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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%.
.