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      The Relationship between Plasma BNP Level and the Myocardial Phosphocreatine/Adenosine Triphosphate Ratio Determined by Phosphorus-31 Magnetic Resonance Spectroscopy in Patients with Dilated Cardiomyopathy

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          Abstract

          The purpose of this study was to evaluate the correlation between the plasma B-type natriuretic peptide (BNP) level and the myocardial phosphocreatine/adenosine triphosphate ratio determined using rapid phosphorus-31 magnetic resonance spectroscopy (<sup>31</sup>P-MRS) in patients with dilated cardiomyopathy (DCM). Thirteen DCM patients, who had slight or moderate heart failure, were examined. The plasma BNP was measured on a day close to the rapid <sup>31</sup>P-MRS study. <sup>31</sup>P-MRS measurements were conducted with a 1.5-T MR instrument. The plasma BNP levels tended to be correlated negatively with the myocardial phosphocreatine/adenosine triphosphate, although the correlation did not reach statistical significance (r = –0.54, p =0.06). By contrast, the log of the plasma BNP levels was correlated negatively with the myocardial phosphocreatine/adenosine triphosphate (r = –0.73, p < 0.01). Our results indicate that the myocardial energy metabolism evaluated using <sup>31</sup>P-MRS tends to be correlated with the severity of heart failure and left ventricular dysfunction estimated using the plasma BNP levels in DCM patients. This paper provides additional information regarding the relationship between the BNP and myocardial energy metabolism in DCM patients.

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          Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure.

          Alan Maisel, Padma Krishnaswamy, Richard M. Nowak … (2002)
          B-type natriuretic peptide is released from the cardiac ventricles in response to increased wall tension. We conducted a prospective study of 1586 patients who came to the emergency department with acute dyspnea and whose B-type natriuretic peptide was measured with a bedside assay. The clinical diagnosis of congestive heart failure was adjudicated by two independent cardiologists, who were blinded to the results of the B-type natriuretic peptide assay. The final diagnosis was dyspnea due to congestive heart failure in 744 patients (47 percent), dyspnea due to noncardiac causes in 72 patients with a history of left ventricular dysfunction (5 percent), and no finding of congestive heart failure in 770 patients (49 percent). B-type natriuretic peptide levels by themselves were more accurate than any historical or physical findings or laboratory values in identifying congestive heart failure as the cause of dyspnea. The diagnostic accuracy of B-type natriuretic peptide at a cutoff of 100 pg per milliliter was 83.4 percent. The negative predictive value of B-type natriuretic peptide at levels of less than 50 pg per milliliter was 96 percent. In multiple logistic-regression analysis, measurements of B-type natriuretic peptide added significant independent predictive power to other clinical variables in models predicting which patients had congestive heart failure. Used in conjunction with other clinical information, rapid measurement of B-type natriuretic peptide is useful in establishing or excluding the diagnosis of congestive heart failure in patients with acute dyspnea. Copyright 2002 Massachusetts Medical Society.
          Article 0 comments Cited 408 times – based on 0 reviews     Review now
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            A rapid bedside test for B-type peptide predicts treatment outcomes in patients admitted for decompensated heart failure: a pilot study.

            Van Cheng, Radmila Kazanagra, Alex M. García … (2001)
            The goal of this study was to determine if B-type natriuretic peptide (BNP) levels predict outcomes of patients admitted with decompensated heart failure. Treatment of decompensated congestive heart failure (CHF) has often been based on titration of drugs to relieve patient's symptoms, a case that could be made for attempting to also treat neurohormonal abnormalities. Because BNP reflects both elevated left ventricular pressure as well as neurohormonal modulation, we hypothesized that BNP might be useful in assessing outcomes in patients admitted with decompensated CHF. We followed 72 patients admitted with decompensated New York Heart Association class III to IV CHF, measuring daily BNP levels. We then determined the association between initial BNP measurement and the predischarge or premoribund BNP measurement and subsequent adverse outcomes (death and 30-day readmission). Of the 72 patients admitted with decompensated CHF, 22 end points occurred (death: n = 13, readmission: n = 9). In these patients, BNP levels increased during hospitalization (mean increase, 233 pg/ml, p < 0.001). In patients without end points, BNP decreased (mean decrease 215 pg/ml). Univariate analysis revealed that the last measured BNP was strongly associated with the combined end point. In patients surviving hospitalization, BNP discharge concentrations were strong predictors of subsequent readmission (area under the receiver operator curve of 0.73). In patients admitted with decompensated CHF, changes in BNP levels during treatment are strong predictors for mortality and early readmission. The results suggest that BNP levels might be used successfully to guide treatment of patients admitted for decompensated CHF.
            Article 0 comments Cited 72 times – based on 0 reviews     Review now
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              Abnormal myocardial phosphorus-31 nuclear magnetic resonance spectroscopy in women with chest pain but normal coronary angiograms.

              B L Sharaf, Graeme Rogers, G Pohost … (2000)
              After hospitalization for chest pain, women are more likely than men to have normal coronary-artery angiograms. In such women, myocardial ischemia in the absence of clinically significant coronary-artery obstruction has long been suspected. Most methods for the detection of the metabolic effects of myocardial ischemia are highly invasive. Phosphorus-31 nuclear magnetic resonance (31P-NMR) spectroscopy is a noninvasive technique that can directly measure high-energy phosphates in the myocardium and identify metabolic evidence of ischemia. We enrolled 35 women who were hospitalized for chest pain but who had no angiographically significant coronary-artery obstructions and 12 age- and weight-matched control women with no evidence of heart disease. Myocardial high-energy phosphates were measured with 31P-NMR spectroscopy at 1.5 tesla before, during, and after isometric handgrip exercise at a level that was 30 percent of the maximal voluntary grip strength. We measured the change in the ratio of phosphocreatine to ATP during exercise. Seven (20 percent) of the 35 women with chest pain and no angiographically significant stenosis had decreases in the phosphocreatine:ATP ratio during exercise that were more than 2 SD below the mean value in the control subjects without chest pain. There were no significant differences between the two groups with respect to hemodynamic variables at rest and during exercise, risk factors for ischemic heart disease, findings on magnetic resonance imaging and radionuclide perfusion studies of the heart, or changes in brachial flow during the infusion of acetylcholine. Our results provide direct evidence of an abnormal metabolic response to handgrip exercise in at least some women with chest pain consistent with the occurrence of myocardial ischemia but no angiographically significant coronary stenoses. The most likely cause is microvascular coronary artery disease.
              Article 0 comments Cited 45 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (publisher-id): CRD
                Journal ID (nlm-ta): Cardiology
                Journal ID (doi): 10.1159/issn.0008-6312
                Title: Cardiology
                Publisher: S. Karger AG
                ISSN (Print): 0008-6312
                ISSN (Electronic): 1421-9751
                Publication date Subscription-year: 2006
                Publication date (Print): September 2006
                Publication date (Electronic): 29 September 2006
                Volume: 106
                Issue: 3
                Pages: 132-136
                Affiliations
                aDepartment of Radiological Technology, School of Health Sciences, Faculty of Medicine, Tohoku University, Departments of bCardiovascular Medicine, cInternal Medicine and Rehabilitation Science, dRadiology, Tohoku University Graduate School of Medicine, Sendai, Japan
                Article
                Publisher ID: 92767 Other ID: Cardiology 2006;106:132–136
                DOI: 10.1159/000092767
                PubMed ID: 16636542
                SO-VID: e310063a-bbba-4a41-944a-7b3b4312bc2a
                Copyright © © 2006 S. Karger AG, Basel
                License:

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                Date received : 11 November 2005
                Date accepted : 28 January 2006
                Page count
                Figures: 4, Tables: 1, References: 19, Pages: 5
                Categories
                Subject: Original Research

                ScienceOpen disciplines: General medicine,Neurology,Cardiovascular Medicine,Internal medicine,Nephrology
                Keywords: Phosphorus-31 magnetic resonance spectroscopy,Heart,B-type natriuretic peptide,High-energy phosphate,Dilated cardiomyopathy
                Data availability:
                ScienceOpen disciplines: General medicine, Neurology, Cardiovascular Medicine, Internal medicine, Nephrology
                Keywords: Phosphorus-31 magnetic resonance spectroscopy, Heart, B-type natriuretic peptide, High-energy phosphate, Dilated cardiomyopathy

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