Robert Jarai

N-terminal pro-brain natriuretic peptide (Nt-proBNP) is a strong independent predictor of death in acute coronary syndromes. In order to improve risk assessment in patients with unstable coronary artery disease we investigated the role of the additional determination of Nt-proBNP levels in patients sub-grouped into high-, medium- and low-risk groups according to the TIMI risk score. Nt-proBNP was determined in 145 consecutive patients admitted to our clinic with typical anginal pain in the past 24 hours and normal left ventricular function. Using classification and regression tree analysis, we investigated whether Nt-proBNP levels provide clinically relevant prognostic information in addition to the TIMI risk score. Nt-proBNP concentrations were determined using a commercially available assay from Biomedica, Austria. The normal range of this assay is <2827 pg/ml. Multivariate logistic regression analysis revealed that TIMI scores and Nt-proBNP levels are independent predictors of mortality (P = 0.001 and P < 0.001, respectively). Patients with Nt-proBNP levels >5225 pg/ml had the highest mortality rate, independent of their TIMI risk classification. In the subset of patients with Nt-proBNP < or =5225 pg/ml, patients at TIMI medium risk but with Nt-proBNP above 2827 pg/ml had significantly higher mortality than patients with lower levels of Nt-proBNP (P = 0.03). Accordingly, we developed a combined risk score consisting of four risk groups: very high (Nt-proBNP > or =5225 pg/ml), high (TIMI high-risk group or TIMI medium-risk group and Nt-proBNP >2827 pg/ml), medium (TIMI medium-risk group and Nt-proBNP < or =2827 pg/ml) and low (TIMI low-risk group). The area under the receiver operating characteristic curve was 0.772 for the TIMI score alone and 0.863 for the combined risk score (P < 0.001). Determination of plasma Nt-proBNP levels and incorporation of these into TIMI risk classification by creating a combined risk score significantly improves risk assessment of patients with unstable coronary artery disease.

ABSTRACT Studies show that patients with schizophrenia have problems with understanding non-literal language, presumably due to theory of mind (ToM) dysfunction, while literal language processing remains intact in these patients. Furthermore, studies about the influence of general intelligence on non-literal language processing show incongruent results in schizophrenia. In the present study, our aim was to identify the influence of good intellectual skills (that is, good neurocognitive skills in general) on non-literal language comprehension on a preliminary sample of schizophrenic patients. 19 patients with schizophrenia and 19 healthy controls (carefully matched for all subtests of WAIS) completed different language tasks in the form of an interview, including conventional and unconventional metaphors, irony, Gricean implicatures, control implicatures and semantics. In the case of the Gricean implicatures, the comprehension of the linguistic incongruity of the utterance and also the comprehension of the intended meaning of the speaker were examined separately. To explore the effect of IQ on non-literal language comprehension, we divided the schizophrenia group into a lower-IQ (IQ ≤ 106) and a higher-IQ (IQ > 106) subgroup by making a median split (median IQ = 106). Our results showed that schizophrenics with lower-IQ were able to understand conventional metaphors presumably relying on their good semantic processing, while they were impaired in the comprehension of unconventional metaphors and irony. However, the higher-IQ schizophrenia subgroup was able to comprehend not only conventional metaphors, but also unconventional metaphors and irony, supposedly using IQ-dependent compensatory mechanisms. Interestingly, both the lower- and the higher-IQ schizophrenia subgroups showed significant impairment in the comprehension of the ToM question of the Gricean implicatures and the patients' IQ had no significant impact on the comprehension of such ToM questions. In conclusion, our findings assume a possible compensatory effect of general cognitive skills on non-literal language processing in schizophrenia. We also argue for the importance of using more complex ToM tasks in order to detect the existing ToM deficit in schizophrenic patients with good cognitive skills.