NT-proBNP in monitoring treatment of patients with congestive heart failure.

OBJECTIVE: The aim of this study was to assess the utility of plasma N-terminal proBrain Natriuretic Peptide (NT-proBNP) assay in monitoring the therapy of congestive heart failure patients. BACKGROUND: Treatment of congestive heart failure aims to improve left ventricular function by reducing the pressure and volume overload. The human heart secretes brain natriuretic peptide in response to increased intracardiac volume or pressure. Therefore the therapy of congestive heart failure could have an effect on the plasma natriuretic peptide level. METHODS: The study included 149 patients with heart failure admitted to the Al-Assad and Al-Mowasah Hospitals, Damascus, Syria, during a 19-month period from February 2004 to September 2005. The age of the patients was between 35-85 years (mean+/-SD: 57+/-13.5). The patients were clinically divided into 4 groups according to the New York Heart Association Classification. Plasma NT-proBNP levels were measured and echocardiography was performed in all patients. We repeated physical examination, echocardiography, the patient's history, and the NT-proBNP assay in 46 patients from different stages after 3 months of drug treatment. The monitored patients were divided into three subgroups according to the clinical state: (A) 21 patients who clinically improved; (B) 18 patients with no clinical improvement; (C) 7 patients who were clinically stable. Plasma NT-proBNP levels were measured by electrochemiluminescence immunoassay (Roche). Statistical analysis was carried out by T-distribution, and the difference was considered to be significant at P < 0.05. RESULTS: The plasma NT-proBNP levels significantly decreased (P < 0.001) in clinically improved patients after 3 months of treatment, and this was accompanied by improvement of the echocardiographic data and symptoms. In contrast, the plasma NT-proBNP levels increased in patients with no clinical improvement and a decrease in the ejection fraction after 3 months of therapy, but the difference was not statistically significant (P > 0.05). There was also no statistically significant difference (P>0.05) between the plasma NT-proBNP level at diagnosis and after 3 months of treatment in clinically stable patients. CONCLUSION: The plasma NT-proBNP levels alter in response to drug therapy and can be used in monitoring treated patients with congestive heart failure.

N-terminal-probrain natriuretic peptide and echocardiography in patients with systolic heart failure.

OBJECTIVE: To compare plasma N-terminal-probrain natriuretic peptide (NT-proBNP) levels with echocardiographic data in patients with systolic heart failure. METHODS: The study included 101 patients with systolic heart failure admitted to Al-Assad and Al-Moussa Hospitals, Damascus, Syria over a 10-month period from February 2004 to January 2005. The findings of the physical examination, electrocardiogram and blood pressure measurement were recorded along with the patient's history, risk factors, and drug treatment. We divided the patients into 4 groups according to the New York Heart Association classifications; class I=19, class II=22, class III=28, class IV=32 patients. We compared the values with 21 age-matched controls with no heart diseases (age range 49-80 years). During the study period, we carried out the plasma NT-proBNP levels and echocardiography of all patients and controls group. We used electroche-miluminescence immunoassay in measuring plasma NT-proBNP. Authorized physicians evaluated the ejection fraction (EF), systolic pulmonary pressure, and left ventricular end systolic diameter. Statistical analysis used was T-Distribution, and the difference considered to be significant at p<0.05. RESULTS: The plasma NT-proBNP levels in patients of asymptomatic heart failure class I (mean 1,038 pg/ml) were significantly higher (p<0.001) as compared with the controls (40.9 pg/ml), and it increased directly with the severity of heart failure. Plasma NT-proBNP levels were conversely correlated with the ejection fraction EF (r= -0.56, p<0.001) and it increased as the EF declined. There was a significant direct linear correlation between plasma NT-proBNP levels and the left ventricular end systolic diameter (r=0.57) and systolic pulmonary pressure r=0.54. CONCLUSION: The left ventricle releases the B-type natriuretic peptide in response to volume or pressure overload, its high level reflects the poor cardiac systolic function, which corresponds with the echocardiographic data.

Effect of hormone replacement therapy on hemostatic variables in post-menopausal women.

OBJECTIVE: Hormone replacement therapy (HRT) has been increasingly promoted over the last 40 years to improve quality of life, and to reduce the risks of osteoporotic fractures and coronary heart disease (CHD). Recent randomized controlled clinical trials reported that HRT usage is associated with an increased risk of myocardial infarction (MI), stroke, and venous thrombosis. We conducted this study to evaluate the mean levels of some hemostatic parameters among groups that differ in estrogen levels and age. METHODS: We studied 150 healthy women in an observational comparative study, divided into 3 groups. Forty women were post-menopausal using HRT for a period of 6 months to 17 years. Fifty-five women were post-menopausal and were not using HRT. Fifty-five women were younger pre-menopausal women with an age range of 20-54 years. The HRT group women were recruited from gynecologist private clinics while the other 2 groups were recruited in a random way from the society in Damascus, Syria between August 2002 and January 2003. We determined estradiol, fibrinogen, antithrombin III (AT III) and protein C in all women. RESULTS: When compared with post-menopausal non-users group, current HRT users had higher mean levels of estradiol, but lower mean levels of AT III and protein C, and similar mean levels of fibrinogen. When compared with pre-menopausal group, current users had similar mean levels of estradiol, AT III and protein C, but higher mean levels of fibrinogen. However, post-menopausal non-users women had higher mean levels of fibrinogen and lower mean levels of AT III and protein C when compared with pre-menopausal women. CONCLUSION: Hormone replacement therapy treatment did not change fibrinogen mean levels, but it caused a decrease in AT III and protein C mean levels.