A biphasic pattern of plasma N-terminal pro-brain natriuretic peptide is seen after anterior myocardial infarction. Plasma level is strongly correlated to wall motion index soon after and remote from acute myocardial infarction. Plasma N-terminal pro-brain natriuretic peptide measured later in hospitalization better predicts poor outcome following myocardial infarction than when it is measured in the immediate post infarction period.

Objective-To compare circulating concentrations of N terminal pro-brain natriuretic peptide (N-BNP) and cardiotrophin 1 in stable and unstable angina. Design and setting-Observational study in a teaching hospital. Patients-15 patients with unstable angina, 10 patients with stable angina, and 15 controls. Main outcome measures-Resting plasma N-BNP and cardiotrophin 1 concentrations. Results-N-BNP concentration (median (range)) was 714 fmol/ml (177-3217 fmol/ml) in unstable angina, 169.5 fmol/ml (105.7-399.5 fmol/ml) in stable angina (p = 0.005 v unstable angina), and 150.5 fmol/ml (104.7-236.9 fmol/ml) in controls (p < 0.0001 v unstable angina; NS v stable angina). Cardiotrophin 1 concentration was 142.5 fmol/ml (42.2-527.4 fmol/ml) in unstable angina, 73.2 fmol/ml (41.5-102

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Background: Echocardiography with Doppler examination of the aortic valve provides a very accurate assessment of the Ž . Ž . transvalvular gradient and is used to monitor progression of aortic stenosis AS . Plasma brain natriuretic peptide BNP has been shown to correlate with end-systolic wall stress in patients with AS. Aim: We hypothesized that plasma N-terminal Ž . Ž . proBNP NT proBNP and a newly identified cytokine cardiotrophin-1 CT-1 , which has been shown to stimulate BNP production at a transcriptional level are elevated in patients with AS and correlate to the maximum trans-valvular aortic Ž . w pressure gradient TVPG . Method: We compared plasma NT proBNP and CT-1 in 15 AS patients five males, mean age 79 w x Ž . x Ž w x. years range 60᎐94 , mean TPVG 39.3 mmHg 20᎐100 with 10 controls five male, mean age 68 years 56᎐79 . Results are w x expressed as mean ranges and comparisons were by the Mann᎐Whitney test. Results: NT proBNP levels were elevated in AS w Ž . x Ž w x . patients 252.9 fmolrml 79.2᎐541.8 when compared with the controls 157.2 fmolrml 104.7᎐236.9 , P-0.005 . Also CT-1 Ž w x w Ž . levels were elevated in AS patients 57.3 fmolrml 33᎐86.3 when compared with the controls 28.3 fmolrml 6.9᎐48.3 , x Ž P-0.0005 . Both NT proBNP and CT-1 levels were correlated to the TVPG r s 0.53 and r s 0.65, P-0.05 and Ps 0.009, . Ž 2 . respectively . On best subset analysis the strongest correlate with TVPG was CT-1 R s 38% . The addition of NT proBNP Ž 2 . did not improve diagnostic accuracy R s 39% . Conclusion: These results suggest NT proBNP and CT-1 levels increase in proportion to the TVPG and could potentially be used to monitor progression of disease non-invasively. These markers may also be useful to identify the optimum time for surgery in AS. ᮊ

Cardiotrophin-1 (CT-1) is a cytokine that has been implicated as a factor involved in myocardial remodelling. The objective of the present study was to establish the relationship between circulating levels of CT-1 and measures of left ventricular size and systolic function in patients with heart failure. We recruited 15 normal subjects [six male; median age 60 years (range 30-79 years)] and 15 patients [11 male; median age 66 years (range 43-84 years)] with a clinical diagnosis of heart failure and echocardiographic left ventricular systolic dysfunction (LVSD). Echocardiographic variables (left ventricular wall motion index, end-diastolic and -systolic volumes, stroke volume, fractional shortening) and plasma CT-1 levels were determined. In patients with LVSD [median wall motion index 0.6 (range 0.3-1.4)], CT-1 was elevated [median 110.4 fmol/ml (range 33-516 fmol/ml)] compared with controls [wall motion index 2 in all cases; median CT-1 level 34.2 fmol/ml (range 6.9-54.1 fmol/ml); P<0.0001]. Log CT-1 was correlated with log wall motion index (r=-0.76, P<0.0001), log left ventricular end-systolic volume (r=0.54, P<0.05), stroke volume (r=-0.60, P=0.007) and log fractional shortening (r=-0.70, P=0.001). In a multivariate model of the predictors of log wall motion index, the only significant predictor was log CT-1 (R(2)=56%, P=0.006). This is the first assessment of the relationship between plasma CT-1 levels and the degree of LVSD in humans, and demonstrates that CT-1 is elevated in heart failure in relation to the severity of LVSD.