Obstructive Lung Diseases |

Distinction of Cardiac From Pulmonary Dyspnea in Chronic Obstructive Pulmonary Disease and Coincident Atrial Fibrillation. Biomarker Serum Evaluation of Inflammation, Latent Ischemia, Dysfunction, Thrombogenesis, Apoptosis, and Cardiovascular Remodeling FREE TO VIEW

Ioannis Angomachalelis*, PhD; George Kyriazis, PhD; Stavros Tryfon, PhD; Nestor Angomachalelis, PhD
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Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece

Chest. 2012;142(4_MeetingAbstracts):724A. doi:10.1378/chest.1389075
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PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: Cardiopulmonary dyspnea represents a vital diagnostic dilemma.This study aims to evaluate NT-ProBNP and other Biomarker serum levels, correlated not only with each other but also with cardiac,pulmonary function indices and blood gases.

METHODS: 33 patients,20 males and 13 females,mean age 73 yrs,underwent 1) Serum evaluation of NT-ProBNP ,Homocysteine (Hcy), Troponin-I (Tr-I),Metalloproteinase-9 ( MMP-9), Erythropoietin (EPO ), C-Reactive Protein (CRP), Tumor Necrosis Factor-a (TNF-a ), Interleukin-6 (IL-6 ) and D-dimers 2) Echocardiography and 3) Pulmonary Function Tests and Blood Gases.

RESULTS: The results showed 1. Abnormal serum mean values of NT-ProBNP= 5.647 pg/ml, Hcy= 18,2 μmol/L, Tr-I = 1,1 ng/ml, MMP-9 = 910 ng/ml, EPO = 30m/U/ml, CRP = 5 mg/dl, TNF-a = 44 pg/ml and D-dimers = 1,3 ng/ml 2. Echo LAD = 4,9 cm, RVSP = 46 mm Hg, and normal EF and LVID 3. Restrictive or Congestive changes of respiratory function 4) decreased PO2 and increasesd alveolo-arterial oxygen difference [P(A-a)O2]= 38 mm Hg 5. Significant correlation of a) NT-ProBNP with Hcy ( r= 0,630 ) b) LAD with RVSP ( r= 410 ), LVID (r= 0,410 ), MMP-9 ( r= - 0,570 ) c) RVSP with MMP-9 (r= -0,660 ) and finally d) Tr-I with EF ( r = -0,430 ) 6. No correlations were found with Respiratory Function Tests and Blood Gases.

CONCLUSIONS: Increased serum values of NT-ProBNP and significant correlation with resulted abnormal Biomarker levels ,also correlated with each other,conclude that the predominant type of existing dyspnea could be consequent to inflammatory,latent ischemic dysfunction,thrombogenesis,cellular damage guided apoptosis and cardiovascular remodeling.The reported dyspnea of cardiac origin is leading and/or further strengthening preexisted thrombogenetic dyspnea and chronic pulmonary hypertention,having been due to COPD.Both , further worsen cardiovascular remodeling,presented as cardiac dysfunction or dyspnea and heart failure mainly with preserved systolic function.However, abnormal respiratory function indices and blood gases distinguish themselves as independent factors of pulmonary dyspnea .

CLINICAL IMPLICATIONS: Further studies should be carried out to classify reported values,distinguishing cardiac from pulmonary dyspnea in COPD and coincident AF.

DISCLOSURE: The following authors have nothing to disclose: Ioannis Angomachalelis, George Kyriazis, Stavros Tryfon, Nestor Angomachalelis

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Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece




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