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lip Medical Research Society . TSF and MAC decr eased' and serum albunun, sigruifcantlv (ta ble). Day I Day 15 change (95%C.I) p-value Albumin 38.3 35.9 2.4 (1.2, 3.8) 2.7 2.6 0.1 (-0.1, 0.3) 10.6 9.1 1.5 (-0.7, 3.8) =0.15 Body weight 59.8 58.5 1.3 (0.6, 2.3) <0.01 Ir SF 10.9 9.5 1.4 (0.6, 2.5) <0.01 ~C 25 Irransferrin ron 24.4 0.6 (0.1, 1.4) <0.01 =0.25 =0.03 Conclusion A significant number of stroke patients in this study were undernourished on admission and their nutrition deteriorated further during their hospital stay. The extent to which nutritional factors contribute to stroke outcome is presently unknown and need further research. modify left ventricular (LV) diastolic performance. The aim of this study was to evaluate the effect of BNP on resting and exercise haemodynamics in isolated diastolic heart failure (DHF). 6 patients with isolated DHF (NYHA class Il-Ill CHF, normal LV systolic function, no myocardial ischaemia, and elevated LV filling pressures on exercise) were studied in a placebo controlled crossover study. Haemodynamic measurements were taken at baseline, at rest after 30 minutes of BNP (Spmol/kg/min) or placebo infusion and on maximum supine bicycle exercise. No significant difference in resting haemodynamics with BNP dw placebo was noted. Exercise duration (EDurn), pulmonary capillary wedge pressure (pCWP), heart rate (HR), mean arterial pressure (MAP) and cardiac index (CI) at maximal exercise on placebo (P) and BNP are shown below (Means ± SEM):EDurn 38 PCWP (mmHl!;) 8.5±O.7 23±3 8.7±O.S 16±2" Changes in Serum Lipid following Acute Stroke SE Gariballa, MO Fotherby, SG Parker" and CM Castleden University division of medicine for tbe elderly, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW Introduction Plasma triglyceride concentrations rise whilst total cholesterol concentration falls following acute myocardial infarction and other serious illness, and do not stabilise after the event until 3 months. It unknown whether similar changes occur following acute stroke and therefore when is the appropriate time for the assessment of serum lipids in such patients. The aims of this study were therefore to assess the serum lipid profile following acute stroke Patients & Methods 22 stroke patients (all had cerebral infarction on CT) 9 of whom were female with a mean age of 72 years (range 55-84) had their non-fasting serum cholesterol and triglyceride measured within 12 hours and 3, 8, and 15 days following an acute stroke. ANOVA and student's paired t test used for statistical analysis Results Mean SE) < 12 hour 3 days 8 days 15 days 5.91(0.30) 5.54(0.35) 4.88(0.22) 4.82(0.24) Cholesterol" 1.59(0.13) 1.64(0.12) Triglvceride« 1.73(0.24) 1.60(0.12) ANOVA p-value=O.02"., p-value=O.9OtThere was a significant difference between the first and the .subsequent serum cholesterol values (p values 0.03, <0.001, <0.001 'respectively). There was no significant change in serum triglyceride profile. 17 patients out of 22 (77%) had serum cholesterol values > 5.2 and 5 out of 22 (23%) had triglyceride values >2 on the first sample. Conclusion Serum cholesterol levels decreased progressively following acute stroke suggesting that assessment of lipid profile for secondary prevention cannot be performed in the immediate post stroke period. No significant change was seen in serum triglyceride levels. A high proportion of cases with cerebral infraction had high cholesterol value on the first sample. Optimum timing for assessment of lipid profile following acute cerebral infarction has yet to be established. 39 EFFECTS OF BRAIN NATRIURETIC PEPTIDE INFUSION ON EXERCISE HAEMODYNAMICS ISOLATED DIASTOLIC HEART FAILURE IN PBM CLARKSON, RJ McFADYEN, NM WHEELDON, TM MACDONALD Department of Clinical Pharmacology, Ninewells Hospital & Medical School, University of Dundee, Dundee, UK Experimental models suggest that brain natriuretic peptide can HR (bpm) MAP (mmH~) 130±7 139±8 CI (L/min/m 2) S.8±O.7 5.8±O.7 P 121±8 127±9 BNP "p-O.Q1 Conclusions: (1) BNP infusion does not affect resting haemodynamics in DHF. (2) BNP decreases PCWP on exercise in DHF, without adversely affecting maximum cardiac output responses. 40 USE OF NATRIURETIC PEPTIDES FOR THE DETECTION OF HYPERTENSIVE LEFT VENTRICULAR HYPERTROPHY PBM CLARKSON, AD MORRIS, C MACLEOD, W COUTIE, TM MACDONALD University Department of Clinical Pharmacology, Ninewells Hospital and MedicalSchool, Dundee DD1 9SY,Scotland, UK Left ventricular hypertrophy (LVH) is a potent predictor of cardiovascularrisk in arterial hypertension. The ECG lacks sensitivity for detecting LVH and although echocardiography has greater sensitivity its high cost, precludes its widespread use. Atrial and brain natriuretic peptides (ANP/BNP) are cardiac hormones secreted predominantly by the atria and ventricles respectively. These peptides have been reported to be elevated in hypertension and, in particular, those with LVH. The aim of the present study was to evaluate the potential of diagnosingLVH in hypertensives by measuring plasma NANP and BNP concentrations. 102 essential hypertensives (aged50 ± 14 yrs; 34M, 68F) who were either untreated, or withdrawn from therapy for at least 1 week were studied. All had echocardiographic measurements of left ventricular mass index (LVMI). After 'hhr of supine bed rest, blood was taken for plasma N-ANP and BNP assay. Results are expressed as mean values ± SEM. 35 patients had LVH (LVMI > 134g/m2 in males, 1l0g/m2 in females). Patients with LVH had higher N-ANP (460(33)pmol/1 v 305(18)pmol/1 (p<0.OO01» and BNP concentrations (7.1(0.7)pmoVl v 4.8(0.4)pmol/1 (p<0.01» compared to those without. However the correlations between LVMI and N-ANP and BNP were poor (N-ANP:- r-0.26 p<0.01, BNP:r-0.23 p-0.02). A plasmaN-ANP concentration of :8SOpmoVIhad a sensitivity of 61% and a specificity of 79% for detection of LVH, whereas a plasma BNP concentration of ~pmo1l1 had only a sensitivity of 63% and a specificity of 67% for detecting LVH. Using receiver operating characteristics the area under the curves were NANP, 0.76;BNP, 0.68 (where a perfect test would be 1.0, and a useless test 0.5). Our data suggestthat, although plasma N-ANP and BNP are elevated in hypertensive LVH, measurement of these peptides are unlikely to be insufficientlyaccurate to be useful in diagnosingLVH in unseleeted hypertensive patients. However, measurement of these peptides is considerably more accurate than using ECG criteria, which only has a sensitivity of approximately 15%. .