Clinical significance of coronary flow reserve in hypertrophied heart: comparison with Doppler index, hemodynamics and plasma natriuretic peptide concentrations

OBJECTIVES: The relationship was investigated between coronary flow reserve and Doppler echocardiographic parameters, hemodynamic parameters and plasma natriuretic peptide concentrations in the hypertrophied heart. METHODS: The subjects were 19 patients with hypertrophied heart due to various etiologies and no significant coronary artery stenosis. All patients were in sinus rhythm. The left ventricular wall thickness, the E/A ratio in transmitral flow velocity pattern and the Doppler index were determined by Doppler echocardiography, and the plasma atrial and brain natriuretic peptide concentrations were measured. At cardiac catheterization, pulmonary capillary wedge pressure and left ventricular end-diastolic pressure were measured, and the coronary flow reserve was obtained by injecting intracoronary adenosine triphosphate into the left anterior descending artery using a Doppler guidewire. RESULTS: Coronary flow reserve in the patients was significantly lower than in 11 normal control subjects (2.50 +/- 0.76 vs 3.90 +/- 0.64, p < 0.001). There were no significant correlations between coronary flow reserve and the left ventricular wall thickness or the E/A ratio. The mean value of the Doppler index in the patients was 0.48 +/- 0.10 and there was a significant negative correlation between coronary flow reserve and the Doppler index (r = -0.73, p < 0.001). The correlation between coronary flow reserve and left ventricular end-diastolic pressure was not significant, but there was a significant negative correlation between coronary flow reserve and pulmonary capillary wedge pressure (r = -0.64, p < 0.01). There were significant negative correlations between coronary flow reserve and atrial (r = -0.62, p < 0.01), or brain natriuretic peptide concentrations (r = -0.56, p < 0.05). CONCLUSIONS: Coronary flow reserve may reflect overall cardiac performance evaluated by the Doppler index and plasma natriuretic peptide concentrations in the hypertrophied heart, and the measurement of coronary flow reserve may be useful for evaluating disease severity in patients with hypertrophied heart.     

Plasma atrial natriuretic factor in essential hypertension: relation to cardiac size, function and systemic hemodynamics

To evaluate determinants of elevated plasma atrial natriuretic factor levels in patients with hypertension, immunoreactive plasma atrial natriuretic factor in 54 normal subjects and 40 untreated hypertensive patients was compared with echocardiographic measurements of cardiac size, function and systemic hemodynamics. In normal subjects, plasma atrial natriuretic factor was related to age, systolic blood pressure and left atrial and ventricular chamber sizes, but only age and ventricular size were independent predictors. In untreated hypertensive patients, atrial natriuretic factor was directly related to age, atrial size, systolic pressure, peripheral resistance and ventricular systolic performance; age, atrial size and peripheral resistance were independent predictors. Eight patients with elevated atrial natriuretic factor values (greater than 25 fmol/ml) were significantly (p less than 0.01) older and had greater atrial and ventricular size and higher systolic pressure and function than normal subjects or patients with normal natriuretic factor levels. Plasma atrial natriuretic factor was inversely related to peak diastolic filling rate in normal subjects (r = -0.59; p less than 0.001), whereas it was positively related to the proportional contribution of atrial systole to left ventricular filling in hypertensive patients (r = 0.77; p less than 0.001). These findings suggest that in normal subjects, impairment of ventricular relaxation with age may contribute to atrial natriuretic factor secretion by increasing left atrial afterload; the correlation with left ventricular size may reflect physiologic fluctuations in plasma volume. In patients with uncomplicated hypertension, left atrial enlargement and consequent stronger atrial contraction contributed to increased atrial natriuretic factor release, whereas no independent relation existed with left ventricular hypertrophy or systolic function. Because ventricular relaxation was normal and ventricular size and systolic performance were increased in hypertensive patients with high atrial natriuretic factor levels, the observed increase in left atrial size and atrial contribution to ventricular filling might reflect a primary increase in venous return in this subset of hypertensive patients.     

Ambulatory blood pressure monitoring and echocardiographic left ventricular wall thickness and mass

In a highly select group of stable hypertensive patients, we have assessed the strength of association between various blood pressure measurements (24 h average automated ambulatory blood pressure, 4 h automated ambulatory morning average blood pressure, multiple office visit average blood pressure, and a single office visit average blood pressure) and various echocardiographic indices of hypertensive cardiac target organ damage (left atrial diameter, left ventricular end diastolic diameter, posterior wall thickness, combined wall thickness, relative wall thickness, left ventricular mass and mass index, and combined wall thickness/left ventricular diastolic diameter ratio). These data demonstrated that a single 24 h average diastolic blood pressure by automatic noninvasive ambulatory monitoring was a significantly better predictor of echocardiographic posterior wall thickness, combined wall thickness or relative wall thickness than the multiple office or single office average diastolic blood pressure. Also there were highly significant correlations between both 24 h average systolic and diastolic blood pressure and these echocardiographic parameters (in descending order of correlation coefficient): combined wall thickness, posterior wall thickness, combined wall thickness/left ventricular diastolic diameter, left ventricular mass index, relative wall thickness, and left ventricular mass. Left ventricular end diastolic dimension did not linearly correlate with any systolic or diastolic blood pressure measurement. Left atrial dimension demonstrated only a significant association with 24 h average diastolic blood pressure. Single office average blood pressure did not linearly correlate with any echocardiographic parameter.(ABSTRACT TRUNCATED AT 250 WORDS)     

Differential increase in natriuretic peptides in elite dynamic and static athletes.

The echocardiographic measures and plasma concentrations of either atrial natriuretic peptide (ANP) or brain natriuretic peptide (BNP) were compared in elite judo practitioners (static athletes), elite marathon runners (dynamic athletes) and healthy controls to investigate the relationship between the different types of left ventricular (LV) hypertrophy and plasma concentrations of natriuretic peptides in athletes. The LV mass and LV wall thickness of marathon runners and judo practitioners were significantly greater than those of controls. The LV end-diastolic dimension index was significantly larger in the marathon group, but smaller in the judo group. The left atrial dimension (LAD) index was significantly larger only in marathon runners. Plasma BNP concentrations were higher in both the judo and marathon groups than in controls, and positively correlated with LV mass as well as with deceleration time. Plasma ANP concentrations were significantly higher in marathon runners than in the controls and judo groups, and positively correlated with the LAD index, but negatively correlated with ejection fraction. Multivariate analyses showed that the type of athlete and LAD index were independent predictors of plasma BNP and ANP concentrations, respectively. Thus, there is an intimate link between plasma concentrations of natriuretic peptides and cardiac morphology in different types of athletes.     

Increased circulating atrial natriuretic factor concentrations in patients with chronic heart failure after inhibition of neutral endopeptidase: effects on diastolic function.

OBJECTIVE--+/- Candoxatrilat was used to raise atrial natriuretic factor (ANF) concentrations in patients with heart failure, and the effects on left ventricular systolic and diastolic function were studied to determine the contribution of peripheral and central mechanisms to the haemodynamic effects. DESIGN--This was a single blind, randomised comparison of +/- candoxatrilat and placebo in patients with mild heart failure. All patients received two intravenous doses of +/- candoxatrilat and two placebo doses on four consecutive days. SETTING--A teaching hospital department of cardiology. PATIENTS--Six men (mean age 52 years) with mild heart failure (New York Heart Association class II) due to ischaemic heart disease (four patients) or dilated cardiomyopathy (two patients) were included. Mean ejection fraction was 37.5% and mean peak oxygen consumption was 20.4 ml/min/kg. MAIN OUTCOME MEASURES--Plasma ANF concentrations, haemodynamic indices and left ventricular diastolic function measured by early to atrial filling rate (E:A ratio) with Doppler echocardiography were determined before and after +/- candoxatrilat and placebo. RESULTS--+/- Candoxatrilat caused a threefold rise of plasma ANF compared with placebo (p < 0.005), but there was no significant change in heart rate, blood pressure, or cardiac output. Mean right atrial pressure fell from 6.7 to 4.7 mmHg (NS) and pulmonary artery wedge pressure fell from 9.2 to 6.7 mmHg (p < 0.05). Doppler echocardiographic measurements of transmitral blood flow showed a significant fall in peak early left ventricular filling velocity from 39.5 to 34.2 cm/s (p < 0.05), along with a non-significant rise in peak atrial filling velocity from 39.7-41.6 cm/s after +/- candoxatrilat. The E:A ratio, a Doppler index of left ventricular diastolic function, fell from a mean of 1.04 to 0.87 (p < 0.05). CONCLUSIONS--+/- Candoxatrilat increased plasma ANF concentrations and reduced right atrial and pulmonary artery wedge pressures. No evidence of an improvement in left ventricular systolic or diastolic function was found, so the fall in preload was due to peripheral effects, either an increase in venous capacitance or a fall in circulating blood volume.     

Hypertensive heart disease with left ventricular diastolic dysfunction demonstrating restrictive hemodynamics: a case report]

A 47-year-old man with hypertensive heart disease and left heart failure due to left ventricular diastolic dysfunction was admitted to our hospital because of emergent hypertension. Chest radiography on admission showed slight cardiomegaly and mild pulmonary congestion with right pleural effusion Echocardiography showed concentric hypertrophy and normal contraction of the left ventricular wall Pulsed Doppler left ventricular inflow velocity wave and pulmonary venous flow velocity wave disclosed restrictive filling patterns. After Ca antagonist, nitrate, and diuretics were administered, blood pressure was normalized, and left ventricular inflow velocity wave showed the relaxation abnormality pattern and pulmonary venous flow velocity wave showed the normal pattern. Radioiodinated iodine-123 metaiodobenzyl guanidine (123I-MIBG) imaging in the state of normalized blood pressure showed decreased heart to mediastinum ratio and increased washout rate. Left heart catheterization and angiography revealed normal end-diastolic pressure and coronary arteries, but coronary flow reserve evaluated with Doppler flow wire and intracoronary adenosine triphosphate administration was impaired: Plasma level of atrial and brain natriuretic peptides, which were markedly elevated on admission, decreased with the improvement of heart failure. Doppler flow velocity patterns, plasma levels of atrial natriuretic peptide and brain natriuretic peptide, cardiac sympathetic nerve activity, and coronary flow reserve might be useful for evaluating the severity of left ventricular diastolic dysfunction in patients with hypertensive heart disease.     

慢性心力衰竭患者心脏标志物水平及超声心动图特点

目的分析慢性心力衰竭(CHF)患者心脏标志物水平及超声心动图特点。 方法选取2017年4月至2018年3月在泰兴市第二人民医院收治的82例CHF患者设为CHF组,选择同期24例健康体检者为对照组。将CHF患者根据心功能分级分为4个CHF亚组：CHF 1级23例、CHF 2级25例、CHF 3级21例和CHF 4级13例。检测外周血脑钠肽(BNP)和生长分化因子－15(GDF－15)水平,采用超声心动图测定室间隔舒张末期厚度(IVSTD)、左室后壁舒张期厚度(LVPWTD)、左心室舒张末期内径(LVDD)、左房收缩末期内径(LAD)。采用Simpson公式计算左室射血分数(EF)、心输出量(CO)、心脏指数(CI)。从心尖四腔切面获得二尖瓣血流频谱,收集舒张早期最大流速(E峰),舒张晚期最大速度(A峰),E/A、舒张早期快速充盈分数(RFF)、左心室重量指数(LVMI)、相对室壁厚度(RWT),并对两组结果进行比较。 结果与对照组比,CHF组患者外周血BNP和GDF－15均明显增高(P<0.05),在CHF组中,随着心功能降低,外周血BNP和GDF－15也增高(P<0.05),与对照组比,CHF组的IVSTD、LVPWTD、LVDD、LAD、LVMI、RWT、CO和A明显增高(P<0.05),CI、EF、E/A和RFF明显减少(P<0.05),在CHF组中,随着心功能降低,IVSTD、LVPWTD、LVDD、LAD、LVMI、RWT、CO和A也明显增高(P<0.05),CI、EF、E/A和RFF也明显减少(P<0.05)。 结论CHF心脏标志物BNP和GDF－15明显增高,超声心动图各指标异常,异常集中表现为左心功能衰竭。     

Relationship between age, body size, gender, and blood pressure and Doppler flow measurements in the aorta and pulmonary artery

Previous studies have demonstrated a relationship between both age and body surface area (BSA) and M-mode echocardiographic measurements of left ventricular, left atrial, and aortic root dimensions and left ventricular wall thickness. We evaluated the relationships between age, BSA, gender and blood pressure, and Doppler aortic and pulmonary artery (PA) flow velocity measurements in 97 adults, aged 21 to 78 years, without clinical evidence of cardiac disease. No significant relationship was found between gender or blood pressure and aortic or PA flow velocity measurements. Aortic peak flow velocity, flow velocity integral, and average acceleration decreased with increasing age (all p less than 0.001), whereas ejection time (corrected for heart rate) increased, and acceleration time did not change. In contrast, there was no relationship between age and Doppler PA flow velocity measurements. Although there was no relationship between BSA and Doppler aortic flow measurements, PA peak flow velocity and average acceleration increased, while acceleration time decreased with increasing BSA (all p less than 0.02). Decreases in aortic peak flow velocity and flow velocity integral may be partly related to known increases in aortic root diameter with aging. The relationship between PA flow velocity measurements and BSA is not readily explained.     

Volume-dependent echocardiographic parameters are not useful for estimating baseline blood volume but are useful for detecting acute changes in vascular filling state

Summary To assess the hypothesis that echocardiographic variables vary as a function of baseline blood volume and change in response to changes in vascular filling state, we evaluated the relationship between the atrial and ventricular dimensions and left ventricular function, as measured by combined Doppler and M-mode echocardiography on the one hand, and blood volume as measured by a standard radioactive isotope technique on the other. Furthermore, we determined the effect of an increment in vascular filling state induced by plasma volume expansion. Test subjects were ten male and six female volunteers. Blood volume/kg was the only factor not different between male and female subjects and therefore suitable for our study. None of the echocardiographic variables correlated with blood volume/kg. Volume loading increased stroke volume, left atrial diameter, right atrial area, left ventricular enddiastolic dimension, mean velocity of circumferential fiber shortening and left ventricular ejection time. It is concluded that echocardiographic variables are unsuitable for estimating blood volume. Serial measurements of atrial dimensions and left ventricular dimensions are useful for detecting rapid changes in vascular filling state.Supported by Schering Nederland BV     

Correlations between plasma concentrations of atrial natriuretic factor and right ventricular function in patients with severe cardiac failure]

The atrial natriuretic factor (ANF) is secreted by the atria in mild and moderate cardiac failure but, during the evolution of the cardiac failure, the ventricles are also recruited and secrete ANF. In order to investigate the relation between plasma ANF and Doppler echocardiographic parameters of severe cardiac failure, the concentrations were measured simultaneously in 20 patients with NYHA Class III and IV cardiac failure (10 due to ischaemic and 10 due to primary dilated cardiomyopathy) despite optimal medical treatment including an angiotensin converting enzyme inhibitor. Overall, there was a weak negative correlation between the plasma ANF concentrations and the decrease in right ventricular surface area (r = -0.58, p less than 0.005, n = 20 patients). This relation was highly significant in ischaemic cardiomyopathy (r = -0.81, p less than 0.002, n = 10 patients) and not significant in primary dilated cardiomyopathy (r = -0.29, NS, n = 10 patients). No relationship was observed between plasma ANF and other echocardiographic parameters (atrial surface area, right and left ventricular dimensions, left ventricular ejection fraction and mass) or with Doppler aortic indices (acceleration, maximum and mean velocities, aortic velocity-time integrals). However, plasma ANF was related to the velocity of mitral regurgitant jets (r = -0.70, p less than 0.01) which is dependent on left ventricular pump function. These results show that plasma ANF concentrations are only related to right ventricular systolic function and the velocity of mitral regurgitation in patients with severe cardiac failure.     

Physiological hypertrophy of the heart and atrial natriuretic peptide during rest and exercise

The influence of physiological cardiac hypertrophy on the concentration of plasma atrial natriuretic peptide was studied in six male athletes and six normally active, matched control men. They were examined by echocardiography during a graded exercise test on a bicycle ergometer. Plasma atrial natriuretic peptide was measured at rest, at each workload until exhaustion, and 15 and 30 minutes after the exercise test. Echocardiography showed that the athletes had a significantly larger left atrium, left ventricular end diastolic diameter, left ventricular posterior wall, interventricular septum, left ventricular ejection fraction, and left ventricular mass than the controls. The athletes performed significantly more work than the control group--325 W v 277 W. The plasma concentration of atrial natriuretic peptide rose by a mean factor of 2.76 (range 1.78-4.28) in all men from rest to maximum exercise. There were no differences between the athletes and the controls in the concentrations of plasma atrial natriuretic peptide at rest, at any workload, or at maximum workload. Neither was there any difference in the increase in plasma atrial natriuretic peptide between the groups. There was no correlation between the plasma concentrations of atrial natriuretic peptide and any of the variables measured by echocardiography. In healthy young men plasma atrial natriuretic peptide rises by a factor of about 2.8 during maximum exercise and the size of the chambers on the left side of the heart or left ventricular hypertrophy does not seem to influence the concentration of plasma atrial natriuretic peptide at rest or during exercise.     

Association of atrial natriuretic peptide and type a natriuretic peptide receptor gene polymorphisms with left ventricular mass in human essential hypertension.

OBJECTIVES: The goal of our study was to investigate the relationships between atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), and type A natriuretic peptide receptor (NPRA) gene polymorphisms and left ventricular structure in human essential hypertension. BACKGROUND: Experimental evidence supports a key role for natriuretic peptides in the modulation of cardiac mass. This relationship has not yet been described in human disease. METHODS: A total of 203 hypertensive patients were studied by mono-bidimensional echocardiography. Three markers of the ANP gene (-C664G, G1837A, and T2238C polymorphisms) and a microsatellite marker of both NPRA and BNP genes were characterized. RESULTS: Patients carrying the ANP gene promoter allelic variant had increased left ventricular mass index (117.4 +/- 1.7 g vs. 95.7 +/- 1.7 g, p = 0.005), left ventricular posterior wall thickness (1.14 +/- 0.07 cm vs. 0.96 +/- 0.01 cm, p < 0.0001), left ventricular septal thickness (1.12 +/- 0.10 cm vs. 1.04 +/- 0.01 cm, p = 0.01), and relative wall thickening (47.5 +/- 4.1% vs. 39.4 +/- 5.3%, p = 0.001) as compared with the wild-type genotype. These associations were independent from anthropometric factors and major clinical features and were confirmed in a large subgroup of never-treated hypertensive patients (n = 148). Carrier status of the ANP gene promoter allelic variant was associated with significantly lower plasma proANP levels: 1,395 +/- 104 fmol/ml versus 3,110 +/- 141 fmol/ml in hypertensive patients carrying the wild-type genotype (p < 0.05). A significant association for NPRA gene variants with left ventricular mass index and left ventricular septal thickness was found. The analysis of BNP did not reveal any effect on cardiac phenotypes. CONCLUSIONS: Our findings show that the ANP/NPRA system significantly contributes to ventricular remodeling in human essential hypertension.     

Cardiac diastolic abnormalities and atrial natriuretic factor in essential hypertension

Cardiac function and plasma levels of atrial natriuretic factor(ANF) were studied in a group of 38 patients with untreatedessential hypertension and in a group of 31 well matched normotensivecontrols. ANF was slightly but significantly higher in hypertensivesand was directly correlated with mean arterial pressure andinversely with plasma renin activity (PRA). Hypertensives showednormal systolic function and higher cardiac mass compared tocontrols. ANF was inversely correlated to echocardiographicindexes of left ventricular performance in the former group.At Doppler echocardiographic evaluation, hypertensives showedan impairment in diastolic function which was correlated tothe increase in ANF levels. Stepwise multiple regression analysisperformed with ANF as the dependent variable and several biohumoraland echocardiographic parameters as the independent variablesshowed that only cardiac diastolic function and PRA significantlyaffect ANF levels in hypertensives. In conclusion, an impairmentin cardiac diastolic function may be responsible together withother factors for the increased ANF levels encountered in essentialhypertension.     

Physiological hypertrophy of the heart and atrial natriuretic peptide during rest and exercise.

The influence of physiological cardiac hypertrophy on the concentration of plasma atrial natriuretic peptide was studied in six male athletes and six normally active, matched control men. They were examined by echocardiography during a graded exercise test on a bicycle ergometer. Plasma atrial natriuretic peptide was measured at rest, at each workload until exhaustion, and 15 and 30 minutes after the exercise test. Echocardiography showed that the athletes had a significantly larger left atrium, left ventricular end diastolic diameter, left ventricular posterior wall, interventricular septum, left ventricular ejection fraction, and left ventricular mass than the controls. The athletes performed significantly more work than the control group--325 W v 277 W. The plasma concentration of atrial natriuretic peptide rose by a mean factor of 2.76 (range 1.78-4.28) in all men from rest to maximum exercise. There were no differences between the athletes and the controls in the concentrations of plasma atrial natriuretic peptide at rest, at any workload, or at maximum workload. Neither was there any difference in the increase in plasma atrial natriuretic peptide between the groups. There was no correlation between the plasma concentrations of atrial natriuretic peptide and any of the variables measured by echocardiography. In healthy young men plasma atrial natriuretic peptide rises by a factor of about 2.8 during maximum exercise and the size of the chambers on the left side of the heart or left ventricular hypertrophy does not seem to influence the concentration of plasma atrial natriuretic peptide at rest or during exercise.     

Impaired left ventricular diastolic filling in patients with familial amyloid polyneuropathy: a pulsed Doppler echocardiographic study.

To assess left ventricular diastolic filling in patients with amyloid heart disease 12 patients with familial amyloid polyneuropathy and 15 normal subjects were studied by pulsed Doppler echocardiography. None of the patients had clinical evidence of overt heart disease or restrictive cardiomyopathy and only two of them showed ventricular wall thickening. The peak flow velocity of rapid diastolic filling and the acceleration rate of early diastolic inflow were significantly lower in patients with familial amyloid polyneuropathy than in controls. The pressure half time was significantly longer in patients than in controls. In addition, the peak flow velocity during atrial contraction and the ratio of atrial peak flow velocity to rapid diastolic peak flow velocity were significantly greater in patients than in controls. Although there were no significant correlations between measurements of diastolic filling and clinical findings in patients with familial amyloid polyneuropathy, the ratio of atrial peak flow velocity to rapid diastolic peak flow velocity was significantly related to left ventricular posterior wall thickness. These findings suggest that in patients with cardiac amyloidosis without restrictive cardiomyopathy, abnormal left ventricular diastolic filling, manifested by a reduction in the rate and volume of rapid diastolic filling with enhanced atrial contraction, can be seen even in the early stage of the disease.     

Association between elevated brain natriuretic peptide levels and the development of left ventricular hypertrophy in patients with hypertension

PURPOSE: To examine whether plasma levels of brain natriuretic peptide identify hypertensive patients at risk for progressive cardiac hypertrophy. SUBJECTS AND METHODS: We examined the association between plasma brain natriuretic peptide levels and left ventricular structural changes in 54 hypertensive patients and 28 normotensive control subjects. Patients were divided into those with elevated (n = 14) or normal (n = 40) levels of brain natriuretic peptide, based on a cutoff level of 41 pg/mL (2 SD above the mean in the control subjects). Left ventricular function and geometry were assessed echocardiographically at baseline and follow-up. RESULTS: At baseline, initial left ventricular chamber size, wall thickness, and systolic function did not differ between the hypertensive patients and normotensive subjects. After a mean (+/- SD) follow-up of 9 +/- 3 months, blood pressure was relatively unchanged in the hypertensive patients with normal brain natriuretic peptide levels, whereas there were significant increases in systolic blood pressure and pulse pressure (both P <0.05 versus baseline) in patients with elevated brain natriuretic peptide levels. Moreover, left ventricular midwall systolic function had decreased significantly at follow-up in those with elevated levels (P <0.05 versus baseline). At follow-up, the hypertensive patients with elevated brain natriuretic peptide levels had a significantly greater left ventricular mass index and relative wall thickness than those with normal levels. Multiple regression analyses determined that only initial plasma brain natriuretic peptide was significantly (P <0.01) associated with subsequent left ventricular hypertrophy. CONCLUSION: Plasma brain natriuretic peptide levels may identify hypertensive patients who are likely to have progressive cardiac hypertrophy.     

Effects of lisinopril upon cardiac hypertrophy, central and peripheral hemodynamics and neurohumoral factors in spontaneously hypertensive rats.

OBJECTIVE: Left ventricular function (LVF) after reversal of left ventricular hypertrophy (LVH) with antihypertensive therapy is still controversial. The present study was undertaken in spontaneously hypertensive rats (SHR) to determine whether LVF of the regressed heart with lisinopril is normally maintained. DESIGN: We compared cardiac function of SHR after reversal of LVH induced by lisinopril with that observed in control SHR and also with effects after a 4-week washout period. METHODS: Administration of lisinopril began at 15 weeks of age and continued for 20 weeks. Cardiac index, renal blood flow, leg muscle blood flow, plasma renin activity, atrial natriuretic peptide level, and norepinephrine concentration were determined. RESULTS: Lisinopril decreased body weight, blood pressure and left ventricular weight and increased leg muscle blood flow; cardiac index and renal blood flow were unaltered. Although norepinephrine concentration was unchanged, plasma renin activity increased and atrial natriuretic peptide decreased in treated SHR. Peak left ventricular pumping ability during volume loading was comparable in the two groups. After a 4-week washout period, left ventricular mass and blood pressure increased but remained lower than controls; cardiac index at rest and during volume loading was similar in the two groups. CONCLUSIONS: These data indicate that LVF of the regressed heart induced by lisinopril was well preserved at rest, during volume loading and also after spontaneous recurrence of hypertension in SHR.     

慢性心力衰竭患者B型脑钠肽水平变化与超声心动图的相关性

目的探讨慢性心力衰竭患者超声心动图指标与外周血B型脑钠肽（BNP）水平变化的关系。方法选择符合诊断标准的慢性心力衰竭患者56例（观察组）,另选同期我院行健康体检的正常人30例（对照组）。观察组根据临床症状按NYHA分级进行分组：Ⅰ级＋Ⅱ级组20例,Ⅲ级组16例,Ⅳ级组20例,共3组。比较分析BNP变化与临床NYHA心功能分级和超声心动图指标的相关性。结果4组研究对象BNP浓度、LVEDD、LAD、LVEF及FS间差异均有统计学意义（P〈0．05）。BNP、LAD、LVEDD分别随心功能分级的升高而升高,呈正相关（P〈0．05）,LVEF和FS随心功能的升高而降低,呈负相关（P〈0．05）。结论慢性心力衰竭患者存在心室结构的重塑。BNP与NYHA心功能分级和超声心动图指标之间存在着明显的相关性。     

Plasma N-terminal pro-brain natriuretic peptide: a marker of left ventricular hypertrophy in hypertrophic cardiomyopathy.

BACKGROUND: B-type natriuretic peptide is secreted mainly in the left ventricle in response to elevated wall tension. Plasma levels of the peptide correlate positively with cardiac filling pressures, making it an excellent marker for the presence of left ventricular dysfunction. In hypertrophic cardiomyopathy, enhanced production of B-type natriuretic peptide is observed. However, the relationship of the various structural and functional features present in the disease with the high plasma levels described is not yet fully clarified. In the present study, we prospectively assessed in hypertrophic cardiomyopathy the relationship of plasma NT-proBNP levels with the extent of left ventricular hypertrophy, presence of left ventricular outflow obstruction and echocardiographic parameters of left ventricular diastolic function. METHODS: The study population included 190 individuals: 53 patients with hypertrophic cardiomyopathy and well-preserved left ventricular systolic function (group A), 92 healthy relatives with no disease expression (group B), and an additional group of 46 healthy volunteers (group C) as controls for NT-proBNP levels. Groups A and B were characterized clinically and by echocardiography and compared with each other. Plasma NT-proBNP levels were measured (ECLIA-Elecsys proBNP) and compared in the 3 groups of individuals included in the study. In hypertrophic cardiomyopathy patients, correlation was sought between NT-proBNP levels, NYHA functional class and echocardiographic data. RESULTS: Groups A and B differed (p < 0.001) in septal thickness, maximal wall thickness, left ventricular hypertrophy score, left atrial size, left atrial fractional shortening, derived transmitral filling indices and plasma NT-proBNP levels (group A: 909.9 +/- 1554.2 pg/ml; group B: 40.7 +/- 45.1 pg/ml). Left ventricular diastolic size and pulmonary venous flow velocity-derived indices were similar in the 2 groups. NT-proBNP levels in group B and C (39.4 +/- 34.5 pg/ml) were similar (p = NS). In hypertrophic cardiomyopathy patients, NT-proBNP levels correlate directly with NYHA functional class (r = 0.56, p < 0.001), septal thickness (r = 0.53, p < 0.001), maximal wall thickness (r = 0.59, p < 0.001), left ventricular hypertrophy score (r = 0.63, p < 0.001), left atrial size (r = 0.32, p = 0.023) and mitral deceleration time (r = 0.46, p = 0.001) and inversely with left atrial fractional shortening (r = -0.41, p = 0.005). Functional class also correlates directly with left ventricular hypertrophy score (r = 0.39, p = 0.006), with the most symptomatic patients having the highest scores. CONCLUSIONS: In hypertrophic cardiomyopathy, plasma NT-proBNP levels depend mainly on the severity of left ventricular hypertrophy rather than on the presence of obstruction. Measurement of the peptide may help in the clinical characterization and follow-up of patients with this disease.     

Associations between plasma natriuretic peptides and echocardiographic abnormalities in geriatric outpatients

Identification of patients with cardiac dysfunction can be difficult in the geriatric population. Recently, different subtypes of the natriuretic peptide family have been advocated as biomarker for the diagnosis of heart failure in the emergency department setting. In this study we looked at associations between natriuretic peptide plasma levels and echocardiographic abnormalities in geriatric outpatients. Two-dimensional transthoracic echocardiography was performed in 209 community-dwelling subjects, visiting the geriatric outpatient clinic of our university hospital. Subjects were 65 years or older and had no markedly impaired cognitive function. Mean atrial natriuretic peptide (ANP) and B-type natriuretic peptide (BNP) plasma levels were respectively 11.0 and 10.8pmol/l. BNP, but not ANP correlated with left ventricular dysfunction and left ventricular mass, whereas both peptides correlated with left atrial dimension and valvular lesions. A natriuretic peptide level in the highest tertile was associated with a higher risk of any echocardiographic abnormality, with odds ratios for BNP of 7.15 (range 2.15-23.71), and for ANP of 3.07 (range 1.15-8.16). In conclusion, elevated BNP and ANP plasma levels are closely related to cardiac abnormalities in elderly subjects. The association between cardiac abnormalities and natriuretic peptides is stronger for BNP than for ANP, hence for detection of cardiac abnormalities measurement of BNP plasma values are preferred over ANP plasma values.