Document Detail

Ventricular-vascular uncoupling increases expression of B-type natriuretic peptide in heart transplantation.
MedLine Citation:
PMID:  15686715     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Allograft adaptation to a foreign circulation is imperfect as noted from persistent limitations to stress. Effective arterial elastance (Ea), a measure of afterload, provides an estimate of aortic impedance. End systolic elastance (Ees) is a load-independent measure of ventricular performance as well as its interaction in the periphery. The ratio (Ea to Ees) characterizes ventricular-vascular coupling; a value close to unity signifies poor mechanical efficiency. The purpose of this investigation was to correlate mechanical efficiency of work with expression of B-type natriuretic peptide BNP, a specific marker of ventricular stress and strain. METHODS: We measured BNP levels in 40 consecutive stable heart transplant recipients free from rejection. In addition, echocardiography was performed to obtain Ea, Ees, and their ratio (Ea to Ees) by the single-beat method. We examined correlates of BNP expression by assessing Ea to Ees, while correcting for mean arterial pressure, body mass index, left ventricular mass index, ejection fraction, and serum creatinine. RESULTS: BNP levels were significantly and positively correlated (r=0.38, P=.05) with an increased Ea to Ees ratio. By multivariable analysis, this relationship persisted independently (t=2.1, P=.04), while the five other measures were insignificant predictors. CONCLUSION: This investigation indicated that the transplanted heart demonstrates poor contractile efficiency and operates at maximal left ventricular work. This is paralleled by a tandem increase in BNP, suggesting that elevation in this stress peptide is at least partly explained by ventriculo-vascular uncoupling in heart transplantation, independent of alterations in blood pressure.
M R Mehra; R V Milani; M B Richie; P A Uber; M H Park; H O Ventura; R L Scott; C J Lavie
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Transplantation proceedings     Volume:  36     ISSN:  0041-1345     ISO Abbreviation:  Transplant. Proc.     Publication Date:  2004 Dec 
Date Detail:
Created Date:  2005-02-02     Completed Date:  2005-07-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0243532     Medline TA:  Transplant Proc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  3149-51     Citation Subset:  IM    
Cardiomyopathy and Heart Transplantation Center Ochsner Clinic Foundation, New Orleans, Louisiana 70121, USA.
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MeSH Terms
Coronary Circulation / physiology*
Heart Transplantation / physiology*
Heart Ventricles
Multivariate Analysis
Myocardial Contraction / physiology*
Natriuretic Peptide, Brain / genetics*
Transplantation, Homologous / physiology
Reg. No./Substance:
114471-18-0/Natriuretic Peptide, Brain

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