• Journal of Chest Surgery
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• 제40권9호
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• pp.593-599
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• 2007

배경: 폐절제술이 우심실 기능에 미치는 영향과 BNP (brain natriuretic peptide)의 관계에 대해서는 아직 자세히 알려져 있지 않다. 본 연구에서는 폐절제술 후 변화하는 혈역학적 수치와 우심부전의 보상기전으로서 증가하는 BNP의 관계에 대해서 알아보고 BNP가 폐절제술 후의 우심부전의 지표가 될 수 있는지를 확인하고자 하였다. 대상 및 방법: 폐암으로 폐엽절제술과 전폐절제술을 시행한 12명의 환자에서 면역화학적 방법(Elecsys $1010^{(R)}$, Roche, Germany)을 이용하여 수술 전후의 NT-proBNP 수준을 측정하고, Swan-Ganz 카테터로 수술 전후에 혈역학적 지표를 측정하여 비교하였으며 수술 전후에 심초음파를 시행하여 우심실 및 좌심실압 등의 변화를 비교하였다. 통계처리는 SPSSWIN(version 11.5)를 이용한 Wilcoxon rank sum test와 linear regression을 이용하였다. 결과: NT-proBNP 수준은 수술 전과 비교하여 수술 후 6시간, 수술 후 1일과 2일, 3일, 7일째에 유의하게 증가하였다(p=0.003, 0.002, 0.002, 0.006, 0.004). Swan-Ganz 카테터를 통한 혈역학적 변수 중에서는 평균 폐동맥압이 수술 전과 비교하여 수술 직후와 수술 후 6시간, 수술 후 1일, 2일, 3일째에 유의하게 증가하였으며(p=0.002, 0.002, 0.006, 0.007, 0.008), 평균 우심실압력은 수술 직후와 수술 후 6시간, 수술 후 1일과 3일에서 유의하게 증가하였다(p=0.006, 0.009, 0.044, 0.032). 폐혈관저항지수[폐혈관저항지수=(평균폐동맥압-평균폐동맥쐐기압)/심박출계수]는 수술 후 6시간, 수술 후 2일에서 유의한 증가가 있었다(p=0.008, 0.028). 평균폐동맥압의 수술 후 변화와 NT-proBNP 변화를 회기분석하였을 때 수술 후 6시간에서 유의성이 있었으며(r=0.602, p=0.038) 이후에는 유의성이 없었다. 심초음파 결과는 수술 전후를 비교하여 유의성이 없었다. 결론: 폐절제술 후 6시간의 폐동맥압의 변화와 NT-proBNP의 변화가 유의성이 있었다. 따라서 폐절제술 후 NT-proBNP의 변화는 폐절제술 후 우심실의 조기 혈역학적 변화를 반영하는 척도가 될 수 있으리라 판단된다.

• Journal of Yeungnam Medical Science
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• 제38권4호
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• pp.337-343
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• 2021

Background: Chromogranin A (CgA) levels have been reported to predict mortality in patients with heart failure. However, information on the prognostic value and clinical availability of CgA is limited. We compared the prognostic value of CgA to that of previously proven natriuretic peptide biomarkers in patients with acute heart failure. Methods: We retrospectively evaluated 272 patients (mean age, 68.5±15.6 years; 62.9% male) who underwent CgA test in the acute stage of heart failure hospitalization between June 2017 and June 2018. The median follow-up period was 348 days. Prognosis was assessed using the composite events of 1-year death and heart failure hospitalization. Results: In-hospital mortality rate during index admission was 7.0% (n=19). During the 1-year follow-up, a composite event rate was observed in 12.1% (n=33) of the patients. The areas under the receiver-operating characteristic curves for predicting 1-year adverse events were 0.737 and 0.697 for N-terminal pro-B-type natriuretic peptide (NT-proBNP) and CgA, respectively. During follow-up, patients with high CgA levels (>158 pmol/L) had worse outcomes than those with low CgA levels (≤158 pmol/L) (85.2% vs. 58.6%, p<0.001). When stratifying the patients into four subgroups based on CgA and NT-proBNP levels, patients with high NT-proBNP and high CgA had the worst outcome. CgA had an incremental prognostic value when added to the combination of NT-proBNP and clinically relevant risk factors. Conclusion: The prognostic power of CgA was comparable to that of NT-proBNP in patients with acute heart failure. The combination of CgA and NT-proBNP can improve prognosis prediction in these patients.

• Clinical and Experimental Pediatrics
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• 제57권8호
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• pp.357-362
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• 2014

Purpose: The incidence of Kawasaki disease (KD) is rare in young infants (less than 3 months of age), who present with only a few symptoms that fulfill the clinical diagnostic criteria. The diagnosis for KD can therefore be delayed, leading to a high risk of cardiac complications. We examined the clinical characteristics and measured the serum levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) levels of these patients for assessing its value in the early detection of KD. Methods: We retrospectively reviewed the data of young infants diagnosed with KD from 2004 to 2012. The control group included 20 hospitalized febrile patients. Laboratory data, including NT-proBNP were obtained for each patient in both groups. Results: Incomplete KD was observed in 21/24 patients (87.5%). The mean fever duration on admission was $1.36{\pm}1.0$ days in the KD group. Common symptoms included erythema at the site of Bacille Calmette-Guerin inoculation (70.8%), skin rash (50.0%), changes of oropharyngeal mucosa (29.1%), and cervical lymphadenopathy (20.8%). The mean number of major diagnostic criteria fulfilled was $2.8{\pm}1.4$. Five KD patients (20.8%) had only one symptom matching these criteria. The incidence of coronary artery complications was 12.5%. The mean serum NT-proBNP level in the acute phase, in the KD and control groups, were $4,159{\pm}3,714pg/mL$ and $957{\pm}902pg/mL$, respectively, which decreased significantly in the convalescent phase. Conclusion: Incomplete KD was observed in 87.5% patients. Serum NT- proBNP might be a valuable biomarker for the early detection of KD in febrile infants aged <3 months.

• 대한수의학회지
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• 제56권4호
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• pp.223-227
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• 2016

This study evaluated the levels of cardiac biomarkers in dogs with either pulmonic stenosis or aortic stenosis and the correlation between biomarkers and the severity of stenosis assessed by the echocardiography. To achieve this study goal, 38 dogs (10 healthy control dogs, 15 dogs with pulmonic stenosis and 13 dogs with aortic stenosis) were examined. The jet velocity and pressure gradient in this study population were measured by echocardiographic estimation, after which the study group was subdivided by the severity of stenosis. The plasma cardiac troponin I (cTnI) and N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured in this study group. The median concentrations of cTnI and NT-proBNP of the disease group were significantly higher than those of the control group, and these increased gradually as stenosis worsened. The severity of stenosis and the concentrations of cTnI and NT-porBNP were also found to be significantly correlated. Finally, the plasma cTnI and NT-proBNP tests were found to beneficial for differentiating clinical patients, predicting the progression of disease, and monitoring the outcome of interventional therapy for stenosis.

• Clinical and Experimental Pediatrics
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• 제61권5호
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• pp.167-173
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• 2018

Purpose: Hemophagocytic lymphohistiocytosis (HLH) is a hyperinflammatory syndrome with many causes, including Kawasaki disease (KD). The purpose of this study was to identify the laboratory tests needed to easily differentiate KD with HLH from incomplete KD alone. Methods: We performed a retrospective study on patients diagnosed with incomplete KD and incomplete KD with HLH (HLH-KD) between January 2012 and March 2015. We compared 8 secondary HLH patients who were first diagnosed with incomplete KD with all 247 incomplete KD diagnosed patients during the study period. The complete blood count, erythrocyte sedimentation rate, platelet count, and serum total protein, albumin, triglyceride, C-reactive protein, N-terminal pro-brain natriuretic peptide (NT-proBNP), and ferritin levels were compared. Clinical characteristics and echocardiography findings were also compared between the 2 groups. Results: The total duration of fever was longer in the HLH-KD group than in the KD group. White blood cell and platelet counts were higher in the KD group. Alanine aminotransferase, ferritin, and coronary artery diameter were increased in the HLH-KD group compared with those in the KD group. The median of NT-proBNP was significantly higher in the HLH-KD group than in the KD group at 889.0 (interquartile range [IQR], 384.5-1792.0) pg/mL vs. 233.0 (IQR, 107.0-544.0) pg/mL. Conclusion: The NT-proBNP level may be helpful in distinguishing incomplete KD from KD with HLH. The NT-proBNP level should be determined in KD patients with prolonged fever, in addition to the white blood cell count, platelet count, and ferritin level, to evaluate secondary HLH.

• Asian Pacific Journal of Cancer Prevention
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• 제17권4호
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• pp.2301-2305
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• 2016

Background: The early detection of anthracycline- induced cardiotoxicity is very important since it might be useful in prevention of cardiac decompensation. This study was designed with the intent of assessing the usefulness of cardiac troponin T (cTnT) and NT- Pro BNP estimation in early prediction of anthracycline induced cardiotoxicity. Materials and Methods: In this prospective study histologically proven breast cancer patients who were scheduled to receive anthracycline containing combination chemotherapy as a part of multimodality treatment were enrolled. Baseline cardiac evaluation was performed by echocardiography (ECHO) and biomarkers like cardiac troponin T (cTnT) and N terminal- pro brain natriuretic peptide (NT- Pro BNP). All patients underwent cTnT and NT- Pro BNP estimation within 24 hours of each cycle of chemotherapy and were followed up after 6 months of initiation of chemotherapy. Any changes in follow up ECHO were compared to ECHO at baseline and cTnT and NT- Pro BNP levels after each cycle of anthracycline-based chemotherapy. Results: Initial data were obtained for 33 patients. Mean change in left ventricular diastolic diameter (LVDD) within 6 months was $0.154{\pm}0.433cms$ (p value=0.049). Seven out of 33 patients had an increase in biomarker cTnT levels (p value=0.5). A significant change in baseline and follow up LVDD was observed in patients with raised cTnT levels (p value=0.026) whereas no change was seen in ejection fraction (EF) and left atrial diameters (LAD) within 6 months of chemotherapy. NT- Pro BNP levels increased in significant number of patients (p value ${\leq}0.0001$) but no statistically significant change was observed in the ECHO parameters within 6 months. Conclusions: Functional monitoring is a poorly effective method in early estimation of anthracycline induced cardiac dysfunction. Estimation of biomarkers after chemotherapy may allow stratification of patients in various risk groups, thereby opening window for interventional strategies in order to prevent permanent damage to the myocardium.

• 대한임상검사과학회지
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• 제54권4호
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• pp.256-264
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• 2022

허혈성 뇌졸중은 뇌동맥의 혈전이나 색전에 의해 폐색되어 산소가 포함된 혈액이 뇌에 도달하는 것을 방지하고, 신경 세포의 괴사를 유발하는 것이다. 본 연구의 목적은 지금까지 연구된 허혈성 뇌졸중의 조기 진단을 가능하게 하는 심혈관 질환 및 심방세동 질환과 관련된 혈청 후보 마커를 정리하고, 각 마커의 OR을 비교 분석하는 것이다. 본 연구에서는 메타분석 기법을 이용하여 혈청 후보 마커의 효과 크기를 분석하고자 하였다. '심혈관질환', '심방세동', '허혈성 뇌졸중', '혈청 표지자'를 키워드로 포함하는 논문에 대한 학술 Database 검색에서 추출된 데이터는 모두 허혈성 뇌졸중 환자에 대한 결과로 제한하였다. 이 연구에서 가장 많이 검색된 마커는 NT-proBNP, D-dimer, CRP 및 GFAP 등으로 나타났다. 결론적으로, NT-proBNP는 허혈성 뇌졸중의 조기 진단에 매우 유용한 것으로 보이며, 특히 심방세동(AF)의 표지자로 알려져 있으며, 앞으로 더 많은 심방세동 표지자가 발굴되어 연구되어야 할 것이다.

• Clinical and Experimental Pediatrics
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• 제57권11호
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• pp.484-488
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• 2014

Purpose: Chronic upper airway obstruction causes hypoxemic pulmonary vasoconstriction, which may lead to right ventricle (RV) dysfunction. Adenotonsillar hypertrophy (ATH) is the most common cause of upper airway obstruction in children. Therefore, we aimed to evaluate RV function in children with ATH. Methods: Twenty-one children (male/female, 15/6; mean age, $92.3{\pm}39.0$ months; age range, 4-15 years) with ATH and 21 healthy age- and gender-matched controls were included in this study. Tricuspid annular plane systolic excursion and RV myocardial performance index were measured by transthoracic echocardiography. Further, the plasma level of N-terminal of probrain natriuretic peptide (NT-proBNP), an indicator of RV function, was determined. Results: The snoring-tiredness during daytime-observed apnea-high blood pressure (STOP) questionnaire was completed by the patients' parents, and loud snoring was noted in the ATH group. The plasma NT-proBNP level was significantly higher in the ATH group than that in the controls ($66.44{\pm}37.63pg/mL$ vs. $27.85{\pm}8.89pg/mL$, P=0.001). The echocardiographic parameters were not significantly different between the groups. Conclusion: We were unable to confirm the significance of echocardiographic evidence of RV dysfunction in the management of children with ATH. However, the plasma NT-proBNP level was significantly higher in the ATH group than that in the control, suggesting that chronic airway obstruction in children may carry a risk for cardiac dysfunction. Therefore, more patients should be examined using transthoracic echocardiography. In addition, pediatricians and otolaryngologists should consider cardiologic aspects during the management of children with severe ATH.

• 한국동물위생학회지
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• 제40권4호
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• pp.287-292
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• 2017

A five-year-old, male, Great Dane weighing 107 kg was presented with anorexia, abdominal distension, and dyspnea for 5 days. Physical examination, blood works, radiography, electrocardiography (ECG), and echocardiography were performed. Based on severely low fractional shortening (FS) and marked four chamber enlargement in echocardiography, continuous atrial fibrillation and occasional ventricular premature complex (VPC) on ECG, the dog was diagnosed as dilated cardiomyopathy (DCM) concurrent with congestive heart failure. Pleural effusion and ascites were modified transudate. In accordance with DCM scoring system recommended by European Society of Veterinary Cardiology (ESVC), DCM score was 13/15 in this case. Concentrations of cTnI and NT-pro-BNP were 1.0 ng/mL and 693 pmol/L, respectively. Since the former and the latter were remarkably high values, it was certain that the patient had grave prognosis. Intensive care was performed for the dog and the clinical signs as well as the radiographic abnormalities were resolved. However, when he presented serious dyspnea again at 25 days post therapy, the dog was dead. In case of canine DCM, the scoring system for the diagnosis and cardiac biomarkers including NT-pro-BNP and cTnI could be useful to advise owners on the status and prognosis of their dog with DCM.

• Journal of Yeungnam Medical Science
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• 제41권2호
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• pp.128-133
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• 2024

Aortic dissection in pregnant patients results in an inpatient mortality rate of 8.6%. Owing to the pronounced mortality rate and speed at which aortic dissections progress, efficient early detection methods are crucial. Here, we highlight the importance of early chest computed tomography (CT) for differentiating aortic dissection from pulmonary embolism in pregnant patients with dyspnea. We present the unique case of a 38-year-old pregnant woman with elevated D-dimer and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, initially suspected of having a pulmonary embolism. Initial transthoracic echocardiography did not indicate aortic dissection. Surprisingly, after an emergency cesarean section, a chest CT scan revealed a DeBakey type I aortic dissection, indicating a diagnostic error. Our findings emphasize the need for early chest CT in pregnant patients with dyspnea and elevated D-dimer and NT-proBNP levels. This case report highlights the critical importance of considering both aortic dissection and pulmonary embolism in the differential diagnosis of such cases, which will inform future clinical practice.