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PubMed2005

BNP as a biomarker in heart disease.

Heart ventricles produce B-type natriuretic peptide (BNP) in response to increased mechanical load and wall stretch. BNP protects the heart from adverse consequences of overload by increasing natriuresis and diuresis, relaxing vascular smooth muscle, inhibiting the renin-angiotensin-aldosterone system, and by counteracting cardiac hypertrophy and fibrosis. BNP is synthesized by human cardiac myocytes as a 108-amino acid prohormone (proBNP), which is cleaved to the 32-residue BNP and the 76-residue N-terminal fragment of proBNP (NT-proBNP). Both can be used as sensitive biomarkers of cardiac dysfunction and well-characterized commercial assays have recently become available. In acute coronary syndromes increased concentrations are strong predictors of recurring myocardial infarction, heart failure, and death. In acute dyspnea, high BNP and NT-proBNP point to a cardiac rather than a pulmonary origin of the symptoms. BNP and NT-proBNP help in the assessment of the severity of ventricular dysfunction and heart failure and as a prognostic predictor, regardless of the primary cause of the condition. They can be used to guide the therapy of heart failure and left ventricular dysfunction. BNP and NT-proBNP work better when they are used for specific clinical purposes, rather than for screening in the general population. Their main strength is the excellent negative predictive value with regard to left ventricular dysfunction and heart failure. BNP and NT-proBNP are nonspecific biomarkers of cardiac dysfunction. Specific diagnostic tools, such as echocardiography, are required to define the actual abnormality.

Biomarkers↗
PubMed1982

Effects of halothane on coronary haemodynamics and myocardial metabolism in patients with ischaemic heart disease and heart failure.

Halothane was administered at an end-tidal concentration of 1% to 10 patients with stable ischaemic heart disease and clinical and haemodymanic signs of moderate heart failure. Measurements of central haemodynamic variables, coronary sinus blood flow and oxygen, lactate and hypoxanthine balances over the myocardium were done before and at steady state during halothane anaesthesia. Halothane induced marked haemodynamic changes with decreases in mean arterial pressure (-43%), mean pulmonary arteriolar occlusion pressure (-42%), systemic vascular resistance (-31%), cardiac index (-20%) stoke volume index (-31%) and left and right stroke work indices (-62% and -55%, respectively). Heart rate and pulmonary vascular resistance did not change. Coronary sinus blood flow decreased in parallel with perfusion pressure, and myocardial oxygen consumption decreased (-40%), as did myocardial oxygen extraction. Rate pressure product and triple product correlated better with changes in myocardial oxygen consumption in the present subset of patients than in healthy volunteers during halothane anaesthesia. The findings suggest that halothane, through its systemic vasodilatory effect, unloads the failing left ventricle and that this peripheral action predominates over the direct cardiodepressant action of the agent. The combined findings of unchanged coronary vascular resistance, decreased myocardial oxygen extraction and absence of increasing or pathological levels of lactate and hypoxanthine in coronary sinus blood imply a direct dilatory effect of halothane on the coronary vasculature.

Aged↗
PubMed1983

Ischemic heart disease and heart weight.

Separate weights for heart ventricle walls and interventricular septa were analyzed in 110 hearts with autopsy findings of ischemic heart disease (coronary atherosclerosis, recent or old myocardial infarcts) and with no other cardiac or systemic causes of cardiac enlargement. In hearts with coronary atherosclerosis alone (without old or recent myocardial infarcts) no weight increase was observed in the left ventricle when compared to 29 controls. Patients having infarcts associated with nonstenosing atherosclerosis (less than 50% of the luminal diameter narrowed) of the coronaries had normal heart weights as well. On the contrary, infarcts associated with stenosing coronary sclerosis (narrowing more than 50%) showed significant signs of left ventricular weight increase, which is interpreted as compensatory heart hypertrophy. The greatest degree of hypertrophy was observed in hearts with left ventricular aneurysms.

Coronary Disease↗
PubMed1982

Myocardial metal content in patients who expired from cyanotic congenital heart disease and acute rheumatic heart disease.

The importance of metals in normal and pathologic cardiovascular function has been recognized. Significant derangements in myocardial Ca2+, Mg2+, and Cu2+ have been reported in ischemic heart injury. We studied 3 groups of hearts: 1) fifteen specimens obtained from patients who had no heart disease, 2) nine specimens from patients who had expired from cyanotic congenital heart disease, and 3) ten specimens from patients who had expired from acute rheumatic heart disease with carditis and severe heart failure. None of the patients had undergone cardiac surgery. Left ventricular lateral wall Mg2+, Ca2+, Cu2+, and Zn2+ contents were measured by atomic absorption spectrometry. The results showed a significant decrease in myocardial Mg2- (Group I 177.06 +/- 32.71; Group II 155.66 +/- 14.79; Group III 149.00 +/- 13.29, p less than 0.05 and p less than 0.01, respectively), and Cu2+ contents (Group I 3.22 +/- 0.37; Group II 2.94 +/- 0.22; Group III 2.56 +/- 0.32, p less than 0.02 and p less than 0.001, respectively), and a rise in myocardial Ca2+ content (Group I 36.06 +/- 10.72; Group II 43.22 +/- 7.01; Group III 46.30 +/- 4.85, p = not significant, and p less than 0.01, respectively). The myocardial Zn2+ content did not change significantly (Group I 26.53 +/- 3.99; Group II 26.00 +/- 4.15; Group III 26.40 +/- 3.53). The myocardial Mg2+/Ca2+ ratio was reduced markedly in both groups (Group I 5.328 +/- 1.879; Group II 3.685 +/- 0.735; Group III 3.135 +/- 0.291, p less than 0.001 for both Groups II and III vs Group I). The latter results correlated closely with the myocardial Mg2+/Ca2+ ratios reported in experimental models in peri-infarction zones. Thus, the myocardium of patients who had expired from cyanotic congenital heart disease and acute rheumatic carditis is jeopardized by ischemia, with metal contents similar to the border areas in myocardial infarction.

Acute Disease↗
PubMed2004

Review of death certificate diagnosis of coronary heart disease and heart failure in Japan.

Vital statistics for coronary heart disease (CHD) were dramatically influenced by the tenth revision of the International Classification of Diseases (ICD-10) in 1995. To better understand the accuracy of death certificate diagnosis of CHD and heart failure, validation studies in Japan were reviewed. Positive predictive values and sensitivity, calculated as validation measures, varied widely between studies, differing with regard to autopsy rates, amount of information on medical records, and period investigated. However, heart failure, which has been frequently assigned on death certificates in Japan, was validated in some studies. Half of these were evaluated to be sudden deaths, including coronary deaths. Because autopsy-based studies on sudden deaths indicated that 30-50% of these were accounted for by CHD deaths, deaths assigned to heart failure should be taken into consideration in order to determine the actual number of CHD deaths in Japan. Focusing on changes in vital statistics after the 1995 ICD revision, the Oita Cardiac Death Surveys (OCDS) allowed interpretation of its effects on CHD and heart failure. Much of the increase in CHD deaths on vital statistics reflects more false positive cases, particularly for out-of-hospital deaths. Considering the Japanese features of vital statistics for CHD, further epidemiological validation studies are needed in order to confirm the accuracy of CHD death certificate diagnoses and to monitor actual CHD trends in Japan.

Coronary Disease↗
PubMed2001

[Are we treating coronary heart disease and heart failure appropriately in the clinic and ambulatory care? Secondary prevention and drug therapy 1998].

We examined retrospectively 186 patients with acute coronary syndrome (ACS) and 163 patients with cardiac insufficiency (CHF) regarding secondary prevention in hospital or externally. Of the Inhospital-patients with ACS 99% had antithrombotic medicaments (AT), 73% betablockers and 73% a statin. CHF-patients had ACEH in 69%. Externally 120 patients with known coronary heart disease (CHD) received in 91% AT, 66% betablocker, 30% statins and 111 CHF-patients in 49% ACEH. Compared to other studies medical therapy ameliorated in CHD and CHF either stationary and ambulatory. The reasons for low prescription of statins may be due to short time since positive results occurred and to the expensive costs in the setting of pressure because of high cost in health system.

Adrenergic beta-Antagonists↗
PubMed2004

Public interest in genetic testing for susceptibility to heart disease and cancer: a population-based survey in the UK.

BACKGROUND: Given the current concerns about the clinical validity of commercially marketed genetic tests for multifactorial diseases, there is a surprising dearth of information about what public demand might be for genetic tests for any complex diseases other than cancer. The aim of this study was to examine interest in genetic testing for the most common multifactorial disease, heart disease, and to compare it with interest in testing for cancer in a general population sample that had not received detailed information about genetic tests. METHODS: Interest in genetic testing for heart disease susceptibility was surveyed and compared to interest in genetic testing for cancer susceptibility among a nationally representative sample of 1,960 British adults as part of the Office for National Statistics Omnibus survey. RESULTS: Sixty-nine percent of respondents expressed interest in being tested for genetic susceptibility to heart disease. Men, people aged 45-60 years, those with less education, and those with a family history were most interested in genetic testing for heart disease. Sixty-four percent of respondents expressed interest in genetic testing for susceptibility to cancer, and gender, age, and education, but not family history, were associated with interest. CONCLUSIONS: Interest in genetic testing for susceptibility to both heart disease and cancer was high, with the most educated individuals being the least interested in testing. Although the shift toward the 'expert patient' is actively encouraged and consistent with today's health policies, there is considerable and justifiable concern about some of the genetic tests for multifactorial diseases that are currently being marketed directly to the public. The high level of initial interest in the general public found in this study supports the need for a public education program around genetic testing for multifactorial diseases.

Adolescent↗
PubMed1990

[Immunohistochemical study of thymus in patients with congenital heart disease or rheumatic heart disease].

A series monoclonal antibodies were used to study the intrathymic distribution of T and B cells and the process of intrathymic differentiation of T cells on frozen sections of 14 patients' thymuses by a more sensitive immunohistochemical method. The observation indicated that most of the cortical lymphocytes reacted with Leu 1, Leu 2 a, Leu 3 a and Leu 4 antibodies, thus indicating coexpression of multiple antigen on cortical lymphocytes. In cortex, the numbers of Leu 1 and Leu 4 positive cells were less than medulla. In contrary, the numbers of Leu 2 a and Leu 3 a positive cells in the cortex were more than the medulla: and the medullary thymocytes showed segregation into Leu 2 a+ Leu 3 a- and Leu 3 a+ Leu 2 a- subsets. The ANAE+ and AIG 3+ cells were almost limited to the medulla. Hence, the staining profile of medulla approximated the staining pattern of peripheral T cell subsets, which were programmed for their respective role as helper and suppressor cells. Our results supported the conclusion that the mature T cells presented in the medulla were derived from the immature cells in the cortex. In addition, the expression of Leu 7 was not only limited to the NK cells scattered in the medulla, but also found at the cortical-septa border. On the other hand, a small number of B lymphocytes scattered in the medulla stained with Leu 14, OKB-2, BA-1 and IgM antibodies. The Hassall's corpuscles were cross reaction with the B cell antibodies mentioned above; while the epithelial cells in thymic parenchyma were only stained with IgM antibody. Based on these findings we conclude that the human thymus predominantly consist of T cells, but it also contains a fraction of B cells and epithelial cells.

Adolescent↗
PubMed1990

Assessment of neuron in congenital heart disease with heart failure.

Pathological studies in five hearts from patients with congenital heart diseases have demonstrated that the number of neurons is similar to that found in normal controls. The number of neurons has been counted in a strip of right atrial wall between the venae cavae. The hearts were selected from a wide spectrum of the population, the youngest being 5-months old and the oldest 35 years old (mean age: 12 years); all were in failure. The neuronal counts are comparable to those found in a normal population of mean age 40 years.

Adult↗