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Left ventricular hypertrophy is the most common organ damage in children with chronic kidney disease (CKD)., Aim: The aim of the study was to assess the usefulness of B-type natriuretic peptide (BNP) as a marker of heart injury in children with CKD., Materials and Methods: We included 66 children (41 boys and 25 girls) aged 0.7 to 18.6 (median 11.6) years with CKD stage 1-5. The concentrations of urea, creatinine, cystatin C and BNP in blood serum were assessed, and the estimated glomerular filtration rate (eGFR) was calculated from the Schwartz and Filler formulas. Patients were divided into groups depending on the CKD stage [group 1: CKD stages 1 + 2 (GFR> 60 ml/min/1.73 m2), group 2: stage 3 (GFR = 30-59 ml/min/1.73 m2), group 3: CKD stage 4 (GFR 15-29 ml/min/ 1.73 m2), group 4 - stage 5 (dialyzed children)]. On the basis of echocardiography, the left ventricular mass (LVM) was calculated, which was indexed for height (left ventricular mass index, LVMI). Left ventricular hypertrophy (LVH) was diagnosed if the LVMI value was > 95th percentile for sex and age., Results: Depending on the CKD stage the median BNP concentrations for group 1, group 2, group 3, and group 4 were 2.5 pg/ml, 6.0 pg/ml, 9.3 pg/ml and 18.0 pg/ml, and the LVH prevalence 27.3%, 33.3%, 60.0% and 63.6% , respectively. Significant correlations between BNP concentration and LVH expressed by LVMI (R=0.256, p=0.038), creatinine (R=0.453, p<0.001), cystatin (R=0.494, p<0.001) and eGFR (R=-0.473, p<0.001) were found., Conclusions: In children with chronic kidney disease, BNP is an indicator of heart failure correlating with renal function parameters and left ventricular mass index., (© 2018 MEDPRESS.)

Diagnosis and treatment of infective endocarditis (IE) is still a challenge for physicians. Group of patients with the worst prognosis is treated in Intensive Cardiac Care Unit (ICCU). Etiologic agent can not be identified in a substantial number of patients., Aim: The aim of study is to find differences between patients with blood culture negative infective endocarditis (BCNIE) and blood culture positive infective endocarditis (BCPIE) treated in ICCU by comparing their clinical course and laboratory parameters., Materials and Methods: Retrospective analysis of 30 patients with IE hospitalized in ICCU Swietokrzyskie Cardiac Centre between 2010 and 2016. This group consist of 26 men (86,67%) and 4 women (13,3%). Mean age was 58 years ±13. Most of the cases were new disease, recurrence of the disease was observed in 2 cases (6,7%). 8 patients (26,7%) required artificial ventilation, 11 (36,7%) received inotropes and 6 (20%) vasopresors. In 14 (46,7%) cases blood cultures was negative (BCNIE), the rest of patients (16, 53,3%) was blood cultures - positive infective endocarditis (BCIE)., Results: Both of the groups were clinically similar. There were no statistically significant differences in incidence of cardiac implants, localization of bacterial vegetations, administered catecholamines, antibiotic therapy, artificial ventilation, surgical treatment, complication and in-hospital mortality. Incidence of cardiac complications in all of BCNIE cases and in 81,3% cases of BCPIE draws attention, but it is not statistically significant difference (p=0,08). There was statistically significant difference in mean BNP blood concentration (3005,17 ng/ml ±2045,2 vs 1013,42 ng/ml ±1087,6; p=0,01), but there were no statistically significant differences in rest of laboratory parameters., Conclusions: BCNIE group has got higher mean BNP blood concentration than BCPIE group. There were no statistically significant differences between these groups in others laboratory parameters, clinical course and administered antibiotic therapy. In our endemic region major cause of BCNIE seems to be early antibiotic therapy prior to collection of blood samples, but further studies are necessary.

Chronic heart failure (CHF), despite the preventive measures taken is the most common problem of modern cardiology. The aging of the body predisposes to the development of PNS, because qualitative changes taking place in the heart of the patient in the elderly are similar to those occurring among patients with heart failure. A growing problem of eldery patients becomes a deterioration of physical fitness leading to the reduction of activity and sedentary lifestyle. There is no doubt that increasing physical activity in the elderly should aim not only to restore the patient to a previous level of functioning, but also improve their physical resources to a higher level of efficiency and to facilitate independent functioning in everyday life., Aim: The aim of the study was to analyze the assessment of 12-week controlled physical training on the concentration of NT-proBNP and D-Dimer in patients with heart failure and impaired functional capacity in VII-X decade of life., Materials and Methods: The study included a group of 72 patients, elderly men and women (within a mean age of 81,6 ± 6,4) with stable heart failure. The plasma concentration of B-type natriuretic peptide and D-Dimer was measured in each and every subject. The subjects were also asked to perform a Timed Up and Go Test (TUG) and the normal gait speed was analyzed over a 6 meter distance., Results: 12-weeks cardiac rehabilitation process, improved the functional capacity of patients which is proved by reduction in duration of the TUG. Analysis of the results showed a correlation between the results of the test TUG and speed of gait. In the group of patients who underwent rehabilitation, a decrease in the concentration of plasma NT-proBNP and D-Dimer were observed., Conclusions: The low-intensity physical training increases functional capacity which is shown to shorten the duration of the TUG test and affects the modulation of neuroendocrine and concentration of NT-proBNP in patients with CHF, regardless of gender.

Unlabelled: Diseases of the cardiovascular system is one of the most common causes of death among people over 65 years. Due to its course and incidence are a major cause of disability and impaired quality of life for seniors, as well as a serious economic problem in health care. Important role in the prevention of cardiovascular disease plays making systematic physical activity, which is a component of any rehabilitation program. Regular physical training by doing cardio-and vasoprotective has a beneficial effect on cardiovascular status and physical performance in patients with diagnosed coronary heart disease, regardless of age., Aim: The aim of this study was to evaluate the effect of controlled exercise on selected biochemical parameters and functional myocardial infarction., Materials and Methods: A group of 89 patients were divided into 3 subgroups. In group I (n = 30) was performed 2 weeks cardiac rehabilitation program, in group II (n = 30) 4 weekly. Streamline the program consisted of a series of interval training performed using a bicycle ergometer and general exercise. The remaining group (gr. III, n = 29) participated in individually selected training program. In all subjects before and after the training cycle underwent thoracic impedance plethysmography, also determined the level of plasma natriuretic peptide NT-proBNP and echocardiography and exercise test., Results: After training, in groups, which carried out a controlled physical training, improvement was observed: exercise capacity of patients respectively in group I (p = 0.0003), group II (p = 0.0001) and group III (p = 0.032), stroke volume SV, cardiac output CO and global myocardial contractility, there was also reduction in the concentration of natriuretic peptide NT-proBNP. Furthermore, the correlation between the results shown pletyzmography parameters and NT-proBNP, SV, CO and EF., Conclusions: Regular physical training as part of the cardiac rehabilitation has a beneficial effect on biochemical parameters and functional myocardial infarction in patients with ACS. Size of the observed changes conditioned by the nature and duration of the training., (© 2016 MEDPRESS.)

Introduction: Cardiotoxicity of drugs in oncology is a growing problem which cardiologists and oncologists have to struggle with. So far, researchers have been looking for biochemical markers which could help to extract a group more prone to developing complications after chemotherapy. Authors’ reports are inconsistent in this topic., Aim: This study assesses the role of troponin I, CK-MB and NT-proBNP as early predictive markers for later cardiotoxicity among patients with breast cancer treated with chemotherapy., Methods: One hundred five patients with breast cancer, without either heart failure or more than moderate severity of valvular heart diseases were qualified to the study., Results: NT-proBNP concentration significantly increased just after the first cycle of chemotherapy, either in a subgroup which developed cardiotoxicity or without this end point (p<0.001, p=0.004). CK-MB did not change significantly during observation. Troponin I did not change in any of the patients. During observation HDL-cholesterol concentration significantly decreased. A transient increase of the concentration of LDL-cholesterol had been noted, but later it decreased below baseline level., Conclusion: Troponin I has too low sensitivity to be used as a prognostic marker for further cardiotoxicity after chemotherapy. No prognostic values have been noted of NT-proBNP and CK-MB due to the lack of differences in both a subgroup with and without cardiotoxicity.

Unlabelled: Amyloidosis is a disease having many different faces. Different symptoms may appear, depending on which organ is involved. That's why correct diagnosis can be difficult. Cardiac involvement must always be considered because of poor prognosis (30 to 68 % patients survive one year). Also in case of rapid progress of cardiac wall thickening, amyloidosis should be taken into account., Material and Methods: we present a case of a female patient with rapid progress of heart failure due to systemic amyloidosis with cardiac involvement., Case Report: 48-old female, with no prior medical history, admitted to cardiology ward because of dyspnea on exertion and leg edema. Couple days before admission hypertrophic cardiomyopathy was diagnosed. Laboratory test revealed elevated troponin I, d-dimers and BNP (natriuretic peptide type B). Electrocardiogram showed low QRS voltage in limb leads. Echocardiography confirmed concentric thickening of left ventricular walls and reduced ejection fraction (40%). We performed cardiac magnetic resonance. Morphology of the delayed enhancement and an increased signal in T2 dependent sequences suggested overlap of general inflammatory process and hypertrophic cardiomyopathy. Because of amyloidosis suspicion, gingival and subcutaneous adipose tissue biopsies were performed. Sirius red stain identified amyloid only in the walls of gingival blood vessels. Diagnosis of amyloidosis was established and further diagnostics planned. Soon after patients condition worsened. Finally, in intensive care unit, after cardiac arrest patient died., Conclusion: Amyloidosis with cardiac involvement has a very poor prognosis. Multiple tissue biopsy and histopathological assessment should lead to correct diagnosis and proper treatment.

Unlabelled: Heart failure (HF), especially during old age, significantly influences the decrease in physical fitness, depriving the patient of their independence during everyday life. The positive results of cardiac rehabilitation are one of the most well documented methods of lowering the frequency of hospitalisation and unfavourable prognosis of cardiovascular diseases. Currently complex cardiac rehabilitation is recommended by the American College of Cardiology (ACC) and American heart Association (AHA) as being an important element of treating patients with HF. However these recommendations are poorly executed in the everyday clinical practise, concerning elderly patients., Aim: The aim of study is the assessment of the efficacy of controlled physical activity in elderly women, in their VII-X decades, with stable cardiac failure, based on exercise training., Materials and Methods: The study included a group of 55 elderly women (mean age 84.73 ± 7.13 tears) with stable heart failure, NYHA II-III. In each patient plasma concentration of B-type natriuretic peptide was measured and a 6 minute walk test (6MWT) was undertaken., Results: In the study group of patients who underwent a 12 weeks of cardiac rehabilitation (72%) a decrease in level of NT-proBNP was observed after completion of physical training. The mean value decreased by 204.7pg/ml. Cardiac rehabilitation resulted in an improvement of physical fitness capacity in the group that qualified for fitness training, which was observed by an increase in distance covered during the 6MWT, initial distance of 236 (±127)m to a distance of 300.9 (±75.9)m. Furthermore using statistical analysis it was shown that in the group qualified for cardiac rehabilitation, there is a positive correlation between distance covered during the 6MWT and the improvement in clinical symptoms as measured by the NYHA classification, r=0.099, p>0.05., Conclusions: Cardiac rehabilitation modified for the individual needs and abilities of the patient is one of the significant elements that make up the complex therapy of elderly women with HF. Systematically undertaken physical activity occupies an important place in the prevention of cardiovascular disorders, by increasing the level of physical fitness, as manifested by the increase in distance covered during the 6MWT and by the change in classification of NYHA to a higher class or by the decrease in plasma concentration of NT-proBNP., (© 2015 MEDPRESS.)

Unlabelled: Due to the aging of the population is an increase in the incidence of heart failure. According to the current guidelines for conduct in the treatment of cardiovascular diseases, rehabilitation is introduced in the first treatment period. Individually matched to the severity of illness of each patient, increases the quality of life of patients and reduces mortality in this group of patients. The aim of the study was to evaluate the effect of controlled exercise on left ventricular systolic function of heart and change the level of concentration of natriuretic peptide NT-pro-BNP in patients with heart failure after invasive treatment of angina pectoris., Material and Methods: The study group consisted of 87 patients, men and women aged 35 to 85 years (mean age 65.6 +/- 10.4) with a diagnosis of heart failure. Patients were divided into 3 groups. I group numbering 19 patients (67.3 +/- 7.8) were subjected to two-week cardiac rehabilitation program, representing 46. Group II patients (59.4 +/- 10.9) was qualified for the 4-week program. The basis for rehabilitation of patients accounted for interval training was performed using a bicycle ergometer. Group III--control, representing 22 patients (68.1 +/- 9.2) were excluded from the training groups because of the high risk. Used with them individually tailored program of cardiac rehabilitation. All patients were performed: submaximal exercise test, echocardiography and examined the concentration of NT-pro-BNP (N-terminal pro-B-type natriuretic peptide). After a period of 6 months from the end of the second phase of cardiac rehabilitation in 32 patients who agreed repeated the scope of clinical trials., Results: In groups where physical training was conducted controlled noticed an improvement in EF and reduction of NT pro-BNP. It was also a significant, negative correlation between the degree of damage to the left ventricle (EF), and the level of NT pro-BNP. After a period of 6 months from the end of the second stage of rehabilitation, the analysis showed a statistically significant further and improve. It was observed that the best results were obtained in the group with the longest period of rehabilitation., Conclusion: Rehabilitation, part of cardiac rehabilitation is an important component of therapy in patients with heart failure. By influencing the improvement actions cardiovascular favorable effect on the clinical course of the disease.

Unlabelled: Both B-type natriuretic peptide and high sensitivity troponin T play the role in the clinical practice now. Examination of this markers is important in ischaemic heart disease, chronic heart failure, pulmonary embolismus, after cardio-pulmonary resuscitations,electrotherapy and renal insufficienty. The aim of this study was to demonstrate the impact of permanent cardiac pacing on selected biochemical parameters of the cardiovascular system, such as the B-type natriuretic peptide and high-sensitivity troponin levels, and usefulness of this biochemical parameters in daily practice., Material and Methods: The study involved 195 people. Finally, 117 patients completed the study. There were distinguished: group I--21 patients with pacemaker AAI/R, group II--59 patients with a pacemaker DDD/R, group III--37 patients with pacemaker VVI/R, a control group--48 healthy subjects of comparable age.In the treatment groups (group I, II, and III) peptide BNP, troponin T detected by high-sensitivity assay, were performed three times. In the control group the same tests were performed once., Results: In the group II blood concentration of B-type natriuretic peptide 3 month after implantation DDD/R was elevated from 157.27 +/- 186.34 microg/1000 microl to 214.46 +/- 249.54 pg/1000microl and was statistical signification higher from the period before implantation ( p < 0.001). 6 month after implantation DDD/R blood concentration of B - type natriuretic peptide was 219.15 +/- 257.59 microg/1000 microl and was statistical significantly higher compared to period before implantation (p < 0.001). In the group II high sensitivity troponin T after implantation elevated from 10.42 +/- 12.81 ng/ml to 17.08 +/- 38.86 ng/ml (p < 0.05)., Conclusions: In the group with DDD/R blood concentration of B-type natriuretic paptide and high sensitivity troponin T are elevated. Both B-type natriuretic peptide and high sensitivity troponin T play important role in examinations patients after cardiac pacing implantations. Cardiac examination after implantation pacing should be completed by B-type natriuretic peptide and high sensitivity troponin T examinations.

Syncope is a transient loss of consciousness, which is the result of global brain hypoperfusion, characterized by rapid onset, short duration, and spontaneous complete resolution. Syncope is a common clinical problem due to its complex, multi-causal etiology, not completely understood pathogenesis and potential complications. Diagnosis of syncope is often associated with the implementation of many medical tests. In the recent years, the role of determining the concentration of NT-proBNP in the differential diagnosis of syncope has been highlighted. Aims of the study was analysis of NT-proBNP concentrations in patients with cardiogenic syncope in comparison to patients with neurogenic syncope and determination of the threshold value of NT-proBNP to differentiate cardiac and neurogenic syncope and to determine its sensitivity and specificity. The study included 160 pts (64 man, 96 women), aged 18 - 77 yrs (mean age 50,6) with a reflex syncope (group I) or cardiac syncope (group II). To determine the etiology of syncope, collected were: medical history for symptoms and circumstances of the syncope, measurements of blood pressure, resting ECG recording, cardiac echocardiography, and the concentration of NT-proBNP levels. Results: the group I included 80 pts (29 men, 51 women), aged 18 - 72 yrs (mean age 41.2). Group II included 80 pts (35 man, 45 women), aged 38 - 77 yrs (mean age 62.1). The assessment of concentrations of NT-proBNP showed significantly higher levels in group II than group I (467.6 +/- 227.4 vs 64.1 +/- 59.1; p <0.0001). In patients with arrhythmias and conduction abnormalities, the levels of NT-proBNP were higher in comparison to those without such disorders (364 +/- 249 vs. 171 +/- 209 pg/ml, p < 0.001). It was found that the concentration of NT-proBNP at 230.6 pg/ml might be a cut-off point that allows the prediction of cardiogenic cause of syncope with 96% specificity, 92% sensitivity and 93% negative predictive value. Conclusions: 1. The concentration of peptide NT-proBNP patients with reflex syncope. 2. It was shown that the cut off concentration of the NT-proBNP equal 230.6 pg/ml is characterized by the high sensitivity, specificity, and negative predictive value in determining the etiology of syncope.

Background: Asymptomatic systolic dysfunction of the left ventricle (LV) refers to patients without current clinical symptoms of heart failure., Aim: 1. Analysis of echocardiographic parameters in patients with stable angina pectoris without symptoms of heart failure and their changes in two years time 2. Determine the importance of NT-proBNP for early detection of asymptomatic heart dysfunction in patients with stable angina pectoris and its influence on the prognosis in two years 3. Analysis of the relationship between the degree of the left ventricular diastolic dysfunction and co-morbidities and selected echocardiographic parameters 4. Significance of prognostic selected echocardiographic parameters (E/ Vp, E/E', Ar) in patients with stable angina pectoris without any symptoms of heart failure., Patients: The study included 57 patients with stable ischemic heart disease, no history of myocardial infarction: including 35 men (61.4%) aged 35-56 years (mean 51.08 +/- 4.01 years) hospitalized in the Department of Coronary Artery Disease, Institute of Cardiology, Jagiellonian University in Krakow. Analysis after two years involved 56 patients (1 patient died after a year of observation)., Methods: Patients were evaluated 2x: before and after 2 years (assessment of clinical status: physical examination, the severity of angina and physical examination, atherosclerotic risk factors, ECG, lipid profile, plasma NT-proBNP). Patients were divided into three groups: Group A, patients with LV normal function (32 patients), Group B - with impaired diastolic function (22), Group C - with impaired systolic and diastolic function (EF < or = 50%, as measured by Simpson; 3 patients)., Results: Subgroups of respondents ABC did not differ significantly with respect to age, sex and risk fac- tors of atherosclerosis. There was a significant correlation between the type of LV dysfunction and indicators of elevated end diastolic pressure in LV: E/Vp (p = 0.0002), E/E' (p = 0.0006), Ar (p = 0.034) and the propagation velocity Vp (0 = 0.001). There was a significant correlation between systolic and diastolic heart dysfunction and the levels of NT-proBNP (p = 0.018). After 2 years, patients with deterioration of heart function in group A noticed a significant correlation between occurrence of diastolic dysfunction and presence of diabetes mellitus type II (p = 0.01). Conclusions: 1. Elevated levels of NT-proBNP indicates the impairment of systolic andlor diastolic asymptomatic patients. NT-proBNP is therefore important for early detection of asymptomatic cardiac dysfunction in patients with stable angina pectoris. 2. In patients with stable angina pectoris without symptoms of heart failure: the value of E/Vp > or = 1.5 and E/E '> or = 8 can be the marker of more advanced coronary atherosclerosis, manifested by three-vessel disease or stenosis of the left main coronary artery.

Introduction: Cardiovascular diseases often coexist with chronic obstructive pulmonary disease (COPD), and in some cases it is difficult to differentiate between cardiac and pulmonary cause of dyspnoea. It is well known that the serum concentration of NT-proBNP in patients with cardiovascular diseases, especially with congestive heart failure, is elevated. The aim of this study was to estimate the usefulness of NT-proBNP serum level measurement in patients with COPD complaining of chronic dyspnoea., Material and Methods: The study group consisted of 81 stable COPD patients in middle age, 65 ± 7 years, (57 of them with concomitant cardiovascular disease). Serum concentration of NT-proBNP was measured using VITROS laboratory test., Results: There were no statistical differences in serum NT-proBNP between patients stratified according to the GOLD staging system for COPD severity or BODE index and mMRC breathlessness scale. The concentration of NT-proBNP was statistically significantly higher in the patients with coexisting cardiovascular diseases (220.8 ± 258.1 vs. 95.4±56.1 pg/ml). The group of patients with NT-proBNP concentration 〉 125 pg/ml (n = 36) was statistically significantly older (67.5 ± 6 years old vs. 63.2 ± 7.1 years old; p = 0.009) and had statistically significantly lower PaO2 (67.4 ± 11.8 mm Hg vs. 73.0 ± 11.6 mm Hg; p = 0.04)., Conclusions: 1. In the group of stable COPD patients there were no differences between NT-proBNP serum concentration according to GOLD staging, BODE index, and mMRC breathlessness scale. 2. The NT-proBNP serum concentration was statistically significantly higher in the group of COPD patients with the concomitant cardiovascular disease. 3. In patients with chronic dyspnoea testing of serum NT-proBNP may be useful in the detection of patients with cardiovascular problems, who require more intensive therapy.

Unlabelled: Aberrant waveform during artificial pacing increases secretion of natriuretic peptides, mainly B-type natriuretic peptide (BNP). The aim of the study was to investigate whether renal function is modified through increased BNP secretion during artificial pacing., Material and Methods: A total of 117 patients with pacemaker implanted were included (pacing mode: AAI/R - 21, DDD/R - 59, VVWl/R - 37) and 48 healthy volunteers served as controls. Serum BNP, creatinine and urea, levels were measured prior to, three and six months after pacemaker implantation., Results: Three and six months after implantation BNP level significantly increased in DDD/R group, urea level increased in AAI/R group whereas creatinine level increased in DDD/R and WI/R group., Conclusions: In patients after pacemaker implantation BNP level increases in DDD/R pacing mode group whereas in other modes it remains stable. Pacemaker implantation leads to changes in renal function. B-type natriuretic peptide level may serve as a useful parameter forrenal and cardiac function assessment after pacemaker implantation.

Unlabelled: The aim of the study was to assess plasma B-type natriuretic peptide (BNP) levels in patients after myocardial infarction (MI) with intraventricular conduction defects (IVCD) and to define relationship between BNP level, treatment strategy and left ventricular performance., Material and Methods: Four types of IVCD were noted: left bundle branch block (LBBB), right bundle branch block (RBBB), left anterior hemiblock (LAH) and left posterior hemiblock (LPH). A total of 158 patients six months after MI treated either invasively or conservatively were included. Of them 126 had IVCD (group A): LBBB-31, RBBB-36, LAH-130, LPH-29, whereas 32 patients without IVCD served as controls (group B). Plasma BNP levels were measured using an immunoenzymatic method. All subjects underwent echocardiography to evaluate left ventricular function., Results: In group A significantly lower plasma BNP levels (186.3 vs 355.3 pg/mL; p < 0.01) and significantly higher left ventricular ejection fraction (EF) (48.4 vs 42.4%; p < 0.05) were noted in favour of invasive treatment. In group B differences between plasma BNP level and echocardiographic parameters of left ventricle function were insignificant. In patients with LBBB plasma BNP levels were significantly lower in those treated invasively (163.9 vs 528.9; p < 0.01). Also, left ventricular EF and myocardial performance index (MPI) were comparable, whereas E/A value was lower as compared with patients treated conservatively (p < 0.05). There were no significant differences in BNP levels in groups with RBBB, LAH and LPH. Multifactorial regression analysis showed that BNP levels were most strongly correlated with magnitude of the ejection fraction EF (p < 0.001). Other parameters which affect significantly BNP level were MPI: OR 9.07 (95% CI 1.03-79.58; p < 0.05) and E/A: OR 6.58 (95% CI 1.01-42.76; p < 0.05)., Conclusions: Invasive strategy in MI with IVCD, especially with LBBB, correlates with lower plasma BNP levels six months after index procedure. In patients with IVCD post MI plasma BNP level is better marker of dysfunction of the left ventricle than its ejection fraction.

Background and Aim: In this study, we aimed to evaluate myocardial functions in patients with diabetes mellitus (DM) and impaired glucose tolerance (IGT). We also aimed to investigate the relationship between B-type natriuretic peptide (BNP) levels and myocardial performance index (Tei index) in these patients., Methods: A total of 38 patients with DM, 34 patients with IGT, and 40 healthy volunteers were recruited to the study. Basal clinical and laboratory findings were recorded. BNP levels of all individuals were measured. Both conventional transthoracic and tissue Doppler echocardiogaphy were performed to all study participants., Results: B-type natriuretic peptide levels of the diabetic group were greater than in patients with IGT and the control group. BNP levels of the IGT group were also higher than the control group. Myocardial performance index values, measured by both the conventional method and tissue Doppler echocardiography, were significantly higher in the diabetic group than in the control group. There was a significant relationship between myocardial performance index and BNP levels., Conclusions: Myocardial functions are disturbed in patients with DM and also in patients with IGT. BNP and myocardial performance index can be used in diabetic patients and in patients with IGT to define myocardial dysfunction.

Various methods and scales have been suggested to assess the risk of cardiac complications in patients who undergo major vascular surgery. Among them, the Vascular-POSSUM score, placed between the ASA and APACHE scales, combines risk factors associated with the clinical status of patients as wellas the extention and duration of surgery. The index is calculated after recording the following physiological parameters: age, selected cardiac and respiratory parameters, ECG, systolic blood pressure, pulse rate, haemoglobin, WBC, urea, sodium, potassium, and GCS. In the second part, procedural parameters are noted: the type of surgery, number of procedures, operative blood loss, malignancy status and CEPOD.The mortality/morbidity risk is calculated. Recently, assessment of b-type natriuretic peptide (NT-pro BNP test), which is a more powerful predictor of prognosis than the ejection fraction and other traditional outcome markers, has been proposed for assessment of perioperative risk.

Objectives: The aim of the study was to evaluate the occurence of death and major adverse cardiac events (MACE) in patients with normal (group A) and elevated (group B) plasma bilirubin levels., Patients and Methods: We evaluated 124 patients (83% males, mean age 50.1 +/- 7.7 yrs) in New York Heart Association class II and III with hypertension-related chronic heart failure. We assessed the occurence of death and MACE (death, urgent heart transplantation and readmission to hospital)., Results: Groups A and B comprised 77 and 47 patients respectively. The independent predictors of death in group B were: N-terminal pro-brain natriuretic peptide (NT-proBNP) level (per 100 pg/ml difference; 95% CI: 1.29-4.76; p = 0.005) and physical component summary score (per 10 point difference; 95% CI: 0.66-0.99; p = 0.03). The independent predictors of MACE in group B were: age (per 10 yrs; 95% CI: 0.1-1.8; p = 0.04), NT-proBNP level (per 100 pg/ml difference; 95% CI: 1.02-3.69; p = 0.04) and the symptoms of depression (95% CI: 1.02-2.5; p = 0.01). The independent predictors of MACE in group A were: NT-proBNP level (per 100 pg/ml difference; 95% CI: 1.31-5.32; p = 0.006) and mental component summary (per 10 point difference; 95% CI: 0.85-0.98; p = 0.01). In a two-year follow-up the death rate was 5.2% in group A, and 23.4% in group B (p = 0.002) and frequency of MACE 18.2% and 42.6% in group A and B (p = 0.003), respectively., Conclusions: Elevated bilirubin levels are associated with higher incidence of death and MACE during a two-year follow-up in patients with hypertension-related chronic heart failure. Thus, it may be used as a simple prognostic factor in such of patients.

The authors describe a case of 21-years old woman with idiopathic pulmonary arterial hypertension with atypical clinical consequences of massive internal bleeding. Despite significant hypovolemia clinical and laboratory presentation was one of RV failure with dilatation of right heart ventricle and increased plasma level of markers of myocardial stretch and injury (NT-proBNP and troponin, respectively). This is attributed to impaired right ventricular coronary perfusion and hypoxia. Intensive treatment restored baseline RV conditions and at 15 months follow-up no persistent right heart impairment was observed. This case demonstrates that bleeding should be also considered in differential diagnosis of exacerbation of right ventricular failure in patients with pulmonary arterial hypertension.

On account of universality and steadily rising frequency of atrial fibrillation new diagnostic and therapeutic methods of that arrhythmia are being sought. This work informs about a predictive role of measurement of C-reactive protein (CRP) and brain natriuretic peptide (BNP)ry concentrations in atrial fibrillation. The presented review of current research in the field of the above mentioned subject shows that high values of CRP quite tightly correlate with the risk of occurrence or relapse of that arrhythmia. Therapy effectiveness of atrial fibrillation is also lower in case of patients with high CRP concentration. Measurement of BNP is currently used, above all, in the diagnosis of heart failure. The work presents the arguments which can justify the usage of measurement of that hormone at above all prognostic proceedings in case of patients with various forms of atrial fibrillation.

Apical ballooning after sudden emotional stress is a new syndrome characterised by abrupt onset of angina-like chest pain, ST-segment elevation, wall motion abnormalities involving the lower anterior wall and apex without significant coronary artery stenosis. We present a case of a 57-year-old woman with apical ballooning syndrome which occurred during premedication the general anaesthesia. We also found an increased B-type natriuretic peptide level in this patent--the finding not reported previously in the literature.

Introduction: Preliminary data indicate that B type natriuretic peptides' levels may rise in exercise induced myocardial ischemia in patients with stable coronary artery disease. Such findings hint at a potential broader application of these markers reaching beyond its present use in chronic heart failure and acute coronary syndromes. Ischemia modified albumin (IMA) is a novel diagnostic marker in acute coronary syndromes as its value increases in states of myocardial ischemia and necrosis. The role of this marker in the assessment of exercise induced myocardial ischemia in stable coronary artery disease has not been extensively investigated and remains unknown., Aim: To examine changes in N-terminal pro-brain natriuretic peptide (NT-proBNP) and ischemia modified albumin (IMA) during an ECG stress test in patients with stable coronary artery disease and to assess the potential of these markers to detect exercise induced myocardial ischemia., Patients and Methods: Patients with angiographically confirmed coronary atherosclerosis were included into the study. In all of them prognostic ECG stress test according to Bruce protocol was performed. The test was considered true positive (ischemia present) in case of significant ST-segment depression in the presence of significant coronary stenosis. The test was considered true negative (ischemia absent) when no significant ST depression was noted in the absence of significant coronary stenosis. In all patients echocardiography was performed and blood was drawn for NT-proBNP, IMA, serum albumin and creatinine before and within the first five minutes after exercise., Results: 41 patients with unequivocal stress test result corresponding to coronary angiogram were included in the final analysis (out of 51 examined patients). 21 patients demonstrated ischemia during exercise, 20 did not. NT-proBNP concentration was significantly higher after the stress test than before in the whole group: 127.9 (10.7-994.2) pg/ml and 110 (10.5-990.2) pg/ml respectively; p < 0.0001. NT-proBNP increase was higher in the ischemic than in the non-ischemic group; however, the difference was not statistically significant: deltaNT-proBNP 12.3 (1.0-172.3) pg/ml and 4.2 (1.0-77.1) pg/ml respectively; p = 0.09. This manifested itself in poor sensitivity and specificity of NT-proBNP in detecting exercise induced myocardial ischemia: 62 and 55% respectively (AUC 0.589). In the whole group the increase of NT-proBNP depended on baseline NT-proBNP concentration (r = 0.54; p = 0.0003), the magnitude of ST-segment depression (r = 0.38; p = 0.01), creatinine concentration (r = 0.34; p= 0.03) and history of myocardial infarcion: log deltaNT-proBNP in post-MI patients and in patients without prior MI 1.19 ( +/- 0.54) i 0.61 ( +/- 0.57) respectively; p = 0.004. In multiple regression analysis the only factor independently determining NT-proBNP increase during exercise was the history of myocardial infarction (beta = 0.342; p = 0.01) but not left ventricle ejection fraction. IMA decreased during exercise in all patients significantly--the mean value before and after exercise was 88.20 (7.72) and 78.05 (8.33) U/ml respectively; p = 0.0001. Decrease in IMA correlated only with increase in albumin concentration measured before and after exercise (r = -0.6; p < 0.0001)., Conclusions: Exercise induced myocardial ischemia has little influence on NT-proBNP increase. The test measuring it has therefore insufficient ability to detect exercise induced ischemia in stable coronary artery disease. In patients with stable coronary artery disease without severe impairment of left ventricular function the history of myocardial infarction is the main factor determining NT-proBNP increase during exercise. Changes in serum albumin concentration during exercise seem to exclude the use of IMA in the assessment of exercise induced myocardial ischemia.

Cardiotoxicity of anthracydines is a serious clinical problem, and it is the main factor limiting their wide use, despite the recognized antineoplastic properties of anthracyclines. Early detection of adverse effects of anthracyclines is therefore very important for proper prevention of congestive heart failure. Current methods of detection of cardiotoxic activity of anthracyclines (ECG, ECHO) are suitable only for fully symptomatic cases. In subclinical damage of the heart these methods are insufficient. Measurement of NT-proBNP has been shown to be a sensitive indicator of cardiac abnormalities. Concentration of NT-proBNP in blood increases very early in response to volume overload of the ventricles of the heart seen in congestive heart failure. Chemical and physical features of NT-proBNP: long half-time in blood, low requirements for sample collection and storage conditions and easy availability of kits for its measurements make NT-proBNP a very good marker of subclinical postanthracycline congestive heart failure.

Unlabelled: At present, primary angioplasty (PTCA) is preferred reperfusion treatment for acute ST elevation myocardial infarction (STEMI). Risk stratification after STEMI includes the evaluation of left ventricular (LV) function. B-type natriuretic peptide testing emerged as a potential marker of LV function and prognosis after STEMI., Aim: The objective was long-term echocardiographic assessment of LV systolic and diastolic function in patients with STEMI who underwent PTCA and to evaluation of the relationship between NT-proBNP plasma levels and LV function. We assessed the value of NT-proBNP in prediction of LV dysfunction after STEMI treated with PTCA., Material and Methods: A series of 98 patients (pts) (75 males, 23 females age from 50.0 to 63.0, mean age 55.0), treated successfully with PTCA in acute phase of STEMI were included in this study. NT-proBNP plasma levels were assessed just before PTCA (BNP-bsl) and at 6 month follow-up (BNP-6m). Transthoracic echocardiography (TTE) was performed at discharge(dc) and at 6 months follow-up (6m). The indices of LV systolic function (LVSF) (LV ejection fraction-EF, wall motion score index-WMSI), LV diastolic function (LVDF) (peak velocity of early (E) and late (A) transmitral flow, E-wave deceleration time (DT), isovolumic relaxation time (IVRT)) and global LV function (Tei index- calculated as a sum of isovolumetric contraction time and IVRT divided by the ejection time) were estimated., Results: At 6 month echocardiographic follow-up we observed the significant improvement of LVSF (the increase of EF (p < 0.0027), the decrease of WMSI (p < 0.0005)) and the deterioration of LVDF (the decrease of E/A (p < 0015), the increase of IVRT (p < 0085)). A negative correlation between BNP-bsl and EF-6m (Rs = -0.2877, p < 0.0072) and BNP-6m and EF-6m (Rs = 0.4125, p < 0.0001) were observed. Multivariate analysis identified BNP-bsl and CPK max during acute phase of STEMI as negative and EF-dc as positive significant, independent predictors of EF-6m., Conclusions: The significant improvement of LV systolic function and LV abnormal relaxation were observed at 6 month follow-up in patients with acute STEMI treated with primary angioplasty. Baseline NT-proBNP plasma level, CPK max plasma level during acute phase of STEMI and echocardiographic LV systolic function indices at discharge are significant and independent predictors of LV systolic function in long-term follow up. Increasing NT-proBNP plasma level at 6 month after STEMI treated with PTCA has a good performance in detecting of LV systolic function deterioration in long-term follow-up.

Introduction: Monitoring of natriuretic peptide concentration may be useful for the identification of high-risk patients presenting with decompensated chronic heart failure (CHF)., Aim: Assessment of the predicting value of a significant decrease (by > or =20% vs. baseline) of N-terminal proBNP (NTpro-BNP, ROCHE) concentration during hospitalisation in patients with decompensated CHF., Methods: This study involved 54 patients admitted to our centre because of CHF decompensation. Concentration of NTpro-BNP was measured on admission and at discharge from hospital. Primary end-points of this study were overall mortality and mortality with a number of cardiovascular-related readmissions., Results: Mean NTpro-BNP concentration on admission was 7435+/-10040 pg/ml and at the time of discharge from hospital -- 4816+/-7822 pg/ml. In 31 (57%) patients a significant decrease (> or =20% vs baseline value) in NTpro-BNP level (mean: -58%+/-21%) was noted, while in the remainder (23 patients; 43%) neither an increase nor a decrease in NTpro-BNP levels was observed (mean: +72%+/-132%) despite optimal treatment and stabilisation of the clinical status. The mean follow-up duration was 358+/-240 days. Cox analysis showed that the absence of significant NTpro-BNP level decrease was associated with an increased risk of death -- RR: 3.69 (95% CI: 1.10-12.37; p=0.035) and was the single independent risk factor for readmission due to cardiovascular-related reasons and/or death -- RR: 2.29 (95% CI: 1.20-4.35; p=0.01). In the group of 23 patients with an increase or decrease in NTpro-BNP concentration of more than or equal to 20%, the survival rate was 65% vs. 87% in the remainder (p=0.02)., Conclusions: The lack of a significant (> or =20%) decrease of NTpro-BNP level during hospitalisation correlates with a higher mortality and rate of readmissions. NTpro-BNP level monitoring may be of clinical importance for risk stratification in patients hospitalised for decompensated CHF.

Unlabelled: THE AIM of the study was to assess the brain natriuretic peptide (BNP) plasma concentrations in patients with CAD and to evaluate the relationships between BNP levels and such parameters of the left ventricular (LV) systolic function as ejection fraction (LVEF) and peak LV emptying rates (PER)., Material and Methods: The study population comprised 69 patients with CAD, aged 30-79 years. All subjects underwent gated equilibrium radionuclide ventriculography at rest. From the data acquired, LVEF and PER were calculated. The plasma BNP concentrations were determined in blood samples taken from patients with CAD and in 18 healthy subjects and the obtained results were compared with those by radionuclide ventriculography. For this purpose patients with CAD were divided into two subgroups: dLVEF (LVEF<50%) and nLVEF (LVEF>50%). Subjects with normal LVEF (nLVEF) were divided into subgroups with PER greater than median value of this parameter and lower than or equal to the median., Results: In patients with CAD both the BNP concentration and its frequency were significantly higher than in controls. In patients with CAD and dLVEF the BNP concentration was significantly higher than in nLVEF cases. Increased BNP concentration was distinctly more frequent in dLVEF group than in nLVEF, but the difference was not significant (p>0.05). In group with nLVEF, the BNP concentration was higher in patients with PER<2.33 (dPER) in comparison to those with PER>2.3 (p>0.05). Not very close, but statistically significant correlation was found between the BNP level on the one hand and the LVEF and PER on the other., Conclusions: Increased plasma BNP in patients with CAD seem to depend not only on the degree of the myocardial contraction, but also on the dynamics of the left ventricular emptying. The reason for the BNP elevation in cases with CAD and reduced LV ejection rate but normal EF needs to be investigated.

Unlabelled: Plasma natriuretic peptide type B (BNP) concentration increases in aortic stenosis (AS) but relation to severity of left ventricle hypertrophy (LVH) is unknown. We analyze the relation between BNP and the LVH (left ventricle mass index (LVMI)), left ventricle thickness (LVTh) in pts with significant aortic stenosis (AS)., Material and Methods: 58 pts with AS (32 male), aged 62 +/- 12, underwent echocardiographic study before aortic valve replacement. BNP level was measured using SHIONORIA BNP test (immunoradiometric method). Results were expressed as a mean (+/- standard deviation). Control group consisted of 26 healthy people. Correlation between BNP level and age, gender, EF, MGA and LVH were also tested., Results: In pts with AS BNP level ranged from 11 to 2010 pg/ml. Mean BNP level was similar in men and women (mean level in whole group 344 +/- 480 pg/ml) and it was higher than in control group (6,1 +/- 3,9 pg/ml). BNP level was related with LVMI (r = 0,42; p<0,001), LVDD (r=0,61; p<0,0001), EF (r = -0,66; p<0,0001 - higher BNP level in lower EF) but not with LVTh (r = -0,08; p = ns), age (r = 0,06; p = ns) and MGA (r = -0,19; p = ns). BNP in 11 pts in eccentric type of hypertrophy was significantly higher (721 +/- 773 pg/ml) then in 47 cases with concentric type of remodeling (256 +/- 337; p = 0,04)., Conclusions: 1. BNP level increased in relation to left ventricle mass index (increase in left ventricle diastolic diameter) but not to wall thickness 2. BNP measurement could potentially be used to monitor left ventricle remodeling in aortic stenosis.

Background: Diagnosis of perimyocarditis is often very challenging. Clinical presentation includes chest pain and ECG changes which are difficult to interpret. Clinical course is usually mild, however, some patients develop heart failure symptoms and require aggressive treatment. Plasma b-type natriuretic peptide (BNP) is a marker of the hemodynamical impairment of the heart. Its diagnostic role in patients with acute perimyocarditis has not yet been examined., Aim: To assess the usefulness of BNP measurement in the diagnosis of perimyocarditis., Methods: The study group consisted of 14 consecutive patients (13 males, mean age 32.1+/-12.4 years) with suspected perimyocarditis (history of influenza, typical symptoms, ECG and echocardiographic results as well as myocardial necrotic markers). Plasma BNP was assessed at bedside at the time of admission., Results: Plasma BNP, measured in 12 patients, was 163+/-154 pg/mL (max. 519 pg/mL) and exceeded upper normal level in 6 (50%) patients. When normal levels were adjusted for age and gender, 9 (80%) patients had elevated BNP. One patient had heart failure symptoms and a BNP level of 205 pg/mL. In all 4 patients who had transient myocardial contractility disturbances, detected by echocardiography, BNP level exceeded 100 pg/mL., Conclusions: BNP level is increased in some patients with acute perimyocarditis. BNP elevation is probably associated with hemodynamical stress caused by transient contractility abnormalities. Diagnostic and prognostic role of BNP in acute perimyocarditis requires further studies.

Left ventricular hypertrophy, in particular concentric, accompanying hypertension is an independent risk factor of sudden death and other serious cardiovascular complications. It is still not clear how ANP and BNP are related to various types of left ventricular geometry and whether BNP is a better predictor of left ventricular hypertrophy and dysfunction than ANP. The aim of the study was estimation of plasma ANP and BNP levels in patients with hypertension in relation to the changes of left ventricular geometry. Investigations were carried out in 80 patients aged 52.5 +/- 12.6. In every patient plasma levels of ANP and BNP were estimated, blood pressure was measured and echocardiographic study was performed. Based on echocardiographic measurements every patient was classified into one of four left ventricular geometric patterns. It was found that in patients with left ventricular concentric hypertrophy plasma level of ANP and BNP was increased whereas in patients with concentric remodeling and eccentric hypertrophy only plasma level of ANP was elevated. In patients with concentric hypertrophy higher levels of ANP and BNP were found compared to patients with concentric remodeling and eccentric hypertrophy.

Chronic congestive heart failure (CHF) is a complex clinical syndrome characterized by marked neurohormonal activation which may lead to further decompensation of the circulatory system. This study was undertaken to establish the role of certain hormones in pathogenesis of congestive heart failure. Plasma levels of brain natriuretic peptide (BNP), cyclic 3'5'-guanosine monophosphate (c-GMP), endothelin 1 (ET-1), and noradrenaline (NA) were examined in patients in patients with CHF and with decompensation of circulatory system. The survey was made in 92 patients with CHF, among them there were 42 females aged 50-76 years (mean 66 years) and 50 males aged 53-76 years (mean 68 years). All patients were divided into 3 groups according to NYHA classification. On admission blood samples were taken from all patients to determine plasma levels of BNP, c-GMP, ET-1, and NA. Then patients received captopril and furosemide. Next blood samples were taken between 5 and 7 day of the treatment, after entire remission symptoms of decompensation. Plasma levels of BNP, c-GMP, ET-1, and NA were estimated with radioimmunoassay. Our study showed that plasma levels of ET-1, BNP, c-GMP, and NA were increased in patients with CHF. 5-7 days of the treatment with ACE inhibitor and diuretic caused significant decrease of ET-1, BNP, and c-GMP levels, but did not influence NA plasma levels. Determination of ET-1, BNP, c-GMP, and NA plasma levels may be a noninvasive method useful in estimation of degree of CHF and efficacy of the treatment.

Proinflammatory cytokines are capable of modulating cardiovascular function by a various mechanisms. The aim of the study was to evaluate the influence of the selected cytokines: tumor necrosis factor alpha (TNF-alpha), interleukin 1 (IL-1), interleukin 2 (IL-2), interleukin 6 (L-6), endothelin 1 (ET-1) on the remodeling of the heart in patients with congestive heart failure (1-year follow-up). The study was made in 45 patients with congestive heart failure treated in the Department of Cardiology. Of these, 31 were men aged from 44 to 77 and 14 were women aged from 48 to 79. Ischaemic heart disease was diagnosed in 22 patients and ischaemic heart disease and hypertension in 10 patients, dilated cardiomyopathy was diagnosed in 6 patients and postinflammatory cardiomyopathy in 7 patients. Blood samples for determination of TNF-alpha, IL-1, IL-2, IL-6, ET-1, aldosterone, catecholamines, brain natriuretic peptide (BNP) and atrial natriuretic peptide (ANP) levels were obtained prior to the treatment and in 3 and 6 and 12 month follow-up. At the same time were estimated: NYHA functional class, structure, systolic and diastolic left ventricle function of the heart using echocardiography and 24-hour ECG Holter monitoring (HR, supraventricular and ventricular arrhythmias). TNF-alpha, IL-1, IL-2, IL-6, ET-1, aldosterone, catecholamines, BNP and ANP plasma levels were determined with radioimmunological assay. In patients with progression of congestive heart failure (worsening of NYHA class and ejection fraction of left ventricle) the plasma concentrations of TNF-alpha and ET-1 significantly increased in following observations. In this group patients we determined a correlation between ejection fraction of the left ventricle and serum concentration of TNF-alpha and ET-1. In patients with improving of NYHA functional class and ejection fraction of left ventricle the plasma concentrations of cytokines were not altering. In all patients the plasma concentration of TNF-alpha correlated with ANP and BNP concentrations.

Natriuretic peptides ANP, BNP and CNP with their receptors A, B, and C play an important role in maintaining the homeostasis. They have vasodilating, diuretic and natriuretic actions and regulate the systemic resistance. These peptides have been proved to contribute in pathogenesis of many diseases, for example heart failure, hypertension, acute coronary events or hepatic and renal insufficiency. The aim of our study was the estimation whether ANP or BNP could be markers of postinfarct heart failure in patients after thrombolytic therapy. The survey was made in 96 patients with acute myocardial infarction (AMI), who were treated in Department of Cardiology of University School of Medicine in Wrocław. Patients were divided into 2 groups. The first group consisted of 56 patients with reperfusion after thrombolytic therapy and the second group created 40 patients without reperfusion. All patients were administered acethylsalicylic acid, 100 mg r-tPA (recombined tissue plasminogen activator) i.v. within 90 min and heparin in typical doses for the first 3-5 days. Venous blood samples for ANP and BNP estimation were taken before thrombolysis and then in 1st, 3rd, 5th and 30th day after treatment. We also measured the ejection fraction and activity of CPK and CK-MB in all the patients. Patients stayed under clinical observation for 12 months. Our study showed that the levels of ANP and BNP increase in 1st day after treatment in all patients with AMI. The normalization of ANP and BNP occurs in 3rd day after treatment in patients with reperfusion and in patients without reperfusion there are increased levels of these peptides even in 30th day. The increased level of BNP (> 160 pg/ml) is a significant risk factor of left ventricle systolic dysfunction, renewed AMI and sudden death in all patients with AMI after thrombolytic therapy whereas the increased level of ANP (> 100 pg/ml)--only in patients without reperfusion. Taking BNP as a marker of postinfarct heart failure it is possible to asses the risk of this complication in first day after thrombolytic therapy and choose the most proper treatment.

Unlabelled: Neurohumoral factors play important role in the pathogenesis of congestive heart failure (CHF) and digoxin (dig) is one of the most frequently used drugs in this condition. The aim of this study was to assess the effects of dig on atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP) and their "second messenger" cyclic 3',5'-guanosine monophosphate (cGMP)., Material and Method: The study group consisted of 25 patients (pts) aged 25-81 with CHF (NYHA II/III), 13 women and 12 men. Control group consisted of 10 healthy volunteers, 2 women and 8 men. The blood samples for evaluation of ANP, BNP and cGMP plasma level was taken at baseline conditions and 3 hours (h) after intravenous injection of 0.25 mg of dig. From the next day 0.25 mg dig was administrated orally for 6 days and plasma levels of ANP, BNP and cGMP were assessed on the 3rd and 6th day of treatment. Medium serum dig concentration on the 6th day was 0.98 ng/mL., Results: The baseline ANP, BNP and cGMP plasma level was significantly higher in pts with CHD than in control group (ANP 144.4 vs 98.8 pg/ml p < 0.001; BNP 130.0 vs 97.2 pg/ml p < 0.001; cGMP 1.44 vs 0.86 pg/ml p < 0.001). In pts with CHF there was a significant increase ANP, BNP and cGMP plasma level 3 h after dig intravenous injection (ANP 205.2 vs 144.4 pg/ml p < 0.01; BNP 227.1 vs 130.0 pg/ml p < 0.01; cGMP 1.84 vs 1.44 pg/ml p < 0.01). The ANP and BNP plasma level after 3 days of oral dig was still significantly increased (ANP 171.1 vs 144.4 pg/ml p < 0.05; BNP 223.7 vs 130.0 pg/ml p < 0.01). ANP, BNP and cGMP plasma level was higher in pts with CHF also after 6 days of oral dig, but the difference was statistically significant. After 6 days of digoxin treatment there was a significant increase of ejection fraction (p < 0.005), with reduction of end-diastolic diameter of left ventricle (p < 0.05) and diameter of left atrium (p < 0.01). ANP at baseline correlated positively with baseline cGMP (r = 0.702 p < 0.05). On the 6th day BNP correlated positively with cGMP (r = 0.628 p < 0.05). 3 h after dig intravenous injection ANP correlated positively with BNP (r = 0.881 p < 0.05), but on the 3rd day of oral dig ANP correlated negatively with BNP (r = -0.536 p < 0.05). On the 6th day of oral dig end-diastolic diameter of left ventricle correlated negatively with BNP (r = -0.483 p < 0.05) and cGMP (r = -0.824 p < 0.05)., Conclusions: 1. In pts with CHF a single intravenous digoxin injection increases ANP, BNP and cGMP plasma level. 2. Oral digoxin administration supports this beneficial neurohumoral effect and improves hemodynamic parameters of left ventricle as well as reduces left atrium diameter.