Australian Journal of Basic and Applied Sciences, 9(36) December 2015, Pages: ISSN: Journal home page:

Size: px

Start display at page:

Download "Australian Journal of Basic and Applied Sciences, 9(36) December 2015, Pages: ISSN: Journal home page:"

Dominick Gilbert
5 years ago
Views:

ISSN:1991-8178 Australian Journal of Basic and Applied Sciences Journal home page: www.ajbasweb.

Physiology, College of Medicine, University of Babylon, Babylon, Iraq.

1 ISSN: Australian Journal of Basic and Applied Sciences Journal home page: Role of Biochemical Tests Artery Disease (ANP, BNP) in the Evaluation of Patients with Coronary 1 Saad Merza AL- Araji, 2 ShokryFaaz Al-Saad and 3 Abdulridha Mohammed Al-Asady 1 Department of Physiology, College of Medicine, University of Babylon, Babylon, Iraq. 2 Department of Physiology, College of Medicine, University of Babylon, Shaheed Al-mihrab Center for catheterization and cardiac surgery/marjan hospital, Babylon, Iraq. 3 Department of Physiology, College of Medicine, University of Babylon, Babylon, Iraq. A R T I C L E I N F O Article history: Received 10 November 2015 Accepted 30 December 2015 Available online 18 January 2016 Keywords: -Diagnosis of Coronary artery disease (CAD) -Atrial natriuretic peptide (ANP) -Brain natriuretic peptide (BNP) A B S T R A C T Background: Coronary artery disease is a major cause of mortality and ill-health. It presents in different ways. The underlying cause is a process of atherosclerosis, which leads to narrowing of the coronary arteries, restricting the blood flow to the heart muscle. Coronary heart disease prevalence is increasing all over the world including our community that is not only a need for better recognition of the warning signs of a heart attack, but also a tremendous need for more efforts targeting prevention (Mowatt, et al.,2008). This study review the current status of coronary diagnostic methods especially diagnostic Biochemical Tests (ANP, BNP). Objective: This study aimed to provide insight to know the physiological changes that help in prediction and diagnosis of coronary artery diseases (CAD). To assess the role of Biochemical Tests (ANP, BNP) in the initial evaluation of patients with moderate risk for coronary artery disease with equivocal or non-diagnostic non-invasive testss (ECG, stress test and echocardiography.etc) before proceeding to conventional (invasive) coronary catheterization. Results: The biochemical parameters like Atrial natriuretic peptide (ANP) and Brain natriuretic peptide (BNP) showed significant association (p<0.001) with coronary artery disease patients as well as diagnosed patients by coronary catheterization that having coronary artery disease. Conclusion: Natriuretic peptides like Atrial Natriuretic Peptide (ANP) and Brain Natriuretic Peptide (BNP) shows high relation with the CAD patients and these parameters play an important role when considered as diagnostic ways for diseases of coronary arteries AENSI Publisher All rights reserved. To Cite This Article: Saad Merza AL- Araji, Shokry Faaz Al-Saad and Abdulridha Mohammed Al-Asady., Role of Biochemical Tests (ANP, BNP) in the Evaluation of Patients with Coronary Artery Disease. Aust. J. Basic & Appl. Sci., 9(36): , 2015 INTRODUCTIONN This is an area where biochemical tests have traditionally not played any role. With the recent clinical characterization of cardiac natriuretic peptides, this promises to be an emerging field of Laboratory Medicine. Natriuretic hormones are a family of related peptides with similar peptide chains as well as degradation pathways. Cardiac natriuretic peptides include atrial natriuretic peptide (ANP) and Brain natriuretic peptide (BNP), while other natriuretic peptides, such as C-type natriuretic peptide and urodilatin, are not produced and secreted by cardiac tissue but by other tissues (Cowie, et al., 2002). Atrial natriuretic peptide ANP and Brain natriuretic peptide BNP derive from precursors, the pre-pro-hormones, which contain a signal peptide sequence at the N-terminal end (Clerico, et al., 2002) The pro-hormones are further split into inactive N- terminal fragments and the biologically active peptide hormones (Clerico, et al., 2002). Whereas ANP is secreted mainly from atrial cardiomyocytes, BNP is preferentially produced and secreted in the left ventricle, although this may be a simplification, as the right side of the human heart also synthesises and secretess BNP in response to disease (Kay, et al., 2003). In general, the plasma concentrations of these peptides are increased in diseases characterized by an expanded fluid volume, such as renal failure, primary aldosteronism and congestive heart failure (CHF), or by stimulation of peptide production caused by ventricular hypertrophy or strain, thyroid disease, excessive circulating glucocorticoid or hypoxia (Clerico, et al.,1999). In agreement with a recent commentary (Struthers, et al.,2002) it is therefore surprising that researchers focused for so long on the single issue of whether cardiac natriuretic peptides identified left Corresponding Author: Saad Merza AL- Araji, Department of Physiology, College of Medicine, University of Babylon, Babylon, Iraq.

2 189 Saad Merza AL- Araji et al, 2015 ventricular (LV) systolic dysfunction or not and did not recognize that these peptides should be used in a more general way in order to detect all cardiac abnormalities, including left ventricular (LV) hypertrophy, left ventricular (LV) diastolic dysfunction, atrial fibrillation and significant cardiac valve disease. It is now clear that measurement of cardiac natriuretic peptides in plasma does not unequivocally diagnose the specific underlying cause of a myocardial dysfunction but rather verify the need for further cardiac examination (Struthers, et al.,2002). Brain natriuretic peptide (BNP) has also emerged as prognostic indicators of long-term mortality early after an acute coronary event. This association was observed across the spectrum of acute coronary syndrome (ACS), including patients with ST-elevation myocardial infarction (STEMI), non-st-elevation myocardial infarction NSTEMI and unstable angina, those with and without elevated cardiac troponins, and those with and without clinical evidence of heart failure (Lemos, et al.,2002);(white, et al.,2003). However, more work remains to be carried out to determine the optimal decision limits for clinical interpretation, as well as the specific therapeutic strategies of persistent cardiac natriuretic peptide elevation in these patients. Quite recently, plasma natriuretic peptide concentrations were also related to risk of cardiovascular events and death in apparently asymptomatic persons (Wang, et al.,2004). MATERIALS AND METHODS Patients: The current study included 60 patients diagnosed by special doctors during the period extended from November 2014 to September The patients were recruited from Shaheed Al-mihrab Center for catheterization and cardiac surgery in Marjaan hospital /Hilla / Iraq. The ages of the patients ranged from 35 to 75 years. There were 38 male and 22 female. Physical Examination: The physical examination that was performed was focused on points that were essential and specific for coronary artery disease. It was divided into two divisions: First, general examination which include the examination for the presence of the cardiac sequels,features of heart failure,clinical sign of hyperlipidemia, blood pressure,pulse, finally systemic examination was done also for presence of systemic diseases. Second, chest examination was done including examination of the heart, lung and chest wall for any abnormalities were present. Biochemical Assessments: Serum ANP (Atrial Natriuretic Peptide) measurements: This ELISA kit uses Competitive-ELISA as the method. The microtiter plate provided in this kit has been pre-coated with ANP. During the reaction, ANP in the sample or standard competes with a fixed amount of ANP on the solid phase supporter for sites on the Biotinylated Detection Ab specific to ANP. Serum BNP (Brain Natriuretic Peptide) measurements: This ELISA kit uses Competitive-ELISA as the method. The microtiter plate provided in this kit has been pre-coated with BNP. During the reaction, BNP in the sample or standard competes with a fixed amount of BNP on the solid phase supporter for sites on the Biotinylated Detection Ab specific to BNP. Results: Serum Atrial Natriuretic Peptide (ANP): Atrial natriuretic peptide (ANP) levels increase (P< 0.001) in patients with cardiovascular-disease the mean (Mean± SD) of (ANP) levels for patients was ± pg/ml while for control it was 30.96±8.76 pg/ml (Table :1). Table 1: Different values of Atrial natriuretic peptide (ANP) between CAD patients and healthy control group in male and female before therapeutic catheterization. Gender Patients (ANP) (pg/ml) Control (ANP) (pg/ml) Mean ±SD Male 166.5±28.42 ** 34.8 ± 9.7 Female ±23.13 ** 28.7±8.6 Total ±30.3 ** 30.96±8.76 **High significant (P<0.001) For the same patients and after ten days to two weeks of a therapeutic catheterization process, a blood sample has been taking from each patient were examined the proportion of the Atrial natriuretic peptide (ANP) again and the (mean± SD) of patients was 33.97±6.1 pg/ml (Table :2).

3 190 Saad Merza AL- Araji et al, 2015 Table 2: Value of Atrial Natriuretic Peptide (ANP) in patients after therapeutic catheterization. Time Patients (ANP) (pg/ml) Before therapeutic catheterization ±30.3 After therapeutic catheterization ±6.1 Fig. 1: Different values of Atrial natriuretic peptide (ANP) between the result before and after operation and control. Serum Brain Natriuretic Peptide: Brain natriuretic peptide (BNP) levels increase (P< 0.001) in patients with cardiovascular-disease the (mean± SD) of (BNP) levels for patients was ± pg/ml while for control it was 38.24±12.68 pg/ml (Table :3). Table 3: Different values of Brain Natriuretic Peptide(BNP) between patients and healthy control group in male and female. Gender Patients (BNP) (pg/ml) Control (BNP) (pg/ml) Mean ±SD Male ±23.7 ** 39.8 ± 9.3 Female ±20.13 ** 36.7±7.63 Total ±28.1** 38.24±9.68 **High significant (P<0.001) For the same patients and after ten days to two weeks of a therapeutic catheterization process, a blood sample has been taking from each patient were examined the proportion of the Brain natriuretic peptide (BNP) again and the (mean± SD) of patients was ± pg/ml (Table :4). Table 4: Value of Brain natriuretic peptide (BNP) in patients after operation. Time Patients (BNP) (pg/ml) Before therapeutic catheterization ±28.1 After therapeutic catheterization ± 56.3

4 191 Saad Merza AL- Araji et al, Brain Natruretic Peptide before theraputic.coronary Cath after theraputic.coronary Cath Control Fig. 2: Brain Natriuretic Peptide (BNP) in patients with coronary artery disease before and after therapeutic catheterization and control. Discussion: Coronary artery syndrome is associated with a rise in atrial natriuretic peptide (ANP) level. The degree of elevation might reflect the severity of LV dysfunction (Morita, et al., 1993). Some have suggested using NP levels as a guide to institute more aggressive treatments aimed at reducing ventricular wall stress (Giugliano, et al.,2006). In our study the elevation in natriuretic peptides in different values of atrial natriuretic peptide (ANP) and brain natriuretic Peptide (BNP) between patients and healthy control group in male and female. B-type natriuretic peptide (BNP) has been used recently as a biological marker in patients with coronary artery disease (CAD). BNP is able to predict systolic dysfunction, adding new prognostic information to existing traditional markers. However it is not known if there is a relation between the quantity of BNP levels and the severity of coronary artery disease (Alberto, et al.,2011). On the other hand, Talwar, et al. (2000) did not find a difference between the BNP levels in patients with stable coronary artery disease and healthy controls. In our study there was a significant association between the serum level of BNP and the presence and extension of coronary artery lesion, this was in agreement with Alberto, et al. (2011). REFERENCES Alberto, C., A. Alan, C. Maria, B-type natriuretic peptide levels predict extent and severity of coronary disease in non-st elevation coronary syndromes and normal left ventricular systolic function Regul Peptides, 167: Clerico, A., G. Iervasi, M.G. Del Chicca, Circulating levels of cardiac natriuretic peptides (ANP and BNP) measured by highly sensitive and specific immunoradiometric assays in normal subjects and in patients with different degrees of heart failure.. J. Endocrinol. Invest., 21(3): Clerico, A., Pathophysiological and clinical relevance of circulating levels of cardiac natriuretic hormones: are they merely markers of cardiac disease? Clin. Chem. Lab. Med., 40: Cowie, M., G. Mendez, BNP and congestive heart failure. Progr. Cardiovasc. Dis. 44: Interface Design. John Wiley & Sons, Inc. Giugliano, E., Braunwald, The year in non ST-segment elevation acute coronary syndromes, J Am Coll Cardiol, 48: Kay, J., B. Trichon, K. Kisslo, Serum brain natriuretic peptide levels cannot differentiate pulmonary disease from left-heart failure if the right ventricle is dilated. Circulation., 108: IV-397. Lemos, M.C. and J. Tucker, The Use of Early Seasonal Climate Forecast in Northeast Brazil: Lessons from the Ceará case, Paper presented at the XXI International Congress of the Latin American Studies Association LASA 98, 24-26, Chicago, IL. Mowatt, G., E. Cummins, N. Waugh, S. Walker, J. Cook, X. Jia, G. Hillis, C. Fraser, Systematic review of the clinical effectiveness and costeffectiveness of 64-slice or higher computed tomography angiography as an alternative to invasive coronary angiography in the investigation of coronary artery disease. Health Technology Assessment, 12: 17.

5 192 Saad Merza AL- Araji et al, 2015 Morita, H., M. Yasue, Yoshimura, Increased plasma levels of natriuretic peptide in patients with acute myocardial infarction, Circulation, 88: Struthers, A., Introducing a new role for BNP: as a general indicator of cardiac structural disease rather than a specific indicator of systolic dysfunction only. Heart., 87: Talwar, V., H. Gordon, K. Lee, Verbal deception and its relation to second-order belief understanding. Developmental Psychology, 43: Wang, T., M. Larson, D. Levy, Plasma natriuretic peptide levels and the risk of cardiovascular events and death. N. Engl. J Med., 350: White, H., J. French, Use of brain natriuretic peptide levels for risk assessment in non- ST-elevation acute coronary syndromes. J. Am. Coll. Cardiol., 42:

To estimate the serum level of N-terminal pro-brain natriuretic peptide levels in acute coronary syndrome

Original Research Article To estimate the serum level of N-terminal pro-brain natriuretic peptide levels in acute coronary syndrome Mohamed Yasar Arafath 1, K. Babu Raj 2* 1 First Year Post Graduate, 2