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Sivri F, Icen YK, Koca H, Coşkun M, Ardınç M, Deniz O, Arici FN, Koc M, Güngör H. Selvester QRS Score is a Predictor of Mortality in Heart Failure with Preserved Ejection Fraction. Arq Bras Cardiol 2023; 120:e20230235. [PMID: 37820175 PMCID: PMC10519357 DOI: 10.36660/abc.20230235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 06/15/2023] [Accepted: 07/17/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND The Selvester QRS (S-QRS) score on a 12-lead electrocardiogram (ECG) is associated with both the amount of myocardial scar and poor prognosis in myocardial infarction patients. However, its prognostic value in heart failure (HF) with preserved ejection fraction (HFpEF) is unknown. OBJECTIVE This study aims to investigate the predictive value of the S-QRS score for mortality in HFpEF. METHODS 359 patients were retrospectively enrolled in this study. Electrocardiographic, echocardiographic, and laboratory features of the patients were recorded. The simplified S-QRS score was measured and recorded. The mean follow-up time of the patients was 38.1±9.5 months. Statistical significance was set at p < 0.05. RESULTS Of 359 patients, 270 were in the survivor group, and 89 were in the deceased group. Age, Hs-CRP, troponin, pro-BNP, left atrial (LA) diameter, LA volume index, QRS duration, Tpe, and S-QRS score were statistically high in the deceased group. In multivariate logistic regression analysis, age, Hs-CRP, NT-proBNP, LA diameter, LA volume index, Tpe, and S-QRS score were shown to be independent risk factors for mortality. In the receiver-operating characteristic (ROC) analysis, the cut-off value of the S-QRS score was 5.5, the sensitivity was 80.8%, and the specificity was 77.2% (AUC:0.880, p:0.00). In Kaplan-Meier analysis, it was found that mortality was higher in the group with S-QRS score ≥ 5.5 than in the group with S-QRS score < 5.5. (Long-rank, p:0.00). CONCLUSIONS We think that the S-QRS score can be used as a prognostic indicator of long-term mortality in patients with HFpEF.
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Affiliation(s)
- Fatih Sivri
- Nazilli State HospitalDepartment of CardiologyAydinTurquiaNazilli State Hospital – Department of Cardiology, Aydin – Turquia
| | - Yahya Kemal Icen
- Adana Health Practice and Research CenterDepartment of CardiologyAdanaTurquiaAdana Health Practice and Research Center – Department of Cardiology, Adana – Turquia
| | - Hasan Koca
- Adana Health Practice and Research CenterDepartment of CardiologyAdanaTurquiaAdana Health Practice and Research Center – Department of Cardiology, Adana – Turquia
| | - Mükremin Coşkun
- Adana Health Practice and Research CenterDepartment of CardiologyAdanaTurquiaAdana Health Practice and Research Center – Department of Cardiology, Adana – Turquia
| | - Mustafa Ardınç
- Adana Health Practice and Research CenterDepartment of CardiologyAdanaTurquiaAdana Health Practice and Research Center – Department of Cardiology, Adana – Turquia
| | - Orshan Deniz
- Adana Health Practice and Research CenterDepartment of CardiologyAdanaTurquiaAdana Health Practice and Research Center – Department of Cardiology, Adana – Turquia
| | - Fatih Necip Arici
- Adana Health Practice and Research CenterDepartment of CardiologyAdanaTurquiaAdana Health Practice and Research Center – Department of Cardiology, Adana – Turquia
| | - Mevlüt Koc
- Adana Health Practice and Research CenterDepartment of CardiologyAdanaTurquiaAdana Health Practice and Research Center – Department of Cardiology, Adana – Turquia
| | - Hasan Güngör
- Adnan Menderes UniversityDepartment of CardiologyAydinTurquiaAdnan Menderes University – Department of Cardiology, Aydin – Turquia
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Longobardo L, Zito C, D'Amico G, Ioppolo A, Terrizzi A, Oteri A, Cusmà-Piccione M. Incremental value of left atrial function analysis in the assessment of left ventricular filling pressures in patients with ST-elevation myocardial infarction. J Cardiovasc Echogr 2022; 32:76-81. [PMID: 36249433 PMCID: PMC9558643 DOI: 10.4103/jcecho.jcecho_74_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 12/14/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Left atrial (LA) reservoir strain provides interesting information about left ventricular (LV) filling pressure. However, the advantages of atrial reservoir strain in comparison with conventional parameters in patients with myocardial infarction are not clear yet. Methods: Fifty patients with ST-elevation myocardial infarction (STEMI) prospectively underwent echocardiographic assessment of LV systolic and diastolic function by conventional parameters and two-dimensional speckle tracking longitudinal strain of left atrium. LV filling pressure was estimated by brain natriuretic peptide (BNP) levels. Results: Systolic and conventional diastolic parameters did not show significant differences between patients with increased and normal BNP values, whereas LA reservoir strain was reduced (33.1 ± 8% vs. 46.5 ± 9.8%; P = 0.001) in patients with higher BNP levels. LA reservoir strain had higher area under curve value (0.880) than the other parameters in identifying patients with elevated BNP and a cut-off value of 40.5% reached sensitivity and specificity values of 93% and 86% and positive and negative predictive values of 92% and 85%. LA reservoir strain reclassified 23 patients with increased BNP values, which were previously estimated to have normal (16 patients) and undeterminable LA pressure (seven patients) by using the recommended algorithm for diastolic function. Conclusions: LA reservoir strain is a useful tool for the evaluation of diastolic function and seems to be more sensitive than conventional parameters in the detection of subtle increase of LV filling pressure in patients with STEMI. It allows physicians to reclassify patients with undeterminable diastolic function according to conventional algorithm.
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Impact of Pulse Wave Velocity and Parameters Reflecting Android Type Fat Distribution on Left Ventricular Diastolic Dysfunction in Patients with Chronic Coronary Syndromes. J Clin Med 2020; 9:jcm9123924. [PMID: 33287316 PMCID: PMC7761650 DOI: 10.3390/jcm9123924] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 11/27/2020] [Accepted: 12/01/2020] [Indexed: 01/12/2023] Open
Abstract
Background: Left ventricular diastolic dysfunction (LVDD) is caused by a decreased left ventricle relaxation and is associated with an increased risk of symptomatic heart failure (HF) and excessive mortality. Aim: To evaluate the frequency and factors related to LVDD in the population with chronic coronary syndromes (CCS). Methods: 200 patients (mean age 63.18 ± 8.12 years, 75.5% male) with CCS were included. LVDD was diagnosed based on the recent echocardiography guidelines. Results: LVDD was diagnosed in 38.5% of CCS population. From the studied factors, after adjustment for age, sex, and N-terminal pro-brain natriuretic peptide (NT-proBNP), LVDD associated positively with android/gynoid (A/G) fat mass ratio, left ventricular mass index (LVMI), and negatively with Z-score and left ventricular ejection fraction (LVEF). In stepwise backward logistic regression analysis, the strongest factors associated with LVDD were pulse wave velocity value, handgrip strength and waist to hip ratio (WHR). Conclusions: LVDD is common among CCS patients and it is associated with parameters reflecting android type fat distribution regardless of NT-proBNP and high-sensitivity troponin T concentrations. Deterioration in diastolic dysfunction is linked with increased aortic stiffness independently of age and sex. Further studies evaluating the effects of increasing physical fitness and lowering abdominal fat accumulations on LVDD in CCS patients should be considered.
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Ojji D, Libhaber E, Lamont K, Thienemann F, Sliwa K. Circulating biomarkers in the early detection of hypertensive heart disease: usefulness in the developing world. Cardiovasc Diagn Ther 2020; 10:296-304. [PMID: 32420112 DOI: 10.21037/cdt.2019.09.10] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Although the varying phenotypic spectra of hypertensive heart disease (HHD) can be assessed by electrocardiography (ECG), echocardiography and cardiovascular magnetic resonance (CMR), ECG criteria for left ventricular hypertrophy (LVH) are insensitive, while echocardiography and CMR are expensive, less readily available and often lack requisite expertise. Consequently, the use of circulating biomarkers in the diagnosis and prognostication of HHD beyond the traditional N-terminal pro- b-type natriuretic peptide (NT-proBNP) and B-type natriuretic peptide (BNP) have become an attractive alternative. We carried out a PubMed and Google Scholar databases' search of original articles on circulating biomarkers used in the diagnosis of the different spectrum of HHD over the last 10 years [2005-2015] in humans. Fourteen studies met the inclusion criteria with NT-pro BNP being the most studied circulating biomarker in HHD followed by soluble ST2 (sST2). There is a lack of data on the use of circulating biomarkers in HHD. There is a need to explore further this area of investigative cardiology.
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Affiliation(s)
- Dike Ojji
- Cardiology Unit, Department of Medicine, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Elena Libhaber
- Soweto Cardiovascular Research Unit, University of Witwatersrand, Johannesburg, South Africa
| | - Kim Lamont
- Soweto Cardiovascular Research Unit, University of Witwatersrand, Johannesburg, South Africa
| | - Friedrich Thienemann
- Hatter Institute for Cardiovascular Research in Africa, Department of Medicine and Cardiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Department of Internal Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Karen Sliwa
- Soweto Cardiovascular Research Unit, University of Witwatersrand, Johannesburg, South Africa.,Hatter Institute for Cardiovascular Research in Africa, Department of Medicine and Cardiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Duarte Vera YC, Cáceres Vinueza SV, Daher Nader JE, Lara Terán JF. Un novedoso agente en el tratamiento de la insuficiencia cardiaca con función sistólica deprimida. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2018; 88:287-297. [DOI: 10.1016/j.acmx.2018.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 01/17/2018] [Accepted: 01/22/2018] [Indexed: 10/17/2022] Open
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6
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Wu M, Yang Y, Wang M, Zeng F, Li Q, Liu W, Guo S, He M, Wang Y, Huang J, Zhou L, Li Y, Hu J, Gong W, Zhang Z. Exogenous Pancreatic Kallikrein Improves Diabetic Cardiomyopathy in Streptozotocin-Induced Diabetes. Front Pharmacol 2018; 9:855. [PMID: 30131697 PMCID: PMC6091235 DOI: 10.3389/fphar.2018.00855] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 07/16/2018] [Indexed: 12/29/2022] Open
Abstract
Aims: To evaluate the protective effects of exogenous pancreatic kallikrein (PKK) treatment on diabetic cardiomyopathy (DCM) and explore the underlying mechanisms. Methods and Results: Streptozotocin (STZ)-induced diabetic rats, a type 1 diabetic model, were treated with either PKK or saline for 12 weeks. Non-diabetic rats were used as controls. PKK administration attenuated the mitochondria swelling, Z line misalignments, myofibrosis and interstitial collagen accumulation in diabetic myocardial tissue. The oxidative stress imbalance including increased nitrotyrosine, decreased anti-oxidative components such as nuclear receptor nuclear factor like 2 (Nrf2), glutathione peroxidase 1(GPx-1), catalase (CAT) and superoxide dismutase (SOD), were recovered in the heart of PKK-treated diabetic rats. In diabetic rats, protein expression of TGF-β1 and accumulation of collagen I in the heart tissues was decreased after PKK administration. Markers for inflammation were decreased in diabetic rats by PKK treatment. Compared to diabetic rats, PKK reversed the degradation of IκB-α, an inhibitive element of heterotrimer nuclear factor kappa B (NF-κB). The endothelial nitric oxide synthase (eNOS) protein and myocardial nitrate/nitrite were impaired in the heart of diabetic rats, which, however, were restored after PKK treatment. The sarcoplasmic reticulum Ca2+-ATPase 2 (SERCA2) and phospholamban (PLN) were mishandled in diabetic rats, while were rectified in PKK-treated diabetic rats. The plasma NT-proBNP level was increased in diabetic rats while was reduced with PKK treatment. Conclusion: PKK protects against DCM via reducing fibrosis, inflammation, and oxidative stress, promoting nitric oxide production, as well as restoring the function of the calcium channel.
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Affiliation(s)
- Meng Wu
- Division of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China.,Department of Endocrinology, The Second Affiliated Hospital, Soochow University, Suzhou, China
| | - Yeping Yang
- Division of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Meng Wang
- Division of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Fangfang Zeng
- Division of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Qin Li
- Division of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenjuan Liu
- Division of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Shizhe Guo
- Division of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Min He
- Division of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China.,Institute of Endocrinology and Diabetology, Fudan University, Shanghai, China
| | - Yi Wang
- Division of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Jie Huang
- Changzhou Qianhong Biopharma Co., Ltd., Changzhou, China
| | - Linuo Zhou
- Division of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Yiming Li
- Division of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China.,Institute of Endocrinology and Diabetology, Fudan University, Shanghai, China
| | - Ji Hu
- Department of Endocrinology, The Second Affiliated Hospital, Soochow University, Suzhou, China
| | - Wei Gong
- Division of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhaoyun Zhang
- Division of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China.,Institute of Endocrinology and Diabetology, Fudan University, Shanghai, China
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7
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Tissera G, Piskorz D, Citta L, Citta N, Citta P, Keller L, Bongarzoni L, Mata L, Tommasi A. Morphologic and Functional Heart Abnormalities Associated to High Modified Tei Index in Hypertensive Patients. High Blood Press Cardiovasc Prev 2016; 23:373-380. [PMID: 27623974 DOI: 10.1007/s40292-016-0167-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 09/05/2016] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION LV dysfunction develops early in hypertension, even previously to left ventricular remodeling. AIMS To determine the frequency of morphologic and functional heart abnormalities associated to abnormal modified Tei Index in untreated hypertensive (HBP) patients (p) with preserved ejection fraction (pEF). METHODS Case-control study. Three groups: (1) HBP without left ventricular hypertrophy (LVH); (2) HBP with LVH; (3) non-HBP controls. Ejection fraction >54 % identified pEF. LVH measured by Devereux method. Systolic and diastolic functions assessed by standard echocardiography and tissue Doppler. 2013 ESH/ESC Hypertension Guidelines normal values were considered. Tei index measured at the lateral and septal LV walls in apical 4-chamber view by tissue Doppler, value >0.40 considered abnormal. STATISTICAL ANALYSIS multifactorial ANOVA test adjusted by sex and age, p < 0.05 statistically significant. RESULTS The study included 14 controls, 88 HBP p without LVH, and 19 HBP p with LVH. The HBP p sample mean age was 58.7 ± 13.5 years and 52 (44.1 %) were males. Mean Tei Index was 0.35 ± 0.03 in controls; 0.42 ± 0.05 in HBP without LVH; and 0.42 ± 0.06 in HBP with LVH (p < 0.025). Abnormal Tei Index was present in 2p (14.3 %) controls; 64 p (72.7 %) HBP without LVH; and 15 p (78.9 %) HBP with LVH (p < 0.0009). Tissue Doppler's wave was 8.4 ± 0.9 cm/s in controls; 8 ± 1.6 cm/s in HBP without LVH and 7.8 ± 1.1 cm/s in HBP with LVH. CONCLUSIONS (1) Left ventricular dysfunction is frequent in HBP p, even without LVH; (2) modified tissue Doppler Tei index is a useful tool for the diagnosis of left ventricular dysfunction.
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Affiliation(s)
- G Tissera
- Centenario National Hospital, Urquiza 3000, 2000, Rosario, Argentina
| | - Daniel Piskorz
- Cardiology Institute Sanatorio Británico SA, Paraguay 40, 2000, Rosario, Argentina. .,Cardiovascular Research Center Sanatorio Británico SA, Paraguay 40, 2000, Rosario, Argentina.
| | - L Citta
- Cardiology Institute Sanatorio Británico SA, Paraguay 40, 2000, Rosario, Argentina
| | - N Citta
- Cardiology Institute Sanatorio Británico SA, Paraguay 40, 2000, Rosario, Argentina
| | - P Citta
- Cardiology Institute Sanatorio Británico SA, Paraguay 40, 2000, Rosario, Argentina
| | - L Keller
- Cardiology Institute Sanatorio Británico SA, Paraguay 40, 2000, Rosario, Argentina
| | - L Bongarzoni
- Cardiology Institute Sanatorio Británico SA, Paraguay 40, 2000, Rosario, Argentina
| | - L Mata
- Cardiology Institute Sanatorio Británico SA, Paraguay 40, 2000, Rosario, Argentina
| | - A Tommasi
- Cardiovascular Research Center Sanatorio Británico SA, Paraguay 40, 2000, Rosario, Argentina
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Al-Nashi M, Eriksson MJ, Östlund E, Bremme K, Kahan T. Cardiac structure and function, and ventricular-arterial interaction 11 years following a pregnancy with preeclampsia. ACTA ACUST UNITED AC 2016; 10:297-306. [DOI: 10.1016/j.jash.2016.01.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Revised: 12/16/2015] [Accepted: 01/12/2016] [Indexed: 11/26/2022]
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9
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Matsuda S, Umemoto S, Yoshimura K, Itoh S, Murata T, Fukai T, Matsuzaki M. Angiotensin Ⅱ Activates MCP-1 and Induces Cardiac Hypertrophy and Dysfunction via Toll-like Receptor 4. J Atheroscler Thromb 2015; 22:833-44. [PMID: 25752363 DOI: 10.5551/jat.27292] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
AIM Angiotensin Ⅱ(Ang Ⅱ) produces reactive oxygen species (ROS), thus contributing to the development of cardiac hypertrophy and subsequent heart failure, and stimulates the expression of monocyte chemoattractant protein-1 (MCP-1). In addition, Toll-like receptor 4 (TLR4) is involved in the upregulation of MCP-1. In order to clarify whether TLR4 is involved in the onset of cardiac dysfunction caused by Ang Ⅱ stimulation, we investigated the effects of TLR4 on oxidative stress, the MCP-1 expression and cardiac dysfunction in mice with Ang Ⅱ-induced hypertension. METHODS TLR4-deficient (Tlr4(lps-d)) and wild-type (WT) mice were randomized into groups treated with Ang Ⅱ, norepinephrine (NE) or a subdepressor dose of the Ang Ⅱreceptor blocker irbesartan (IRB) and Ang Ⅱ for two weeks. RESULTS Ang Ⅱ and NE similarly increased systolic blood pressure in all drug-treated groups compared to that observed in the control group among both WT and Tlr4(lps-d) mice (p<0.05). In the WT mice, Ang Ⅱ induced cardiac hypertrophy as well as vascular remodeling and perivascular fibrosis of the intramyocardial arteries and monocyte/macrophage infiltration in the heart (p<0.05). Furthermore, Ang Ⅱ treatment decreased the left ventricular diastolic function and resulted in a greater left ventricular end-systolic dimension (p<0.05) in addition to producing a five-fold increase in the NADPH oxidase activity, ROS content and MCP-1 expression (p<0.05). In contrast, the Tlr4(lps-d) mice showed little effects of Ang Ⅱ on these indices. In the WT mice, IRB treatment reversed these changes compared to that seen in the mice treated with Ang Ⅱ alone. NE produced little effect on any of the indices in either the WT or Tlr4(lps-d) mice. CONCLUSIONS TLR4 may be involved in the processes underlying the increased oxidative stress, selectively activated MCP-1 expression and cardiac hypertrophy and dysfunction seen in cases of Ang Ⅱ- induced hypertension.
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Affiliation(s)
- Susumu Matsuda
- Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine
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10
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Krzesiński P, Gielerak G, Stańczyk A, Piotrowicz K, Piechota W, Skrobowski A. Association of N-terminal pro-brain natriuretic peptide and hemodynamic parameters measured by impedance cardiography in patients with essential hypertension. Clin Exp Hypertens 2014; 37:148-54. [PMID: 24786840 DOI: 10.3109/10641963.2014.913611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim of this study was to evaluate the association of NT-proBNP with clinical and hemodynamic assessment in 156 patients with arterial hypertension. NT-proBNP correlated positively with, i.e. age (r=0.310, p=0.00008), mean blood pressure (MBP; r=0.199, p=0.0136), Heather index (HI; r=0.375, p<0.00001) and negatively with thoracic fluid content (TFC; r=-0.300, p=0.0002). The patients with higher NT-proBNP were older (46.1 versus 40.6 years, p=0.001), with higher MBP (102.6 versus 98.5 mm Hg, p=0.0043), HI (14.54 versus 11.93 Ohm s2, p=0.009) and lower TFC (27.5 versus 29.4 1/kOhm, p=0.0032). The independent predictors of higher NT-proBNP were: age, MBP and HI.
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Affiliation(s)
- Paweł Krzesiński
- Department of Cardiology and Internal Diseases, Military Institute of Medicine , Warsaw , Poland and
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11
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Santos RC, de Faria APC, Barbaro NR, Modolo R, Ferreira-Melo SE, Matos-Souza JR, Coelho OR, Yugar-Toledo JC, Fontana V, Calhoun D, Moreno H. Tadalafil-induced improvement in left ventricular diastolic function in resistant hypertension. Eur J Clin Pharmacol 2013; 70:147-54. [PMID: 24271647 DOI: 10.1007/s00228-013-1611-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 11/05/2013] [Indexed: 12/18/2022]
Abstract
PURPOSE Left ventricular hypertrophy and diastolic dysfunction (LVDD) remain highly frequent markers of cardiac damage and risk of progression to symptomatic heart failure, especially in resistant hypertension (RHTN). We have previously demonstrated that administration of sildenafil in hypertensive rats improves LVDD, restoring phosphodiesterase type 5 (PDE-5) inhibition in cardiac myocytes. METHODS We hypothesized that the long-acting PDE-5 inhibitor tadalafil may be clinically useful in improving LVDD in RHTN independently of blood pressure (BP) reduction. A single blinded, placebo-controlled, crossover study enrolled 19 patients with both RHTN and LVDD. Firstly, subjects received tadalafil (20 mg) for 14 days and after a 2-week washout period, they received placebo orally for 14 days. Patients were evaluated by office BP and ambulatory BP monitoring (ABPM), endothelial function (FMD), echocardiography, plasma brain natriuretic peptide (BNP-32), cyclic guanosine monophosphate (cGMP) and nitrite levels. RESULTS No significant differences were detected in BP measurements. Remarkably, at least four echocardiographic parameters related with diastolic function improved accompanied by decrease in BNP-32 in tadalafil use. Although increasing cGMP, tadalafil did not change endothelial function or nitrites. There were no changes in those parameters after placebo. CONCLUSION The current findings suggest that tadalafil improves LV relaxation through direct effects PDE-5-mediated in the cardiomyocytes with potential benefit as an adjunct to treat symptomatic subjects with LVDD such as RHTN patients.
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Affiliation(s)
- Rodrigo C Santos
- Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
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Sahin DY, Gür M, Elbasan Z, Kırım S, Uçar H, Seker T, Kaypaklı O, Uysal OK, Kıvrak A, Koyunsever NY, Akıllı RE, Çaylı M. NT-proBNP predicts impaired myocardial function in newly diagnosed hypertensive patients with preserved ejection fraction. Clin Exp Hypertens 2013; 36:289-94. [PMID: 23865488 DOI: 10.3109/10641963.2013.810234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
N-terminal pro-brain natriuretic peptide (NT-proBNP) is an excellent biomarker to diagnose left ventricular (LV) dysfunction. LV myocardial performance index (MPI-Tei index) is commonly used as a measure of combined systolic and diastolic function. We aimed to investigate the relationship between NT-proBNP and tissue Doppler derived MPI in newly diagnosed hypertensive patients with preserved LV ejection fraction (LVEF). We studied 236 patients with newly diagnosed HT (mean age; 52.9 ± 5.2 years). Echocardiographic examination was performed in all patients. LV mass index (LVMI) was calculated. Conventional Doppler indices (E and A waves) were recorded. The MPI value was obtained from the tissue Doppler derived ejection time, isovolumic contraction and relaxation times. The patients were divided into two groups according to the median NT-proBNP value (NT-proBNPlow group <114 pg/ml and NT-proBNPhigh group ≥114 pg/ml). Patients with NT-proBNPhigh were older and had higher levels of glucose and creatinine, lower E/A ratio and higher LVMI and MPI values than patients with NT-proBNPlow. However, LVEF were similar among the groups. Multiple linear regression analysis showed that NT-proBNP was independently associated with age, LVMI, MPI and E/A ratio. Increased NT-proBNP level was independently associated with impaired myocardial performance index in newly diagnosed hypertensive patients with preserved LVEF.
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Yin WH, Chen JW, Lin SJ. Prognostic value of combining echocardiography and natriuretic peptide levels in patients with heart failure. Curr Heart Fail Rep 2012; 9:148-53. [PMID: 22351121 DOI: 10.1007/s11897-012-0082-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Heart failure (HF) is still a global public health issue, despite the enormous progress made in its diagnosis and treatment. More often than not, acute or chronic decompensated HF leads to hospitalization and presents a dismal prognosis. Evidently, clinical symptoms alone are not reliable enough guidance for the HF treatment; therefore, parameters able to identify adverse prognoses are valuable in tailoring treatment regimens for individual patients. Echocardiography and natriuretic peptides (NPs) have demonstrated their capacities in giving independent diagnostic and prognostic information regarding patients with HF. Although abnormalities either of an echocardiographic index of left ventricular function or of an NP denote an increased risk of mortality or HF, the highest risk comes from abnormalities of both left ventricular function and NP levels. In this review, we survey the most recent publications exploring the utility of NP levels and echocardiographic indices integration, claimed to offer powerful incremental prognostication in patients with established HF.
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Affiliation(s)
- Wei-Hsian Yin
- Division of Cardiology, Heart Center, Cheng-Hsin General Hospital, No. 45, Cheng-Hsin Street, Pei-Tou, Taipei 112, Taiwan, Republic of China.
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Frederiksen CA, Juhl-Olsen P, Jakobsen CJ, Sloth E. Echocardiographic Evaluation of Systolic and Diastolic Function: A Preoperative Study of Correlation with Serum NT-proBNP. J Cardiothorac Vasc Anesth 2012; 26:197-203. [DOI: 10.1053/j.jvca.2011.07.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Indexed: 11/11/2022]
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15
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Makita Y, Okamoto M, Yoshida N, Hashimoto M, Shintani Y, Kajihara K, Nakano Y, Kihara Y. The origin and clinical significance of the signal opposite to the mitral E-wave: a simple and novel indicator of left ventricular filling pressure. Echocardiography 2011; 28:606-11. [PMID: 21718357 DOI: 10.1111/j.1540-8175.2011.01414.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES We noted a low-velocity signal opposite to the early diastolic transmitral flow (E) by pulsed Doppler echocardiography. The purpose of this study was to examine the origin and significance of this signal. BACKGROUND The background of the signal remains uncertain. METHODS We studied 59 adult patients (34 men and 25 women; mean age, 58.9 [20.2] years) without mitral valve heart disease. Mitral E-wave velocity and the signal (EW) opposite the E-wave were measured by pulsed Doppler echocardiography. Early diastolic mitral valve ring motion velocity (Ea) was measured by pulsed tissue Doppler echocardiography. Pulmonary capillary wedge pressure (PCWP) was measured by a Swan-Ganz catheter in 34 of the 59 patients. RESULTS A blue signal was observed during early diastole from the mitral valve ring to the mitral orifice areas by color tissue Doppler echocardiography. The velocity profile method revealed the same direction and time between peak Ea and EW. Peak EW positively correlated with Ea (r = 0.67, P < 0.01). There were significant positive correlations between mean PCWP and E/Ea (r = 0.61, P < 0.01) and E/EW (r = 0.59, P < 0.01). E/EW was significantly greater in patients with PCWP > 12 mmHg than in patients with PCWP ≤ 12 mmHg (5.6 [1.3] cm/s vs. 4.3 [0.9] cm/s, P < 0.01). CONCLUSIONS EW may be related to mitral valve ring motion, and the E/EW ratio may be a noninvasive simple parameter for assessing left ventricular filling pressure.
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Affiliation(s)
- Yuko Makita
- Department of Cardiology Clinical Laboratory, Hiroshima Prefectural Hospital, Minami-ku, Hiroshima, Japan.
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Bao Y, Shang X, Zhou L, Hu R, Li Y, Ding W. Relationship between N-terminal pro-B-type natriuretic peptide levels and metabolic syndrome. Arch Med Sci 2011; 7:247-56. [PMID: 22291764 PMCID: PMC3258734 DOI: 10.5114/aoms.2011.22075] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Revised: 11/07/2010] [Accepted: 12/16/2010] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Previous studies have shown that obese individuals have reduced natriuretic peptide levels. But conflicting data exist on the relation of natriuretic peptide levels to other metabolic risk factors. MATERIAL AND METHODS We investigated the relationship between plasma N-terminal pro-B-type natriuretic peptide levels (NT-proBNP) and metabolic syndrome (MetS) and metabolic risk factors in 469 patients free of heart failure. Two hundred thirty diagnosed MetS cases and 239 non-MetS cases were included in this study. Echocardiography examinations were performed and left ventricular mass index was calculated according to the Devereux correction formula. NT-proBNP was measured by electrochemiluminescence. The log-transformed NT-proBNP levels were used for abnormal distribution. Multiple linear regression analysis was performed to assess the association between levels of NT-proBNP and metabolic factors. Covariance analysis was used for group comparisons. RESULTS Log NT-proBNP levels were independently related to age, gender, body mass index, systolic blood pressure, diastolic blood pressure, fasting blood glucose, triglyceride, high density lipoprotein cholesterol, low density lipoprotein cholesterol, left ventricular mass index and left ventricular ejection fraction in multiple linear regression analysis (p < 0.05). Adjusted log NT-proBNP levels were lower in persons with MetS compared with those without MetS (p < 0.05). Individuals with hyperlipidaemia, elevated body mass index, diastolic blood pressure and fasting plasma glucose had lower levels of log NT-proBNP than those without MetS (p < 0.05). CONCLUSIONS There is a relationship between metabolic components and lower plasma NT-proBNP concentration. These findings raise the possibility that reduced plasma NT-proBNP levels are a manifestation of MetS, which might possess significant clinical and pathophysiological implications.
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Affiliation(s)
- Yuanyuan Bao
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
- These first two authors contributed equally to this work
| | - Xiliang Shang
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
- These first two authors contributed equally to this work
| | - Linuo Zhou
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Renming Hu
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Yiming Li
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
| | - Wei Ding
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, China
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Li WY, Chiu FC, Chien YF, Lin JW, Hwang JJ. Association of amino-terminal pro-brain natriuretic peptide with metabolic syndrome. Intern Med 2011; 50:1143-7. [PMID: 21628927 DOI: 10.2169/internalmedicine.50.4765] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE This study evaluated the relationship between individual components in metabolic syndrome (MetS) and amino-terminal pro-brain natriuretic peptide (NT-proBNP). METHODS A screening program for MetS in 2008 in Taiwan excluded subjects aged <30 years and pregnant women. Fasting glucose, insulin level, high-sensitivity C-reactive protein (hsCRP), and NT-proBNP were assessed. A propensity-score matching process was used to select subjects with and without MetS comparable in age, gender, body height, and serum creatinine levels. A multiple regression model was used to determine the association between individual components of MetS and NT-proBNP. Finally 270 subjects with MetS and another 270 matched subjects without MetS aged ≥30 years were included. RESULTS The subjects with MetS had higher uric acid and hsCRP, but not NT-proBNP. Multiple regression model showed that log (NT-proBNP) was positively associated with systolic blood pressure (β=0.002 per mmHg, p=0.013), but negatively associated with body mass index (β=-0.017 per kg/m(2), p=0.018), triglyceride (β=-0.00048 per mg/dL, p=0.020) and insulin level (β=-0.005 per mU/L, p=0.005). Log (NT-proBNP) was neutral to waist circumference, fasting glucose, high-density lipoprotein cholesterol, and diastolic blood pressure. CONCLUSION MetS was not associated with serum NT-proBNP concentrations due to the contradictory effects of each component.
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Affiliation(s)
- Wen-Yi Li
- Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Taiwan
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Assessment of left ventricular structure and function in preeclampsia by echocardiography and cardiovascular biomarkers. J Hypertens 2009; 27:2257-64. [DOI: 10.1097/hjh.0b013e3283300541] [Citation(s) in RCA: 120] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kusunose K, Yamada H, Nishio S, Tomita N, Niki T, Yamaguchi K, Koshiba K, Yagi S, Taketani Y, Iwase T, Soeki T, Wakatsuki T, Akaike M, Sata M. Clinical Utility of Single-Beat E/e′ Obtained by Simultaneous Recording of Flow and Tissue Doppler Velocities in Atrial Fibrillation With Preserved Systolic Function. JACC Cardiovasc Imaging 2009; 2:1147-56. [DOI: 10.1016/j.jcmg.2009.05.013] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2009] [Revised: 05/14/2009] [Accepted: 05/26/2009] [Indexed: 10/20/2022]
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Sezen Y, Baş M, Demirbag R, Yildiz A, Celik H, Aksoy S. N-terminal pro-brain natriuretic peptide in cases with metabolic syndrome and its relationship with components of metabolic syndrome and left ventricular mass index. Clin Biochem 2009; 42:1500-3. [PMID: 19615987 DOI: 10.1016/j.clinbiochem.2009.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2009] [Revised: 06/19/2009] [Accepted: 07/01/2009] [Indexed: 11/17/2022]
Abstract
OBJECTIVE In this study we investigated N-terminal pro-brain natriuretic peptide (Nt-proBNP) levels in patients with metabolic syndrome (MetS) and its relationship between MetS components. METHODS Thirty nine recently diagnosed MetS cases and 59 control cases were included in the present study. Left ventricular mass index (LVMI) was calculated and Nt-proBNP was determined. RESULTS Both groups were similar in terms of age and sex. Body mass index were significantly higher in MetS than non-MetS. LVMI measurements were not different between MetS and control groups (p=0.168). Nt-proBNP levels were similar in both groups (p=0.954). There was a significant correlation between Nt-proBNP and LVMI, age, serum LDL- and HDL-cholesterol levels. Nt-proBNP was independently related with age (beta=0.357, p=0.015) and LDL-cholesterol (beta=-0.255, p=0.049) in the multivariate analysis. CONCLUSIONS Nt-proBNP levels don't have a significant increase in MetS. But there was a significant relationship between Nt-proBNP levels and age and LDL-cholesterol.
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Affiliation(s)
- Yusuf Sezen
- Harran University, Faculty of Medicine, Department of Cardiology, Sanliurfa, Turkey.
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Utility of plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) to distinguish between congestive heart failure and non-cardiac causes of acute dyspnea in cats. J Vet Cardiol 2009; 11 Suppl 1:S51-61. [DOI: 10.1016/j.jvc.2008.12.001] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2008] [Revised: 11/25/2008] [Accepted: 12/03/2008] [Indexed: 11/23/2022]
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Lalor SM, Connolly DJ, Elliott J, Syme HM. Plasma concentrations of natriuretic peptides in normal cats and normotensive and hypertensive cats with chronic kidney disease. J Vet Cardiol 2009; 11 Suppl 1:S71-9. [PMID: 19398225 DOI: 10.1016/j.jvc.2009.01.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2008] [Revised: 01/25/2009] [Accepted: 01/30/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To determine if natriuretic peptide concentrations are increased in cats with systemic hypertension and/or chronic kidney disease (CKD). ANIMALS 22 normal cats, 13 normotensive cats with mild-moderate CKD (NT-CKD), 15 hypertensive cats with mild-moderate CKD (HT-CKD) and 8 normotensive cats with severe CKD (NT-CKD-severe). METHODS N-terminal pro-B-type (NT-proBNP) and pro-A-type (NT-proANP) natriuretic peptides were measured in plasma samples from all cats using commercially available assays and concentrations in the normal and diseased groups compared using non-parametric statistical tests. Spearman's rank correlation was used to test for an association between natriuretic peptide and creatinine concentrations. RESULTS NT-proANP was significantly higher in the NT-CKD-severe than the normal group of cats (P=0.006) but there were no other differences between groups. NT-proBNP concentrations were significantly higher in the HT-CKD group than both the normal (P<0.001) and the NT-CKD (P<0.001) groups. NT-proBNP concentrations were also higher in the NT-CKD-severe (P<0.001) and the NT-CKD (P=0.005) groups than the normal group. NT-proANP but not NT-proBNP was significantly and positively associated with plasma creatinine concentration. CONCLUSIONS Measurement of NT-proBNP shows promise as a diagnostic marker for systemic hypertension in the cat. Its concentration is not significantly increased in cats with mild-moderate normotensive CKD.
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Affiliation(s)
- Stephanie M Lalor
- Department of Veterinary Clinical Sciences, Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire AL9 7TA, United Kingdom
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Clinical applications of N-terminal pro B-type natriuretic peptide in heart failure and other cardiovascular diseases. Heart Fail Rev 2009; 15:293-304. [DOI: 10.1007/s10741-009-9142-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Mornos C, Ionac A, Cozma D, Rusinaru D, Maximov D, Petrescu L, Lupu A, Dragulescu SI. The relationship between tissue Doppler imaging and seric NTproBNP levels in sinus rhythm patients: a prospective study. Int J Cardiovasc Imaging 2007; 24:399-407. [PMID: 17972161 DOI: 10.1007/s10554-007-9279-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2007] [Accepted: 10/15/2007] [Indexed: 11/30/2022]
Abstract
UNLABELLED N-terminal pro-brain natriuretic peptide (NTproBNP) correlates with left ventricular (LV) filling pressure. The ratio between early diastolic transmitral velocity and early mitral annular diastolic velocity (E/Ea) reflects LV filling pressure in a variety of cardiac diseases. However this relationship was not validated in some categories of patients. Our aim was to evaluate the correlation between tissue Doppler velocities of the mitral annulus and NTproBNP levels in sinus rhythm patients. METHODS Echocardiography was performed in 111 consecutive patients simultaneously with NTproBNP measurement. E/Ea and E/(Ea x Sa) were calculated (Sa is the maximal systolic velocity of mitral annulus); the average of the velocities of septal and lateral mitral annulus was used. RESULTS Simple regression analysis demonstrated a significant linear correlation between E/(Ea x Sa) and NTproBNP (r = 0.71, P < 0.0001), superior to E/Ea correlation (r = 0.58, P < 0.0001). Significant but weaker correlations were found between NTproBNP and Sa, pulmonary artery systolic pressure, Ea, mitral E/A (early/late diastolic transmitral velocity), E wave, mitral E deceleration time and LV ejection fraction (LVEF). The optimal E/(Ea x Sa) cut-off for prediction of NTproBNP levels > 900 pg/ml was 1.5 (sensitivity = 81%, specificity = 70%). Among analyzed parameters, E/(Ea x Sa) was best correlated with NTproBNP levels in patients with LVEF >or= 50% (r = 0.80, P < 0.0001), with depressed LVEF (<50%) (r = 0.66, P < 0.0001), with regional wall motion abnormalities (r = 0.75, P < 0.0001), and with E/Ea 8 to 15 (r = 0.58, P < 0.0001). CONCLUSIONS E/(Ea x Sa) strongly correlates with NTproBNP, regardless of LVEF, and can be a simple and accurate echocardiographic index in patients in sinus rhythm, particularly in those with regional wall motion abnormalities or intermediate E/Ea.
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Affiliation(s)
- Cristian Mornos
- Cardiology Clinic, Institute of Cardiovascular Diseases, Str PP Carp nr 13A, Timisoara, Romania.
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