REMODELING OF THE RIGHT HEART AND THE LEVEL OF BRAIN NATRIURETIC PEPTIDE IN PATIENTS WITH CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION: A COMPARATIVE CROSS-SECTIONAL OBSERVATIONAL STUDY
Aim. To study the right heart remodeling and level of N-terminal brain natriuretic peptide (Nt-proBNP) in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Material and methods. Patients (n=79) after pulmonary embolism were included into the study. The main group consisted of pati...
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| Format: | Article |
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Столичная издательская компания
2015-09-01
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| Series: | Рациональная фармакотерапия в кардиологии |
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| Online Access: | http://www.rpcardio.ru/jour/article/view/2 |
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| author | A. A. Klimenko N. A. Shostak N. A. Demidova I. V. Novikov S. M. Sorokoletov S. V. Madoyan |
| author_facet | A. A. Klimenko N. A. Shostak N. A. Demidova I. V. Novikov S. M. Sorokoletov S. V. Madoyan |
| author_sort | A. A. Klimenko |
| collection | DOAJ |
| description | Aim. To study the right heart remodeling and level of N-terminal brain natriuretic peptide (Nt-proBNP) in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Material and methods. Patients (n=79) after pulmonary embolism were included into the study. The main group consisted of patients (n=43) with an increase in systolic pulmonary artery pressure (SPAP) >30 mm Hg: 30 (37.9%) patients had pulmonary hypertension (PH) degree I, and 13 (16.5%) — PH degree II–III. Group of comparison con- sisted of 36 patients expired pulmonary embolism and having SPAP <30 mm Hg. The control group consisted of 20 people. 6-minute walk test (6-MWT) and Doppler echocardiography were performed in all patients. Besides myocardial tissue Doppler echocardiography and assessment of Nt-proBNP level were performed in 38 and 71 patients, respectively. Results. Dyspnea occurred in 90.7% of patients with various degrees of PH and 80.5% of patients with normal SPAP. Patients without PH and with PH I complained of palpitations, weakness, fatigue, and dizziness with similar frequency. Patients with PH I were comparable with ones of comparison group in 6-MWT distance that dramatically decreased in patients with PH II–III. Enlargement of the right atrium (RA) and/or right ventricular (RV) was observed in 76.7% of patients with PH I and 100% of patients with PH II–III. RV diastolic function abnormalities (E/A<1 and E/A>2) were detected in 19.4%, 16.7% and 61.5% of patients of comparison group, PH I and PH II–III patients, respectively. According to myocardial tissue Doppler echocardiography Em/Am<1 was observed in 8 (72.7%) patients of the comparison group and in 13 (76.4%) patients with PH. Nt-proB-NP level was 17.3 [2.3, 33.9] fmol/ml in PH I patients and 142.1 [62.1, 171.8] fmol/ml in PH II–III patients. Nt-proBNP level was 6.5 [3.1, 18.3] fmol/mL in patients of the comparison group, and it was higher than this in patients of the control group (3.5 [1.8, 7.5 fmol/ml]. Conclusion. Various indicators of heart remodeling and RV diastolic dysfunction were found in the majority of patients after pulmonary embolism, including those with nor- mal SPAP. Elevation of Nt-proBNP level adequately reflects the severity of RV dysfunction in CTEPH patients only in PH II–III. This marker has low diagnostic value in patients with- out CTEPH and PH I patients. |
| first_indexed | 2024-03-12T09:53:03Z |
| format | Article |
| id | doaj.art-233d9e143981474683526d40fd0435fc |
| institution | Directory Open Access Journal |
| issn | 1819-6446 2225-3653 |
| language | English |
| last_indexed | 2024-03-12T09:53:03Z |
| publishDate | 2015-09-01 |
| publisher | Столичная издательская компания |
| record_format | Article |
| series | Рациональная фармакотерапия в кардиологии |
| spelling | doaj.art-233d9e143981474683526d40fd0435fc2023-09-02T12:21:04ZengСтоличная издательская компанияРациональная фармакотерапия в кардиологии1819-64462225-36532015-09-019325826410.1234/1819-6446-2013-3-258-2642REMODELING OF THE RIGHT HEART AND THE LEVEL OF BRAIN NATRIURETIC PEPTIDE IN PATIENTS WITH CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION: A COMPARATIVE CROSS-SECTIONAL OBSERVATIONAL STUDYA. A. Klimenko0N. A. Shostak1N. A. Demidova2I. V. Novikov3S. M. Sorokoletov4S. V. Madoyan5Российский национальный исследовательский медицинский университет имени Н.И. Пирогова, МоскваРоссийский национальный исследовательский медицинский университет имени Н.И. Пирогова, МоскваРоссийский национальный исследовательский медицинский университет имени Н.И. Пирогова, МоскваРоссийский национальный исследовательский медицинский университет имени Н.И. Пирогова, МоскваРоссийский национальный исследовательский медицинский университет имени Н.И. Пирогова, Москва; Городская клиническая больница №1 имени Н.И. Пирогова, МоскваГородская клиническая больница №13, МоскваAim. To study the right heart remodeling and level of N-terminal brain natriuretic peptide (Nt-proBNP) in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Material and methods. Patients (n=79) after pulmonary embolism were included into the study. The main group consisted of patients (n=43) with an increase in systolic pulmonary artery pressure (SPAP) >30 mm Hg: 30 (37.9%) patients had pulmonary hypertension (PH) degree I, and 13 (16.5%) — PH degree II–III. Group of comparison con- sisted of 36 patients expired pulmonary embolism and having SPAP <30 mm Hg. The control group consisted of 20 people. 6-minute walk test (6-MWT) and Doppler echocardiography were performed in all patients. Besides myocardial tissue Doppler echocardiography and assessment of Nt-proBNP level were performed in 38 and 71 patients, respectively. Results. Dyspnea occurred in 90.7% of patients with various degrees of PH and 80.5% of patients with normal SPAP. Patients without PH and with PH I complained of palpitations, weakness, fatigue, and dizziness with similar frequency. Patients with PH I were comparable with ones of comparison group in 6-MWT distance that dramatically decreased in patients with PH II–III. Enlargement of the right atrium (RA) and/or right ventricular (RV) was observed in 76.7% of patients with PH I and 100% of patients with PH II–III. RV diastolic function abnormalities (E/A<1 and E/A>2) were detected in 19.4%, 16.7% and 61.5% of patients of comparison group, PH I and PH II–III patients, respectively. According to myocardial tissue Doppler echocardiography Em/Am<1 was observed in 8 (72.7%) patients of the comparison group and in 13 (76.4%) patients with PH. Nt-proB-NP level was 17.3 [2.3, 33.9] fmol/ml in PH I patients and 142.1 [62.1, 171.8] fmol/ml in PH II–III patients. Nt-proBNP level was 6.5 [3.1, 18.3] fmol/mL in patients of the comparison group, and it was higher than this in patients of the control group (3.5 [1.8, 7.5 fmol/ml]. Conclusion. Various indicators of heart remodeling and RV diastolic dysfunction were found in the majority of patients after pulmonary embolism, including those with nor- mal SPAP. Elevation of Nt-proBNP level adequately reflects the severity of RV dysfunction in CTEPH patients only in PH II–III. This marker has low diagnostic value in patients with- out CTEPH and PH I patients.http://www.rpcardio.ru/jour/article/view/2легочная гипертензияхроническая тромбоэмболическая легочная гипертензиятромбоэмболия легочной артерииправый желудочекдиастолическая дисфункциятканевая миокардиальная допплерэхокардиографияN-концевой мозговой натрийуретический пептид |
| spellingShingle | A. A. Klimenko N. A. Shostak N. A. Demidova I. V. Novikov S. M. Sorokoletov S. V. Madoyan REMODELING OF THE RIGHT HEART AND THE LEVEL OF BRAIN NATRIURETIC PEPTIDE IN PATIENTS WITH CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION: A COMPARATIVE CROSS-SECTIONAL OBSERVATIONAL STUDY Рациональная фармакотерапия в кардиологии легочная гипертензия хроническая тромбоэмболическая легочная гипертензия тромбоэмболия легочной артерии правый желудочек диастолическая дисфункция тканевая миокардиальная допплерэхокардиография N-концевой мозговой натрийуретический пептид |
| title | REMODELING OF THE RIGHT HEART AND THE LEVEL OF BRAIN NATRIURETIC PEPTIDE IN PATIENTS WITH CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION: A COMPARATIVE CROSS-SECTIONAL OBSERVATIONAL STUDY |
| title_full | REMODELING OF THE RIGHT HEART AND THE LEVEL OF BRAIN NATRIURETIC PEPTIDE IN PATIENTS WITH CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION: A COMPARATIVE CROSS-SECTIONAL OBSERVATIONAL STUDY |
| title_fullStr | REMODELING OF THE RIGHT HEART AND THE LEVEL OF BRAIN NATRIURETIC PEPTIDE IN PATIENTS WITH CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION: A COMPARATIVE CROSS-SECTIONAL OBSERVATIONAL STUDY |
| title_full_unstemmed | REMODELING OF THE RIGHT HEART AND THE LEVEL OF BRAIN NATRIURETIC PEPTIDE IN PATIENTS WITH CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION: A COMPARATIVE CROSS-SECTIONAL OBSERVATIONAL STUDY |
| title_short | REMODELING OF THE RIGHT HEART AND THE LEVEL OF BRAIN NATRIURETIC PEPTIDE IN PATIENTS WITH CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION: A COMPARATIVE CROSS-SECTIONAL OBSERVATIONAL STUDY |
| title_sort | remodeling of the right heart and the level of brain natriuretic peptide in patients with chronic thromboembolic pulmonary hypertension a comparative cross sectional observational study |
| topic | легочная гипертензия хроническая тромбоэмболическая легочная гипертензия тромбоэмболия легочной артерии правый желудочек диастолическая дисфункция тканевая миокардиальная допплерэхокардиография N-концевой мозговой натрийуретический пептид |
| url | http://www.rpcardio.ru/jour/article/view/2 |
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