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Relationship between sleep-disordered breathing and plasma brain natriuretic peptide in chronic heart failure
S176
Journal of Cardiac Failure Vol. 10 No. 5 Suppl. 2004
O-085
O-087
Prognostic Value of Combination of N-Terminal Pro-BNP and Troponin T After Initiation of Treatment in Patients with Chronic Heart Failure NARUSE HIROYUKI1, ISHII JUNNICHI2, NAKANO TADASHI1, NAKAMURA YUU1, MORI YOSHIHISA1, MATRUI SHIGERU1, KONDO TAKESHI1, HISHIDA HITOSHI1 1 Department of Internal Medicine, Fujita Health University School of Medicine, Aichi, Japan, 2Division of Critical Care, Fujita Health University Graduate School of Health Science, Aichi, Japan
Relationship Between Sleep-disordered Breathing and Plasma Brain Natriuretic Peptide in Chronic Heart Failure
We evaluated the prognostic value of combination of N-terminal pro-BNP (NT pro-BNP) and cardiac troponin T (TnT) after treatment in patients with chronic heart failure (CHF). Methods: We measured NT pro-BNP, BNP and TnT on admission for CHF (NYHA III or IV) and 2 months after treatment (n ⫽ 149). Results: During a mean follow-up of 567 days, 54 cardiac events occurred (10 cardiac deaths and 44 readmissions for CHF). On a multivariate analysis, NT pro-BNP and TnT (P ⬍ 0.01) but not BNP were independent predictors of cardiac events. NT pro-BNP ⬎ 1200 pg/ml and/or TnT ⬎ 0.01 ng/ml 2 months after treatment were associated with increased cardiac mortality and morbidity rates (Table). Conclusion: The combination of NT pro-BNP and TnT measurements after treatment may be highly effective for risk stratification in patients with CHF.
Risk Stratification Using Combination of NT Pro-BNP and TnT Group I (n=68)
Group II (n=34)
Group III (n=10)
Group IV (n=37)
NT proBNP and TnT
<1200 pg/ml and <0.01 ng/ml
>1200 pg/ml and <0.01 ng/ml
<1200 pg/ml and >0.01 ng/ml
>1200 pg/ml and >0.01 ng/ml
Cardiac death
0 (0%)
3 (8.8%)
1 (10%)
6 (16.2%)
Cardiac event
11 (16.2%)
13 (38.2%)
6 (60%)
24 (64.9%)
O-086 Plasma BNP Level is a Good Indicator of Left Ventricular Diastolic Dysfunction in Patients Undergoing Chronic Hemodialysis OSUMI YUKIO1, TADOKORO MITSUNOBU2, KARIYA TATSUYA2, YOKOYAMA HITOMI2, SAWADA SHIGEKI2, OHNO MICHIYA3, SEGAWA TOMONORI3, OHASHI SHIGEHIRO3, WATANABE SACHIRO3, ITO HIROYASU2 1 Hashima City Hospital, 2Sawada Hospital, 3Gifu Prefectural Hospital Background: Plasma BNP level is reported to reflect left ventricular (LV) diastolic dysfunction in patients with heart failure. However, it is still unknown whether plasma BNP level reflects LV diastolic function in patients undergoing hemodialys. Methods: We measured plasma ANP and BNP levels and simultaneously assessed LV systolic and diastolic function by electrocardiographic-gated 99mTcMIBI myocardial single-photon emission computed tomography (SPECT) program (QGS program) before and after hemodialysis in 31 patients undergoing hemodialysis. The relationship among plasma ANP and BNP levels, LV systolic and diastolic function was obtained. Results: The decrease rate in body weight was negatively correlated with plasma ANP level but not with plasma BNP. LV ejection fraction was positively correlated with plasma BNP level both before and after hemodialysis. Peak filling rate (PFR) was positively correlated with plasma BNP level both before and after hemodialysis. When all patients were divided into patients with well LV systolic function (well group) and poor LV function (poor group), plasma BNP level after hemodialysis was negatively correlated with LV ejection fraction in the poor group but not in the well group. Plasma BNP level was negatively correlated with PFR in both the well and poor groups. Conclusion: It is suggested that plasma BNP level is a good indicator of LV diastolic dysfunction in patients undergoing chronic hemodialysis.
MASUDA JUN1, TANIGAWA TAKASHI1, ONISHI KATSUYA2, TANABE MASAKI1, KITAMURA TETSUYA1, ITO MASAAKI1, NAKANO TAKESHI1 1 The First Department of Internal Medicine, Mie University School of Medicine, Tsu, Japan, 2Department of Laboratory Medicine, Mie University School of Medicine, Tsu, Japan Background: Sleep-disordered breathing (SDB) is a poor prognostic indicator in patients with congestive heart failure (CHF). Plasma brain natriuretic peptide (BNP) levels correlate with severity of CHF and are an important prognostic predictor in CHF patients. Accordingly, we assessed the relationship between plasma BNP and SDB severity in patients with CHF. Methods: Forty-two patients with stable CHF and left ventricular ejection fraction (LVEF) ⬍40% (30 men, mean age 63 ⫾ 11 years) underwent overnights sleep study with use of pulse-oxymetry, and were evaluated 4% oxygen desaturation index (ODI), a number of episodes of oxygen concentration reduction 4% from baseline per hour. In all patients, hemodynamic parameters and plasma BNP levels were measured during cardiac catheterization. Result: Twenty-three patients had SDB when we defined SDB as 4%ODI ⬎ 5, and mean 4%ODI was 13.3 per hour. Patients with and without SDB did not differ with respect to pulmonary capillary wedge pressure (13 ⫾ 9 versus 11 ⫾ 7 mmHg) and LVEF (31 ⫾ 7 versus 33 ⫾ 10 %). Plasma BNP levels were significantly higher in SDB group (480 ⫾ 337 versus 207 ⫾ 218 pg/ml), and well correlated with 4%ODI (r ⫽ 0.517, P ⫽ 0.0004). Conclusions: Plasma BNP levels are significantly elevated in CHF patients with SDB and closely correlated with 4%ODI. Our findings suggest that plasma BNP may be a biochemical marker of central sleep apnea in CHF patients.
O-088 Prognostic Value of Combination of N-Terminal Pro-BNP and Troponin T in Patients Hospitalized for Worsening Chronic Heart Failure ISHII JUNNICHI1, NAKANO TADASHI2, NAKAMURA YUU2, NARUSE HIROYUKI2, MORI YOSHIHISA2, MATSUI SHIGERU2, KONDO TAKESHI2, MORIMOTO SHINICHIRO2, HISHIDA HITOSHI2 1 Division of Critical Care, Fujita Health University Graduate School of Health Science, Aichi, Japan, 2Department of Internal Medicine, Fujita Health University School of Medicine, Aichi, Japan We investigated the prognostic value of combination of N-terminal proBNP (NT pro-BNP) and troponin T (TnT) on admission in 244 patients hospitalized for worsening chronic heart failure (CHF;NYHA class 3 or 4). NT pro-BNP, BNP and TnT were measured on admission. Results: During a mean follow-up of 409 days, there were 100 cardiac events (43 cardiac deaths and 57 readmissions for CHF). On a multivariate analysis, NT pro-BNP and TnT (P ⬍ 0.01) were independent predictors of cardiac events. NT pro-BNP ⬎ 6600 pg/ml and/or TnT ⬎ 0.028 ng/ml were associated with increased cardiac mortality and cardiac event rates (Table). Conclusion: The combination of NT pro-BNP and TnT measurements may be highly effective for risk stratification in patients hospitalized for worsening CHF.
Subgroup
I (n=107)
NT pro-BNP >6600 pg/ml
(-)
(+)
(-)
(+)
TnT >0.028 ng/ml
(-)
(-)
(+)
(+)
Cardiac death
5 (4.6%)
6 (18%)
6 (16%)
26 (39%) <0.0001
Cardiac event
28 (26%)
12 (36%)
15 (39%)
45 (68%) <0.0001
II (n=33) III (n=38) IV (n=66) P value
Journal of Cardiac Failure Vol. 10 No. 5 Suppl. 2004
O-085
O-087
Prognostic Value of Combination of N-Terminal Pro-BNP and Troponin T After Initiation of Treatment in Patients with Chronic Heart Failure NARUSE HIROYUKI1, ISHII JUNNICHI2, NAKANO TADASHI1, NAKAMURA YUU1, MORI YOSHIHISA1, MATRUI SHIGERU1, KONDO TAKESHI1, HISHIDA HITOSHI1 1 Department of Internal Medicine, Fujita Health University School of Medicine, Aichi, Japan, 2Division of Critical Care, Fujita Health University Graduate School of Health Science, Aichi, Japan
Relationship Between Sleep-disordered Breathing and Plasma Brain Natriuretic Peptide in Chronic Heart Failure
We evaluated the prognostic value of combination of N-terminal pro-BNP (NT pro-BNP) and cardiac troponin T (TnT) after treatment in patients with chronic heart failure (CHF). Methods: We measured NT pro-BNP, BNP and TnT on admission for CHF (NYHA III or IV) and 2 months after treatment (n ⫽ 149). Results: During a mean follow-up of 567 days, 54 cardiac events occurred (10 cardiac deaths and 44 readmissions for CHF). On a multivariate analysis, NT pro-BNP and TnT (P ⬍ 0.01) but not BNP were independent predictors of cardiac events. NT pro-BNP ⬎ 1200 pg/ml and/or TnT ⬎ 0.01 ng/ml 2 months after treatment were associated with increased cardiac mortality and morbidity rates (Table). Conclusion: The combination of NT pro-BNP and TnT measurements after treatment may be highly effective for risk stratification in patients with CHF.
Risk Stratification Using Combination of NT Pro-BNP and TnT Group I (n=68)
Group II (n=34)
Group III (n=10)
Group IV (n=37)
NT proBNP and TnT
<1200 pg/ml and <0.01 ng/ml
>1200 pg/ml and <0.01 ng/ml
<1200 pg/ml and >0.01 ng/ml
>1200 pg/ml and >0.01 ng/ml
Cardiac death
0 (0%)
3 (8.8%)
1 (10%)
6 (16.2%)
Cardiac event
11 (16.2%)
13 (38.2%)
6 (60%)
24 (64.9%)
O-086 Plasma BNP Level is a Good Indicator of Left Ventricular Diastolic Dysfunction in Patients Undergoing Chronic Hemodialysis OSUMI YUKIO1, TADOKORO MITSUNOBU2, KARIYA TATSUYA2, YOKOYAMA HITOMI2, SAWADA SHIGEKI2, OHNO MICHIYA3, SEGAWA TOMONORI3, OHASHI SHIGEHIRO3, WATANABE SACHIRO3, ITO HIROYASU2 1 Hashima City Hospital, 2Sawada Hospital, 3Gifu Prefectural Hospital Background: Plasma BNP level is reported to reflect left ventricular (LV) diastolic dysfunction in patients with heart failure. However, it is still unknown whether plasma BNP level reflects LV diastolic function in patients undergoing hemodialys. Methods: We measured plasma ANP and BNP levels and simultaneously assessed LV systolic and diastolic function by electrocardiographic-gated 99mTcMIBI myocardial single-photon emission computed tomography (SPECT) program (QGS program) before and after hemodialysis in 31 patients undergoing hemodialysis. The relationship among plasma ANP and BNP levels, LV systolic and diastolic function was obtained. Results: The decrease rate in body weight was negatively correlated with plasma ANP level but not with plasma BNP. LV ejection fraction was positively correlated with plasma BNP level both before and after hemodialysis. Peak filling rate (PFR) was positively correlated with plasma BNP level both before and after hemodialysis. When all patients were divided into patients with well LV systolic function (well group) and poor LV function (poor group), plasma BNP level after hemodialysis was negatively correlated with LV ejection fraction in the poor group but not in the well group. Plasma BNP level was negatively correlated with PFR in both the well and poor groups. Conclusion: It is suggested that plasma BNP level is a good indicator of LV diastolic dysfunction in patients undergoing chronic hemodialysis.
MASUDA JUN1, TANIGAWA TAKASHI1, ONISHI KATSUYA2, TANABE MASAKI1, KITAMURA TETSUYA1, ITO MASAAKI1, NAKANO TAKESHI1 1 The First Department of Internal Medicine, Mie University School of Medicine, Tsu, Japan, 2Department of Laboratory Medicine, Mie University School of Medicine, Tsu, Japan Background: Sleep-disordered breathing (SDB) is a poor prognostic indicator in patients with congestive heart failure (CHF). Plasma brain natriuretic peptide (BNP) levels correlate with severity of CHF and are an important prognostic predictor in CHF patients. Accordingly, we assessed the relationship between plasma BNP and SDB severity in patients with CHF. Methods: Forty-two patients with stable CHF and left ventricular ejection fraction (LVEF) ⬍40% (30 men, mean age 63 ⫾ 11 years) underwent overnights sleep study with use of pulse-oxymetry, and were evaluated 4% oxygen desaturation index (ODI), a number of episodes of oxygen concentration reduction 4% from baseline per hour. In all patients, hemodynamic parameters and plasma BNP levels were measured during cardiac catheterization. Result: Twenty-three patients had SDB when we defined SDB as 4%ODI ⬎ 5, and mean 4%ODI was 13.3 per hour. Patients with and without SDB did not differ with respect to pulmonary capillary wedge pressure (13 ⫾ 9 versus 11 ⫾ 7 mmHg) and LVEF (31 ⫾ 7 versus 33 ⫾ 10 %). Plasma BNP levels were significantly higher in SDB group (480 ⫾ 337 versus 207 ⫾ 218 pg/ml), and well correlated with 4%ODI (r ⫽ 0.517, P ⫽ 0.0004). Conclusions: Plasma BNP levels are significantly elevated in CHF patients with SDB and closely correlated with 4%ODI. Our findings suggest that plasma BNP may be a biochemical marker of central sleep apnea in CHF patients.
O-088 Prognostic Value of Combination of N-Terminal Pro-BNP and Troponin T in Patients Hospitalized for Worsening Chronic Heart Failure ISHII JUNNICHI1, NAKANO TADASHI2, NAKAMURA YUU2, NARUSE HIROYUKI2, MORI YOSHIHISA2, MATSUI SHIGERU2, KONDO TAKESHI2, MORIMOTO SHINICHIRO2, HISHIDA HITOSHI2 1 Division of Critical Care, Fujita Health University Graduate School of Health Science, Aichi, Japan, 2Department of Internal Medicine, Fujita Health University School of Medicine, Aichi, Japan We investigated the prognostic value of combination of N-terminal proBNP (NT pro-BNP) and troponin T (TnT) on admission in 244 patients hospitalized for worsening chronic heart failure (CHF;NYHA class 3 or 4). NT pro-BNP, BNP and TnT were measured on admission. Results: During a mean follow-up of 409 days, there were 100 cardiac events (43 cardiac deaths and 57 readmissions for CHF). On a multivariate analysis, NT pro-BNP and TnT (P ⬍ 0.01) were independent predictors of cardiac events. NT pro-BNP ⬎ 6600 pg/ml and/or TnT ⬎ 0.028 ng/ml were associated with increased cardiac mortality and cardiac event rates (Table). Conclusion: The combination of NT pro-BNP and TnT measurements may be highly effective for risk stratification in patients hospitalized for worsening CHF.
Subgroup
I (n=107)
NT pro-BNP >6600 pg/ml
(-)
(+)
(-)
(+)
TnT >0.028 ng/ml
(-)
(-)
(+)
(+)
Cardiac death
5 (4.6%)
6 (18%)
6 (16%)
26 (39%) <0.0001
Cardiac event
28 (26%)
12 (36%)
15 (39%)
45 (68%) <0.0001
II (n=33) III (n=38) IV (n=66) P value