Paradoxical changes in brain natriuretic peptide levels and loading conditions after intravenous conscious sedation

Comparison of Current Echocardiographic Modalities Used to Assess Left Ventricle Diastolic Function in Pediatric Patients

Tissue Doppler imaging, left ventricular color M-mode velocity propagation, and deformation imaging techniques from the medical literature were critically reviewed. The review was undertaken to evaluate the accuracy, reproducibility, and clinical efficiency of echocardiographic technologies for image acquisition and data analysis in assessing pediatric diastolic function. Tissue Doppler imaging, velocity propagation, and deformation imaging all show low variability and high reproducibility and specificity. Age, growth, heart rate, morphology, and sonographic technique affect some pediatric echocardiographic indices more than others; therefore, each should not be solely relied on. Their complementary diagnostic information should be evaluated collectively as a complete echocardiographic examination by expertly trained medical professionals.

N-terminal pro-B-type natriuretic peptide as a marker of disease severity in patients with pericardial effusions

BACKGROUND/AIMS

N-terminal pro-B-type natriuretic peptide (NT-proBNP) has recently been introduced as a useful marker in diagnosing underlying disease in patients with dyspnea and for determining the prognosis of patients with heart failure. The purpose of this study was to evaluate the value of the NT-proBNP as a marker of disease severity in patients with pericardial effusions.

METHODS

We enrolled 69 consecutive patients who showed moderate or large pericardial effusion with preserved left ventricular (LV) systolic function; 42 patients finally participated in the study, and 13 (31.0%) of them showed cardiac tamponade. We analyzed the etiologies, the clinical and echocardiographic variables, and the serum NT-proBNP levels in these patients.

RESULTS

The mean NT-proBNP level was 751+/- 1002 ng/L (range 5 to 5289), and the median level was 385 ng/L (interquartile range 152 to 844). The NT-proBNP levels were higher in those patients with jugular venous distension (p=0.002), pulsus paradoxus (p=0.016), heart rate > or = 100/min (p=0.006), cardiac tamponade (p=0.001), large pericardial effusion (p=0.029), exaggerated respiratory variation of the transmitral inflow (p=0.006), or plethora of the inferior vena cava (p=0.01). The NT-proBNP levels showed significant correlation with heart rate (r=0.517, p<0.001) and the diameter of the inferior vena cava (r=0.329, p=0.03).

CONCLUSIONS

NT-proBNP may be useful as a marker of disease severity in patients suffering from pericardial effusion, but further prospective studies with more patients will be needed.

Recurrent hyponatremia after intrathecal methotrexate not related to antidiuretic hormone: is a natriuretic peptide activated?

We report the development of recurrent hyponatremia after intrathecal methotrexate that was not associated with elevated levels of antidiuretic hormone. We speculate that a central nervous system natriuretic peptide may be involved in the pathogenesis of the naturesis following intrathecal methotrexate.