N-terminal prohormone brain natriuretic peptide (NT-proBNP) as a noninvasive marker for restrictive syndromes

Constrictive pericarditis (CP) and restrictive cardiomyopathy share many similarities in both their clinical and hemodynamic characteristics and N-terminal prohormone brain natriuretic peptide (NT-proBNP) is a sensitive marker of cardiac diastolic dysfunction. The objectives of the present study were to determine whether serum NT-proBNP was high in patients with endomyocardial fibrosis (EMF) and CP, and to investigate how this relates to diastolic dysfunction. Thirty-three patients were divided into two groups: CP (16 patients) and EMF (17 patients). The control group consisted of 30 healthy individuals. Patients were evaluated by bidimensional echocardiography, with restriction syndrome evaluated by pulsed Doppler of the mitral flow and serum NT-proBNP measured by immunoassay and detected by electrochemiluminescence. Spearman correlation coefficient was used to analyze the association between log NT-proBNP and echocardiographic parameters. Log NT-proBNP was significantly higher (P < 0.05) in CP patients (log mean: 2.67 pg/mL; 95 percentCI: 2.43-2.92 log pg/mL) and in EMF patients (log mean: 2.91 pg/mL; 95 percentCI: 2.70-3.12 log pg/mL) compared with the control group (log mean: 1.45; 95 percentCI: 1.32-1.60 log pg/mL). There were no statistical differences between EMF and CP patients (P = 0.689) in terms of NT-proBNP. The NT-proBNP log tended to correlate with peak velocity of the E wave (r = 0.439; P = 0.060, but not with A wave (r = -0.399; P = 0.112). Serum NT-proBNP concentration can be used as a marker to detect the presence of diastolic dysfunction in patients with restrictive syndrome; however, serum NT-proBNP levels cannot be used to differentiate restrictive cardiomyopathy from CP.

[Preoperative cardiological evaluation. Report of 255 cases]. / Avaliação cardiológica pré-operatória. Estudo de 255 casos.

PURPOSE: To study preoperative cardiological consultations in a cardiology referral center in a general hospital. METHODS: Two hundred and fifty five patients were studied between June and December 1989; the ages ranged between 16 and 82 (mean 55) years, 120 (47%) were male and 135 (53%) female. A questionnaire was applied by the physicians during consultation. RESULTS: Main symptoms were thoracic pain in 30 (11.8%) cases, dyspnea in 57 (22.4%), palpitations in 13 (5.1%). Symptoms of cardiac disease were absent in 141 (55.3%) patients. On physical examination arterial hypertension was detected in 75 (29.4%) cases and a cardiac murmur in 21 (8.2%). Diagnosis of coronary artery disease was made in 30 (11.8%) cases--13 (5.1%) with history of previous myocardial infarction, aortic valve stenosis in 5 (1.9%), other valvular heart diseases in 14 (5.5%), cardiac arrhythmias in 11 (4.3%). Heart disease was absent in 90 (35.4%) patients. Sixty-five (25.5%) patients were on drug therapy for heart diseases. Consultations were obtained for patients that had been already admitted to the hospital in 171 (67%) cases. Cardiological follow up was recommended to 150 (58.8%) patients. Seven patients died; the cause of the death was related to the primary disease. Contraindication for surgery imposed by cardiological evaluation did not occur. CONCLUSION: In this study, patients with heart disease tolerated the surgical procedures. Preoperative cardiological evaluation added useful data for postoperative care and also for long term follow-up of the patients.