Modest Elevation in BNP in Asymptomatic Hypertensive Patients Reflects Sub-Clinical Cardiac Remodeling, Inflammation and Extracellular Matrix Changes 英文参考文献.docVIP

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Modest Elevation in BNP in Asymptomatic Hypertensive Patients Reflects Sub-Clinical Cardiac Remodeling, Inflammation and Extracellular Matrix Changes 英文参考文献.doc

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Modest Elevation in BNP in Asymptomatic Hypertensive Patients Reflects Sub-Clinical Cardiac Remodeling, Inflammation and Extracellular Matrix Changes 英文参考文献

ModestElevationinBNPinAsymptomaticHypertensive PatientsReflectsSub-ClinicalCardiacRemodeling, InflammationandExtracellularMatrixChanges DermotPhelan1,2.,ChrisWatson2.,RamonMartos1,2,PatrickCollier,AnilPatle1,SeamasDonnelly2, MarkLedwidge1,JohnBaugh2*,KenMcDonald1,2 1HeartFailureUnit,StVincent’sUniversityHospital,ElmPark,Dublin,Ireland,2SchoolofMedicineandMedicalScience,UCDConwayInstitute,UniversityCollegeDublin, Dublin,Ireland Abstract InasymptomaticsubjectsB-typenatriureticpeptide(BNP)isassociatedwithadversecardiovascularoutcomesevenatlevels wellbelowcontemporarythresholdsusedforthediagnosisofheartfailure.Themechanismsbehindtheseobservationsare unclear.WeexaminedthehypothesisthatinanasymptomatichypertensivepopulationBNPwouldbeassociatedwithsub- clinicalevidenceofcardiacremodeling,inflammationandextracellularmatrix(ECM)alterations.Weperformedtransthoracic echocardiography and sampled coronary sinus (CS) and peripheral serum from patients with low (n=14) and high BNP (n=27). Peripheral BNP was closely associated with CS levels (r=0.92, p,0.001). CS BNP correlated significantly with CS levelsofmarkersofcollagentypeIandIIIturnoverincluding:PINP(r=0.44,p=0.008),CITP(r=0.35,p=0.03)andPIIINP (r=0.35,p=0.001),andwithCSlevelsofinflammatorycytokinesincluding:TNF-a(r=0.49,p=0.002),IL-6(r=0.35,p=0.04), andIL-8(r=0.54,p,0.001).ThehighBNPgrouphadgreaterCSexpressionoffibro-inflammatorybiomarkersincluding:CITP (3.860.7 versus 5.161.9, p=0.007), TNF-a (3.260.5 versus 3.761.1, p=003), IL-6 (1.961.3 versus 3.462.7, p=0.02) and hsCRP(1.261.1versus2.461.1,p=0.04),andgreaterleftventricularmassindex(97620versus118626g/m2,p=0.03)and leftatrialvolumeindex(1862versus2164,p=0.008).Ourdataprovideinsightintothemechanismsbehindtheobserved negative prognostic impact of modest elevations in BNP and suggest that in an asymptomatic hypertensive cohort a peripheralBNPmeasurementmaybeausefulmarkerofanearly,sub-clinicalpathologicalprocesscharacterizedbycardiac remodeling,inflammationandECMalteration