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Efficacy of B-type natriuretic peptide in assessment of heart failure severity in African American heart failure patients
168A
POSTERS: Heart Failure/Hypertrophy
AJH–April 2002–VOL. 15, NO. 4, PART 2
with systolic/diastolic blood pressure (SBP/DBP) measured at 3-month interval visits. At baseline, BP averaged 123.6/75.5 mmHg in the 4644 patients on ACEI and 126.4/75.7 mmHg in the 366 patients not on ACEI. Response of BP to V vs. P was assessed using least-squares means (LSM) from an analysis of covariance (ANCOVA). V produced statistically significant BP reductions at all analyzed time points in ACEI treated patients. Slightly greater reductions occurred in the non-ACEI treated patients but not statistically significantly different from ACEI treated patients at endpoint (Table). Final visit SBP in ACEI treated patients was 116.1 mmHg in V and 120.2 mmHg in P. In non-ACEI treated patients final visit SBP was 118.9 mmHg in V and 122.6 mmHg in P. Thus V exerts a similar reduction in BP in HF regardless of background ACEI therapy. The vasoconstrictor effects of angiotensin, suppressible by ARB are therefore similar in ACEI and non-ACEI treated patients. V’s effects on BP are additive to ACEI given in doses similar to those found effective in clinical trials. Table: LSM Change from Baseline in SBP/DBP in ACEI (yes) and ACEI (no) Background Therapy Groups (Placebo-Subtracted) (*p⬍0.05)
Overall (n) ACEI (yes) (n) ACEI (no) (n)
4 mo
12 mo
18 mo
24 mo
End-point
⫺4.3*/ ⫺2.8* (4628) ⫺4.0*/ ⫺2.7* (4302) ⫺6.7*/ ⫺3.6* (326)
⫺4.4*/ ⫺2.8* (4111) ⫺4.1*/ ⫺2.7* (3828) ⫺6.9*/ ⫺3.2* (283)
⫺3.7*/ ⫺1.9* (3685) ⫺3.5*/ ⫺1.8* (3439) ⫺5.8*/ ⫺3.2* (246)
⫺3.4*/ ⫺1.9* (2456) ⫺3.1*/ ⫺1.9* (2283) ⫺9.0*/ ⫺4.0* (173)
⫺3.7*/ ⫺1.8* (4976) ⫺3.5*/ ⫺1.7* (4612) ⫺5.0*/ ⫺2.0 (364)
Key Words: Angiotensin Receptor Blockers, Renin Angiotensin System, Blood Pressure
P-380 HYPERTENSION IN HEART FAILURE PATIENTS WITH NORMAL LVEF IS CHARACTERIZED BY DECREASED ATRIAL EJECTION FUNCTION AND TWO DISTINCT PATTERNS OF ABNORMAL LV FILLING IN ADDITION TO LVH Ioannis A. Stathopoulos, Icilma V. Fergus, David Scott, Debashish Roychoudry, Frank C. Messineo. Cardiology, Lang Research Center, New York Hospital Medical Center of Queens, Flushing, New York, United States; Cardiology, Lang Research Center, New York Hospital Medical Center of Queens, Flushing, New York, United States; Hypertension, New York Hospital Medical Center of Queens, Flushing, New York, United States; Cardiology, Lang Research Center, New York Hospital Medical Center of Queens, Flushing, New York, United States; Cardiology, Lang Research Center, New York Hospital Medical Center of Queens, Flushing, New York, United States. Hypertension (HTN) is associated with LVH, abnormal LV diastolic function and congestive heart failure (CHF) often with normal systolic function. Although LV size and function has been characterized in this group, left atrial (LA) volumes and function have not been well studied. Therefore, we characterized LA volumes and function in a group of hypertensive patients (HT) with acute CHF and normal systolic function. Twenty-eight patients with known or new onset HTN, hospitalized with pulmonary congestion and with normal systolic function were studied and compared to six normal individuals. LV mass and LVEF were measured by 2D echo, and atrial volumes by the Disc Summation method. Atrial ejection force (AEF) [0.5 x x mitral orifice area x (peak A velocity)2], a measure of LA contractility, and atrial total emptying fraction (ATEF), a measure of LA pump function, were measured. The ratio of peak early filling (E) and atrial filling (A) velocities was determined with mitral pulse wave Doppler. Means were compared by unpaired t-test with a p value of ⬍ 0.05 considered significant. The study group consisted of 18 females and 10 males (16 Caucasians, 10 Afro-Americans, 2 Asians). The HT group was older (69.39 ⫾ 15.45
yrs vs 51.66 ⫾ 7.73 yrs, p⬍ 0.001) and had a mean SBP, DBP and pulse pressure of 180 ⫾ 42 mmHg, 92 ⫾ 20 mmHg and 87 ⫾ 27 mmHg, respectively. The LVEF of the HT group, although normal, was lower (59 ⫾ 5 % vs 64 ⫾ 2 %, p⫽0.023) than control, whereas LV mass index was higher (122.7 ⫾ 33.1 gm/m2 vs 76.4 ⫾ 8.2 gm/m2, p⫽0.002). Peak E and A waves were similar in the two groups. However, the E/A ratios distributed in a bimodal fashion in the HT group, such that HT patients had either higher (2.14 ⫾ 0.68) or lower (0.66 ⫾ 0.17) than normal (1.118 ⫾ 0.213) ratios. The maximal (77 ⫾ 29.91 cc vs 44.33 ⫾ 8.06 cc, p⫽0.01) and minimal (41.875 ⫾ 19.51 cc vs 22.83 ⫾ 10.22 cc, p⫽0.02) LA volumes were higher in the HT group. The ATEF was decreased, compared to normals (49.58 ⫾ 9.35 % vs 59.66 ⫾ 8.11 %, p⫽0.02). Conclusion: The HT group with CHF had increased LV mass. Atrial contractile function (AEF) was not depressed, while atrial pump function (ATEF) was decreased. In addition, the HT group demonstrated two patterns of LV filling, one with increased and one with decreased E/A ratios. This bimodal pattern may reflect the different relative contribution of delayed relaxation and volume overload in hypertensive patients with heart failure. Key Words: Heart Failure, Atrial Fibrillation, Hypertension
P-381 EFFICACY OF B-TYPE NATRIURETIC PEPTIDE IN ASSESSMENT OF HEART FAILURE SEVERITY IN AFRICAN AMERICAN HEART FAILURE PATIENTS Robert L. Scott, Talal Hamden, Mandeep R. Mehra, Myung H. Park, Patricia Uber. Cardiology, Ochsner Clinic Foundation, New Orleans, LA, United States. Heart failure is a major cause of morbidity and mortality in the United States. B-Type natriuretic peptide (BNP)has emerged as a sensitive predictor of heart failure severity and prognosis. To date, the overall efficacy of BNP in assessing the severity of heart failure has not specifically been addressed in African Americans. Methods: 44 patients (15 African American/29 White) with heart failure were evaluated for disease severity, ejection fraction, age, race, sex and BNP levels. Results: There were no significan differences in BNP levels between African American and White patients. Among all patients the levels of BNP were significantly higher among the NYHA class III/IV patients compared with the NYHA class I/II patients. The ejection fraction of the African American patients (27.4%) was significantly lower compared to the White patients(40.7%). The use of beta-blocker therapy correlated with neither the BNP levels nor the ejection fraction. Discussion: BNP levels correlated with disease severity in both African American and White patients with heart failure. There was no significant difference in BNP levels between African American and White patients with heart failure (both diastolic and systolic). The African American patients demonstrated significantly lower ejection fractions compared to the white patients. The fact that our analysis did not demonstrate an overall benefit with the use of beta-blocker therapy is not surprising given that our cohort consisted of both diastolic and systolic dysfunction. This analysis suggests that the measurement of B-type natriuretic peptide levels can provide a fast and effective diagnostic tool in African American heart failure patients. Race
EF
BNP
Black White
27 40
504 ⫾ 461 384 ⫾ 333
p ⬍ 0.0204
Key Words: Natriuretic Peptide, African American, Beta-Blocker
POSTERS: Heart Failure/Hypertrophy
AJH–April 2002–VOL. 15, NO. 4, PART 2
with systolic/diastolic blood pressure (SBP/DBP) measured at 3-month interval visits. At baseline, BP averaged 123.6/75.5 mmHg in the 4644 patients on ACEI and 126.4/75.7 mmHg in the 366 patients not on ACEI. Response of BP to V vs. P was assessed using least-squares means (LSM) from an analysis of covariance (ANCOVA). V produced statistically significant BP reductions at all analyzed time points in ACEI treated patients. Slightly greater reductions occurred in the non-ACEI treated patients but not statistically significantly different from ACEI treated patients at endpoint (Table). Final visit SBP in ACEI treated patients was 116.1 mmHg in V and 120.2 mmHg in P. In non-ACEI treated patients final visit SBP was 118.9 mmHg in V and 122.6 mmHg in P. Thus V exerts a similar reduction in BP in HF regardless of background ACEI therapy. The vasoconstrictor effects of angiotensin, suppressible by ARB are therefore similar in ACEI and non-ACEI treated patients. V’s effects on BP are additive to ACEI given in doses similar to those found effective in clinical trials. Table: LSM Change from Baseline in SBP/DBP in ACEI (yes) and ACEI (no) Background Therapy Groups (Placebo-Subtracted) (*p⬍0.05)
Overall (n) ACEI (yes) (n) ACEI (no) (n)
4 mo
12 mo
18 mo
24 mo
End-point
⫺4.3*/ ⫺2.8* (4628) ⫺4.0*/ ⫺2.7* (4302) ⫺6.7*/ ⫺3.6* (326)
⫺4.4*/ ⫺2.8* (4111) ⫺4.1*/ ⫺2.7* (3828) ⫺6.9*/ ⫺3.2* (283)
⫺3.7*/ ⫺1.9* (3685) ⫺3.5*/ ⫺1.8* (3439) ⫺5.8*/ ⫺3.2* (246)
⫺3.4*/ ⫺1.9* (2456) ⫺3.1*/ ⫺1.9* (2283) ⫺9.0*/ ⫺4.0* (173)
⫺3.7*/ ⫺1.8* (4976) ⫺3.5*/ ⫺1.7* (4612) ⫺5.0*/ ⫺2.0 (364)
Key Words: Angiotensin Receptor Blockers, Renin Angiotensin System, Blood Pressure
P-380 HYPERTENSION IN HEART FAILURE PATIENTS WITH NORMAL LVEF IS CHARACTERIZED BY DECREASED ATRIAL EJECTION FUNCTION AND TWO DISTINCT PATTERNS OF ABNORMAL LV FILLING IN ADDITION TO LVH Ioannis A. Stathopoulos, Icilma V. Fergus, David Scott, Debashish Roychoudry, Frank C. Messineo. Cardiology, Lang Research Center, New York Hospital Medical Center of Queens, Flushing, New York, United States; Cardiology, Lang Research Center, New York Hospital Medical Center of Queens, Flushing, New York, United States; Hypertension, New York Hospital Medical Center of Queens, Flushing, New York, United States; Cardiology, Lang Research Center, New York Hospital Medical Center of Queens, Flushing, New York, United States; Cardiology, Lang Research Center, New York Hospital Medical Center of Queens, Flushing, New York, United States. Hypertension (HTN) is associated with LVH, abnormal LV diastolic function and congestive heart failure (CHF) often with normal systolic function. Although LV size and function has been characterized in this group, left atrial (LA) volumes and function have not been well studied. Therefore, we characterized LA volumes and function in a group of hypertensive patients (HT) with acute CHF and normal systolic function. Twenty-eight patients with known or new onset HTN, hospitalized with pulmonary congestion and with normal systolic function were studied and compared to six normal individuals. LV mass and LVEF were measured by 2D echo, and atrial volumes by the Disc Summation method. Atrial ejection force (AEF) [0.5 x x mitral orifice area x (peak A velocity)2], a measure of LA contractility, and atrial total emptying fraction (ATEF), a measure of LA pump function, were measured. The ratio of peak early filling (E) and atrial filling (A) velocities was determined with mitral pulse wave Doppler. Means were compared by unpaired t-test with a p value of ⬍ 0.05 considered significant. The study group consisted of 18 females and 10 males (16 Caucasians, 10 Afro-Americans, 2 Asians). The HT group was older (69.39 ⫾ 15.45
yrs vs 51.66 ⫾ 7.73 yrs, p⬍ 0.001) and had a mean SBP, DBP and pulse pressure of 180 ⫾ 42 mmHg, 92 ⫾ 20 mmHg and 87 ⫾ 27 mmHg, respectively. The LVEF of the HT group, although normal, was lower (59 ⫾ 5 % vs 64 ⫾ 2 %, p⫽0.023) than control, whereas LV mass index was higher (122.7 ⫾ 33.1 gm/m2 vs 76.4 ⫾ 8.2 gm/m2, p⫽0.002). Peak E and A waves were similar in the two groups. However, the E/A ratios distributed in a bimodal fashion in the HT group, such that HT patients had either higher (2.14 ⫾ 0.68) or lower (0.66 ⫾ 0.17) than normal (1.118 ⫾ 0.213) ratios. The maximal (77 ⫾ 29.91 cc vs 44.33 ⫾ 8.06 cc, p⫽0.01) and minimal (41.875 ⫾ 19.51 cc vs 22.83 ⫾ 10.22 cc, p⫽0.02) LA volumes were higher in the HT group. The ATEF was decreased, compared to normals (49.58 ⫾ 9.35 % vs 59.66 ⫾ 8.11 %, p⫽0.02). Conclusion: The HT group with CHF had increased LV mass. Atrial contractile function (AEF) was not depressed, while atrial pump function (ATEF) was decreased. In addition, the HT group demonstrated two patterns of LV filling, one with increased and one with decreased E/A ratios. This bimodal pattern may reflect the different relative contribution of delayed relaxation and volume overload in hypertensive patients with heart failure. Key Words: Heart Failure, Atrial Fibrillation, Hypertension
P-381 EFFICACY OF B-TYPE NATRIURETIC PEPTIDE IN ASSESSMENT OF HEART FAILURE SEVERITY IN AFRICAN AMERICAN HEART FAILURE PATIENTS Robert L. Scott, Talal Hamden, Mandeep R. Mehra, Myung H. Park, Patricia Uber. Cardiology, Ochsner Clinic Foundation, New Orleans, LA, United States. Heart failure is a major cause of morbidity and mortality in the United States. B-Type natriuretic peptide (BNP)has emerged as a sensitive predictor of heart failure severity and prognosis. To date, the overall efficacy of BNP in assessing the severity of heart failure has not specifically been addressed in African Americans. Methods: 44 patients (15 African American/29 White) with heart failure were evaluated for disease severity, ejection fraction, age, race, sex and BNP levels. Results: There were no significan differences in BNP levels between African American and White patients. Among all patients the levels of BNP were significantly higher among the NYHA class III/IV patients compared with the NYHA class I/II patients. The ejection fraction of the African American patients (27.4%) was significantly lower compared to the White patients(40.7%). The use of beta-blocker therapy correlated with neither the BNP levels nor the ejection fraction. Discussion: BNP levels correlated with disease severity in both African American and White patients with heart failure. There was no significant difference in BNP levels between African American and White patients with heart failure (both diastolic and systolic). The African American patients demonstrated significantly lower ejection fractions compared to the white patients. The fact that our analysis did not demonstrate an overall benefit with the use of beta-blocker therapy is not surprising given that our cohort consisted of both diastolic and systolic dysfunction. This analysis suggests that the measurement of B-type natriuretic peptide levels can provide a fast and effective diagnostic tool in African American heart failure patients. Race
EF
BNP
Black White
27 40
504 ⫾ 461 384 ⫾ 333
p ⬍ 0.0204
Key Words: Natriuretic Peptide, African American, Beta-Blocker