Brain – ABC CARDIOL

IJCS

Review Article

The Gut Brain-Axis in Neurological Diseases

Pedro Melo Barbosa et al. Egberto Reis Barbosa

Abstract

Recent evidence suggests that dysfunction of the gut-brain axis may be an important factor contributing to many diseases of the nervous system. Increased gut permeability associated with chronic gastrointestinal dysfunction, as well as changes in the composition of the gut microbiota could contribute to exposure of the enteric and central nervous system to pathogens and its metabolites, including endotoxins and pro-inflammatory cytokines. As a consequence, dysfunction of the host’s immune system could contribute to an abnormal immunological response leading to auto-immune conditions, such as multiple sclerosis. So far, gut dysbiosis has been reported in association with Parkinson’s disease, Alzheimer’s disease, multiple sclerosis, neurodevelopmental and neuropsychiatric conditions, and cerebrovascular disease. These findings suggest that the possibility of targeting the gut microbiota could become a future therapeutic option to treat these conditions. However, before this knowledge can be useful in the clinical setting, more data is needed to establish clear causal relationships between dysfunction of the gut-brain axis and neurological diseases.

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Editorial

Is Grace Risk Score the Holy Grail in Risk Stratification or Can We Improve it Even Further with Additional Biomarkers?

Ana Teresa Timóteo

B-type natriuretic peptide (BNP) has been recognized as a very useful marker for the detection of acute and chronic left ventricular dysfunction, both systolic and diastolic, that can be present in the context of sudden and prolonged myocardial ischemia.^, These are the first steps in the ischemic cascade, leading to cell necrosis. For that reason, natriuretic peptides are usually elevated in the context of acute coronary syndromes.

Myocardial ischemia, even in the absence of left ventricular dysfunction, augments cardiac BNP gene expression, increasing plasma NT-proBNP concentrations.^, BNP kinetics usually peaks at 16 hours of symptom’s onset in ST-elevation myocardial infarction and a second peak is usually observed by the fifth day. We can speculate that the first peak might be associated with ischemia and the second peak to left ventricular dysfunction associated with cell necrosis and early remodelling.

[…]

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Original Article

BNP was Associated with Ischemic Myocardial Scintigraphy and Death in Patients at Chest Pain Unit

Jader Cunha de Azevedo et al. Bruno Cezario Costa Reis Nathalia Monerat P.B. Barreto Diogenes S. F. Junior … Lais S. Prezotti Victor Rebelo Procaci Vivian Werneck Octaviano Andre Volschan Evandro Tinoco Mesquita Claudio Tinoco Mesquita

Background:

Recent studies have suggested that B-type Natriuretic Peptide (BNP) is an important predictor of ischemia and death in patients with suspected acute coronary syndrome. Increased levels of BNP are seen after episodes of myocardial ischemia and may be related to future adverse events.

Objectives:

To determine the prognostic value of BNP for major cardiac events and to evaluate its association with ischemic myocardial perfusion scintigraphy (MPS).

Methods:

This study included retrospectively 125 patients admitted to the chest pain unit between 2002 and 2006, who had their BNP levels measured on admission and underwent CPM for risk stratification. BNP values were compared with the results of the MPS. The chi-square test was used for qualitative variables and the Student t test, for quantitative variables. Survival curves were adjusted using the Kaplan-Meier method and analyzed by using Cox regression. The significance level was 5%.

Results:

The mean age was 63.9 ± 13.8 years, and the male sex represented 51.2% of the sample. Ischemia was found in 44% of the MPS. The mean BNP level was higher in patients with ischemia compared to patients with non-ischemic MPS (188.3 ± 208.7 versus 131.8 ± 88.6; p = 0.003). A BNP level greater than 80 pg/mL was the strongest predictor of ischemia on MPS (sensitivity = 60%, specificity = 70%, accuracy = 66%, PPV = 61%, NPV = 70%), and could predict medium-term mortality (RR = 7.29, 95% CI: 0.90-58.6; p = 0.045) independently of the presence of ischemia.

Conclusions:

BNP levels are associated with ischemic MPS findings and adverse prognosis in patients presenting with acute chest pain to the emergency room, thus, providing important prognostic information for an unfavorable clinical outcome.

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Artigo Original

Prognostic value of perioperative N-terminal pro-B-type natriuretic peptide in noncardiac surgery

Flávia Kessler Borges et al. Mariana Vargas Furtado Ana Paula Webber Rossini Carolina Bertoluci … Vinícius Leite Gonzalez Eduardo Gehling Bertoldi Denis Maltz Grutcki Leandro Gazziero Rech Mariana Magalhães Carisi Anne Polanczyk

BACKGROUND: Preoperative NT-proBNP has been shown to predict adverse cardiac outcomes, although recent studies suggested that postoperative NT-proBNP determination could provide additional information in patients submitted to noncardiac surgery. OBJECTIVE: To evaluate the prognostic value of perioperative NT-proBNP in intermediate and high risk cardiovascular patients undergoing noncardiac surgery. METHODS: This study prospectively enrolled 145 patients aged >45 years, with at least one Revised Cardiac Risk Index risk factor and submitted to intermediate or high risk noncardiac surgery. NT-proBNP levels were measured pre- and postoperatively. Short-term cardiac outcome predictors were evaluated by logistic regression models. RESULTS: During a median follow-up of 29 days, 17 patients (11.7%) experienced major adverse cardiac events (MACE- 14 nonfatal myocardial infarctions, 2 nonfatal cardiac arrests and 3 cardiac deaths). The optimum discriminatory threshold levels for pre- and postoperative NT-proBNP were 917 and 2962 pg/mL, respectively. Pre- and postoperative NT-proBNP (OR 4.7; 95% CI 1.62-13.73; p=0.005 and OR 4.5; 95% CI 1.53-13.16; p=0.006) were significantly associated with MACE. Preoperative NT-proBNP was significantly and independently associated with adverse cardiac events in multivariate regression analysis (adjusted OR 4.2; 95% CI 1.38-12.62; p=0.011). CONCLUSION: NT-proBNP is a powerful short-term marker of perioperative cardiovascular events in high risk patients. Postoperative levels were less informative than preoperative levels. A single preoperative NT-proBNP measurement should be considered in the preoperative risk assessment.

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Artigo Original

Effects of levosimendan on TNF-alpha, BNP and MMP-1 in patients with heart failure with anemia

Mutlu Büyüklü et al. Akif Turhan Kürüm Ersan Tatlý Turan Set

BACKGROUND: Levosimendan is known with its two-sided effects of strengthening myofibril contraction without increasing myocardial oxygen demand. Anemia is a deteriorating situation that causes increase of drug dosing in patients with heart failure. OBJECTIVES: In this study, we compared the effectiveness of levosimendan treatment in decompensated heart failure patients with or without anemia. METHODS: Twenty-three anemic patients having class 3 or 4 heart failure according to New York Heart Association (NYHA) and an ejection fraction of below 35% were included to the study. Another 23 patients with the same cardiac diagnosis but without anemia served as control group. Twenty-four hours levosimendan treatment was added to the traditional heart failure treatment of these patients. Samples were taken to measure serum tumor necrotizing factor alpha (TNF-alpha), aminoterminal pro-brain natriuretic peptide (NT-proBNP) and matrix metalloproteinase-1 (MMP-1) levels before and after the administration. RESULTS: There was no significant difference between serum TNF-alpha and MMP-1 levels before and after the treatment (p>0.05). Although NT-proBNP level decreased in both groups after the treatment this was not statistically significant (p=0.531 and p=0.913 for anemia and control groups respectively). Significant restoration of functional capacity was seen in both groups assessed according to NYHA (p<0.001 and p=0.001 for anemia and control groups respectively). CONCLUSION: Levosimendan treatment shows similar effects in heart failure patients with anemia to that of patients without anemia. However, the early effect of this treatment on TNF-alpha, NT-proBNP and MMP-1 levels is not evident. It provides significant improvement in functional capacity without influence from anemia.

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The Gut Brain-Axis in Neurological Diseases

Abstract

Is Grace Risk Score the Holy Grail in Risk Stratification or Can We Improve it Even Further with Additional Biomarkers?

BNP was Associated with Ischemic Myocardial Scintigraphy and Death in Patients at Chest Pain Unit

Background:

Objectives:

Methods:

Results:

Conclusions:

Prognostic value of perioperative N-terminal pro-B-type natriuretic peptide in noncardiac surgery

Effects of levosimendan on TNF-alpha, BNP and MMP-1 in patients with heart failure with anemia

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