Natriuretic peptides in the prognosis and management of acute coronary syndromes
Donald W. Reynolds Cardiovascular Research Center and Division of Cardiology, University of Texas Southwestern Medical Center, Dallas TX, USA. Reviews in cardiovascular medicine
(Impact Factor: 0.56).
03/2010; 11 Suppl 2:S24-34. DOI: 10.3909/ricm11S2S0004
Over the past decade, an evidence base has accumulated to support natriuretic peptide (NP) testing for diagnosis, risk assessment, and therapeutic monitoring and guidance of patients with heart failure. Investigators have also explored multiple other potential uses for these tests, including risk assessment of patients with suspected acute coronary syndromes (ACS). This article discusses the utility of NPs in the diagnosis and management of patients with ACS.
Available from: Chris Pemberton
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ABSTRACT: New biomarkers are needed to assist clinical decision making in cardiovascular disease. We have recently shown that signal peptides may represent a novel biomarker target in cardiovascular diseases.
We developed a novel immunoassay for the signal peptide of preproANP (ANPsp) and used it to document cardiac tissue levels of ANPsp in explant human hearts (n = 9), circulating venous concentrations of ANPsp in healthy volunteers (n = 65), temporal ANPsp concentrations in patients with ST-elevation myocardial infarction (STEMI) <4 h after chest pain onset (n = 23), and regional plasma ANPsp concentrations in patients undergoing clinically indicated catheterization (n = 10). We analyzed the structure and sequence of circulating ANPsp by tandem mass spectrometry (MS/MS).
ANPsp levels in human heart tissue were 50-1000 times lower than those of ANP/NT-proANP. ANPsp was detectable in control human plasma at concentrations comparable with ANP itself (approximately 20 ng/L). In STEMI patients, plasma concentrations of ANPsp rose to peak values at 5 h after symptom onset, significantly earlier than myoglobin, creatine kinase-MB, and troponin (P < 0.001). There were significant arteriovenous increases in ANPsp concentrations (P < 0.05) across the heart and kidney; arterial and coronary sinus concentrations of ANPsp both negatively correlated with systolic and mean arterial blood pressures (both P < 0.01). MS/MS verified circulating ANPsp to be preproANP(16-25) and preproANP(18-25).
ANPsp is a novel circulating natriuretic peptide with potential to act as a cardiovascular biomarker. The rapid increase of plasma ANPsp in STEMI and its significant relationship with blood pressure encourage further study of its potential clinical utility.
Clinical Chemistry 01/2012; 58(4):757-67. DOI:10.1373/clinchem.2011.176990 · 7.91 Impact Factor
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ABSTRACT: Hepatitis C virus (HCV) has been already linked to possible myocarditis and cardiomyopathy development. The brain natriuretic peptide (BNP) is a sensitive biomarker of left ventricular dysfunction. The present study aimed to evaluate the potential risk of cardiac injury in HIV-infected and HCV/HIV-coinfected patients with or without antiretroviral (ARV) therapy by comparing BNP serum levels in the groups studied.
Eighty HIV-infected patients (65 men, 15 women, mean age 40 years; 29 with HCV coinfection, 48 on combined ARV therapy) were included in the cross-sectional study. BNP serum levels were evaluated by enzyme-linked immunosorbent assay. The BNP cut-off level for possible heart failure was 42 fmol/l as in an immunocompetent population.
Seventy-eight (97.5%) patients studied had a BNP concentration above 42 fmol/l; seven patients (8.7%) had a concentration above 168 fmol/l associated with a worse outcome. There was no difference in the mean BNP serum levels in ARV-treated and untreated patients. However, the mean BNP serum level was significantly higher in HCV/HIV-coinfected patients in comparison with HIV-monoinfected patients (160.0±130.9 vs. 81.9±37.2 fmol/l; P<0.0001). There was no relationship between BNP serum levels and HIV viral load, CD4 cell count, sex, age, and abacavir or protease inhibitors use.
A significant association was found between HCV coinfection and BNP serum level in HIV-infected patients. HCV coinfection possibly enhances the risk of left ventricular dysfunction development in this vulnerable population.
European journal of gastroenterology & hepatology 07/2012; 24(11):1308-12. DOI:10.1097/MEG.0b013e32835702c6 · 2.25 Impact Factor
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ABSTRACT: Background. Periodontal diseases, which are the cause of chronic inflammatory processes, can predispose to increased susceptibility to vascular illnesses based on atherosclerosis. The advancement of periodontitis can significantly influence inflammatory reactivity of the organism and progress of atherosclerosis, in consequence causing acute myocardial infarction (MI) or stroke. The aim of this study was to examine influence of periodontitis on the selected cardiovascular system parameters and a correlation between selected clinical parameters of periodontitis and cardiovascular system parameters. Methods. Case group consisted of 112 patients (below 60 yrs of age) hospitalized due to acute myocardial infraction and diagnosed on the basis of ECG, with acute ST elevation MI (STEMI) and acute non-ST-elevation MI (NSTEMI). Clinical tests (conducted within the second day of hospitalization) included: clinical examination and laboratory tests such as: lipid profile, C-reactive proteins (CRP), fibrinogen, interleukin-6 (IL-6), tumor necrosis factor - alfa (TNF-α), brain natriuretic peptide (BNP). Periodontal examination included: approximal plaque index (API), clinical attachment level (CAL), pocket depth (PD), bleeding index (BI), tooth mobility and the number of teeth. Intima media thickness (IMT) value and the number of atherosclerotic plaques in carotid arteries were assessed by ultrasound test. Results. Numerous risk factors along with coexisting periodontitis in the group of patients with acute MI can elevate pro-inflammatory and pro-thrombotic reactivity of the organism and the risk of arteriosclerosis, in consequence provoking acute MI or stroke. Among the patients with severe periodontitis, an increased level of fibrinogen, IL-6, TNF-α, atherosclerotic changes (increased IMT and numerous atherosclerotic plaques) prevailed. Conclusion. Periodontitis can constitute an independent risk factor in cardiovascular diseases.
Czasopismo stomatologiczne 08/2012; 65(5-5):636 -653. DOI:10.5604/00114553.1007597
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