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Abstract

B. Gremmler¹, K. Kisters², M. Kunert¹, H. Schleiting¹

¹Department of Cardiology, Marienhospital Bottrop, Germany,²Internal Medicine, St. Anna-Hospital, Herne, and University of Münster, Germany, and ³University of Witten/Herdecke, Germany
Background: The determination of NT-proBNP- values is increasingly used to distinguish dyspnoea induced by heart failure from pulmonary associated dyspnoea. Furthermore, the course of heart failure is studied with this parameter, especially the effectiveness of heart failure treatment. Similar observations with NT-proBNP-values were increasingly seen in heart failure due to hypertensive origin, in this context especially as a follow up of antihypertensive drug-therapy. In contrast to this biochemical determined parameter the pulse pressure-value exists as a hemodynamic control in treatment of hypertension. Therefore we performed a research on a connection between NT-proBNP-values and pulse pressure-values to prove a possible correlation. Methods: NT-proBNP-levels were analyzed before left-heart catheterization in 100 patients (unselected population; m = 73, w = 27; 61.2 ± 9.7 years). The determination of NT- proBNP in plasma was performed using the electrochemiluminescence technology in the fully automatic Elecsyc®analyser (Roche-Diagnostics) and the Elecsys®proBNP immunoassay (Roche-Diagnostics, Mannheim, Germany). The pulse pressure-value was invasively measured in the aortic arch before application of contrast-medium. The NT-proBNP values were compared to the invasively measured pulse pressure-values accordingly. Results: The NT-proBNP values in correlation to the pulse pressue-values are pointed out in the scatter-diagram. There was no significant correlation between both parameters (coefficent = 0.014). Conclusion: A safe and reliable correlation between NT-proBNP-values and pulse pressue was not found. On the other hand a great variation of NT-proBNP -levels was observed concerning the corresponding pulse pressure values. An augmented NT-proBNP level without correspondance to the pulse pressure value may perhaps be a prognostic marker of an initial heart failure-syndrome induced by hypertension.Correspondence to:
Dr. B. Gremmler,
PD Dr. L. Ulbricht
Marienhospital Bottrop
Department of Cardiology
Josef-Albers-Straße 70
46236 Bottrop, Germany
Email: [email protected]

Abstract

B. Gremmler, K. Kisters, C. Funke, H. Schleiting, M. Kunert and L.J. Ulbricht

Abstract

M. Kunert¹, B. Gremmler¹, H. Schleiting¹, R. Susilo², U.P. Strauss² and L.J. Ulbricht¹,³

¹Marienhospital Bottrop, Department of Cardiology, Bottrop, ²Trommsdorff Arzneimittel GmbH, Research & Development, Alsdorf, and ³University of Witten/Herdecke, Germany
Reperfusion arrhythmias represent a risk factor for death of post infarct patients receiving revascularization therapy, such as percutaneous transluminal angioplasty (PTCA). A relative deficiency of potassium (K+) and magnesium ions (Mg2+) has been shown to represent risk factors for certain types of arrhythmia. The aim of the present study was to assess the efficacy of a combined treatment with both cations in acutely infarcted patients receiving PTCA, regarding the occurrence of heart rhythm disorders and left ventricular function. Potassium/magnesium-therapy was initiated before (early-onset), and maintained during and up to 12 weeks after performance of PTCA. The study was designed as monocentric, prospective, placebo-controlled and double-blind. A total of 262 patients were enrolled in the study. An interim analysis revealed no differences between both study groups of treatment regarding primary outcome parameters: 1) Incidence of accelerated ventricular rhythm, 2) Incidence of ventricular tachycardia and ventricular fibrillation, and 3) Ejection fraction. Therefore, according to the protocol, the study was interrupted. However, a retrospective subanalysis of ECG-recordings revealed a significant reduction of ventricular extrasystoles and couplets in the K+/Mg2+-group. Both study groups were equal regarding quality and quantity of adverse events.Correspondence to:
Dr. M. Kunert
Department of Cardiology
Marienhospital Bottrop
Josef-Albers-Straße 70
46236 Bottrop, Germany
Email: [email protected]

Abstract

B. Gremmler¹,⁴, K. Kisters², M. Hausberg³, M. Kunert¹ and L.J. Ulbricht¹,⁴

¹Department of Cardiology, Marienhospital Bottrop, ²Department of Medicine, St. Anna Hospital Herne, ³AKTE Arbeitskreis Trace Elements and Electrolytes, ⁴University of Witten/Herdecke, Germany
Background: Abnormalities of diastolic function are first signs of cardiac remodeling in hypertension. Despite sufficient long-term antihypertensive treatment, a diastolic dysfunction concerning left ventricular relaxation is observed in many cases. Doppler echocardiography has become well-accepted as reliable, reproducible and a practical noninvasive method for diagnosis and longitudinal follow-up of patients with these diastolic dysfunctions. Since it was shown that dipyridamole treatment increased vasodilatorstimulated phosphoprotein Ser239phosphorylation (VASP), a benefit concerning diastolic dysfunction could be indirectly possible by dipyridamole-induced endothelial resistance reduction. Methods: Prospective observation of 11 long-term successfully pretreated, hypertensive patients with abnormal relaxation in the mitral inflow velocity curve. Patients with coronary artery disease, reduced cardiac ejection fraction, disease of valves or E-F deceleration time lower than 240 ms were excluded. The measurement of the ratio between peak early flow velocity (E) and peak late transmitral flow velocity (A) (E/A ratio) was carried out before and under additional dipyridamole treatment (200 mg sustained release twice daily). There was no change of continual antihypertensive medication during the observation time (12.6 ± 4.7 d). Results: A significant amelioration of the E/A ratio from 0.68 ± 0.11 to 0.81 ± 0.12 was observed (p = 0.017). No relevant change of blood pressure values was registered. Discussion: The additional treatment of sustained release dipyridamole to the continual antihypertensive medication shows a significant improvement of diastolic dysfunction already in a small patient group. This improvement was demonstrated by analysis of Doppler-echographic measurement (E/A ratio). Since there was no affect concerning blood pressure behavior, a greater clinical observation may be justified.Correspondence to:
Dr. med. B. Gremmler, PD Dr. med. L.J. Ulbricht
Marienhospital, Josef-Albers-Straße 70, 46236 Bottrop
Email: dr.bernhard.gremmler@ t-online.de

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