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PubMed2002

Health related quality of life in patients with congestive heart failure: comparison with other chronic diseases and relation to functional variables.

OBJECTIVE: To assess health related quality of life of patients with congestive heart failure; to compare their quality of life with the previously characterised general population and in those with other chronic diseases; and to correlate the different aspects of quality of life with relevant somatic variables. SETTING: University hospital. PATIENTS AND DESIGN: A German version of the generic quality of life measure (SF-36) containing eight dimensions was administered to 205 patients with congestive heart failure and systolic dysfunction. Cardiopulmonary evaluation included assessment of New York Heart Association (NYHA) functional class, left ventricular ejection fraction, peak oxygen uptake, and the distance covered during a standardised six minute walk test. RESULTS: Quality of life significantly decreased with NYHA functional class (linear trend: p < 0.0001). In NYHA class III, the scores of five of the eight quality of life domains were reduced to around one third of those in the general population. The pattern of reduction was different in patients with chronic hepatitis C and major depression, and similar in patients on chronic haemodialysis. Multiple regression analysis showed that only the NYHA functional class was consistently and closely associated with all quality of life scales. The six minute walk test and peak oxygen uptake added to the explanation of the variance in only one of the eight quality of life domains (physical functioning). Left ventricular ejection fraction, duration of disease, and age showed no clear association with quality of life. CONCLUSIONS: In congestive heart failure, quality of life decreases as NYHA functional class worsens. Though NYHA functional class was the most dominant predictor among the somatic variables studied, the major determinants of reduced quality of life remain unknown.

Chronic Disease↗
PubMed2006

Relationship between Doppler transmitral flow velocity pattern and plasma atrial and brain natriuretic peptide concentrations in anuric patients on maintenance hemodialysis.

Plasma atrial (ANP) and brain (BNP) natriuretic peptide levels were compared to determine if transmitral flow velocity pattern is an instantaneous marker of body fluid balance in anuric patients on hemodialysis (HD). We measured plasma ANP and BNP levels and performed Doppler echocardiography in 38 anuric patients before and after HD. Patients with valvular disease, left ventricular systolic dysfunction having a fractional shortening < 0.3, arrhythmia, or left ventricular hypertrophy were excluded. The relationships between plasma ANP or BNP levels and the transmitral flow velocity pattern were evaluated. We also determined if the magnitude of the decrease in plasma ANP level was related to that in the early peak of transmitral flow velocity (peak E). The mean age of the subjects was 61.1 +/- 9.7 years. The ANP level of 213.6 +/- 146.1 pg/mL was related to peak E of 61 +/- 15 cm/s before HD (R = 0.504, P < 0.001), but not after HD. Plasma ANP level was not related to peak late transmitral flow velocity (peak A) or peak E/peak A before or after HD. BNP level was not related to the transmitral flow velocity pattern. The magnitude of decrease in hANP level during HD was significantly related to that in peak E (R = 0.342, P < 0.05). Before HD, peak E was related to the plasma ANP level, reflecting volume overload. Change in peak E showed a weak relationship with that of plasma ANP level in the same HD patient. The measurement of peak E during a HD session may potentially enable the assessment of hydration status during HD.

Aged↗
PubMed2004

Impaired left ventricular diastolic function during isometric exercise in asymptomatic patients with hyperlipidaemia.

BACKGROUND: Left ventricular (LV) diastolic dysfunction is an early sign, and may be more sensitive indicator, of ischaemic heart disease (IHD) than systolic dysfunction. METHODS: LV diastolic function was assessed during isometric exercise (IME) in 37 consecutive normotensive hyperlipidaemics (LIP), without cardiac history or symptoms. Each patient underwent a stress ECG test and 2-D echo and Doppler cardiography. During the latter, transmitral flow at rest and at peak standardised IME using handgrip was studied. From the tracings, the E/A (peak velocity of the early/atrial components), the contribution of atrial systole to LV filling (ACF), the deceleration time (DT) of the E wave and the isovolumic relaxation time (IVRT) were calculated. Results were compared to 37 age-matched normal healthy volunteers (NOR). RESULTS: Resting E/A was not different between NOR and the LIP. A significant reduction in E/A with IME was observed in LIP but not in NOR. Impaired LV filling (shown by E/A<1) was demonstrated in five patients (13%) at rest and in 20 patients (54%) at peak IME. All NOR had E/A>1 suggesting normal LV filling. Fifteen of the 30 patients with negative stress ECG test demonstrated LV diastolic dysfunction. ACF was higher in LIP than NOR and increased significantly (P<0.005) by 23% during IME. DT and IVRT in LIP were not different from NOR. In neither NOR nor LIP, were the LV diastolic functional parameters related to gender, smoking habit or levels of total cholesterol, LDL- or HDL-cholesterol or triglycerides. CONCLUSION: The prevalence of LV diastolic dysfunction in asymptomatic patients with hyperlipidaemia despite a negative stress ECG test may be evidence of early underlying pre-clinical myocardial ischaemia.

Adult↗
PubMed2001

[ACE inhibition in patients with myocardial infarct and ventricular dysfunction: inappropriate application of therapy standards in patient samples].

Several reports indicate the benefit of ACE inhibitors for patients with left ventricular systolic dysfunction after acute myocardial infarction (MI). We sought to determine the implementation of the treatment guidelines in patient samples from the general population. Furthermore we aimed to identify patient characteristics associated with the use of ACE inhibitors. Screening of two MI-registries allowed the identification of 226 MI patients with left ventricular dysfunction. Patients were considered to be eligible for ACE inhibitor therapy when a EF < or = 40% was documented in the patient records of cardiac rehabilitation clinics (REG-MI, n = 147) or detected by standardised echocardiography (KORA, n = 78). On average 5.5 years following MI, a standardised questionnaire and a detailed medical history was obtained. Specifically, information was collected regarding current medication and potential contraindications for ACE inhibitors. MI patients with LV dysfunction received ACE inhibitors in 62% (REG-MI) and 45% (KORA). The doses prescribed were substantially smaller than target doses used in the large-scale studies (REG-MI: 40 +/- 4%, KORA: 23 +/- 3%, % of target doses). Only 13% (REG-MI) and 3% (KORA) received more than 50% of the target dosage. Additionally, actual doses of the most frequently used ACE inhibitors were significantly different (captopril: 23 +/- 2%, enalapril: 42 +/- 5% of target doses). The likelihood of receiving ACE inhibitors was significantly higher in patients with written recommendation for such medication (odds ratio 6.02, confidence interval 1.93-20.16) and in patients visiting cardiologists (odds ratio 3.69, confidence interval 1.26-11.07) as revealed by multivariate analysis of the REG-MI database. Despite national and international guidance, a large proportion of MI patients with left ventricular dysfunction is not receiving ACE inhibitors, and when used, the doses prescribed are markedly smaller than target doses used in clinical trials that established the utility of these drugs. Medical care by cardiologists and written recommendation of ACE inhibition in patient records were independent predictors of a more appropriate prescription of ACE inhibitors.

Aged↗
PubMed2002

Reversible left ventricular dysfunction simulating a myocardial infarction after pericardiectomy.

A 39 year old man with postoperative constrictive pericarditis after pericardiectomy developed major left ventricular systolic dysfunction with an anterior wall infarct pattern on ECG but no regional wall motion abnormalities by echocardiography or serum enzymatic evidence of a myocardial infarction. The left ventricular dysfunction resolved over two weeks with supportive treatment. It is postulated that this patient's transient left ventricular dysfunction and ECG changes were caused by myocardial inflammation and oedema induced by operative trauma during pericardiectomy.

Adult↗
PubMed2000

Efficient utilization of echocardiography for the assessment of left ventricular systolic function.

BACKGROUND: We hypothesized that patients could be selected for echocardiographic evaluation of left ventricular (LV) systolic function on the basis of historic, clinical, radiographic, and electrocardiographic criteria. METHODS AND RESULTS: We prospectively evaluated 300 consecutive inpatients referred for the echocardiographic assessment of LV function, of whom 124 (41%) had LV systolic dysfunction (LVSD) (LV ejection fraction <0.45). Among the historic variables, male sex was the only predictor of LVSD, whereas of the abnormal physical and radiographic findings, cardiomegaly on chest radiography was the only predictor. Among the electrocardiographic findings, the presence of left bundle branch block was positively correlated with the presence of LVSD, whereas a normal electrocardiogram was negatively correlated with this finding. Only 2 patients with LVSD had a normal electrocardiogram. The addition of significant predictors on physical examination and chest radiography doubled the predictive value of the historic variables for determining LVSD. The addition of electrocardiographic findings further doubled the predictive value of the model. Almost 45% of the predictive power of the final multivariate model (chi-square of 48 of the total chi-square of 108) was based on the absence of normal electrocardiogram in patients with LVSD. When chest radiographic findings were excluded from the model, the overall predictive power of the model did not change, with the normal electrocardiogram gaining greater prominence: Full 56% of the predictive power of the model (chi-square of 60 of the total chi-square of 108) resided in the ability of a normal electrocardiogram to discriminate between patients with and those without LVSD. CONCLUSIONS: Historic, chest radiographic, and electrocardiographic variables can be used to predict low likelihood of LVSD on echocardiography. In particular, when the electrocardiogram is normal, it is extremely unlikely to have LVSD. It can be argued that such patients should not be referred for echocardiography.

Aged↗
PubMed2005

Concentric left ventricular remodeling in endothelial nitric oxide synthase knockout mice by chronic pressure overload.

OBJECTIVE: Heart failure as a consequence of sustained hemodynamic overload is among the most prevalent diseases in developed countries. The aim of the present study was to investigate the specific role of endothelial nitric oxide synthase (eNOS) in pressure overload-induced left ventricular (LV) hypertrophy. METHODS AND RESULTS: Chronic pressure-overload LV hypertrophy was induced by abdominal aortic banding (AC) in wild-type (WT) and eNOS(-/-) mice. Six weeks after abdominal AC, the consequences of the sustained pressure overload on LV morphology and function were noninvasively and invasively assessed using echocardiography and a 1.4 F conductance catheter. Sham-operated eNOS(-/-) mice had significantly increased systolic blood pressure, slightly enhanced systolic function (preload recruitable stroke work) and normal diastolic function but no evidence of left ventricular hypertrophy when compared to sham-operated WT animals. AC resulted in a greater increase in anterior wall thickness in eNOS(-/-) mice (0.8+/-0.03 mm) compared to WT mice (0.7+/-0.03 mm; P<0.05). The LV end-diastolic diameter was unchanged by AC in eNOS(-/-) mice (sham: 3.8+/-0.1 mm, AC: 3.7+/-0.2 mm) but significantly increased in WT mice (sham: 3.9+/-0.1 mm, AC: 4.5+/-0.2 mm; P<0.05). Interstitial fibrosis and myocyte hypertrophy were greater in eNOS(-/-) than in WT mice after AC. AC in eNOS(-/-) mice caused a greater diastolic than systolic dysfunction compared to WT mice. CONCLUSION: Chronic pressure overload in eNOS(-/-) mice results in concentric LV hypertrophy without LV dilation and impaired systolic and diastolic function. These findings suggest that eNOS limits LV remodeling and dysfunction and modulates extracellular matrix proteins under chronic pressure overload.

Animals↗
PubMed2006

A systematic review: effect of angiotensin converting enzyme inhibition on left ventricular volumes and ejection fraction in patients with a myocardial infarction and in patients with left ventricular dysfunction.

BACKGROUND AND AIM: To summarize and quantify results of echocardiographic studies examining the effect of angiotensin converting enzyme (ACE) inhibition on left ventricular remodelling in patients with acute myocardial infarction (MI) and in patients with left ventricular systolic dysfunction (LVSD). METHODS: Systematic review of the literature and meta-analysis of eligible studies providing data on end-diastolic and end-systolic volumes and left ventricular ejection fraction (LVEF) were performed. RESULTS: Data from 16 eligible studies were meta-analysed. The results of studies including patients with MI and preserved LVEF (>45%) showed no significant benefit of ACE inhibition. Results of studies/subgroups with mean LVEF < or =45% demonstrated significant differences in diastolic and systolic volumes of 3.0 (0.1, 6.0) ml and 2.25 (0.04, 4.4) ml in short-term (4-14 weeks) follow-up in favour of ACE inhibitor, p=0.041 and p=0.046 respectively. In the long-term (6-12 months) follow-up, the differences in diastolic and systolic volumes were 4.2 (0.98, 7.4) ml and 3.3 (0.9, 5.8) ml in favour of ACE inhibitor, p=0.01 and p=0.007 respectively. LVEF improved in both short and long-term follow-up, p=0.034 and p=0.021, respectively. CONCLUSION: Chronic use of ACE inhibition has a small but sustained and beneficial effect on remodelling in patients with myocardial infarction and patients with chronic left ventricular dysfunction.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2001

Diabetes related cardiomyopathy time dependent echocardiographic evaluation in an experimental rat model.

Type I diabetes is associated with a unique form of cardiomyopathy in the absence of atherosclerosis. The mechanisms involved in this phenomenon are not defined, but in humans this is associated with initial diastolic dysfunction followed by altered contractile performance. A relevant animal model would provide opportunities for mechanistic studies and experimental therapeutics, but none have been previously established for this unique form of cardiac pathophysiology, particularly with respect to clinically relevant and time-dependent diastolic and systolic assessments. Here we tested the hypothesis that the streptozotocin rat model mimics human phenomena with respect to time-dependent diastolic and systolic performance deficits, and investigated a role for cardiac hypertrophy and/or fibrosis. Streptozotocin was dosed 65 mg/kg i.p. and cardiac performance was assessed longitudinally for 56 days using noninvasive echocardiographic techniques. Significant hyperglycemia was detected within 3 days and remained elevated throughout the study (p<0.05). Significant reductions in HR and diastolic performance (transmitral flow velocities and slopes) were observed within 3 days relative to age matched controls, and these reductions progressed throughout the 56 day study. In contrast, statistically significant systolic dysfunction (LV fractional shortening, cardiac output) and LV dilation were detected only after 35 days. Increases in LV size and/or extent of fibrosis were not observed at any time. These results demonstrate the value of echocardiographic methods for time-dependent diastolic and systolic assessments in rodent models. Furthermore, diastolic dysfunction precedes contractile abnormalities in the streptozotocin model, similar to events that occur in humans.

Analysis of Variance↗
PubMed2005

Cardiovascular abnormalities in hyperthyroidism: a prospective Doppler echocardiographic study.

PURPOSE: We investigated the prevalence and clinical importance of cardiovascular abnormalities in patients with hyperthyroidism. METHODS: All consecutive patients diagnosed with hyperthyroidism during a period of 24 months were included in the study. Medical history, complete physical examination results, electrocardiographic findings, laboratory determinations, and Doppler echocardiographic findings were obtained for all patients within 24 hours of diagnosis, and after euthyroidism had been achieved. Age- and sex-matched controls also were studied. RESULTS: Thirty-nine patients (mean [+/-SD] age, 52 +/- 20 years; range, 25 to 86 years; 72% women), and 39 age- and sex-matched controls, were included. Atrial fibrillation was present in 7 patients (18%). Moderate or severe mitral or tricuspid regurgitation, or both, were present in 9 patients (23%) and in only 1 control (3%; P= 0.01). Mean pulmonary arterial systolic pressure was 38 +/- 12 mm Hg (range, 17 to 64 mm Hg) in patients and 27 +/- 4 mm Hg (range, 19 to 37 mm Hg) in controls (P= 0.001). Sixteen patients (41%) and 1 control (3%) had pulmonary arterial systolic pressure >or=35 mm Hg. Left ventricular systolic dysfunction was detected in 1 patient. After correction of hyperthyroidism, a significant decrease in pulmonary arterial systolic pressure was observed, and the levels became similar to those of controls. CONCLUSION: In patients with hyperthyroidism, there is a high prevalence of pulmonary hypertension and atrioventricular valve regurgitation. These abnormalities usually correct after treatment for hyperthyroidism.

Adult↗
PubMed2004

Heart failure in women.

Women who experience heart failure (HF) exhibit distinct differences from men. Because women are a minority in major HF trials and because diagnostic criteria have been variable in epidemiologic surveys, many questions remain unanswered. This article describes differences in sex hormone effects and responses to injury, pressure overload, and aging, which may account for differences observed in epidemiology, risk factors and causes, mechanisms for disease development, response to treatment, and outcomes. Hypertension,diastolic dysfunction, diabetes, obesity, and inactivity are more important factors in women, whereas ischemic heart disease and systolic dysfunction are more important factors in men. Women appear to benefit less from established treatments but have better survival. Future studies directed exclusively at women may be warranted to confirm or establish benefits of existing and future treatments.

Adult↗
PubMed2005

Hypertension--still an important cause of heart failure?

Hypertension has been the single most important risk factor for heart failure until the last few decades. Now, it is frequently claimed that atherosclerotic coronary artery disease dominates as the major underlying cause, and hypertension is of lesser importance. We here review evidence regarding the contribution of hypertension to heart failure in the recent decades. It is not possible, in our view, to be confident of the relative importance of hypertension and coronary artery disease since there are significant limitations in the available data. The often-questionable diagnostic criteria used in defining heart failure is one such limitation. The absence or inadequacy of blood pressure recordings over the years prior to a diagnosis of heart failure seriously hinders the reaching of firm conclusions in many reports. Extrapolations from aetiological observations in one racial group to those in other racial groups, and from highly selected study groups in tertiary referral centres to patients with heart failure in primary and secondary care, may not be justified. Finally, the situation of heart failure primarily due to impaired left ventricular diastolic function, where hypertension is a frequent precursor, is often ignored in discussions of aetiology. Our view is that hypertension remains and probably is the single most, important modifiable risk factor for cardiac failure in some races and countries, where the dominant cardiac abnormality is left ventricular diastolic dysfunction. The situation is less clear for patients with heart failure primarily due to left ventricular systolic dysfunction.

Heart Failure↗
PubMed2005

The applications of B-type natriuretic peptide measurement in the intensive care unit.

PURPOSE OF REVIEW: Plasma B-type natriuretic peptide levels are used to screen for cardiac dysfunction in the emergency department and outpatient population. However, in the critically ill patient elevated plasma B-type natriuretic peptide levels do not necessarily reflect just ventricular dysfunction, as there are important confounding factors to consider. This review summarizes the recent advances in the application of B-type natriuretic peptide measurement in the intensive care unit. RECENT FINDINGS: B-Type natriuretic peptide levels are very useful in identifying cardiac dysfunction but not the specific pathology, whether it is right or left ventricular failure, diastolic or systolic dysfunction. Elevated serum B-type natriuretic peptide levels also occur in severe sepsis or septic shock. It also predicts cardiac dysfunction in sepsis. The lack of correlation of B-type natriuretic peptide concentrations with filling pressures in the intensive care unit precludes its use for monitoring cardiac therapy. Some studies involving patients with sepsis or septic shock demonstrate a positive correlation with mortality, while others failed to establish such a relation. The prognostic value of B-type natriuretic peptide in predicting mortality and morbidity remains controversial, partly due to different study designs. SUMMARY: B-Type natriuretic peptide is potentially a very useful diagnostic tool in the intensive care unit. To date there have been few studies and the results are often contradictory, mainly due to the special setting of the intensive care unit, which is constantly exposed to hemodynamically unstable patients, different case mixes as well as vigorous treatments. All of these are potential confounders to B-type natriuretic peptide levels and make interpretations of B-type natriuretic peptide difficult. We need more research on these confounding factors to accentuate the positive value of B-type natriuretic peptide in the intensive care unit.

Biomarkers↗
PubMed2002

[Quantitative evaluation of functional mitral insufficiency in dilated cardiomyopathy: morphological and functional correlations].

BACKGROUND: Angiography and echo-color Doppler imaging are routinely used for the semiquantitative grading of functional mitral regurgitation (MR) in dilated cardiomyopathy. However, in case of severe regurgitation the results obtained using these two methods are discrepant. We propose quantitative echocardiographic evaluation and the related morphological parameters of remodeling of the ventricular and mitral apparatuses for the estimate of severe regurgitation. METHODS: Fifty-two patients with dilated cardiomyopathy and functional MR (28 males, 24 females, ejection fraction < or = 40%) were evaluated by means of echocardiography for a total of 73 echocardiograms (basal and 21 at the sixth month). The echo measurements included the left ventricular end-diastolic and end-systolic volumes, ejection fraction, area jet/left atrial area, diastolic and systolic mitral annulus areas and fractional contraction (MAC, %), systolic tenting area (TA, cm2, area enclosed between the annular plane and mitral leaflets), systolic tethering length (TL, cm, papillary tips and intervalvular fibrosa distance); quantitative Doppler (using the mitral and aortic stroke volumes) and PISA methods were averaged to calculate the regurgitant volume (RV, ml/beat), regurgitant fraction (RF, %), and effective regurgitant orifice (ERO, mm2). RESULTS: The strongest correlation with ERO, RV and RF was obtained with systolic TA (beta = 0.40, 0.67 and 0.60; SE 1.68, 1.56 and 1.38; p = 0.01, p = 0.0001 and p = 0.0001, respectively) and MAC (beta = -0.33, -0.61 and -0.61; SE 0.31, 0.31 and 1.49; p = 0.03, p = 0.0001 and p = 0.0001, respectively). We did not find any correlation with ejection fraction (p = NS). The following values were found to be indicative of severe functional MR: ERO > or = 40 mm2, RV > or = 49 ml/beat, RF > or = 57%, MAC < or = 12.5%, TA > or = 7.7 cm2, and TL > or = 4.7 cm. CONCLUSIONS: We did not find any significant correlation between the quantitative functional MR echo parameters and systolic dysfunction. The major determinants of ERO, RV and RF were the loss of MAC and larger systolic TAs. These parameters are significantly proportional to the severity of functional MR as assessed by the semiquantitative criteria commonly adopted in the clinical practice. We propose the values of ERO, RV, RF, TA, MAC and TL as indicative of severe functional MR.

Cardiomyopathy, Dilated↗
PubMed2004

Relationship between plasma BNP levels and left ventricular diastolic function as measured by radionuclide ventriculography in patients with coronary artery disease.

BACKGROUND: Radionuclide ventriculography enables such parameters of the left ventricular (LV) function as the ejection fraction (EF), ejection rate (ER) and filling rate (FR) to be measured correctly. The impairment of the LV function in coronary artery disease (CAD) results in an increase in plasma brain natriuretic peptide (BNP). The aim of this study was to check whether the reduction of the average filling rate (AFR) leads to an increase in plasma BNP levels in patients with CAD and nEF and whether that increase is comparable to that occurring in subjects with a reduced PER. MATERIAL AND METHODS: The study population comprised 69 patients with CAD and 18 healthy subjects--a control group (CG). In all cases radionuclide ventriculography was performed at rest and the plasma BNP level was estimated. RESULTS: The plasma BNP concentration was significantly higher in the group with CAD than in those with CG . In patients with CAD and a decreased LVEF (dEF), the BNP level was significantly higher than in those with normal LVEF (nEF). In the subgroup with nEF and an AFR < or = 1.04 EDV/s, the level of plasma BNP was significantly higher than in that with an AFR >1.04. In the total CAD group, a significant correlation was found between plasma BNP concentrations and the LVEF, PER and AFR. In patients with nEF, the level of plasma BNP correlated only with the AFR. CONCLUSIONS: It is concluded that the diastolic dysfunction of the left ventricle in patients with CAD leads to an elevation of plasma BNP concentrations despite the normal ejection fraction. A diastolic dysfunction of the left ventricle affects the BNP plasma concentration to a greater degree than a systolic dysfunction.

Adult↗
PubMed1991

Left ventricular diastolic dysfunction in patients with congestive heart failure.

This study reviewed 372 male patients with congestive heart failure. Two hundred and eighty-three (77%) had congestive heart failure due to systolic dysfunction as demonstrated by radionuclide angiography. Eighty-seven (23%) with congestive heart failure were identified who had normal ejection fractions. All patients met the Framingham criteria for congestive heart failure. These 87 individuals had unrecognized diastolic heart failure. It is important to distinguish between systolic and diastolic heart failure because the pathophysiology, treatment, and prognosis differ significantly. The most frequent cause of diastolic heart failure in this study was hypertension. Diastolic dysfunction should be considered in patients with acute heart failure and severe uncontrolled hypertension, or in patients with ischemic heart disease who develop acute pulmonary edema. Patients who do not respond or deteriorate when treated for heart failure using conventional therapy may also have diastolic dysfunction. These patients warrant special recognition and tailored management.

Aged↗
PubMed2004

Association between C-reactive protein levels and N-terminal pro-B-type natriuretic peptide in pre-dialysis patients.

BACKGROUND: The prevalence of inflammation is high among patients with chronic renal failure but the reason of inflammation is unclear. We test the hypothesis that inflammation in chronic renal failure could be the consequence of an increased left-ventricular wall tension related to ventricular dysfunction, hypervolemia or both. METHODS: For assessing left-ventricular filling pressure, plasma level of N-terminal pro-B-type natriuretic peptide (N-BNP) was used, as B-type natriuretic peptide is secreted from the cardiac ventricles in response to increased wall tension. N-BNP levels and C-reactive protein (CRP) were measured on the same day in 75 pre-dialysis patients. A previous history of cardiomiopathy with systolic dysfunction was present in 27 (36%) of them. RESULTS: The levels of N-BNP were not normally distributed (mean: 2,589 +/- 4,514 pg/ml; median: 789 pg/ml). The distribution of CRP levels was also not normal (mean: 15 +/- 27 mg/l; median: 5 mg/l). Both parameters correlated significantly (r: 0.41; p < 0.005). N-BNP was higher (p < 0.001) in patients with known ventricular dysfunction. Excluding these patients, the correlation between N-BNP and CRP was stronger (r: 0.88; p < 0.001). Univariate analysis in these patients without known cardiomyopathy showed that N-BNP levels also correlated with systolic and diastolic blood pressure (r: 0.54; p < 0.005) and inversely with creatinine clearance (r: -0.43; p < 0.01), serum albumin (r: 0.6; p < 0.001) and hemoglobin levels (r: 0.37; p < 0.05). CRP levels correlated significantly (p < 0.01) with the same parameters as N-BNP in univariate analysis. However, in multiple stepwise regression analysis in which CRP was the dependent variable, only the association with N-BNP remained significant (r: 0.87; p < 0.001). CONCLUSIONS: Our results suggest a link between left-ventricular filling pressure and inflammation in patients with advanced renal insufficiency. The importance of strict volume control in these patients, in order to reduce left-ventricular pressure and therefore inflammation, should be considered.

Adult↗
PubMed1999

Does acute volume overloading in the setting of left ventricular dysfunction and pulmonary hypertension affect the defibrillation threshold?

The impact of acute volume overload hemodynamics on the DFT with concurrent moderate left ventricular systolic dysfunction is unknown. Ten mongrel dogs (17.2 kg), using a crossover study design, each had baseline (study 1) hemodynamic, echocardiographic, and DFT measurements. These measurements were repeated after left ventricular dysfunction was induced using a norepinephrine (5 micrograms/kg per min) infusion (study 2). Hemodynamic and DFT parameters were obtained simulating acute heart failure by volume overload with an 0.9% normal saline infusion to an associated mean pulmonary capillary wedge pressure of > 19 mmHg (study 3). Numerous significant echocardiographic and hemodynamic parameters were noted when the animals from studies 1 and 2, 2 and 3, and 1 and 3 were compared. A significant difference in the DFT was observed only when study animals 1 and 3 were compared (P < 0.02). None of the dogs were hypoxemic at the time of the acute heart failure DFT. The mechanism of this finding remains unknown. This data would suggest that acute volume overload with associated left ventricular dysfunction does adversely affect the DFT in a canine model.

Acute Disease↗