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Usefulness of plasma BNP levels as a marker of left ventricular wall stress in obese individuals.

Int Heart J. 2009 Mar;50(2):173-82

Authors: Tosa S, Watanabe H, Iino K, Terui G, Kosaka T, Hasegawa H, Ito H

Plasma brain natriuretic peptide (BNP) level is known to reflect left ventricular wall stress (LVWS). Recent studies have shown that obese individuals have lower BNP levels. However, the usefulness of BNP level as a marker of LVWS in obese individuals remains unclear. This study examined whether BNP reflects LVWS even in obese individuals.This study enrolled 136 hospital inpatients who had suffered chronic heart failure (NYHA class I or II), or who had undergone a thorough examination for angina pectoris. On the basis of body mass index (BMI), we divided the inpatients into nonobese (< 25) and obese (> or = 25) groups. All BNP measurements, cardiac catheterizations, and echocardiographic examinations were carried out within 24 hours. Although no significant differences were found between the two groups in the hemodynamic parameters examined, including end-diastolic LVWS (LV-EDWS) and end-systolic LVWS (LV-ESWS), BNP levels were significantly lower in the obese group compared to the nonobese group. In the nonobese group, a definite correlation between LV-EDWS or LV-ESWS and BNP (r = 0.43, r = 0.46, respectively) was observed, whereas no correlation was found between LV-EDWS or LV-ESWS and BNP in the obese group (r = -0.09, r = 0.06, respectively). To explore the mechanism for suppressed BNP levels in obese individuals, the correlation of BNP with biochemical markers was analyzed. Statistical significance was found only between adiponectin and BNP (r = 0.44), implying that BNP or adiponectin might influence the plasma levels of the other.In conclusion, BNP levels cannot be used as a marker of LVWS in obese individuals.

PMID: 19367028 [PubMed - indexed for MEDLINE]

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Next day discharge after successful primary angioplasty for acute ST elevation myocardial infarction. An open randomized study “Prague-5″.

Int Heart J. 2008 Nov;49(6):653-9

Authors: Jirmár R, Widimský P, Capek J, Hlinomaz O, Groch L

This study tested the feasibility and safety of next day hospital discharge after successful primary PCI for uncomplicated STEMI. Twenty-three p-PCI patients (out of 271 consecutive patients) who fulfilled the study inclusion criteria were enrolled in the pilot nonrandomized phase (transfer of patients from the coronary unit to a standard ward within 24 hours after their admission) of the study. The randomized phase of the study screened a total of 1946 consecutive STEMI patients undergoing p-PCI in the two participating centers. Only 56 (ie, 2.9% from all p-PCI) very low risk patients residing less than 20 km from the PCI center were selected. They were randomized 1:2 to either a standard hospital stay (group A, n = 19, age, 58 +/- or first day discharge (group B, n = 37, age, 56 +/- 10; NS). There were no serious complications among 79 study patients within 30 days. The duration of hospital stay was 105 +/- 45 hours (group A) and 29 +/- 3 hours (P < 0.0001) in group B. Ejection fraction after 30 days was 56.8 +/- 6.5% in group A versus 57.3 +/- 7% in group B (NS). A patient comfort questionnaire showed a clear preference of first day discharge in all patients randomized into group B. The results indicate that next day discharge after successful p-PCI is feasible and safe in selected uncomplicated STEMI patients.

PMID: 19075481 [PubMed - indexed for MEDLINE]

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Combination therapy with amiodarone and enalapril in patients with paroxysmal atrial fibrillation prevents the development of structural atrial remodeling.

Int Heart J. 2008 Jul;49(4):435-47

Authors: Komatsu T, Ozawa M, Tachibana H, Sato Y, Orii M, Kunugida F, Nakamura M

The purpose of this study was to examine the relationship between long-term efficacy of amiodarone therapy (100-200 mg/day) combined with angiotensin converting enzyme inhibitor (ACEI; enalapril 5 mg/day) administration, and the development of structural atrial remodeling in patients with paroxysmal atrial fibrillation (AF). Fifty-eight patients (40 men, 18 women, mean age, 68 +/- 8 years, mean follow-up period, 43 +/- 18 months) with AF refractory to >or= two class I antiarrhythmic drugs were divided into two groups; those treated with enalapril on amiodarone (group A, n = 25) and those treated with amiodarone alone (group B, n = 33), to evaluate the efficacy of combination therapy. 1) At 12 and 24 months, the survival rates for patients free from AF recurrence were 80% and 64% in group A, and 45% and 30% in group B, respectively (P < 0.05, group A versus group B). The percentage of patients with conversion to permanent AF despite amiodarone therapy was 20% in group A and 48.5% in group B (P < 0.05, group A versus group B). 2) In group B, left atrial dimension (LAD) was significantly greater after amiodarone therapy (40.2 +/- 6.3 mm) than at baseline (35.2 +/- 6.6 mm) (P < 0.01), whereas there was no significant difference in LAD between baseline and after amiodarone therapy in group A (39.1 +/- 5.0 mm versus 41.0 +/- 5.0 mm, respectively). In patients with paroxysmal AF, ACE-I appears to enhance the efficacy of amiodarone therapy in maintaining sinus rhythm and preventing the development of structural remodeling in atria.

PMID: 18753727 [PubMed - indexed for MEDLINE]

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