N-terminal pro-brain natriuretic peptide used for the prediction of coronary artery stenosis.

BACKGROUND: The level of the inactive N-terminal fragment of pro-brain (B-type) natriuretic peptide (NT-proBNP) is a prognostic marker in patients with acute and chronic coronary artery disease (CAD). It might also be valuable for non-invasive diagnosis of coronary artery disease. MATERIALS AND METHODS: The NT-proBNP was measured in 781 consecutive patients with normal left ventricular function referred for coronary angiography owing to symptoms or signs of CAD. The diagnostic value of NT-proBNP was assessed for predicting CAD at angiography. RESULTS: Elevated NT-proBNP levels were associated with the extent of CAD and with the female sex (P < 0.001). The ability of NT-proBNP to predict significant coronary disease at angiography was assessed separately for men using a cut-off point of 85 pg mL(-1), positive likelihood ratio 2.2 (95% CI, 1.7-3.0), negative likelihood ratio 0.53 (95% CI 0.45-0.63) and area under the receiver-operating-characteristic (ROC) curve 0.72: for women, it was assessed using a cut-off point of 165 pg mL(-1), positive likelihood ratio 2.4 (95% CI, 1.7-3.4), negative likelihood ratio 0.55 (95% CI, 0.44-0.70) and area under ROC curve 0.71. In multiple logistic-regression analysis, NT-proBNP added significant independent predictive power to other clinical variables in models predicting CAD (odds ratio 2.76, 95% CI, 1.76-4.32, P < 0.001). CONCLUSIONS: The NT-proBNP is a marker of non-obstructive CAD and of significant coronary stenosis. In conjunction with other clinical information, measurement of NT-proBNP with the use of sex-specific reference ranges may improve the non-invasive prediction of CAD.

[Leptospirosis (Weil's syndrome) with renal failure, severe jaundice, disseminated hemorrhages and xanthopsia]. / Leptospirose mit akutem Nierenversagen, schwerem lkterus, disseminierten Blutungen und Xanthopsie.

We report a case of a 48-year-old man from western Austria with severe leptospirosis. This disease occurs worldwide but predominates in the tropics. The infectious urine of a wide variety of domestic and wild animals mediates transmission of the infection, which characteristically has a biphasic pattern. It begins with the "leptospiraemic phase" with high fever, conjunctival suffusion, muscle pain and headache. Hepatitis, nephritis and haemorrhages may follow. The second "immune phase" has a greater variety of clinical manifestations. Fever and the initial symptoms may recur and the central and peripheral nervous system may be involved. The patient reported showed all major characteristics except conjunctival suffusion. The outcome was favourable despite some conditions with a poor prognosis (jaundice, renal failure, haemorrhages). The extreme severity of jaundice and the xanthopsia (yellow vision) make the case unique.