Effect Study of the Recombinant Human Brain Natriuretic Peptide in Patients with Heart Failure Combined with Hypotension

Objective: This paper aims to investigate the effect of applying recombinant human brain natriuretic peptide in patients with heart failure combined with hypotension. Recombinant human brain natriuretic peptide is a synthetic polypeptide drug that is primarily used to treat acute heart failure. Its mechanism of action closely mimics that of human endogenous brain natriuretic peptide. By binding to receptors on cardiomyocytes, it exerts its pharmacological effects. Methods: For the study, 76 heart failure patients with hypotension were selected from our hospital between May 2022 and June 2023. These patients were divided into two groups: a control group and an observation group, each comprising 38 patients. The control group received dopamine treatment, while the observation group was treated with recombinant brain natriuretic peptide. The objective was to compare the effects of the treatments in both groups by analyzing cardiac function indices and levels of vasoactive substances to identify any significant differences in outcomes. Results: The overall response rate of the patients in the observation group and the control group was 94.74% and 73.68%, significantly higher as compared with the observation group (P 0.05). After the following treatment, BNP, ANNP and urine output in the observation group were significantly different compared with the control group, of the statistical significance (P Conclusion: For the treatment of heart failure patients with hypotension, the clinical application of recombinant human brain natriuretic peptide is the most ideal, and significantly improves the cardiac function of patients, which is worth popularizing.

Lyophilized recombinant human brain natriuretic peptide: A promising therapy in patients with chronic heart failure

Lyophilized recombinant brain natriuretic peptide(BNP)is an exogenous peptide synthesized by artificial recombination technology,with a similar structure and similar physiological effects with the endogenous natriuretic peptide secreted by the human body.It’s main mechanism of action is to increase cyclic guanosine monophosphate by binding with its corresponding receptor in the body,regulating,thus,the imbalance of the vascular system and cardiac hemodynamics,improving the heart’s pumping capacity,and inhibiting sympathetic excitability and myocardial remodeling.Moreover,it can promote mitochondrial metabolism and enhance the use of adenosine triphosphate in cardiomyocytes.In the present study,102 chronic heart failure(HF)patients were randomly assigned to a control and an observation group consisting of 51 patients each.Patients of the control group were treated with standard HF therapy for 3 d including oral metoprolol tartrate tablets,spironolactone,and olmesartanate while patients of the observation group were administered the recombinant human BNP injection for the same time-period,plus the standard HF therapy.The recombinant human BNP group(observation group)demonstrated better physical,emotional,social,and economic scores,as well as cardiac and inflammatory biomarkers such as serum hypersensitive C-reactive protein,N-terminal pro BNP and troponin I levels,compared to the control group.Moreover,cardiac function was also improved,as left ventricular ejection fraction and stroke volume were significantly higher in the observation group than in the control group.Interestingly,adverse reactions were not different between the 2 groups.However,these results are not generalizable and the need of large multicenter randomized controlled trials examining the safety and efficacy of recombinant human BNP in HF patients is of major importance.

Lyophilized recombinant human brain natriuretic peptide for chronic heart failure:Effects on cardiac function and inflammation

BACKGROUND Chronic heart failure(CHF)is a serious and prevalent condition characterized by impaired cardiac function and inflammation.Standard therapy for CHF has limitations,prompting the exploration of alternative treatments.Recombinant human brain natriuretic peptide(BNP)has emerged as a potential therapy,with evidence suggesting that it can improve cardiac function and reduce inflammation in patients with CHF.However,further research is required to determine the efficacy and safety of lyophilized recombinant human BNP in CHF patients and its impact on microinflammatory status.This study aimed to investigate the effects of lyophilized recombinant human BNP therapy on CHF patients’cardiac function and microinflammatory status.AIM To investigate the effects of freeze-dried recombinant human BNP therapy on cardiac function and microinflammatory status in patients with CHF.METHODS In total,102 CHF patients admitted to our hospital from January 2021 to January 2022 were randomly assigned to control and observation groups(n=51 patients/group).The control patients were treated with standard HF therapy for 3 d,whereas the observational patients were injected with the recombinant human BNP for 3 d.Clinical efficacy,inflammatory factor levels,myocardial damage,cardiac function before and after the treatment,and adverse reactions during treatment were compared between the two groups.RESULTS The overall clinical efficacy was higher in the observation group than in the control group.Compared with baseline,serum hypersensitive C-reactive protein,N-terminal proBNP,and troponin I level,and physical,emotional,social,and economic scores were lower in both groups after treatment,with greater reductions in levels and scores noted in the observation group than in the control group.The overall incidence of adverse reactions in the observation group was not significantly different compared with that in the control group(P>0.05).CONCLUSION Freeze-dried recombinant human BNP therapy can improve heart function and enhance microinflammatory status,thereby improving overall quality of life without any obvious side effects.This therapy is safe and reliable.

Clinical study of recombinant human brain natriuretic peptide in patients with acute myocardial infarction complicating congestive heart failure

Objectives To observe the efficacy and safety of recombinant human brain natriuretic peptide(rh-BNP) on patients with acute myocardial infarction complicating congestive heart failure.Methods 40 patients with acute myocardial infarction complicated by congestive heart failure were randomly divided into control group and treatment group of 20 cases.The control group,15 cases of acute anterior myocardial infarction,5 cases of acute inferior wall myocardial infarction, 15 males and 5 females,aged 55-70 years,mean age 58±12 years;treated 16 cases of acute anterior myocardial infarction,4 cases of acute myocardial infarction,16 males and 4 females,aged 56-70 years,mean age 59±11 years;two groups of age,gender,severity of disease and vascular lesions no significant difference and comparable(P】0.05).Conventional group were given aspirin,clopidogrel, statins,Inotropic,diuretic and vasodilator therapy.In the con- ventional treatment group based on the use of recombinant human brain natriuretic peptide(new bios,Tibet Pharmaceutical Co.,Ltd.Chengdu Nuodikang biopharmaceutical production, usage:1.5μg/Kg intravenous injection(impact), then 0.0075μg-0.01μg/(kg·min)infusion rate).Continuous medication 72 h.The clinical symptoms observed for 3 days in patients before treatment and after treatment,heart rate,blood pressure and left ventricular ejection fraction (LVEF) and tumor necrosis factor(TNF-α),brain natriuretic peptide(BNP) levels were measured.Results In control group,8 cases markedly effect,5 cases effect and 7 cases no effect,the total effective rate was 65%;In treatment group,13 cases markedly effect,6 cases effect and 1 cases no effect,the total effective rate was 95%,compared with two groups P New bios treatment group significantly increased cardiac index(CI) in patients with heart failure and left ventricular ejection fraction(LVEF) than the control group(all P【0.05),further reduce the levels of tumor necrosis (TNF-α) and brain natriuretic peptide(BNP).Conclusions rh-BNP can improve symptoms and heart function,reduced plasma tumor necrosis factor(TNF-α) and BNP levels of acute myocardial infarction patients with congestive heart failure,the treatment safe and reliable.As small sample size observed,larger sample to be accumulated to further evaluate its efficacy and safety.

Effect of recombinant human brain natriuretic peptide on serum inflammatory factors, neuroendocrine hormones and cardiac function in patients with acute myocardial infarction complicated with heart failure

Objective:To investigate the effect of recombinant human brain natriuretic peptide (BNP) on inflammatory factors, neuroendocrine hormones and cardiac function indexes in patients with acute myocardial infarction complicated with heart failure.Methods:A total of91 cases of acute myocardial infarction with heart failure patients were divided into the control group (n=44) and observation group (n=47) according to the random data table, two groups of patients were given conventional treatment, based on this, the control group was given intravenous infusion of Nitroglycerin Injection treatment, the observation group received intravenous injection of recombinant human brain natriuretic peptide treatment, compared serum inflammatory factors, neuroendocrine hormone and cardiac function and other indexes of two groups before and after treatment.Results: there was no significant difference between the two groups before treatment. After treatment, the levels of TNF-α, hs-CRP, IL-6, MCP-1, LVESD and LVEDD in the two groups were significantly lower than those within the group before treatment, and the observation group was significantly lower than the control group;The two groups after treatment LVEF levels were significantly higher than those in the group before treatment, and the observation group was significantly higher than that of control group;the observation group after treatment PRA, Ang II and ALD and NE levels were significantly lower than those before treatment, and was significantly lower than the control group after treatment, the difference was significant, PRA, Ang, ALD and NE levels of control group before and after the treatment was no significant difference.Conclusion:recombinant human brain natriuretic peptide in the treatment of acute myocardial infarction with heart failure can effectively reduce the serum inflammatory factors and neuroendocrine hormone levels, improve heart function, and have a certain clinical value.

Clinical Efficacy of Recombinant Brain Natriuretic Peptide in Patients with Acute Myocardial Infarction After On-Pump Coronary Artery Bypass Grafting (CABG)

Objective:To evaluate the clinical efficacy of intravenous recombinant human brain natriuretic peptide(rhBNP)in patients with acute myocardial infarction after on-pump coronary artery bypass grafting(CABG).Methods:40 cases of coronary heart disease,left ventricular ejection fraction<50%and(plasma brain natriuretic peptide in type N terminal)NT-proBNP>300 pg/ml underwent on-pump coronary artery bypass surgery with cardiopulmonary bypass were enrolled and randomly divided into two groups,experimental group of 20 patients after operation on the basis of conventional therapy plus recombinant human brain natriuretic peptide treatment(first loading dose of 1.5μg/kg intravenously,to maintain dose of 0.01μg/kg/min continuous infusion of 72h),20 cases of the control group was given routine treatment,observe two groups of patients before and after treatment of blood pressure,heart rate,urine volume,blood creatinine and NT-proBNP,and to observe the left ventricular ejection fraction(LVEF),echocardiography and the length of time the index.Results:the experimental group after treatment,urine volume,left ventricular ejection fraction(LVEF),cardiac index(CI)was significantly higher than that before treatment,the serum creatinine,plasma N-terminal pro brain natriuretic peptide(NTproBNP),the content of serum troponin T peptide(cT nT),creatine kinase isoenzyme(CK MB)was significantly lower than before treatment.Conclusion:Recombinant human brain natriuretic peptide can improve cardiac and renal function in patients with acute period of acute myocardial infarction underwent coronary artery bypass surgery,shorten the hospitalization time,and it is safe and feasible.

Plasma brain natriuretic peptide and atria natriuretic peptide as predictors for diastolic heart failure in patients with type 2 diabetes mellitus

Objective To study the change of diastolic cardiac function in diabetic patients and to determine the diagnostic value of plasma brain natriuretic peptide （BNP） and atria natriuretic peptide （ANP） for diastolic heart failure in patients with type 2 diabetes mellitus. Methods Twelve healthy subjects and seventy-one diabetic patients were included in the study. Plasma BNP and ANP were measured with immtmoradiometic assay. Results Plasma levels of BNP and ANP increased significantly with increased severity of diastolic heart dysfunction. The ratio of E/A had significant negative correlation with the plasma levels ofBNP （r=0.669,P〈0.001） and ANP （r=0.579, P〈0.01）. AUC of ANP and BNP in ROC model was 91.9% and 65.3%, respectively. Conclusions The plasma level of BNP might be a valuable predictor for differential diagnosis of diastolic cardiac function in diabetic patients.

Plasma brain natriuretic peptide level in older outpatients with heart failure is associated with physical frailty, especially with the slowness domain

Objective To determine the association between plasma brain natriuretic peptide （BNP） level in patients with heart failure （HF） and physical frailty as well as with each domain of physical frailty. Methods Two hundred and six outpatients of cardiovascular medicine aged 60 years and older who had been hospitalized for HF or had been given a prescription medication for HF were included. Physical frailty was assessed using the following five domains： slowness, weakness, exhaustion, low activity, and shrinking, according to the Cardiovascular Health Study. Patients were divided into nonfi-ailty and frailty groups according to frailty scores. Plasma BNP level was measured. The 6-min walk test was performed to measure endurance. Results Plasma BNP was significantly different between the two groups （frailty group： 158.0 i 214.7 pg/mL, nonfrailty group： 65.2 ~ 88.0 pg/mL, P 〈 0.01）. Multivariate logistic regression analysis revealed log-transformed plasma BNP （Log BNP） was significantly associated with physical frailty （OR： 1.68, 95% CI： 1.11-2.56）, and Log BNP was significantly associated with the slowness domain （walking speed 〈 1.0 m/s） of physical frailty （OR： 1.75, 95% Ch 1.15-2.67）. Additionally, Log BNP was negatively correlated to the 6-minute walk distance （6MWD） （p=0.37, P 〈 0.01）, while 6MWD was positively correlated to walking speed （p = 0.66, P 〈 0.01）. Conclusions Plasma BNP level was related to physical frailty, especially in the slowness domain. Endurance may intervene in the associations between plasma BNP level and walking speed.

Brain natriuretic peptide is a potent vasodilator in aged human microcircula- tion and shows a blunted response in heart failure patients

Background Brain natriuretic peptide （BNP） is normally present in low levels in the circulation, but it is elevated in parallel with the degree of congestion in heart failure subjects （CHF）. BNP has natriuretic effects and is a potent vasodilator. It is suggested that BNP could be a therapeutic alternative in CHF. However, we postulated that the high levels of circulating BNP in CHF may downregulate the response of microvascular natriuretic receptors. This was tested by comparing 15 CHF patients （BNP 〉 3000 ng/L） with 10 matched, healthy controls. Methods Cutaneous microvascular blood flow in the forearm was measured by laser Doppler Flowmetry. Local heating （＋44°C, 10 min） was used to evoke a maximum local dilator response. Results Non-invasive iontophoretic administration of either BNP or acetylcholine （ACh）, a known endothelium-dependent dilator, elicited an increase in local flow. The nitric oxide synthase inhibitor, l-N-Arginine- methyl-ester （L-NAME）, blocked the BNP response （in controls）. Interestingly, responses to BNP in CHF patients were reduced to about one third of those seen in healthy controls （increase in flow： 251% in CHF vs. 908% in controls; P 〈 0.001）. In contrast, the vasodilator responses to ACh and to local heating were only somewhat attenuated in CHF patients. Thus, dilator capacity and nitric oxide signalling were not af- fected to the same extent as BNP-mediated dilation, indicating a specific downregulation of the latter response. Conclusions The findings show for the first time that microvascular responses to BNP are markedly reduced in CHF patients. This is consistent with the hypothesis of BNP receptor function is downregulated in CHF.

Plasma brain natriuretic peptide, platelet parameters, and cardiopulmonary function in chronic obstructive pulmonary disease

BACKGROUND Chronic obstructive pulmonary disease(COPD)is a chronic respiratory disease with worldwide occurrence and high disability and mortality rate.It occurs mostly in the elderly population with pulmonary heart disease,type II respiratory failure,and other serious complications.AIM To investigate the correlation of plasma brain natriuretic peptide(BNP)and platelet parameters with cardiac function and pulmonary hypertension in patients with COPD and pulmonary heart disease.METHODS From June 2016 to June 2019,52 patients with COPD-pulmonary heart disease(pulmonary heart disease group),30 patients with COPD(COPD group),and 30 healthy individuals(control group)in our hospital were enrolled in the study.The pulmonary heart disease group was further divided into subgroups according to cardiac function classification and pulmonary artery pressure.Plasma BNP and platelet parameters were estimated and compared among each group and subgroup.The correlation of plasma BNP and platelet parameters with cardiac function classification and pulmonary artery pressure was then analyzed.RESULTS In the pulmonary heart disease group,the COPD group,and the control group,the levels of plasma BNP,platelet distribution width(PDW),and mean platelet volume(MPV)showed a decreasing trend(P<0.05),while an increasing trend was found in platelet count(PLT)and plateletcrit(PCT)levels among the three groups(P<0.05).In the pulmonary hypertension mild,moderate,and severe subgroups,the levels of plasma BNP,PDW,and MPV showed an increasing trend(P<0.05),while a decreasing trend was observed in PLT levels(P<0.05);however,PCT levels showed no significant difference among the three subgroups(P>0.05).In the cardiac function grade I,II,III,and IV subgroups,the levels of plasma BNP,PDW,and MPV showed an increasing trend(P<0.05),while a decreasing trend was noted in PLT and PCT levels among the four subgroups(P<0.05).Correlation analysis showed that the levels of plasma BNP,PDW,and MPV in patients with pulmonary heart disease were positively correlated with their pulmonary artery pressure(P<0.05),while PLT was negatively correlated with their pulmonary artery pressure(P<0.05).Moreover,plasma BNP,PDW,and MPV levels were positively correlated with cardiac function grade(P<0.05)of these patients,while PLT and PCT levels were negatively correlated with their cardiac function grade(P<0.05).CONCLUSION Plasma BNP and PLT parameters are significantly correlated with the cardiac function and pulmonary hypertension in patients with COPD and pulmonary heart disease,indicating that these parameters have high clinical relevance in reflecting the health condition of these patients and for guiding their treatment.

Brain natriuretic peptide and optimal management of heart failure

Aside from the important role of brain natriuretic peptide (BNP) in diagnosis, and differential diagnosis of heart failure, this biological peptide has proved to be an independent surrogate marker of rehospitalization and death of the fatal disease. Several randomized clinical trials demonstrated that drugs such as beta blocker, angiotensin converting enzyme inhibitor, spiro- nolactone and amiodarone have beneficial effects in decreasing circulating BNP level during the management of chronic heart failure. The optimization of clinical decision-making appeals for a representative surrogate marker for heart failure prognosis. The serial point-of-care assessments of BNP concentration provide a therapeutic goal of clinical multi-therapy and an objective guid- ance for optimal treatment of heart failure. Nevertheless new questions and problems in this area remain to be clarified. On the basis of current research advances, this article gives an overview of BNP peptide and its property and role in the management of heart failure.

Serum brain natriuretic peptide in children with Kawasaki disease

BACKGROUND： Kawasaki disease （KD） is a common cause of acquired heart disease in children. Recent studies have focused on the biochemical markers of the myocardium, their high sensitivity and specificity and significance in the diagnosis of KD. This study aimed to determine the serum level of brain natriuretic peptide （BNP） and its relation with the heart function of children with KD and to explore its clinical value in diagnosis of KD.METHODS： Forty-three KD children, aged from 5 months to 8 years （mean 2.3±0.6 years ）, were admitted to Qingdao Children＇s Hospital from February 2007 to April 2009. Among them 27 were male, and 16 female. The 43 patients served as a KD group. Patients with myocarditis, cardiomyopathy, congenital heart disease and other primary heart diseases were excluded. Thirty healthy children, aged from 3 months to 15 years （mean 2.5±0.8 years） or 17 males and 13 females served as a control group. There were no significant differences in age and gender between the two groups （P〉0.05）. In the KD group, ELISAwas used to measure the levels of serum BNP in acute and convalescent stages; and in the control group, the levels of serum BNP were measured once randomly. Left ventricular ejection fraction （LVEF）, left ventricular shorten fraction （LVSF）, cardiac index （CI） and left ventricular inflow velocity through the mitral annulus （including E-velocity and A-velocity） were measured by two- dimensional echocardiography in the acute and convalescent stages in the KD group. All data were expressed as mean±SD. The methods of analysis included Student＇s t test and the linear regression analysis test. P〈0.05 was considered statistically significant.RESULTS： The level of serum BNP in the acute stage （517.26±213.40） ng/ml was significantly higher than that in the convalescent stage （91.56±47.97） ng/ml in the control group （37.55±7.56） ng/ ml （P〈0.01）. The levels of LVEF, LVSF and CI in the acute stage were significantly lower than those in the convalescent stage （P〈0.05）, but the E/A level was not significantly different between the acute and convalescent stages （P〉0.05）. Linear regression analysis showed that the BNP level was negatively correlated with the levels of LVEF, LVSF and C1（r=-0.63, -0.52, -0.53, P〈0.05） , but not significantly correlated with the E/A level （r=-0.18, P〉0.05）.CONCLUSION： The levels of serum BNP are significantly increased in KD patients, and are negatively correlated with the levels of LVEF, LVSF, and CI. The detection of serum BNP level is of clinical significance in the diagnosis of KD.

Biological characteristics of brain natriuretic peptide and its association with central nervous system diseases

OBJECTIVE： To explain the mechanisms of tuhe synthesis, secretion and regulation of brain natriuretic peptide （BNP）, and analyze its role in central nervous system diseases. DATA SOURCES： An online search of Pubmed was undertaken to identify articles related to BNP published in English from January 1990 to February 2007 by using the key words of ＂brain natriuretic pepfide （BNP）, central nervous system, subarachnoid hemorrhage （SAH）, brain edema, epilepsy＂. Other articles were searched in China Hospital Knowledge Database （CHKD） by concrete name of journals and title of articles. STUDY SELECTION： The collected articles were primarily screened, those about BNP and its association with central nervous system diseases were selected, whereas the obviously irrelative ones excluded, and the full-texts of the other literatures were searched manually. DATA EXTRACTION： Totally 96 articles were collected, 40 of them were enrolled, and the other 56 were excluded due to repetitive studies or reviews. DATA SYNTHESIS： At present, there are penetrating studies on BNP in the preclinical medicine and clinical medicine of cerebrovascular and cardiovascular diseases, and the investigative outcomes have been gradually applied in clinical practice, and satisfactory results have been obtained. However, the application of BNP in diagnosing and treating central nervous system diseases is still at the experimental phase without - outstanding outcomes, thus the preclinical and clinical studies should be enhanced. CONCLUSION： As a kind of central medium or modulator, BNP plays a certain role in the occurrence, development and termination of central nervous system diseases, the BNP level in serum has certain changing law in SAH, brain edema, epilepsy, etc., but the specific mechanisms are unclear.

Science Letters:Brain natriuretic peptide: A potential indicator of cardiomyogenesis after autologous mesenchymal stem cell transplantation?

We observed in a pilot study that there was a transient elevation of brain natriuretic peptide (BNP) level shortly after the transplantation in the patient with ischemic heart failure, which is unexplainable by the simultaneous increase of the cardiac output and six-minute walk distance. Similar findings were observed in the phase I trial. We postulated on the basis of the finding of Fukuda in vitro that this transient elevation of BNP level against the improvement of cardiac function and exercise capacity might indicate cardiomyogenesis in patients after mesenchymal stem cell transplantation. Further study is warranted to verify the hypothesis.

Changes of Plasma Levels of Brain Natriuretic Peptide in Patients with Chronic Heart Failure

To investigate the changes of plasma brain natriuretic peptide （BNF） levels inpatients with chronic heart failure （CHF）. Methods Plasma BNP concentrations in patients with CHF （n=56） and in normal controls （n=60） were measured with specific radioimmunoassay. Left ventricular ejection fraction in patients with chronic heart failure was measured with 99mTc gated cardiac blood pool scintigraphy. Results The results showed that Plasma BNP concentrations in patients with CHF were significantly higher than normal controls （223±79 ng/L vs 40±15 ng/L, P 〈 0.01）. Plasma BNP concentrations had a significant negative correlation with left ventricular ejection fractions（r=-0.68, P 〈 0.01 ）. Conclusions These results indicates that Plasma BNP levels are increased in patients with CHF, and they markedly increased according to the severity of heart failure classified by NYHA classifi- cation. The plasma BNP levels may be a biochemical parameter for evaluating the left ventricular function.

Effects of compound danshen dripping pills on the levels of serum inflammatory factors, brain natriuretic peptide and blood lipid in CABG postoperative patients

Objective:To explore the effects of compound danshen dripping pills on the levels of serum inflammatory factors,brain natriuretic peptide(BNP)and blood lipid in CABG postoperative patients.Methods:156 cases of patients who were given CABG from January 2015 to January 2018 in Baogang Hospital were chosen and randomly divided into the observation group(n=78)and the control group(n=78).Both groups were given conventional drugs,simultaneously,the observation group was given compound danshen dripping pills.The treatment lasted 3 months.The clinical efficacy was compared between two groups of patients,and the levels of serum inflammatory factors,plasma BNP and blood lipid before and after treatment in two groups of patients were detected in order to make a comparison in the incidence of adverse cardiac events between two groups of patients.Results:After treatment,the total effective rate of treatment in the observation group was significantly higher than that in the control group;in the two groups,the levels of serum interleukin-6(IL-6),interleukin-8(IL-8),C-reactive protein and plasma BNP after treatment were obviously lower than those before treatment,and these indicators in the observation group were lower than those in the control group(p<.05);the levels of TG,TC and LDL-C in two groups were obviously lower(p<.05)with the level of HDL-C significantly higher(all p<.05),and the descending or ascending range of each indicator in the observation group was obviously larger than that in the control group(p<.05);in the follow-up visit,the incidence of adverse cardiac events in the observation group of patients was significantly lower than that in the control group of patients(p<.05).Conclusions:Compound danshen dripping pills can effectively reduce the levels of serum inflammatory factors and BNP,regulate blood lipid metabolism and reduce the incidence of adverse cardiac events in CABG postoperative patients.

Association of Atrial Fibrillation and Amino-terminal Pro-brain Natriuretic Peptide Concentrations in Patients After Off-Pump Coronary Artery Bypass Grafting

Objectives To investigate the possible role of amino-terminal pro-brain natriuretic peptide （NT-proBNP） in the occurrence of atrial fibrillation （AF） after coronary artery bypass grafting （CABG）. Methods This study group included 70 consecutive patients scheduled for elective off-pump CABG. The patients with ejection fraction （EF） less than 0. 30, history of AF, use of class Ⅰ or Ⅲ antiarrhythmic drug, implanted pacemaker, postoperative myocardial infarction or chest reopening for pericardial tamponade were excluded. Preoperative and postoperative serum NT-proBNP levels were measured by radioimmunoassay technique. Results Postoperative AF occurred in 15 patients （21.4%）; these patients had significantly higher median NT-proBNP levels when compared with those without AF after the operation （ P 〈 0. 01 ）. Using multivariate logistic regression analyses, an increase in NT-proBNP level after CABG was found to be independently associated with AF （ OR = 3.78, 95% IC = 1.81 - 4. 89, P 〈 0. 01 ）. Increased age, diabetes mellitus, preoperative use of β-blocker, proximal right coronary artery involvement, and longer operation time were al- so associated with AF. Conclusions These results indicated that AF was associated with higher NT-proBNP concentrations after off pump CABG; the increase in NT-proBNP after CABG may play an important role in the occurrence of AF after the operation. The further studies are needed to define the reason that lead to higher NT-proBNP concentrations among the patients who present AF after off pump CABG.

Differential effects of atrial and brain natriuretic peptides on human pulmonary artery:An in vitro study

BACKGROUND The prevalence of cardiovascular diseases,especially heart failure,continues to rise worldwide.In heart failure,increasing levels of circulating atrial natriuretic peptide(ANP)and brain natriuretic peptide(BNP)are associated with a worsening of heart failure and a poor prognosis.AIM To test whether a high concentration of BNP would inhibit relaxation to ANP.METHODS Pulmonary arteries were dissected from disease-free areas of lung resection,as well as pulmonary artery rings of internal diameter 2.5–3.5 mm and 2 mm long,were prepared.Pulmonary artery rings were mounted in a multiwire myograph,and a basal tension of 1.61gf was applied.After equilibration for 60 min,rings were pre-constricted with 11.21μmol/L PGF2α(EC80),and concentration response curves were constructed to vasodilators by cumulative addition to the myograph chambers.RESULTS Although both ANP and BNP were found to vasodilate the pulmonary vessels,ANP is more potent than BNP.pEC50 of ANP and BNP were 8.96±0.21 and 7.54±0.18,respectively,and the maximum efficacy(Emax)for ANP and BNP was-2.03 gf and-0.24 gf,respectively.After addition of BNP,the Emax of ANP reduced from-0.96gf to-0.675gf(P=0.28).CONCLUSION BNP could be acting as a partial agonist in small human pulmonary arteries,and inhibits relaxation to ANP.Elevated levels of circulating BNP could be responsible for the worsening of decompensated heart failure.This finding could also explain the disappointing results seen in clinical trials of ANP and BNP analogues for the treatment of heart failure.

Effect of atorvastatin on serum oxidative stress and N-terminal brain natriuretic peptide expression in rats

Objective:To investigate the effect of atorvastatin on serum oxidative stress and N-terminal brain natriuretic peptide expression in rats.Methods:A total of 40 healthy male SD rats were randomly divided into the sham group(Croup A,n=10,saline 5 mL/d),ischemia-reperfusion group(Group B,n=10,saline S mL/d),atorvastatin group(Group C,n=10.atorvastatin 20 mg/kg·d),atorvastatin + N-amino-arginine group(Group D,n=10,atorvastatin 20 mg/kg·d + N-amino arginine 15 mg/kg).Myocardial ischemia-reperfusion rat model was eslablished after 3 days of gavage.N-amino arginine 15 mg/kg was given by tail vein injection 15 min before ischemia.After reperfusion,enzymology indicators such us creatine kinase(CK) and lactate dehydrogenase and the oxidative stress parameters such as nitric oxide(NO),malondialdehyde(MDA) and total superoxide dismutase(TSOD),and n-terminal pro-brain natriuretic peptide(NT-proBNP)expression was detected by immunohistochemistry.Results:LDH and CK levels of group A were significantly lower than the outer three groups,and group B was the highest.There was significant difference between group B and group C(P<0.05),and no significant difference between group B and group D(P>0.05).MDA levels in group B were significantly higher than the other three groups.The lowest was group A,followed by group C,the difference among groups was significantly(P<0.05).TSOD and NO levels in group B was the lowest,the level in group A was the highest,followed by group C,the difference among groups was significant(P<0.05).NT-proBNP level in group B was significantly higher than the other three groups,the lowest was group A,followed by group C,the difference among groups was significant(P<0.05).Conclusions:Atorvastatin has a protective effect on the myocardial injury in the myocardial ischemia and reperfusion rats.It can increase NO synthesis and decrease MDA content,increase serum TSOD activity and the oxidative stress effect,meanwhile protect myocardial cells and reduce myocardial injury.

Plasma N-terminal pro-brain natriuretic peptide levels in elderly patients with isolated diastolic dysfunction

Objective To investigate plasma N-terminal pro-brain natriuretic peptide (NT-BNP) levels and to assess their clinical significance in elderly patients with isolated diastolic dysfunction. Methods Plasma NT-BNP level were measured by electrochemiluminescence immunoassay in 34 symptomatic patients (Group 1), 34 asymptomatic patients (Group 2) with isolated diastolic dysfunction, and in 16 elderly healthy subjects (control group, Group 3), serving controls. Colored Doppler echocardiography was performed to evaluate the patients' cardiac structures and functions. Results The plasma NT-BNP level in Group 1 was significantly higher than those in Group 2 and Group 3 and increased with the severity of heart failure. There was no significant difference of plasma NT-BNP levels between Group 2 and Group 3 (p>0.05). A NT-BNP value of 102.75 pg/mL showed a sensitivity of 88.2%, a specificity of 87.5%, and an accuracy of 88.1% for diagnosing diastolic dysfunction. Patients with restrictive filling pattern on echocardiography had higher NT-BNP levels than those of impaired relaxation pattern (1961.2±304.9 versus 460.1±92.7pg/mL, p<0.001). Conclusion The elevation of plasma NT-BNP level in elderly patients with isolated diastolic dysfunction correlates with the severity of their diastolic abnormalities. The level of plasma NT-BNP has an important clinical value in the diagnosis of elderly patients with isolated diastolic dysfunction.