Utility of BNP as a biomarker for assessing functional class during therapy in a heart failure specialty clinic

210A

POSTERS: Heart Failure/Hypertrophy

forward and backward waves to be distinguished at any site. It has been proposed that wave reflection is increased in heart failure (HF). 24 patients with Class II-III heart failure (mean age 66⫾8yrs) were studied. The group was subdivided into hypertensives (HT: 130⫾19/72⫾13) and non-hypertensives (NT: 114⫾18/65⫾9 mmHg). Carotid flow and BP were measured by pulsed Doppler U/S and arterial tonometry. Brachial BP and ejection fraction (EF) were also measured. Carotid pulse wave velocity (c), dI, augmentation index (AI) and wave reflection were calculated. Data are means ⫾ SD, p was calculated using Student’s t-test. Despite similar EF [31⫾9 (HT); 30⫾14% (NT)], dI⫹c1, a measure of ventricular wave power, did not differ between the groups [219⫾110(HT); 177⫾124 mWm-2 (NT)]. AI was markedly increased in HT [18.6⫾12.6(HT); 1.7⫾4.1% (NT)p⬍0.01]. Cerebral reflection was similar in both groups [17.2⫾7.1(HT); 18.1⫾8.6% (NT)], but reflection from the body was significantly increased in HT [14.1⫾16.4(HT), 4.7⫾4.7 (NT), p⬍0.01]. c did not differ significantly [13.5⫾6.2 (HT); 10.9⫾5.0 ms-1 (NT)]. These data show that heart failure patients are not homogeneous in terms of wave reflection patterns. Co-existing hypertension is associated with an additional burden on the heart due to wave reflection from the periphery. In contrast the reflection pattern from the cerebral circulation is not affected by hypertension. Differing categories of heart failure may benefit from specifically tailored therapy. Key Words: heart failure, wave intensity analysis, hypertension

P-535 RELATIONSHIP BETWEEN LEFT VENTRICULAR MASS AND 24 HOUR BLOOD PRESSURE PROFILES IN BLACK-AFRICAN PATIENTS WITH SEVERE HYPERTENSION Ivo V. Radevski, E. Libhaber, G. P. Candy, Z. P. Valtchanova, P. Sareli. 1Department of Cardiology, Chris Hani-Baragwanath Hospital, Bertsham, South Africa The relationship between left ventricular mass (LVM) and ambulatory blood pressure (ABP) profiles has not been investigated in black African patients with severe hypertension. Fifty nine patients Black patients with ambulatory day diastolic blood pressures (DBP) ⱖ110 and ⱕ140mm Hg with echocardiographic determined LVM, received either nisoldipine (n⫽30; 40 mg once daily) or enalapril (n⫽29; 40mg/D) for 2 months in a double blind randomised trial. The patients (33 female) aged (46⫾9 years; BSA (1.8⫾0.2 kg/m2)) had baseline mean 24h ambulatory BP 180⫾13/118⫾6 mm Hg. Patients receiving nisoldipine (NP) decreased mean 24h ABP (180⫾12/119⫾7 mm Hg to 143⫾15/94⫾9 mm Hg) and LVM index (LVMI 146⫾41 to 124⫾34g/m2) significantly. In contrast, those receiving enalapril a modest decrease in mean 24h ABP (179⫾14/117⫾5 mm Hg to 169⫾19/110⫾12 mm Hg; p⬍0.001 for change in SBP and DBP compared to NP) was without regression of the LVMI (139⫾38 to 139⫾49 g/m2; p⬍0.002 for the change compared to NP). For the whole group, a stepwise regression model for baseline LVM showed age, gender, 24h SBP (but not 24h DBP) and body weight to be predictors of LVM (R2⫽0.49; p⬍0.0001). The degree of change in LVMI correlated with degree of change in the 24h, daytime and nighttime SBP profiles (r⫽0.28, 0.33 and 0.27 respectively; all p⬍0.05). There was no correlation between the corresponding DBP profiles and the degree LVMI regression. In conclusion, 24h SBP but not 24h DBP, is a strong predictor of LVM in black African patients with severe hypertension and the degree of LVMI regression correlated with degree of change in SBP but not DBP profiles. Key Words: left ventricular hypertrophy, Severe Hypertension, Left Ventricular Mass Regression

AJH–April 2001–VOL. 14, NO. 4, PART 2

P-536 UTILITY OF BNP AS A BIOMARKER FOR ASSESSING FUNCTIONAL CLASS DURING THERAPY IN A HEART FAILURE SPECIALTY CLINIC Shang C. Lee, Tracy L. Stevens, Sharon M. Sandberg, Denise M. Heublein, Susan M. Nelson, Douglas W. Mahoney, Michihisa Jougasaki, Margaret M. Redfield, John C. Burnett. 1Internal Medicine, Mayo Clinic, Rochester, MN, United States Although studies have suggested that circulating levels of the biologically active C-terminal ANP and the biologically inactive N-terminal ANP and BNP have diagnostic utility in the detection of left ventricular systolic dysfunction, no studies have directly assessed the relative value of these peptides prospectively in monitoring functional class of patients undergoing treatment over time for congestive heart failure (CHF). Further, value of the natriuretic peptides as compared to non-invasive measurement of left ventricular ejection fraction (LVEF) in assessing symptom status during treatment of CHF also has not been reported. The current study was designed to compare the utility of plasma ANP (both C-terminal ANP and N-terminal ANP) and plasma BNP as well as LVEF in assessing NYHA Class I-IV during the outpatient treatment of CHF. Ninety-eight subjects with known CHF were evaluated. Baseline LVEF measured with echocardiography and natriuretic peptides measured with radioimmunoassay were obtained. NYHA class was determined independently by attending HF specialists. Forty-one subjects were re-studied during a 6-12 month follow-up period during which drug therapy was optimized. At baseline, all natriuretic peptides and LVEF correlated positively with NYHA class (P ⬍ 0.005). Plasma BNP however was a more sensitive and specific marker for NYHA class when compared to LVEF or the other natriuretic peptides by ROC analysis. At follow-up, only changes of BNP, not LVEF nor the other natriuretic peptides, correlated to changes of NYHA class after optimizing therapy (P ⫽ 0.04). When comparing the two visits, BNP decreased (-45% ⫾ 12%, N ⫽ 14, P ⫽ 0.002) in subjects whose NYHA class improved while BNP remained unchanged (-1% ⫾ 10%, N ⫽ 25, P ⫽ 0.95) in those whose NYHA class remained stable. There was no change in LVEF in those whose NYHA class improved or remained unchanged (⫹40% ⫾ 22%, P ⫽ 0.09 and ⫹14% ⫾ 10%, P ⫽ 0.20, respectively). This investigation demonstrates the superiority of plasma BNP compared to C-terminal ANP, N-terminal ANP or LVEF by echocardiography in assessing NYHA class. In addition, this study importantly documents that plasma BNP is a more sensitive biomarker than ANP and LVEF by echocardiography in the follow up of patients undergoing therapy for CHF. Plasma BNP can be a useful tool in managing CHF patients. Key Words: Natriuretic Peptides, Heart Failure, Biomarker

P-537 RELATIONSHIP BETWEEN TOTAL EJECTION ISOVOLUME INDEX AND NEUROHORMONAL EFFECTS IN PATIENTS WITH ESSENTIAL HYPERTENSION Tomohiko Shigemasa, Eiji Miyajima, Kazuo Kimura, Osamu Tochikubo, Satoshi Umemura. 1Cardiovascular Center, Yokohama City University, School of Medicine, Yokohama, Kanagawa, Japan It is known that left ventricular diastolic dysfunction is preliminary to systolic dysfunction in patients with essential hypertension (EH). The purpose of this study was to examine the relationship between the a Doppler-derived index (total ejection isovolume index : TEI index) of combined systolic and diastolic myocardial performance and neurohormonal effects or circadian blood pressure (BP) changes in patients with EH. We examined ambulatory 24-hour BP and echocardiography in 52 untreated patients with EH (53⫾2⬍SE⬎ y; 30 men and 22 women). TEI index was univariately significantly related to nighttime mean BP (r⫽0.44, p⬍0.005) and left ventricular mass index (r⫽0.49, p⬍0.001). Furthermore, 20 inpatients (53⫾3 y; 15 men and 5 women) of 52 with