1
|
Pezzuto B, Contini M, Berna G, Galotta A, Cattaneo G, Maragna R, Gugliandolo P, Agostoni P. Dynamic trend of lung fluid movement during exercise in heart failure: From lung imaging to alveolar-capillary membrane function. Int J Cardiol 2024; 407:132041. [PMID: 38643800 DOI: 10.1016/j.ijcard.2024.132041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 03/10/2024] [Accepted: 04/10/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND In chronic heart failure (HF), exercise-induced increase in pulmonary capillary pressure may cause an increase of pulmonary congestion, or the development of pulmonary oedema. We sought to assess in HF patients the exercise-induced intra-thoracic fluid movements, by measuring plasma brain natriuretic peptide (BNP), lung comets and lung diffusion for carbon monoxide (DLCO) and nitric oxide (DLNO), as markers of hemodynamic load changes, interstitial space and alveolar-capillary membrane fluids, respectively. METHODS AND RESULTS Twenty-four reduced ejection fraction HF patients underwent BNP, lung comets and DLCO/DLNO measurements before, at peak and 1 h after the end of a maximal cardiopulmonary exercise test. BNP significantly increased at peak from 549 (328-841) to 691 (382-1207, p < 0.0001) pg/mL and almost completely returned to baseline value 1 h after exercise. Comets number increased at peak from 9.4 ± 8.2 to 24.3 ± 16.7, returning to baseline (9.7 ± 7.4) after 1 h (p < 0.0001). DLCO did not change significantly at peak (from 18.01 ± 4.72 to 18.22 ± 4.73 mL/min/mmHg), but was significantly reduced at 1 h (16.97 ± 4.26 mL/min/mmHg) compared to both baseline (p = 0.0211) and peak (p = 0.0174). DLNO showed a not significant trend toward lower values 1 h post-exercise. CONCLUSIONS Moderate/severe HF patients have a 2-step intra-thoracic fluid movement with exercise: the first during active exercise, from the vascular space toward the interstitial space, as confirmed by comets increase, without any effect on diffusion, and the second, during recovery, toward the alveolar-capillary membrane, clearing the interstitial space but worsening gas diffusion.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
| |
Collapse
|
2
|
Kriechbaum SD, Birmes J, Wiedenroth CB, Adameit MSD, Gruen D, Vietheer J, Richter MJ, Guth S, Roller FC, Rademann M, Fischer-Rasokat U, Rolf A, Liebetrau C, Hamm CW, Keller T, Rieth AJ. Exercise MR-proANP unmasks latent right heart failure in CTEPH. J Heart Lung Transplant 2022; 41:1819-1830. [PMID: 36210266 DOI: 10.1016/j.healun.2022.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/31/2022] [Accepted: 08/22/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The present study was designed to investigate the dynamics of right atrial pressure (RAP) and mid-regional pro-atrial natriuretic peptide (MR-proANP) during physical exercise in patients with chronic thromboembolic pulmonary hypertension (CTEPH) and to determine whether these parameters might serve as a tool to measure exercise-dependent atrial stress as an indicator of right heart failure. METHODS This prospective observational cohort study included 100 CTEPH patients who underwent right heart catheterization during physical exercise (eRHC). Blood samples for MR-proANP measurement were taken prior, during, and after eRHC. MR-proANP levels were correlated to RAP levels at rest, at peak exercise (eRAP), and during recovery. RAP at rest ≤7 mmHg was defined as normal and eRAP >15 mmHg as suggestive of right heart failure. RESULTS During eRHC mean RAP increased from 6 mmHg (standard deviation, SD 4) to 16 mmHg (SD 7; p < 0.001). MR-proANP levels and dynamics correlated with RAP at rest (rs = 0.61; p < 0.001) and at peak exercise (rs = 0.66; p < 0.001). Logistic regression analysis revealed the peak MR-proANP level (B = 0.058; p = 0.004) and the right atrial area (B = 0.389; p < 0.001) to be associated with eRAP dynamics. A peak MR-proANP level ≥139 pmol/L (AUC = 0.81) and recovery level ≥159 pmol/L (AUC = 0.82) predicted an eRAP >15 mmHg. Physical exercise unmasked right heart failure in 39% of patients with normal RAP at rest; these patients were also characterized by a more distinct increase in MR-proANP levels (p = 0.005) and higher peak (p < 0.001) and recovery levels (p < 0.001). CONCLUSIONS RAP and MR-proANP dynamics unmask manifest and latent right heart failure in CTEPH patients.
Collapse
Affiliation(s)
- Steffen D Kriechbaum
- Campus Kerckhoff, University of Giessen, Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Bad Nauheim, Germany.
| | - Judith Birmes
- Campus Kerckhoff, University of Giessen, Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Bad Nauheim, Germany
| | - Christoph B Wiedenroth
- Campus Kerckhoff, University of Giessen, Heart and Thorax Center, Department of Thoracic Surgery, Bad Nauheim, Germany
| | - Miriam S D Adameit
- Campus Kerckhoff, University of Giessen, Heart and Thorax Center, Department of Thoracic Surgery, Bad Nauheim, Germany
| | - Dimitri Gruen
- Justus Liebig University Giessen, Medical Clinic I, Division of Cardiology, Giessen, Germany
| | - J Vietheer
- Campus Kerckhoff, University of Giessen, Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Bad Nauheim, Germany
| | - Manuel J Richter
- Department of Pneumology, Kerckhoff-Klinik, Bad Nauheim, Germany; Department of Internal Medicine, Justus Liebig University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Stefan Guth
- Campus Kerckhoff, University of Giessen, Heart and Thorax Center, Department of Thoracic Surgery, Bad Nauheim, Germany
| | - Fritz C Roller
- Justus Liebig University Giessen, Department of Radiology, Giessen, Germany
| | - Matthias Rademann
- Campus Kerckhoff, University of Giessen, Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
| | - Ulrich Fischer-Rasokat
- Campus Kerckhoff, University of Giessen, Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany; Justus Liebig University Giessen, Medical Clinic I, Division of Cardiology, Giessen, Germany
| | - Andreas Rolf
- Campus Kerckhoff, University of Giessen, Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Bad Nauheim, Germany; Justus Liebig University Giessen, Medical Clinic I, Division of Cardiology, Giessen, Germany
| | - Christoph Liebetrau
- Campus Kerckhoff, University of Giessen, Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Bad Nauheim, Germany; Cardioangiologisches Centrum Bethanien, Frankfurt am Main, Germany
| | - Christian W Hamm
- Campus Kerckhoff, University of Giessen, Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Bad Nauheim, Germany; Justus Liebig University Giessen, Medical Clinic I, Division of Cardiology, Giessen, Germany
| | - Till Keller
- Campus Kerckhoff, University of Giessen, Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Bad Nauheim, Germany; Justus Liebig University Giessen, Medical Clinic I, Division of Cardiology, Giessen, Germany
| | - Andreas J Rieth
- Campus Kerckhoff, University of Giessen, Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Bad Nauheim, Germany
| |
Collapse
|
3
|
Klein S, Nolte I, Rumstedt K, Sehn M, Raue JF, Weiner F, Treese JS, Beyerbach M, Bach JP. The effect of treatment with pimobendan in dogs with preclinical mitral valve disease - a placebo-controlled double-blinded crossover study. BMC Vet Res 2021; 17:310. [PMID: 34563187 PMCID: PMC8467240 DOI: 10.1186/s12917-021-03014-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/14/2021] [Indexed: 11/26/2022] Open
Abstract
Background Pimobendan is a widely used medication for the treatment of dogs with congestive heart failure (CHF) and preclinical degenerative mitral valve disease (DMVD) with cardiomegaly. The benefit of a treatment in dogs with preclinical DMVD but without cardiomegaly has not yet been elucidated. Some positive effects concerning life quality and a decrease in cardiac biomarkers could be verified. This study aimed to further investigate these results using a placebo-controlled double-blinded crossover design. Out of a total of 15 dogs, eight were allocated to sequence-group AB, in which dogs received pimobendan (A) during the first treatment period and placebo (B) during the second period. Accordingly, sequence-group BA was treated first with placebo followed by pimobendan. Each treatment period lasted six months and included a baseline investigation and follow-ups after 90 and 180 days. The investigations included a questionnaire completed by the owners, echocardiographic examination, and measurements of NT-proBNP, cTnI and lactate before and after a standardised submaximal exercise test. Results NT-proBNP values decreased significantly during the treatment period with pimobendan, and the post-exercise increase was attenuated at day 180. No significant treatment effects could be verified for cTnI and lactate, neither pre- nor post-exercise. Left ventricular size decreased under treatment, whereas no significant changes in left atrial size were detected. The owners described their dogs under treatment with pimobendan as being more active at day 90 (11/15) and day 180 (12/15). Those animals treated with placebo were described as being more active at day 90 (2/15) and day 180 (5/15). Conclusions Pimobendan had reducing effects on the concentrations of pre- and post-exercise cardiac biomarkers and the size of the left ventricle in dogs with DMVD ACVIM B1. Exercise testing in addition to an assessment of cardiac biomarkers might improve the decision when to initiate pimobendan treatment in dogs with DMVD. Supplementary Information The online version contains supplementary material available at 10.1186/s12917-021-03014-5.
Collapse
Affiliation(s)
- Stephanie Klein
- Clinic for Small Animals, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Ingo Nolte
- Clinic for Small Animals, University of Veterinary Medicine Hannover, Hannover, Germany.
| | - Katja Rumstedt
- Clinic for Small Animals, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Maximiliane Sehn
- Clinic for Small Animals, University of Veterinary Medicine Hannover, Hannover, Germany
| | | | - Franziska Weiner
- Clinic for Small Animals, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Julia Sophie Treese
- Clinic for Small Animals, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Martin Beyerbach
- Institute for Biometry, Epidemiology and Information Processing, WHO Collaborating Centre for Research and Training for Health at the Human-Animal-Environment Interface, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Jan-Peter Bach
- Clinic for Small Animals, University of Veterinary Medicine Hannover, Hannover, Germany
| |
Collapse
|
4
|
Functional Role of Natriuretic Peptides in Risk Assessment and Prognosis of Patients with Mitral Regurgitation. J Clin Med 2020; 9:jcm9051348. [PMID: 32380651 PMCID: PMC7290430 DOI: 10.3390/jcm9051348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 04/29/2020] [Accepted: 05/01/2020] [Indexed: 12/24/2022] Open
Abstract
The management of mitral valve regurgitation (MR), a common valve disease, represents a challenge in clinical practice, since the indication for either surgical or percutaneous valve replacement or repair are guided by symptoms and by echocardiographic parameters which are not always feasible. In this complex scenario, the use of natriuretic peptide (NP) levels would serve as an additive diagnostic and prognostic tool. These biomarkers contribute to monitoring the progression of the valve disease, even before the development of hemodynamic consequences in a preclinical stage of myocardial damage. They may contribute to more accurate risk stratification by identifying patients who are more likely to experience death from cardiovascular causes, heart failure, and cardiac hospitalizations, thus requiring surgical management rather than a conservative approach. This article provides a comprehensive overview of the available evidence on the role of NPs in the management, risk evaluation, and prognostic assessment of patients with MR both before and after surgical or percutaneous valve repair. Despite largely positive evidence, a series of controversial findings exist on this relevant topic. Recent clinical trials failed to assess the role of NPs following the interventional procedure. Future larger studies are required to enable the introduction of NP levels into the guidelines for the management of MR.
Collapse
|
5
|
Kutsch J, Faul C, von Scheidt W, Schwaiblmair M, Berghaus TM. The association of the N-terminal pro-brain-type natriuretic peptide response to exercise with disease severity in therapy-naive pulmonary arterial hypertension: a cohort study. Respir Res 2018; 19:8. [PMID: 29334941 PMCID: PMC5769493 DOI: 10.1186/s12931-017-0712-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 12/28/2017] [Indexed: 11/10/2022] Open
Abstract
Background While the N-terminal pro-brain-type natriuretic peptide (NT-proBNP) at rest is known to be associated with prognosis in pulmonary arterial hypertension (PAH), it is unclear if the NT-proBNP response to exercise (ΔNT-proBNP) can contribute to a better assessment of disease severity. Methods We investigated the association of NT-proBNP values at rest and during peak exercise with hemodynamics and cardiopulmonary exercise testing parameters in 63 therapy-naive PAH patients. Results The median NT-proBNP increases from 1414 at rest to 1500 pg/ml at peak exercise. The ΔNT-proBNP is baseline-dependent in PAH. Both, NT-proBNP at rest and NT-proBNP at peak exercise, are significantly correlated with hemodynamics and functional capacity. However, neither NT-proBNP at peak exercise nor ΔNT-proBNP correlated better with surrogate markers of disease severity than NT-proBNP at rest. Conclusion The ΔNT-proBNP does not contribute to a better assessment of disease severity in PAH. Electronic supplementary material The online version of this article (10.1186/s12931-017-0712-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- J Kutsch
- Department of Cardiology, Respiratory Medicine and Intensive Care, Klinikum Augsburg, Ludwig-Maximilians-University Munich, Stenglinstrasse 2, 86156, Augsburg, Germany
| | - C Faul
- Department of Cardiology, Respiratory Medicine and Intensive Care, Klinikum Augsburg, Ludwig-Maximilians-University Munich, Stenglinstrasse 2, 86156, Augsburg, Germany
| | - W von Scheidt
- Department of Cardiology, Respiratory Medicine and Intensive Care, Klinikum Augsburg, Ludwig-Maximilians-University Munich, Stenglinstrasse 2, 86156, Augsburg, Germany
| | - M Schwaiblmair
- Department of Cardiology, Respiratory Medicine and Intensive Care, Klinikum Augsburg, Ludwig-Maximilians-University Munich, Stenglinstrasse 2, 86156, Augsburg, Germany
| | - T M Berghaus
- Department of Cardiology, Respiratory Medicine and Intensive Care, Klinikum Augsburg, Ludwig-Maximilians-University Munich, Stenglinstrasse 2, 86156, Augsburg, Germany.
| |
Collapse
|
6
|
Verboven K, Hansen D, Jocken JWE, Blaak EE. Natriuretic peptides in the control of lipid metabolism and insulin sensitivity. Obes Rev 2017; 18:1243-1259. [PMID: 28901677 DOI: 10.1111/obr.12598] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 07/08/2017] [Accepted: 07/20/2017] [Indexed: 12/24/2022]
Abstract
Natriuretic peptides have long been known for their cardiovascular function. However, a growing body of evidence emphasizes the role of natriuretic peptides in human substrate and energy metabolism, thereby connecting the heart with several insulin-sensitive organs like adipose tissue, skeletal muscle and liver. Obesity may be associated with an impaired regulation of the natriuretic peptide system, also indicated as a natriuretic handicap. Evidence points towards a contribution of this natriuretic handicap to the development of obesity, type 2 diabetes mellitus and cardiometabolic complications, although the causal relationship is not fully understood. Nevertheless, targeting the natriuretic peptide pathway may improve metabolic health in obesity and type 2 diabetes mellitus. This review will focus on current literature regarding the metabolic roles of natriuretic peptides with emphasis on lipid metabolism and insulin sensitivity. Furthermore, it will be discussed how exercise and lifestyle intervention may modulate the natriuretic peptide-related metabolic effects.
Collapse
Affiliation(s)
- K Verboven
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands.,REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - D Hansen
- REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - J W E Jocken
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - E E Blaak
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center+, Maastricht, The Netherlands
| |
Collapse
|
7
|
Cao L, Zhu W, Wagar EA, Meng QH. Biomarkers for monitoring chemotherapy-induced cardiotoxicity. Crit Rev Clin Lab Sci 2016; 54:87-101. [PMID: 28013560 DOI: 10.1080/10408363.2016.1261270] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Cardiotoxicity, including acute and late-onset cardiotoxicity, is a well-known adverse effect of many types of antitumor agents. Early identification of patients with cardiotoxicity is important to ensure prompt treatment and minimize toxic effects. The etiology of chemotherapy-induced cardiotoxicity is multifactorial. Traditional methods for assessment of chemotherapy-induced cardiotoxicity typically involve serial measurements of cardiac function via multi-modality imaging techniques. Typically, however, significant left ventricular dysfunction has already occurred when cardiotoxicity is detected by imaging techniques. Biomarkers, most importantly cardiac natriuretic peptides and troponins, are promising markers for identifying patients potentially at risk for clinical heart failure symptoms. This review summarizes the recent progress in clinical utilization of biomarkers for early diagnosis of acute cardiotoxicity and for prediction of late-onset cardiotoxicity. We also discuss the conflicting results of different studies and the association of results with study design.
Collapse
Affiliation(s)
- Liyun Cao
- a Department of Laboratory Medicine , Unit 37, The University of Texas MD Anderson Cancer Center , Houston , TX , USA and
| | - Wuqiang Zhu
- b Department of Biomedical Engineering , University of Alabama at Birmingham , Birmingham , AL , USA
| | - Elizabeth A Wagar
- a Department of Laboratory Medicine , Unit 37, The University of Texas MD Anderson Cancer Center , Houston , TX , USA and
| | - Qing H Meng
- a Department of Laboratory Medicine , Unit 37, The University of Texas MD Anderson Cancer Center , Houston , TX , USA and
| |
Collapse
|
8
|
Sinha SK, Garg S, Thakur R, Krishna V, Singh K, Sachan M, Goel A, Razi M, Pandey U, Varma CM. Prognostic Importance of Exercise Brain Natriuretic Peptide in Asymptomatic Chronic Organic Severe Mitral Regurgitation: An Observational Study. J Clin Med Res 2016; 8:797-804. [PMID: 27738481 PMCID: PMC5047018 DOI: 10.14740/jocmr2680w] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2016] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The optimal timing of surgery in patients with chronic organic severe mitral regurgitation (MR) continues to be debated, especially for those who are asymptomatic. The aim of the study was to determine independent and additive prognostic value of exercise brain natriuretic peptide (eBNP) in patients with severe asymptomatic MR and normal left ventricular ejection fraction (LVEF). METHODS Two hundred twenty-three consecutive patients with severe MR defined by effective regurgitant orifice (ERO) area ≥ 40 mm2 and/or residual volume ≥ 60 mL, LVEF > 60%, and normal LV end-systolic diameter < 40 mm underwent symptom limited exercise treadmill test (TMT). Echocardiography was done immediately after exercise. Data were obtained within 3 minutes of peak exercise. BNP levels were assessed before echo (after 30 minutes of supine rest) and at exercise (i.e., within the 3 minutes of the end of effort). Patients were followed up every 3 months up to 15 months for major adverse cardiac events (MACEs) (cardiovascular death, need for mitral valve surgery and hospitalization for acute pulmonary edema or heart failure). RESULTS Mean age was 31.2 ± 9 years (range: 18 - 40) with majority being male (n = 153; 68%). Etiologies were rheumatic (n = 201; 90%), mitral valve prolapse (n = 17; 7.6%) and hypertrophic cardiomyopathy (n = 5; 2.4%). BNP level significantly increased from rest (65.24 ± 43.92 pg/mL; median: 43.5 pg/mL) to exercise (100.24 ± 98.24 pg/mL; median: 66.5 pg/mL; P < 0.001). Patients were divided into three tertiles according to eBNP levels (T1 = 15 - 44; T2 = 45 - 104; T3 = 105 - 400). There was trend for significantly lower exercise time in T3. During TMT, 66 (29.5%) stopped exercise due to dyspnea. They had similar resting BNP level compared with others but had significantly higher eBNP level (136 ± 109.7 pg/mL vs. 84.88 ± 90.2 pg/mL; P < 0.001). During follow-up (15 months), MACE occurred in 83 patients (37.2%): mitral valve replacement (MVR) in 59 patients (symptomatic: 43; LV dilatation or dysfunction: 9; both symptoms and dilatation/dysfunction: 7), 17 hospitalizations for congestive heart failure, five patients developing acute pulmonary edema and atrial fibrillation in remaining two patients. This was 7.6%, 35% and 69% in T1, T2 and T3, respectively and had significantly higher eBNP level than without any event (165 ± 119 pg/mL vs. 57 ± 48 pg/mL; P < 0.001). Using receiver operating characteristic curve analysis, the best cut-off value of eBNP level to predict cardiac events was 90 pg/mL (sensitivity: 75%; specificity: 88.6%; positive predictive value: 79%; negative predictive value: 83.9%). CONCLUSION In asymptomatic patients, eBNP level provides incremental prognostic value beyond echocardiographic data and those with elevated eBNP should be considered at high risk for reduced event-free survival and might be considered for early MVR.
Collapse
Affiliation(s)
- Santosh Kumar Sinha
- Department of Cardiology, LPS Institute of Cardiology, G. S. V. M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Shalini Garg
- Department of Cardiology, LPS Institute of Cardiology, G. S. V. M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Ramesh Thakur
- Department of Cardiology, LPS Institute of Cardiology, G. S. V. M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Vinay Krishna
- Department of Cardiology, LPS Institute of Cardiology, G. S. V. M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Karandeep Singh
- Department of Cardiology, LPS Institute of Cardiology, G. S. V. M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Mohit Sachan
- Department of Cardiology, LPS Institute of Cardiology, G. S. V. M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Amit Goel
- Department of Cardiology, LPS Institute of Cardiology, G. S. V. M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Mahamdula Razi
- Department of Cardiology, LPS Institute of Cardiology, G. S. V. M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Umeshwar Pandey
- Department of Cardiology, LPS Institute of Cardiology, G. S. V. M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Chandra Mohan Varma
- Department of Cardiology, LPS Institute of Cardiology, G. S. V. M. Medical College, Kanpur, Uttar Pradesh 208002, India
| |
Collapse
|
9
|
Natriuretic peptide control of energy balance and glucose homeostasis. Biochimie 2016; 124:84-91. [DOI: 10.1016/j.biochi.2015.05.017] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 05/19/2015] [Indexed: 12/27/2022]
|
10
|
Capoulade R, Magne J, Dulgheru R, Hachicha Z, Dumesnil JG, O'Connor K, Arsenault M, Bergeron S, Pierard LA, Lancellotti P, Pibarot P. Prognostic value of plasma B-type natriuretic peptide levels after exercise in patients with severe asymptomatic aortic stenosis. Heart 2014; 100:1606-12. [DOI: 10.1136/heartjnl-2014-305729] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
11
|
Magne J, Mahjoub H, Pibarot P, Pirlet C, Pierard LA, Lancellotti P. Prognostic importance of exercise brain natriuretic peptide in asymptomatic degenerative mitral regurgitation. Eur J Heart Fail 2014; 14:1293-302. [DOI: 10.1093/eurjhf/hfs114] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Julien Magne
- University of Liège, Department of Cardiology; University Hospital Sart Tilman; B-4000 Liège Belgium
| | | | | | - Charles Pirlet
- University of Liège, Department of Cardiology; University Hospital Sart Tilman; B-4000 Liège Belgium
| | - Luc A. Pierard
- University of Liège, Department of Cardiology; University Hospital Sart Tilman; B-4000 Liège Belgium
| | - Patrizio Lancellotti
- University of Liège, Department of Cardiology; University Hospital Sart Tilman; B-4000 Liège Belgium
| |
Collapse
|
12
|
Parthenakis FI, Patrianakos AP, Haritakis CN, Zacharis EA, Nyktari EG, Vardas PE. NT-proBNP response to dobutamine stress echocardiography predicts left ventricular contractile reserve in dilated cardiomyopathy. Eur J Heart Fail 2014; 10:475-81. [DOI: 10.1016/j.ejheart.2008.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2007] [Revised: 01/28/2008] [Accepted: 03/06/2008] [Indexed: 11/28/2022] Open
Affiliation(s)
| | | | | | | | - Eva G. Nyktari
- Department of Cardiology; Heraklion University Hospital; Crete Greece
| | - Panos E. Vardas
- Department of Cardiology; Heraklion University Hospital; Crete Greece
| |
Collapse
|
13
|
Shimomura Y, Baba R, Watanabe A, Horikoshi Y, Asami K, Hyakuna N, Iwai A, Matsushita T, Yamaji K, Hori T, Tsurusawa M. Assessment of late cardiotoxicity of pirarubicin (THP) in children with acute lymphoblastic leukemia. Pediatr Blood Cancer 2011; 57:461-6. [PMID: 21298773 DOI: 10.1002/pbc.23012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Accepted: 12/09/2010] [Indexed: 11/09/2022]
Abstract
BACKGROUND Pirarubicin (tetrahydropyranyl-adriamycin: THP) is a derivative of doxorubicin with reportedly less cardiotoxicity in adults. However no studies of cardiotoxicity in children treated with THP have been reported. This study was performed to assess the THP-induced cardiotoxicity for children with acute lymphoblastic leukemia (ALL). PATIENTS AND METHODS This study comprised 61 asymptomatic patients aged from 7.6 to 25.7 years old. Median follow-up time after completion of anthracycline treatment was 8.1 years (range: 1.7-12.5). The cumulative dose of THP ranged from 120 to 740 mg/m(2) with a median of 180 mg/m(2) . Patients underwent electrocardiogram (ECG), echocardiography, the 6-min walk test (6MWT), and measurements of serum brain natriuretic peptide (BNP) before and after exercise. RESULTS All subjects showed normal left ventricular function assessed by echocardiography. Ventricular premature contraction in Holter ECG and reduced exercise tolerance in the 6MWT were detected in 2/46 (3.3%) and 5/41(12.2%), respectively. Abnormal BNP levels were detected in 6/60 (10%) both before and after exercise. The cumulative dose of THP was significantly correlated with BNP levels after exercise (r = 0.27, P = 0.03), but not with any other cardiac measurements. Further analysis revealed that subjects with a high cumulative dose ≧300 mg/m(2) had significantly higher BNP levels after exercise compared with subjects with a low cumulative dose <300 mg/m(2) (P = 0.04). CONCLUSIONS No significant cardiac dysfunction was detected in long-term survivors who received THP treatment. The use of post-exercise BNP level to indicate high cardiotoxicity risk should be verified by further study.
Collapse
Affiliation(s)
- Yasuto Shimomura
- Department of Pediatrics, Aichi Medical University, Aichi-gun, Aichi-ken, Japan
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Atehortúa DS, Gallo JA, Rico M, Durango L. Efecto de un programa de rehabilitación cardiaca basado en ejercicio sobre la capacidad física, la función cardiaca y la calidad de vida, en pacientes con falla cardiaca. REVISTA COLOMBIANA DE CARDIOLOGÍA 2011. [DOI: 10.1016/s0120-5633(11)70163-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
15
|
Nilsson B, Goetze JP, Chen X, Pehrson S, Svendsen JH. Increased NT-pro-B-type natriuretic peptide independently predicts outcome following catheter ablation of atrial fibrillation. Scandinavian Journal of Clinical and Laboratory Investigation 2009; 69:843-50. [DOI: 10.3109/00365510903318209] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
16
|
Petracca F, Affuso F, Di Conza P, Micillo F, Castellano G, Guardasole V, Scopacasa F, Saccà L, Fazio S. Usefulness of NT-proBNP in the assessment of patients with aortic or mitral regurgitation. J Cardiovasc Med (Hagerstown) 2009; 10:928-32. [PMID: 19606057 DOI: 10.2459/jcm.0b013e32832fcca7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Recent application of brain natriuretic peptide and N-terminal prohormone brain natriuretic peptide (NT-proBNP) in cardiac valvular disease is very promising. AIMS To test the usefulness of NT-proBNP in the assessment of patients with aortic or mitral regurgitation. PATIENTS AND METHODS Sixty-seven patients - 23 with aortic and 12 with mitral regurgitation vs. 32 controls - were examined by color Doppler echocardiography, cardiopulmonary exercise testing, Minnesota Living with Heart Failure Questionnaire (MLWHFQ) and plasma NT-proBNP assay at rest (T0) and after maximal physical exercise (T1). RESULTS NT-proBNP was significantly higher in patients than in controls, both at T0 (298 +/- 85 vs. 46 +/- 11 pg/ml; P < 0.01) and at T1 (366 +/- 106 vs. 50 +/- 12 pg/ml; P < 0.01). MLWHFQ score was significantly higher in patients (19 +/- 3 vs. 1 +/- 0.6; P < 0.001) with a significant inverse correlation with VO2max (r = -0.538, P < 0.001) and a direct correlation with NT-proBNP (T0: r = 0.415, P < 0.01; T1: r = 0.458, P < 0.01). NT-proBNP was inversely correlated with VO2max (T0: r = -0.444, P < 0.001; T1:r = -0.428, P < 0.001) and directly correlated with left atrial diameter (T0: r = 0.370, P < 0.01; T1: r = 0.409, P = 0.001), and left ventricular mass index (r = 0.279, P < 0.01, and r = 0.272, P < 0.01). No correlations were found between echocardiographic parameters of valvular disease severity and VO2max, NT-proBNP and MLWHFQ. CONCLUSIONS NT-proBNP is useful in the assessment of the cardiac functional damage secondary to mitral and aortic regurgitation.
Collapse
|
17
|
Cattadori G, Wasserman K, Meloni C, Mustaq S, Contini M, Apostolo A, Andreini D, Magrì D, Sciomer S, Veglia F, Berna G, Introcaso G, Palermo P, Fiorentini C, Agostoni P. Alveolar Membrane Conductance Decreases as BNP Increases During Exercise in Heart Failure. Rationale for BNP in the Evaluation of Dyspnea. J Card Fail 2009; 15:136-44. [DOI: 10.1016/j.cardfail.2008.10.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2008] [Revised: 09/05/2008] [Accepted: 10/03/2008] [Indexed: 11/26/2022]
|
18
|
Conraads VMA, De Maeyer C, Beckers P, Possemiers N, Martin M, Van Hoof V, Vrints CJ. Exercise-induced biphasic increase in circulating NT-proBNP levels in patients with chronic heart failure. Eur J Heart Fail 2008; 10:793-5. [PMID: 18599343 DOI: 10.1016/j.ejheart.2008.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2008] [Revised: 05/21/2008] [Accepted: 06/10/2008] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Exercise increases natriuretic peptide levels in chronic heart failure (CHF) patients, but the effect is considered minor. We assessed acute and short-term release (<24 h) of NT-proBNP in CHF patients after a maximal cardiopulmonary exercise test (CPET) and 2 different submaximal training sessions. METHODS AND RESULTS 102 CHF patients either performed CPET (Group 1), a 1 h endurance (Group 2) or a combined endurance-resistance training session (Group 3). NT-proBNP concentration was determined before, at exercise cessation and after 18-22 h (Protocol A). In 20 patients, samples were obtained before, at exercise cessation, after 15, 30, 45, 60, 90 min, 2, 3, 4, 5, 6, 12, 22 h (Protocol B). Protocol A: At peak exercise, a 15%, 11% and 17% relative increase (p<0.001 vs baseline, all 3 groups) was seen, with a return to baseline after 18-22 h. The increase correlated with indicators of more advanced heart failure. Protocol B: A biphasic pattern was derived with a first peak within 1 h of exercise termination and a second peak (39%, 31% and 33% higher than baseline; p<0.05, all 3 groups) after 4-12 h. CONCLUSIONS The observed biphasic release of B-type natriuretic peptides supports standardization of sampling, taking recent exercise into account.
Collapse
|
19
|
Koç M, Bozkurt A, Acartürk E, Sahin DY, Unal I. Usefulness of N-terminal pro-B-type natriuretic peptide increase with exercise for predicting cardiovascular mortality in patients with heart failure. Am J Cardiol 2008; 101:1157-62. [PMID: 18394451 DOI: 10.1016/j.amjcard.2007.11.070] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2007] [Revised: 11/27/2007] [Accepted: 11/27/2007] [Indexed: 11/19/2022]
Abstract
N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) level at rest is related to left ventricular (LV) function and cardiovascular mortality in patients with heart failure (HF). There are limited and controversial data regarding changes in NT-pro-BNP level during exercise in patients with HF. The aim of this study was to investigate the effects of exercise on NT-pro-BNP levels and the relation between increases in NT-pro-BNP and the LV ejection fraction and cardiovascular mortality in patients with HF. Seventy-five patients with HF (New York Heart Association classes I to III) and 20 healthy subjects were enrolled in the study. Echocardiographic examination was performed. The modified Bruce protocol was used for symptom-limited exercise testing. Levels of NT-pro-BNP were measured at rest and after peak exercise. The patients were followed up for 690 to 840 days for cardiovascular mortality. Exercise induced significant increases in NT-pro-BNP in patients and controls. Except for a relative increase in NT-pro-BNP during exercise (relative DeltaNT-pro-BNP), NT-pro-BNP concentrations at rest and during peak exercise and absolute increases in NT-pro-BNP during exercise (absolute DeltaNT-pro-BNP) were significantly higher in patients with HF (p <0.001). Absolute DeltaNT-pro-BNP was positively correlated with NT-pro-BNP at rest (p <0.001). The level of absolute DeltaNT-pro-BNP was the most important parameter in predicting a LV ejection fraction <30% (p <0.001). Absolute DeltaNT-pro-BNP and LV end-systolic volume were found to be independent predictors of mortality (p = 0.012 and p = 0.015, respectively). In conclusion, exercise induced increases in NT-pro-BNP in patients and healthy subjects. Absolute increase in NT-pro-BNP is a reliable parameter in predicting a low LV ejection fraction and may help in the identification of patients at high risk for mortality.
Collapse
Affiliation(s)
- Mevlüt Koç
- Department of Cardiology, School of Medicine, Cukurova University, Adana, Turkey.
| | | | | | | | | |
Collapse
|
20
|
Pascual-Figal DA, Peñafiel P, de la Morena G, Redondo B, Nicolás F, Casas T, Valdés M. Relation of B-type natriuretic peptide levels before and after exercise and functional capacity in patients with idiopathic dilated cardiomyopathy. Am J Cardiol 2007; 99:1279-83. [PMID: 17478157 DOI: 10.1016/j.amjcard.2006.12.050] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2006] [Revised: 12/07/2006] [Accepted: 12/07/2006] [Indexed: 10/23/2022]
Abstract
Although much is known about the value of B-type natriuretic peptide (BNP) at rest, the significance of the responsiveness of BNP during exercise in patients with chronic heart failure (HF) without coronary artery disease remains to be established. A role of BNP release during exercise in the functional disability of patients with chronic HF and idiopathic dilated cardiomyopathy (IDC) was hypothesized. One hundred five consecutive patients with an established diagnosis of HF and IDC who underwent symptom-limited cardiopulmonary exercise testing were studied. BNP was measured immediately before exercise and within 1 minute of the end of exercise. BNP at rest increased significantly at peak exercise (median from 66.5 (first, third quartiles 18, 168) to 72.0 pg/ml (26, 208), p <0.001), but BNP response was not uniform. BNP response increased in 63% of patients, did not change in 22%, and decreased in 15%. BNP at rest and BNP response showed an inverse correlation (p <0.001, r = -0.523). Aging and low left ventricular ejection fraction were independent predictors of higher BNP levels at rest, but lower BNP response. Beta-blocker therapy did not influence BNP response. BNP at rest correlated negatively with functional capacity (p <0.001, r = -0.516), whereas BNP response correlated positively (p = 0.002, r = 0.326). Patients with BNP release (vs patients without) had higher maximum oxygen consumption (19.2 +/- 5.1 vs 15.9 +/- 3.6, p <0.001), better functional capacity (59 +/- 13% vs 50 +/- 15%, p = 0.002), and lower minute ventilation/carbon dioxide production slope (33.6 +/- 4.8 vs 36.5 +/- 7.7, p = 0.026) independent of other clinical parameters. In conclusion, BNP release during exercise could be a determinant of functional capacity in patients with chronic HF and IDC.
Collapse
Affiliation(s)
- Domingo A Pascual-Figal
- Cardiology Department, Hospital Universitario Virgen de la Arrixaca, University of Murcia, Murcia, Spain.
| | | | | | | | | | | | | |
Collapse
|
21
|
Engelmann MDM, Niemann L, Kanstrup IL, Skagen K, Godtfredsen J. Natriuretic peptide response to dynamic exercise in patients with atrial fibrillation. Int J Cardiol 2006; 105:31-9. [PMID: 16207542 DOI: 10.1016/j.ijcard.2004.10.046] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2004] [Accepted: 10/16/2004] [Indexed: 11/17/2022]
Abstract
BACKGROUND In patients with atrial fibrillation (AF) information regarding exercise release of atrial natriuretic peptide (ANP) is sparse and data on plasma brain natriuretic peptide (BNP) response to exercise is lacking. The aim of this study was to investigate plasma ANP and BNP response to exercise in patients with permanent AF and to assess if the response was different from the response in healthy age- and sex-matched control subjects. METHODS Plasma venous concentrations of ANP and BNP were determined at rest, at peak exercise and 30 min from the end of exercise in 38 patients with permanent AF and in 43 age- and sex-matched healthy control subjects. RESULTS Plasma concentrations of ANP and BNP were significantly higher in AF patients compared with the healthy control group at rest, peak exercise and after 30 min of recovery (p<0.0001). ANP and BNP increased significantly during exercise in both patients with AF and in the healthy control subjects (p<0.05). The increase in plasma concentration of ANP and BNP during exercise was significantly higher in AF patients compared with healthy controls (p=0.0002 for ANP; p<0.0001 for BNP). In the recovery period plasma BNP decreased significantly (p<0.0001) where as the decrease in plasma ANP was insignificant (p=0.4). CONCLUSIONS Patients with permanent AF have elevated levels of ANP and BNP at rest and exhibit much higher exercise release compared to healthy control subjects. This enhanced secretion of potent vasodilating and natriuretic agents may represent an important compensatory mechanism to improve exercise capacity in patients with AF.
Collapse
|
22
|
Pinarli FG, Oğuz A, Tunaoğlu FS, Karadeniz C, Gökçora N, Elbeg S. Late cardiac evaluation of children with solid tumors after anthracycline chemotherapy. Pediatr Blood Cancer 2005; 44:370-7. [PMID: 15602715 DOI: 10.1002/pbc.20281] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The therapeutic potential of anthracycline antibiotics is limited by their cardiotoxicity. Electrocardiography, exercise testing, and two-dimensional echocardiography are non-invasive techniques used in the follow-up of children for cardiotoxicity. Plasma B-type natriuretic peptide (BNP) levels are thought to be useful markers in the early detection of AC induced cardiomyopathy. PROCEDURE We evaluated cardiac status of 34 patients with solid tumors treated with anthracycline antibiotics. All of the patients were asymptomatic and had no evidence of residual malignancy. They were evaluated by electrocardiography, exercise testing, echocardiography, and plasma BNP levels measured before and after the exercise testing. RESULTS Electrocardiography revealed only minor abnormalities of little clinical significance. All of the patients completed the exercise testing without complication, and the duration of the exercise for each patient was between normal limits. Cardiac output (CO) and wall stress (WS) were significantly increased in patients, than in controls in echocardiographic evaluation of systolic functions (P < 0.001). Diastolic filling patterns showed various abnormalities; M-E, M-A, T-E, T-A, AT, and IVRT were significantly higher than those of controls. Mean plasma BNP levels of the patients (10.56 +/- 10.22 pg/ml) were significantly higher than BNP levels of the healthy controls (4.09 +/- 2.26 pg/ml) (P < 0.016), before exercise testing. The mean plasma BNP levels of the patients (15.70 +/- 14.06 pg/ml) were higher than resting state after exercise testing, but it was not statistically significant (P > 0.05). CONCLUSION Our findings demonstrated that echocardiographic and biochemical abnormalities could be found even at low cumulative doses of AC antibiotics. The use of serial echocardiographic studies and plasma BNP determinations to identify high-risk patients for cardiotoxicity needs to be verified by additional studies.
Collapse
Affiliation(s)
- F Güçlü Pinarli
- Department of Pediatric Oncology, Gazi University Medical Faculty, Ankara, Turkey.
| | | | | | | | | | | |
Collapse
|
23
|
Ogino K, Ogura K, Kinugawa T, Osaki S, Kato M, Furuse Y, Kinugasa Y, Tomikura Y, Igawa O, Hisatome I, Shigemasa C. Neurohumoral profiles in patients with hypertrophic cardiomyopathy: differences to hypertensive left ventricular hypertrophy. Circ J 2004; 68:444-50. [PMID: 15118286 DOI: 10.1253/circj.68.444] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Patients with hypertrophic cardiomyopathy (HCM) or hypertensive heart disease (HHD) have increased concentrations of various neurohumoral factors. Thus, the aim of the present study was to evaluate the differences in the neurohumoral profiles of HCM and HHD. METHODS AND RESULTS Plasma concentrations of epinephrine, norepinephrine, atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), angiotensin II and endothelin-1 were measured in 40 patients with HCM, 35 with HHD, and 15 controls. Additionally, the concentrations of these neurohumoral factors in the coronary sinus and aortic root were measured in 12 HCM patients and 10 controls. Plasma concentrations of norepinephrine, ANP and BNP were significantly higher in HCM than HHD and controls. In HCM, there was no significant correlation between the left ventricular mass index and any neurohumoral factor. The plasma BNP concentration significantly correlated with left intraventricular pressure gradient in HCM. There were significant differences in the plasma concentrations of ANP and BNP between HCM with and without left ventricular diastolic dysfunction. Transcardiac production of BNP was significantly higher in patients with obstructive HCM than in those with non-obstructive HCM. CONCLUSIONS The significant neurohumoral differences between HCM and HHD were the plasma concentrations of norepinephrine, ANP and BNP. In HCM patients, the plasma BNP concentration may reflect the intraventricular pressure gradient and left ventricular diastolic dysfunction whereas the plasma ANP concentration reflects only the left ventricular diastolic dysfunction.
Collapse
MESH Headings
- Aged
- Atrial Natriuretic Factor/blood
- Cardiomyopathy, Hypertrophic/blood
- Cardiomyopathy, Hypertrophic/complications
- Cardiomyopathy, Hypertrophic/diagnostic imaging
- Cardiomyopathy, Hypertrophic/physiopathology
- Coronary Vessels
- Echocardiography
- Female
- Heart Ventricles/diagnostic imaging
- Humans
- Hypertension/complications
- Hypertrophy, Left Ventricular/blood
- Hypertrophy, Left Ventricular/diagnostic imaging
- Hypertrophy, Left Ventricular/etiology
- Male
- Middle Aged
- Natriuretic Peptide, Brain/blood
- Norepinephrine/blood
- Pressure
- Ventricular Dysfunction, Left/blood
- Ventricular Dysfunction, Left/etiology
- Ventricular Function
Collapse
Affiliation(s)
- Kazuhide Ogino
- Department of Cardiovascular Medicine, Faculty of Medicine, Tottori University, Yonago, Japan.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
de Groote P, Soudan B, Lamblin N, Rouaix-Emery N, Mc Fadden E, Meurice T, Mouquet F, Bauters C. Is hormonal activation during exercise useful for risk stratification in patients with moderate congestive heart failure? Am Heart J 2004; 148:349-55. [PMID: 15309008 DOI: 10.1016/j.ahj.2004.03.044] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We previously demonstrated that A-type natriuretic peptide (ANP) at peak exercise was an independent predictor of cardiac survival. No data are available concerning the predictive value of B-type natriuretic peptide (BNP) at peak exercise. METHODS One hundred and fifty consecutive stable patients with moderate congestive heart failure (CHF) underwent echocardiography and a cardiopulmonary exercise test. Blood samples were drawn at rest and at peak exercise for the determination of plasma levels of ANP, BNP, and norepinephrine. RESULTS Exercise significantly increased plasma values of ANP, BNP, and norepinephrine. After a median follow-up period of 1171 days, there were 35 cardiac related deaths. Mortality rates at 1 and 2 years were 4% and 8%, respectively. Independent predictors of cardiac survival were percent of maximal predicted oxygen consumption (RR = 4.8 [2.1-11], P =.002), BNP at rest (RR = 2.5 [1.2-5.6], P =.01), and left atrial diameter (RR = 2.8 [1.2-6.5], P =.02). CONCLUSIONS In patients with stable, moderate CHF, plasma levels of ANP, BNP, and norepinephrine measured at peak exercise did not improve risk stratification. However, in addition to percent of maximal predicted oxygen consumption and left atrial diameter, plasma level of BNP at rest was an independent predictor of survival in CHF patients with low risk of cardiac events.
Collapse
Affiliation(s)
- Pascal de Groote
- TOP Service de Cardiologie C, Hôpital Cardiologique, Lille Cedex, France.
| | | | | | | | | | | | | | | |
Collapse
|
25
|
Mottram PM, Haluska BA, Marwick TH. Response of B-type natriuretic peptide to exercise in hypertensive patients with suspected diastolic heart failure: correlation with cardiac function, hemodynamics, and workload. Am Heart J 2004; 148:365-70. [PMID: 15309010 DOI: 10.1016/j.ahj.2004.02.012] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Diastolic heart failure (DHF) is characterized by dyspnea due to increased left ventricular (LV) filling pressures during stress. We sought the relationship of exercise-induced increases in B-type natriuretic peptide (BNP) to LV filling pressures and parameters of cardiovascular performance in suspected DHF. METHODS Twenty-six treated hypertensive patients with suspected DHF (exertional dyspnea, LV ejection fraction >50%, and diastolic dysfunction) underwent maximal exercise echocardiography using the Bruce protocol. BNP, transmitral Doppler, and tissue Doppler for systolic (Sa) and early (Ea) and late (Aa) diastolic mitral annular velocities were obtained at rest and peak stress. LV filling pressures were estimated with E/Ea ratios. RESULTS Resting BNP correlated with resting pulse pressure (r=0.45, P=0.02). Maximal exercise performance (4.6 +/- 2.5min) was limited by dyspnea. Blood pressure increased with exercise (from 143 +/- 19/88 +/- 8 to 191 +/- 22/ 90 +/- 10 mm Hg); 13 patients (50%) had a hypertensive response. Peak exercise BNP correlated with peak transmitral E velocity (r = 0.41, P <.05) and peak heart rate (r = -0.40, P <.05). BNP increased with exercise (from 48 +/- 57 to 74 +/- 97 pg/mL, P =.007), and the increment of BNP with exercise was associated with maximal workload and peak exercise Sa, Ea, and Aa (P <.01 for all). Filling pressures, approximated by lateral E/Ea ratio, increased with exercise (7.7 +/- 2.0 to 10.0 +/- 4.8, P <.01). BNP was higher in patients with possibly elevated filling pressures at peak exercise (E/Ea >10) compared to those with normal pressures (123 +/- 124 vs 45 +/- 71 pg/mL, P =.027). CONCLUSIONS Augmentation of BNP with exercise in hypertensive patients with suspected DHF is associated with better exercise capacity, LV systolic and diastolic function, and left atrial function. Peak exercise BNP levels may identify exercise-induced elevation of filling pressures in DHF.
Collapse
|
26
|
Bentzen H, Pedersen RS, Nyvad O, Pedersen EB. Effect of exercise on natriuretic peptides in plasma and urine in chronic heart failure. Int J Cardiol 2004; 93:121-30. [PMID: 14975537 DOI: 10.1016/s0167-5273(03)00156-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2002] [Revised: 12/26/2002] [Accepted: 01/13/2003] [Indexed: 01/16/2023]
Abstract
BACKGROUND Plasma atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) are elevated in chronic heart failure (CHF). ANP is known to be increased during exercise in healthy subjects and CHF, while the response in BNP during exercise is less clear and does not exist in C-type natriuretic peptide (CNP) and aquaporin-2 (AQP2) in either healthy subjects or CHF. METHODS Eleven patients with CHF and eleven healthy subjects performed a maximal aerobic exercise test. ANP and BNP in plasma were determined every 3 min and at maximum exercise by radioimmunoassay (RIA) and CNP and AQP2 in urine were determined before and after the exercise test by RIA. RESULTS The absolute increase in BNP during exercise was higher in patients with CHF (CHF: 4.1 pmol/l; healthy subjects: 1.3 pmol/l, P<0.05) and was positively correlated to BNP at rest (P<0.05), while the absolute increase in ANP during exercise was the same in the two groups (CHF: 4.2 pmol/l; healthy subjects: 6.8 pmol/l, not significant, NS). In CHF, exercise did not change either u-CNP excretion (rest: 9.8 ng/mmol creatinine; after exercise: 8.8 ng/mmol, NS) or u-AQP2 (rest: 466 ng/mmol creatinine; after exercise: 517 ng/mmol creatinine, NS) as well as in healthy subjects where u-CNP (rest: 9.7 ng/mmol creatinine; after exercise: 9.2 ng/mmol creatinine) and u-AQP2 (rest: 283 ng/mmol creatinine; after exercise: 307 ng/mmol creatinine) were the same at rest and after exercise. CONCLUSION The absolute increase in BNP during exercise is higher in patients with CHF compared to healthy subjects. It is suggested that this is a compensatory phenomenon to improve the exercise capacity in CHF, and that BNP is a more important factor in cardiovascular homeostasis during exercise in CHF than ANP.
Collapse
Affiliation(s)
- Hans Bentzen
- Department of Medicine, Holstebro Hospital, DK-7500 Holstebro, Denmark.
| | | | | | | |
Collapse
|
27
|
Krüger S, Graf J, Merx MW, Stickel T, Kunz D, Hanrath P, Janssens U. Brain natriuretic peptide kinetics during dynamic exercise in patients with chronic heart failure. Int J Cardiol 2004; 95:49-54. [PMID: 15159038 DOI: 10.1016/j.ijcard.2003.04.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2002] [Revised: 04/07/2003] [Accepted: 04/13/2003] [Indexed: 11/22/2022]
Abstract
BACKGROUND The kinetics of brain natriuretic peptide (BNP) secretion in chronic heart failure (CHF) during dynamic exercise have been the subject of controversial debate. The present study was therefore aimed to further clarify whether marked changes in BNP levels occur during and directly after vigorous exercise in CHF patients. METHODS We prospectively studied 37 patients with CHF (60+/-10 years, LVEF 26+/-6%) and 20 healthy controls (58+/-11 years, LVEF 60+/-3%). Standardized exercise testing was performed in all CHF patients and controls. Venous blood samples for measurement of BNP were obtained prior to symptom-limited exercise, at peak exercise and at 1 and 5 min of recovery time. RESULTS BNP concentrations were significantly higher in CHF compared to controls at rest, peak exercise and at 1 and 5 min of recovery. BNP levels did not change significantly during exercise in the control group. In CHF patients, BNP levels showed no marked difference at rest (428+/-421 pg/ml), peak exercise (507+/-450 pg/ml, n.s.), 1 min (560+/-460 pg/ml, n.s.) and 5 min recovery (526+/-424 pg/ml, n.s.). Strikingly, 6 of 37 CHF patients (16%) showed a decrease in BNP at exercise compared to rest but none of the controls. CONCLUSIONS BNP levels in CHF patients and healthy controls are not significantly altered by vigorous exercise. In contrast to controls, 16% of CHF patients showed a decrease in BNP levels at exercise. In CHF, BNP levels were inversely correlated with peak VO(2), VO(2)-AT and LVEF.
Collapse
Affiliation(s)
- Stefan Krüger
- Medical Clinic I, University Hospital, University of Technology, Aachen, Germany.
| | | | | | | | | | | | | |
Collapse
|
28
|
Marie PY, Mertes PM, Hassan-Sebbag N, de Talence N, Djaballah K, Djaballah W, Friberg J, Olivier P, Karcher G, Zannad F, Bertrand A. Exercise release of cardiac natriuretic peptides is markedly enhanced when patients with coronary artery disease are treated medically by beta-blockers. J Am Coll Cardiol 2004; 43:353-9. [PMID: 15013114 DOI: 10.1016/j.jacc.2003.07.047] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2003] [Revised: 07/02/2003] [Accepted: 07/07/2003] [Indexed: 11/21/2022]
Abstract
OBJECTIVES This study sought to identify determinants of the exercise rise in plasma levels of cardiac natriuretic peptides (NPs) in patients with coronary artery disease (CAD). BACKGROUND During stress, there is a variable rise in the plasma level of NPs, but this rise frequently reaches levels that are known to lower the cardiac load and that thus might be beneficial to CAD patients. METHODS Plasma venous concentrations of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) were determined at rest and peak exercise in 104 patients with chronic CAD who were referred to exercise thallium-201 ((201)Tl) single-photon emission computed tomography (SPECT) and radionuclide angiography. RESULTS The extent of scarred myocardium by (201)Tl-SPECT and patient age were the best independent predictors of NP concentrations at rest, but also of increases in NP concentration during exercise (all p < 0.001). Moreover, beta-blocking treatment was an additional and strong independent predictor of the increase in NP concentrations at exercise (p < 0.001 for ANP; p = 0.001 for BNP). On average, exercise increases in NP concentrations were more than twice as high in patients with (n = 55) than in those without (n = 49) beta-blocker treatment (ANP: +49 +/- 63 vs. +22 +/- 25 ng/l, p = 0.01; BNP: +24 +/- 5 vs. +11 +/- 15 ng/l, p = 0.04), whereas NP concentrations at rest were equivalent in the two groups (ANP: 34 +/- 34 vs. 30 +/- 33 ng/l, p = NS; BNP: 85 +/- 152 vs. 57 +/- 101 ng/l, p = NS). CONCLUSIONS Patients with chronic CAD exhibit much higher exercise releases of ANP and BNP when they are treated with beta-blockers. This enhanced secretion of potent vasodilating and natriuretic agents constitutes an original therapeutic mechanism for further protecting diseased hearts against stress.
Collapse
|
29
|
Kjaer A, Appel J, Hildebrandt P, Petersen CL. Basal and exercise-induced neuroendocrine activation in patients with heart failure and in normal subjects. Eur J Heart Fail 2004; 6:29-39. [PMID: 15012916 DOI: 10.1016/s1388-9842(03)00035-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2001] [Revised: 10/08/2002] [Accepted: 01/23/2003] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Neuroendocrine activation is a pathophysiological response and an important prognostic marker in patients with chronic heart failure (CHF). Although chronic activation is well described, data on the responsiveness of the hormone systems are more limited. Most previous studies have looked at activation during maximal exercise, whereas we believe that activation at a submaximal level might be more pathophysiologically relevant. AIM To compare exercise-induced neurohormonal activation between CHF patients and normal subjects using the same relative and submaximal workload. SUBJECTS Twenty-three newly-diagnosed CHF patients and 18 age- and gender-matched healthy subjects were exercised at two workloads, which were calculated to correspond to 50 and 75% of each individual's heart rate response. RESULTS In CHF patients, baseline levels of ANP, BNP, AVP, PRA and ET-1 were elevated compared to healthy subjects. Exercise induced an increase in ANP, A and NA in both CHF patients and in normal subjects, however BNP was only increased in CHF patients and not in normal subjects. CONCLUSION When CHF patients exercise at the same relative and submaximal level as age-matched healthy subjects, the relative increases in ANP, A and NA were similar, however, BNP levels only increased in the CHF group.
Collapse
Affiliation(s)
- Andreas Kjaer
- Department of Clinical Physiology and Nuclear Medicine, Frederiksberg Hospital, University of Copenhagen, Frederiksberg, Denmark.
| | | | | | | |
Collapse
|
30
|
Pliquett RU, Cornish KG, Patel KP, Schultz HD, Peuler JD, Zucker IH. Amelioration of depressed cardiopulmonary reflex control of sympathetic nerve activity by short-term exercise training in male rabbits with heart failure. J Appl Physiol (1985) 2003; 95:1883-8. [PMID: 12857767 DOI: 10.1152/japplphysiol.00486.2003] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The reflex regulation of sympathetic nerve activity has been demonstrated to be impaired in the chronic heart failure (CHF) state compared with the normal condition (Liu JL, Murakami H, and Zucker IH. Circ Res 82: 496-502, 1998). Exercise training (Ex) appears to be beneficial to patients with CHF and has been shown to reduce sympathetic outflow in this disease state (Hambrecht R, Hilbrich L, Erbs S, Gielen S, Fiehn E, Schoene N, and Schuler G. J Am Coll Cardiol 35: 706-713, 2000). We tested the hypothesis that Ex corrects the reduced cardiopulmonary (CP) reflex response to volume expansion in the CHF state. Normal, normal with Ex, CHF, and CHF with Ex (CHF-Ex) groups (n = 10-21) of male New Zealand White rabbits were studied. CHF was induced by chronic ventricular pacing. Rabbits were instrumented to record left ventricular end-diastolic pressure (LVEDP), left ventricular end-diastolic diameter (LVEDD), and renal sympathetic nerve activity (RSNA). Experiments were carried out with the animals in the conscious state. Volume expansion was performed with 6% dextran in normal saline at a rate of 5 ml/min to approximately 20% of estimated plasma volume without any significant effect on mean arterial pressure being exhibited. The relationships between RSNA and LVEDP and between RSNA and LVEDD were determined by linear regression; the slopes served as an index of CP reflex sensitivity. Normal rabbits exhibited a CP reflex sensitivity of -8.4 +/- 1.5%delta RSNA/mmHg. This value fell to 0.0 +/- 1.3%delta RSNA/mmHg in CHF rabbits (P < 0.001). Ex increased CP reflex sensitivity to -5.0 +/- 0.7%delta RSNA/mmHg in CHF-Ex rabbits (P < 0.05 compared with CHF). A similar trend was seen when related to the change in LVEDD. Furthermore, resting RSNA expressed as a percentage of maximum RSNA in response to cigarette smoke was also normalized by Ex in rabbits with CHF. Ex had no effect on these parameters in normal rabbits. These data confirm an impairment of CP reflex sensitivity and sympathoexcitation in CHF vs. normal animals. Ex substantially restored both CP reflex sensitivity and baseline RSNA in CHF animals. Thus Ex beneficially affects reflex regulation in CHF, thereby lowering resting sympathetic nerve activity.
Collapse
Affiliation(s)
- R U Pliquett
- Department of Physiology and Biophysics, University of Nebraska Medical Center, Omaha, Nebraska 68198-4575, USA
| | | | | | | | | | | |
Collapse
|
31
|
Abstract
BACKGROUND Heart failure (HF) is a significant clinical and economic burden in the industrialized world. Advances in pharmaceutical compounds and various medical device technologies along with the use of sophisticated HF clinics have enhanced HF treatment and improved morbidity, mortality, and quality of life. However, hospital readmission rates remain stubbornly high. B-type natriuretic peptide (BNP) levels provide valuable information about a patient's chance of readmission within 30 days of discharge, making BNP a potentially useful tool for making discharge decisions and possibly reducing readmissions. METHODS This review examines the strength and level of evidence in key areas to determine if BNP levels could be used as a guide for discharge of HF patients. Although most of the literature describes nonrandomized studies, there is general agreement that BNP levels can be measured accurately and precisely, that BNP levels reflect varying physiologic states, and that they predict outcomes. CONCLUSIONS More studies are needed to determine extent of biologic variability. The further use of BNP as a potential discharge marker is promising but awaits additional randomized study that reflects use in a broad-based population.
Collapse
Affiliation(s)
- Mary A Caldwell
- School of Nursing, University of California-San Francisco, Box 0610, San Francisco, CA 94143-0610, USA
| | | | | |
Collapse
|