OBJECTIVES: The aim of this study was to assess the predictive value of the cardiac hormone B- type natriuretic peptide(BNP) for long- term outcome in a large cohort of stable angina patients. BACKGROUND: Recent data ...OBJECTIVES: The aim of this study was to assess the predictive value of the cardiac hormone B- type natriuretic peptide(BNP) for long- term outcome in a large cohort of stable angina patients. BACKGROUND: Recent data suggest a role of BNP in stable ischemic heart disease beyond its known value in heart failure and acute coronary syndromes. METHODS: In 1,085 patients with coronary artery disease(CAD) baseline levels of BNP were prospectively associated with cardiovascular(CV) events during a mean follow- up of 2.5 years. RESULTS: BNP concentrations were significantly elevated in patients with future CV events(median [25th/75th interquartile range] 119.2 [43.6/300.4] pg/ml vs. 36.2 [11.3/94.6] pg/ml; p< 0.001). Kaplan- Meier survival analysis showed a stepwise decrease in event- free survival across quartiles of BNP baseline concentration(plogrank< 0.001). Patients in the highest quartile revealed a 6.1- fold increased risk(p=0.001) compared to patients in the lowest quartile after adjustment for potential confounders. For a cut- off value of 100 pg/ml, an independently increased risk of adverse outcome(hazard ratio [HR] 4.4; p< 0.001) could be demonstrated. One standard deviation(SD) decrease in ejection fraction implied the most prominent increase in risk of future CV events(HR 1.69; p< 0.001) followed by one SD increase in BNP(HR 1.53; p< 0.001). The highest prognostic accuracy could be demonstrated for BNP(area under the curve 0.671). CONCLUSIONS: The data of this large group of CAD patients provide independent evidence that BNP is a strong predictor of cardiovascular risk in patients with stable angina independent of left ventricular systolic performance and known risk factors.展开更多
Five right- handed patients with a right- sided vestibular neuritis were examined twice with fluorodeoxyglucose positron emission tomography while lying supine with eyes closed: once during the acute stage (mean, 6.6 ...Five right- handed patients with a right- sided vestibular neuritis were examined twice with fluorodeoxyglucose positron emission tomography while lying supine with eyes closed: once during the acute stage (mean, 6.6 days) and then 3 months later when central vestibular compensation had occurred. Regional cerebral glucose metabolism (rCGM) was significantly increased (p < 0.001 uncorrected) during the acute stage in multisensory vestibular cortical and subcortical areas (parietoinsular vestibular cortex in the posterior insula, posterolateral thalamus, anterior cingulate gyrus [Brodmann area 32/24], pontomesencephalic brainstem, hippocampus). Simultaneously, there was a significant rCGM decrease in the visual (Brodmann area 17 to 19) and somatosensory cortex areas in the postcentral gyrus as well as in parts of the auditory cortex (transverse temporal gyrus). Fluorodeoxyglucose positron emission tomography thus allows imaging of the cortical activation pattern that is induced by unilateral peripheral vestibular loss. It was possible to demonstrate that the central vestibular system including the vestibular cortex exhibits a visual- vestibular activation- deactivation pattern during the acute stage of vestibular neuritis similar to that in healthy volunteers during unilaterl labyrinthine stimulation. Contrary to experimental vestibular stimulation, the activation of the vestibular cortex was not bilateral but was unilateral and contralateral to the right- sided labyrinthine failure.展开更多
文摘OBJECTIVES: The aim of this study was to assess the predictive value of the cardiac hormone B- type natriuretic peptide(BNP) for long- term outcome in a large cohort of stable angina patients. BACKGROUND: Recent data suggest a role of BNP in stable ischemic heart disease beyond its known value in heart failure and acute coronary syndromes. METHODS: In 1,085 patients with coronary artery disease(CAD) baseline levels of BNP were prospectively associated with cardiovascular(CV) events during a mean follow- up of 2.5 years. RESULTS: BNP concentrations were significantly elevated in patients with future CV events(median [25th/75th interquartile range] 119.2 [43.6/300.4] pg/ml vs. 36.2 [11.3/94.6] pg/ml; p< 0.001). Kaplan- Meier survival analysis showed a stepwise decrease in event- free survival across quartiles of BNP baseline concentration(plogrank< 0.001). Patients in the highest quartile revealed a 6.1- fold increased risk(p=0.001) compared to patients in the lowest quartile after adjustment for potential confounders. For a cut- off value of 100 pg/ml, an independently increased risk of adverse outcome(hazard ratio [HR] 4.4; p< 0.001) could be demonstrated. One standard deviation(SD) decrease in ejection fraction implied the most prominent increase in risk of future CV events(HR 1.69; p< 0.001) followed by one SD increase in BNP(HR 1.53; p< 0.001). The highest prognostic accuracy could be demonstrated for BNP(area under the curve 0.671). CONCLUSIONS: The data of this large group of CAD patients provide independent evidence that BNP is a strong predictor of cardiovascular risk in patients with stable angina independent of left ventricular systolic performance and known risk factors.
文摘Five right- handed patients with a right- sided vestibular neuritis were examined twice with fluorodeoxyglucose positron emission tomography while lying supine with eyes closed: once during the acute stage (mean, 6.6 days) and then 3 months later when central vestibular compensation had occurred. Regional cerebral glucose metabolism (rCGM) was significantly increased (p < 0.001 uncorrected) during the acute stage in multisensory vestibular cortical and subcortical areas (parietoinsular vestibular cortex in the posterior insula, posterolateral thalamus, anterior cingulate gyrus [Brodmann area 32/24], pontomesencephalic brainstem, hippocampus). Simultaneously, there was a significant rCGM decrease in the visual (Brodmann area 17 to 19) and somatosensory cortex areas in the postcentral gyrus as well as in parts of the auditory cortex (transverse temporal gyrus). Fluorodeoxyglucose positron emission tomography thus allows imaging of the cortical activation pattern that is induced by unilateral peripheral vestibular loss. It was possible to demonstrate that the central vestibular system including the vestibular cortex exhibits a visual- vestibular activation- deactivation pattern during the acute stage of vestibular neuritis similar to that in healthy volunteers during unilaterl labyrinthine stimulation. Contrary to experimental vestibular stimulation, the activation of the vestibular cortex was not bilateral but was unilateral and contralateral to the right- sided labyrinthine failure.
