Eric Stanton

A direct comparison of the natriuretic peptides and their relationship to survival in chronic heart failure of a presumed non‐ischaemic origin

The natriuretic peptides have been validated as sensitive and specific markers of left ventricular dysfunction; brain natriuretic peptide (BNP), N‐terminal atrial natriuretic peptide (NT‐proANP) and N‐terminal brain natriuretic peptide (NT‐proBNP) elevations have been associated with New York Heart Association (NYHA) Class I–IV heart failure. We directly compared the association of each of these markers with 1‐year survival in 173 patients with chronic heart failure of a presumed nonischaemic origin entering the PRAISE‐2 Trial, a clinical study which assessed the therapeutic effect of Amlodipine in patients with NYHA Class III and IV heart failure and a left ventricular ejection fraction (LVEF) <30%. BNP, NT‐proBNP, and NT‐proANP levels were all correlated with 1‐year mortality by univariate Cox proportional hazards analyses. With respect to multivariate Cox proportional hazards regression models containing variables deemed significant in univariate analyses, NT‐proANP alone was identified as an independent predictor of 1‐year mortality when log‐transformed continuous covariates were utilized in the analysis. When the analysis was repeated using dichotomous covariates, NT‐proANP remained the most significant predictor of 1‐year mortality, followed by NT‐proBNP, NYHA classification and BNP. We conclude that all three natriuretic peptides are significant predictors of short‐term mortality in subjects with chronic congestive heart failure (CHF) of a presumed nonischaemic origin. Larger prospective studies are required to validate the clinical utility of NT‐proANP as a discriminating marker of short‐term survival, and to validate proposed cutoffs of approximately 2300 pmol/l for NT‐proANP, 1500 pg/ml for NT‐proBNP, and 50 pmol/l for BNP as prognostic indicators of adverse short‐term outcome.

The utility of four biochemical markers in the triage of chest pain patients.

Four biochemical markers, creatine kinase (CK)-MB isoenzyme, myoglobin, myosin light chains and troponin I, were studied in 1,338 patients presenting to the emergency department with chest pain suggestive of coronary artery disease (CAD). One hundred and eighty-seven patients had an acute myocardial infarction (MI). At least one of the four markers was over the threshold on the first sample in 78% of MI patients, as compared to only 40% with an elevated CK-MB. After 4 h, 88% had at least one marker elevated. None of the 69 patients with atypical chest pain, no history of CAD, no markers over threshold on the first sample and a normal electrocardiogram had an acute MI or unstable angina. If we had discharged this group, we would have saved USD 264,000, estimating a cost of USD 2,000 per day. Using four biochemical markers improved the early diagnosis of CAD and may help identify groups suitable for early discharge.

Serum Levels of Biochemical Markers of Traumatic Brain Injury

Background. A biomarker would be valuable in the diagnosis, risk stratification and prognosis of patients with traumatic brain injury (TBI). Methods. We measured serum levels of S-100 β, neuron specific enolase (NSE) and myelin basic protein (MBP) in 50 TBI subjects, and 50 age and gender matched controls. Patients were recruited within 6 hours of the initial injury, they had an initial Glasgow Coma Scale (GCS) score of 14 or less, or a GCS score of 15 with witnessed loss of consciousness (LOC) or amnesia. Results. S-100 β, NSE and MBP levels were significantly higher in TBI subjects than in control subjects ( 𝑃 0 . 0 0 1 for S-100 β and NSE; 𝑃 = 0 . 0 0 9 for MBP). Initial S-100 β levels were significantly higher in TBI subjects who had not retuned to normal activities 2 weeks following their injury than in TBI subjects who had retuned to normal activities ( 𝑃 = 0 . 0 2 2 ). MBP levels were higher in TBI subjects with positive findings on the baseline CT scan than in CT-negative subjects ( 𝑃 = 0 . 0 0 7 ). Conclusions. S-100 β, NSE and MBP may be present in the sera of TBI subjects in elevated quantities relative to controls. S-100 β may aid in predicting short-term outcome in TBI subjects.