American heart journal
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American heart journal · Nov 2004
Comparative Study Clinical TrialUtility of B-natriuretic peptide in the evaluation of left ventricular diastolic function: comparison with tissue Doppler imaging recordings.
Although Doppler echocardiography provides assessment of abnormal left ventricular (LV) diastolic filling dynamics, its inherent limitations suggest the need for additional measures of diastolic dysfunction. The ratio of mitral velocity to early diastolic velocity of the mitral annulus (E/E') derived from tissue Doppler imaging is associated with the mean LV end diastolic pressure (LVEDP). Because data suggest that B-natriuretic peptide (BNP) reflects ventricular pressure, we hypothesized that BNP levels correlate with indices of LV diastolic function by tissue Doppler imaging. ⋯ BNP levels correlate with the E/E' ratios from tissue Doppler imaging (r = 0.48) and can reliably provide estimation of LV filling pressures. Although BNP levels do not correlate well with E/E' ratios across the full spectrum of values, the combination of BNP levels along with E/E' ratios from tissue Doppler imaging may be a better predictor of elevated LV filling pressures in patients with suspected diastolic dysfunction.
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American heart journal · Nov 2004
Prognostic value of low-level cardiac troponin-I elevations in patients without definite acute coronary syndromes.
Low-level cardiac troponin-I (cTn-I) elevations predict adverse cardiovascular outcomes in patients with definite acute coronary syndromes (ACS), as defined by the presence of chest pain accompanied by ischemic electrocardiographic changes. However, their prognostic value in other clinical situations remains unclear. ⋯ Low-level cTn-I elevations identify a subset of patients at increased risk for future cardiovascular events, even when obtained outside the context of definite ACS or presentation with chest pain.
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American heart journal · Nov 2004
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialEffect of nesiritide (human b-type natriuretic peptide) and dobutamine on heart rate variability in decompensated heart failure.
Previous studies have suggested that natriuretic peptides may have direct sympathoinhibitory effects. Nesiritide (recombinant human B-type natriuretic peptide) has been recently approved for treatment of decompensated congestive heart failure (CHF). We sought to assess the effects of nesiritide compared with dobutamine on time-domain indices of heart rate variability (HRV) in patients with decompensated CHF. ⋯ Low-dose nesiritide therapy in patients with decompensated CHF improves indices of overall HRV and parasympathetic modulation, particularly if HRV is severely depressed at baseline. Dobutamine and possibly high-dose nesiritide can potentially lead to further deterioration of autonomic dysregulation.