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Role of ranolazine in heart failure: From cellular to clinic perspective. Eur J Pharmacol 2022; 919:174787. [PMID: 35114190 DOI: 10.1016/j.ejphar.2022.174787] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 12/25/2021] [Accepted: 01/25/2022] [Indexed: 12/17/2022]
Abstract
Ranolazine was approved by the US Food and Drug Administration as an antianginal drug in 2006, and has been used since in certain groups of patients with stable angina. The therapeutic action of ranolazine was initially attributed to inhibitory effects on fatty acids metabolism. As investigations went on, however, it developed that the main beneficial effects of ranolazine arise from its action on the late sodium current in the heart. Since late sodium currents were discovered to be involved in various heart pathologies such as ischemia, arrhythmias, systolic and diastolic dysfunctions, and all these conditions are associated with heart failure, ranolazine has in some way been tested either directly or indirectly on heart failure in numerous experimental and clinical studies. As the heart continuously remodels following any sort of severe injury, the inhibition by ranolazine of the underlying mechanisms of cardiac remodeling including ion disturbances, oxidative stress, inflammation, apoptosis, fibrosis, metabolic dysregulation, and neurohormonal impairment are discussed, along with unresolved issues. A projection of pathologies targeted by ranolazine from cellular level to clinical is provided in this review.
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Farhan S, Clare RM, Jarai R, Giugliano RP, Lokhnygina Y, Harrington RA, Kristin Newby L, Huber K. Fasting glucose, NT-proBNP, treatment with eptifibatide, and outcomes in non-ST-segment elevation acute coronary syndromes: An analysis from EARLY ACS. Int J Cardiol 2017; 232:264-270. [PMID: 28089149 DOI: 10.1016/j.ijcard.2017.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 12/29/2016] [Accepted: 01/03/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Higher N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels have been linked to a more favorable glucometabolic profile. Little is known about the interaction of NT-proBNP and fasting glucose in non-ST-segment elevation acute coronary syndrome (NSTE ACS). METHODS Fasting glucose and NT-proBNP were measured in 2240 patients enrolled in the EARLY ACS trial. Multivariable Cox models were used to assess associations between fasting glucose and NT-proBNP and a 96-hour composite of death, myocardial infarction (MI), recurrent ischemia, or thrombotic bailout; 30-day death or MI; and 1-year mortality. RESULTS In adjusted Cox models, neither NT-proBNP nor fasting glucose was associated with the 96-hour endpoint (p=0.95 and p=0.87). NT-proBNP was associated with 30-day death or MI (hazard ratio [HR] 1.11, 95% confidence interval [CI] 1.02-1.22, p=0.02) and 1-year mortality (HR 1.63, 95% CI 1.42-1.89, p<0.0001), but fasting glucose was associated only with 1-year death (HR 1.53, 95% CI 1.08-2.16, p=0.02). NT-proBNP×glucose interaction terms were non-significant in all models. As fasting glucose levels increased, the risk of 96-hour and 30-day endpoints increased among patients who received early eptifibatide but not delayed, provisional use (pint=0.035 and pint=0.029). Higher NT-proBNP levels were associated with greater 30-day death or MI among patients who received early eptifibatide but not delayed, provisional use (pint=0.045). CONCLUSION NT-proBNP and fasting glucose concentrations were associated with intermediate-term ischemic outcomes and may identify differential response to treatment with eptifibatide. CLINICALTRIALS. GOV IDENTIFIER NCT00089895.
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Affiliation(s)
- Serdar Farhan
- 3rd Department of Internal Medicine, Cardiology, and Intensive Care Medicine, Wilhelminen Hospital, Vienna, Austria
| | | | - Rudolf Jarai
- 3rd Department of Internal Medicine, Cardiology, and Intensive Care Medicine, Wilhelminen Hospital, Vienna, Austria
| | - Robert P Giugliano
- TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Robert A Harrington
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Kurt Huber
- 3rd Department of Internal Medicine, Cardiology, and Intensive Care Medicine, Wilhelminen Hospital, Vienna, Austria.
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Hemingway H, Feder GS, Fitzpatrick NK, Denaxas S, Shah AD, Timmis AD. Using nationwide ‘big data’ from linked electronic health records to help improve outcomes in cardiovascular diseases: 33 studies using methods from epidemiology, informatics, economics and social science in the ClinicAl disease research using LInked Bespoke studies and Electronic health Records (CALIBER) programme. PROGRAMME GRANTS FOR APPLIED RESEARCH 2017. [DOI: 10.3310/pgfar05040] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BackgroundElectronic health records (EHRs), when linked across primary and secondary care and curated for research use, have the potential to improve our understanding of care quality and outcomes.ObjectiveTo evaluate new opportunities arising from linked EHRs for improving quality of care and outcomes for patients at risk of or with coronary disease across the patient journey.DesignEpidemiological cohort, health informatics, health economics and ethnographic approaches were used.Setting230 NHS hospitals and 226 general practices in England and Wales.ParticipantsUp to 2 million initially healthy adults, 100,000 people with stable coronary artery disease (SCAD) and up to 300,000 patients with acute coronary syndrome.Main outcome measuresQuality of care, fatal and non-fatal cardiovascular disease (CVD) events.Data platform and methodsWe created a novel research platform [ClinicAl disease research using LInked Bespoke studies and Electronic health Records (CALIBER)] based on linkage of four major sources of EHR data in primary care and national registries. We carried out 33 complementary studies within the CALIBER framework. We developed a web-based clinical decision support system (CDSS) in hospital chest pain clinics. We established a novel consented prognostic clinical cohort of SCAD patients.ResultsCALIBER was successfully established as a valid research platform based on linked EHR data in nearly 2 million adults with > 600 EHR phenotypes implemented on the web portal (seehttps://caliberresearch.org/portal). Despite national guidance, key opportunities for investigation and treatment were missed across the patient journey, resulting in a worse prognosis for patients in the UK compared with patients in health systems in other countries. Our novel, contemporary, high-resolution studies showed heterogeneous associations for CVD risk factors across CVDs. The CDSS did not alter the decision-making behaviour of clinicians in chest pain clinics. Prognostic models using real-world data validly discriminated risk of death and events, and were used in cost-effectiveness decision models.ConclusionsEmerging ‘big data’ opportunities arising from the linkage of records at different stages of a patient’s journey are vital to the generation of actionable insights into the diagnosis, risk stratification and cost-effective treatment of people at risk of, or with, CVD.Future workThe vast majority of NHS data remain inaccessible to research and this hampers efforts to improve efficiency and quality of care and to drive innovation. We propose three priority directions for further research. First, there is an urgent need to ‘unlock’ more detailed data within hospitals for the scale of the UK’s 65 million population. Second, there is a need for scaled approaches to using EHRs to design and carry out trials, and interpret the implementation of trial results. Third, large-scale, disease agnostic genetic and biological collections linked to such EHRs are required in order to deliver precision medicine and to innovate discovery.Study registrationCALIBER studies are registered as follows: study 2 – NCT01569139, study 4 – NCT02176174 and NCT01164371, study 5 – NCT01163513, studies 6 and 7 – NCT01804439, study 8 – NCT02285322, and studies 26–29 – NCT01162187. Optimising the Management of Angina is registered as Current Controlled Trials ISRCTN54381840.FundingThe National Institute for Health Research (NIHR) Programme Grants for Applied Research programme (RP-PG-0407-10314) (all 33 studies) and additional funding from the Wellcome Trust (study 1), Medical Research Council Partnership grant (study 3), Servier (study 16), NIHR Research Methods Fellowship funding (study 19) and NIHR Research for Patient Benefit (study 33).
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Affiliation(s)
- Harry Hemingway
- Institute of Health Informatics, University College London, London, UK
- Farr Institute of Health Informatics Research, University College London, London, UK
| | - Gene S Feder
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Natalie K Fitzpatrick
- Institute of Health Informatics, University College London, London, UK
- Farr Institute of Health Informatics Research, University College London, London, UK
| | - Spiros Denaxas
- Institute of Health Informatics, University College London, London, UK
- Farr Institute of Health Informatics Research, University College London, London, UK
| | - Anoop D Shah
- Institute of Health Informatics, University College London, London, UK
- Farr Institute of Health Informatics Research, University College London, London, UK
| | - Adam D Timmis
- Farr Institute of Health Informatics Research, University College London, London, UK
- Barts Health NHS Trust, London, UK
- Farr Institute of Health Informatics Research, Queen Mary University of London, London, UK
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Beltrami M, Nuti R, Gilleman M, Palazzuoli A. The potential role of natriuretic peptides in acute coronary syndrome stratification. Future Cardiol 2013; 9:297-300. [DOI: 10.2217/fca.13.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Matteo Beltrami
- Department of Internal Medicine, UOS Cardiology, S. Maria alle Scotte Hospital Siena, University of Siena, Italy
| | - Ranuccio Nuti
- Department of Internal Medicine, UOS Cardiology, S. Maria alle Scotte Hospital Siena, University of Siena, Italy
| | - Marilyn Gilleman
- Department of Internal Medicine, UOS Cardiology, S. Maria alle Scotte Hospital Siena, University of Siena, Italy
| | - Alberto Palazzuoli
- Department of Internal Medicine, UOS Cardiology, S. Maria alle Scotte Hospital Siena, University of Siena, Italy.
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Aldous SJ. Cardiac biomarkers in acute myocardial infarction. Int J Cardiol 2012; 164:282-94. [PMID: 22341694 DOI: 10.1016/j.ijcard.2012.01.081] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 12/16/2011] [Accepted: 01/26/2012] [Indexed: 01/11/2023]
Abstract
Each year, a large number of patients are seen in the Emergency Department with presentations necessitating investigation for possible acute myocardial infarction. Patients can be stratified by symptoms, risk factors and electrocardiogram results but cardiac biomarkers also have a prime role both diagnostically and prognostically. This review summarizes both the history of cardiac biomarkers as well as currently available (established and novel) assays. Cardiac troponin, our current "gold standard" biomarker criterion for the diagnosis of myocardial infarction has high sensitivity and specificity for this diagnosis and therapies instituted in patients with elevated troponin have been shown to influence outcomes. Other markers of myocardial necrosis, inflammation and neurohormonal activity have also been shown to have either diagnostic or prognostic utility, but none have been shown to be superior to troponin. The measurement of multiple biomarkers and the use of point of care markers may accelerate current diagnostic protocols for the assessment of such patients.
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Palazzuoli A, Caputo M, Fineschi M, Navarri R, Calabrò A, Cameli M, Campagna MS, Franci B, Pierli C, Nuti R, Maisel A. B-type natriuretic peptide as an independent predictor of coronary disease extension in non-ST elevation coronary syndromes with preserved systolic function. Eur J Prev Cardiol 2011; 19:366-73. [DOI: 10.1177/1741826711406608] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: B-type natriuretic peptide (BNP) has been employed as a risk marker in patients with coronary artery disease (CAD) with ST elevation and non-ST elevation. It is not yet established if early BNP measurements provide additional information to troponin and electrocardiographic analysis in patients without ventricular enlargement and systolic dysfunction. Design: This study compared BNP levels in patients with stable angina (SA) and acute coronary syndromes with non-ST elevation in relation to angiographic lesions (NSTEMI-ACS). Moreover, the diagnostic utility of BNP was determined using the receiver operating characteristic curve. Patients: 280 patients with CAD without ST elevation and preserved systolic function were studied. BNP samples were measured in all recruited patients within 24 hours of hospitalization. Results: BNP values increased progressively with the severity of diagnosis: SA ( n = 85; 50.4 ± 50 pg/ml) NSTEMI-ACS ( n = 195; 283 ± 269 pg/ml; p < 0.0001). The analysis of BNP in relation to the number of involved vessels demonstrated significantly increased levels in patients with multivessel disease compared to patients with 1- or 2-vessel disease ( p < 0.001 and p < 0.003). Values of BNP >80 pg/ml were shown to be able to predict CAD severity and coronary vessel involvement (AUC = 0.80; p = 0.0001) with a sensitivity of 78% and a specificity of 72%. In multivariate analysis, BNP levels >80 pg/ml, CAD history, and ST deviation >2 mm were confirmed as independent predictors of CAD severity. Conclusions: Circulating BNP levels appear elevated in NSTEMI-ACS, without left ventricular systolic dysfunction. A BNP cut-off value of 80 pg/ml is a good predictor of CAD extension.
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Affiliation(s)
- Alberto Palazzuoli
- Department of Internal Medicine and Metabolic Disease Cardiology Section, University of Siena, Italy
| | - Maria Caputo
- Department of Internal Medicine and Metabolic Disease Cardiology Section, University of Siena, Italy
| | | | - Romina Navarri
- Department of Internal Medicine and Metabolic Disease Cardiology Section, University of Siena, Italy
| | - Anna Calabrò
- Department of Internal Medicine and Metabolic Disease Cardiology Section, University of Siena, Italy
| | - Matteo Cameli
- Department of Internal Medicine and Metabolic Disease Cardiology Section, University of Siena, Italy
| | - Maria Stella Campagna
- Department of Internal Medicine and Metabolic Disease Cardiology Section, University of Siena, Italy
| | - Beatrice Franci
- Department of Internal Medicine and Metabolic Disease Cardiology Section, University of Siena, Italy
| | - Carlo Pierli
- UO Invasive Cardiology Le Scotte Hospital Siena, Italy
| | - Ranuccio Nuti
- Department of Internal Medicine and Metabolic Disease Cardiology Section, University of Siena, Italy
| | - Alan Maisel
- Cardiac Care Unit and Heart Failure Program, San Diego Veterans Affairs Medical Center, San Diego, California, USA
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Palazzuoli A, Antonelli G, Quatrini I, Nuti R. Natriuretic peptides in heart failure: where we are, where we are going. Intern Emerg Med 2011; 6:63-8. [PMID: 20853071 DOI: 10.1007/s11739-010-0438-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Accepted: 07/13/2010] [Indexed: 01/24/2023]
Abstract
Tremendous advances have been made in understanding the pathophysiology and treatment of congestive heart failure (CHF). However, diagnosis still remains difficult, even with a comprehensive physical examination. Symptoms such as dyspnea are non-specific and poorly sensitive indicators for early CHF that can be largely undetected. The discovery of natriuretic peptides (BNP) as diagnostic biomarkers has been one of the most critical advances for heart failure diagnosis. Therefore, both B-type and N-terminal pro-B-type have potential role in the diagnosis of heart failure, as well as in prognostic risk assessment. A single determination of BNP at any time during the progression of chronic HF provides a clinically useful tool for risk stratification. The hypothesis that repeated measurements might carry prognostic information beyond a single measure was confirmed in different settings. One of the main interests is given to the values of repeated determinations for monitoring progression of disease, and for the evaluation of the clinical effects of medical therapy. Nevertheless, despite thousands of papers describing their potential utility, current guidelines have not endorsed the highest level of recommendation for their use, in part, because the application in clinical practice is often limited for the absence of well codified cut off. Recently, European guidelines emphasized the role of natriuretic peptides as potential laboratory markers. In the near future, algorithm building will take into consideration clinical and echocardiographic parameters as well as NP measurements, and this may lead to a correct diagnosis and identification of patients at high risk. The purpose of this review is to discuss the clinical approaches and future applications of natriuretic peptides in heart failure and coronary disease.
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Affiliation(s)
- Alberto Palazzuoli
- Department of Internal Medicine and Metabolic Diseases, S Maria alle Scotte Hospital, University of Siena, Siena, Italy.
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Palazzuoli A, Maisel A, Caputo M, Fineschi M, Quatrini I, Calabrò A, Campagna MS, Franci B, Grothgar S, Pierli C, Nuti R. B-type natriuretic peptide levels predict extent and severity of coronary disease in non-ST elevation coronary syndromes and normal left ventricular systolic function. ACTA ACUST UNITED AC 2011; 167:129-33. [DOI: 10.1016/j.regpep.2010.12.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Revised: 12/08/2010] [Accepted: 12/27/2010] [Indexed: 11/26/2022]
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Ramos RB, Strunz CM, Avakian SD, Ramires JA, Mansur ADP. B-type natriuretic peptide as a predictor of anterior wall location in patients with non-ST-elevation myocardial infarction. Clinics (Sao Paulo) 2011; 66:437-41. [PMID: 21552669 PMCID: PMC3072005 DOI: 10.1590/s1807-59322011000300013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Accepted: 11/30/2010] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Involvement of the left ventricular anterior wall in ST-elevation myocardial infarction has a worse prognosis compared with other regions. In non-ST-elevation myocardial infarction, noninvasive methods of locating the ischemic myocardial territory have been limited. The objective of this report is therefore to determine what factors are predictive of the anterior location of the ischemic myocardial territory. METHODS This study included 170 patients with non-ST-elevation myocardial infarction. Clinical, echocardiographic, and laboratory characteristics, including B-type natriuretic peptide measured within 24 hours of hospitalization, and coronary angiographic features were analyzed. RESULTS The mean age was 64.5 ± 12.3 years, and 112 of the patients were male (66%). The median follow-up was 23 months. The territory involved, as determined from the angiogram, was divided into anterior [n = 80 (47%)] regions and inferior and lateral [n = 90 (53%)] regions. Multivariate analysis showed that B-type natriuretic peptide was the only independent predictor of an anterior wall infarct [OR = 3.70 (95% CI: 1.61 - 8.53); P = 0.002] in non-STelevation myocardial infarction patients. Multivariate analysis also showed that B-type natriuretic peptide was an independent predictor of in-hospital cardiac events during index admission [OR = 5.05 (95% CI: 1.49 - 17.12); P = 0.009] and of cardiac events occurring during follow-up [HR = 1.79 (95% CI: 1.05 - 3.04); P = 0.032]. CONCLUSIONS B-type natriuretic peptide was the only factor independently associated with anterior wall involvement in non-ST-elevation myocardial infarction, and the peptide levels upon admission predicted in-hospital and subsequent cardiac events.
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Affiliation(s)
- Rogério Bicudo Ramos
- Heart Institute, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Transient elevation of NT-pro-BNP as a predictor for myocardial ischemia. Clin Res Cardiol 2010; 99:857-9. [DOI: 10.1007/s00392-010-0211-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2010] [Accepted: 08/19/2010] [Indexed: 01/08/2023]
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Palazzuoli A, Gallotta M, Quatrini I, Nuti R. Natriuretic peptides (BNP and NT-proBNP): measurement and relevance in heart failure. Vasc Health Risk Manag 2010; 6:411-8. [PMID: 20539843 PMCID: PMC2882893 DOI: 10.2147/vhrm.s5789] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Indexed: 01/19/2023] Open
Abstract
For patients presenting with acute dyspnea, an incorrect diagnosis could increase the mortality risk. When used in the evaluation of patients with acute symptoms, brain natriuretic peptide and N-terminal pro-brain natriuretic peptide (BNP and NT-proBNP, respectively) testing is highly sensitive for the diagnosis or exclusion of acute or chronic decompensated heart failure (HF). It has been demonstrated that BNP and proBNP levels can facilitate diagnosis and guide HF therapy. Natriuretic peptide (NP) levels are strictly related with HF severity; they are particularly increased in more advanced New York Heart Association (NYHA) classes and in patients with poor outcome. Therefore elevated NP levels were found to correlate with the severity of left ventricular systolic dysfunction, right ventricular dysfunction and pressures, and left ventricular filling alterations. However, the optimal use of NP determination agrees with patient history, physical examination, and all other diagnostic tools. There are some clinical conditions (ie, obesity, renal insufficiency anemia) for which the NP measurement is not diagnostic. Algorithm building taking into consideration all clinical and echocardiographic parameters, as well as NP measurements, may lead to the earlier identification and better risk stratification of patients with chronic HF, independently from etiology.
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Affiliation(s)
- A Palazzuoli
- Department of Internal Medicine and Metabolic Diseases, Section of Cardiology Le Scotte Hospital, University of Siena, Italy.
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Molina-Mora MJ, Cabrera-Bueno F, Jiménez-Navarro M, Linde-Estrella A, García-Pinilla JM, Teresa-Galván ED. [Prognostic value of B-type natriuretic peptide in unstable angina and non-ST-elevation myocardial infarction]. Med Clin (Barc) 2009; 133:569-73. [PMID: 19783260 DOI: 10.1016/j.medcli.2009.04.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Accepted: 04/16/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND OBJECTIVE The B-type natriuretic peptide (BNP) has recently emerged as a prognostic marker in acute coronary syndromes (ACS). This role is based on results from randomized trials and other high selected population studies. The aim of this study was to determine the prognostic value of BNP in unselected patients with non-ST-elevated-ACS. PATIENTS AND METHOD BNP plasma concentrations were measured in 100 consecutive patients admitted in 2007 with non-ST-elevated-ACS, taking as cut-off value 80pg/ml (high BNP levels on 48% of patients). RESULTS After one year-of follow-up, 21 major adverse cardiovascular events occurred: 12 ACS, 7 hospitalizations for heart failure and 2 sudden cardiac deaths. No relationship was found between BNP levels and events on follow-up. BNP >80pg/ml was the only independent predictor of heart failure and death. No relationship was found between high levels of BNP and coronary events during the follow-up. CONCLUSIONS BNP was an independent predictor of heart failure and mortality in unselected patients with non-ST-elevated-ACS.
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Nørgaard BL, Terkelsen CJ, Riiskjær M, Holmvang L, Grip L, Heickendorff L, Thygesen K. Risk prediction in acute coronary syndrome from serial in-hospital measurements of N-terminal pro-B-type natriuretic peptide. ACTA ACUST UNITED AC 2009; 10:159-66. [DOI: 10.1080/17482940802100261] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Meaudre E, Jego C, Kenane N, Montcriol A, Boret H, Goutorbe P, Habib G, Palmier B. B-type natriuretic peptide release and left ventricular filling pressure assessed by echocardiographic study after subarachnoid hemorrhage: a prospective study in non-cardiac patients. Crit Care 2009; 13:R76. [PMID: 19454040 PMCID: PMC2717439 DOI: 10.1186/cc7891] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Revised: 05/09/2009] [Accepted: 05/20/2009] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Serum B-type natriuretic peptide (BNP) is frequently elevated after subarachnoid hemorrhage (SAH), but whether this high BNP level is related to transient elevation of left ventricular filling pressure (LVFP) is unknown. However, in patients with preexistent cardiac pathologies, it is impossible to differentiate between BNP elevation caused by chronic cardiac abnormalities and BNP related to acute neurocardiac injury. METHODS All adult patients with SAH admitted to our intensive care unit were eligible. Patients were excluded for the following reasons: admission >48 hours after aneurysm rupture, pre-existing hypertension, or cardiac disease. Levels of BNP and cardiac troponin Ic were measured daily for 7 days. Echocardiography was performed by a blinded cardiologist on days 1, 2, and 7. Doppler signals from the mitral inflow, tissue Doppler, and the color M-mode-derived flow propagation velocity (FPV) were obtained to assess echo-estimated LVFP. RESULTS During a 3-year period, sixty-six consecutive patients with SAH were admitted. Thirty one patients were studied. The BNP level was >100 ng/L in 25 patients (80%) during the first 3 days, with a peak on day 2 (median, 126 ng/L) followed by a gradual decrease (median variation days 1 to 7, 70%). All patients had an ejection fraction >50%. Early transmitral velocity/tissue Doppler mitral annular early diastolic velocity was low: 5.4 (+/- 1.5) on day 1, 5.8 (+/- 1.2) on day 2, and 5.1 (+/- 0.9) on day 7. Early transmitral velocity/FPV was also low: 1.27 (+/- 0.4), 1.25 (+/- 0.3), and 1.1 (+/- 0.2) on days 1, 2, and 7, respectively. Cardiac troponin Ic levels ranged from 0 to 3.67 microg/L and were correlated with BNP (r = 0.63, P < 0.01). CONCLUSIONS BNP rises gradually over two days and return to normal within a week after SAH. Its release is associated with myocardial necrosis, but is unrelated to elevated LVFP assessed by echocardiography.
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Affiliation(s)
- Eric Meaudre
- Department of Anesthesiology and Critical Care, Hôpital d'Instruction des Armées Sainte-Anne, Boulevard Sainte-Anne, Toulon, BP 20545 – 83041, Cedex 9, France
| | - Christophe Jego
- Department of Cardiology, Hôpital d'Instruction des Armées Sainte-Anne, Boulevard Sainte-Anne, Toulon, BP 20545 – 83041, Cedex 9, France
| | - Nadia Kenane
- Department of Anesthesiology and Critical Care, Hôpital d'Instruction des Armées Sainte-Anne, Boulevard Sainte-Anne, Toulon, BP 20545 – 83041, Cedex 9, France
| | - Ambroise Montcriol
- Department of Anesthesiology and Critical Care, Hôpital d'Instruction des Armées Sainte-Anne, Boulevard Sainte-Anne, Toulon, BP 20545 – 83041, Cedex 9, France
| | - Henry Boret
- Department of Anesthesiology and Critical Care, Hôpital d'Instruction des Armées Sainte-Anne, Boulevard Sainte-Anne, Toulon, BP 20545 – 83041, Cedex 9, France
| | - Philippe Goutorbe
- Department of Anesthesiology and Critical Care, Hôpital d'Instruction des Armées Sainte-Anne, Boulevard Sainte-Anne, Toulon, BP 20545 – 83041, Cedex 9, France
| | - Gilbert Habib
- Department of Cardiology, Centre Hospitalo-Universitaire de la Timone, 264 Rue Saint-Pierre, Marseille, 13385, Cedex 5, France
| | - Bruno Palmier
- Department of Anesthesiology and Critical Care, Hôpital d'Instruction des Armées Sainte-Anne, Boulevard Sainte-Anne, Toulon, BP 20545 – 83041, Cedex 9, France
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Olivieri F, Spazzafumo L, Antonicelli R, Marchegiani F, Cardelli M, Sirolla C, Galeazzi R, Giovagnetti S, Mocchegiani E, Franceschi C. Combination of biomarkers to predict mortality in elderly patients with myocardial infarction. Mech Ageing Dev 2008; 129:231-7. [DOI: 10.1016/j.mad.2008.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2007] [Revised: 01/11/2008] [Accepted: 01/16/2008] [Indexed: 11/29/2022]
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