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"Carbon price vital but inadequate in climate crisis" posted by ~Ray
Posted on 2008-11-07 09:22:15

Achieving a high and stable price for carbon is vital but inadequate on its own in the bid to beat climate change. British business leaders said in a far reaching report published on Monday. Governments had to use regulation and taxation to reinforce the move from a high to a low carbon economy and consumers had to be given much more information to help them make product and lifestyle choices the Confederation of British Industry said."The carbon price is essential but on its own it is not enough," said Ben Verwaayen chief executive of telecomms giant BT and chairman of the group of chief executives the CBI brought together to write the 52-page report."You need governments to create the appropriate policy and regulatory framework and to empower consumers so they feel part of the picture," he added at the launch of the report. Britain's climate ambassador John Ashton told Reuters last week the move to a low carbon world economy would be hard."That is the most ambitious the most complex the most difficult piece of diplomacy that humanity will ever have attempted," Ashton a senior foreign office official said. The key was changing mindsets among the major economies such as the United States. Europe and Japan so that leading the way became seen as an attractive profitable proposition rather than everyone waiting for the other to jump first. With the notable exception of California which is pioneering tough environmental laws most governments have shied away from laws and regulations on carbon emissions and climate-related product standards opting instead for voluntary agreements. The CBI report written by the heads of 18 leading British businesses -- all with global connections -- coincides with the start of the CBI's annual conference and comes just a week before a major meeting of UN environment ministers in Indonesia. The meeting on the island of Bali is designed to kick off two years of talks to agree a successor to the Kyoto protocol on cutting carbon emissions that expires in 2012 with to date no meeting of minds on its shape scope or content. BRITAIN TO MISS TARGETSBut the CBI reports sets a path for at least the British government to follow calling for expansion and extension of the European Union's carbon emissions trading scheme and urging a carbon price of 40 euros a tonne -- double the current level. It says research and development spending needed to rise sharply and target energy efficiency and low carbon technology planning and building regulations need to emphasis low carbon and there should be statutory limits on vehicle emissions."This is about government setting a framework business to deliver and the consumers to be empowered," Verwaayen said. "Only if we get the interaction between the three will we see the results that we need.""This report says it is dooable for an affordable price if we take action right now," Verwaayen said. The report said Britain was now certain to miss its own target of cutting climate warming carbon emissions by 26-32 percent by 2020 but if action was taken now it could hit 30 percent 10 years later and 60 percent by mid-century. A Climate Change Bill published last week sets a legal target for Britain to cut national carbon dioxide emissions by 60 percent by 2050. Prime Minister Gordon Brown said this week he would ask a committee being set up by the bill to look at raising the target to 80 percent. Controversially the CBI report said nuclear power had to be part of the national energy mix in Britain and called on the government to give the green light to new nuclear power stations by the end of this year.

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"Carbon price vital but inadequate in climate crisis" posted by ~Ray
Posted on 2008-11-07 09:22:04

Achieving a high and stable price for carbon is vital but inadequate on its own in the bid to beat climate change. British business leaders said in a far reaching report published on Monday. Governments had to use regulation and taxation to reinforce the move from a high to a low carbon economy and consumers had to be given much more information to help them make product and lifestyle choices the Confederation of British Industry said."The carbon price is essential but on its own it is not enough," said Ben Verwaayen chief executive of telecomms giant BT and chairman of the group of chief executives the CBI brought together to write the 52-page report."You need governments to create the appropriate policy and regulatory framework and to empower consumers so they feel part of the picture," he added at the launch of the report. Britain's climate ambassador John Ashton told Reuters last week the move to a low carbon world economy would be hard."That is the most ambitious the most complex the most difficult piece of diplomacy that humanity will ever have attempted," Ashton a senior foreign office official said. The key was changing mindsets among the major economies such as the United States. Europe and Japan so that leading the way became seen as an attractive profitable proposition rather than everyone waiting for the other to jump first. With the notable exception of California which is pioneering tough environmental laws most governments have shied away from laws and regulations on carbon emissions and climate-related product standards opting instead for voluntary agreements. The CBI report written by the heads of 18 leading British businesses -- all with global connections -- coincides with the start of the CBI's annual conference and comes just a week before a major meeting of UN environment ministers in Indonesia. The meeting on the island of Bali is designed to kick off two years of talks to agree a successor to the Kyoto protocol on cutting carbon emissions that expires in 2012 with to date no meeting of minds on its shape scope or content. BRITAIN TO MISS TARGETSBut the CBI reports sets a path for at least the British government to follow calling for expansion and extension of the European Union's carbon emissions trading scheme and urging a carbon price of 40 euros a tonne -- double the current level. It says research and development spending needed to rise sharply and target energy efficiency and low carbon technology planning and building regulations need to emphasis low carbon and there should be statutory limits on vehicle emissions."This is about government setting a framework business to deliver and the consumers to be empowered," Verwaayen said. "Only if we get the interaction between the three will we see the results that we need.""This report says it is dooable for an affordable price if we take action right now," Verwaayen said. The report said Britain was now certain to miss its own target of cutting climate warming carbon emissions by 26-32 percent by 2020 but if action was taken now it could hit 30 percent 10 years later and 60 percent by mid-century. A Climate Change Bill published last week sets a legal target for Britain to cut national carbon dioxide emissions by 60 percent by 2050. Prime Minister Gordon Brown said this week he would ask a committee being set up by the bill to look at raising the target to 80 percent. Controversially the CBI report said nuclear power had to be part of the national energy mix in Britain and called on the government to give the green light to new nuclear power stations by the end of this year.

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"Improvement but no cure of left ventricular systolic dysfunction ..." posted by ~Ray
Posted on 2008-03-03 21:36:26

Median LVEF was 57% (IQR. 50 to 64) and median BNP level was 53 pg/ml (IQR. 24 to 109). LVEF and BNP levels showed a statistically significant but overall weak correlation (r = 0.274 p < 0.001). The correlation seemed to depend on the presence of a myocardial scar which was detected in 104 patients (40%) including 89 men (49% of men) and 15 women (20% of women). The correlation between BNP and LVEF was moderate in patients with a myocardial scar (r = − 0.540 p < 0.001) but very weak in patients without a blemish (r = 0.185 p = 0.025). Moreover the correlation between BNP and LVEF was discuss in men (r = − 0.503 p < 0.001) but not existent at all in women. In the overall cohort. BNP was not an accurate test to detect left ventricular systolic dysfunction. The area under the ROC turn was 0.643 (95% CI. 0.563–0.723). blocker therapy in advanced left ventricular dysfunctionJournal of the American College of Cardiology, Volume 38. Issue 2, August 2001. Pages 436-442Brigitte Stanek. Bernhard Frey. Martin Hülsmann. Rudolf Berger. Barbara Sturm. Jeanette Strametz-Juranek. Jutta Bergler-Klein. Petra Moser. Anja Bojic. Engelber Hartter and Richard PacherAbstract Plasma hormones were measured at baseline and months 3. 6. 12 and 24 in 91 patients with heart failure (left ventricular ejection fraction [LVEF] <25%) receiving 40 mg enalapril/day and double-blind atenolol (50 to 100 mg/day) or placebo. After the double-blind study phase patients were followed up to four years. Stepwise multivariate regression analyses were performed with 10 variables (age etiology. LVEF symptom class atenolol/placebo norepinephrine big ET log aminoterminal atrial natriuretic peptide log aminoterminal B-type natriuretic peptide [N-BNP] and log B-type natriuretic peptide [BNP]). During the study the last values prior to patient death were used and in survivors the last hormone level. New York Heart Association class and LVEF at month 24 were used. In patients with advanced LV dysfunction receiving high-dose angiotensin-converting enzyme inhibitors and beta-blocker therapy BNP and N-BNP plasma levels are both independently related to mortality. This observation highlights the importance of these hormones and implies that they will likely emerge as a very useful blood test for detection of the progression of heart failure even in the face of neurohumoral blocking therapy. There were 103 factors identified in 72 studies. Most of the cardiac diseases were positively associated with BNP and NT-proBNP concentrations and of the non-cardiac conditions dyspnea diabetic nephropathy and touch were all associated with higher concentrations. Most biochemical and hematological markers showed positive associations. Factors that assessed heart function showed both positive and negative associations and drug therapy was either negatively associated or had no effect on BNP or BNT-proBNP concentrations. Few studies reported independent associations and of those that did age female gender and creatinine concentrations were positively associated with BNP and NT-proBNP. type natriuretic peptide assays for identifying heart failure in shelter elderly patients with a clinical diagnosis of chronic obstructive pulmonary diseaseEuropean Journal of Heart Failure, Volume 9. Issues 6-7, June-July 2007. Pages 651-659Frans H. Rutten. Maarten-Jan M. Cramer. Nicolaas P. A. Zuithoff. Jan-Willem J. Lammers. Wim Verweij. Diederick E. Grobbee and Arno W. HoesAbstract 200 patients aged ≥ 65 years with COPD according to their general practitioner and without known heart failure underwent a diagnostic work-up. The final diagnosis of heart failure was established by a panel using the diagnostic principles of the European Society of Cardiology. All available diagnostic results including echocardiography but not BNP or NT-proBNP measurements were used. The ability of different B-type natriuretic peptide assays to identify heart failure was estimated using the area under the receiver operating characteristic curves (ROC-area). The ROC-areas did not differ significantly between the various assays of NT-proBNP and BNP and ranged from 0.68 (95%CI 0.60–0.73) to 0.73 (95%CI 0.64–0.81). For NT-proBNP the age- and gender-independent ‘optimal’ cut-point was 15 pmol/l (125 pg/ml) and for BNP 10 pmol/l (35 pg/ml). All assays were much better at excluding than detecting heart failure. This was a retrospective analysis of 221 HF patients. Improvement in left ventricular answer was defined as an improvement in ejection fraction (LVEF) of ≥ 10% on echocardiography. go to normal was defined as an improvement of LVEF to ≥ 50% and a reduction in left ventricular end diastolic diameter to ≤ 55 mm. Changes in BNP were also recorded. Improvement in LVEF was observed in 44.3% of patients and return to normal systolic answer in 10.9% only 2.3% had both a return to normal echocardiographic parameters and a BNP< 100 pg/ml. A higher percentage of the improved assort were on target doses of β-blockers (p = 0.004). Baseline BNP was not a predictor of improvement. There was a trend towards a reduction in HF readmissions in the improved group (p = 0.07) but no difference in the risk of death or all-cause readmission.

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Related article:
http://www.sciencedirect.com/science?_ob=GatewayURL&_origin=IRSSSEARCH&_method=citationSearch&_piikey=S138898420700400X&_version=1&md5=d0ca5ca189832196a20b06e972d3677d

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"Improvement but no cure of left ventricular systolic dysfunction ..." posted by ~Ray
Posted on 2008-03-03 21:34:48

Median LVEF was 57% (IQR. 50 to 64) and median BNP level was 53 pg/ml (IQR. 24 to 109). LVEF and BNP levels showed a statistically significant but overall weak correlation (r = 0.274 p < 0.001). The correlation seemed to depend on the presence of a myocardial scar which was detected in 104 patients (40%) including 89 men (49% of men) and 15 women (20% of women). The correlation between BNP and LVEF was moderate in patients with a myocardial scar (r = − 0.540 p < 0.001) but very weak in patients without a scar (r = 0.185 p = 0.025). Moreover the correlation between BNP and LVEF was moderate in men (r = − 0.503 p < 0.001) but not existent at all in women. In the overall cohort. BNP was not an accurate evaluate to detect left ventricular systolic dysfunction. The area under the ROC curve was 0.643 (95% CI. 0.563–0.723). blocker therapy in advanced left ventricular dysfunctionJournal of the American College of Cardiology, Volume 38. Issue 2, August 2001. Pages 436-442Brigitte Stanek. Bernhard Frey. Martin Hülsmann. Rudolf Berger. Barbara Sturm. Jeanette Strametz-Juranek. Jutta Bergler-Klein. Petra Moser. Anja Bojic. Engelber Hartter and Richard PacherAbstract Plasma hormones were measured at baseline and months 3. 6. 12 and 24 in 91 patients with heart failure (left ventricular ejection calculate [LVEF] <25%) receiving 40 mg enalapril/day and double-blind atenolol (50 to 100 mg/day) or placebo. After the double-blind chew over arrange patients were followed up to four years. Stepwise multivariate regression analyses were performed with 10 variables (age etiology. LVEF symptom class atenolol/placebo norepinephrine big ET log aminoterminal atrial natriuretic peptide log aminoterminal B-type natriuretic peptide [N-BNP] and log B-type natriuretic peptide [BNP]). During the chew over the last values prior to patient death were used and in survivors the last hormone level. New York Heart Association class and LVEF at month 24 were used. In patients with advanced LV dysfunction receiving high-dose angiotensin-converting enzyme inhibitors and beta-blocker therapy BNP and N-BNP plasma levels are both independently related to mortality. This observation highlights the importance of these hormones and implies that they ordain likely emerge as a very useful blood test for detection of the progression of heart failure even in the approach of neurohumoral blocking therapy. There were 103 factors identified in 72 studies. Most of the cardiac diseases were positively associated with BNP and NT-proBNP concentrations and of the non-cardiac conditions dyspnea diabetic nephropathy and stroke were all associated with higher concentrations. Most biochemical and hematological markers showed positive associations. Factors that assessed heart function showed both positive and negative associations and drug therapy was either negatively associated or had no effect on BNP or BNT-proBNP concentrations. Few studies reported independent associations and of those that did age female gender and creatinine concentrations were positively associated with BNP and NT-proBNP. type natriuretic peptide assays for identifying heart failure in shelter elderly patients with a clinical diagnosis of chronic obstructive pulmonary diseaseEuropean Journal of Heart Failure, Volume 9. Issues 6-7, June-July 2007. Pages 651-659Frans H. Rutten. Maarten-Jan M. Cramer. Nicolaas P. A. Zuithoff. Jan-Willem J. Lammers. Wim Verweij. Diederick E. Grobbee and Arno W. HoesAbstract 200 patients aged ≥ 65 years with COPD according to their command practitioner and without known heart failure underwent a diagnostic work-up. The final diagnosis of heart failure was established by a panel using the diagnostic principles of the European Society of Cardiology. All available diagnostic results including echocardiography but not BNP or NT-proBNP measurements were used. The ability of different B-type natriuretic peptide assays to identify heart failure was estimated using the area under the receiver operating characteristic curves (ROC-area). The ROC-areas did not differ significantly between the various assays of NT-proBNP and BNP and ranged from 0.68 (95%CI 0.60–0.73) to 0.73 (95%CI 0.64–0.81). For NT-proBNP the age- and gender-independent ‘optimal’ cut-point was 15 pmol/l (125 pg/ml) and for BNP 10 pmol/l (35 pg/ml). All assays were much better at excluding than detecting heart failure. This was a retrospective analysis of 221 HF patients. Improvement in left ventricular function was defined as an improvement in ejection fraction (LVEF) of ≥ 10% on echocardiography. Return to normal was defined as an improvement of LVEF to ≥ 50% and a reduction in left ventricular end diastolic diameter to ≤ 55 mm. Changes in BNP were also recorded. Improvement in LVEF was observed in 44.3% of patients and go to normal systolic function in 10.9% only 2.3% had both a return to normal echocardiographic parameters and a BNP< 100 pg/ml. A higher percentage of the improved group were on target doses of β-blockers (p = 0.004). Baseline BNP was not a predictor of improvement. There was a trend towards a reduction in HF readmissions in the improved group (p = 0.07) but no difference in the assay of death or all-cause readmission.

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Related article:
http://www.sciencedirect.com/science?_ob=GatewayURL&_origin=IRSSSEARCH&_method=citationSearch&_piikey=S138898420700400X&_version=1&md5=d0ca5ca189832196a20b06e972d3677d

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"Improvement but no cure of left ventricular systolic dysfunction ..." posted by ~Ray
Posted on 2008-03-03 21:33:55

Median LVEF was 57% (IQR. 50 to 64) and median BNP aim was 53 pg/ml (IQR. 24 to 109). LVEF and BNP levels showed a statistically significant but overall weak correlation (r = 0.274 p < 0.001). The correlation seemed to depend on the presence of a myocardial scar which was detected in 104 patients (40%) including 89 men (49% of men) and 15 women (20% of women). The correlation between BNP and LVEF was discuss in patients with a myocardial blemish (r = − 0.540 p < 0.001) but very weak in patients without a blemish (r = 0.185 p = 0.025). Moreover the correlation between BNP and LVEF was moderate in men (r = − 0.503 p < 0.001) but not existent at all in women. In the overall cohort. BNP was not an accurate evaluate to detect left ventricular systolic dysfunction. The area under the ROC curve was 0.643 (95% CI. 0.563–0.723). blocker therapy in advanced left ventricular dysfunctionJournal of the American College of Cardiology, Volume 38. air 2, August 2001. Pages 436-442Brigitte Stanek. Bernhard Frey. Martin Hülsmann. Rudolf Berger. Barbara Sturm. Jeanette Strametz-Juranek. Jutta Bergler-Klein. Petra Moser. Anja Bojic. Engelber Hartter and Richard PacherAbstract Plasma hormones were measured at baseline and months 3. 6. 12 and 24 in 91 patients with heart failure (left ventricular ejection fraction [LVEF] <25%) receiving 40 mg enalapril/day and double-blind atenolol (50 to 100 mg/day) or placebo. After the double-blind study phase patients were followed up to four years. Stepwise multivariate regression analyses were performed with 10 variables (age etiology. LVEF symptom categorise atenolol/placebo norepinephrine big ET log aminoterminal atrial natriuretic peptide log aminoterminal B-type natriuretic peptide [N-BNP] and log B-type natriuretic peptide [BNP]). During the study the last values prior to patient death were used and in survivors the measure hormone level. New York Heart Association class and LVEF at month 24 were used. In patients with advanced LV dysfunction receiving high-dose angiotensin-converting enzyme inhibitors and beta-blocker therapy BNP and N-BNP plasma levels are both independently related to mortality. This observation highlights the importance of these hormones and implies that they will likely appear as a very useful blood test for detection of the progression of heart failure even in the face of neurohumoral blocking therapy. There were 103 factors identified in 72 studies. Most of the cardiac diseases were positively associated with BNP and NT-proBNP concentrations and of the non-cardiac conditions dyspnea diabetic nephropathy and touch were all associated with higher concentrations. Most biochemical and hematological markers showed positive associations. Factors that assessed heart function showed both positive and negative associations and drug therapy was either negatively associated or had no cause on BNP or BNT-proBNP concentrations. Few studies reported independent associations and of those that did age female gender and creatinine concentrations were positively associated with BNP and NT-proBNP. type natriuretic peptide assays for identifying heart failure in stable elderly patients with a clinical diagnosis of chronic obstructive pulmonary diseaseEuropean Journal of Heart Failure, Volume 9. Issues 6-7, June-July 2007. Pages 651-659Frans H. Rutten. Maarten-Jan M. Cramer. Nicolaas P. A. Zuithoff. Jan-Willem J. Lammers. Wim Verweij. Diederick E. Grobbee and Arno W. HoesAbstract 200 patients aged ≥ 65 years with COPD according to their general practitioner and without known heart failure underwent a diagnostic work-up. The final diagnosis of heart failure was established by a adorn using the diagnostic principles of the European Society of Cardiology. All available diagnostic results including echocardiography but not BNP or NT-proBNP measurements were used. The ability of different B-type natriuretic peptide assays to determine heart failure was estimated using the area under the receiver operating characteristic curves (ROC-area). The ROC-areas did not differ significantly between the various assays of NT-proBNP and BNP and ranged from 0.68 (95%CI 0.60–0.73) to 0.73 (95%CI 0.64–0.81). For NT-proBNP the age- and gender-independent ‘optimal’ cut-point was 15 pmol/l (125 pg/ml) and for BNP 10 pmol/l (35 pg/ml). All assays were much better at excluding than detecting heart failure. This was a retrospective analysis of 221 HF patients. Improvement in left ventricular function was defined as an improvement in ejection calculate (LVEF) of ≥ 10% on echocardiography. Return to normal was defined as an improvement of LVEF to ≥ 50% and a reduction in left ventricular end diastolic diameter to ≤ 55 mm. Changes in BNP were also recorded. Improvement in LVEF was observed in 44.3% of patients and return to normal systolic answer in 10.9% only 2.3% had both a go to normal echocardiographic parameters and a BNP< 100 pg/ml. A higher percentage of the improved group were on target doses of β-blockers (p = 0.004). Baseline BNP was not a predictor of improvement. There was a trend towards a reduction in HF readmissions in the improved group (p = 0.07) but no difference in the risk of death or all-cause readmission.

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Related article:
http://www.sciencedirect.com/science?_ob=GatewayURL&_origin=IRSSSEARCH&_method=citationSearch&_piikey=S138898420700400X&_version=1&md5=d0ca5ca189832196a20b06e972d3677d

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"Improvement but no cure of left ventricular systolic dysfunction ..." posted by ~Ray
Posted on 2008-03-03 21:33:55

Median LVEF was 57% (IQR. 50 to 64) and median BNP level was 53 pg/ml (IQR. 24 to 109). LVEF and BNP levels showed a statistically significant but overall weak correlation (r = 0.274 p < 0.001). The correlation seemed to depend on the presence of a myocardial scar which was detected in 104 patients (40%) including 89 men (49% of men) and 15 women (20% of women). The correlation between BNP and LVEF was moderate in patients with a myocardial scar (r = − 0.540 p < 0.001) but very weak in patients without a blemish (r = 0.185 p = 0.025). Moreover the correlation between BNP and LVEF was moderate in men (r = − 0.503 p < 0.001) but not existent at all in women. In the overall cohort. BNP was not an accurate test to detect left ventricular systolic dysfunction. The area under the ROC turn was 0.643 (95% CI. 0.563–0.723). blocker therapy in advanced left ventricular dysfunctionJournal of the American College of Cardiology, Volume 38. air 2, August 2001. Pages 436-442Brigitte Stanek. Bernhard Frey. Martin Hülsmann. Rudolf Berger. Barbara Sturm. Jeanette Strametz-Juranek. Jutta Bergler-Klein. Petra Moser. Anja Bojic. Engelber Hartter and Richard PacherAbstract Plasma hormones were measured at baseline and months 3. 6. 12 and 24 in 91 patients with heart failure (left ventricular ejection fraction [LVEF] <25%) receiving 40 mg enalapril/day and double-blind atenolol (50 to 100 mg/day) or placebo. After the double-blind chew over phase patients were followed up to four years. Stepwise multivariate regression analyses were performed with 10 variables (age etiology. LVEF symptom categorise atenolol/placebo norepinephrine big ET log aminoterminal atrial natriuretic peptide log aminoterminal B-type natriuretic peptide [N-BNP] and log B-type natriuretic peptide [BNP]). During the study the measure values prior to patient death were used and in survivors the measure hormone aim. New York Heart Association categorise and LVEF at month 24 were used. In patients with advanced LV dysfunction receiving high-dose angiotensin-converting enzyme inhibitors and beta-blocker therapy BNP and N-BNP plasma levels are both independently related to mortality. This observation highlights the importance of these hormones and implies that they will likely emerge as a very useful daub test for detection of the progression of heart failure even in the approach of neurohumoral blocking therapy. There were 103 factors identified in 72 studies. Most of the cardiac diseases were positively associated with BNP and NT-proBNP concentrations and of the non-cardiac conditions dyspnea diabetic nephropathy and touch were all associated with higher concentrations. Most biochemical and hematological markers showed positive associations. Factors that assessed heart function showed both positive and contradict associations and drug therapy was either negatively associated or had no effect on BNP or BNT-proBNP concentrations. Few studies reported independent associations and of those that did age female gender and creatinine concentrations were positively associated with BNP and NT-proBNP. type natriuretic peptide assays for identifying heart failure in stable elderly patients with a clinical diagnosis of chronic obstructive pulmonary diseaseEuropean Journal of Heart Failure, Volume 9. Issues 6-7, June-July 2007. Pages 651-659Frans H. Rutten. Maarten-Jan M. Cramer. Nicolaas P. A. Zuithoff. Jan-Willem J. Lammers. Wim Verweij. Diederick E. Grobbee and Arno W. HoesAbstract 200 patients aged ≥ 65 years with COPD according to their general practitioner and without known heart failure underwent a diagnostic work-up. The final diagnosis of heart failure was established by a adorn using the diagnostic principles of the European Society of Cardiology. All available diagnostic results including echocardiography but not BNP or NT-proBNP measurements were used. The ability of different B-type natriuretic peptide assays to identify heart failure was estimated using the area under the receiver operating characteristic curves (ROC-area). The ROC-areas did not differ significantly between the various assays of NT-proBNP and BNP and ranged from 0.68 (95%CI 0.60–0.73) to 0.73 (95%CI 0.64–0.81). For NT-proBNP the age- and gender-independent ‘optimal’ cut-point was 15 pmol/l (125 pg/ml) and for BNP 10 pmol/l (35 pg/ml). All assays were much better at excluding than detecting heart failure. This was a retrospective analysis of 221 HF patients. Improvement in left ventricular function was defined as an improvement in ejection fraction (LVEF) of ≥ 10% on echocardiography. go to normal was defined as an improvement of LVEF to ≥ 50% and a reduction in left ventricular end diastolic diameter to ≤ 55 mm. Changes in BNP were also recorded. Improvement in LVEF was observed in 44.3% of patients and return to normal systolic function in 10.9% only 2.3% had both a return to normal echocardiographic parameters and a BNP< 100 pg/ml. A higher percentage of the improved group were on target doses of β-blockers (p = 0.004). Baseline BNP was not a predictor of improvement. There was a trend towards a reduction in HF readmissions in the improved group (p = 0.07) but no difference in the risk of death or all-cause readmission.

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Related article:
http://www.sciencedirect.com/science?_ob=GatewayURL&_origin=IRSSSEARCH&_method=citationSearch&_piikey=S138898420700400X&_version=1&md5=d0ca5ca189832196a20b06e972d3677d

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"Improvement but no cure of left ventricular systolic dysfunction ..." posted by ~Ray
Posted on 2008-03-03 21:33:55

Median LVEF was 57% (IQR. 50 to 64) and median BNP level was 53 pg/ml (IQR. 24 to 109). LVEF and BNP levels showed a statistically significant but overall weak correlation (r = 0.274 p < 0.001). The correlation seemed to depend on the presence of a myocardial scar which was detected in 104 patients (40%) including 89 men (49% of men) and 15 women (20% of women). The correlation between BNP and LVEF was moderate in patients with a myocardial scar (r = − 0.540 p < 0.001) but very weak in patients without a scar (r = 0.185 p = 0.025). Moreover the correlation between BNP and LVEF was moderate in men (r = − 0.503 p < 0.001) but not existent at all in women. In the overall cohort. BNP was not an accurate test to detect left ventricular systolic dysfunction. The area under the ROC curve was 0.643 (95% CI. 0.563–0.723). blocker therapy in advanced left ventricular dysfunctionJournal of the American College of Cardiology, Volume 38. Issue 2, August 2001. Pages 436-442Brigitte Stanek. Bernhard Frey. Martin Hülsmann. Rudolf Berger. Barbara Sturm. Jeanette Strametz-Juranek. Jutta Bergler-Klein. Petra Moser. Anja Bojic. Engelber Hartter and Richard PacherAbstract Plasma hormones were measured at baseline and months 3. 6. 12 and 24 in 91 patients with heart failure (left ventricular ejection fraction [LVEF] <25%) receiving 40 mg enalapril/day and double-blind atenolol (50 to 100 mg/day) or placebo. After the double-blind study phase patients were followed up to four years. Stepwise multivariate regression analyses were performed with 10 variables (age etiology. LVEF symptom class atenolol/placebo norepinephrine big ET log aminoterminal atrial natriuretic peptide log aminoterminal B-type natriuretic peptide [N-BNP] and log B-type natriuretic peptide [BNP]). During the study the measure values prior to patient death were used and in survivors the measure hormone level. New York Heart Association categorise and LVEF at month 24 were used. In patients with advanced LV dysfunction receiving high-dose angiotensin-converting enzyme inhibitors and beta-blocker therapy BNP and N-BNP plasma levels are both independently related to mortality. This observation highlights the importance of these hormones and implies that they will likely emerge as a very useful blood test for detection of the progression of heart failure change surface in the approach of neurohumoral blocking therapy. There were 103 factors identified in 72 studies. Most of the cardiac diseases were positively associated with BNP and NT-proBNP concentrations and of the non-cardiac conditions dyspnea diabetic nephropathy and stroke were all associated with higher concentrations. Most biochemical and hematological markers showed positive associations. Factors that assessed heart function showed both positive and negative associations and medicate therapy was either negatively associated or had no cause on BNP or BNT-proBNP concentrations. Few studies reported independent associations and of those that did age female gender and creatinine concentrations were positively associated with BNP and NT-proBNP. type natriuretic peptide assays for identifying heart failure in shelter elderly patients with a clinical diagnosis of chronic obstructive pulmonary diseaseEuropean Journal of Heart Failure, Volume 9. Issues 6-7, June-July 2007. Pages 651-659Frans H. Rutten. Maarten-Jan M. Cramer. Nicolaas P. A. Zuithoff. Jan-Willem J. Lammers. Wim Verweij. Diederick E. Grobbee and Arno W. HoesAbstract 200 patients aged ≥ 65 years with COPD according to their general practitioner and without known heart failure underwent a diagnostic work-up. The final diagnosis of heart failure was established by a adorn using the diagnostic principles of the European Society of Cardiology. All available diagnostic results including echocardiography but not BNP or NT-proBNP measurements were used. The ability of different B-type natriuretic peptide assays to determine heart failure was estimated using the area under the receiver operating characteristic curves (ROC-area). The ROC-areas did not differ significantly between the various assays of NT-proBNP and BNP and ranged from 0.68 (95%CI 0.60–0.73) to 0.73 (95%CI 0.64–0.81). For NT-proBNP the age- and gender-independent ‘optimal’ cut-point was 15 pmol/l (125 pg/ml) and for BNP 10 pmol/l (35 pg/ml). All assays were much better at excluding than detecting heart failure. This was a retrospective analysis of 221 HF patients. Improvement in left ventricular function was defined as an improvement in ejection fraction (LVEF) of ≥ 10% on echocardiography. go to normal was defined as an improvement of LVEF to ≥ 50% and a reduction in left ventricular end diastolic diameter to ≤ 55 mm. Changes in BNP were also recorded. Improvement in LVEF was observed in 44.3% of patients and go to normal systolic function in 10.9% only 2.3% had both a return to normal echocardiographic parameters and a BNP< 100 pg/ml. A higher percentage of the improved group were on aim doses of β-blockers (p = 0.004). Baseline BNP was not a predictor of improvement. There was a trend towards a reduction in HF readmissions in the improved group (p = 0.07) but no difference in the risk of death or all-cause readmission.

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