O3 NT-proBNP values compared with invasively measured left ventricular hemodynamic parameters

EUROPEAN

JOURNAL

OF’

INTERNAL MEDICINE

ELSEVIER

European

Journal

of Internal

Medicine

14 (2003)

Sl-SlS9 www.elsevier.com/locate/ejim

Abstracts of the 4th Congress of the European Federation of Internal Medicine Berlin, Germany, lo- 13 September, 2003 02 Carotid artery intima-media thickness as a risk factor for cardiovascular events in diabetic and non-diabetic patients with congestive heart failure A. Radman, J. Murin, J. Bulas, A. Reptova, T. Ravingerova, L. Baqi, K. Kozlikova, P. Mikes, W. Ghanem (Bratislava, SK)

Oral communication

Cardiovascular

medicine I

01 May time of symptom onset inlluence mortality of myocardial infarction? Data from a prospective cohort of emergency calls R. Manfredini, B. Boari, S. Bressan, M. Gallerani, R. Salmi, F. Portaluppi (Department of Clinical and Experimental Medicine, Section of Internal Medicine and Hypertension Center, University of Ferrara. Ferrara, Italy)

Objective: Myocardial infarction (MI) occurs more frequently in the morning, due to the concomitant unfavorable timing of several risk factors, However. little is known about the possible influence of this circadian pattern on prognosis. The aim of this study was to evaluate if circadian rhythms influence mortality from MI. Methods: We considered all consecutive MIS admitted to the Emergency Department of Ferrara, Italy, after a call to the Emergency Coordinating Unit, between January 1998 and December 1999. Diagnosis was made on the basis of clinical and laboratory findings, electrocardiogram, or autopsy. Site of infarction was presumably classified according to the territory served by a coronary vessel, and MB-creatinkinase peak serum level was always determined. Total sample consisted of 221 MIS (mean age=68.7 years, males=72%). Forty patients (males= 825%) died in the Emergency Department, the remaining 181 were admitted to the hospital. Of these, 25 (males=60%) died during hospital permanence. Symptoms onset was defined as the earliest time a patient (or a relative or a witness) first noted definite symptoms or signs (chest pain, dyspnea, shock, cardiac arrest). Based on the timing of symptom onset, patients were divided both into 24 l-h intervals and four 6-h intervals (Group A=OO:Ol to 6.00 am. Group B=6.01 to 12:00 am, Group C=12:01 to 6.00 pm, and Group D=6.00 to 24:00 pm). Partial Fourier series for rhythm analysis, and c2 test for goodness of fit were used, respectively. Results: The circadian variation of MI showed a main peak in the morning around 9 am (p=O.OlO). Moreover, the frequency of fatal vs. nonfatal cases was highest in Group B (p
matter

0

2003

Published

by Elsevier

B.V.

Background: Intima-media thickness (IMT) of carotid artery (CA) correlates with cardiovascular events (CVE) and cardiac function. Aim: To relate CA IMT to left ventricular (LV) function and CVE in diabetic [diabetes mellitus (DM) type 21 (D) and non-diabetic (ND) pts with congestive heart failure (CHF). Patients and methods: 280 pts followed for a mean time period of 2 years were divided into 2 groups: D: 150 pts (m: 82, f: 68, age 60.7595 y), ND: 130 pts (m: 74, f: 56, age 62.5210.9 y). Diagnosis of CHF done clinically and by ECHO (EF<40%). LV hypertrophy (LVH) defined by ECHO-Penn convention as LV mass index >134 g/m’ (m), >I 10 g/m’ (f). DM defined clinically or by oral glucose tolerance test (2 h blood glucose 111.1 mmol/l). Acute myocardial infarction (AMI) and stroke diagnosis done according to standard procedures. CA IMT measured by B-mode ultrasound of the far wall (bilaterally IMT of CA common, bifurcation and internal, mean of 6 values calculated). Significant differences were assumed for p0.93 mm/IMT<0.93 mm: ND: IMT>O.IO mm/ IMT
03 NT-proBNP values compared with invasively measured left ventricular hemodynamic parameters B. Gremmler, K. Kisters, M. Kunert, H. Schleiting, B. Berg, L. Ulbricht (Bottrop, Miinster, Witten-Herdecke, D)

Abstracts

s2

I European

Journal

of Internal

Background: proBNP is synthesized predominantly in the left ventricle of the heart. Determination of plasma levels of NT-proBNP is used as an aid in the diagnosis of left ventricular dysfunction within chronic heart failure. Methods: We analysed prospectively the NT-proBNP-levels before a left-heart catherization in 125 patients (m=87; f=38; mean age 60.5?10.2 years). The determination of NT-proBNP in plasma was performed by utilizing the electrochemiluminescence technology in the fully automatic Elecsys-analyser and the Elecsys-NTproBNP immunoassay. At the end of the study we compared the double blindly determined values of NT-proBNP with the invasively measured left ventricular hemodynamic parameters. Results: A significant (p=O.OOS) increase of the NT-proBNP-values (1770.8?1407.4 pg/ml) was observed in cases of very low ejection fraction (<41%) compared to the remaining ejection fractions (>40%). Furthermore a significant (p=O.O25) increase of the NT-proBNP-values (931.621223.9 pglml) was measured in cases of heavy reduced dP/dt max (cl500 mmHG/sec) compared to the remaining groups. The increase of NT-proBNP-values (2028.8?1904.1 pg/ml) in cases of high end-diastolic pressures was distinct but not significant. However a great standard value-deviation was seen in all three parameters and their subgroups. Further there was no significant correlation between the NT-proBNP-levels and the hemodynamic values in cases of middle or moderate heart failure. Conclusion: In cases of low ejection-fractions, high end-diastolic pressure and strong reduced dP/dt max a typical increase of NT-proBNPvalues was seen. These results were partly described in previous studies. However, the partly reported narrow correlation of the BNP-values to the left ventricular parameters was not found in the cases of middle and moderate heart failure respectively normal heart function, Regarding the high standard-deviation in all groups and subgroups it may be possible to discriminate an unfavourable course of heart failure in early stage. This aspect should observed in long-term studies.

04 Is intravenous thrombolysis Myocardial Infarction? A. Ali, J. Sharma (Mansjield,

beneficial

to

elderly

patients

with

UK)

Background: Management of acute Myocardial Infarction (Ml) in the elderly has been a matter of controversy [1,2]. We have studied the outcome of elderly patients admitted with Ml in our hospital. Methods: We studied consecutive patients from the MINAP database. All the patients with biochemically proven myocardial infarction and age 75 years and above were selected for this study. Diagnosis of acute Ml was made on the basis of elevated troponin T and or positive ECG changes. A proportion of patients with positive ECG changes were treated with thrombolysis. Outcome was measured as in-patient mortality. Results: One hundred fifty one patients aged 75 and above were studied, mean age (females 79.5 SD2.8 and males 78SD2.5). Positive ECG changes were present in 77 (50.7%) whereas troponin T was elevated in 95% of patients. 7 patients, with ECG evidence of Ml, died before Troponin T could be measured. 50 (65%) of the 77 patients were thrombolysed. Total mortality was 25 (16.5%) of the 151 patients. There was no difference in the mean age of patients who died (81.7 vs. 81 years) (p=O.52) as compared to patients who were discharged alive. However there was a significantly higher mortality in the patients with positive ECG (18/77; 23% vs. 7/74 (9.5%) (p=O.O2)) and there was a trend for higher mortality in the patients who were thrombolysed (24%, 12/50, vs. 13%, 13/101; p=O.O8) in the whole group. There was no difference in the patients within positive ECG group who were treated with thrombolysis or not (12/50 vs. 6/27) p=O.81. Conclusions: Only half of the elderly patients with biochemically proven acute Ml present with typical ECG changes and only two thirds of these patients received thrombolysis. Mortality remains high (17%) in

Medicine

14 (2003)

Sl -S159

this age group. Thrombolysis did not incur any benefit for mortality. These findings are consistent with the paper by Thiemann et al [l]. More research is required in the elderly patients to establish best and safe practice. References [l] Thiemann DR et al. Circulation [2] Estess JM et al. Heart 2002;87.

2000;101:2239-46.

05 Low levels of vitamin B12 as risk factor for venous thromboembolic disease (VTD) A.M. Diaz de Tuesta, J.A. Nieto, P.J. Marchena, M.D. Ruiz, A. Garcia, 0. Belinchon, F. Saiz (Cuenca, E) Objectives: To investigate whether plasma levels of vitamins that are involved in homocysteine (Hc) metabolism are associated with an elevated risk of VTD. Methods: We measured concentrations of fasting Hc levels and after oral methionine loading, vitamin B12, folate, vitamin B6, creatinine and albumine in 79 consecutive patients with VTD, diagnosed by image tests and 36 controls (admitted to hospital without cardiovascular disease), adjusted for age and sex. Results: The age of VTD group ranged from 20 to 95 years (median 70). Fasting Hc levels correlated positively with age (r=O.93; p= O.OOOl)and creatinine (r=O.376; p=O.OOOl), and negatively with vitamin B12 (r=0.24; p=O.Ol) and folate (r=O.32; p=O.OOl) concentrations, but not with vitamin B6 levels (r=O.O7; p=O.53). Fasting Hc levels were significantly higher (12.9257.16 vs. 10.68k5.02 kmol/L; p=O.O41), and vitamin B12 (437.15?240.98 vs. 593.56k223.64 pg/ml; p=O.O04) and folate levels (7.57k4.36 vs. 9.5223.38 rig/ml; p=O.O39) were significantly in patients with VTD than in the control group. These differences were predominantly found in the male subgroup. In a multivariable analysis controlling the age and creatinine, only vitamin B12 concentrations (Odds Ratio: 5.79; p=O.O09) were independently associated with VTD. Compared to the highest quartile, the Odds Ratio for VTD in the lowest quartile was 14.78 (95% Cl, 2.42-103.9; p= 0.008). Conclusions: Measurement of vitamin B12 levels might help to identify people at risk of venous thromboembolism.

06 Validity of BNP for the diagnosis different situations A. Azevedo, M. Alvelos, E. Martins, Barros (Porro, P)

of left ventricular R.A.

Rodrigues,

dysfunction

in

P. Bettencourt,

H.

Objective: B-type natriuretic peptide (BNP) levels are elevated in response to ventricular pressure/volume overload. It appeared to discriminate patients referred to specialized heart failure centres from healthy controls. The aim of this study was to evaluate the accuracy of BNP for the diagnosis of left ventricular dysfunction in a community sample of Portuguese adults. Methods: We studied 559 community-dwellers from Port0 aged ~45 years recruited by random digit dialling. Data were collected by clinical interview, echocardiography and plasma BNP measurement by the BIOSlTE* meter. Ventricular dysfunction was defined as systolic dysfunction and/or moderate-severe valvular disease. ROC curves were performed for the assessment of the overall accuracy of BNP and for choosing the best cut-off point for dichotomization. Results: Overall 3.8% of participants had ventricular systolic dysfunction and/or valvular disease. The area under the ROC curve (AUC)