INTRODUÇÃO: Avaliação da função diastólica de pacientes portadores de estenose ou insuficiência aórtica submetidos à troca valvar. OBJETIVOS: Avaliação da função diastólica através da análise do NTpró-BNP como método não invasivo para caracterização da insuficiência cardíaca diastólica, comparando com os dados ecocardiográficos através do Doppler Pulsado em Fluxo Mitral, Doppler Pulsado em Veias Pulmonares e Doppler Tecidual em portadores de IAO e EAO. MÉTODOS: Foram avaliados 63 pacientes, 32 pacientes com IAO (25 pacientes do sexo masculino e 7 do sexo feminino), 31 pacientes com EAO (11 pacientes do sexo masculino e 20 pacientes do sexo feminino). As variáveis foram comparadas na média entre os pacientes portador de IAO e EAO no pré e pós-operatório. RESULTADOS: A idade dos pacientes variou de 21 a 81 com média de 55 anos. Observa-se diferença quanto à média de idades entre as diferentes patologias (t-Student p< 0,0001). Os pacientes com IAO apresentam uma média de idade igual a 45,7±14,3 com variação entre 21 e 79 anos e os pacientes com EAO apresentam uma média de idade igual a 61,5±14,7 com variação entre 21 e 81 anos. Na IAO em relação à disfunção diastólica tivemos os seguintes dados com significância estatística do pré para o pós-operatório (6 meses): TRIV (p=0,0011), diferença entre Tempo de onda A mitral e onda A pulmonar (p=0,0097), Vol. Sistólico de AE (p=0,0019), Vol Sistólico de AE Indexado (0,0011), Vol. Diastólico de AE (p=0,0110), DDVE (p<0,0001), DSVE (p<0,0001), VSF (p<0,0001), VDF (p<0,0001), Massa Indexada de VE (p<0,0001) e Relação Volume/Massa do VE (p<0,0001). Na EAO em relação à disfunção diastólica tivemos os seguintes dados com significância estatística do pré para o pós-operatório (6 meses): E/E (p=0,0379), TRIV (p=0,0072), diferença entre o tempo de onda A mitral e tempo de onda A pulmonar (p=0,0176), Vol sistólico de AE(p=0,0242), Vol. Sistólico de AE indexado (p=0,0237), FEdeAE (p=0,0339), DDVE (p=0,0002), DSVE (p=0,0085), VDF (p=0,0194), Massa Indexada de VE (p<0,0001) e Relação Volume/Massa de VE(p<0,0001). O NTpró-BNP se correlacionou positivamente com os diversos graus de disfunção diastólica tanto no pré como pós-operatório CONCLUSÃO: Foram verificados no estudo da função diastólica variação com significância estatística tanto na IAO como na EAO na comparação do pré e o pós-operatório. Da mesma forma notamos variação do NT-proBNP com correlação com as variáveis ecocardiográficas que caracterizam a disfunção diastólica. / INTRODUCTION: Assessment of diastolic function in patients with aortic stenosis or aortic regurgitation waiting for aortic valve replacement. OBJECTIVE: Assesment of diastolic function with Doppler methods:Doppler signals from transvalvar mitral inflow, tissue Doppler imaging (TDI) and Doppler in pulmonary veins(DPV) correlating with serum brain peptide natriuretic (NTproNP) before and 6 months after aortic valve replacement (AVR). METHODS: We have analyzed 63 patients, 32 with AR (25 males and 7 females), 31 AS (11 males and 20 females).The indices were compared with AS and AR before and after AVR. RESULTS: The ages of patients ranged from 21 to 81 mean age was 55 years old.We have seen difference between mean age of AS and AR (t-Student-p<0.0001). Patients with AR have had mean age 45.67 plus/minus 14.28, range 21 to 79 years old and patients with AS have had mean age 61.50 plus/minus 14.72, range 21 to 81 years old. The patients who had AR the indices showed differences: Isovolumetric Relaxation Time IRT(p=0.0011), Diference between the pulmonary A wave duration and mitral A duration (p=0.0097), Left Atrial Systolic Volume (p=0.0019), Left Atrial Systolic Volume Index(p=0.0011), Left Atrial Diastolic Volume (p=0.0110), Left Ventricular Diastolic Diameter (p<0.0001), Left Ventricular Systolic Diameter (p<0.0001), End Systolic Volume (p<0.0001), End Diastolic Volume (p<0.0001), Left Ventricular Mass Index (p<0.0001) and Left Ventricular Volume and Left Ventricular Mass Index ratio (p<0.0001). Analyzing patients with AS the indices who showed differences: (The ratio of mitral velocity to early diastolic velocity of the mitral annulus) E/E (p=0.0379)(Isovolumetric Relaxation Time)(p=0.0072) IRT, Diference between the pulmonary A wave duration and mitral A duration (p=0.0176), Left Atrial Sistolic Volume (p=0.0242), Left Atrial Systolic Volume Index (p=0.0237), Left Atrial Ejection Fraction (p=0.0339) Left Ventricular Diastolic Diameter (p=0.0002), Left Ventricular Systolic Diameter (p=0.0085), End Diastolic Volume (LVEDV) (p=0.0194), Left ventricular Mass Index(p<0.0001), Left Ventricular Volume and Mass Index Ratio (p<0.0001). CONCLUSIONS: As we studied diastolic function we have verified significant statistic variation in aortic regurgitation and aortic stenosis comparing before and after aortic valve replacement. Likewise we have seen there is correlation between NTproBNP and echocardiographic variables that show diastolic dysfunction.

Background: N-terminal pro-brain natriuretic peptide (NT-proBNP) is secreted by cardiac ventricular myocytes upon pressure and volume overload and is a prognostic marker to monitor the severity of precapillary pulmonary hypertension and the extent of right heart failure. Objectives: The impact of physical exercise on NT-proBNP levels in patients with left heart disease was demonstrated previously. No data regarding patients with isolated right heart failure and the influence of acute exercise on NT-proBNP serum levels exist. Methods: Twenty patients with precapillary pulmonary hypertension were examined. Hemodynamic parameters were measured during right heart catheterization. Serum NT-proBNP of patients was measured at rest, after a 6-min walking test, during ergospirometry and during recovery, all within 7 h. Significant differences in sequential NT-proBNP values, relative changes compared to values at rest and the correlation between NT-proBNP and obtained parameters were assessed. Results: At rest, the mean serum level of NT-proBNP was 1,278 ± 998 pg/ml. The mean level of NT-proBNP at maximal exercise was increased (1,592 ± 1,219 pg/ml), whereas serum levels decreased slightly during recovery (1,518 ± 1,170 pg/ml). The relative increase of serum NT-proBNP during exercise correlated with pulmonary vascular resistance (r = 0.45; p = 0.026) and cardiac output (r = –0.5; p = 0.015). Conclusions: In this study, we demonstrated acute changes in NT-proBNP levels due to physical exercise in a small group of patients with precapillary pulmonary hypertension. Our results also confirm the predominant usefulness of NT-proBNP as an intraindividual parameter of right heart load. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Obesity has grown to epidemic proportions, and in lack of efficient life-style and medical treatments, the bariatric surgeries are performed in rising numbers. The most common surgery is the Gastric Bypass (GBP) surgery, with the Biliopancreatic diversion with duodenal switch (DS) as an option for the most extreme cases with a BMI&gt;50 kg/m2. In paper I 20 GBP-patients were examined during the first post-operative year regarding the natriuretic peptide, NT-ProBNP, which is secreted from the cardiac ventricles. Levels of NT-ProBNP quickly increased during the first post-surgery week, and later established itself on a higher level than pre-surgery. In paper II we report of 5 patient-cases after GBP-surgery with severe problems with postprandial hypoglycaemia that were successfully treated with GLP-1-analogs. The effect of treatment could be observed both symptomatically and in some cases using continuous glucose measuring systems (CGMS). In paper III three groups of subjects; 15 post-GBP patients, 15 post-DS, and 15 obese controls were examined for three days using CGMS during everyday life. The post-GBP group had high glucose variability as measured by MAGE and CONGA, whereas the post-DS group had low variability. Both post-operative groups exhibited significant time in hypoglycaemia, about 40 and 80 minutes per day &lt;3.3mmol/l and 20 and 40 minutes &lt; 2.8mmol/l, respectively, longer time for DS-group. Remarkably, only about 20% of these hypoglycaemic episodes were accompanied with symptoms. In Paper IV the hypoglycaemia counter regulatory system was investigated; 12 patients were examined before and after GBP-surgery with a stepped hypoglycaemic hyperinsulinemic clamp. The results show a downregulation of symptoms, counter regulatory hormones (glucagon, cortisol, epinephrine, norepinephrine, growth hormone), incretin hormones (GLP-1 and GIP), and sympathetic nervous response. In conclusion patients post bariatric surgery exhibit a downregulated counter regulatory response to hypoglycaemia, accompanied by frequent asymptomatic hypoglycaemic episodes in everyday life. Patients suffering from severe hypoglycaemic episodes can often be treated successfully with GLP-1-analogues.

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Background Coronavirus Disease-2019 (COVID-19) affected elderly individuals disproportionately in terms of hospitalization and adverse outcome. Objective This cross-sectional study examined the associations of COVID-19 diagnosis (COVID-negative versus COVID-positive) with levels of four clinical markers – cardiac troponin T (cTnT), high-sensitive C-reactive protein (hsCRP), D-dimer and b-type natriuretic peptide (NT-proBNP) – along with potential differences in associations by sex in a hospital-based sample of elderly individuals. Methods The sample comprised individuals aged ≥80 years visiting the Emergency at Karolinska universitetssjukhuset (Huddinge) between January 2020 and December 2021 for whom data on polymerase chain reaction-based COVID-19 testing were available (n=2668). Plasma levels of the markers were measured using standard methods. Right skewed outcome variables were natural-log (Ln) transformed. Multivariable linear regression models were fitted. Results Participants’ median age was 87 years (interquartile range: 85–90) and 58.4% were female. Approximately 13% of the participants were COVID-19 positive. There was no statistically significant association between COVID-positive diagnosis and any of the markers after controlling for age and sex. On sex stratification, COVID-19 positive males had 55.3% (95% confidence interval (CI): 1.1%–138.4%; P=0.044) higher hsCRP levels than COVID-negative males. Additionally, age was positively associated with cTnT (Ln cTnT βadjusted: 0.041; 95% CI: 0.033–0.050; P&lt;0.001) and NT-proBNP (Ln NTproBNP βadjusted: 0.059; 95% CI: 0.015–0.102; P=0.008). Conclusion COVID-positive diagnosis was not related with the markers apart from a sex-specific, positive association with hsCRP observed among males. Future studies should explore the relationship of these markers with mortality to determine their prognostic utility among elderly individuals.

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Des immunoadsorbeurs ont été développés à partir de disques CIM monolithiques pour l'analyse de biomarqueurs impliqués dans des maladies cardio-vasculaires. Les colonnes développées ont permis d'isoler sélectivement la myoglobine et le NT-proBNP du sérum humain. Les colonnes anti-NT-proBNP ont permis l'isolation quantitative du NT-proBNP (R2=0,998) à des concentrations jusqu'à 750 amol/μL de sérum.<br />Six matériaux à accès restreints ont été évalués en fonction de leur aptitude à exclure l'hémoglobine d'hémolysats sanguins. Des injections à différents pH ont montré que la rétention de l'hémoglobine est drastiquement restreinte à pH 10,7. En raison d'une bonne stabilité à pH basique, la colonne polymérique Biotrap 500 MS RAM a été retenue pour l'extraction d'antibiotiques d'hémolysats sanguins. Des extractions quantitatives d'analytes à faibles concentrations (200 pg/μL) ont été réalisées sans effet mémoire d'hémoglobine sur la colonne.<br />Un nouveau système 2D-HPLC-ESI-MS/MS pour l'analyse protéomique a été développé. Le système est composé d'une séparation par RP-HPLC à pH 10,0, suivie d'une séparation par IP-RP-HPLC à pH 2,1. Ce nouveau système a été comparé à un système conventionnel SCX x IP-RP-HPLC. L'orthogonalité des méthodes de séparation est plus élevée dans l'approche SCX x IP-RP-HPLC que dans le schéma RP x IP-RP-HPLC. Cependant, en raison d'une meilleure distribution des peptides et d'une meilleure efficacité de séparation, le système RP x IP-RP-HPLC permet d'identifier significativement plus de peptides. Les deux approches sont complémentaires et une combinaison des deux systèmes permet d'identifier plus de peptides que des analyses répétées par un système unique.