ACTA ENDOCRINOLOGICA (BUC)

The determination of cardiac peptides at rest and during exercise stress testing (ET) represents a useful tool for the diagnosis of heart failure patients, but their usefulness in isolated LV diastolic dysfunction was less studied until now.\r\nAim. The aim of this study is to compare the effect of ET upon cardiac peptides in patients with left ventricular systolic and diastolic dysfunction.\r\nMethods. There were studied 101 heart failure patients, 58 with systolic LV dysfunction (LVEF 37.8%) and 43 patients with isolated LV diastolic dysfunction, mainly with hypertension (31 cases). All patients were submitted to a symptom-limited ET on cycloergometer, blood samples being obtained before ET and at peak effort. The plasmatic levels of N terminal pro brain-type natriuretic peptide (NT-proBNP) were determined using ELISA method (n.v. <250 fmol/ml). The systolic and diastolic LV functions were determined by echo-Doppler, according to ESC guidelines.\r\nResults. The results showed that the rest NT-proBNP values were increased in patients with LV systolic dysfunction (640?220 fmol/ml) in comparison with diastolic dysfunction (419 ?120 fmol/ml), p<0.01. At peak effort NT-proBNP increased to 790?242 fmol/ml (23%) in patients with systolic dysfunction (p<0.04) and to 490.2?179 fmol/ml (17%) in patients with diastolic dysfunction (p= NS). There was a close relationship between rest and exercise NT-proBNP values in both systolic (r=0.99, p< 0.05) and diastolic (r=0.72) LV dysfunction. \r\nIn conclusion, in heart failure patients with both systolic and diastolic LV dysfunction, NT-proBNP is increased at rest and during exercise, the increase being significant for patients with LV systolic dysfunction, probably in relationship with more important hemodynamic abnormalities.

Though increased BMI represents a risk factor for developing heart failure, in heart failure (HF) patients it paradoxically increases survival. This effect was not\r\nstudied in relationship with BNP and ACE mutations. Objective. To investigate the relationship between BNP fragment (8-29) plasmatic level, ACE I/D polymorphism and BMI in patients with chronic congestive heart failure. Methods. We studied 50 patients with HF, NYHA III and IV, mean age 64.96?13.24 years, 21 patients with BMI &#8805;30 kg/m2 vs 29 patients with BMI<30 kg/m2. BMI, ACE polymorphism,\r\nthe plasmatic levels of BNP fragment (8-29) were determined.\r\nResults. Mean plasmatic BNP fragment (8-29) level was\r\n1891.02?1008.06 pg/mL, mean BMI value 29.09?7.59 kg/m?, with a negative correlation between the two parameters (r=-\r\n0.46), stronger in women (r=-0.79 vs. r=-0.32 in men). Significant greater value of BNP fragment (8-29) was registered in nonobese patients (2130.77?866.58 pg/mL vs. 1547.765?1135.744pg/mL, p<0.05). The distribution of ACE mutation was: DD allele 36%, II allele 24%, and ID allele 40%. In all three groups, the patients with BMI &#8805;\r\n30kg/m2 presented lower values of BNP fragment (8-29) levels.\r\nConclusion. In HF patients, there was an inverse correlation between BNP value and BMI, obese patients having lower BNP fragment (8-29) values, no matter the ACE\r\npolymorphism.

Context. The prevalence of patients with concomitant heart failure (HF) and diabetes mellitus (DM) is high. Objective. To analyze the role of NT-pro-BNP levels in the evaluation of diabetic patients with heart failure. Design. Retrospective comparative cohort study. Subjects and Methods. A total of 174 patients admitted to our Cardiology Department, previously diagnosed with HF, were enrolled. Among these patients, 47.7% had DM. HF was defined according to the 2016 ESC criteria. The NT-pro BNP levels above 126 pg/mL indicate a high probability of heart failure. Results. In diabetic patients there were significant correlations between NT-pro-BNP values and the following parameters: hemoglobin (rho=-0.28, p=0.01), hematocrit (rho= -0.27, p=0.014), total cholesterol (rho= -0.21, p=0.048), triglycerides (rho= -0.283, p=0.01), ejection fraction (rho= -0.465, p<0.0001), end-diastolic volume (rho= 0.253, p= 0.026), end-systolic volume (rho= 0.29 p=0.01). Only the following 3 parameters: ejection fraction (p= 0.0009), hemoglobin (p= 0.0092) and triglycerides (p= 0.0380) were independent predictive factors for elevated NT-pro-BNP values. Conclusion. In diabetic heart failure patients, the value of NT-pro-BNP holds a pivotal role in the evaluation of their overall status, facilitating the establishment of correct management and follow-up.

Background. Myocardial involvement is frequent in patients with systemic lupus erythematosus (SLE), and its early detection assures the prognosis improvement. Objective. To assess the NT-proBNP levels and its correlation with systolic longitudinal performance, during exercise testing in a SLE population Subjects and Methods. The study included 30 SLE patients (80 % females), with a mean age of 44.8 ± 9.91 years. All subjects were submitted to an echo Doppler examination, including the determination of the global longitudinal strain (GLS). Also, they performed a cardiopulmonary exercise testing (CPE) on cycloergometer, assessing the peak oxygen uptake. Venous blood samples were taken and NT-proBNP levels were determined before exercise, at peak effort and two hours after exercise. Results. The left ventricular ejection fraction was normal but GLS was low in SLE patients ( -16.96 ± 3.12%, vs. -19.5 ± 3.05% normal range) and much lower in those with diastolic dysfunction (-14.5 ± 2.3% vs. - 19.2± 1.85%, p=0.0014). During CPE, the patients performed a mean 71.96% ± 13.9% of predicted VO2 max. The mean values of NT-proBNP were: 186.84 ± 186.8 pg/mL at rest, 221.68 ± 245.76 pg/mL at peak effort and 412.48 ± 400.28 pg/mL post effort. No correlation was registered between GLS and peak VO2. We found a negative correlation between GLS ant NT-proBNP at peak effort (r = -0.508) and post exercise (r=-0.623). Conclusion. The exercise NT-proBNP levels can be used together with GLS for an early detection of systolic dysfunction in SLE patients.

Introduction. Considering the very important role of adiponectin and leptin in\r\natherogenesis, it is important to study their relationship with other important factors in\r\nestablishing the cardiometabolic risk: hyperglycemia and serum lipids.\r\nPatients and Methods. There were studied 79 subjects (s), aged 59? 9 years, divided\r\ninto 3 groups according to body mass index (BMI): group I with BMI<25 kg/m2 - 19 s,\r\ngroup II with BMI 25-30 kg/m2 - 30s, and group III with BMI >30 kg/m2 - 30 s. In all\r\nsubjects the plasmatic levels of adiponectin, leptin and other cardiometabolic risk factors:\r\nblood glucose, total cholesterol, triglycerides, high density cholesterol, low density\r\ncholesterol were measured.\r\nResults. Considering the values of adiponectin and leptin in the three groups,\r\nadiponectin was significantly increased (14355?9120.40 vs 5889.167?6278.963 ng/mL,\r\np=0.015) and leptin significantly decreased (7212?7428.45 vs 9235.81?10988.66 pg/mL,\r\np=0.03), in group I in comparison with group II+III. Adiponectin and leptin were not\r\nsignificantly different in subjects with fasting glucose less or more than 110 mg/dL and the\r\nsame insignificant difference was registered for both adipokines between diabetic and non\r\ndiabetic subjects. Considering the plasma lipid fractions, it was registered an inverse\r\nsignificant correlation between adiponectin and total cholesterol, respectively LDL\r\ncholesterol, and a positive correlation with HDL cholesterol; leptin was inversely correlated\r\nwith HDL cholesterol, but not with LDL cholesterol or total cholesterol.\r\nConclusion. In the present study, the plasmatic values of adipokines (adiponectin and\r\nleptin) were correlated only to the BMI values (obesity) and respectively to the lipidic\r\nfractions. No correlation was registered with diabetes or impaired fasting glucose.