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Is there circadian variation of big endothelin and NT‑proBNP in patients with severe congestive heart failure?


Authors: O. Ludka 1;  J. Špinar 1;  Z. Pozdíšek 1;  V. Musil 1;  L. Špinarová 2;  J. Vítovec 2;  J. Tomandl 3
Authors‘ workplace: Interní kardiologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MU Dr. Jindřich Špinar, CSc., FESC2I. interní kardio‑angiologická klinika Lékařské fakulty MU a FN u sv. Anny Brno, přednosta prof. MU Dr. Jiří Vítovec, CSc. 1
Published in: Vnitř Lék 2010; 56(6): 488-493
Category: Original Contributions

Overview

Introduction:
Circadian rhytmus have long been recognized to occur in many bio­logic phenomena, including secretion of hormones as well as autonomic nervous system. There is increasing evidence that circadian rhythms have been also found in cardiovascular events, for example, myocardial infarction, sudden cardiac death as well as stroke have shown a circadian pattern of the distribution. The pathophysiology and the mechanism underlying these variations are the focus of much investigation, while i tis not full understood up to date. Heart rate, blood pressure, neurohumoral vasoactive factors, such as plasma norepinephrine levels and renin activity, and probably also contractility are increased in the morning hours.

Aim:
The aim of our study was to evaluate the circadian variability of plasma big endothelin and NT‑proBNP level in patients with severe heart failure.

Patients:
13 patients with severe heart failure, stable for at least one month, male/ female –  8/ 5, NYHA III/ IV –  11/ 2, mean left ventricle ejection fraction 23 ± 5 %, mean cardiothoracic ratio 59 ± 7 %, all treated with RAAS blocade (11× ACE‑ I, 2× ARB), all treated with diuretics, 12 patients treated with beta‑blockers, 7 with digoxin. The cause of heart failure was ischemic heart disease (9) or dilated cardiomyopathy (4).

Methods:
Blood samples for big endothelin and NT‑proBNP were taken every two hours during a standartised daily regime.

Results:
Mean plasma level of big endothelin (ranging from 1.25 to 1.71 pmol/ l) had significant diurnal variability (upper limit of normal values 0.7 pmol/ l). Mean plasma level of NT‑proBNP (ranging from 782 to 934 pmol/ l) had no diurnal variability (upper limit of normal values of 350 pmo/ l).

Summary:
Plasma level of NT‑proBNP is stable during 24 hours and shows no circadian variability. Plasma big endothelin showed a morning peak after a systematic increase during bed rest. NT‑proBNP could be evaluated any time during the day, big endothelin sample should be taken during standartised condition.

Key words:
NT‑proBNP –  big endothelin –  circadian variation –  heart failure


Sources

1. Bartůněk L. Endoteliny a chronická srdeční insuficience. Vnitř Lék 2000; 46: 54– 57.

2. Frelin C, Guedin H. Why are circulating concentrations of endothelin‑1 so low? Cardiovasc Res 1994; 28: 1613– 1622.

3. Pacher R, Stanek B, Hüelsmann M et al. Prognostic impact of big endothelin‑1 plasma concentrations compared with invasive hemodynamic evaluation in severe heart failure. J Am Coll Cardiol 1996; 27: 633– 641.

4. Sharma RB, Coats AJ, Anker SD. The role of inflammatory mediators in chronic heart failure: cytokines, nitric oxide, and endothelin‑1. Int J Cardiol 2000; 72: 175– 186.

5. Špinar J, Špinarová L, Vítovec J et al. Big endothelin and chronic heart failure. Vnitř Lék 2002; 48: 3– 7.

6. Gardner RS, Ozalp F, Murday AJ et al. N‑terminal pro‑brain natriuretic peptide. A new gold standard in predicting mortality in patients with advanced heart failure. Eur Heart J 2003; 24: 1735– 1743.

7. Špinarová L, Toman J. Humorální změny u chronického srdečního selhání. Cor Vasa 2001; 43: 513– 519.

8. Eguchi K, Kario K, Shimada K et al. Circadian variation of blood pressure and neurohumoral factors during the acute phase of stroke. Clin Exp Hypertens 2002; 24: 109– 114.

9. Bruins S, Fokkema MR, Römer JW et al. High intraindividual variation of B‑type natriuretic peptide (BNP) and amino‑terminal proBNP in patients with stable chronic heart failure. Clin Chem 2004; 50: 2052– 2058.

10. Elherik K, Khan F, McLaren M et al. Circadian variation in vascular tone and endothelial cell function in normal males. Clin Sci (Lond.) 2002; 102: 547– 552.

11. Herold M, Cornélissen G, Loeckinger Aet al. About 8- hour variation of circulating human endothelin‑1. Peptides 1998; 19: 821– 825.

12. Maeda M, Kachi H, Takagi H et al. Is there circadian variation of plasma endothelin (ET‑ 1) in patients with systemic scleroderma (SSc)? J Dermatol Sci 1997; 16: 38– 44.

13. Li JJ, Huang CX, Fang CH et al. Circadian variation in ischemic threshold in patients with stable angina: relation to plasma endothelin‑1. Angiology 2002; 53: 409– 413.

Labels
Diabetology Endocrinology Internal medicine

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Internal Medicine

Issue 6

2010 Issue 6

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