TY - JOUR
T1 - N-terminal pro-brain natriuretic protein levels in takotsubo cardiomyopathy
AU - Nguyen, Thanh Ha
AU - Neil, Christopher J
AU - Sverdlov, Aaron L
AU - Mahadavan, Gnanadevan
AU - Chirkov, Yuliy Y
AU - Kucia, Angela M
AU - Stansborough, Jeanette
AU - Beltrame, John F
AU - Selvanayagam, Joseph B
AU - Zeitz, Christopher J
AU - Struthers, Allan D
AU - Frenneaux, Michael P
AU - Horowitz, John D
N1 - Crown Copyright © 2011. Published by Elsevier Inc. All rights reserved.
PY - 2011/11/1
Y1 - 2011/11/1
N2 - Takotsubo cardiomyopathy (TTC) is characterized by reversible left ventricular (LV) systolic dysfunction independent of fixed coronary disease or coronary spastic pathogenesis. A number of investigators have documented marked elevation of natriuretic peptide levels at presentation in such patients. We sought to determine the pattern, extent, and determinants of the release of N-terminal pro-B type natriuretic peptide/B type natriuretic peptide (NT-proBNP/BNP) in patients with TTC. We evaluated NT-proBNP/BNP release acutely and during the first 3 months in 56 patients with TTC (96% women, mean age 69 ± 11 years). The peak plasma NT-proBNP levels were compared to the pulmonary capillary wedge pressure and measures of regional and global LV systolic dysfunction (systolic wall stress, wall motion score index, and LV ejection fraction) as potential determinants of NT-proBNP/BNP release. In patients with TTC, the plasma concentrations of NT-proBNP (median 4,382 pg/ml, interquartile range 2,440 to 9,019) and BNP (median 617 pg/ml, interquartile range 426 to 1,026) were substantially elevated and increased significantly during the first 24 hours after the onset of symptoms (p = 0.001), with slow and incomplete resolution during the 3 months thereafter. The peak NT-proBNP levels exhibited no significant correlation with either pulmonary capillary wedge pressure or systolic wall stress. However, the peak NT-proBNP level correlated significantly with the simultaneous plasma normetanephrine concentrations (r = 0.53, p = 0.001) and the extent of impairment of LV systolic function, as measured by the wall motion score index (r = 0.37, p = 0.008) and LV ejection fraction (r = -0.39, p = 0.008). In conclusion, TTC is associated with marked and persistent elevation of NT-proBNP/BNP levels, which correlated with both the extent of catecholamine increase and the severity of LV systolic dysfunction.
AB - Takotsubo cardiomyopathy (TTC) is characterized by reversible left ventricular (LV) systolic dysfunction independent of fixed coronary disease or coronary spastic pathogenesis. A number of investigators have documented marked elevation of natriuretic peptide levels at presentation in such patients. We sought to determine the pattern, extent, and determinants of the release of N-terminal pro-B type natriuretic peptide/B type natriuretic peptide (NT-proBNP/BNP) in patients with TTC. We evaluated NT-proBNP/BNP release acutely and during the first 3 months in 56 patients with TTC (96% women, mean age 69 ± 11 years). The peak plasma NT-proBNP levels were compared to the pulmonary capillary wedge pressure and measures of regional and global LV systolic dysfunction (systolic wall stress, wall motion score index, and LV ejection fraction) as potential determinants of NT-proBNP/BNP release. In patients with TTC, the plasma concentrations of NT-proBNP (median 4,382 pg/ml, interquartile range 2,440 to 9,019) and BNP (median 617 pg/ml, interquartile range 426 to 1,026) were substantially elevated and increased significantly during the first 24 hours after the onset of symptoms (p = 0.001), with slow and incomplete resolution during the 3 months thereafter. The peak NT-proBNP levels exhibited no significant correlation with either pulmonary capillary wedge pressure or systolic wall stress. However, the peak NT-proBNP level correlated significantly with the simultaneous plasma normetanephrine concentrations (r = 0.53, p = 0.001) and the extent of impairment of LV systolic function, as measured by the wall motion score index (r = 0.37, p = 0.008) and LV ejection fraction (r = -0.39, p = 0.008). In conclusion, TTC is associated with marked and persistent elevation of NT-proBNP/BNP levels, which correlated with both the extent of catecholamine increase and the severity of LV systolic dysfunction.
KW - Adult
KW - Aged
KW - Aged, 80 and over
KW - C-Reactive Protein
KW - Echocardiography
KW - Female
KW - Humans
KW - Magnetic Resonance Imaging, Cine
KW - Male
KW - Middle Aged
KW - Natriuretic Peptide, Brain
KW - Normetanephrine
KW - Peptide Fragments
KW - Prospective Studies
KW - Pulmonary Wedge Pressure
KW - Severity of Illness Index
KW - Stroke Volume
KW - Systole
KW - Takotsubo Cardiomyopathy
KW - Ventricular Dysfunction, Left
U2 - 10.1016/j.amjcard.2011.06.047
DO - 10.1016/j.amjcard.2011.06.047
M3 - Article
C2 - 21871590
VL - 108
SP - 1316
EP - 1321
JO - American Journal of Cardiology
JF - American Journal of Cardiology
SN - 0002-9149
IS - 9
ER -