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Early risk stratification using cardiac troponin T and brain natriuretic peptide in patients with congestive heart failure
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Journal of Cardiac Failure Vol. 5 No. 3 Suppl. 2 1999
P-133 PLASMA BRAIN NATRIURETIC PEPTIDE CONCENTRATIONS AND LV DIASTOLIC DYSFUNCTION IN CHRONIC HEART FAILURE WITH PRESERVED LV SYSTOLIC FUNCTION Shusuke Matsuo, Jirou Ohiwa, Syuji Tujiyarna, Yukihiro Fujimoto Yasuaki Shimohara, Hiroto Mashiba Department of Cardiology, Kure Kyousai Hospital, Hiroshima 737-8505, Japan
P-134 EARLY RISK STRATIFICATION USING CARDIAC TROPONIN T AND BRAIN NATRIURETIC PEPTIDE IN PATIENTS WITH CONGESTIVE HEART FAILURE Hiro)atki Naruse, Junmchi Ishii, YoshihisaMori, Toshikazu Ando, Hiroshi Kurokawa, TakeshiKondo, Masanori Noraura, Hitoshi Hishida Departmentof cardiolo~, Fujita Health University,Aichi 470-1192, Japan
[Purpose] It is unclear whether plasma BNP concentrations are elevated, when only left ventdcular (LV) diastolic dysfunction is present. And so, in cases with preserved LV systolic function, plasma BNP concentrations in the group with impaired LV diastolic function were compared to that in the group with preserved LV diastolic function. [Methods and Results] We performed transthoratic echocardiography for patients in chronic heart failure, and plasma BNP concentrations were determined. The duration of rnitral flow with atrial contruction (TM A duration) and the duration of pulmonary vein atrial flow reversal (PV A duration) were measured by p a l s e d wave Doppler echocardlography. We defined impaired LV diastolic function as a condition in which PV A duration was longer than T M A duration, and preserved LV systolic function as a condition in which fractional shortening was more than 25'/,,. Exclusion criteria included chronic atrial fibrillation, mitral stenosis, moderate or severe mitral regurgitation and chronic renal failure. Fractional shortening was more than 25% in 61 patients. PV A duration was longer than TM A duration in 24 patients, and in other 37 patients LV diastolic function were preserved. In the group with impaired LV diastolic function, plasma BNP concentrations were significantly higher (151.45:34.8 vs 40.55:8.7, p<0.001) . [Conclusions] In cases with preserved LV systolic function, plasma BNP concentrations had been already elevated in the group with impaired LV diastolic function.
P-135 CYTOK1NE AND NATRIURETIC PEPTIDES IN AGED PATIENTS WITH ACUTE CONGESTIVE HRART FAILURE Makoto Sakai, Tom Taniguchi, Tamotsu Imai Division o f Cardiology, Tokyo Metropolitan Geriatric Hospital, Tokyo 173-0015, Japan We investigated the pathophysiological role o f inflammatory cytokine, interleukin-6 (IL-6), and atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) in aged patients with acute congestive heart failure (CHF). The subjects included 30 patients (mean age 82 years) with CHF and 5 control patients (mean age 85 years) without CHF. In the severity o f acute CHF on admission, 5 patients were classified according to the Killip class as class I (no CHF), 15 patients as class II (mild to moderate CHF), 13 patients as class III (severe CHF) and 2 patients as class IV (shock). A comparison was made o f plasma levels oflL-6, ANP, BNP and cGMP among 3 groups o f Killip I , II and Ill+IV. Plasma ANP and cGMP levels showed no significant differences among 3 groups. Plasma BNP and IL-6 levels increased significantly in the groups with CI-IF compared with the control group ( BNP: Killip T 89___32, II 828__.572, III+IV742+452 pg/ml, IL-6: Killip I 4.04-2.7, II 39.9__.48.7, Ill+IV 38.14-61.2pg/ml ). However, plasma BNP and IL-6 levels showed no significant differences between the groups o f Killip II and Ill+IV. Plasma BNP showed no significant correlation with plasma 1I,-6 levels. Thus, IL-6 suggests an important role in the pathophysiology o f CHF even in the elderly, independent o f the secretion o f BNP.
Recent studies have found that cardiac troponin T (TnT) and troponin I (TnI) are useful prognostic indicators in patients (pts) with congestive heart failure (CHF). We studied prospectively to evaluate whether the combination of these specific markers for myocardial cell injury and biochemical markers for cardiac function is effective for early risk stratification in CHF. M e t h o d s : We measured TnT, TnI, BNP and ANT levels at admission in 98 CHF pts., and followed up (mean period of 15 months). Result: 36 cardiac events occurred. In a stepwise Cox regression analysis including TnT, TnI, ANP, BNP, age, sex, NYHA class and LVEF, independentpredictors for cardiac event were TnT (p=.01), BNP (p=0.02) and NYHA class (p=0.04). On the basis of TnT (0.05 ng/inl) and BNP (450 pg/ml) values, the pts were divided into 3 subgroups at high (64%), intermediate(38%), and low (19%) risk of cardiac event rate. Conclusion: These findings suggest that the combination of admission values of TnT and BNP are valuable for early risk assessment in CHF.
P-136 ADDITIVE EFFECTS OF AGING AND CARDIAC HYPERTROPHY ON BRAIN NATRIURETIC PEPTIDE Makoto Suzuki, Mareomi Hamada, Yuji Shigematsu,Yuji Hara, Osamu Sasaki ,Tomoaki Ohtsuka ,Kunio Hiwada. Ehime University,Ehime 791-0295 Japan While left ventricular (LV) hypertrophy (LVH) and aging are well recognized as an independent risk of cardiac events, the additive effects of each otheron cardiac status remain unknown. The purpose of our study is to examine whether and how aging affects the hypertensive heart in view point of plasma brain natriuretic peptide (BNP)level. According to LV mass and relative wall thickness (RWT), 185 hypertensives were divided into four groups as follows; 80 hypertensives with normal LV geometry(NO;37-80 yr;LV mass 94+_ 14 g/m 2, RWT, 0.35 ± 0.08), 16 hypertensiveswith concentric LV remodeling(CR;48-86 yr;106_+ 11 g/m 2, 0.47 _+0.03), 61 hypertensives with eccentric LVH (EH; 37-89 yr;1 35+ 12 gtm2,0.39± 0.03)and 28 hypertensives with concentric LVH(CH;37-90 yr;146_+ 26 g/m2,0.50± 0.09).All groups demonstrated the significant positive relationship between aging and plasma BNPI evel. Further CH displayed the steepest relation of plasma BNP level with age.(Figure) Conclusion; In view of plasma BNP level, the present study indicates that aging has the additive unfavorable effect on the hypertensive heart, especially with concentric LVH. Plasma BNP Level (pg/ml)
2oot 7 150
p
O O20 40 60 80 100 Age (yr)
Journal of Cardiac Failure Vol. 5 No. 3 Suppl. 2 1999
P-133 PLASMA BRAIN NATRIURETIC PEPTIDE CONCENTRATIONS AND LV DIASTOLIC DYSFUNCTION IN CHRONIC HEART FAILURE WITH PRESERVED LV SYSTOLIC FUNCTION Shusuke Matsuo, Jirou Ohiwa, Syuji Tujiyarna, Yukihiro Fujimoto Yasuaki Shimohara, Hiroto Mashiba Department of Cardiology, Kure Kyousai Hospital, Hiroshima 737-8505, Japan
P-134 EARLY RISK STRATIFICATION USING CARDIAC TROPONIN T AND BRAIN NATRIURETIC PEPTIDE IN PATIENTS WITH CONGESTIVE HEART FAILURE Hiro)atki Naruse, Junmchi Ishii, YoshihisaMori, Toshikazu Ando, Hiroshi Kurokawa, TakeshiKondo, Masanori Noraura, Hitoshi Hishida Departmentof cardiolo~, Fujita Health University,Aichi 470-1192, Japan
[Purpose] It is unclear whether plasma BNP concentrations are elevated, when only left ventdcular (LV) diastolic dysfunction is present. And so, in cases with preserved LV systolic function, plasma BNP concentrations in the group with impaired LV diastolic function were compared to that in the group with preserved LV diastolic function. [Methods and Results] We performed transthoratic echocardiography for patients in chronic heart failure, and plasma BNP concentrations were determined. The duration of rnitral flow with atrial contruction (TM A duration) and the duration of pulmonary vein atrial flow reversal (PV A duration) were measured by p a l s e d wave Doppler echocardlography. We defined impaired LV diastolic function as a condition in which PV A duration was longer than T M A duration, and preserved LV systolic function as a condition in which fractional shortening was more than 25'/,,. Exclusion criteria included chronic atrial fibrillation, mitral stenosis, moderate or severe mitral regurgitation and chronic renal failure. Fractional shortening was more than 25% in 61 patients. PV A duration was longer than TM A duration in 24 patients, and in other 37 patients LV diastolic function were preserved. In the group with impaired LV diastolic function, plasma BNP concentrations were significantly higher (151.45:34.8 vs 40.55:8.7, p<0.001) . [Conclusions] In cases with preserved LV systolic function, plasma BNP concentrations had been already elevated in the group with impaired LV diastolic function.
P-135 CYTOK1NE AND NATRIURETIC PEPTIDES IN AGED PATIENTS WITH ACUTE CONGESTIVE HRART FAILURE Makoto Sakai, Tom Taniguchi, Tamotsu Imai Division o f Cardiology, Tokyo Metropolitan Geriatric Hospital, Tokyo 173-0015, Japan We investigated the pathophysiological role o f inflammatory cytokine, interleukin-6 (IL-6), and atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) in aged patients with acute congestive heart failure (CHF). The subjects included 30 patients (mean age 82 years) with CHF and 5 control patients (mean age 85 years) without CHF. In the severity o f acute CHF on admission, 5 patients were classified according to the Killip class as class I (no CHF), 15 patients as class II (mild to moderate CHF), 13 patients as class III (severe CHF) and 2 patients as class IV (shock). A comparison was made o f plasma levels oflL-6, ANP, BNP and cGMP among 3 groups o f Killip I , II and Ill+IV. Plasma ANP and cGMP levels showed no significant differences among 3 groups. Plasma BNP and IL-6 levels increased significantly in the groups with CI-IF compared with the control group ( BNP: Killip T 89___32, II 828__.572, III+IV742+452 pg/ml, IL-6: Killip I 4.04-2.7, II 39.9__.48.7, Ill+IV 38.14-61.2pg/ml ). However, plasma BNP and IL-6 levels showed no significant differences between the groups o f Killip II and Ill+IV. Plasma BNP showed no significant correlation with plasma 1I,-6 levels. Thus, IL-6 suggests an important role in the pathophysiology o f CHF even in the elderly, independent o f the secretion o f BNP.
Recent studies have found that cardiac troponin T (TnT) and troponin I (TnI) are useful prognostic indicators in patients (pts) with congestive heart failure (CHF). We studied prospectively to evaluate whether the combination of these specific markers for myocardial cell injury and biochemical markers for cardiac function is effective for early risk stratification in CHF. M e t h o d s : We measured TnT, TnI, BNP and ANT levels at admission in 98 CHF pts., and followed up (mean period of 15 months). Result: 36 cardiac events occurred. In a stepwise Cox regression analysis including TnT, TnI, ANP, BNP, age, sex, NYHA class and LVEF, independentpredictors for cardiac event were TnT (p=.01), BNP (p=0.02) and NYHA class (p=0.04). On the basis of TnT (0.05 ng/inl) and BNP (450 pg/ml) values, the pts were divided into 3 subgroups at high (64%), intermediate(38%), and low (19%) risk of cardiac event rate. Conclusion: These findings suggest that the combination of admission values of TnT and BNP are valuable for early risk assessment in CHF.
P-136 ADDITIVE EFFECTS OF AGING AND CARDIAC HYPERTROPHY ON BRAIN NATRIURETIC PEPTIDE Makoto Suzuki, Mareomi Hamada, Yuji Shigematsu,Yuji Hara, Osamu Sasaki ,Tomoaki Ohtsuka ,Kunio Hiwada. Ehime University,Ehime 791-0295 Japan While left ventricular (LV) hypertrophy (LVH) and aging are well recognized as an independent risk of cardiac events, the additive effects of each otheron cardiac status remain unknown. The purpose of our study is to examine whether and how aging affects the hypertensive heart in view point of plasma brain natriuretic peptide (BNP)level. According to LV mass and relative wall thickness (RWT), 185 hypertensives were divided into four groups as follows; 80 hypertensives with normal LV geometry(NO;37-80 yr;LV mass 94+_ 14 g/m 2, RWT, 0.35 ± 0.08), 16 hypertensiveswith concentric LV remodeling(CR;48-86 yr;106_+ 11 g/m 2, 0.47 _+0.03), 61 hypertensives with eccentric LVH (EH; 37-89 yr;1 35+ 12 gtm2,0.39± 0.03)and 28 hypertensives with concentric LVH(CH;37-90 yr;146_+ 26 g/m2,0.50± 0.09).All groups demonstrated the significant positive relationship between aging and plasma BNPI evel. Further CH displayed the steepest relation of plasma BNP level with age.(Figure) Conclusion; In view of plasma BNP level, the present study indicates that aging has the additive unfavorable effect on the hypertensive heart, especially with concentric LVH. Plasma BNP Level (pg/ml)
2oot 7 150
p
O O20 40 60 80 100 Age (yr)