Factors responsible for elevated plasma B-type natriuretic peptide levels in severe aortic stenosis: Comparison between elderly and younger patients

AbstractBackgroundElevated plasma B-type natriuretic peptide (BNP) is a predictor of outcome and helpful for risk stratification in aortic stenosis (AS). However, left ventricular (LV) diastolic dysfunction progresses with aging and may also influence plasma BNP levels in elderly patients. We hypothesized that plasma BNP levels may be influenced by age in severe AS, and that factors that affect the elevation of plasma BNP levels may be different between elderly and younger patients with AS.MethodsWe performed echocardiography in 341 patients with severe AS [aortic valve area (AVA)<1.0cm2] and classified them into two groups by age (elderly ≥75 years old, n=201; younger patients <75 years old, n=140). We used multivariate linear regression analysis to assess the factors that determine plasma BNP levels in both groups.ResultsAge was found to be one of the independent determinants of plasma BNP levels in all patients (β=0.135, p=0.005). Although AVA was similar in the two groups, plasma BNP levels and E/e′ were significantly higher in elderly than younger patients [133.0 (IQR, 73.3–329.7)pg/dl vs 92.8 (IQR, 40.6–171.8)pg/dl, p<0.01; 20±8 vs 16±6, p<0.01, respectively). In multivariate stepwise linear regression analysis, AVA index, LV ejection fraction, mass index, E/e′, estimated systolic pulmonary artery pressure (eSPAS), and the presence of atrial fibrillation were independent determinants of plasma BNP levels in younger patients. In contrast, the independent determinants of plasma BNP levels in elderly patients were LV ejection fraction, mass index, E/e′, eSPAS, the presence of atrial fibrillation, age, and hemoglobin levels, but not AVA index.ConclusionsThere may be differences in the factors that influence plasma BNP levels between elderly and younger patients with severe AS. In elderly patients, plasma BNP levels may be influenced more by these factors than AS severity compared with younger patients

Hydration of fly ash cement

Abstract It is necessary to establish the material design system for the utilization of large amounts of fly ash as blended cement instead of disposing of it as a waste. Cement blended with fly ash is also required as a countermeasure to reduce the amount of CO 2 generation. In this study, the influences of the glass content and the basicity of glass phase on the hydration of fly ash cement were clarified and hydration over a long curing time was characterized. Two kinds of fly ash with different glass content, one with 38.2% and another with 76.6%, were used. The hydration ratio of fly ash was increased by increasing the glass content in fly ash in the specimens cured for 270 days. When the glass content of fly ash is low, the basicity of glass phase tends to decrease. Reactivity of fly ash is controlled by the basicity of the glass phase in fly ash during a period from 28 to 270 days. However, at an age of 360 days, the reaction ratios of fly ash show almost identical values with different glass contents. Fly ash also affected the hydration of cement clinker minerals in fly ash cement. While the hydration of alite was accelerated, that of belite was retarded at a late stage.