Methods and ResultsThis was a retrospective review of patients with HFpEF and HFrEF from the HABIT trial. The HFpEF patients compared with HFrEF patients were older and more obese and had lower baseline BNP values. Intra-individual BNP dispersion (spread of distribution over time) was greater in HFpEF than in HFrEF owing to rapid fluctuations (within 3 days). Slowly varying changes in BNP (estimated by a moving average) were equally predictive of ADHF risk in both HFpEF and HFrEF. However, in HFpEF, a rapid rise in BNP >200 pg/mL within 3 days was associated with an increased risk of acute decompensated heart failure (ADHF; hazard ratio 4.0), whereas a similar association was not observed in HFrEF. Weight gain ≥5 lb in 3 days had a high specificity but low sensitivity for ADHF in both HFpEF and HFrEF, whereas a lower threshold of ≥2 lb weight gain over 3 days in patients with HFpEF (but not HFrEF) was a moderately sensitive cutoff associated with decompensation (60% sensitivity). ConclusionsPatients with HFpEF and HFrEF have variations in their BNP and weight before decompensation. The rapid time scale behaves differently between the groups. In those with HFpEF, a 3-day period characterized by ≥2 lb weight gain and/or >200 pg/mL BNP rise was significantly associated with decompensation. Future prospective studies investigating different weight and BNP cutoffs for home monitoring of HFpEF and HFrEF patients should be performed to fully learn the value of BNP changes before clinical deompensation.

Prognostic impact of neutrophil gelatinase-associated lipocalin and B-type natriuretic in patients with ST-elevation myocardial infarction treated by primary PCI: a prospective observational cohort study

ObjectivesNeutrophil gelatinase-associated lipocalin (NGAL) from a pathophysiological perspective connects various pathways that affect the prognosis after myocardial infarction. The objective was to evaluate the benefits of measuring NGAL for prognostic...

Assessment of acute lung injury/acute respiratory distress syndrome using B-type brain natriuretic peptide.

To investigate the clinical value of B-type natriuretic peptide (BNP) in the assessment of severity and prognosis in acute lung injury/acute respiratory distress syndrome (ALI/ARDS). Plasma BNP level, arterial blood gases, serum C-reactive protein level, alveolar-arterial oxygen tension difference and oxygenation index were measured in patients with and without ALI/ARDS within 24 h of admission to an intensive care unit. Patients with ALI/ARDS were divided into mild, moderate or severe groups according to the degree of hypoxaemia. Survival >28 days was recorded. A total of 59 patients with ALI/ARDS and 14 patients without ALI/ARDS were included in the study. Of the patients with ALI/ARDS, 18 had mild hypoxaemia, 20 had moderate hypoxaemia and 21 had severe hypoxaemia. The mean ± SD BNP level was significantly higher in all three ALI/ARDS groups (92.41 ± 28.19 pg/ml, 170.64 ± 57.34 pg/ml and 239.06 ± 59.62 pg/ml, respectively, in the mild, moderate and severe groups) than in the non-ALI/ARDS group (47.27 ± 19.63 pg/ml); the increase in BNP level with increasing severity was also statistically significant. When divided according to outcome, the BNP level in the death group (267.07 ± 45.06 pg/ml) was significantly higher than in the survival group (128.99 ± 45.42 pg/ml). The BNP level may be of value in evaluating severity and prognosis in patients with ALI/ARDS.

Serum B-Type Natriuretic Peptide is Affected by Neoplastic Edema in Patients with a Brain Tumor

A positive correlation between serum B-type natriuretic peptide levels and the amount of dislodgement of intracranial structures (mass effect) produced by brain tumors has been demonstrated previously. The aim of our prospective observational study was to evaluate a possible relationship between serum B-type natriuretic peptide levels and the amount of neoplastic edema in patients affected by brain tumor. We prospectively studied 110 patients with a supratentorial brain tumor. Serum N-terminal-pro B-type natriuretic peptide was measured and brain magnetic resonance images were analyzed to discriminate between neoplastic tissue and perilesional edema. A multivariate linear regression model predictive for serum N-terminal-pro B-type natriuretic peptide levels was generated. The radiologic diagnoses were meningioma in 45 patients (40.9%), glioma in 33 (30%), and metastasis in 32 (29.1%). A mass effect was present in 29 (26.4%) patients. Serum N-terminal-pro B-type natriuretic peptide was 125.61 ± 174.14 pg/mL (median 60 pg/mL, interquartile range 28-139 pg/mL). Four variables were entered into a multivariate linear regression model predictive for serum N-terminal-pro B-type natriuretic peptide values: age, neoplastic edema volume, metastatic lesion, and the presence of a mass effect (whole model P < 0.0001; R(2) = 0.5555; adjusted R(2) = 0.5294). Our data demonstrate that serum B-type natriuretic peptide levels are positively correlated to neoplastic brain edema in patients with a brain tumor and suggest a possible cerebral source for this phenomenon.

Effect of B-type Natriuretic Peptides on Long-Term Outcomes After Transcatheter Aortic Valve Implantation

B-type natriuretic peptide (BNP) levels are elevated in patients with aortic stenosis (AS) and decrease acutely after replacement of the stenotic valve. The long-term prognostic value of BNP after transcatheter aortic valve implantation (TAVI) and the relative prognostic utility of single versus serial peri-interventional measurements of BNP and N-terminal prohormone BNP (NT-pro-BNP) are unknown. This study sought to determine the impact of BNP levels on long-term outcomes after TAVI and to compare the utility of BNP versus NT-pro-BNP measured before and after intervention. We analyzed 340 patients with severe AS and baseline pre-TAVI assessment of BNP. In 219 patients, BNP and NT-pro-BNP were measured serially before and after intervention. Clinical outcomes over 2 years were recorded. Patients with high baseline BNP (higher tertile ≥591 pg/ml) had increased risk of all-cause mortality (adjusted hazard ratio 3.16, 95% confidence interval 1.84 to 5.42; p <0.001) and cardiovascular death at 2 years (adjusted hazard ratio 3.37, 95% confidence interval 1.78 to 6.39; p <0.001). Outcomes were most unfavorable in patients with persistently high BNP before and after intervention. Comparing the 2 biomarkers, NT-pro-BNP levels measured after TAVI showed the highest prognostic discrimination for 2-year mortality (area under the curve 0.75; p <0.01). Baseline-to-discharge reduction, but not baseline levels of BNP, was related to New York Heart Association functional improvement. In conclusion, high preintervention BNP independently predicts 2-year outcomes after TAVI, particularly when elevated levels persist after the intervention. BNP and NT-pro-BNP and their serial periprocedural changes provide complementary prognostic information for symptomatic improvement and survival.

The lymphocyte-to-monocyte ratio: An added value for death prediction in heart failure

Background and aimLeukocytes and their subpopulation have been long implicated in the progression of the syndrome of heart failure (HF), especially heart infiltration cells. Previous reports have suggested that they can predict worse outcome in patients with HF, and can also affect the function of other cells and myocardial extracellular matrix remodeling process. However, the lymphocyte-to-monocyte ratio (LMR) and its possible value as prognostic marker have not been evaluated. Methods and resultsA total of 390 patients with acute HF were recruited and followed for 6 months. Their total blood count with leukocyte differential was obtained. Two groups were formed according to the endpoints of HF death and optimal cut-off value of LMR, and were compared. A multivariate Cox-regression model was used to establish the prognostic value with the endpoints of HF and all-cause mortality. Median age of the patients was 78 years and 48.5% of them were men. No major difference was observed between the clinical characteristics of the two groups. Patients who died of HF had significantly higher values of B-type natriuretic peptide and lower values of LMR. Leukocyte and monocyte counts revealed a multivariate-adjusted risk for both endpoints, whereas relative lymphocyte counts had only significant value for all-cause mortality. The multivariate-adjusted hazard ratios for the 6-month HF and all-cause mortality in patients with LMR values < 2.0 were, respectively, 2.28 (95% CI: 1.25–4.15) and 2.39 (95% CI: 1.39–4.10). ConclusionOur results show that, upon discharge from hospital after an episode of acute HF, a lower value of LMR is independently associated with a higher risk of mortality within 6 months.

Kalp Yetersizliğinde Anemi ve B Tipi Natriüretik Peptid Düzeyinin Fiziksel Fonksiyon ile İlişkisi

Heart failure is a complex clinical condition caused by structural or functional changes affecting the dilatation and/or ejection ability of the ventricle. Anemia and B-type natriuretic peptide (BNP) levels are commonly observed conditions in heart failure, affecting quality of life, physical functioning, mortality, and morbidity. In cases with heart failure, it is important that nurses and other healthcare personnel closely monitor anemia and BNP values that are closely associated with functional capacity. This article focuses on the association between heart failure and anemia and BNP level, and its effect on physical function, considering that the results will provide guidance for nurses and healthcare professionals in patient monitoring, treatment and care planning.

8B.02

Objective: It is well known that congestive heart failure (CHF) is characterized by an increased adrenergic tone and by an impaired baroreflex sympathetic and vagal control. In recent years have been developed additional therapeutic options, baroreflex activation therapy (BAT), capable to antagonize the sympathetic overactivity. It has been reported in CHF patients a significant reduction in muscle sympathetic nerve activity (MSNA) after 6 months BAT. Whether the effects on sympathetic and clinical variables were maintained chronically is unknown. Design and method: Eleven CHF patients (NYHA class III, left ventricular ejection fraction < 40%, with optimized and stable medical therapy and no active resinchronization therapy) have been evaluated at baseline and after 6 and 24 months BAT follow-up. During each step we collected clinical parameters, HYHA class, six-minute hall walk distance (6MHW), quality of life from the Minnesota Living with Heart Failure Questionnaire score (QOL), LVEF (3D echo), B-type natriuretic peptide (BNP), estimated glomerular filtration rate (eGFR), MSNA by microneurography, and baro reflex sensitivity (variated Kienbaum's method). Results: Two patients died during long-term follow-up (pneumoniae and acute HF). In the surviving 9 the beneficial effects observed at 6 months (MSNA -28%; BRS +100%; 6MWD +22.7%; LVEF +10%; QOL +37.2%) were maintained 21.5 ± 4.2 months (MSNA -31.6%,p < 0.001; BRS +100%,p < 0.001; 6MWD +19%,p = 0.01; LVEF +2.4%,p < 0.01; QOL +42.7%p < 0.01). A slight but not significant reduction was observed in blood pressure, heart rate, BNP and eGFR values. Hospitalization was not necessary after BAT. Conclusions: BAT provides long-term reduction in sympathetic activity and improvement in baroreflex sensitivity. This is accompanied by an improvement in clinical status, quality of life and functional capacity and by a reduction in rates of hospitalization.

Kinetics of B-type natriuretic peptide plasma levels in patients with left-sided breast cancer treated with radiation therapy: Results after one-year follow-up

Purpose: To analyze temporal changes of B-type natriuretic peptide (BNP) used as index of heart remodeling in left-sided breast cancer patients after radiotherapy (RT) and its relationship with dosimetric parameters.Methods and materials: BNP and dose-volume parameters for heart and ventricle were collected in 59 patients (median age 58.0 years) during a 1-year follow-up. Biochemical measurements were performed before the RT treatment (T0), at 15 days during RT (T15day), at the end of RT (TendRT), and then at 1, 3, 6, 9, 12 months (T1, T3, T6, T9 and T12). A logistical regression analysis was performed to identify demographic characteristics, dosimetric variables and risk factors associated with increased values of BNP.Results: The ratio between the BNP value at T12 and the BNP value at T0 (BNPT12/BNPT0) increased significantly (p < 0.01). A significant association was found between the variation of BNP values after 1 year and the isodose received by 50% of the volume (D50% [Gy]) both to the heart (p = 0.03) and ventricle (p = 0.04).Conclusions: BNP plasma levels could provide additional information about subclinical RT-induced cardiotoxicity earlier than traditional ecocardiographic data.

Effect of Correction of Anemia on Echocardiographic and Clinical Parameters in Patients With Aortic Stenosis Involving a Three-Cuspid Aortic Valve and Normal Left Ventricular Ejection Fraction

The objective of the study is to investigate the impact of anemia (defined as hemoglobin concentration of <12 g/dl in women and 13 g/dl in men) on prognosis and to study the effect of recovery from anemia on echocardiographic and clinical parameters in patients with aortic stenosis (AS). This was a prospective study in 315 patients with moderate or severe AS. Patients with anemia received oral iron (ferrous sulfate with mucoproteose, 160 mg iron/day) and erythropoietin, if needed, or intravenous iron, if necessary. The following tests were performed before and after normalization of hemoglobin values: echocardiogram, 6-minute walk test, N-terminal B-type natriuretic peptide, and measures of depression, cognitive impairment, and dependence. Patient mean age was 74 years (SD 9). Mean follow-up was 25 months (SD 8). Anemia prevalence in the overall group was 22% (n = 70). Patients who are anemic had a higher rate of complications at follow-up (mortality, hospital admission, or need for valve procedure; 80% vs 62%, p = 0.009). In total, 89% of patients recovered from anemia, with a mean time to recovery of 4.6 weeks (SD 1.4). Improvements were observed on echocardiographic parameters of peak velocity (4.1 to 3.7 m/s, p = 0.02) and mean gradient (44 to 35 mm Hg, p = 0.02). Performance on the 6-minute walk test improved from 235 to 303 m (p <0.001). Median N-terminal B-type natriuretic peptide value decreased from 612 to 189 pg/dl (p <0.001). In conclusion, patients with AS and anemia have a worse prognosis than those without anemia. Resolution of anemia is associated with improvements in echocardiographic parameters and functional status, suggesting that treatment of iron deficiency is a relevant option in the management of patients with AS, particularly in nonoperable cases.

B-type natriuretic peptide response and reverse left ventricular remodeling after surgical correction of functional mitral regurgitation in patients with advanced cardiomyopathy

BackgroundRestrictive mitral annuloplasty (RMA) can reverse left ventricular (LV) remodeling and reduce plasma B-type natriuretic peptide (BNP), a surrogate biomarker of heart failure. However, the relationship between reverse LV remodeling and plasma BNP changes after RMA is poorly defined. We explored the main hemodynamic factors contributing to change in plasma BNP after RMA in patients with functional mitral regurgitation (MR). MethodsTwenty-four patients with moderate to severe functional MR secondary to LV systolic dysfunction [ejection fraction (EF) <40%] underwent 64-row multidetector computed tomography (MDCT) before and 1.4 months after RMA. LV end-diastolic volume index (EDVI), end-systolic volume index (ESVI), LVEF, and regional and global end-systolic wall stress (ESS) were calculated from 3-dimensional MDCT images, with blood samples for plasma BNP measurement collected the same day. ResultsAfter RMA, LV volumes and global ESS were decreased, while LVEF improved (all p<0.01). There were significant correlations between changes in LVEDVI and LVESVI (r=0.90, p<0.0001), LVESVI and global ESS (r=0.54, p=0.006), and global ESS and LVEF (r=−0.60, p=0.002). The median value for the plasma BNP also decreased from 597pg/ml [interquartile range (IQR), 360–934pg/ml] to 207pg/ml (IQR, 124–271pg/ml), in association with changes in LVEDVI (r=0.47, p=0.019), LVESVI (r=0.56, p=0.004), LVEF (r=−0.60, p=0.002), and global ESS (r=0.74, p<0.0001). Multivariate regression analysis showed that global ESS change was the strongest contributor to change in natural-log-transformed plasma BNP (standardized partial regression coefficient=0.59, p=0.004), indicating a strong association between decrease in LV afterload and reduction in plasma BNP level after RMA. ConclusionsThere may be a significant association between LV reverse remodeling and plasma BNP change after RMA. Furthermore, LV end-systolic myocardial stress may be the key mechanical stimulus influencing plasma BNP after surgical correction for functional MR. Whether these favorable BNP responses and reverse remodeling can predict improved survival requires further study.

B-Type Natriuretic Peptide as Prognostic Marker in Newly Diagnosed Acute Coronary Syndrome Patients

Background: B-type Natriuretic Peptide (BNP) a neurohormone synthesized in ventricular myocardium and released into the circulation in response to ventricular dilatation and pressure overload, is a current biomarker used for identifying patients at high risk of Acute Coronary Syndrome (ACS). High level of BNP is associated with an increased risk of Major Adverse Cardiac Events (MACE) including new or progressive heart failure and myocardial infarction. The objective of this study was to assess the prognosis of newly diagnosed ACS patients by using plasma BNP level. Methods: This study was conducted in the department of Biochemistry, Bangabandhu Sheikh Mujib Medical University (BSMMU) in collaboration with National Institute of Cardiovascular Disease (NICVD) from January 2013 to December 2013. Total 100 newly diagnosed ACS patients, aged 30 to 70 years, irrespective of sex who reported within 24 hours of onset of symptoms were enrolled in this study by purposive and convenient sampling. Plasma BNP level of selected study subjects was measured within 24 hours of onset of symptoms. Then subjects were grouped on the basis of their empirical cut-off value of plasma BNP concentration Group I having plasma BNP level &lt;135 pg/mL and Group II having plasma BNP level 135 pg/mL. Results: Of 100 ACS patients, 86 were male and 14 were female with the mean age 49.61±10.28 years and the age range of 30 to 70 years. Among 26 patients in Group I, good recovery, morbidity and mortality were 22 (84.6%), 4 (15.4%) and zero and among 74 patients in Group II good recovery, morbidity and mortality were 18 (24.3%), 53 (71.6%) and 3 (3.0%) respectively. Differences in outcome between groups were statistically significant (P=0.001). Above the empirical cut-off value of BNP (135 pg/mL) good prognosis was for 18 (24.3%) and bad prognosis was for 56 (75.7 %) patients and relative risk 3.48 in 95% CI (2.25-5.36). Conclusion: It can be concluded from this study that higher baseline plasma BNP concentration is associated with more adverse clinical outcomes in ACS patients. Since the baseline plasma BNP concentrations at the onset of event shows incremental prognostic value, so plasma BNP can be used clinically as a biomarker of prognosis in ACS patients.DOI: http://dx.doi.org/10.3329/cmoshmcj.v14i1.22870 Chatt Maa Shi Hosp Med Coll J; Vol.14 (1); Jan 2015; Page 1-5