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\title{NT-proBNP as a Diagnostic Marker in CCF}
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             \author[1]{Dr. Vedavathi  R.}

             \affil[1]{  KEMPEGOWDA INSTITUTE OF MEDICAL SCIENCES, BANGALORE.}

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\date{\small \em Received: 10 December 2015 Accepted: 3 January 2016 Published: 15 January 2016}

\maketitle


\begin{abstract}
        


Introduction-? Heart failure prevalence is raising throughout the world.? The overall prevalence of HF is thought to be increasing because current therapies for cardiac disorders, such as Myocardial Infarction (MI), Valvular Heart Disease, and Arrhythmias, are allowing patients to survive longer. ? American Heart Association (AHA) guidelines define HF as a "Complex clinical syndrome that results from structural or functional impairment of ventricular filling or ejection of blood, which in turn leads to the cardinal clinical symptoms of dyspnea and fatigue and signs of HF namely edema and rales". ? Making the correct diagnosis in patients with Suspected Acute Heart Failure is challenging, and confirmatory in only 40-50% of Cases. ? Several Studies have shown that when added to routine history, Clinical Examination and Conventional investigations measurement of plasma natriuretic peptide levels improve diagnostic accuracy. ? B-type natriuretic peptides (BNP) that are synthesized by the left and right atria in response to cardiomyocyte stretching. ? The human BNP gene encodes a 108 amino acid pro hormone named proBNP.

\end{abstract}


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\let\tabcellsep& 	 	 		 
\section[{III. Results}]{III. Results}\par
Comparison of mean NT-proBNP: IV. Discussion\par
? Among 30 controls: 1. 29 had NT-proBNP levels within normal range for their age. 2. 1 had elevated level of NT-ProBNP for their age.\par
? Among 30 cases: 3. 24 had NT-ProBNP level elevated for their age and were diagnosed to have congestive cardiac failure. 4. 6 had NT-ProBNP levels within normal limits for their age. These 6 patients had a normal 2D-ECHO. Breathlessness in these patients was due to non cardiac cause.    
\section[{ETIOLOGY OF AMONG 30 CASES}]{ETIOLOGY OF AMONG 30 CASES}\par
ETIOLOGY OF DYSPNEA AMONG 30 CASES\begin{figure}[htbp]
\noindent\textbf{}\includegraphics[]{image-2.png}
\caption{\label{fig_0}?}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{}\includegraphics[]{image-3.png}
\caption{\label{fig_1}}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{}\includegraphics[]{image-4.png}
\caption{\label{figure4}}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{} \par 
\begin{longtable}{P{0.5726003490401396\textwidth}P{0.27739965095986036\textwidth}}
\tabcellsep 2. b) Exclusion Criteria\\
\tabcellsep 1. Cor pulmonale.\\
? CASES: Patients suspected to have heart failure based on history, Clinical examination and ECG (Age and Sex Matched individuals).\tabcellsep 2. Sepsis. 3. Lung Cancer. 4. Pulmonary Embolism. 5. ARDS.\\
? CONTROLS: Patients without heart failure and\tabcellsep 6. Liver Cirrhosis.\\
diseases mentioned in Exclusion Criteria.\tabcellsep 7. Renal failure.\\
? In our study cutoff levels for NT-pro BNP was\tabcellsep 8. Patients not willing to participate in the study.\\
1. >450 pg/ml for those aged < 50 years.\tabcellsep \\
2. >900 pg/ml for those aged 50-70 years.\tabcellsep \\
a) Inclusion Criteria\tabcellsep \\
1. Age 40-70 years.\tabcellsep \end{longtable} \par
 
\caption{\label{tab_0}?}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{} \par 
\begin{longtable}{P{0.7216556291390729\textwidth}P{0.036026490066225166\textwidth}P{0.03377483443708609\textwidth}P{0.04052980132450331\textwidth}P{0.018013245033112583\textwidth}}
\tabcellsep \tabcellsep \tabcellsep \multicolumn{2}{l}{Comparision of Mean EF}\\
\tabcellsep \tabcellsep \tabcellsep vaalues\\
\multicolumn{2}{l}{V. Discussion}\tabcellsep \tabcellsep \\
\multicolumn{2}{l}{? The mean value of NT-proBNP raises with}\tabcellsep \tabcellsep \\
\multicolumn{2}{l}{100.00\% decreasing EF. NT-ProBNP values have a inverse}\tabcellsep \tabcellsep \\
\multicolumn{2}{l}{100.00\% relationship with Ef Values. There was a strong}\tabcellsep \tabcellsep \\
\multicolumn{2}{l}{correlation between the 2 variable with a p value of 90.00\% <0.001 80.00\% ? There is a raise in NT-proBNP value with increasing}\tabcellsep \tabcellsep \\
\multicolumn{2}{l}{70.00\% NYHA grades. There was a significant correlation}\tabcellsep \tabcellsep \\
\multicolumn{2}{l}{40.00\% 50.00\% between the 2 variables with a 'P' value of 0.049 60.00\% ? The mean NT-ProBNP Value among controls was 568.43 pg/ml. The mean NT-proBNP value among cases as 8253.13pg/ml. It was statistically}\tabcellsep \multicolumn{2}{l}{43.30\%}\tabcellsep Normal DCm\\
\multicolumn{2}{l}{30.00\% significant with a 'P' value of <0.001.}\tabcellsep \tabcellsep \tabcellsep IHD\\
\multicolumn{2}{l}{20.00\% VI. Conclusion}\tabcellsep 20.00\%\tabcellsep 23.30\%\tabcellsep RHD\\
0.00\% 10.00\%\tabcellsep 0.00\% 0.00\% 0.00\%\tabcellsep 13.30\%\tabcellsep \\
\tabcellsep Control(N30)\tabcellsep \tabcellsep \\
\tabcellsep \tabcellsep Case(N30)\tabcellsep \end{longtable} \par
  {\small\itshape [Note: 1]} 
\caption{\label{tab_1}Comparison of Mean EF values}\end{figure}
 			\footnote{NT-proBNP as a Diagnostic Marker in CCF © 2016 Global Journals Inc. (US)} 		 		\backmatter  			  				\begin{bibitemlist}{1}
\bibitem[Longo et al.]{b2}\label{b2} 	 		\textit{},  		 			D L Longo 		,  		 			A S Fauci 		,  		 			D L Kasper 		,  		 			S L Hauser 		,  		 			J L Jameson 		.  	 	 		\textit{Loscalzo J eds}  		2 p. 2112.  	 
\bibitem[Yancy et al. ()]{b3}\label{b3} 	 		‘ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation’.  		 			C W Yancy 		,  		 			M Jessup 		,  		 			B Bozkurt 		,  		 			Casey Butlerj 		,  		 			De 		,  		 			M Drazner 		.  	 	 		\textit{American Heart Association Task Forcw on Practice guidelines circulation}  		2013. 128 p. .  	 
\bibitem[Dokainish ()]{b5}\label{b5} 	 		‘Combining tissue Doppler Echocardiography and B-type natriuretic peptide in the evaluation of left ventricular filling pressures: review of literature and clinical recommendations’.  		 			H Dokainish 		.  	 	 		\textit{Can J Cardiol}  		2007. 23 p. .  	 
\bibitem[Mcmurray et al. ()]{b4}\label{b4} 	 		‘ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The task force for the diagnosis and treatment of acute and chronic heart failure 2012 of the European society of cardiology. Developed in collaboration with the heart failure association (HFA) of the ESC’.  		 			Jjv Mcmurray 		,  		 			S Adamopoulos 		,  		 			S D Anker 		,  		 			A Auricchio 		,  		 			M Bohm 		,  		 			K Dickstein 		.  	 	 		\textit{Eur J Heart Fail}  		2012. 14 p. .  	 
\bibitem[Mann and Chakinala]{b1}\label{b1} 	 		‘Heart Failure : Pathophysiology and diagnosis’.  		 			D L Mann 		,  		 			M Chakinala 		.  	 	 		\textit{Harrison's Principles of internal Medicine 19 th ed},  				 (McGraw-Hill)  		 	 
\bibitem[Schocken et al. ()]{b0}\label{b0} 	 		‘Prevention of heart failure: A scientific statement from the American heart association councils on Epidemiology and prevention’.  		 			D D Schocken 		,  		 			E J Benjamin 		,  		 			G C Fonarrow 		.  	 	 		\textit{Cardiovascular Nursing, and high blood pressure Research; Quality care and Outcomes Research Interdisciplinary Working group; and Functional Genomics and Translational Biology Interdisciplinary Working Group},  				2008. 117 p. 2544.  	 	 (Circulation) 
\end{bibitemlist}
 			 		 	 
\end{document}
