quality of life and unchanged plasma level of brain natriuretic peptide and IL-6. Phase 2: for patients with the lower BMI (26.2 4- 0.7 kg/m2), the use of 6g salt/day ...
Poster Display L Neuro-hormones and cytokines quality of life and unchanged plasma level of brain natriuretic peptide and IL-6. Phase 2: for patients with the lower BMI (26.2 4- 0.7 kg/m2), the use of 6g salt/day dropped acutely the plasma norepinephrine (7354-90 vs 5904-74 pg/mL, p=0.03), calcium (54-0,03 vs 4,94.0,04 mg/dL, p=0.005), glucose (115=t=7 vs 1104.6 mg/dL, p=0.0l), albumin (4,74-0,1 vs 4,64-0,1 g/mL, p=0.01), cholesterol (2034-7 vs 1984.7 mg/mL, p=0.04) but had no effects on quality of life. For patients with higher BMI we did not find any differences for food consumption, as well as for the biochemistry data and quality of life. Conclusion: Low salt diet can be associated to neurohormonal activation and reduction of intake of protein. However, difference in response may be dependent of BMI. The intake of salt for patients with heart failure should be individualized, since the response for dietary salt can be distinct between different subjects. Further studies to test dietary salt restriction for a longer periods is recommended.
90 Normal values and within-subject variability of cardiac 123I-metaiodobenzylguanidine scintigraphy in healthy individuals; implications for studying sympathetic activity in heart failure patients.
Sunday, 13 June 2004
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Methods: We examined 19 in-patients with decompensated CHF (all NYHA IV). All of them had insufficient diuretic response (less than 1500 ml/day) to i. v. furosemide (average - 157,9 4, 15,0 mg daily) combined with spironolactone (average - 85,9 4- 10,2 mg daily). Enoxaparine (40 mg daily) adininistred for a period 5 days, during which doses of diuretics and other drugs didn't change. Plasma aldosterone samples were taken before and after enoxaparine administration. Study was non-placebocontrolled, based on ethical reasons. Results: After enoxaparine administration daily diuresis increased progressively (baseline 1265 4, 108 ml, 1st day - 1700 4- 148 ml, 2nd day - 1920 4- 153 ml, 3rd day - 2020 4. 162 ml, 4th day - 2087 4- 160 ml, 5th day - 1985 :/: 155 ml - p < 0,01 vs baseline). It accompanied by significant decrease of body mass (from 84,8 + 2,3 to 81,3 4- 2,2 kg, p < 0,0l) and plasma aldosterone level (from 210,9 4, 38,4 to 129,7 4- 13,6 pg/ml, p < 0,05). There was a direct significant correlation between plasma aldosterone reduction and average daily diuresis increment during enoxaparin treatment (figure). Ci:orrt~l~tion: r ~ - 13,6833, D ----0 . 0 0 7 o.
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G. A. Somsen 1, H. Verberne 2, E. Fleury 1, A. Righetti 1
JHopital Cantonal de Geneve, Cardiology, Geneve, Switzerland," 2Academic Medical Centre, Nuclear Medicine, Amsterdam, Netherlands Background: [123I]-meta-iodobenzylguanidine (MIBG) scintigraphy can be used to assess cardiac sympathetic activity which is related to severity and prognosis in heart failure. Although cardiac MIBG scintigraphy is increasingly used to monitor the effect of therapeutical interventions, normal values and within-subject variability are lacking. Therefore, we determined the normal values and within-subject variability of clinically used scintigraphic MIBG indices in a relatively large cohort of healthy individuals. Methods: 25 healthy volunteers underwent planar and Single Photon Emission Computed Tomography (SPECT) imaging at 15 (early) and 240 (late) minutes after MIBG injection. In 9 subjects a second M1BG scintigraphy was performed after 3 months to determine within-subject variability. Heart-Mediastinum ratio (H/M) and cardiac washout were calculated for planar and SPECT images. On late SPECT images relative segmental uptake (% maximum myocardial uptake) was determined in septal, antero-lateral and inferior segments. Results: H/M was 1.894.0.14 and 1.934.0.16 at 15 and 240 minutes, respectively. Washout was 37.04-5.5% and 27.04-7.4% for planar and SPECT images, respectively. Segmental uptake on late SPECT images was: septal 0.984-0.06%, antero-lateral 1.074.0.05% and inferior 0.954-0.07%. The within-subject variability of all planar and SPECT indices, calculated as the coefficient of variation, was 5% or less. Conclusion: MIBG H/M and washout derived from planar images and relative segmental MIBG uptake obtained from SPECT images show a low inter-individual and within-subject variability. This enables the detection of small (regional) variations in cardiac sympathetic nervous function which is of clinical value, especially to monitor the effect of therapeutic interventions in heart failure patients.
91 Anti-aldosterone and diuretic effects of enoxaparine in severe decompensated heart failure. L. Voronkov 1, E. Besaga 1, S. Savitsky 2, E. Zaika 1
JStrazhesco Institute of Cardiology, Heart Failure Department, Kyiv, Ukraine; 2Strazhesco institute of Cardiology, Department of Radioisotopic Assay, Kyiv, Ukraine Objectives: Heparine is one of major physiologic inhibitors of aldosterone synthesis. We tested the hypotesis that low-molecular heparine enoxaparine may be effective in treatment of severe oedema in congestive heart failure (CHF) due to its probable anti-aldosterone mechanism.
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Conclusions: Enoxaparine demonstrated anti-aldosterone and diuretic effects in severe decompensated CttF. This observation seems to be promising in regard of new anti-aldosterone strategy in CHF management.
92 Osteopontin plasma levels are elevated in patients with chronic heart failure in relation to clinical severity and cytokine expression. S. Del Ry, M. Maltinti, R. Poletti, C. Pass±no, M. Emdin, D. Giannessi CNR, Institute of Clinical Physiology, Pisa, Italy Osteopontin (OPN) is an extracellular matrix protein also expressed in myocardinm in response to necrotic injury and in experimental models of chronic heart failure (CHF). No data are available about plasma levels of this protein in CHF patients. Aim of this study was to assess the circulating levels OPN in patients with CHF with relation to clinical severity and to the levels of interleukin (1L)-6, a cytokine associated with poor evolution of disease. Plasma levels of OPN and IL-6 were evaluated in 125 CHF subjects (age range: 20-87 yrs, LVEF%
