bluuebunny/crossref_metadata_2025_split huggingface dataset:
Heart rate variability in severe right or left heart failure: the role of pulmonary hypertension and resistances
Authors: Fauchier Laurent , Babuty Dominique , Melin Alexandre , Bonnet Pierre , Cosnay Pierre , Fauchier Jean Paul 
Published: February 2004

AbstractBackground:The decrease in heart rate variability (HRV) might be related to the hemodynamic status in heart failure. However, HRV in patients with severe isolated right heart failure has not been extensively studied.Aims:This study compared HRV in patients with congestive heart failure (CHF) and in patients with isolated right heart failure.Methods:Time and frequency domain analysis of HRV on 24‐h ECG recording was assessed in 15 healthy subjects and in two groups of patients with severe heart failure awaiting heart or heart/lung transplantation. These were 15 patients with CHF due to idiopathic dilated cardiomyopathy (IDC) and 10 patients with isolated right heart failure due to primary pulmonary hypertension (PPH).Results:Measurement of HRV were significantly decreased in both groups of patients compared with the control group. Patients with IDC had higher pulmonary capillary wedge pressure than patients with PPH (P=0.04) but lower pulmonary artery pressure and lower pulmonary vascular resistance (PVR) (P<0.0001). However, all the measurements of HRV were significantly lower in patients with IDC than in patients with PPH (range 22–77%, P<0.05 to P<0.01). None of the HRV measurements correlated with filling pressure measurements.Conclusions:The increase in pulmonary vascular resistance in heart failure is not the main causal factor behind a decrease in HRV.
QT dispersion correlates to myocardial viability assessed by dobutamine stress echocardiography in patients with severely depressed left ventricular function due to coronary artery disease
Authors: Bountioukos Manolis , Schinkel Arend F.L. , Poldermans Don , Rizzello Vittoria , Vourvouri Eleni C. , Krenning Boudewijn J. , Biagini Elena , Roelandt Jos R.T.C. , Bax Jeroen J. 
Published: February 2004

AbstractBackground:T dispersion is prolonged in numerous cardiac diseases, representing a general repolarization abnormality.Aim:To evaluate the influence of viable myocardium on QT dispersion in patients with severely depressed left ventricular (LV) function due to coronary artery disease.Methods and results:103 patients with ischemic cardiomyopathy (LV ejection fraction [EF]: 25±6%) were studied. Patients underwent 12‐lead electrocardiography to assess QT dispersion, and two‐dimensional echocardiography to identify segmental dysfunction. Dobutamine stress echocardiography (DSE) was then performed to detect residual viability. Resting echo demonstrated 1260 dysfunctional segments; of these, 476 (38%) were viable. Substantial viability (≥4 viable segments on DSE) was found in 62 (60%) patients. QT dispersion was lower in these patients, than in patients without viability (55±17 ms vs. 65±22 ms, P=0.012). Viable segments negatively correlated to QT dispersion (r=−0.333, P=0.001). In contrast, there was no correlation between LVEF and QT dispersion (r=−0.001, P=NS).Conclusions:There is a negative correlation between QT dispersion and the number of viable segments assessed by DSE. Patients with severely depressed LV function and a low QT dispersion probably have a substantial amount of viable tissue. Conversely, when QT dispersion is high, the likelihood of substantial viability is reduced.
Left–right asymmetric ventricular expression of CARP in the piglet heart: regional response to experimental heart failure
Authors: Torrado Mario , López Eduardo , Centeno Alberto , Castro‐Beiras Alfonso , Mikhailov Alexander T. 
Published: February 2004

AbstractBackground and aim:Cardiac ankyrin repeat protein (CARP), whose expression is down‐regulated in response to doxorubicin (Dox) in vitro, has been proposed to be a marker of experimentally‐induced cardiac hypertrophy in rodent models. In piglets, the rapid hypertrophy rate of the left ventricle (LV) as compared to that of the right ventricle (RV) represents a natural model of asymmetric ventricular enlargement. We tested whether CARP expression correlates with postnatal ventricular hypertrophy and to what extent CARP can be sensitive to Dox treatment in vivo.Methods:CARP mRNA and protein levels were quantified (by Northern blot hybridization, semi‐quantitative RT‐PCR and Western blot) in the piglet heart, both during early postnatal development and upon Dox‐induced cardiomyopathy (Dox‐CM).Results:The study revealed: (1) significantly augmented CARP mRNA and protein levels in the LV compared to the RV resulting in left vs. right asymmetry in ventricular CARP expression throughout early postnatal development; (2) dose‐ and chamber‐dependent CARP mRNA and protein enrichment in ventricular myocardium in response to Dox; and (3) abolishment of asymmetric patterns of ventricular CARP expression at heart failure resulting from Dox‐CM.Conclusions:(1) CARP is differentially regulated in the LV and RV during both postnatal development and disease; and (2) monitoring of ventricular CARP expression patterns can be used for further analysis of transition from compensated to overt heart failure.
Beneficial effects of carvedilol on angiotensin‐converting enzyme activity and renin plasma levels in patients with chronic heart failure
Authors: Solal Alain Cohen , Jondeau Guillaume , Beauvais Florence , Berdeaux Alain 
Published: February 2004

AbstractObjective:To assess the effects of carvedilol treatment on the renin–angiotensin system in patients with chronic heart failure (CHF).Background:Carvedilol improves survival of patients suffering from CHF but the effects of the drug on angiotensin‐converting enzyme (ACE) activity, renin and aldosterone are not well characterized in patients receiving an ACE inhibitor.Methods:A randomized, multicenter, double‐blind, 6‐month, placebo‐controlled study of carvedilol vs. placebo was conducted in 64 CHF patients. Circulating levels of ACE activity, active renin and aldosterone as well as left ventricular diameters and ejection fraction by echography were assessed.Results:During the study, left ventricular ejection fraction increased from 25±11% to 31±12% with carvedilol and from 27±12% to 28±12% with placebo (P=0.03). This beneficial effect was associated with marked blunting of active renin secretion (−53% in the carvedilol group vs.−13% in the placebo group, P=0.04). ACE activity was reduced by 30% in the carvedilol group (P=0.07 vs. placebo). Aldosterone was not changed.Conclusion:Carvedilol markedly reduced the increase in active renin observed with time despite ACE‐inhibitors and tended to decrease ACE activity. These findings may in part explain the beneficial actions of carvedilol and highlights the profound effect of betablockade on renin in patients already receiving ACE‐inibitors.
Biological variation of the natriuretic peptides and their role in monitoring patients with heart failure
Authors: Wu Alan H.B. , Smith Andrew 
Published: February 2004

AbstractBackground:B‐type natriuretic peptide (BNP) and the inactive metabolite NT‐proBNP are proven tests for diagnosis and staging of severity for patients with heart failure. However, the utility of these biomarkers for monitoring the success of drug therapy remains to be determined. Results of longitudinal studies on serial blood testing must be linked to overall patient morbidity and mortality outcomes. We previously determined the 8‐week biological variability (BV) of BNP and NT‐proBNP assays in healthy subjects and the 1‐day BV for BNP alone in patients with compensated and stable heart failure. From these studies, the percent statistical change in serial samples of approximately 100% difference was estimated (95% confidence).Methods:We applied the biological variability concepts to the serial results of BNP and NT‐proBNP collected from patients with heart failure and compared the performance of these two markers.Results:While there are minor differences in the results between the assays from one time period to another, the overall interpretation of results are essentially identical. Moreover, the majority of individual serial time points are not significantly different from the previous value.Conclusion:Frequent testing (e.g. daily) for BNP and NT‐proBNP to monitor therapy for patients with CHF is not indicated, as overall changes require several days to become evident.
N‐terminal probrain natriuretic peptide (NT‐proBNP) in the emergency diagnosis and in‐hospital monitoring of patients with dyspnoea and ventricular dysfunction
Authors: Bayés‐Genís Antoni , Santaló‐Bel Miquel , Zapico‐Muñiz Edgar , López Laura , Cotes Carlos , Bellido Jesús , Leta Rubén , Casan Pere , Ordóñez‐Llanos Jordi 
Published: February 2004

AbstractObjective:To evaluate the utility of NT‐proBNP in the emergency diagnosis and in‐hospital monitoring of patients with acute dyspnoea and ventricular dysfunction.Background:Misdiagnosis of heart failure (HF) is common in the urgent care setting using clinical diagnostic tests. Reports show that BNP is useful to diagnose HF in patients with acute dyspnoea.Methods:Prospective study of 100 patients attending the Emergency Department (ED) for acute dyspnoea. Final diagnosis was determined on the basis of ED data sheets, echocardiography and pulmonary function tests. NT‐proBNP levels were obtained on admission, at 24 h and at day 7.Results:Patients with ventricular dysfunction were sub‐classified into decompensated HF and masked HF, defined as HF with concomitant signs of pulmonary disease. Decompensated and masked HF patients had significantly higher NT‐proBNP values than patients with non‐cardiac dyspnoea (normal ventricular function) (920±140 and 978±363 vs. 50±15 pmol/L; P<0.001 and P<0.01, respectively). The mean area under the ROC curve for NT‐proBNP was 0.957 (95% CI, 0.918 to 0.996, P<0.001). In multiple logistic‐regression analysis NT‐proBNP>115 pmol/l was the strongest independent predictor of ventricular dysfunction (odds ratio 45.4; 95% CI: 4.5–452.3). At day 7, a significant and similar reduction in NT‐proBNP was observed in the two groups of patients with ventricular dysfunction (P<0.001 vs. admission values), but complete clinical resolution was less frequent in masked HF patients (P<0.05 vs. decompensated HF).Conclusions:NT‐proBNP is a new candidate marker for the detection and exclusion of ventricular dysfunction in patients attending the ED for acute dyspnoea. NT‐proBNP may also serve to monitor outcome during hospitalization.
Reduced readmission rate for alternating diagnoses of heart failure and pulmonary disease after implementation of B‐type natriuretic peptide testing
Authors: Wu Alan H.B. , Harrison Alex , Maisel Alan S. 
Published: February 2004

AbstractBackground:Patients with heart failure (HF) or pulmonary diseases (PD) present with similar symptoms. Effective disease management requires an accurate diagnosis. B‐type natriuretic peptide (BNP) is increased in patients with HF and is normal in PD patients without cardiac involvement.Objective:To determine if the readmission rate for patients with either HF or PD who later present with the alternate diagnosis (PD or HF) is decreased with the implementation of BNP testing at one hospital.Methods:We retrospectively determined the impact of BNP testing on reducing diagnostic ambiguities for patients admitted to an emergency department (ED) with these diseases. We compared a HF DRG (Diagnostic Related Group) (#428) and PD DRGs (#480–496) before vs. 1 and 2 y after implementation of BNP testing.Results:In a 12‐month period before BNP, there were 42 total visits (15 cases) where a patient presented with a HF DRG and returned within 6 months with a PD DRG, and 41 visits (14 cases) where there was a PD→HF readmission. One year after BNP implementation, the corresponding number of visits decreased 52% to 20 visits (15 cases) for HF→PD, and 73% to 11 visits (8 cases) for PD→HF readmissions. A similar reduction in readmissions was observed in the second year after BNP testing. The total number of HF and PD cases in 1999 (1029 patients) was similar to 2001 (985), and was higher in 2002 (1350) during these time intervals. The ED length‐of‐stay (LOS) was slightly higher for the HF→PD cases with BNP testing, whereas there was no change in LOS for the PD→HF cases.Conclusion:We hypothesize that prior to BNP implementation, there may have been diagnostic ambiguities in the initial diagnosis of HF or PD, which contributed to a repeat visit for the alternate diagnosis (PD or HF). With BNP testing, the apparent number of inappropriate visits decreased. Reducing unnecessary ED admissions helps justify the costs for implementing BNP testing in the hospital.
Essential biochemistry and physiology of (NT‐pro)BNP
Authors: Hall Christian 
Published: February 2004

AbstractBrain natriuretic peptide (BNP) is a 32 amino acid cardiac natriuretic peptide hormone originally isolated from porcine brain tissue. The human BNP gene is located on chromosome 1 and encodes the prohormone proBNP. The biologically active BNP and the remaining part of the prohormone, NT‐proBNP (76 amino acids) can be measured by immunoassay in human blood. Cardiac myocytes constitute the major source of BNP related peptides. The main stimulus for peptide synthesis and secretion is myocyte stretch. Recently, cardiac fibroblasts have also been shown to produce BNP. Other neurohormones may stimulate cardiac BNP production in different cardiac cell types. In contrast to atrial natriuretic peptides (ANP/NT‐proANP), which originate mainly from atrial tissue, BNP related peptides are produced mainly from ventricular myocytes. Ventricular (NT‐pro)BNP production is strongly upregulated in cardiac failure and locally in the area surrounding a myocardial infarction. In peripheral organs BNP binds to the natriuretic peptide receptor type A causing increased intracellular cGMP production. The biological effects include diuresis, vasodilatation, inhibition of renin and aldosterone production and of cardiac and vascular myocyte growth. In mice BNP gene knockout leads to cardiac fibrosis, gene over‐expression to hypotension and bone malformations. BNP is cleared from plasma through binding to the natriuretic peptide clearance receptor type C, but it seems relatively resistant to proteolysis by neutral endopeptidase NEP 24.11. Clearance mechanisms for NT‐proBNP await further study. While the plasma concentration of NT‐proBNP and BNP is approximately equal in normal controls, NT‐proBNP plasma concentration is 2–10 times higher than BNP in patients with heart failure. This relative change in peptide levels may be explained by shifts in cardiac secretion and/or clearance mechanisms.
N‐terminal pro brain natriuretic peptide in arterial hypertension—a marker for left ventricular dimensions and prognosis
Authors: Hildebrandt Per , Boesen Mikael , Olsen Michael , Wachtell Kristian , Groenning Bjoern 
Published: February 2004

AbstractIn arterial hypertension risk factor evaluation, including LV mass measurements, and risk stratification using risk charts or programs, is generally recommended. In heart failure NT‐proBNP has been shown to be a marker of LV dimensions and of prognosis. If the same diagnostic and prognostic value is present in arterial hypertension, risk factor evaluation would be easier. In 36 patients with arterial hypertension, electrocardiographic LV hypertrophy and preserved left ventricular function, NT‐proBNP was eight‐fold higher than in healthy subjects. The log NT‐proBNP correlated with LV mass index (R=0.47, P=0.0002) measured by magnetic resonance imaging. In other subjects with arterial hypertension a significant but weak correlation to diastolic properties has been demonstrated. As for prognosis, a recent study in patients with hypertension, electrocardiographic left ventricular hypertrophy and preserved LV function demonstrated that NT‐proBNP was a very strong prognostic marker, especially combined with a history of cardiovascular disease. Patients with high NT‐proBNP and known cardiovascular disease had a seven‐fold increase in CV events compared to patients with low NT‐proBNP and no CV disease, while patients with either high NT‐proBNP or CV disease had a three–four‐fold increased risk. In conclusion NT‐proBNP predicts LV mass in hypertensive patients and is a very strong prognostic marker in these patients. This could indicate a use of NT‐proBNP in the future for risk stratification and perhaps monitoring of treatment in patients with arterial hypertension.
Brain and other natriuretic peptides: molecular aspects
Authors: Vanderheyden Marc , Bartunek Jozef , Goethals Marc 
Published: February 2004

AbstractNatriuretic peptides have emerged as important candidates for development of diagnostic tools and therapeutic agents in cardiovascular disease. The family contains of three major peptides—ANP, BNP, CNP—that participate in cardiovascular and cardiorenal homeostasis. Each of these natriuretic peptides binds differentially to specific receptors that signal through different mechanisms. They are cleared enzymatically by neutral endopeptidase as well as by receptor‐mediated endocytosis. Because of its fast induction and specific expression in overt heart failure, BNP seems the most promising natriuretic peptide. It is predominantly synthesized in the cardiac ventricles, released as pre‐proBNP and then enzymatically cleaved to BNP and the N‐terminal portion of BNP(NT‐proBNP). Blood measurements of BNP and NT‐proBNP have been shown to identify patients with LV dysfunction. This review focuses on the physiology of natriuretic peptides as a group and brain natriuretic peptide in more detail, its structure and regulation as well as its effects at the cellular level.
Can natriuretic peptides be used for the diagnosis of diastolic heart failure?
Authors: Dahlström U. 
Published: February 2004

AbstractMany patients with heart failure have stiff hearts with an increased wall thickness and small volumes leading to diastolic dysfunction. Different definitions for diastolic heart failure have been proposed but today there is no generally accepted definition and there are few large controlled studies telling us how it should be managed. Natriuretic peptides (BNP or NT‐proBNP) might be used to detect patients with diastolic dysfunction especially in those patients having a restrictive filling pattern or pseudo‐normalised mitral flow pattern and in those, who are symptomatic. However, patients with relaxation abnormalities and mild symptoms or asymptomatic may have normal levels of the natriuretic peptides indicating no or only slight elevation of the left ventricular filling pressures. Thus low levels cannot be used as a rule out diagnosis of diastolic dysfunction.
Natriuretic peptides for risk stratification of patients with acute coronary syndromes
Authors: Galvani Marcello , Ferrini Donatella , Ottani Filippo 
Published: February 2004

AbstractNatriuretic peptides (BNP and NT‐proBNP) have been shown to be useful tools for risk stratification of patients with acute myocardial ischemia encompassing the whole spectrum of acute coronary syndromes (ACS), particularly for prediction of mortality. Both BNP and NT‐proBNP possess several characteristics of the ideal biomarker, showing independent and incremental prognostic value above traditional clinical, electrocardiographic, and biochemical (particularly troponin) risk indicators. Specifically, in ACS patients, BNP and NT‐proBNP have powerful prognostic value both in patients without a history of previous heart failure or without clinical or instrumental signs of left ventricular dysfunction on admission or during hospital stay. They can also be easily and rapidly measured in an emergency context. We have performed a meta‐analysis of available studies concerning the prognostic value of natriuretic peptides. Our results show that the prognostic value of natriuretic peptides is similar: (1) both at short‐ and long‐term; (2) when natriuretic peptides are measured at first patient contact or during hospital stay; (3) for BNP or NT‐proBNP; and (4) in patients with ST elevation myocardial infarction or no ST elevation ACS. These data suggest that natriuretic peptide measurement should be integrated into routine evaluation of patients with an ACS.
An exploratory study of performance measurement systems and relationships with performance results
Authors: Evans James R 
Published: February 2004

AbstractThe design of an effective performance measurement system, which includes the selection of appropriate measures and approaches for analyzing results, is central to aligning an organization’s operations with its strategic direction. Despite its importance, this is one area that many organizations fail to address effectively. This paper reports exploratory empirical results, obtained from an on‐line survey, on the relative emphasis and types of performance measurements and analysis approaches used by organizations in manufacturing, service, and not‐for‐profit (including education and health care) sectors. The results suggest that organizations with more mature performance measurement systems report better results in terms of customer, financial, and market performance.
Comparison of the anti‐allodynic and antinociceptive effects of systemic; intrathecal and intracerebroventricular morphine in a rat model of central neuropathic pain
Authors: Yu W. , Hao J‐X. , Xu X‐J. , Wiesenfeld‐Hallin Z. 
Published: February 2004

The present study has assessed the efficacy and potency of systemic, intrathecal (i.t.) and intracerebroventricular (i.c.v.) morphine in alleviating a chronic mechanical allodynia‐like behaviour in a rat model of central pain after spinal cord injury. The anti‐allodynic potency of morphine was compared to its antinociceptive potency in both spinally injured and normal rats. Systemic (intraperitoneal or subcutaneous) morphine did not significantly relieve allodynia up to 3 mg/kg cumulative dose, which was sedative. Mechanical allodynia‐like behaviour was only significantly relieved by 10 mg/kg morphine which caused severe sedation. Low doses of i.c.v. morphine abolished vocalization of allodynic rats to von Frey hair stimulation. However, other components of abnormal reactions to innocuous mechanical stimulation, such as agitation, jumping and avoidance, were only relieved by i.c.v. morphine at high, sedative doses. In contrast, i.t. morphine dose dependently reversed all components of the allodynic reactions without causing sedation. Morphine administered by all three routes produced powerful antinociception in the tail flick test in normal rats. The antinociceptive potency of morphine was reduced after systemic, i.t. and, particularly, i.c.v. administration in allodynic rats.These results indicated that i.t. morphine relieved the mechanical allodynia‐like responses in spinally injured rats, whereas systemic or i.c.v. morphine only increased the response threshold to innocuous mechanical stimulation at high doses, which was associated with sedation, making it difficult to assess the anti‐allodynic effect. However, i.c.v. morphine may be particularly effective for the affective component of pain in the present model. The antinociceptive potency of morphine was also reduced in spinally injured rats. It is suggested that morphine may be differentially effective against different types of pain after different routes of administration. Spinal morphine may be a therapeutic alternative in treating central pain after spinal cord injury.