Yuming Hao

Brain Natriuretic Peptide for Prevention of Contrast-Induced Nephropathy After Percutaneous Coronary Intervention or Coronary Angiography

BACKGROUND Many methods reportedly prevent contrast-induced nephropathy (CIN), but the effect of brain natriuretic peptide (BNP) on CIN is unknown. In this study we investigated recombinant BNP use before coronary angiography (CA) or nonemergent percutaneous coronary intervention (PCI) in patients with unstable angina. METHODS One thousand patients with unstable angina were prospectively evaluated. The patients were randomly assigned to: group A, isotonic normal saline (NaCl 0.9%, 1 mL/kg/h) for 24 hours before CA or PCI; and group B, human recombinant BNP (rhBNP; 0.005 μg/kg/min). Serum creatinine (Scr) levels and estimated glomerular filtration rate were measured before and 24, 48, and 72 hours, and 7 days after the procedure. The primary outcome was CIN incidence defined according to a relative (≥ 25%) or absolute (≥ 0.5 mg/dL and 44 μmol/L, respectively) increase in Scr from baseline within 48 hours. The secondary end points were the changes in the Scr and estimated glomerular filtration rate, before and after the procedure. RESULTS Contrast volume, a history of diabetes mellitus, and BNP administration independently predicted CIN. The incidence of CIN was significantly greater in group A than in group B (14.8% vs 5.6%; P < 0.01). Renal function was less compromised in patients who received rhBNP. The Scr of all patients with CIN remained increased for 24 hours, but it was lower and recovered faster in patients who received rhBNP. CONCLUSIONS rhBNP administration before CA or PCI protects renal function and can significantly decrease CIN incidence.

Recombinant Brain Natriuretic Peptide for the Prevention of Contrast-Induced Nephropathy in Patients with Chronic Kidney Disease Undergoing Nonemergent Percutaneous Coronary Intervention or Coronary Angiography: A Randomized Controlled Trial.

The role of brain natriuretic peptide (BNP) in the prevention of contrast-induced nephropathy (CIN) is unknown. This study aimed to investigate BNPs effect on CIN in chronic kidney disease (CKD) patients undergoing elective percutaneous coronary intervention (PCI) or coronary angiography (CAG). The patients were randomized to BNP (0.005 μg/kg/min before contrast media (CM) exposure and saline hydration, n = 106) or saline hydration alone (n = 103). Cystatin C, serum creatinine (SCr) levels, and estimated glomerular filtration rates (eGFR) were assessed at several time points. The primary endpoint was CIN incidence; secondary endpoint included changes in cystatin C, SCr, and eGFR. CIN incidence was significantly lower in the BNP group compared to controls (6.6% versus 16.5%, P = 0.025). In addition, a more significant deterioration of eGFR, cystatin C, and SCr from 48 h to 1 week (P < 0.05) was observed in controls compared to the BNP group. Although eGFR gradually deteriorated in both groups, a faster recovery was achieved in the BNP group. Multivariate logistic regression revealed that using >100 mL of CM (odds ratio: 4.36, P = 0.004) and BNP administration (odds ratio: 0.21, P = 0.006) were independently associated with CIN. Combined with hydration, exogenous BNP administration before CM effectively decreases CIN incidence in CKD patients.

Fractional systolic and diastolic pressures act as predictors of coronary artery disease

Aims. This study was designed to determine if fractional systolic/diastolic pressures act as predictors of the extent of coronary artery disease. Patients and methods. A total of 545 consecutive patients (305 men, 240 women, with mean age 54.2 years) were involved in the study. The patients were diagnosed with coronary and non-coronary artery disease confirmed by angiography. Results. 353 patients were confirmed to have coronary artery disease, with 134 cases involving one vessel, 101 two vessels and 118 three vessels. There were significant differences between brachial and ascending aortic systolic blood pressures, fractional systolic blood pressures and fractional diastolic blood pressures in the patients with coronary artery disease compared with patients with non-coronary artery disease. Blood pressure measured in the brachial artery was higher than the pressure measured in the ascending artery. Ascending aortic fractional systolic/diastolic pressures were associated with coronary Gensini score, and were significantly related to the number of diseased vessels. Conclusions. Fractional systolic and diastolic pressures in the ascending aorta were strong predictive factors for the extent of coronary artery disease. Central pressures measured invasively in the ascending aorta were more predictive than peripheral pressures for the evaluation of coronary artery disease.

551 BLOOD PRESSURE LEVELS ON ADMISSION AND AT DISCHARGE IN PATIENTS WITH ACUTE CORONARY SYNDROME (ACS)

Background: In patients with ACS, a J-shaped curve association existed between blood pressure (BP) and the risk of future cardiovascular events. There is few researches reported about the real situation of BP in patient with ACS on admission and the changes of BP at discharge. Methods and Results: Five hundred and sixty nine patients with ACS was collected in the study. The BP was 134.18 ± 20.868/81.09 ± 12.573mmHg on admission and 123.42 ± 13.542/74.63 ± 8.252 mmHg at discharge, the overall BP was decreased at discharge (P < 0.001). The proportion of patients with BP<110/70mmHg was 14.2% on admission and 19.7% at discharge respectively. The ratio for patients with lower BP was significantly increased at discharge (P < 0.001). For the patients with lower discharge BP, 59.8% of them didn’t have lower BP on admission, and even half of them have BP ≥140/90mmHg on admission. For the patients with systolic BP (SBP) < 110mmHg on admission, the discharge systolic BP was increased 8.385 ± 13.133mmHg (P < 0.001). And for the patients with the diastolic BP (DBP) < 70mmHg on admission, the discharge diastolic BP was increased 5.841 ± 9.194mmHg (P < 0.001). Conclusions: The proportion of lower blood pressure(<110/70mmHg) was increased at discharge than on admission in patients with ACS, the lower BP drugs including ACEI and &bgr;-blokers given to the patients with ACS should be with caution to avoid making the BP too lower.

Comparison of single-plane and biplane area-length methods for right ventricular volume calculation: In vivo and vitro study

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