The Level of Serum Intact Terminal Peptide of Procollagen and Its Clinical Significance in Patients with Chronic Keshan Disease

Objectives To evaluate the changes of serum intact terminal peptide of procollagen in patients with chronic Keshan disease (KD) and investigate their clinical significance. Methods The concentrations of serum intact N-terminal peptide of type procollagen (P NP) and intact N-terminal peptide of type procollagen were measured by radioimmunoassay in 35 patients with chronic KD and 31 normal control. Doppler ultrasounds was used to determine several parameters of left ventricular systole and diastole functions. Results The concentration of serum P NP (74.07±16.74)μg/L and the ratio of P NP/ P NP (18.02 ±4.60) in chronic KD were significantly increased as compared to the control (39.63±12.07 μg/L, 12.12±4.24; P< 0.001). Serum P NP (4.19±0.64)μg/L in chronic KD was higher than that in the control (3.36±0.65 μg/L,P < 0.001) too. The higher of serum concentration of P NP and the ratio of P NP/ P NP, the worse of cardiac function in patients with chronic KD. A negative correlation was found between serum P NP/ P NP, P NP and VE/VA, LVEF (γ=-0.4502, -0.4608, P< 0.01 and γ=-0.3936, -0.3904, respectively; P<0.05). Conclusions These findings suggested that tissue synthesis of collagen type and type was abnormally increased in chronic KD. On the other hand, our results indicated that P NP and P NP were related to several functional alterations of the left ventricle. Serum procollagen peptide measurements might therefore provide indirectly diagnostic information on myocardial fibrosis associated with chronic KD.

Analyses of N‑Terminal Pro‑Brain Natriuretic Peptide,Cardiac Troponin T,and Creatine Kinase MB in Pericardial Fluid in Sudden Cardiac Death Caused by Ischemic Heart Disease

Background:Biochemical analyses of N‑terminal pro‑brain natriuretic peptide(NT‑proBNP),cardiac troponin T(cTnT),and creatine kinase MB(CK‑MB)have been reported to be valuable for the auxiliary diagnosis of sudden cardiac death(SCD)in previous forensic studies.Aims and Objectives:The present study aimed to evaluate the diagnostic efficiency of combined analyses of NT‑proBNP,cTnT and CK‑MB in the pericardial fluid for forensic diagnosis of SCD caused by ischemic heart disease.Materials and Methods:Levels of NT‑proBNP,cTnT,and CK‑MB in the pericardial fluid of 132 medicolegal autopsy cases were obtained through electrochemiluminescence method.Results:NT‑proBNP,cTnT,and CK‑MB levels were significantly elevated in SCD cases(P<0.05).Receiver‑operating characteristics(ROC)analysis showed that NT‑proBNP,cTnT,and CK‑MB have diagnostic value for the diagnosis of SCD:NT‑proBNP,cutoff value of 2236 pg/ml;cTnT,cutoff value of 199.51 ng/ml;CK‑MB:cutoff value of 2742.5 ng/ml,and the combined analyses of these three biomarkers have better diagnostic efficiency than each single biomarker alone.Moreover,the causes of SCD were sub‑divided into acute ischemic heart disease,acute myocardial infarction(AMI),and recurrent myocardial infarction subgroups for further analysis,which revealed that the ratio of cTnT/CK‑MB could be used to distinguish AMI with the cutoff value of 0.1085 estimated by ROC analysis.Conclusion:These observations suggested that the postmortem biochemical analyses of NT‑proBNP,cTnT,and CK‑MB in the pericardial fluid may assist to diagnose SCD in forensic practice,and the combined analyses of multiple biomarkers have better diagnostic efficiency than each single biomarker alone.On the basis of the postmortem biochemical analyses of NT‑proBNP,cTnT and CK‑MB,combining the ratio of cTnT/CK‑MB could be used to distinguish AMI.

Left atrial minimum volume by real-time three-dimensional echocardiography as an indicator of diastolic dysfunction

Background Left atrial （LA） maximum volume is becoming a prognostic biomarker for left ventricular （LV） diastolic dysfunction. However, we assessed LV diastolic function by measuring LA phasic volumes using real-time threedimensional echocardiography （RT3DE） in patients with stable coronary artery disease （CAD）. Methods Sixty-five stable CAD patients with normal LV ejection fraction （LVEF） were divided into three groups according to degree of coronary stenosis： control （n=15） with 〈50% stenosis as control group, mildS （n=25） with mild stenosis （50%- 70%） and severeS （n=25） with 〉70% stenosis. LA phasic volumes and function were evaluated and compared using RT3DE and two dimensional echocardiography （2DE）. N-terminal pro-B-type natriuretic peptide （NT-proBNP） levels were examined. The correlations of RT3DE-derived parameters with other conventional indices were analyzed. Results Significant correlations between RT3DE and 2DE for LA volume measurements were： control, r=0.93; mildS, 1=0.94; severeS, r=0.90 （all P 〈0.05）. Patients with severe coronary stenosis presented higher NT-proBNP level, indices of LA minimum volume and volume before atrial contraction, but lower LA total emptying fraction （LAEF） and LAEFpass^ve. Significant correlations of RT3DE derived LA volume indices with E/E＇ （r=0.695） and NF-proBNP （r=0.630） level were found. Conclusions RT3DE derived, LA indices correlate well with NT-proBNP level and may be superior to 2DE measurements for the evaluation of LV diastolic dysfunction. Enlargement of LA minimum volume in stable CAD patients without systolic dysfunction appears earlier and may be better correlated with LV diastolic function than that of LA maximum volume.