title: Relationship with plasma neurohormones and dyssynchrony detected by Doppler echocardiography in patients undergoing permanent pacemaker implantation.
abstract: OBJECTIVE
  To determine whether isovolumic relaxation flow (IRF) and isovolumic contraction flow (ICF) resulted from asynchrony and asynergy due to VVI and DDD pacemakers modulated neurohormones, we measured neurohormone levels in plasma and investigated the characteristics of IRF and ICF using Doppler echocardiography.
  
  
  RESULTS
  We studied 11 patients with dual-chamber pacemakers (DDD) and 11 patients, with ventricular inhibiting mode (VVI). All patients underwent Doppler echocardiography of the left ventricle. Atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), renin and aldosteron were measured. The LV was scanned for the presence of intracavitary flow during the isovolumic relaxation and isovolumic contraction period. The plasma levels of BNP and ANP were significantly lower in DDD mode than in VVI mode (56 +/- 32 pg/ml vs. 94 +/- 32 pg/ml, p = 0.022 and 98 +/- 20 pg/ml vs. 134 +/- 17 pg/ml, p = 0.042, respectively). There were no significant differences in the plasma level of renin or aldosteron. VVI mode versus DDD mode increased isovolumic relaxation flow time (129 +/- 41 vs. 111 +/- 36 sec, p = 0.020) and isovolumic relaxation flow velocity (50 +/- 4 vs. 37 +/- 2 cm/s, p = 0.018). A strong relationship between blood ANP and BNP levels and IRF velocity was found in patients with a VVI pacemaker (r: 0.632, p: 0.028; r: 0.528, p: 0.024, respectively).
  
  
  CONCLUSIONS
  VVI mode has a longer isovolumic relaxation time, isovolumic relaxation flow velocity and has higher ANP and BNP plasma levels than DDD mode. IRF resulting from asynergy and asynchrony in VVI mode pacemakers versus DDD mode pacemakers affects the plasma levels of ANP and BNP compared to renin and aldosteron.
authors.affiliation: Department of Cardiology, Trakya University School of Medicine, Edirne, Turkey. turhankurum1@superonline.com
authors.forename: Turhan
authors.initials: T
authors.lastname: Kürüm
authors.forename: Mahmut
authors.initials: M
authors.lastname: Yüksel
authors.forename: Gültaç
authors.initials: G
authors.lastname: Ozbay
authors.forename: Saadet
authors.initials: S
authors.lastname: Söyük
authors.forename: Mevlüt
authors.initials: M
authors.lastname: Türe
mesh_terms: D000368:Aged; D000450:Aldosterone / Q000097:blood; D009320:Atrial Natriuretic Factor / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001783:Blood Flow Velocity / Q000502:physiology; D002304:Cardiac Pacing, Artificial; D003324:Coronary Artery Disease / Q000097:blood / Q000503:physiopathology / Q000601:surgery; D015150:Echocardiography, Doppler; D005260:Female; D006329:Heart Conduction System / Q000000981:diagnostic imaging* / Q000378:metabolism* / Q000503:physiopathology; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000378:metabolism / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology; D020097:Natriuretic Peptide, Brain / Q000097:blood; D018377:Neurotransmitter Agents / Q000097:blood*; D010138:Pacemaker, Artificial; D012083:Renin / Q000097:blood; D013223:Statistics as Topic; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D018377:Neurotransmitter Agents; D020097:Natriuretic Peptide, Brain; D000450:Aldosterone; D009320:Atrial Natriuretic Factor; D012083:Renin