Dear Editor: Syncope is a serious problem with life-time prevalence of 35% (1). It is estimated that 1-3% of referrals to emergency departments and in-patient admissions are due to syncope (2). The underlying conditions can be cardiac or neurologic. Considering the completely different circumstances ruling the encounters with cardiac and neurologic syncope, in recent years many attempts have beenmade to find the proper tool for differentiating cardiac and non-cardiac causes of syncope. ...

Background: Cystatin C (Cys C) has been implicated as a prognostic marker in cardiovascular disease. The aim of this study was to evaluate the value of Cys C as a marker of acute kidney injury (AKI) in acute heart failure (AHF), the impact of Cys C and N-terminal probrain natriuretic peptides (NT-proBNP) on in-hospital and 12 months mortality were also investigated.Materials and Methods: A total of 162 patients with AHF were enrolled. NT-proBNP, Cys C, serum creatinine (Scr), blood urea nitrogen (BUN) and parameters of echocardiography were measured for analyze. The in-hospital and 12 months mortality was analyzed.Results: There was 28 (17%) of all AHF patients with AKI. Compared with no-AKI patients, the levels of Cys C (1.51±0.34vs. 1.32±0.29, P=0.003) and NT-proBNP (8163.87±898.06 vs. 5922.45±576.73, P=0.001) were higher in AKI patients. Higher levels of NT-proBNP (odds ratio (OR)=1.92, 95% confidence interval (CI): 2.19-10.98, P=0.018, OR=4.31, 95% CI: 2.35-9.82,P=0.002, respectively) and Cys C (OR=1.48, 95% CI: 1.75-4.16, P=0.027, OR=2.72, 95% CI: 1.92-4.28, P=0.017, respectively)were independent association with the in-hospital and 12 months mortality. Cys C was positively correlated with NT-proBNP (r=0.87, P<0.001). Combining tertiles of Cys C and NT-proBNP improved risk stratification further. Compared with patients without AKI CysC, patients with AKI cysC was associated with higher in-hospital (7.28 vs. 10.134, P=0.002) and 12-month mortality (13.28 vs. 32.134, P=0.001).Conclusion: Cys C was not only a promising risk marker in patients hospitalized for AHF, but also an independent predictor of 12-month mortality. Combining tertiles of Cys C and NT-proBNP could be used to distinguish the mortality risk identification of patients with AHF. AKI was an independent predictor of in-hospital and 12-month mortality.

With interest, I read the article by Khalilian et al. entitled "Relationship between echocardiographic findings and laboratory serum biomarkers in patients with and without low cardiac output" that recently published in your valuable journal. We know that in adult patients, atrial natriuretic peptides (ANP) and brainnatriuretic peptides (BNP) have been used for diagnosis, monitoring of treatment effects, and estimating the prognosis of systolic and diastolic heart failure. Furthermore, ANP would remain quite stable during storage in plasma at -80oC for even 12 months.

Background: Cardiac dysfunction is one of the major causes of morbidity and mortality in thalassemia patients. This study aimed to compare the effect of Brain Natriuretic Peptides (BNP) and Calcitonin Gene-Related Peptide (CGRP) with echocardiographic findings in early diagnosis of cardiac disease in major thalassemia patients. Materials and Methods: This study was performed on 80 patients among 500 major thalassemia patients and 80 healthy people. Those with metabolic, endocrine disorder, hypertension, heart failure, and valvular disease excluded from the study. These two groups were matched based on age and sex. Essential heart findings were analyzed using Mylab 60. After blood sampling, levels of CGRP and BNP were measured by use of ELISA kit from extracted plasma. Mann-Whitney test, independent t-test, and Pearson correlation were used to analyze data and P< 0. 05 was considered significant. Results: The results showed that mean age of all participants was 17. 581± 5. 344 years when distributed between case and control as 18. 21 ± 5. 14 and 16. 95 ± 5. 49 respectively without significant difference. Means of weight, length, hemoglobin, systolic and diastolic pressure were lower in patients group. The majority of echocardiography findings of left and right heart were higher in case group. The average of CGRP and BNP level were more in case group (p<0. 05). A positive correlation was observed between BNP (R=0. 229, P=0. 041) and right MPI. There was also correlation between PEP(R=0. 0238, P=0. 035), PEP/ET(P=0. 005) of right heart and peak A velocity of left heart (R=0. 245, P=0. 03) with CGRP. Conclusion: Findings of this survey showed that systolic and diastolic function of left heart would be changed in patients with major beta thalassemia. Therefore, monitoring BNP and CGRP in symptom free thalassemia patients as well as serial echocardiography is recommended.

BACKGROUND: Rapid measuring of B-type natriuretic peptide (BNP) in the emergency departments effectively results in evaluating patients with acute cardiac attacks and has appeared to be a useful prognostic marker of cardiovascular risk. A current study came to address the association between plasma N-terminal pro BNP level and severity of coronary vessels' defects based on Gensini score in patients with stable angina pectoris candidate for coronary angiography.METHODS: The study population consisted of 92 consecutive patients with appearance of stable angina and candidate for coronary angiography. All participants underwent selective left and right coronary angiography. For BNP measurement and just before the catheterization of left coronary, 5cc blood samples were drawn from coronary.RESULTS: With respect to the role of N terminal pro BNP for predicting severity of CAD based on Gensini scoring, linear regression analysis confirmed that plasma BNP level was a strong predictor for CAD severity (p=0.009) in the presence of study cofounders. A significant correlation was also observed between N terminal pro BNP and left ventricular ejection fraction, so that all patients with left ventricular dysfunction (EF < 40%) had plasma N terminal pro BNP level higher than 100 pg/ml.CONCLUSIONS: NT-pro BNP can be a good parameter for predicting the severity of coronary vessels' involvement besides other diagnostic tools. In all patients with left ventricular ejection fraction less than 40%, plasma NT-pro BNP level was higher than 100 pg/ml.