Peak VO2 is More Potent Than B-Type Natriuretic Peptide as a Prognostic Parameter in Cardiac Patients

“…Twenty-three studies were based in Europe, 8 -28,46,47 5 in North America, 29 -33 1 in Australia and New Zealand, 34 and 7 in East Asia [35][36][37][38][39][40]45 (predominantly in Japan), and 4 were multinational. [41][42][43][44] Thirty-six studies were prospective cohorts and 4 "nested" case-control studies; 14 studies recruited participants from population registers (such as general practitioners' lists or electoral rolls), and 26 were hospital based (of which 10 were clinical trials).…”

Section: Resultsmentioning

confidence: 99%

B-Type Natriuretic Peptides and Cardiovascular Risk

et al. 2009

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Background-Measurement of B-type natriuretic peptide (BNP) concentration or its precursor (N-terminal fragment [NT-proBNP]) is recommended in patients with symptoms of left ventricular dysfunction and in other settings, but the relevance of these peptides to cardiovascular disease (CVD) in general populations or in patients with stable vascular disease is uncertain. Methods and Results-Data were collated from 40 long-term prospective studies involving a total of 87 474 participants and 10 625 incident CVD outcomes. In a comparison of individuals in the top third with those in the bottom third of baseline values of natriuretic peptides, the combined risk ratio (RR), adjusted for several conventional risk factors, was 2.82 (95% confidence interval [CI], 2.40 to 3.33) for CVD. Analysis of the 6 studies with at least 250 CVD outcomes (which should be less prone to selective reporting than are smaller studies) yielded an adjusted RR of 1. Key Words: cardiovascular diseases Ⅲ meta-analysis Ⅲ natriuretic peptides B -type natriuretic peptide (BNP) is a 32-amino acid polypeptide secreted by ventricular myocytes during periods of increased ventricular stretch and wall tension. This peptide is believed to play an important role in the regulation of blood pressure, blood volume, and sodium balance. On secretion, the BNP precursor is split into the biologically active peptide and the more stable N-terminal fragment (NT-proBNP). 1,2 Measurement of circulating levels of BNP or NT-proBNP has been recommended in the diagnosis and prognosis of patients with symptoms of left ventricular dysfunction 3 and for stratification of risk in patients with acute coronary syndromes. 4,5 Because in vitro studies have reported that natriuretic peptides are directly released from cardiomyocytes in response to myocardial ischemia, 6,7 it has been proposed that their circulating levels are relevant to subsequent risk of cardiovascular diseases (CVDs) other than heart failure. Clinical Perspective on p 2187Although many prospective studies have investigated concentrations of natriuretic peptides in relation to the subsequent risk of CVD (eg, coronary heart disease [CHD] or stroke), most of them have not been systematically assessed. 8 -47 Two previous relevant reviews (in total involving 11 studies 48,49 ) involved only about one sixth of the currently available data. Interpretation of the evidence has been complicated by studies that have involved different markers (ie, BNP, NT-proBNP, or both), populations with different base- We report an updated meta-analysis of findings from 40 long-term prospective studies of BNP and NT-proBNP involving a total of 87 474 individuals, including 10 625 incident CVD outcomes, in 3 distinct groups: participants from approximately general populations, people selected on the basis of elevated CVD risk factors, and patients with stable CVD at study entry. Methods Study SelectionWe sought prospective studies that had been published before July 2009 and reported on associations of circulating BNP and/or NTproBNP w...

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“…14,15 It has been well documented that recovery V • O2 is prolonged in patients with heart failure. 12, 16 Pavia et al reported that T1/2 V…”

Section: Discussionmentioning

confidence: 99%

Oxygen Uptake Kinetics During and After Exercise are Useful Markers of Coronary Artery Disease in Patients With Exercise Electrocardiography Suggesting Myocardial Ischemia

Tajima

Itoh

Osada

et al. 2009

Circ J

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xercise electrocardiogram (ECG) is widely used to diagnose and evaluate the severity of patients with coronary artery disease (CAD). However, ischemia detected from the change in the ST segment of the ECG during exercise, is said to be not highly sensitive or specific. A meta-analysis on sensitivity and specificity found 68±16% in sensitivity and 77±17% in specificity. 1 For this reason, nuclear medicine stress test 2 or stress echocardiography by exercise or dobutamine 3 are used in combination in daily clinical practice. The present study is designed to increase the sensitivity and specificity for detection of myocardial ischemia by non-invasive cardiopulmonary exercise testing (CPET) in which changes in gas exchange occur consequent to exercise-induced myocardial dyskinesis, which accompanies myocardial ischemia. Editorial p 1795Recent reports have shown the usefulness of CPET for detecting myocardial ischemia in CAD patients. [4][5][6] We 4 and others 5,6 found that oxygen uptake (V • O2) failed to continue to increase linearly with increasing work rate above the anaerobic threshold (AT) or ischemic threshold during an increasing work rate CPET in CAD patients. When the left ventricular wall becomes hypokinetic, akinetic or even dyskinetic secondary to ischemia, the decreased stroke volume prevents oxygen (O2) transport to increase at a rate sufficient to supply the muscles with the O2 needed to regenerate the high energy phosphate (adenosine triphosphate (ATP)) needed by the skeletal muscles to sustain muscle contraction, aerobically. Thus V• O2 fails to increase appropriately for the increasing work rate. Because V• O2 is a product of cardiac output times the arterial-venous O2 difference, its altered kinetics reflects altered cardiac function during exercise. V • O2 kinetics at the beginning of exercise and recovery 7 reflect abrupt early changes in cardiac output at these 2 functional states, and both are slow to change in patients with congenital heart disease 8 and heart failure. 9 We hypothesized that the work rate above which myocardial (Received May 7, 2009; revised Background:The aim of the current study was to determine if the slowed exercise oxygen uptake (V • O2) kinetics, which is developed by myocardial ischemia, would be accompanied by delayed recovery V• O2 kinetics in patients with coronary artery disease (CAD). Methods and Results: Thirty-seven patients with significant ST depression during treadmill exercise underwent cardiopulmonary exercise testing with cycle ergometer. Measurements performed are the ratios of change in increase in oxygen (O2) uptake relative to increase in work rate (∆V • O2/∆WR) across anaerobic threshold (AT) and 1 mm ST depression point (ST-dep), the time constants of V • O2 during recovery (T1/2 V • O2), stress radio-isotope scintigraphy and coronary angiography. Patients were divided into CAD positive (CAD+) and CAD negative (CAD-) groups, based on coronary angiography. In CAD+, ∆V• O2/∆WR decreased above AT and ST-dep, in contrast to CAD-patients. The T1/2 V •...

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Peak VO2 is More Potent Than B-Type Natriuretic Peptide as a Prognostic Parameter in Cardiac Patients

Abstract: These results indicate that peak VO(2) is more potent than BNP for predicting the mortality in patients with mixed cardiac disease.

Cited by 22 publications

References 31 publications

Change in Ischemia-Modified Albumin and Its Clinical Significance During Exercise Stress Testing

Change in Ischemia-Modified Albumin and Its Clinical Significance During Exercise Stress Testing

B-Type Natriuretic Peptides and Cardiovascular Risk

Oxygen Uptake Kinetics During and After Exercise are Useful Markers of Coronary Artery Disease in Patients With Exercise Electrocardiography Suggesting Myocardial Ischemia

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