Comparative assessment of satellite- and drone-based vegetation indices to predict arthropod biomass in shrub-steppes.

Arthropod biomass is a key element in ecosystem functionality and a basic food item for many species. It must be estimated through traditional costly field sampling, normally at just a few sampling points. Arthropod biomass and plant productivity should be narrowly related because a large majority of arthropods are herbivorous, and others depend on these. Quantifying plant productivity with satellite or aerial vehicle imagery is an easy and fast procedure already tested and implemented in agriculture and field ecology. However, the capability of satellite or aerial vehicle imagery for quantifying arthropod biomass and its relationship with plant productivity has been scarcely addressed. Here, we used unmanned aerial vehicle (UAV) and satellite Sentinel-2 (S2) imagery to establish a relationship between plant productivity and arthropod biomass estimated through ground-truth field sampling in shrub steppes. We UAV-sampled seven plots of 47.6-72.3 ha at a 4-cm pixel resolution, subsequently downscaling spatial resolution to 50 cm resolution. In parallel, we used S2 imagery from the same and other dates and locations at 10-m spatial resolution. We related several vegetation indices (VIs) with arthropod biomass (epigeous, coprophagous, and four functional consumer groups: predatory, detritivore, phytophagous, and diverse) estimated at 41-48 sampling stations for UAV flying plots and in 67-79 sampling stations for S2. VIs derived from UAV were consistently and positively related to all arthropod biomass groups. Three out of seven and six out of seven S2-derived VIs were positively related to epigeous and coprophagous arthropod biomass, respectively. The blue normalized difference VI (BNDVI) and enhanced normalized difference VI (ENDVI) showed consistent and positive relationships with arthropod biomass, regardless of the arthropod group or spatial resolution. Our results showed that UAV and S2-VI imagery data may be viable and cost-efficient alternatives for quantifying arthropod biomass at large scales in shrub steppes. The relationship between VI and arthropod biomass is probably habitat-dependent, so future research should address this relationship and include several habitats to validate VIs as proxies of arthropod biomass.

Laparoscopic Colposacropexy Mesh Excision Secondary to Severe Spondylodiscitis.

STUDY OBJECTIVE: To describe laparoscopic mesh excision for severe spondylodiscitis secondary to colposacropexy mesh infection and demonstrate its feasibility. DESIGN: Step-by-step description of the surgical procedure using an educational video. SETTING: Spondylodiscitis is an uncommon and severe complication after sacrocolpopexy [1], with only 34 cases published to date [2]. Symptoms usually appear weeks after surgery, the most common being back pain irradiating toward the lower extremities and fever [3,4]. Treatment consists of intravenous antibiotic therapy for a minimum of 6 weeks, and approximately 70% require a surgical treatment [2] including mesh removal and debridement of the necrotic material [5]. INTERVENTIONS: A 55-year-old woman received an intervention for colposacropexy 2 months before owing to severe hysterocele and cystocele and consulted for fever and intense lumbar pain. She was diagnosed as having L5 to S1 spondylodiscitis secondary to colposacropexy mesh infection. She received endovenous antibiotic treatment for 6 weeks and underwent a laparoscopic mesh excision to facilitate resolution of infection. Laparoscopic approach with a standard 4-port placement configuration was used, enabling the identification of the colposacropexy mesh. Surgical strategy initially consisted of dissection of the promontory, vesicovaginal, and pararectal spaces, having previously identified the main anatomic landmarks to preserve them. Suspension of the promontory peritoneum and the bladder to the abdominal wall enabled a better exposure of the surgical field, facilitating the dissection and excision of the mesh. Postoperative course was uneventful, and the patient was discharged 4 days later. CONCLUSION: Owing to minimal morbidity and good results, laparoscopic mesh excision should be considered an effective treatment for spondylodiscitis secondary to mesh infection.

Tratamiento con 177LU-DOTATATE en tumores neuroendocrinos. Estudio preliminar / 177Lu-DOTATATE treatment in neuroendocrine tumours. A preliminary study

La terapia con péptidos análogos de la somatostatina marcados con radionúclidos es un nuevo tratamiento prometedor para tratar tumores neuroendocrinos. El objetivo del presente estudio preliminar es presentar nuestra experiencia en la terapia con 177Lu-DOTATATE y evaluar la tolerabilidad y la eficacia a corto plazo en pacientes con tumores que expresan receptores para la somatostatina. Se han tratado 7 pacientes con tumores neuroendocrinos metastásicos, cada uno con 4 dosis de 177Lu-DOTATATE y se ha evaluado su respuesta al tratamiento en forma de respuesta bioquímica (marcadores tumorales y analítica), según métodos de imagen (gammagrafía de receptores de somatostatina, tomografía computarizada y resonancia magnética) y respuesta funcional y de calidad de vida (mediante la Escala de actividad de Karnofsky). Se ha evaluado también la toxicidad del tratamiento. Los resultados obtenidos han sido los siguientes: respuesta bioquímica: el 60% de los pacientes mostraron una normalización de sus niveles de marcadores tumorales, mientras que en el 40% disminuyeron de manera significativa; respuesta en técnicas de imagen: el 85,7% presentaron una respuesta parcial, mientras que el 14,3% mostraron enfermedad estable; mejoría de la calidad de vida: el 100% de los pacientes mostraron una mejoría significativa en la calidad de vida con un incremento de la Escala de actividad de Karnofsky, y en cuanto a la toxicidad: ningún paciente presentó toxicidad aguda o crónica, y el 42,8% de los pacientes presentaron toxicidad subaguda hematológica transitoria. A pesar de tratarse de un estudio preliminar podemos afirmar que el tratamiento con 177Lu-DOTATATE es un tratamiento seguro, con pocos efectos adversos y que consigue una respuesta objetiva en la mayoría de los pacientes (AU)

Therapy with radiolabelled somatostatin analogue peptides is a promising new therapy to treat neuroendocrine tumours. The aim of this preliminary study is to present our experience with 177Lu-DOTATATE therapy, and evaluate tolerability and short-term efficacy in patients with tumours expressing somatostatin receptors. A total of 7 patients with metastatic neuroendocrine tumours were treated, each with 4 doses of 177Lu-DOTATATE. The treatment response was evaluated in the form of biochemical response (tumour markers), imaging methods (somatostatin receptor scintigraphy, computed tomography, and magnetic resonance), and functional and quality of life responses using the Karnofsky performance status scale. Treatment toxicity was also evaluated. The results obtained were as follows: Biochemical response: 60% of patients showed tumour marker levels returning to normal, while they decreased significantly in the remaining 40%. Imaging response: 85.7% had a partial response, while 14.3% showed stable disease. All (100%) patients showed a significant improvement in quality of life, with increased Karnofsky scale scores. No patient had acute or chronic toxicity, and subacute transient haematological toxicity was observed in 42.8% of patients. Despite being a preliminary study, it was found that treatment with 177Lu-DOTATATE is a safe treatment with few side effects, and an objective response was achieved in most patients (AU)

177Lu-DOTATATE treatment in neuroendocrine tumours. A preliminary study. / Tratamiento con 177LU-DOTATATE en tumores neuroendocrinos. Estudio preliminar.

Therapy with radiolabelled somatostatin analogue peptides is a promising new therapy to treat neuroendocrine tumours. The aim of this preliminary study is to present our experience with 177Lu-DOTATATE therapy, and evaluate tolerability and short-term efficacy in patients with tumours expressing somatostatin receptors. A total of 7 patients with metastatic neuroendocrine tumours were treated, each with 4 doses of 177Lu-DOTATATE. The treatment response was evaluated in the form of biochemical response (tumour markers), imaging methods (somatostatin receptor scintigraphy, computed tomography, and magnetic resonance), and functional and quality of life responses using the Karnofsky performance status scale. Treatment toxicity was also evaluated. The results obtained were as follows: Biochemical response: 60% of patients showed tumour marker levels returning to normal, while they decreased significantly in the remaining 40%. Imaging response: 85.7% had a partial response, while 14.3% showed stable disease. All (100%) patients showed a significant improvement in quality of life, with increased Karnofsky scale scores. No patient had acute or chronic toxicity, and subacute transient haematological toxicity was observed in 42.8% of patients. Despite being a preliminary study, it was found that treatment with 177Lu-DOTATATE is a safe treatment with few side effects, and an objective response was achieved in most patients.

Are motorway wildlife passages worth building? Vertebrate use of road-crossing structures on a Spanish motorway.

Numerous road and railway construction projects include costly mitigation measures to offset the barrier effect produced on local fauna, despite the scarcity of data on the effectiveness of such mitigation measures. In this study, we evaluate the utility of different types of crossing structures. Vertebrate use of 43 transverse crossing structures along the A-52 motorway (north-western Spain) was studied during spring 2001. Research centered on wildlife passages (9), wildlife-adapted box culverts (7), functional passages (6 overpasses, 7 underpasses) and culverts (14), with marble dust being used to record animal tracks. A total of 424 track-days were recorded, with most of the larger vertebrate groups present in the area being detected. All crossing structure types were used by animals, although the intensity of use varied significantly among them (Kruskal-Wallis test, p<0.05); culverts were used less frequently than other structures. Crossing structure type and width were identified as the most important factors in their selection for use. Wildlife passages and adapted culverts allowed crossing by certain species (wild boar, roe deer, Eurasian badger), which do not tend to cross elsewhere. These results highlight the importance of using both mixed-type structures and wildlife passages in reducing the barrier effect of roads.

Prognostic value of brain natriuretic peptide in heart transplant patients.

BACKGROUND: Continuously elevated B-type natriuretic peptide B (BNP) levels are associated with adverse prognosis in heart failure, but this has been less well established in heart transplantation, where medium- to long-term studies are lacking. The purpose of this study was to determine whether BNP levels determined in the first year of transplant have prognostic implications for subsequent outcome. METHODS: A retrospective case-control study was carried out in 71 heart transplant patients with a total of 488 biopsies and BNP determinations. Determinations that might raise BNP levels (rejection, high lung pressures, renal dysfunction, depressed ventricular function and graft vascular disease) and those obtained in the first 4 months were excluded. The final analysis included 56 patients with 155 BNP determinations spread over Months 5, 7, 9 and 12. Two groups were made according to the presence of major events after the first year (death, late rejection and ventricular dysfunction associated or not with graft vascular disease): group with events: 13 patients, 37 determinations; group without events: 43 patients, 118 determinations. RESULTS: There were no differences in the clinical profile of the patients. Mean follow-up was 6 years. Mean BNP was higher in the events group for determinations at Month 5 [event: 140 (95), no events: 68 (68); p = 0.01], Month 7 [event: 174 (32), no event: 66 (65); p = 0.002], Month 9 [event: 143 (37), no event: 58 (54); p = 0.002] and Month 12 [event: 126 (55), no event: 48 (37); p = 0.001]. The receiver-operator characteristic (ROC) curve showed that a BNP value of 100 pg/ml classified patients with a sensitivity of 80% and a specificity of 75% (p = 0.0001). CONCLUSIONS: BNP values determined in the first year of transplant might help to distinguish a sub-group of patients with a higher rate of significant complications in long-term follow-up.

Proyecto de investigación para evaluar la eficacia de los «Cuidados Primarios de Duelo» (CPD) en viudas: un ensayo clínico aleatorizado por médicos / No disponible

Objetivo: evaluar la eficacia de los «Cuidados Primarios de Duelo» (CPD), una intervención biopsicosocial en duelo diseñada específicamente para la atención primaria (AP). Diseño: ensayo clínico aleatorizado por médicos, distribuidos en dos grupos paralelos: control (GC) e intervención (GI). Emplazamiento: 19 Centros de Salud de Vizcaya del Servicio Vasco de Salud/Osakidetza. Participantes: 104 mujeres captadas antes de transcurridos 3 meses del fallecimiento de su pareja y 31 médicos de AP colaboradores. Intervenciones: GI: 7 sesiones de CPD, de 45 minutos cada una, realizadas a los 4, 4½, 5, 6, 8, 10 y 13 meses de la muerte del cónyuge y en lasque se aplicarán las técnicas generales (REFINO: relación, escucha, facilitación, información, normalización y orientación) y específicas (anticipación de fechas, toma de decisiones,...) de los CPD. GC: 7 sesiones realizadas con la misma periodicidad que el GI, pero libres en duración y contenido. Mediciones principales: se analizarán las «mejorías» en el InventarioTexas Revisado de Duelo, Inventario de Experiencias en Duelo, calidad de vida (SF-36) y salud mental (GHQ-28), a los 3, 9, 15 y 21 meses del fallecimiento del cónyuge; mediante análisis de la covarianza ajustado por las variables predictoras y confusoras que se consideren, y con un modelo lineal mixto. Todos los análisis se harán por intención de tratar. Discusión: el proyecto es muy complejo y está lleno de dificultades, pero las conclusiones que se deriven del mismo aportarán evidencias científicas útiles para definir la atención más apropiada a las personas en duelo en AP (AU)

Objective: to evaluate the effectiveness of «Primary BereavementCare» (PBC), a bereavement intervention specifically designed for primary health care (PHC). Design: a cluster (family physicians)-randomized controlled trial. Location: 19 Basque Health Service (Osakidetza) Centers in Biscay. Participants: 104 women selected within 3 months of their partners' demise, and 31 collaborating family physicians. Interventions: experimental group: 7 sessions of 45 minutes each, performed at 4, 4½, 5, 6, 8, 10 and 13 months after partner death, applying PBC general techniques (REFINO: relationship, «ear», facilitation, information, normalization, and orientation) and PBC specific techniques(date anticipation, decision taking, etc.). Control group: 7 sessions with the same frequency, but without specific content and duration. Principal measurements: «improvements» are analyzed according tothe Texas Revised Inventory of Grief, Grief Experiences Inventory, qualityof life (SF-36) and mental health (GHQ-28), at 3, 9, 15 and 21 monthsfollowing the partner's death; via a covariance analysis adjusted by predictedand confounding variables, using a mixed linear model. All analyses will be performed on an intention-to-treat basis. Discussion: the project is very complex and full of difficulties, but theconclusions obtained will provide useful scientific evidence for the definitionof the most appropriate care for the bereaved in PHC (AU)

Is there a correlation between brain naturietic peptide levels and echocardiographic and hemodynamic parameters in heart transplant patients?

BACKGROUND: Brain naturietic peptide (BNP) elevations have been reported in heart transplant patients both at baseline and during rejection. An association between BNP levels and certain echocardiographic and hemodynamic abnormalities has also been found in nontransplanted heart disease patients. We sought to determine whether BNP values were correlated with echocardiographic and hemodynamic parameters among a large cohort of heart transplant patients. MATERIALS AND METHODS: We studied 71 consecutive heart transplant patients, excluding combined grafts, retransplants, and pediatric cases. We performed 488 BNP determinations during catheterization and within 48 hours of echocardiography. Hemodynamic parameters included mean pulmonary artery pressure, right ventricular systolic and diastolic pressures. Doppler echocardiography parameters were wall thickness, ventricular mass, left and right ventricular end-diastolic and end-systolic diameters, isovolumic relaxation time, and mitral flow deceleration time. RESULTS: We observed significant correlations between BNP values and left ventricular size, ventricular mass, and a restrictive filling pattern. BNP levels were also significantly correlated with right ventricular size, mean pulmonary artery pressure, and right ventricular diastolic and end-diastolic pressures. CONCLUSIONS: In heart transplant patients, BNP levels positively correlated with ventricular diameters and a restrictive filling pattern. An increase in right ventricle and pulmonary artery pressures was associated with elevated BNP values.

Valor de la medición ecográfica de longitud cervical en gestantes con amenaza de parto prematuro para predecir un parto pretérmino / Value of ultrasonographic measurement of cervical length in predicting preterm birth after threatened preterm labor

No disponible

La forma de captar participantes influye en su grado de colaboración / The way participants are recruited affects their degree of collaboration

No disponible

El rastreo oseo isotópico en la fibromialgia reumática / Oseo fibromyalgia syndrome

Existen muy pocos estudios que relacionen la Fibromialgia reumática (FR) con el Rastreo Óseo Isotópico (RO). El objetivo de este trabajo es evaluar el valor del RO en el diagnóstico de la FR e intentar encontrar un patrón óseo gammagráfico que permita el diagnóstico de esta patología, al igual que sucede con otras enfermedades osteoarticulares reumáticas, ayudando también así en el diagnóstico diferencial con éstas. Se han estudiado 19 mujeres (edad 24-69 años). 14 de ellas presentaban diagnóstico clínico de FR y 5 sospecha clínica. A todas ellas se les realizó un gran número de pruebas diagnósticas: analíticas sanguíneas, Radiología convencional, Electrocardiogramas, Electroencefalogramas, Electromiografia, Ecografía, Tomografía computerizada, Resonancia magnética y RO. En todos los RO se observaron incrementos anormales de captación de intensidad variable, de localización difusa o puntual y a nivel poliarticular, además de los hallazgos ya conocidos por la patología osteoarticular concomitante de las pacientes. No se observó la presencia de fase vascular positiva en ningún caso a pesar de ser zonas dolorosas en la exploración clínica. No se observó relación entre la localización e intensidad de captación del radiofármaco y la presencia clínica de dolor.Pensamos que los pacientes con FR podrían presentar un patrón gammagráfico variable en cuanto a localización e intensidad de captación, de tipo poliarticular en fase tardía.

[Bone scintigraphy and somatostatin receptor scintigraphy in pediatric patients with bone involvement in Langerhans cell histiocytosis]. / Gammagrafía ósea y gammagrafía de receptores de la somatostatina en pacientes pediátricos con histiocitosis de células de Langerhans ósea.

Langerhans cell histiocytosis (LCH) is a granulomatous disease which can involve multiples sites of the body. Diagnostic imaging is of utmost importance in the management of these patients. Up to now radiographic skeletal survey and bone scintigraphy (BS) have been used to assess bone involvement (both with low specificity). Magnetic resonance imaging (MRI) and CT have been used to assess visceral involvement but with the limitation that they cannot give information about the functional status. Recently somatostatin receptor scintigraphy (SSRS) has been proposed to detect active lesions and to monitor response to treatment. The aim of this study is to assess bone and somatostatin receptor scintigraphy in the detection of bone involvement in LCH in children. Twenty scintigraphies (12 SSRS and 8 BS) were performed in seven patients (3 girls and 4 boys) aged at diagnosis: 18 month-12 years (mean age 6 years). The findings obtained in the scintigraphies were compared with clinical evolution and other imaging techniques. Bone scintigraphy detected all the LCH bone lesions, and discovered one unknown lesion. SSRS scintigraphy visualised the active lesions in 3 patients (clinical and other imaging techniques were also positive). SSRS was negative in one patient classified as disease free and another in clinical remission. SSRS detected 2 new unknown bone lesions, but could not detect LCH bone lesions confirmed in other imaging techniques in 2 patients. Somatostatin receptor and Bone scintigraphy can be used to detect active LCH bone lesions in children and can help to monitor response to treatment. Further studies with more patients are needed to confirm the diagnostic usefulness of these techniques.

Gammagrafía ósea y gammagrafía de receptores de la somatostatinaen pacientes pediátricos con histiocitosis de células de Langerhans ósea / Bone scintigraphy and somatostatin receptor scintigraphy in pediatric patients with bone involvement in langerhans cell histiocytosis

La histiocitosis de células de Langerhans (HCL) es una enfermedad granulomatosa que puede afectar a múltiples lugares del cuerpo. El diagnóstico por imagen es de gran importancia en el manejo de estos pacientes. Hasta ahora, la radiografía del esqueleto y la gammagrafía ósea (GO) se han empleado para la valoración de la afectación ósea (ambos con baja especificidad). La resonancia magnética (RM) y la tomografía computarizada (TC) se han empleado en la valoración de la afectación visceral pero con la limitación de que no pueden ofrecer información sobre el estado funcional de las lesiones. Recientemente se ha propuesto la gammagrafía de receptores de somatostatina (GRS) para detectar lesiones activas y monitorizar la respuesta al tratamiento. El objetivo de este estudio es estudiar el valor de la gammagrafía ósea y de receptores de la somatostatina en la detección de la afectación ósea en la HCL.Se realizaron 20 estudios gammagráficos (12 GRS y 8 GO) a 7 pacientes (3 mujeres y 4 varones) de edades al diagnóstico comprendidas entre 18 meses y 12 años (edad media 6 años).Los hallazgos obtenidos en los estudios gammagráficos se compararon con la evolución clínica y otras técnicas de imagen.La gammagrafía ósea detectó todas las lesiones óseas de HCL y descubrió una lesión desconocida. La GRS visualizó las lesiones activas en 3 pacientes (con clínica y otras técnicas de imagen también positivas). La GRS fue negativa en un paciente libre de enfermedad y otro con remisión clínica. La GRS detectó en dos ocasiones lesiones nuevas desconocidas, pero no pudo detectar las lesiones óseas de HCL confirmadas por otras técnicas de imagen en 2 pacientes.La GRS y la GO pueden ser útiles en niños con HCL y puede ayudar en la monitorización de la respuesta al tratamiento. Se necesitan más estudios con mayor número de pacientes para confirmar la utilidad diagnóstica de estas técnicas. (AU)

Radioimmunometric assay of B-type natriuretic peptide (BNP) in heart transplantation: correlation between BNP determinations and biopsy grading of rejection.

The aim of this study was to determine whether elevated brain natriuretic peptide (BNP) levels after heart transplantation are correlated with the severity of rejection by using endomyocardial biopsy (EMB) and echocardiographic parameters indicative of ventricular function of the transplanted heart. This was an observational study of 80 orthotopic heart transplant recipients (11 women and 69 men; mean age 53+/-11 years). BNP determinations were performed within 48 h of endomyocardial biopsy. The echocardiographic study and BNP determination were also performed in a group of healthy volunteers. We found significantly higher BNP mean levels in heart transplant patients than in healthy volunteers (volunteers, 16.7+/-16.2 pg.ml-1; transplant, 213.4+/-268.6 pg.ml-1; P<0.001). Transplant recipients with rejection grades 2, 3 and 4 on EMB had significantly higher BNP levels than those with rejection grades 0 and 1 (higher rejection grade, 162.5+/-168.4 pg.ml-1; lower rejection grade, 292+/-361.8 pg.ml-1; P<0.01). BNP values of patients with good left ventricular function (LVF) were significantly lower than in patients with mildly and moderately impaired LVF and patients with severely impaired LVF (good function, 199.76+/-233.6 pg.ml-1; mildly/moderately impaired LVF, 937+/-644.5 pg.ml-1; severely impaired LVF, 1038+/-491.2 pg.ml-1; P<0.001). It is concluded that BNP plasma levels are elevated in heart transplant patients compared to the normal population. The distribution of BNP levels in heart transplanted patients show a wide range. BNP elevation is greater in patients with higher rejection grades on EMB and greater impairment of left ventricular function.

Hodgkin's disease. Prognostic value of Gallium-67 scintigraphy.

AIM: The aim of this study is to assess the clinical impact of gallium-67 scintigraphy, before and after treatment, in patients with Hodgkin's disease, and to compare the overall survival between the patients whose gallium studies after treatment were negative and those whose studies remained positive. METHODS: We have studied 75 patients (40 women, 35 men) with Hodgkin's disease. All the patients underwent (67)Ga scintigraphy at the moment of the diagnosis (basal study) and in the case that basal study was positive (abnormal hyper-uptake focus) we performed follow-up studies after the treatment. We have calculated the overall survival among patients whose studies after treatment were negative (1(st) group) and those whose studies remained positive (2(nd) group) and between patients whose studies were negative at diagnosis (3(rd) group). RESULTS: Gallium scintigraphy was positive at diagnosis in 47 patients (62.6%). In 39 of them we were able to perform the follow-up study after treatment. The follow-up study was negative in 31 patients while in 8 patients the gallium scintigraphy remained positive. The overall survival was significantly higher (p<0.001) in the 1(st) group compared with the 2(nd) group. The overall survival was higher in the 1(st) group compared with the 3(rd) but statistic significance level was not reached. CONCLUSION: Our data suggest that: 1) in Hodgkin's disease (67)Ga scintigraphy is useful to establish the diagnosis of complete remission; 2) if the gallium scan remains positive after treatment, the prognosis of patients is worse than the prognosis of patients with a negative scan.

Un análisis inapropiado pone en duda los beneficios de la educación sanitaria en la fibromialgia / Inadequate analysis cats doubt ov the benefits of health education in fibromyalgia

No disponible

Radioimmunometric assay of natriuretic peptide type-B (BNP) in heart failure.

The aim of this study was to assess the value of the radioimmunometric determination of natriuretic peptide type-B (brain natriuretic peptide, BNP) in the diagnosis and prognosis of heart failure, and to study the association between BNP and the clinical, analytical and echocardiographic variables associated with the evolution of heart failure. The study group included 169 patients (74 women and 95 men; mean, 66 years) with heart failure of different causes, admitted consecutively to our hospital. BNP levels were measured with a radioimmunometric assay (Shionora BNP Cis ) after day 3 of admission. Patients were also studied by echocardiography. A significant association between the cause of heart failure and the BNP concentration was found (patients with ischaemic disease had the highest BNP values). Systolic function was worse in patients with ischaemic disease or dilated cardiomyopathy. High BNP values were also associated with advanced functional class and male sex. Plasma creatinine correlated positively with plasma BNP. However, we found no significant association with the other clinical variables evaluated. Of the echocardiographic variables analysed, BNP correlated positively with the ventricular diameter and pulmonary artery systolic pressure, and inversely with the shortening fraction; patients with severely impaired systolic function had the highest BNP values. It can be concluded that BNP levels (by radioimmunometric assay) are increased in patients with heart failure, and increase in relation to left ventricular dysfunction and the severity of heart failure. The strong independent association of plasma BNP with the left ventricular ejection fraction, its stability and the low cost of measurement suggest that plasma BNP assay could become a routine test. BNP assay could be included as an important factor in clinical and therapeutic decision making, as it complements the information provided by other variables used in the diagnosis of heart failure.