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Article: B-type natriuretic peptide (BNP) levels: diagnostic and therapeutic potential.

Maisel, A S

2001 Volume 2 Suppl 2, Page(s) S13–8

Abstract: Finding a simple blood test that would aid in the diagnosis and management of patients with CHF would clearly have a favorable impact on the staggering costs associated with the disease. B-type natriuretic peptide (BNP) may be the first potential "white ... ...

Abstract	Finding a simple blood test that would aid in the diagnosis and management of patients with CHF would clearly have a favorable impact on the staggering costs associated with the disease. B-type natriuretic peptide (BNP) may be the first potential "white count" for heart failure. The fact that a point-of-care, rapid assay for BNP has recently been approved by the FDA gives the clinician an opportunity to explore its potential usefulness. Data suggest that serial point-of-care testing of BNP will be of immense help in patients presenting to urgent care clinics with dyspnea. Additionally, BNP might serve as a screen for patients referred for echocardiography, and might also be an effective way to improve the in-hospital management of patients admitted with decompensated CHF. Finally, the role of BNP in the outpatient cardiac or primary care clinic may be one of critical importance in titration of therapies as well as assessment of the state of the patient's neurohormonal compensation.
MeSH term(s)	Atrial Natriuretic Factor/blood ; Heart Failure/blood ; Heart Failure/diagnosis ; Heart Failure/therapy ; Humans ; Natriuretic Peptide, Brain ; Point-of-Care Systems ; Predictive Value of Tests ; Sensitivity and Specificity ; Ventricular Dysfunction, Left/blood
Chemical Substances	Natriuretic Peptide, Brain (114471-18-0) ; Atrial Natriuretic Factor (85637-73-6)
Language	English
Publishing date	2001
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2108910-3
ISSN	1530-6550
ISSN	1530-6550
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Article: Practical approaches to treating patients with acute decompensated heart failure.

Maisel, A S

Journal of cardiac failure

2001 Volume 7, Issue 2 Suppl 1, Page(s) 13–17

Abstract: Finding a simple blood test to aid in the diagnosis and treatment of patients with congestive heart failure would have a favorable impact on the costs associated with the disease. B-type natriuretic peptide (BNP) is synthesized in the cardiac ventricles ... ...

Abstract	Finding a simple blood test to aid in the diagnosis and treatment of patients with congestive heart failure would have a favorable impact on the costs associated with the disease. B-type natriuretic peptide (BNP) is synthesized in the cardiac ventricles and correlates with left ventricular pressure, amount of dyspnea, and the state of neurohormonal modulation, making this peptide the first potential "white count" for heart failure. Data indicate that serial point-of-care testing of BNP should be helpful in patients presenting to urgent care clinics with dyspnea. BNP might serve as a screen for patients referred for echocardiography. A low BNP level makes echocardiographic indices of left ventricular dysfunction (both systolic and diastolic) highly unlikely. BNP may also be effective in improving in-hospital management of patients admitted with decompensated congestive heart failure. In some cases BNP levels may obviate the need for invasive hemodynamic monitoring and, when such monitoring is used, may help tailor treatment of decompensated patients. Finally, the role of BNP in outpatient cardiac or primary care clinics may be important in the titration of therapies and assessment of the state of neurohormonal compensation of patients.
MeSH term(s)	Acute Disease ; Atrial Natriuretic Factor/blood ; Heart Failure/blood ; Heart Failure/diagnosis ; Heart Failure/therapy ; Humans ; Point-of-Care Systems ; Predictive Value of Tests
Chemical Substances	Atrial Natriuretic Factor (85637-73-6)
Language	English
Publishing date	2001-09-11
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1281194-4
ISSN	1532-8414 ; 1071-9164
ISSN (online)	1532-8414
ISSN	1071-9164
DOI	10.1054/jcaf.2001.26646
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Article: Beneficial effects of metoprolol treatment in congestive heart failure. Reversal of sympathetic-induced alterations of immunologic function.

Maisel, A S

Circulation

1994 Volume 90, Issue 4, Page(s) 1774–1780

Abstract: Background: Little information is available to explain why beta-blockers are beneficial in certain patients with congestive heart failure (CHF). Since catecholamines alter immune function, we asked whether beta-blocker treatment leads to enhancement of ... ...

Abstract	Background: Little information is available to explain why beta-blockers are beneficial in certain patients with congestive heart failure (CHF). Since catecholamines alter immune function, we asked whether beta-blocker treatment leads to enhancement of immune function. Methods and results: Fifteen patients with New York Heart Association class III-IV CHF secondary to dilated cardiomyopathy were titrated to a minimum dose of metoprolol 25 mg BID on a background therapy of digoxin, diuretic, and angiotensin-converting enzyme inhibitors. Cardiac and immunologic studies were done before and 6 months to 1 year after treatment. While these patients served as their own controls, an additional population of patients with heart failure was followed for a similar time period on traditional medications. A panel of seven delayed hypersensitivity skin tests were placed at 6- to 12-month intervals on the patient's forearm. Seventy percent of all CHF patients were anergic (unable to respond to more than 1 antigen). The 30% who could respond averaged 2.2 antigens. After treatment with metoprolol, only 20% remained anergic (P < .001). The 80% of responders averaged 4.2 antigens (P < .001). Additionally, patients treated with metoprolol had an increased percentage of T cells, natural killer cells, and increased interleukin-2 receptor density upon stimulation with concanavalin A. These changes correlated to increases in ejection fraction. Patients not treated with metoprolol remained anergic and had no beneficial immunologic changes. Conclusions: It appears that patients with dilated cardiomyopathy who are treated with metoprolol have enhancement of cell-mediated immunity and improvement of T-cell function; these improvements are correlated to improvement in ejection fraction.
MeSH term(s)	Adult ; Aged ; Cell Division/drug effects ; Concanavalin A/pharmacology ; Heart Failure/drug therapy ; Heart Failure/physiopathology ; Humans ; Immune System/drug effects ; Immune System/physiopathology ; Lymphocyte Subsets/pathology ; Metoprolol/therapeutic use ; Middle Aged ; Skin Tests ; Stroke Volume ; Sympathetic Nervous System/physiopathology
Chemical Substances	Concanavalin A (11028-71-0) ; Metoprolol (GEB06NHM23)
Language	English
Publishing date	1994-10
Publishing country	United States
Document type	Clinical Trial ; Journal Article
ZDB-ID	80099-5
ISSN	1524-4539 ; 0009-7322 ; 0069-4193 ; 0065-8499
ISSN (online)	1524-4539
ISSN	0009-7322 ; 0069-4193 ; 0065-8499
DOI	10.1161/01.cir.90.4.1774
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Article ; Online: Adiponectin is independently associated with NT-proBNP: The Multi-Ethnic Study of Atherosclerosis.

Allison, M A / Criqui, M H / Maisel, A S / Daniels, L B / Roberts, C K / Polak, J F / Cushman, M

Nutrition, metabolism, and cardiovascular diseases : NMCD

2015 Volume 25, Issue 8, Page(s) 780–786

Abstract: Background and aims: To investigate the associations between selected adipokines and the N-terminal prohormone of B-type natriuretic peptide (NT-proBNP).: Methods and results: As many as 1489 individuals enrolled in the Multi-Ethnic Study of ... ...

Abstract	Background and aims: To investigate the associations between selected adipokines and the N-terminal prohormone of B-type natriuretic peptide (NT-proBNP). Methods and results: As many as 1489 individuals enrolled in the Multi-Ethnic Study of Atherosclerosis were evaluated at 4 clinic visits about every 2 years. The evaluation included fasting venous blood, which was analyzed for NT-proBNP (at visits 1 and 3) and the adipokines adiponectin and leptin (at visits 2 and 3). The mean age was 64.8 ± 9.6 years and 48% were female. After multivariable adjustment, a 1-SD increment in adiponectin was associated with a 14 pg/ml higher NT-proBNP level (p < 0.01), while, compared to the 1st quartile of adiponectin, the 2nd, 3rd and 4th quartiles had 28, 45 and 67% higher NT-proBNP levels (p < 0.01 for all). For changes in NT-proBNP over the follow-up period, and after multivariable adjustment including baseline NT-proBNP, a 1-SD increment in adiponectin was associated with a 25 pg/ml absolute increase in NT-proBNP (p < 0.01), while those in the 2nd, 3rd and 4th quartiles of adiponectin were associated with increases of 5, 28 and 65 pg/ml (p = 0.74, 0.09 and <0.01, respectively). There was a significant interaction between adiponectin and sex for visit 3 NT-proBNP (p-interaction < 0.01), with significantly stronger associations in men. Leptin was not associated with NT-proBNP. Conclusion: Higher adiponectin, but not leptin, is significantly associated with higher levels of NT-proBNP, as well as with greater longitudinal increases in NT-proBNP. The associations were stronger in men.
MeSH term(s)	Adiponectin/blood ; Adult ; Aged ; Aged, 80 and over ; Atherosclerosis/blood ; Biomarkers/blood ; Female ; Follow-Up Studies ; Humans ; Leptin/blood ; Male ; Middle Aged ; Multivariate Analysis ; Natriuretic Peptide, Brain/blood ; Peptide Fragments/blood ; Sex Factors
Chemical Substances	Adiponectin ; Biomarkers ; Leptin ; Peptide Fragments ; pro-brain natriuretic peptide (1-76) ; Natriuretic Peptide, Brain (114471-18-0)
Language	English
Publishing date	2015-08
Publishing country	Netherlands
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	1067704-5
ISSN	1590-3729 ; 0939-4753
ISSN (online)	1590-3729
ISSN	0939-4753
DOI	10.1016/j.numecd.2015.04.005
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Article: Adiponectin is independently associated with NT-proBNP: The Multi-Ethnic Study of Atherosclerosis

Allison, M.A / Criqui, M.H / Maisel, A.S / Daniels, L.B / Roberts, C.K / Polak, J.F / Cushman, M

Nutrition, metabolism, and cardiovascular diseases. 2015 Aug., v. 25, no. 8

2015

Abstract: To investigate the associations between selected adipokines and the N-terminal prohormone of B-type natriuretic peptide (NT-proBNP).As many as 1489 individuals enrolled in the Multi-Ethnic Study of Atherosclerosis were evaluated at 4 clinic visits about ... ...

Abstract	To investigate the associations between selected adipokines and the N-terminal prohormone of B-type natriuretic peptide (NT-proBNP).As many as 1489 individuals enrolled in the Multi-Ethnic Study of Atherosclerosis were evaluated at 4 clinic visits about every 2 years. The evaluation included fasting venous blood, which was analyzed for NT-proBNP (at visits 1 and 3) and the adipokines adiponectin and leptin (at visits 2 and 3). The mean age was 64.8 ± 9.6 years and 48% were female. After multivariable adjustment, a 1−SD increment in adiponectin was associated with a 14 pg/ml higher NT-proBNP level (p < 0.01), while, compared to the 1st quartile of adiponectin, the 2nd, 3rd and 4th quartiles had 28, 45 and 67% higher NT-proBNP levels (p < 0.01 for all). For changes in NT-proBNP over the follow-up period, and after multivariable adjustment including baseline NT-proBNP, a 1−SD increment in adiponectin was associated with a 25 pg/ml absolute increase in NT-proBNP (p < 0.01), while those in the 2nd, 3rd and 4th quartiles of adiponectin were associated with increases of 5, 28 and 65 pg/ml (p = 0.74, 0.09 and <0.01, respectively). There was a significant interaction between adiponectin and sex for visit 3 NT-proBNP (p-interaction < 0.01), with significantly stronger associations in men. Leptin was not associated with NT-proBNP.Higher adiponectin, but not leptin, is significantly associated with higher levels of NT-proBNP, as well as with greater longitudinal increases in NT-proBNP. The associations were stronger in men.
Keywords	adiponectin ; atherosclerosis ; blood ; females ; leptin ; men ; metabolism ; nationalities and ethnic groups ; natriuretic peptides
Language	English
Dates of publication	2015-08
Size	p. 780-786.
Publishing place	Elsevier B.V.
Document type	Article
ZDB-ID	1067704-5
ISSN	0939-4753
ISSN	0939-4753
DOI	10.1016/j.numecd.2015.04.005
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Article: Beta-adrenoceptor control of immune function in congestive heart failure.

Maisel, A S / Michel, M C

British journal of clinical pharmacology

1990 Volume 30 Suppl 1, Page(s) 49S–53S

Abstract: 1. We have determined the number of beta-adrenoceptors and the isoprenaline-stimulated cAMP generation in lymphocyte subsets. The in vitro beta-adrenergic sensitivity was greatest in Tsuppressor/cytotoxic- and natural killer cells and smallest in Thelper- ...

Abstract	1. We have determined the number of beta-adrenoceptors and the isoprenaline-stimulated cAMP generation in lymphocyte subsets. The in vitro beta-adrenergic sensitivity was greatest in Tsuppressor/cytotoxic- and natural killer cells and smallest in Thelper- and B-cells. B lymphocytes appear to have a poor receptor coupling to adenylate cyclase as they have many beta-adrenoceptors but generate only little cAMP in response to isoprenaline. 2. A 7 day treatment of healthy volunteers with terbutaline decreased the number of circulating cells in those lymphocyte subsets with a high in vitro sensitivity to beta-adrenoceptor stimulation (i.e. Tsuppressor/cytotoxic- and natural killer cells) but not in those with a poor in vitro sensitivity (i.e. Thelper- and B-lymphocytes). 3. Similar alterations of circulating lymphocyte subsets were found in patients with congestive heart failure (CHF). These alterations were not related to the aetiology of CHF but to its severity and could be correlated with plasma catecholamine levels. 4. We conclude that prolonged exposure to beta-adrenoceptor agonists or enhanced sympathetic activity can decrease the number of circulating lymphocytes with an increase in the Thelper-/Tsuppressor/cytotoxic-cell ratio.
MeSH term(s)	Adenylyl Cyclases/metabolism ; Adult ; Aged ; Cyclic AMP/biosynthesis ; Female ; Heart Failure/immunology ; Humans ; Isoproterenol/pharmacology ; Lymphocytes/drug effects ; Lymphocytes/immunology ; Lymphocytes/metabolism ; Male ; Middle Aged ; Receptors, Adrenergic, beta/immunology ; T-Lymphocyte Subsets/drug effects ; Terbutaline/pharmacology
Chemical Substances	Receptors, Adrenergic, beta ; Cyclic AMP (E0399OZS9N) ; Adenylyl Cyclases (EC 4.6.1.1) ; Isoproterenol (L628TT009W) ; Terbutaline (N8ONU3L3PG)
Language	English
Publishing date	1990
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	188974-6
ISSN	1365-2125 ; 0306-5251 ; 0264-3774
ISSN (online)	1365-2125
ISSN	0306-5251 ; 0264-3774
DOI	10.1111/j.1365-2125.1990.tb05468.x
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Article: Beta-adrenergic receptors in congestive heart failure: present knowledge and future directions.

Maisel, A S / Michel, M C

Cardiology

1989 Volume 76, Issue 5, Page(s) 338–346

Abstract: In recent years substantial information has become available on the function and regulation of beta-adrenergic receptors in experimental model systems and in the human heart. Beta-Adrenergic receptors mediate the positive inotropic and chronotropic ... ...

Abstract	In recent years substantial information has become available on the function and regulation of beta-adrenergic receptors in experimental model systems and in the human heart. Beta-Adrenergic receptors mediate the positive inotropic and chronotropic effects of the sympathetic neurotransmitter norepinephrine in the heart. They can be altered in various disease states including congestive heart failure. In order to enhance understanding of beta-adrenergic receptor regulation in heart failure, we here review the present knowledge and the open question in three areas: (1) the differential role of beta 1- and beta 2-adrenergic receptors: (2) regulation of the number of cardiac beta-adrenergic receptors by drugs and disease states: and (3) regulation of the responsiveness of cardiac beta-adrenergic receptors.
MeSH term(s)	Animals ; Heart/physiopathology ; Heart Failure/drug therapy ; Heart Failure/physiopathology ; Humans ; Receptors, Adrenergic, beta/drug effects ; Receptors, Adrenergic, beta/physiology
Chemical Substances	Receptors, Adrenergic, beta
Language	English
Publishing date	1989
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, P.H.S. ; Review
ZDB-ID	80092-2
ISSN	1421-9751 ; 0008-6312
ISSN (online)	1421-9751
ISSN	0008-6312
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Article: A prospective study of an algorithm using cardiac troponin I and myoglobin as adjuncts in the diagnosis of acute myocardial infarction and intermediate coronary syndromes in a veteran's hospital.

Maisel, A S / Templin, K / Love, M / Clopton, P

Clinical cardiology

2000 Volume 23, Issue 12, Page(s) 915–920

Abstract: Background: Accurate and cost-effective evaluation of acute chest pain has been problematic for years. The high prevalence of missed myocardial infarctions (MI) has led to conservative triage behavior on the part of physicians, leading to expensive ... ...

Abstract	Background: Accurate and cost-effective evaluation of acute chest pain has been problematic for years. The high prevalence of missed myocardial infarctions (MI) has led to conservative triage behavior on the part of physicians, leading to expensive admissions to coronary care units. New algorithms are sorely needed for more rapid and accurate triage of patients with chest pain to appropriate treatment settings. Hypothesis: We sought to test an algorithm for rapid diagnosis of MI and acute coronary syndromes using cardiac troponin I (cTnI) and myoglobin as adjuncts to creatine kinase (CK)-MB. We hypothesized our algorithm would be both sensitive and specific at early time points, and would allow safe stratification of patients not ruling in by conventional CK-MB criteria. Methods: This was a 6-month prospective study of 505 consecutive patients who presented with chest pain at a university-affiliated veteran's hospital. The percentage of MIs at various time points was identified using combinations of markers. Safety outcomes were assessed by follow-up of patients discharged home. Cost savings analysis was assessed by surveying the physicians as to whether the use of the algorithm affected their disposition of patients. Forty-nine patients ruled in for MI. Using the combination of cTnI, 2-h doubling of myoglobin, and CK-MB, 37 (76%) ruled in at the time of presentation, 43 (88%) at 2 h, and 100% by 6 h. Results: Cardiac troponin I plus a 2-h myoglobin was as accurate as the combination of all three markers and performed better than CK-MB in detecting patients presenting late and as a predictor for complications when CK-MB was normal. Of the 456 patients with normal markers after 6 h, only 140 were sent to the coronary care unit (CCU), and 176 were sent home. A 3-month follow-up showed minimal adverse events. One-half of physicians completing a survey stated the use of markers changed their disposition of patients, leading to an estimated 6-month cost savings of a half-million dollars. Conclusions: We developed an algorithm using troponin I and myoglobin as adjuncts to usual CK-MB levels that allowed for rapid and accurate assessment of patients with acute MI. It also afforded physicians important input into their decision making as to how best to triage patients presenting with chest pain. Their comfort in sending home certain subgroups of patients who otherwise would have been admitted to the CCU was rewarded with a good short-term prognosis and a large cost savings to the hospital.
MeSH term(s)	Algorithms ; Angina, Unstable/diagnosis ; Biomarkers ; California ; Cost Savings ; Hospitals, Veterans ; Humans ; Myocardial Infarction/diagnosis ; Myocardial Infarction/economics ; Myoglobin/blood ; Prospective Studies ; Sensitivity and Specificity ; Syndrome ; Troponin I/blood
Chemical Substances	Biomarkers ; Myoglobin ; Troponin I
Language	English
Publishing date	2000-10-24
Publishing country	United States
Document type	Journal Article
ZDB-ID	391935-3
ISSN	1932-8737 ; 0160-9289
ISSN (online)	1932-8737
ISSN	0160-9289
DOI	10.1002/clc.4960231212
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Article: Receptor redistribution does not accompany terbutaline-induced down regulation of beta-adrenergic receptors on human mononuclear leukocytes.

Maisel, A S / Motulsky, H J

Clinical pharmacology and therapeutics

1987 Volume 42, Issue 1, Page(s) 100–106

Abstract: Mononuclear leukocytes are easily accessible cells for investigating the regulation of beta-adrenergic receptors in humans. We have previously shown that brief incubations with agonists redistribute (? internalize) most of the beta-adrenergic receptors ... ...

Abstract	Mononuclear leukocytes are easily accessible cells for investigating the regulation of beta-adrenergic receptors in humans. We have previously shown that brief incubations with agonists redistribute (? internalize) most of the beta-adrenergic receptors on mononuclear leukocytes away from the cell surface without changing total receptor number. However, negligible redistribution occurred after exercise or an infusion of isoproterenol. The current study was designed to ask whether receptor redistribution occurs over a longer time course after administration of terbutaline, a beta 2-adrenergic agonist that is known to cause a decrease in receptor number. Normal volunteers were given terbutaline, 5 mg t.i.d. for 6 days. As expected, the number of beta-adrenergic receptors decreased. However, the remaining receptors were not redistributed. Redistribution also did not occur after 1 or 2 days of terbutaline, at which time down regulation was minimal. We also found that terbutaline did not alter the ability of the receptors to be redistributed or desensitized by a preincubation with isoproterenol.
MeSH term(s)	Administration, Oral ; Adult ; Humans ; Isoproterenol/metabolism ; Leukocytes/drug effects ; Leukocytes/metabolism ; Male ; Middle Aged ; Radioligand Assay ; Receptors, Adrenergic, beta/blood ; Receptors, Adrenergic, beta/drug effects ; Terbutaline/pharmacology
Chemical Substances	Receptors, Adrenergic, beta ; Isoproterenol (L628TT009W) ; Terbutaline (N8ONU3L3PG)
Language	English
Publishing date	1987-07
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	123793-7
ISSN	1532-6535 ; 0009-9236
ISSN (online)	1532-6535
ISSN	0009-9236
DOI	10.1038/clpt.1987.115
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Article: Delayed air embolism simulating pulmonary thromboembolism in the intensive care unit: role of echocardiography.

Kimura, B J / Chaux, G E / Maisel, A S

Critical care medicine

1994 Volume 22, Issue 11, Page(s) 1884–1886

MeSH term(s)	Aged ; Catheterization, Central Venous/adverse effects ; Critical Care ; Diagnosis, Differential ; Echocardiography ; Embolism, Air/diagnostic imaging ; Embolism, Air/etiology ; Emergencies ; Female ; Humans ; Jugular Veins ; Pulmonary Embolism/diagnostic imaging ; Time Factors
Language	English
Publishing date	1994-11
Publishing country	United States
Document type	Case Reports ; Journal Article ; Review
ZDB-ID	197890-1
ISSN	1530-0293 ; 0090-3493
ISSN (online)	1530-0293
ISSN	0090-3493
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