Prognostic Significance of NT-proBNP Levels in Patients over 65 Presenting Acute Myocardial Infarction Treated Invasively or Conservatively.

OBJECTIVES: Assessment of prognostic significance of NT-proBNP level and the effects of invasive (I) and conservative (C) treatment of acute myocardial infarction (AMI) in patients over 65. MATERIALS AND METHODS: One-year survival was assessed in 286 consecutive patients with AMI aged 65-100 (79 ± 8) subjected to I or C treatment (136 and 150 individuals), respectively. RESULTS: 245 (85%) patients survived in-hospital stay: 124 (91.1%) received I treatment and 121 (80.6%) received C treatment. Heart failure (HF) was diagnosed in 30 patients receiving I treatment (22.6%) and in 71 subjected to C treatment (47.3%), p < 0,0001. NT-proBNP levels in the latter group were significantly higher than in the 185 patients without HF (12311 ± 13560 pg/mL versus 4773 ± 8807 pg/mL, p < 0.0001). NT-proBNP levels after coronary angioplasty were lower than in patients receiving C treatment (5922 ± 10250 pg/mL versus 8718 ± 12024 pg/mL, p = 0.0002). Left ventricular ejection fraction was significantly higher in I patients than in C patients (47 ± 13% versus 42 ± 11.6%, p = 0.004). During the one-year follow-up, 82.3% of I patients and 61.2% of the C patients survived (p < 0.0003). There was a significantly lower probability of death at NT-proBNP below 8548.5 pg/mL. CONCLUSIONS: The NT-proBNP level in the first day of AMI is a good prognosticator. One-year follow-up prognosis for patients who received I treatment in the AMI is better than that for C patients. I patients exhibit superior left ventricular function after angioplasty and in the follow-up.

[Use of intermittent ultrafiltration in decompensated, diuretic-resistant heart failure--six case reports]. / Zastosowanie ultrafiltracji zylnej w leczeniu chorych z ciezka, oporna na leczenie zastoinowa niewydolnoscia serca--opis szesciu przypadków.

Veno/venous ultrafiltration is a novel alternative method of treatment in patients with decompensated heart failure with fluid retention. Intermittent ultrafiltration treatment was used in 6 patients (mean age of 58+/-2 years) with decompensated heart failure and volume overload occurring despite optimal pharmacological treatment. Patients received 3.5+/-1 ultrafiltration treatments, with each treatment removing 2500+/-200 ml of fluid. There were no significant procedure-related complications. One patient died due to progression of heart failure whereas 5 patients were successfully discharged from hospital on oral furosemide.