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Serotonin a Possible Marker for Decompensated Heart Failure






 Serotonin a Possible Marker for Decompensated Heart Failure

SAN DIEGO – Plasma levels of serotonin were significantly elevated in patients with decompensated systolic heart failure, compared with patients in the compensated state and with normal controls, according to a single-center study.
The finding suggests that that serotonin has an active role in the progression of heart failure, researchers led by Dr. Ahmed M. Selim reported Sept. 15 during a poster session at the annual meeting of the Heart Failure Society of America.
“More studies should be done to test the sensitivity, specificity, and prognostic value of serotonin as a marker for congestive heart failure and also to investigate the therapeutic benefits of the medications affecting this pathway,” wrote the researchers from the department of cardiology at Albert Einstein College of Medicine, New York.
They noted that, while the relationship between heart failure and the serotoninergic system has been established in previous research, fluctuations in serotonin levels during the course of the disease and its correlation with exacerbation of heart failure have never been tested.
Dr. Selim, a heart failure research fellow, and his associates collected plasma serotonin levels from 29 patients who were admitted with decompensated heart failure, 61 patients with stable heart failure, and 22 normal controls. They excluded patients receiving medications affecting serotonin receptors and those with pulmonary hypertension. All heart failure patients were on stable doses of heart failure medications and had left-ventricular ejections fractions of 40% or less, while normal controls had a mean ejection fraction of 59%.
Overall, the mean age of patients was 55 years, and 62% were male.
The researchers reported that the mean serotonin level in the control group was 2.4 ng/mL, compared with 4.1 ng/mL in the compensated group and 11.8 ng/mL in the decompensated group. This was independent of age, race, renal function, diabetes mellitus, and hypertension. “All results were highly significant,” the researchers wrote.
Dr. Selim and his associates stated that they had no relevant financial disclosures to make.

Elevated BNP Predicts Risk in General Population


 Elevated BNP Predicts Risk in General Population


STOCKHOLM – High plasma levels of B-type natriuretic peptide linked with a significantly increased risk for heart failure, myocardial infarction, and death during 9 years of follow-up in a group of nearly 2,000 adults from the general U.S. population.
Plasma levels of B-type natriuretic peptide (BNP) “had predictive utility for death, heart failure, and MI, even when adjusted for risk factors and structural abnormalities” of the heart in the general population, Dr. Paul M. McKie said at the annual Congress of the European Society of Cardiology.
“We’re actively working on trying to narrow down the at-risk population” who are possible candidates for routine BNP screening, said Dr. McKie, a cardiologist at the Mayo Clinic in Rochester, Minn. “We’re planning a proof-of-concept intervention trial to see if we can intervene with aggressive risk factor reduction and improve outcomes in people with high BNP levels.” People who may get the most benefit from BNP screening and intervention are those with some level of underlying cardiac risk but no current heart failure, he added.
Results from another analysis recently reported by Dr. McKie and his associates at Mayo showed that relatively high BNP levels could not predict the long-term risk of death or cardiovascular events in people from the general adult population without symptomatic heart failure, elevated plasma creatinine, clinical cardiovascular risk factors (such as hypertension, diabetes, peripheral vascular disease, or MI), or cardiac abnormalities identified by echocardiography (such as left atrial enlargement, wall-motion abnormalities, and valvular dysfunction) (J. Am. Coll. Cardiol. 2010;55:2140-7).
That finding, coupled with the new report, suggests that high BNP is prognostic in the people without heart failure or elevated creatinine but with one or more risk factors or a cardiac structural abnormality, which was found in a majority of the general population studied. Among 2,042 unselected people aged 45 years or older residing in Olmsted County, Minn., and participating in the Rochester Epidemiology Project, 1,288 (63%) had one or more clinical risk factors or an echocardiographic abnormality.
The new analysis began with the 2,042 Olmsted County residents and excluded 45 who had symptomatic heart failure, and 6 with a plasma creatinine of more than 2.0 mg/dL. The researchers measured plasma levels of BNP (specifically amino-terminal pro-BNP) with an immunoassay. These healthy, normal subjects from the community without symptomatic heart failure or elevated creatinine had BNP levels well below the levels found in patients with heart failure, Dr. McKie said.
The analysis examined the risk for death, incident heart failure, or incident MI during an average 9 years of follow-up. People in the highest BNP tertile consistently had double the rates of all three outcomes during follow-up than did people in the lowest tertile after adjustment for age, sex, body mass index, clinical risk factors, or echocardiographic abnormalities, differences that were statistically significant. The analysis also showed that the link between high BNP levels and adverse outcomes remained significant after adjustment for plasma levels of atrial natriuretic peptide. “BNP is a more robust prognostic marker than atrial natriuretic peptide in the general population without heart failure,” Dr. McKie said.
Dr. McKie said that he had no disclosures.
Hazard Ratios for Top Tertile of Plasma BNP, Compared With Lowest Tertile

Elevated BNP Predicts Risk in General Population



 Elevated BNP Predicts Risk in General Population


STOCKHOLM – High plasma levels of B-type natriuretic peptide linked with a significantly increased risk for heart failure, myocardial infarction, and death during 9 years of follow-up in a group of nearly 2,000 adults from the general U.S. population.
Plasma levels of B-type natriuretic peptide (BNP) “had predictive utility for death, heart failure, and MI, even when adjusted for risk factors and structural abnormalities” of the heart in the general population, Dr. Paul M. McKie said at the annual Congress of the European Society of Cardiology.
“We’re actively working on trying to narrow down the at-risk population” who are possible candidates for routine BNP screening, said Dr. McKie, a cardiologist at the Mayo Clinic in Rochester, Minn. “We’re planning a proof-of-concept intervention trial to see if we can intervene with aggressive risk factor reduction and improve outcomes in people with high BNP levels.” People who may get the most benefit from BNP screening and intervention are those with some level of underlying cardiac risk but no current heart failure, he added.
Results from another analysis recently reported by Dr. McKie and his associates at Mayo showed that relatively high BNP levels could not predict the long-term risk of death or cardiovascular events in people from the general adult population without symptomatic heart failure, elevated plasma creatinine, clinical cardiovascular risk factors (such as hypertension, diabetes, peripheral vascular disease, or MI), or cardiac abnormalities identified by echocardiography (such as left atrial enlargement, wall-motion abnormalities, and valvular dysfunction) (J. Am. Coll. Cardiol. 2010;55:2140-7).
That finding, coupled with the new report, suggests that high BNP is prognostic in the people without heart failure or elevated creatinine but with one or more risk factors or a cardiac structural abnormality, which was found in a majority of the general population studied. Among 2,042 unselected people aged 45 years or older residing in Olmsted County, Minn., and participating in the Rochester Epidemiology Project, 1,288 (63%) had one or more clinical risk factors or an echocardiographic abnormality.
The new analysis began with the 2,042 Olmsted County residents and excluded 45 who had symptomatic heart failure, and 6 with a plasma creatinine of more than 2.0 mg/dL. The researchers measured plasma levels of BNP (specifically amino-terminal pro-BNP) with an immunoassay. These healthy, normal subjects from the community without symptomatic heart failure or elevated creatinine had BNP levels well below the levels found in patients with heart failure, Dr. McKie said.
The analysis examined the risk for death, incident heart failure, or incident MI during an average 9 years of follow-up. People in the highest BNP tertile consistently had double the rates of all three outcomes during follow-up than did people in the lowest tertile after adjustment for age, sex, body mass index, clinical risk factors, or echocardiographic abnormalities, differences that were statistically significant. The analysis also showed that the link between high BNP levels and adverse outcomes remained significant after adjustment for plasma levels of atrial natriuretic peptide. “BNP is a more robust prognostic marker than atrial natriuretic peptide in the general population without heart failure,” Dr. McKie said.
Dr. McKie said that he had no disclosures.
Hazard Ratios for Top Tertile of Plasma BNP, Compared With Lowest Tertile

Robotic Catheter Could Improve Treatment of Heart Condition


ScienceDaily (Sep. 16, 2010) — Atrial fibrillation is a heart disorder that affects more than two million Americans, and is considered a key contributor to blood clots and stroke. Now researchers from North Carolina State University are developing a new computerized catheter that could make the surgical treatment of atrial fibrillation faster, cheaper and more effective -- while significantly decreasing radiation exposure related to the treatment.


"We are developing a robotic catheter with significantly improved maneuverability and control," says Dr. Gregory Buckner, a professor of mechanical and aerospace engineering at NC State and lead researcher of the team developing the new catheter. "This should reduce the time needed to perform atrial ablation procedures and improve patient outcomes."
Atrial fibrillation occurs when there is random electrical activity in the upper chambers of the heart, the atria. This causes the heart to operate less efficiently, and can lead to lightheadedness and fatigue. It can also lead to blood pooling in the heart, which contributes to blood clots and increased risk of stroke.
Doctors have developed a cardiac ablation technique that mitigates fibrillation by inserting a catheter into the heart and then using extreme heat or cold to create small scars through the walls of the affected atria. These scars block the problematic electrical signals. Throughout this procedure, doctors use X-rays to track the tip of the catheter -- exposing the patient and medical personnel to radiation.
Existing commercial catheters are manually controlled and can only move in two directions. These catheters require doctors to painstakingly manipulate the catheter to control exactly where each individual lesion should be applied.
But the robotic catheter developed by Buckner's team significantly reduce operating times, utilizing "smart materials" to provide significantly better maneuverability. The smart materials act as internal muscles, contracting when an electric current is applied. This allows the catheter to bend left, right, up, down or any combination of those directions. Furthermore, doctors can use a specialized joystick to locate key points on the atrium. A computer program can then trace a curve along those points -- essentially connecting the dots -- creating a solid line of scar tissue that will block the electric signals causing fibrillation.
"If we can reduce the duration of the procedure, it will simultaneously reduce radiation exposure for the patient and medical personnel," Buckner says. "It will also provide cost savings for hospitals and health insurance companies."
The researchers received a Phase II Small Business Innovation Research grant from the National Institutes of Health in August to take their "robotic catheter" prototype from the lab and put it into the hands of doctors. The $1.1 million grant will fund two years of development and surgical testing. Approximately half of these funds will go to NC State, while the remainder will go to Southeast TechInventures, which will help bring the technology to the marketplace.
Other members of Buckner's research team include Dr. Bruce Keene and Dr. Guillaume Chanoit of NC State's College of Veterinary Medicine, and Dr. Salim Idriss, a pediatric electrophysiologist at Duke University Medical Center. Surgical evaluations of their robotic catheter prototypes will begin in 2011.
Other groups have commercialized their own robotic catheter designs, but these require multi-million dollar capital investments and customized catheter laboratories. Buckner's technology could be made available at a fraction of the cost to a larger number of patients due to significant reductions in initial overhead and operational costs, as well as logistical concerns.
NC State's Department of Mechanical and Aerospace Engineering is part of the university's College of Engineering.

Getting the News Out: Disease Transmission Model Says Media Coverage Cuts Infection Rate and Pandemic Extent





ScienceDaily (Sep. 16, 2010) — At the first sign of a disease pandemic, public health officials should begin strongly communicating about the extent of the outbreak and the steps that can be taken by the public to avoid infection. That's the recommendation of two mathematical biologists who have modified the most widely used infectious disease transmission model to account for the impact of news media coverage.

During outbreaks of serious infectious diseases, many individuals closely follow media reports and as a result, take precautions to protect themselves against the disease. These precautions may include staying home, getting vaccinated, avoiding crowds, using disinfectants, canceling travel plans and wearing face masks.
Known as "self-isolation," these precautions can significantly reduce the severity of an outbreak, according to mathematical modeling done by researchers at the Georgia Institute of Technology and Marshall University in Huntington, West Virginia.
"The more forcefully the media provides information about pandemic infections and deaths, the more the total number of infections is reduced," said Howard Weiss, a professor in the Georgia Tech School of Mathematics. "Media coverage also reduces the maximum number of infections at any particular time, which is important for allocating the resources needed for treating infectious diseases."
The benefit of publicly reporting disease outbreaks seems obvious, and public health officials in the United States have a policy of regularly communicating with the news media about such incidents. But according to Weiss, not all world governments choose to communicate so well -- and nobody had used rigorous mathematical techniques to study the impact of that communication before.
Epidemiologists use the S-I-R model to anticipate the effect of disease outbreaks. The basic model places individuals into one of three groups signified by each letter of the acronym:
  • Susceptible individuals are those that are vulnerable to the disease;
  • Infected individuals are those who have the disease;
  • Removed individuals are those who are not in the other groups because they have been vaccinated, have isolated themselves from the population, have already recovered from the disease -- or have died.
Weiss and collaborator Anna Mummert, an assistant professor of mathematics at Marshall University, modified that model to take into account ways that individuals could move from the "Susceptible" group to the "Removed" group without passing through the "Infected" group. By "self-isolating" as a result of news media warnings, they reasoned, individuals could move directly into the "Removed" class because they are no longer susceptible.
"On a chart showing the number of infected people at any one time, as you increase the intensity of the media coverage, you substantially decrease the number of infections," Weiss noted. "We are assuming that people self-isolate at a rate that is proportional to the amount of media coverage, though we would like to study that in more detail."
The sooner the media coverage of a pandemic begins, the fewer individuals will ultimately be infected. But Weiss said the model shows that almost any media coverage is helpful at reducing the extent of a pandemic.
"Telling the public always helps, but the longer you wait, the less it helps," he said. "If you wait long enough, the effect of media coverage is essentially negligible."
In a paper about the model submitted to a biostatistics journal, Mummert and Weiss describe testing their model with a hypothetical outbreak of Ebola Hemorrhagic Fever in Huntington -- a college community of about 50,000 residents.
They also tested the model on a long-term infection -- HIV, the virus that causes AIDS. In the case of pandemics that occur over a long period of time, regular coverage by the news media may be required to maintain a lower infection rate.
In their model, Mummert and Weiss did not look at such issues as the quality of news coverage, or what may happen if news reports turn out to be false or overstated. They also didn't study the effect of individuals occasionally leaving their isolation to purchase food or medicine, for instance.
The paper cites the case of a false rumor spread across the Internet in 2003 about a restaurant worker in New York's Chinatown who had supposedly died of the SARS infection. That rumor led to a decrease in travel to that area.
Likewise, they note, a recommendation from the Centers for Disease Control and Prevention in 2003 to avoid nonessential travel to SARS-infected nations led to a dramatic reduction in travel to those areas.
Weiss acknowledges that strong communications about such dreaded diseases as Ebola could create public panic. In those rare cases, public health officials will have to weigh the benefits against the risks.
"In general, our advice to public health officials anywhere in the world is not to hold back," he added. "They should get out the news about infectious disease outbreaks loudly and quickly. It's clear that vigorous media reporting can have a substantial effect on reducing the impact of an outbreak."

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