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Mele M, Mele A, Imbrici P, Samarelli F, Purgatorio R, Dinoi G, Correale M, Nicolotti O, De Luca A, Brunetti ND, Liantonio A, Amoroso N. Pleiotropic Effects of Direct Oral Anticoagulants in Chronic Heart Failure and Atrial Fibrillation: Machine Learning Analysis. Molecules 2024; 29:2651. [PMID: 38893525 PMCID: PMC11174118 DOI: 10.3390/molecules29112651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/21/2024] [Accepted: 05/30/2024] [Indexed: 06/21/2024] Open
Abstract
Oral anticoagulant therapy (OAT) for managing atrial fibrillation (AF) encompasses vitamin K antagonists (VKAs, such as warfarin), which was the mainstay of anticoagulation therapy before 2010, and direct-acting oral anticoagulants (DOACs, namely dabigatran etexilate, rivaroxaban, apixaban, edoxaban), approved for the prevention of AF stroke over the last thirteen years. Due to the lower risk of major bleeding associated with DOACs, anticoagulant switching is a common practice in AF patients. Nevertheless, there are issues related to OAT switching that still need to be fully understood, especially for patients in whom AF and heart failure (HF) coexist. Herein, the effective impact of the therapeutic switching from warfarin to DOACs in HF patients with AF, in terms of cardiac remodeling, clinical status, endothelial function and inflammatory biomarkers, was assessed by a machine learning (ML) analysis of a clinical database, which ultimately shed light on the real positive and pleiotropic effects mediated by DOACs in addition to their anticoagulant activity.
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Affiliation(s)
- Marco Mele
- Department of Pharmacy—Drug Sciences, University of Bari, Via Orabona 4, 70125 Bari, Italy; (M.M.); (A.M.); (P.I.); (F.S.); (R.P.); (G.D.); (O.N.); (A.D.L.); (N.A.)
- Department of Cardiology, “Ospedali Riuniti” University Hospital, Viale Pinto 1, 71100 Foggia, Italy;
| | - Antonietta Mele
- Department of Pharmacy—Drug Sciences, University of Bari, Via Orabona 4, 70125 Bari, Italy; (M.M.); (A.M.); (P.I.); (F.S.); (R.P.); (G.D.); (O.N.); (A.D.L.); (N.A.)
| | - Paola Imbrici
- Department of Pharmacy—Drug Sciences, University of Bari, Via Orabona 4, 70125 Bari, Italy; (M.M.); (A.M.); (P.I.); (F.S.); (R.P.); (G.D.); (O.N.); (A.D.L.); (N.A.)
| | - Francesco Samarelli
- Department of Pharmacy—Drug Sciences, University of Bari, Via Orabona 4, 70125 Bari, Italy; (M.M.); (A.M.); (P.I.); (F.S.); (R.P.); (G.D.); (O.N.); (A.D.L.); (N.A.)
| | - Rosa Purgatorio
- Department of Pharmacy—Drug Sciences, University of Bari, Via Orabona 4, 70125 Bari, Italy; (M.M.); (A.M.); (P.I.); (F.S.); (R.P.); (G.D.); (O.N.); (A.D.L.); (N.A.)
| | - Giorgia Dinoi
- Department of Pharmacy—Drug Sciences, University of Bari, Via Orabona 4, 70125 Bari, Italy; (M.M.); (A.M.); (P.I.); (F.S.); (R.P.); (G.D.); (O.N.); (A.D.L.); (N.A.)
| | - Michele Correale
- Department of Cardiology, “Ospedali Riuniti” University Hospital, Viale Pinto 1, 71100 Foggia, Italy;
| | - Orazio Nicolotti
- Department of Pharmacy—Drug Sciences, University of Bari, Via Orabona 4, 70125 Bari, Italy; (M.M.); (A.M.); (P.I.); (F.S.); (R.P.); (G.D.); (O.N.); (A.D.L.); (N.A.)
| | - Annamaria De Luca
- Department of Pharmacy—Drug Sciences, University of Bari, Via Orabona 4, 70125 Bari, Italy; (M.M.); (A.M.); (P.I.); (F.S.); (R.P.); (G.D.); (O.N.); (A.D.L.); (N.A.)
| | - Natale Daniele Brunetti
- Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71100 Foggia, Italy;
| | - Antonella Liantonio
- Department of Pharmacy—Drug Sciences, University of Bari, Via Orabona 4, 70125 Bari, Italy; (M.M.); (A.M.); (P.I.); (F.S.); (R.P.); (G.D.); (O.N.); (A.D.L.); (N.A.)
| | - Nicola Amoroso
- Department of Pharmacy—Drug Sciences, University of Bari, Via Orabona 4, 70125 Bari, Italy; (M.M.); (A.M.); (P.I.); (F.S.); (R.P.); (G.D.); (O.N.); (A.D.L.); (N.A.)
- National Institute of Nuclear Physics, Section of Bari, Via Orabona 4, 70125 Bari, Italy
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Van Nynatten LR, Slessarev M, Martin CM, Leligdowicz A, Miller MR, Patel MA, Daley M, Patterson EK, Cepinskas G, Fraser DD. Novel plasma protein biomarkers from critically ill sepsis patients. Clin Proteomics 2022; 19:50. [PMID: 36572854 PMCID: PMC9792322 DOI: 10.1186/s12014-022-09389-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/09/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Despite the high morbidity and mortality associated with sepsis, the relationship between the plasma proteome and clinical outcome is poorly understood. In this study, we used targeted plasma proteomics to identify novel biomarkers of sepsis in critically ill patients. METHODS Blood was obtained from 15 critically ill patients with suspected/confirmed sepsis (Sepsis-3.0 criteria) on intensive care unit (ICU) Day-1 and Day-3, as well as age- and sex-matched 15 healthy control subjects. A total of 1161 plasma proteins were measured with proximal extension assays. Promising sepsis biomarkers were narrowed with machine learning and then correlated with relevant clinical and laboratory variables. RESULTS The median age for critically ill sepsis patients was 56 (IQR 51-61) years. The median MODS and SOFA values were 7 (IQR 5.0-8.0) and 7 (IQR 5.0-9.0) on ICU Day-1, and 4 (IQR 3.5-7.0) and 6 (IQR 3.5-7.0) on ICU Day-3, respectively. Targeted proteomics, together with feature selection, identified the leading proteins that distinguished sepsis patients from healthy control subjects with ≥ 90% classification accuracy; 25 proteins on ICU Day-1 and 26 proteins on ICU Day-3 (6 proteins overlapped both ICU days; PRTN3, UPAR, GDF8, NTRK3, WFDC2 and CXCL13). Only 7 of the leading proteins changed significantly between ICU Day-1 and Day-3 (IL10, CCL23, TGFα1, ST2, VSIG4, CNTN5, and ITGAV; P < 0.01). Significant correlations were observed between a variety of patient clinical/laboratory variables and the expression of 15 proteins on ICU Day-1 and 14 proteins on ICU Day-3 (P < 0.05). CONCLUSIONS Targeted proteomics with feature selection identified proteins altered in critically ill sepsis patients relative to healthy control subjects. Correlations between protein expression and clinical/laboratory variables were identified, each providing pathophysiological insight. Our exploratory data provide a rationale for further hypothesis-driven sepsis research.
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Affiliation(s)
| | - Marat Slessarev
- grid.39381.300000 0004 1936 8884Medicine, Western University, London, ON Canada ,grid.415847.b0000 0001 0556 2414Lawson Health Research Institute, London, ON Canada
| | - Claudio M. Martin
- grid.39381.300000 0004 1936 8884Medicine, Western University, London, ON Canada ,grid.415847.b0000 0001 0556 2414Lawson Health Research Institute, London, ON Canada
| | - Aleks Leligdowicz
- grid.39381.300000 0004 1936 8884Medicine, Western University, London, ON Canada ,grid.415847.b0000 0001 0556 2414Lawson Health Research Institute, London, ON Canada
| | - Michael R. Miller
- grid.415847.b0000 0001 0556 2414Lawson Health Research Institute, London, ON Canada ,grid.39381.300000 0004 1936 8884Pediatrics, Western University, London, ON Canada
| | - Maitray A. Patel
- grid.39381.300000 0004 1936 8884Computer Science, Western University, London, ON N6A 3K7 Canada
| | - Mark Daley
- grid.415847.b0000 0001 0556 2414Lawson Health Research Institute, London, ON Canada ,grid.39381.300000 0004 1936 8884Computer Science, Western University, London, ON N6A 3K7 Canada ,grid.494618.6The Vector Institute for Artificial Intelligence, Toronto, ON M5G 1M1 Canada
| | - Eric K. Patterson
- grid.415847.b0000 0001 0556 2414Lawson Health Research Institute, London, ON Canada
| | - Gediminas Cepinskas
- grid.415847.b0000 0001 0556 2414Lawson Health Research Institute, London, ON Canada ,grid.39381.300000 0004 1936 8884Medical Biophysics, Western University, London, ON N6A 3K7 Canada
| | - Douglas D. Fraser
- grid.415847.b0000 0001 0556 2414Lawson Health Research Institute, London, ON Canada ,grid.39381.300000 0004 1936 8884Pediatrics, Western University, London, ON Canada ,grid.39381.300000 0004 1936 8884Clinical Neurological Sciences, Western University, London, ON Canada ,grid.39381.300000 0004 1936 8884Physiology and Pharmacology, Western University, London, ON Canada ,grid.412745.10000 0000 9132 1600London Health Sciences Centre, Room C2-C82, 800 Commissioners Road East, London, ON N6A 5W9 Canada
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Kerr B, Brandon L. Atrial Fibrillation, thromboembolic risk, and the potential role of the natriuretic peptides, a focus on BNP and NT-proBNP - A narrative review. IJC HEART & VASCULATURE 2022; 43:101132. [PMID: 36246770 PMCID: PMC9562601 DOI: 10.1016/j.ijcha.2022.101132] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/30/2022] [Accepted: 10/05/2022] [Indexed: 10/25/2022]
Abstract
Atrial fibrillation (AF) is one of the most commonly encountered arrythmia in clinical practice. AF itself can be driven by genetic predisposition, ectopic electrical activity, and abnormal atrial tissue substrates. Often there is no single etiological mechanism, but rather a combination of factors that feed back to remodel and worsen tissue substrate, "AF begets AF". The clinical consequences of AF can often include emboli, heart failure, and early mortality. The classical AF cardioembolic (CE) concept requires thrombus formation in the left atrial appendage, with subsequent embolization. The temporal dissociation between AF occurrence and CE events has thrown doubt on AF as the driver of this mechanism. Instead, there has been a resurgence of the "atrial cardiomyopathy" (ACM) concept. An ACM is proposed as a potential mechanism of embolic disease through promotion of prothrombotic mechanisms, with AF instead reflecting atrial disease severity. Regardless, AF has been implicated in 25% to 30% of cryptogenic strokes. Natriuretic peptide(NP)s have been shown to be elevated in AF, with higher levels of both NT-proBNP and BNP being predictive of incidental AF. NPs potentially reflect the atrial environment and could be used to identify an underlying ACM. Therefore, this narrative review examines this evidence and mechanisms that may underpin the role of NPs in identifying atrial dysfunction, with focus on both, BNP and NTproBNP. We explore their potential role in the prediction and screening for both, ACM and AF. Moreover, we compare both NPs directly to ascertain a superior biomarker.
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Key Words
- ACM, Atrial cardiomyopathy
- AF, Atrial fibrillation
- ARISTOTLE trial, Apixaban For Reduction In Stroke And Other Thromboembolic Events In Atrial Fibrillation Trial
- ASSERT trial, Atrial Fibrillation Evaluation In Pacemaker Patient’s Trial
- ASSERT-II trial, Asymptomatic Atrial Fibrillation and Stroke Evaluation in Pacemaker Patients and the Atrial Fibrillation Reduction Atrial Pacing Trial
- AUC, Area Under The Curve
- Atrial cardiomyopathy
- Atrial fibrillation
- BNP
- BNP, Brain natriuretic peptide
- CE, Cardioembolic
- CHA2DS2-Vasc, Congestive Heart Failure, Hypertension, Age ≥ 75, Diabetes, Stroke/TIA/Thromboembolism, Vascular Disease, Age 65–74
- CHARGE, Cohorts For Heart And Aging Research In Genomic Epidemiology
- CI, Confidence Intervals
- CNP, C-type natriuretic peptide
- EHRAS, EHRA/ HRS/APHRS/SOLAECE
- ESUS, Embolic Stroke of Unknown Source
- IMPACT Trial, Implementation of An RCT To Improve Treatment With Oral Anticoagulants In Patients With Atrial Fibrillation
- MR-proANP, Mid Regional Pro-Atrial Natriuretic Peptide
- NP, Natriuretic peptide
- NT-proBNP
- NT-proBNP, N-Terminal Pro Brain Natriuretic Peptide
- Natriuretic peptides
- RE-LY study, The Randomized Evaluation of Long-Term Anticoagulation Therapy study
- SE, Standard Error
- TE, Thromboembolic event
- TIA, Transient ischemic attack
- TRENDS trial, A Prospective Study of the Clinical Significance of Atrial Arrhythmias Detected by Implanted Device Diagnostics
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Ben Halima H, Bellagambi FG, Hangouët M, Alcacer A, Pfeiffer N, Heuberger A, Zine N, Bausells J, Elaissari A, Errachid A. A novel electrochemical strategy for NT-proBNP detection using IMFET for monitoring heart failure by saliva analysis. Talanta 2022; 251:123759. [DOI: 10.1016/j.talanta.2022.123759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/15/2022] [Accepted: 07/19/2022] [Indexed: 11/25/2022]
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Bellagambi FG, Petersen C, Salvo P, Ghimenti S, Franzini M, Biagini D, Hangouët M, Trivella MG, Di Francesco F, Paolicchi A, Errachid A, Fuoco R, Lomonaco T. Determination and stability of N-terminal pro-brain natriuretic peptide in saliva samples for monitoring heart failure. Sci Rep 2021; 11:13088. [PMID: 34158583 PMCID: PMC8219749 DOI: 10.1038/s41598-021-92488-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 06/01/2021] [Indexed: 02/05/2023] Open
Abstract
Heart failure (HF) is the main cause of mortality worldwide, particularly in the elderly. N-terminal pro-brain natriuretic peptide (NT-proBNP) is the gold standard biomarker for HF diagnosis and therapy monitoring. It is determined in blood samples by the immunochemical methods generally adopted by most laboratories. Saliva analysis is a powerful tool for clinical applications, mainly due to its non-invasive and less risky sampling. This study describes a validated analytical procedure for NT-proBNP determination in saliva samples using a commercial Enzyme-Linked Immuno-Sorbent Assay. Linearity, matrix effect, sensitivity, recovery and assay-precision were evaluated. The analytical approach showed a linear behaviour of the signal throughout the concentrations tested, with a minimum detectable dose of 1 pg/mL, a satisfactory NT-proBNP recovery (95-110%), and acceptable precision (coefficient of variation ≤ 10%). Short-term (3 weeks) and long-term (5 months) stability of NT-proBNP in saliva samples under the storage conditions most frequently used in clinical laboratories (4, - 20, and - 80 °C) was also investigated and showed that the optimal storage conditions were at - 20 °C for up to 2.5 months. Finally, the method was tested for the determination of NT-proBNP in saliva samples collected from ten hospitalized acute HF patients. Preliminary results indicate a decrease in NT-proBNP in saliva from admission to discharge, thus suggesting that this procedure is an effective saliva-based point-of-care device for HF monitoring.
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Affiliation(s)
- Francesca G. Bellagambi
- grid.5395.a0000 0004 1757 3729Department of Chemistry and Industrial Chemistry, University of Pisa, 56124 Pisa, Italy ,grid.7849.20000 0001 2150 7757Institute of Analytical Sciences (ISA) – UMR 5280, University Claude Bernard Lyon 1, 69100 Lyon, France
| | - Christina Petersen
- grid.452599.60000 0004 1781 8976Cardiology Division, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy
| | - Pietro Salvo
- grid.5326.20000 0001 1940 4177Institute of Clinical Physiology, National Research Council, 56124 Pisa, Italy
| | - Silvia Ghimenti
- grid.5395.a0000 0004 1757 3729Department of Chemistry and Industrial Chemistry, University of Pisa, 56124 Pisa, Italy
| | - Maria Franzini
- grid.5395.a0000 0004 1757 3729Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Denise Biagini
- grid.5395.a0000 0004 1757 3729Department of Chemistry and Industrial Chemistry, University of Pisa, 56124 Pisa, Italy
| | - Marie Hangouët
- grid.4444.00000 0001 2112 9282Institute of Analytical Sciences (ISA), UMR 5280, French National Center for Scientific Research (CNRS), 69100 Lyon, France
| | - Maria Giovanna Trivella
- grid.5326.20000 0001 1940 4177Institute of Clinical Physiology, National Research Council, 56124 Pisa, Italy
| | - Fabio Di Francesco
- grid.5395.a0000 0004 1757 3729Department of Chemistry and Industrial Chemistry, University of Pisa, 56124 Pisa, Italy
| | - Aldo Paolicchi
- grid.5395.a0000 0004 1757 3729Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Abdelhamid Errachid
- grid.7849.20000 0001 2150 7757Institute of Analytical Sciences (ISA) – UMR 5280, University Claude Bernard Lyon 1, 69100 Lyon, France
| | - Roger Fuoco
- grid.5395.a0000 0004 1757 3729Department of Chemistry and Industrial Chemistry, University of Pisa, 56124 Pisa, Italy
| | - Tommaso Lomonaco
- grid.5395.a0000 0004 1757 3729Department of Chemistry and Industrial Chemistry, University of Pisa, 56124 Pisa, Italy
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Risk Stratification and Efficacy of Spironolactone in Patients with Heart Failure with Preserved Ejection Fraction: Secondary Analysis of the TOPCAT Randomized Clinical Trial. Cardiovasc Drugs Ther 2021; 36:323-331. [PMID: 33791916 DOI: 10.1007/s10557-021-07178-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/22/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE We aimed to develop a simple risk score for patients with HFpEF and assessed the efficacy of spironolactone across baseline risk. METHODS We developed risk stratification scheme for cardiovascular death in placebo arm of the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist trial (TOPCAT). We screened candidate risk indicators and determined strong risk predictors using COX regression. The absolute risk reduction (ARR) in cardiovascular death with spironolactone was evaluated across baseline risk groups. COX regressions were performed to assess the hazard ratios (HRs) of spironolactone therapy for cardiovascular death and drug discontinuation in each risk category. RESULTS A simple risk score scheme was constructed based on five risk indicators weighted by estimates from the model, including age, diastolic blood pressure, renal dysfunction, white blood cell, and left ventricular ejection fraction. The risk score scheme showed good discrimination in placebo cohort (C index=0.70). ARR with spironolactone therapy was observed only in patients at very high risk (7.9%). Spironolactone therapy significantly reduced the risk of cardiovascular death in the very high-risk group (HR: 0.57; 95%CI, 0.39-0.84; P =0.005 and P for interaction 0.03) but showed similar risk of drug discontinuation across risk categories (P for interaction=0.928). CONCLUSION This simple risk score stratifies patients with HFpEF by their baseline risk of cardiovascular death. Patients at very high risk derive great benefits from spironolactone therapy. This easy-to-use risk score provides a practical tool that can facilitate risk stratification and tailoring therapy for those who benefit most from spironolactone. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT00094302.
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Amplatz B, Sarg B, Faserl K, Hammerer-Lercher A, Mair J, Lindner HH. Exposing the High Heterogeneity of Circulating Pro B-Type Natriuretic Peptide Fragments in Healthy Individuals and Heart Failure Patients. Clin Chem 2021; 66:1200-1209. [PMID: 32797158 DOI: 10.1093/clinchem/hvaa130] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 05/22/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND The high molecular complexity of variably O-glycosylated and degraded pro B-type natriuretic peptide (proBNP) derived molecular forms challenges current immunoassays. Antibodies used show pronounced differences in cross-reactivities with these circulating fragments, which still need to be better characterized on a molecular level. To pave the way for advanced quantitative assays in the future, it is critical to fully understand these circulating forms. METHODS Plasma samples were collected from 8 heart failure (HF) patients and 2 healthy controls. NT-proBNP and proBNP were purified by immunoprecipitation and analyzed by nano-flow liquid chromatography coupled to high-resolution mass spectrometry. Fragments formed during proteolysis in solution digestion were distinguished from naturally occurring peptides by using an 18O stable isotope labeling strategy. RESULTS We detected 16 previously unknown circulating fragments of proBNP peptides (9 of which are located in the N-terminal and 7 in the C-terminal region), revealing a more advanced state of degradation than previously known. Two of these fragments are indicative of either unidentified processing modes or a far-reaching C-terminal degradation (or a combination thereof) of the precursor proBNP. CONCLUSIONS Our results further restrict ideal target epitopes for immunoassay antibodies and expand the current thinking of diversity, degradation, and processing of proBNP, as well as the distribution of circulating forms.
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Affiliation(s)
- Benno Amplatz
- Institute of Clinical Biochemistry, Innsbruck Medical University, Innsbruck , Austria
| | - Bettina Sarg
- Institute of Clinical Biochemistry, Innsbruck Medical University, Innsbruck , Austria
| | - Klaus Faserl
- Institute of Clinical Biochemistry, Innsbruck Medical University, Innsbruck , Austria
| | | | - Johannes Mair
- Department of Internal Medicine III-Cardiology and Angiology, Innsbruck Medical University, Innsbruck, Austria
| | - Herbert H Lindner
- Institute of Clinical Biochemistry, Innsbruck Medical University, Innsbruck , Austria
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McKechnie DG, Papacosta AO, Lennon LT, Welsh P, Whincup PH, Wannamethee SG. Inflammatory markers and incident heart failure in older men: the role of NT-proBNP. Biomark Med 2021; 15:413-425. [PMID: 33709785 PMCID: PMC8559131 DOI: 10.2217/bmm-2020-0669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Aim: To determine the relationship between baseline inflammation (CRP and IL-6) with natriuretic peptide (NP) activity (measured by NT-proBNP) and incident heart failure (HF) in older men. Methods & results: In the British Regional Heart Study, 3569 men without prevalent myocardial infarction or HF were followed for mean 16.3 years; 327 developed HF. Baseline CRP and IL-6 were significantly and positively associated with NT-proBNP. Those in the highest CRP and IL-6 quartiles had an elevated risk of HF after age and BMI adjustment (HR = 1.42 [1.01–1.98] and 1.71 [1.24–2.37], respectively), which markedly attenuated after NT-proBNP adjustment (HR = 1.15 [0.81–1.63] and 1.25 [0.89–1.75], respectively). Conclusion: NP activity is associated with pro-inflammatory biomarkers and may explain the link between inflammation and incident HF. Inflammation describes the body’s natural response to infections, injuries and toxins. Inflammation is a helpful response in the short term, but it is thought that long-lasting inflammation – for example, due to illnesses such as diabetes or obesity – may have harmful effects. Previous studies have found that people with higher levels of inflammatory molecules in the blood seem to be more likely to develop heart failure (HF) later on. The amount of fluid in the body is controlled, in part, by molecules in the blood known as ‘natriuretic peptides' (NPs). People with HF have much higher levels of NPs in their blood, and these are used to help diagnose HF. There are suggestions that inflammation and natriuretic peptides are linked to one another. Using a sample of men aged 60–79 years, who did not have HF, we compared blood markers of inflammation and NPs at a baseline examination. Men with higher blood inflammatory markers tended to have higher blood NP levels. We then followed these men up for an average of 16.3 years. Men with higher blood inflammatory markers at baseline were more likely to develop HF, as expected, even after accounting for differences in age and BMI. However, when we accounted for NP levels at baseline, the increased risk of HF with inflammation disappeared. This suggests that NP activity is important in the relationship between inflammation and the risk of HF. Future studies should account for this when examining the link. It is possible that NPs or, more likely, whatever is driving their release, may explain why people with inflammation are more likely to get HF.
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Affiliation(s)
- Douglas Gj McKechnie
- Department of Primary Care & Population Health, University College London, London, UK
| | - A Olia Papacosta
- Department of Primary Care & Population Health, University College London, London, UK
| | - Lucy T Lennon
- Department of Primary Care & Population Health, University College London, London, UK
| | - Paul Welsh
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
| | - Peter H Whincup
- Population Health Research Institute, St George's University of London, London, UK
| | - S Goya Wannamethee
- Department of Primary Care & Population Health, University College London, London, UK
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Abstract
The effect of bariatric surgery on natriuretic peptide levels in patients with obesity is unclear. The purpose of this study was to conduct a systematic review and meta-analysis to determine the effect of bariatric surgery on BNP and NT-proBNP levels. MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched to February 2020. Primary outcomes included change in NT-proBNP or BNP levels following bariatric surgery and change in weight and body mass index (BMI). Secondary outcomes included change in blood pressure, echocardiographic findings, and heart failure symptoms. MINORS tool was used to assess quality of evidence. Twelve studies with 622 patients were included. Most patients underwent Roux-en-Y gastric bypass (RYGB) (70.5%). Mean absolute reduction in BMI was 23%. NT-proBNP levels increased significantly from baseline at 6 months (mean difference (MD) 53.67 pg/mL; 95% CI, 28.72-78.61; P = <0.001, I2 = 99%; 8 studies) and 12 months (MD 51.16 pg/mL; 95% CI, 20.46-81.86; P = 0.001, I2 = 99%; 8 studies) post-bariatric surgery. BNP levels also increased significantly at 6 months (MD 17.57 pg/mL; 95% CI, 7.62-27.51; P <0.001, I2 = 95%; 4 studies). Systolic and diastolic blood pressure decreased significantly 12 months after surgery. Studies measuring echocardiographic findings saw improvement in LV mass and E/A ratio, but no significant change in ejection fraction. Bariatric surgery is associated with increased natriuretic peptide levels in the absence of deteriorating cardiac function, and may be associated with improved cardiac and metabolic function after the procedure.
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du Fay de Lavallaz J, Badertscher P, Nestelberger T, Zimmermann T, Miró Ò, Salgado E, Christ M, Geigy N, Cullen L, Than M, Javier Martin-Sanchez F, Di Somma S, Frank Peacock W, Morawiec B, Walter J, Twerenbold R, Puelacher C, Wussler D, Boeddinghaus J, Koechlin L, Strebel I, Keller DI, Lohrmann J, Michou E, Kühne M, Reichlin T, Mueller C. B-Type Natriuretic Peptides and Cardiac Troponins for Diagnosis and Risk-Stratification of Syncope. Circulation 2019; 139:2403-2418. [PMID: 30798615 DOI: 10.1161/circulationaha.118.038358] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND The utility of BNP (B-type natriuretic peptide), NT-proBNP (N-terminal proBNP), and hs-cTn (high-sensitivity cardiac troponin) concentrations for diagnosis and risk-stratification of syncope is incompletely understood. METHODS We evaluated the diagnostic and prognostic accuracy of BNP, NT-proBNP, hs-cTnT, and hs-cTnI concentrations, alone and against those of clinical assessments, in patients >45-years old presenting with syncope to the emergency department in a prospective diagnostic multicenter study. BNP, NT-proBNP, hs-cTnT and hs-cTnI concentrations were measured in a blinded fashion. Cardiac syncope, as adjudicated by 2 physicians based on all information available including cardiac work-up and 1-year follow-up, was the diagnostic end point. EGSYS (Evaluation of Guidelines in Syncope Study), a syncope-specific diagnostic score, served as the diagnostic comparator. Death and major adverse cardiac events at 30 and 720 days were the prognostic end points. Major adverse cardiac events were defined as death, cardiopulmonary resuscitation, life-threatening arrhythmia, implantation of pacemaker/implantable cardioverter defibrillator, acute myocardial infarction, pulmonary embolism, stroke/transient ischemic attack, intracranial bleeding, or valvular surgery. ROSE (Risk Stratification of Syncope in the Emergency Department), OESIL (Osservatorio Epidemiologico della Sincope nel Lazio), SFSR (San Fransisco Syncope Rule), and CSRS (Canadian Syncope Risk Score) served as the prognostic comparators. RESULTS Among 1538 patients eligible for diagnostic assessment, cardiac syncope was the adjudicated diagnosis in 234 patients (15.2%). BNP, NT-proBNP, hs-cTnT, and hs-cTnI were significantly higher in cardiac syncope versus other causes (P<0.01). The diagnostic accuracy for cardiac syncope, as quantified by the area under the curve, was 0.77 to 0.78 (95% CI, 0.74-0.81) for all 4 biomarkers, and superior to EGSYS (area under the curve, 0.68 [95%-CI 0.65-0.71], P<0.001). Combining BNP/NT-proBNP with hs-cTnT/hs-cTnI further improved diagnostic accuracy to an area under the curve of 0.81 (P<0.01). BNP, NT-proBNP, hs-cTnT, and hs-cTnI cut-offs, achieving predefined thresholds for sensitivity and specificity (95%), allowed for rule-in or rule-out of ≈30% of all patients. A total of 450 major adverse cardiac events occurred during follow-up. The prognostic accuracy of BNP, NT-proBNP, hs-cTnI, and hs-cTnT for major adverse cardiac events was moderate-to-good (area under the curve, 0.75-0.79), superior to ROSE, OESIL, and SFSR, and inferior to CSRS. CONCLUSIONS BNP, NT-proBNP, hs-cTnT, and hs-cTnI concentrations provide useful diagnostic and prognostic information in emergency department patients with syncope. CLINICAL TRIAL REGISTRATION URL: https://www. CLINICALTRIALS gov. Unique identifier: NCT01548352.
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Affiliation(s)
- Jeanne du Fay de Lavallaz
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (J.d.F.d.L., P.B., T.N., T.Z., J.W., R.T., C.P., D.W., J.B., L.K., I.S., J.L., E.M., M.K., T.R.)
- GREAT Network, Roma, Italy (J.d.F.d.L., P.B., T.N., T.Z., O.M., E.S., L.C., M.F., F.J.M.-S., S.D.S., W.F.P., B.M., J.W., R.T., C.P., D.W., J.B., L.K., I.S.)
| | - Patrick Badertscher
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (J.d.F.d.L., P.B., T.N., T.Z., J.W., R.T., C.P., D.W., J.B., L.K., I.S., J.L., E.M., M.K., T.R.)
- GREAT Network, Roma, Italy (J.d.F.d.L., P.B., T.N., T.Z., O.M., E.S., L.C., M.F., F.J.M.-S., S.D.S., W.F.P., B.M., J.W., R.T., C.P., D.W., J.B., L.K., I.S.)
- Division of Cardiology, University of Illinois at Chicago, IL (P.B.)
| | - Thomas Nestelberger
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (J.d.F.d.L., P.B., T.N., T.Z., J.W., R.T., C.P., D.W., J.B., L.K., I.S., J.L., E.M., M.K., T.R.)
- GREAT Network, Roma, Italy (J.d.F.d.L., P.B., T.N., T.Z., O.M., E.S., L.C., M.F., F.J.M.-S., S.D.S., W.F.P., B.M., J.W., R.T., C.P., D.W., J.B., L.K., I.S.)
| | - Tobias Zimmermann
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (J.d.F.d.L., P.B., T.N., T.Z., J.W., R.T., C.P., D.W., J.B., L.K., I.S., J.L., E.M., M.K., T.R.)
- GREAT Network, Roma, Italy (J.d.F.d.L., P.B., T.N., T.Z., O.M., E.S., L.C., M.F., F.J.M.-S., S.D.S., W.F.P., B.M., J.W., R.T., C.P., D.W., J.B., L.K., I.S.)
| | - Òscar Miró
- GREAT Network, Roma, Italy (J.d.F.d.L., P.B., T.N., T.Z., O.M., E.S., L.C., M.F., F.J.M.-S., S.D.S., W.F.P., B.M., J.W., R.T., C.P., D.W., J.B., L.K., I.S.)
- Hospital Clinic, Barcelona, Catalonia, Spain (O.M., E.S.)
| | - Emilio Salgado
- GREAT Network, Roma, Italy (J.d.F.d.L., P.B., T.N., T.Z., O.M., E.S., L.C., M.F., F.J.M.-S., S.D.S., W.F.P., B.M., J.W., R.T., C.P., D.W., J.B., L.K., I.S.)
- Hospital Clinic, Barcelona, Catalonia, Spain (O.M., E.S.)
| | - Michael Christ
- Department of Emergency Medicine, Kantonsspital Luzern, Switzerland (M.C.)
| | - Nicolas Geigy
- Department of Emergency Medicine, Hospital of Liestal, Switzerland (N.G.)
| | - Louise Cullen
- GREAT Network, Roma, Italy (J.d.F.d.L., P.B., T.N., T.Z., O.M., E.S., L.C., M.F., F.J.M.-S., S.D.S., W.F.P., B.M., J.W., R.T., C.P., D.W., J.B., L.K., I.S.)
- Royal Brisbane & Women's Hospital, Herston, Australia (L.C.)
| | - Martin Than
- Christchurch Hospital, Christchurch, New Zealand (M.T.)
| | - F Javier Martin-Sanchez
- GREAT Network, Roma, Italy (J.d.F.d.L., P.B., T.N., T.Z., O.M., E.S., L.C., M.F., F.J.M.-S., S.D.S., W.F.P., B.M., J.W., R.T., C.P., D.W., J.B., L.K., I.S.)
- Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, Spain (F.J.M.S.)
| | - Salvatore Di Somma
- GREAT Network, Roma, Italy (J.d.F.d.L., P.B., T.N., T.Z., O.M., E.S., L.C., M.F., F.J.M.-S., S.D.S., W.F.P., B.M., J.W., R.T., C.P., D.W., J.B., L.K., I.S.)
- Emergency Medicine, Department of Medical-Surgery Sciences and Translational Medicine, University Sapienza Rome, Sant'Andrea Hospital, Italy (S.D.S.)
| | - W Frank Peacock
- GREAT Network, Roma, Italy (J.d.F.d.L., P.B., T.N., T.Z., O.M., E.S., L.C., M.F., F.J.M.-S., S.D.S., W.F.P., B.M., J.W., R.T., C.P., D.W., J.B., L.K., I.S.)
- Baylor College of Medicine, Department of Emergency Medicine, Houston, TX (W.F.P.)
| | - Beata Morawiec
- GREAT Network, Roma, Italy (J.d.F.d.L., P.B., T.N., T.Z., O.M., E.S., L.C., M.F., F.J.M.-S., S.D.S., W.F.P., B.M., J.W., R.T., C.P., D.W., J.B., L.K., I.S.)
- 2nd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland (B.M.)
| | - Joan Walter
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (J.d.F.d.L., P.B., T.N., T.Z., J.W., R.T., C.P., D.W., J.B., L.K., I.S., J.L., E.M., M.K., T.R.)
- GREAT Network, Roma, Italy (J.d.F.d.L., P.B., T.N., T.Z., O.M., E.S., L.C., M.F., F.J.M.-S., S.D.S., W.F.P., B.M., J.W., R.T., C.P., D.W., J.B., L.K., I.S.)
| | - Raphael Twerenbold
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (J.d.F.d.L., P.B., T.N., T.Z., J.W., R.T., C.P., D.W., J.B., L.K., I.S., J.L., E.M., M.K., T.R.)
- GREAT Network, Roma, Italy (J.d.F.d.L., P.B., T.N., T.Z., O.M., E.S., L.C., M.F., F.J.M.-S., S.D.S., W.F.P., B.M., J.W., R.T., C.P., D.W., J.B., L.K., I.S.)
- Department of General and Interventional Cardiology, University Heart Center Hamburg, University Hospital Hamburg-Eppendorf, Hamburg, Germany (R.T.)
| | - Christian Puelacher
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (J.d.F.d.L., P.B., T.N., T.Z., J.W., R.T., C.P., D.W., J.B., L.K., I.S., J.L., E.M., M.K., T.R.)
- GREAT Network, Roma, Italy (J.d.F.d.L., P.B., T.N., T.Z., O.M., E.S., L.C., M.F., F.J.M.-S., S.D.S., W.F.P., B.M., J.W., R.T., C.P., D.W., J.B., L.K., I.S.)
| | - Desiree Wussler
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (J.d.F.d.L., P.B., T.N., T.Z., J.W., R.T., C.P., D.W., J.B., L.K., I.S., J.L., E.M., M.K., T.R.)
- GREAT Network, Roma, Italy (J.d.F.d.L., P.B., T.N., T.Z., O.M., E.S., L.C., M.F., F.J.M.-S., S.D.S., W.F.P., B.M., J.W., R.T., C.P., D.W., J.B., L.K., I.S.)
| | - Jasper Boeddinghaus
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (J.d.F.d.L., P.B., T.N., T.Z., J.W., R.T., C.P., D.W., J.B., L.K., I.S., J.L., E.M., M.K., T.R.)
- GREAT Network, Roma, Italy (J.d.F.d.L., P.B., T.N., T.Z., O.M., E.S., L.C., M.F., F.J.M.-S., S.D.S., W.F.P., B.M., J.W., R.T., C.P., D.W., J.B., L.K., I.S.)
| | - Luca Koechlin
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (J.d.F.d.L., P.B., T.N., T.Z., J.W., R.T., C.P., D.W., J.B., L.K., I.S., J.L., E.M., M.K., T.R.)
- GREAT Network, Roma, Italy (J.d.F.d.L., P.B., T.N., T.Z., O.M., E.S., L.C., M.F., F.J.M.-S., S.D.S., W.F.P., B.M., J.W., R.T., C.P., D.W., J.B., L.K., I.S.)
- Department of Heart Surgery, University Hospital Basel, Switzerland (L.K.)
| | - Ivo Strebel
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (J.d.F.d.L., P.B., T.N., T.Z., J.W., R.T., C.P., D.W., J.B., L.K., I.S., J.L., E.M., M.K., T.R.)
- GREAT Network, Roma, Italy (J.d.F.d.L., P.B., T.N., T.Z., O.M., E.S., L.C., M.F., F.J.M.-S., S.D.S., W.F.P., B.M., J.W., R.T., C.P., D.W., J.B., L.K., I.S.)
| | - Dagmar I Keller
- Emergency Department, University Hospital Zurich, Switzerland (D.I.K.)
| | - Jens Lohrmann
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (J.d.F.d.L., P.B., T.N., T.Z., J.W., R.T., C.P., D.W., J.B., L.K., I.S., J.L., E.M., M.K., T.R.)
| | - Eleni Michou
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (J.d.F.d.L., P.B., T.N., T.Z., J.W., R.T., C.P., D.W., J.B., L.K., I.S., J.L., E.M., M.K., T.R.)
| | - Michael Kühne
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (J.d.F.d.L., P.B., T.N., T.Z., J.W., R.T., C.P., D.W., J.B., L.K., I.S., J.L., E.M., M.K., T.R.)
| | - Tobias Reichlin
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (J.d.F.d.L., P.B., T.N., T.Z., J.W., R.T., C.P., D.W., J.B., L.K., I.S., J.L., E.M., M.K., T.R.)
- Department of Cardiology, Inselspital, Bern, University Hospital, University of Bern, Switzerland (T.R.)
| | - Christian Mueller
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland (J.d.F.d.L., P.B., T.N., T.Z., J.W., R.T., C.P., D.W., J.B., L.K., I.S., J.L., E.M., M.K., T.R.)
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Kasahara S, Sakata Y, Nochioka K, Miura M, Abe R, Sato M, Aoyanagi H, Fujihashi T, Yamanaka S, Shiroto T, Sugimura K, Takahashi J, Miyata S, Shimokawa H. Conversion formula from B-type natriuretic peptide to N-terminal proBNP values in patients with cardiovascular diseases. Int J Cardiol 2019; 280:184-189. [DOI: 10.1016/j.ijcard.2018.12.069] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 12/07/2018] [Accepted: 12/24/2018] [Indexed: 01/03/2023]
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Jansen van Vuren E, Malan L, von Känel R, Lammertyn L, Cockeran M, Malan NT. Longitudinal changes of cardiac troponin and inflammation reflect progressive myocyte stretch and likelihood for hypertension in a Black male cohort: The SABPA study. Hypertens Res 2019; 42:708-716. [PMID: 30626934 DOI: 10.1038/s41440-018-0183-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 10/12/2018] [Accepted: 10/17/2018] [Indexed: 11/09/2022]
Abstract
Inflammation was cross-sectionally associated with subclinical wall remodeling and hypertension. Whether longitudinal changes (∆) in inflammation, myocyte injury (troponin T), and stretch (N-terminal-pro-B-type natriuretic peptide) are associated with hypertension and ECG left ventricular hypertrophy (ECG-LVH) is unclear. The first prospective analysis in Africa assessing these associations included a cohort of Black and White teachers (N = 338; aged 20-63 years). Fasting blood samples were obtained to measure tumor necrosis factor-alpha (TNF-α), cardiac troponin T (cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP). Ambulatory blood pressure, 2-lead ECG and resting 10-lead ECG values were obtained. A higher mean hypertensive status (62%) was evident in Blacks compared to Whites (44%, p < 0.001). Over 3-years, NT-proBNP increased in both ethnic groups. No associations were evident in women or in White men. In Black men, ECG-LVH at follow-up was positively associated with baseline cTnT (Adj R2 0.43; β = 0.48; 95% CI 0.28-0.68, p < 0.001) and baseline SBP (Adj R2 0.43; β = 0.29; 95% CI 0.09-0.49, p = 0.006). In Black men, baseline TNF-α (OR = 1.49, 95% CI 1.05-2.14, p = 0.03) and decreased ΔTNF-α (OR = 2.07, 95% CI 1.26-3.40, p = 0.004) increased the likelihood for cTnT levels ≥ 4.2 ng/L. Here, baseline NT-proBNP (OR = 1.12, 95% CI 1.01-1.23, p = 0.03) and ΔNT-proBNP progression (OR = 1.09, 95% CI 1.00-1.81, p = 0.04) increased the likelihood for 24-h hypertension. In conclusion, chronically increased levels of markers of myocyte injury accompanied by progressive myocardial stretch, reflective of cardiac metabolic overdemand, may ultimately increase hypertension and ischemic heart disease risk in a cohort of Black males.
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Affiliation(s)
- Esmé Jansen van Vuren
- North-West University, Hypertension in Africa Research Team (HART), Potchefstroom, South Africa
| | - Leoné Malan
- North-West University, Hypertension in Africa Research Team (HART), Potchefstroom, South Africa.
| | - Roland von Känel
- North-West University, Hypertension in Africa Research Team (HART), Potchefstroom, South Africa.,University Hospital Zurich, Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, Zurich, Switzerland
| | - Leandi Lammertyn
- North-West University, Hypertension in Africa Research Team (HART), Potchefstroom, South Africa.,North-West University, MRC Research Unit for Hypertension and Cardiovascular Disease, Potchefstroom, South Africa
| | - Marike Cockeran
- North-West University, Medicine Usage in South Africa (MUSA), Potchefstroom, South Africa
| | - Nicolaas T Malan
- North-West University, Hypertension in Africa Research Team (HART), Potchefstroom, South Africa
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N-terminal pro b-type natriuretic peptide (NT-pro-BNP) -based score can predict in-hospital mortality in patients with heart failure. Sci Rep 2016; 6:29590. [PMID: 27411951 PMCID: PMC4944149 DOI: 10.1038/srep29590] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 06/22/2016] [Indexed: 12/15/2022] Open
Abstract
Serum N-terminal pro b-type natriuretic peptide (NT-pro-BNP) testing is recommended in the patients with heart failure (HF). We hypothesized that NT-pro-BNP, in combination with other clinical factors in terms of a novel NT-pro BNP-based score, may provide even better predictive power for in-hospital mortality among patients with HF. A retrospective study enrolled adult patients with hospitalization-requiring HF who fulfilled the predefined criteria during the period from January 2011 to December 2013. We proposed a novel scoring system consisting of several independent predictors including NT-pro-BNP for predicting in-hospital mortality, and then compared the prognosis-predictive power of the novel NT-pro BNP-based score with other prognosis-predictive scores. A total of 269 patients were enrolled in the current study. Factors such as "serum NT-pro-BNP level above 8100 mg/dl," "age above 79 years," "without taking angiotensin converting enzyme inhibitors/angiotensin receptor blocker," "without taking beta-blocker," "without taking loop diuretics," "with mechanical ventilator support," "with non-invasive ventilator support," "with vasopressors use," and "experience of cardio-pulmonary resuscitation" were found as independent predictors. A novel NT-pro BNP-based score composed of these risk factors was proposed with excellent predictability for in-hospital mortality. The proposed novel NT-pro BNP-based score was extremely effective in predicting in-hospital mortality in HF patients.
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Reddy M, Singh S, Rawat A, Sharma A, Suri D, Rohit MK. Pro-brain natriuretic peptide (ProBNP) levels in North Indian children with Kawasaki disease. Rheumatol Int 2016; 36:551-9. [PMID: 26849890 DOI: 10.1007/s00296-016-3430-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 01/26/2016] [Indexed: 12/20/2022]
Abstract
The diagnosis of Kawasaki disease (KD), a common pediatric vasculitis, is based solely on clinical criteria. There is a need for a robust laboratory marker that can help differentiate KD from other acute, febrile, childhood illnesses and also to predict cardiac involvement. We conducted a cross-sectional study of 25 consecutive patients admitted with diagnosis of KD from January 2013 to April 2014 and compared them with age- and sex-matched febrile controls. We studied the serum pro-brain natriuretic peptide (ProBNP) [ProBNP and N-terminal pro-B-type natriuretic peptide (NT-ProBNP) levels], a marker of myocardial dysfunction, in children with KD in acute and convalescent phases of disease. These levels were also estimated in febrile controls for comparison. The ProBNP (ProBNP and NT-ProBNP) levels were much higher in the acute phase of the KD patients compared to levels in the convalescent phase of KD (p = 0.000014). Similarly, the levels in the acute phase were higher when compared to the age- and sex-matched febrile controls (p = 0.000126). The receiver operating curve (ROC) analysis for the ProBNP levels in the acute phase of KD yielded an area under the curve of 0.954 ± 0.034 (p < 0.000, 95 % CI 0.886-1.0). Based on ROC analysis, a cutoff of 1025 pg/mL for ProBNP levels in the acute phase of KD had 88 % sensitivity and 96 % specificity for the diagnosis of KD. A lower cut-off of 514 pg/mL yielded a 100 % sensitivity and 80 % specificity for the diagnosis of KD. The ProBNP levels were higher in those with coronary artery abnormalities (CAA) compared to those without CAA in both acute (p = 0.013) and convalescent (p = 0.045) phases. ProBNP levels may be used as a surrogate marker for the differentiation of KD from other febrile, infectious illnesses and may also predict the involvement of coronary arteries.
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Affiliation(s)
- Mounika Reddy
- Division of Allergy-Immunology, Advanced Pediatrics Centre, Postgraduate Institute of Medical, Education and Research (PGIMER), Chandigarh, India
| | - Surjit Singh
- Division of Allergy-Immunology, Advanced Pediatrics Centre, Postgraduate Institute of Medical, Education and Research (PGIMER), Chandigarh, India.
| | - Amit Rawat
- Division of Allergy-Immunology, Advanced Pediatrics Centre, Postgraduate Institute of Medical, Education and Research (PGIMER), Chandigarh, India
| | - Avinash Sharma
- Division of Allergy-Immunology, Advanced Pediatrics Centre, Postgraduate Institute of Medical, Education and Research (PGIMER), Chandigarh, India
| | - Deepti Suri
- Division of Allergy-Immunology, Advanced Pediatrics Centre, Postgraduate Institute of Medical, Education and Research (PGIMER), Chandigarh, India
| | - Manoj Kumar Rohit
- Department of Cardiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Della Rocca G, Vetrugno L, Coccia C, Pierconti F, Badagliacca R, Vizza CD, Papale M, Melis E, Facciolo F. Preoperative Evaluation of Patients Undergoing Lung Resection Surgery: Defining the Role of the Anesthesiologist on a Multidisciplinary Team. J Cardiothorac Vasc Anesth 2015; 30:530-8. [PMID: 27013123 DOI: 10.1053/j.jvca.2015.11.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Indexed: 12/25/2022]
Affiliation(s)
- Giorgio Della Rocca
- Department of Anesthesia and Intensive Care Medicine, University of Udine, Udine, Italy.
| | - Luigi Vetrugno
- Department of Anesthesia and Intensive Care Medicine, University of Udine, Udine, Italy
| | - Cecilia Coccia
- Department of Anesthesia and Critical Care Medicine, Institute of Oncology "Regina Elena" IRE-IRCCS, Rome, Italy
| | - Federico Pierconti
- Department of Anesthesia and Critical Care Medicine, Institute of Oncology "Regina Elena" IRE-IRCCS, Rome, Italy
| | | | | | | | - Enrico Melis
- Thoracic Surgery Unit, Department of Surgical Oncology, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Francesco Facciolo
- Thoracic Surgery Unit, Department of Surgical Oncology, "Regina Elena" National Cancer Institute, Rome, Italy
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Strapazzon G, Vezzaro R, Hofer G, Dal Cappello T, Procter E, Balkenhol K, Platzgummer S, Brugger H. Factors associated with B-lines after exposure to hypobaric hypoxia. Eur Heart J Cardiovasc Imaging 2015; 16:1241-6. [PMID: 25851323 DOI: 10.1093/ehjci/jev074] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 03/06/2015] [Indexed: 02/03/2023] Open
Abstract
AIMS Increased extravascular lung water (EVLW) is seen as B-lines on chest ultrasonography. In lowlanders ascending to altitude the time course, relationship with the patient's clinical status and factors affecting B-lines are still unclear. The aim was to monitor B-lines, clinical status and N-terminal B-type natriuretic peptide (NT-proBNP) during exposure to high altitude. METHODS AND RESULTS Chest ultrasonography, blood samples, cardiovascular parameters, and signs and symptoms of high altitude pulmonary oedema (HAPE) were prospectively assessed in 19 participants at baseline and after ascent to 3830 m (9, 24, 48, 72 h, and 8 days) by blinded investigators. Potential confounding factors (e.g. altitude variations, physical effort) were minimized. Generalized estimating equations were used to analyse factors associated with B-lines. B-lines changed with exposure to altitude (P = 0.006) in a parabolic-like pattern within the first 72 h; 10 of 18 participants (55.6%) had >5 B-lines at 24 h. B-lines were correlated with the number of signs and symptoms (partial coefficient = 0.372, P = 0.001). B-lines were associated with time (P = 0.038), sex (P = 0.013), and SpO2 (P = 0.042), but not with NT-proBNP (P = 0.546). The participant with a clinical diagnosis of HAPE had 23 B-lines. CONCLUSION B-lines during exposure to altitude seem to reflect the individual response to hypobaric hypoxia and represent clinically relevant alterations at high altitude, also in patients with HAPE. Similar to previous studies, our results support a non-cardiogenic aetiology of B-lines.
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Affiliation(s)
- Giacomo Strapazzon
- EURAC Institute of Mountain Emergency Medicine, Viale Druso 1, Bolzano 39100, Italy
| | - Roberto Vezzaro
- Department of Radiology, University Hospital of Padova, Padova, Italy
| | - Georg Hofer
- Department of Anesthesiology and Critical Care Medicine, General Hospital of Silandro, Silandro, Italy
| | - Tomas Dal Cappello
- EURAC Institute of Mountain Emergency Medicine, Viale Druso 1, Bolzano 39100, Italy
| | - Emily Procter
- EURAC Institute of Mountain Emergency Medicine, Viale Druso 1, Bolzano 39100, Italy
| | - Karla Balkenhol
- EURAC Institute of Mountain Emergency Medicine, Viale Druso 1, Bolzano 39100, Italy
| | - Stefan Platzgummer
- Department of Laboratory Medicine, General Hospital of Merano, Merano, Italy
| | - Hermann Brugger
- EURAC Institute of Mountain Emergency Medicine, Viale Druso 1, Bolzano 39100, Italy
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Abstract
Cardiac and renal diseases often coexist and patients with cardiac and renal failure have high morbidity and mortality. Cardiorenal syndromes (CRSs) are disorders of the heart and kidneys whereby dysfunction in one organ may induce dysfunction in the other organ. Five subtypes of CRSs have been defined by the Acute Dialysis Quality Initiative Consensus Group. There is a need for early detection and monitoring of patients with CRSs. Biomarkers play a key role in the diagnosis and monitoring of acute myocardial infarction, chronic heart failure, and chronic kidney disease. In recent years, new biomarkers have been identified that may play a role in the early diagnosis of acute kidney injury. Herein, we review the use of serum and urine biomarkers in the diagnosis and management of CRSs. The established cardiac and renal biomarkers such as the cardiac troponins, natriuretic peptides, urine albumin, and creatinine, as well as the new renal biomarkers cystatin C and neutrophil gelatinase-associated lipocalin are reviewed in detail. The recent advances in assay methods, clinical studies, and recommendations in clinical guidelines are discussed. With advances in biomarker research, in future, perhaps a multimarker approach will become feasible to stratify the diagnosis of CRS for individualized treatment and prognosis.
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Snaedal S, Qureshi AR, Carrero JJ, Heimbürger O, Stenvinkel P, Bárány P. Determinants of N-Terminal Pro-Brain Natriuretic Peptide Variation in Hemodialysis Patients and Prediction of Survival. Blood Purif 2014; 37:138-45. [DOI: 10.1159/000360267] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 02/02/2014] [Indexed: 11/19/2022]
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Vetrugno L, Langiano N, Gisonni R, Rizzardo A, Venchiarutti PE, Divella M, Pompei L, Causero A, Rocca GD. Prediction of early postoperative major cardiac events after elective orthopedic surgery: the role of B-type natriuretic peptide, the revised cardiac risk index, and ASA class. BMC Anesthesiol 2014; 14:20. [PMID: 24655733 PMCID: PMC3998048 DOI: 10.1186/1471-2253-14-20] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 02/27/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate pre- and post-operative brain natriuretic peptide (BNP) levels and compare the power of this test in predicting in-hospital major adverse cardiac events (MACE: atrial fibrillation, flutter, acute heart failure or non-fatal/fatal myocardial infarction) in patients undergoing elective prosthesis orthopedic surgery to that of the Revised Cardiac Risk Index (RCRI) and American Society of Anesthesiology (ASA) class, the most useful scores identified to date. METHODS The study was an observational study of consecutive patients undergoing elective prosthesis orthopedic surgery. Surgical risk was established using RCRI score and ASA class criteria. Venous blood was sampled before surgery and on postoperative day 1 for the measurement of BNP. The intraoperative data collected included details of the surgery and anesthesia and any MACE experienced up until hospital discharge. RESULTS MACE occurred in 14 of the 227 patients treated (6.2%). Age was statistical associated with MACE (p < 0.004). Preoperative BNP levels were higher (p < 0.0007) in patients who experienced MACE than in event-free patients (median values: 92 and 35 pg/mL, respectively). Postoperative BNP levels were also greater (p < 0.0001) in patients sustaining MACE than in event-free patients (median values: 165 and 45 pg/mL, respectively). ROC curve analysis demonstrated that for a cut-off point ≥ 39 pg/mL, the area under the curve for preoperative BNP was equal to 0.77, while a postoperative BNP cut-off point ≥ 69 pg/mL gave an AUC of 0.82. CONCLUSIONS Both pre- and post-operative BNP concentrations are predictors of MACE in patients undergoing elective prosthesis orthopedic surgery.
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Affiliation(s)
- Luigi Vetrugno
- Department of Anesthesia and Intensive Care Medicine, University-Hospital of Udine, P,le S, M, della Misericordia 15, ZIP code: 33100 Udine, Italy.
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Abstract
The concept of the heart as an endocrine organ arises from the observation that the atrial cardiomyocytes in the mammalian heart display a phenotype that is partly that of endocrine cells. Investigations carried out between 1971 and 1983 characterised, by virtue of its natriuretic properties, a polypeptide referred to atrial natriuretic factor (ANF). Another polypeptide isolated from brain in 1988, brain natriuretic peptide (BNP), was subsequently characterised as a second hormone produced by the mammalian heart atria. These peptides were associated with the maintenance of extracellular fluid volume and blood pressure. Later work demonstrated a plethora of other properties for ANF and BNP, now designated cardiac natriuretic peptides (cNPs). In addition to the cNPs, other polypeptide hormones are expressed in the heart that likely act upon the myocardium in a paracrine or autocrine fashion. These include the C-type natriuretic peptide, adrenomedullin, proadrenomedullin N-terminal peptide and endothelin-1. Expression and secretion of ANF and BNP are increased in various cardiovascular pathologies and their levels in blood are used in the diagnosis and prognosis of cardiovascular disease. In addition, therapeutic uses for these peptides or related substances have been found. In all, the discovery of the endocrine heart provided a shift from the classical functional paradigm of the heart that regarded this organ solely as a blood pump to one that regards this organ as self-regulating its workload humorally and that also influences the function of several other organs that control cardiovascular function.
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Richter B, Koller L, Hohensinner PJ, Zorn G, Brekalo M, Berger R, Mörtl D, Maurer G, Pacher R, Huber K, Wojta J, Hülsmann M, Niessner A. A multi-biomarker risk score improves prediction of long-term mortality in patients with advanced heart failure. Int J Cardiol 2013; 168:1251-7. [DOI: 10.1016/j.ijcard.2012.11.052] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Revised: 09/06/2012] [Accepted: 11/11/2012] [Indexed: 12/29/2022]
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Savarese G, Trimarco B, Dellegrottaglie S, Prastaro M, Gambardella F, Rengo G, Leosco D, Perrone-Filardi P. Natriuretic peptide-guided therapy in chronic heart failure: a meta-analysis of 2,686 patients in 12 randomized trials. PLoS One 2013; 8:e58287. [PMID: 23472172 PMCID: PMC3589263 DOI: 10.1371/journal.pone.0058287] [Citation(s) in RCA: 130] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 02/01/2013] [Indexed: 11/21/2022] Open
Abstract
Background The role of cardiac natriuretic peptides in the management of patients with chronic heart failure (HF) remains uncertain. The purpose of this study was to evaluate whether natriuretic peptide-guided therapy, compared to clinically-guided therapy, improves mortality and hospitalization rate in patients with chronic HF. Methodology/Principal Findings MEDLINE, Cochrane, ISI Web of Science and SCOPUS databases were searched for articles reporting natriuretic peptide-guided therapy in HF until August 2012. All randomized trials reporting clinical end-points (all-cause mortality and/or HF-related hospitalization and/or all-cause hospitalization) were included. Meta-analysis was performed to assess the influence of treatment on outcomes. Sensitivity analysis was performed to test the influence of potential effect modifiers and of each trial included in meta-analysis on results. Twelve trials enrolling 2,686 participants were included. Natriuretic peptide-guided therapy (either B-type natriuretic peptide [BNP]- or N-terminal pro-B-type natriuretic peptide [NT-proBNP]-guided therapy) significantly reduced all-cause mortality (Odds Ratio [OR]:0.738; 95% Confidence Interval [CI]:0.596 to 0.913; p = 0.005) and HF-related hospitalization (OR:0.554; CI:0.399 to 0.769; p = 0.000), but not all-cause hospitalization (OR:0.803; CI:0.629 to 1.024; p = 0.077). When separately assessed, NT-proBNP-guided therapy significantly reduced all-cause mortality (OR:0.717; CI:0.563 to 0.914; p = 0.007) and HF-related hospitalization (OR:0.531; CI:0.347 to 0.811; p = 0.003), but not all-cause hospitalization (OR:0.779; CI:0.414 to 1.465; p = 0.438), whereas BNP-guided therapy did not significantly reduce all-cause mortality (OR:0.814; CI:0.518 to 1.279; p = 0.371), HF-related hospitalization (OR:0.599; CI:0.303 to 1.187; p = 0.142) or all-cause hospitalization (OR:0.726; CI:0.609 to 0.964; p = 0.077). Conclusions/Significance Use of cardiac peptides to guide pharmacologic therapy significantly reduces mortality and HF related hospitalization in patients with chronic HF. In particular, NT-proBNP-guided therapy reduced all-cause mortality and HF-related hospitalization but not all-cause hospitalization, whereas BNP-guided therapy did not significantly reduce both mortality and morbidity.
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Affiliation(s)
- Gianluigi Savarese
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Bruno Trimarco
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Santo Dellegrottaglie
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
- Division of Cardiology, Ospedale Medico-Chirurgico Accreditato Villa dei Fiori, Acerra, Naples, Italy
| | - Maria Prastaro
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | | | - Giuseppe Rengo
- Department of Medical Translational Sciences, Federico II University, Naples, Italy
| | - Dario Leosco
- Department of Medical Translational Sciences, Federico II University, Naples, Italy
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Gao M, Wang R, Jiayong Z, Liu Y, Sun G. NT-ProBNP levels are moderately increased in acute high-altitude pulmonary edema. Exp Ther Med 2013; 5:1434-1438. [PMID: 23737894 PMCID: PMC3671802 DOI: 10.3892/etm.2013.976] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Accepted: 01/16/2013] [Indexed: 11/18/2022] Open
Abstract
The aim of the present study was to investigate the effect of B-type natriuretic peptides (BNPs) in acute high-altitude pulmonary edema (HAPE). The study enrolled 46 subjects from lowland Han, including 33 individuals who had acutely ascended to a high altitude (21 individuals with HAPE as the case group and 12 individuals without HAPE as the high-altitude control group) and 13 healthy normal residents as the plain control group. The serum concentrations of N-terminal probrain natriuretic peptide (NT-proBNP), erythropoietin (EPO), vascular endothelial growth factor (VEGF) and nitric oxide (NO) were measured. There were significant differences in the serum concentrations of NT-ProBNP, NO, VEGF and EPO among the three groups. The serum concentrations of NT-ProBNP, EPO and VEGF were significantly higher in the HAPE patients and high-altitude control individuals than those of the plain group. No significant differences were identified between the HAPE patients and the high-altitude control group. In contrast to these three parameters, the serum concentrations of NO in the high-altitude control group were significantly higher than those of the HAPE patients and the plain group, while there were no significant differences in the serum concentrations of NO between the HAPE patients and the plain group. Furthermore, serum concentrations of NT-ProBNP and EPO were significantly reduced following treatment in the HAPE patients, however, no significant changes were identified in VEGF or NO concentrations. BNPs are increased in HAPE with severe hypoxia and right ventricular overload, but are decreased subsequent to treatment. BNPs may therefore be a potential biomarker for the diagnosis and prognosis of HAPE.
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Affiliation(s)
- Mingdong Gao
- Department of Cardiology, Tianjin Chest Hospital, Tianjin 30051
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Liu H, Wang C, Liu L, Zhuang Y, Yang X, Zhang Y. Perioperative application of N-terminal pro-brain natriuretic peptide in patients undergoing cardiac surgery. J Cardiothorac Surg 2013; 8:1. [PMID: 23289601 PMCID: PMC3618288 DOI: 10.1186/1749-8090-8-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 11/03/2012] [Indexed: 11/16/2022] Open
Abstract
Background The purpose of the research was to find out the factors which influence plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, then to assess whether preoperative plasma NT-proBNP levels could predict postoperative outcomes of cardiac surgery. Methods Between November 2008 and February 2010,225 patients who underwent cardiac surgery in our department were included in the study. The mean age was 61.25 ± 12.54 years, and 156 (69.3%) patients were male. NT-proBNP, CK-MB, cTnT and creatinine levels were measured preoperatively and 24 hours after operation. Postoperatively outcomes including ventilation time, length of stay in ICU and hospital, and mortality were closely monitored. The endpoints includes: 1) use of inotropic agents or intra-aortic balloon pump ≥24 h; 2) creatinine level elevated to hemodialysis; 3) cardiac events; 4) ICU stay ≥5d; 5) ventilation dependence ≥ 72 h; 6) deaths within 30 days of surgery. Results NT-proBNP concentrations (median [interquartile range]) increased from 728.4 pg/ml (IQR 213.5 to 2551 pg/ml) preoperatively to 1940.5 pg/ml (IQR 995.9 to 3892 pg/ml) postoperatively (P = 0.015). Preoperative atrial fibrillation, NYHA class III/IV, ejection fraction, pulmonary arterial pressure, left ventricle end-diastolic diameter (LVEDD), preoperative plasma creatinine and cTnT levels were significantly associated with preoperative NT-proBNP levels in univariate analysis. The preoperative NT-proBNP was closely related to ventilation time (P = 0.009), length of stay in ICU (P = 0.004) and length of stay in hospital (P = 0.019). Receiver operating characteristic curves demonstrated a cut-off value above 2773.5 pg/ml was the best cutoff (sensitivity of 63.6% and specificity of 80.8%) to predict the mortality within 30d of surgery. Conclusions Preoperative plasma NT-proBNP level presents a high individual variability in patients undergoing cardiac surgery. NYHA classification, ejection fraction, pulmonary arterial pressure, LVEDD, atrial fibrillation, preoperative plasma creatinine, and cTnT levels are significantly associated with preoperative NT-proBNP levels. Preoperative NT-proBNP is a valuable marker in predicting postoperative outcomes.
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Affiliation(s)
- Hua Liu
- Department of Cardiac Surgery, Zhongshan hospital, Fudan University, No.180 Fenglin Road, Shanghai 200032, China
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Jungbauer CG, Kaess B, Buchner S, Birner C, Lubnow M, Resch M, Debl K, Buesing M, Zerback R, Riegger G, Luchner A. Equal performance of novel N-terminal proBNP (Cardiac proBNP®) and established BNP (Triage BNP®) point-of-care tests. Biomark Med 2012; 6:789-96. [DOI: 10.2217/bmm.12.67] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Recently, a novel point-of-care test (POCT) for N-terminal proBNP (NTproBNP) has been introduced (Cardiac proBNP®, Roche). Aim: The aim was to compare the novel POCT for NTproBNP with the established POCT for BNP. Methods: NTproBNP and BNP were assessed in 222 individuals with chronic heart failure (n = 151) or controls (n = 71) with both POCTs. Results: NTproBNP and BNP were closely correlated upon regression analysis (r = 0.93; p < 0.01). NTproBNP and BNP were both correlated with ejection fraction and New York Heart Association stage. Receiver operating characteristic analysis yielded satisfying and equivalent predictive values for the detection of left ventricular dysfunction (ejection fraction <40%; NTproBNP: area under the curve 0.97; BNP: area under the curve 0.96; p > 0.05) and presence of New York Heart Association stage >2 (area under the curve 0.92 vs 0.91 for NT-proBNP and BNP, respectively; p > 0.05). Conclusion: The NTproBNP POCT allows biochemical detection of heart failure with satisfactory predictive values, is equivalent to the BNP POCT and will improve near-patient testing.
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Affiliation(s)
- Carsten G Jungbauer
- Department of Cardiology, Klinik und Poliklinik fuer Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Bernhard Kaess
- Department of Cardiology, Klinik und Poliklinik fuer Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Stefan Buchner
- Department of Cardiology, Klinik und Poliklinik fuer Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Christoph Birner
- Department of Cardiology, Klinik und Poliklinik fuer Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Matthias Lubnow
- Department of Cardiology, Klinik und Poliklinik fuer Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Markus Resch
- Department of Cardiology, Klinik und Poliklinik fuer Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Kurt Debl
- Department of Cardiology, Klinik und Poliklinik fuer Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Monika Buesing
- Department of Cardiology, Klinik und Poliklinik fuer Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Rainer Zerback
- Clinical Operations, Roche Diagnostics GmbH, Mannheim, Germany
| | - Günter Riegger
- Department of Cardiology, Klinik und Poliklinik fuer Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Andreas Luchner
- Department of Cardiology, Klinik und Poliklinik fuer Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
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Ljunggren M, Lindahl B, Theorell-Haglöw J, Lindberg E. Association between obstructive sleep apnea and elevated levels of type B natriuretic peptide in a community-based sample of women. Sleep 2012; 35:1521-7. [PMID: 23115401 DOI: 10.5665/sleep.2202] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) is associated with an increased risk of cardiovascular disease. One contributory factor may be hemodynamic stress due to the negative intrathoracic pressure during each episode of apnea. Type B natriuretic peptide (BNP) is secreted by the cardiac ventricles in response to volume expansion and pressure load and the authors hypothesized that there would be an association between indices of OSA during the night and levels of BNP in the morning. SETTING Community-based in Uppsala, Sweden. PARTICIPANTS There were 349 women who participated. MEASUREMENTS AND RESULTS Participants underwent full-night polysomnography and anthropometric measurements, and answered questionnaires about medical conditions and current medication. The morning after the polysomnography, blood samples were drawn for analysis of plasma BNP, C-reactive protein, creatinine, and hemoglobin. There was an increase in mean BNP as the severity of sleep apnea increased, increasing from a mean value of 8.5 ng/L among women with an apnea-hypopnea index (AHI) < 5 to 18.0 ng/L in women with an AHI ≥ 30. Elevated BNP levels (≥ 20 ng/L) were found in 29.8% of the women, whereas 70.2% had normal levels. The odds ratio was 2.2 for elevated BNP levels for women with an AHI of 5-14.9 in relation to women with an AHI < 5, 3.1 for women with an AHI of 15-29.9, and 4.6 for women with an AHI ≥ 30 after adjustment for age, body mass index, systolic blood pressure, antihypertensive drugs, and creatinine. CONCLUSIONS There is a dose-response relationship in women between the severity of sleep apnea during the night and the levels of BNP in the morning.
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Affiliation(s)
- Mirjam Ljunggren
- Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden
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The N-terminal pro-B-type natriuretic peptide as a predictor of disease progression in patients with pericardial effusion. Int J Cardiol 2012; 157:192-6. [DOI: 10.1016/j.ijcard.2010.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Revised: 11/23/2010] [Accepted: 12/04/2010] [Indexed: 11/23/2022]
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Vetrugno L, Costa MG, Pompei L, Chiarandini P, Drigo D, Bassi F, Gonano N, Muzzi R, Della Rocca G. Prognostic power of pre- and postoperative B-type natriuretic peptide levels in patients undergoing abdominal aortic surgery. J Cardiothorac Vasc Anesth 2012; 26:637-42. [PMID: 22387082 DOI: 10.1053/j.jvca.2012.01.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The first aim of the present study was to evaluate the pre- and postoperative B-type natriuretic peptide (BNP) levels in patients undergoing surgery for repair of an infrarenal abdominal aortic aneurysm (AAA) and analyze their power as a predictor of in-hospital cardiac events. The second aim was to evaluate the association among pre- and postoperative BNP levels, postoperative patient complications, and length of hospital stay. DESIGN Prospective observational study. SETTING A university hospital. PARTICIPANTS Forty-five patients undergoing elective surgery for an abdominal aortic aneurysm. INTERVENTIONS The plasma BNP level was assessed just before surgery and then on postoperative day 1. Cardiac troponin I levels were measured postoperatively on arrival to the intensive care unit (time 0) and then 12, 48, and 72 hours later. MEASUREMENTS AND MAIN RESULTS The preoperative BNP concentration in patients who developed an acute myocardial infarction was 209 (IQR 84-346) pg/mL compared with 74 (IQR 28-142) pg/mL in those who did not. The difference between groups was statistically significant (p = 0.04). The Spearman correlation showed that postoperative BNP levels correlated significantly with preoperative BNP levels (r = 0.73, p = 0.0001), length of hospital stay (r = 0.35, p = 0.04), and troponin I concentration at 0 hour (r = 0.42, p = 0.02), 12 hours (r = 0.51, p = 0.0052), and 48 hours (r = 0.40, p = 0.033). In contrast, preoperative BNP levels correlated with troponin I at only 12 hours (r = 0.34, p = 0.02). Postoperative BNP levels were influenced significantly by transfusions (p = 0.035) and cross-clamping times (p = 0.038). CONCLUSIONS The present results confirm the high negative predictive value of preoperative BNP levels; and postoperative BNP levels showed a better correlation with postoperative troponin levels, blood transfusion, and postoperative cardiac events.
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Affiliation(s)
- Luigi Vetrugno
- Department of Anesthesiology and Intensive Care, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, University of Udine, Udine, Italy.
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Prognostic utility of changes in N-terminal pro-brain natriuretic Peptide combined with sequential organ failure assessment scores in patients with acute lung injury/acute respiratory distress syndrome concomitant with septic shock. Shock 2012; 36:109-14. [PMID: 21478812 DOI: 10.1097/shk.0b013e31821d8f2d] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We investigated the prognostic utility of changes in N-terminal pro-brain natriuretic peptide (NT-proBNP) in combination with Sequential Organ Failure Assessment (SOFA) score in patients with acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) concomitant with septic shock. Forty-nine mechanically ventilated patients with ALI/ARDS concomitant with septic shock were studied. N-terminal pro-brain natriuretic peptide levels were measured on the first 3 days (days 0, 1, and 2) in the intensive care unit. The median NT-proBNP levels in survivors and nonsurvivors were 3,999 vs. 2,819 pg/mL on day 0 (P = 0.719); 4,495 vs. 5,397 pg/mL on day 1 (P = 0.543); and 2,325 vs. 14,173 pg/mL on day 2 (P = 0.028). N-terminal pro-brain natriuretic peptide levels increased significantly from baseline values in nonsurvivors only. We observed a monotonic increase in 28-day mortality associated with increasing quartiles of percent change in NT-proBNP on day 2 (P < 0.0001). Kaplan-Meier survival analysis revealed that mortality was significantly higher in patients with a change in NT-proBNP of 30% or more (log-rank P < 0.0001). On day 2, areas under the receiver operating characteristic curves for predicting 28-day mortality were 0.74 for SOFA alone and 0.85 (P = 0.028) for SOFA combined with percent change in NT-proBNP. In conclusion, in patients with ALI/ARDS concomitant with septic shock, a rising trend (high percent change) in NT-proBNP levels had better prognostic utility than absolute levels. The combination of percent change in NT-proBNP with SOFA may provide superior prognostic accuracy to SOFA alone.
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Karaca O, Guler GB, Guler E, Gunes HM, Alizade E, Agus HZ, Gol G, Kahveci G, Esen O, Esen AM, Turkmen M. Serum Carbohydrate Antigen 125 Levels in Nonischemic Dilated Cardiomyopathy: A Useful Biomarker for Prognosis and Functional Mitral Regurgitation. ACTA ACUST UNITED AC 2011; 18:144-50. [DOI: 10.1111/j.1751-7133.2011.00260.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Changchien EM, Ahmed S, Betti F, Higa J, Kiely K, Hernandez-Boussard T, Morton J. B-type natriuretic peptide increases after gastric bypass surgery and correlates with weight loss. Surg Endosc 2011; 25:2338-43. [PMID: 21424205 DOI: 10.1007/s00464-010-1565-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Accepted: 12/22/2010] [Indexed: 12/01/2022]
Abstract
BACKGROUND Coronary artery disease is the primary cause of death in the United States, with obesity as a leading preventable risk factor. Previous studies have established the beneficial effect of Roux-en-Y gastric bypass on both weight and cardiac risk factors. Further assessment of cardiac function may be accomplished using B-type natriuretic peptide (BNP), which has demonstrated clinical utility in diagnosing congestive heart failure. This study aimed to assess changes in BNP after intentional weight loss through gastric bypass surgery. METHODS Plasma volume, weight, and BNP were measured preoperatively and at 3, 6, and 12 months postoperatively for 101 consecutive patients undergoing laparoscopic gastric bypass surgery by a single surgeon in an academic medical setting. Outcomes were compared by matched t-test. Multivariable linear regression and Pearson's correlation were used to examine predictors of pro-B-type natriuretic peptide (NT-proBNP) concentration. RESULTS The concentration of BNP increased significantly from a mean preoperative level of 50.5 ng/l to postoperative levels of 73.9 ng/l at 3 months (P=0.013), 74.3 ng/l at 6 months (P<0.001), and 156.3 ng/l at 12 months (P<0.001). In addition, excess weight loss was the only statistically significant predictor of increased BNP concentration (odds ratio, 1.483; P<0.05). CONCLUSION Gastric bypass leads to significant excess weight loss and surprisingly increased BNP concentrations. Correlation of BNP increase with weight loss suggests an additional novel mechanism for surgically induced weight loss.
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Affiliation(s)
- Eric M Changchien
- Department of Surgery, Stanford Medical Center, 300 Pasteur Drive, H3680, Stanford, CA 94305, USA
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Park BH, Kim YS, Chang J, Kim SK, Kang YA, Jung JY, Lee KJ, Son JY, Kim EY, Lim JE, Park MS. N-terminal pro-brain natriuretic peptide as a marker of right ventricular dysfunction after open-lung approach in patients with acute lung injury/acute respiratory distress syndrome. J Crit Care 2010; 26:241-8. [PMID: 21106338 DOI: 10.1016/j.jcrc.2010.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Revised: 09/24/2010] [Accepted: 10/03/2010] [Indexed: 01/24/2023]
Abstract
PURPOSE The purpose of the study was to evaluate the utility of N-terminal pro-brain natriuretic peptide (NT-proBNP) as a marker of right ventricular (RV) dysfunction after open-lung approach (OLA) in patients with acute lung injury (ALI)/acute respiratory distress syndrome (ARDS). MATERIALS AND METHODS Twenty-seven patients with ALI/ARDS underwent OLA (2-minute steps of fixed pressure-controlled ventilation with progressive positive end-expiratory pressure levels up to 30 cm H(2)O, followed by stepwise decrement of positive end-expiratory pressure level by 2 cm H(2)O). Patients who showed a PaO(2)/FiO(2) increase of more than 50% from baseline were defined as responders. Plasma NT-proBNP levels were taken immediately before OLA and 2 and 6 hours later. A minimum 30% increase in NT-proBNP level from baseline was considered significant. RESULTS Right-over-left ventricular stroke work ratio and its percentage change did not differ between responders and nonresponders, whereas these values were higher in patients showing NT-proBNP increase (P < .05). The NT-proBNP percentage change correlated with right-over-left ventricular stroke work ratio percentage change (r = 0.83), pulmonary vascular resistance (r = 0.81), and RV ejection fraction (r = -0.79) and correlated with plateau pressure in nonresponders only (r = 0.82). CONCLUSIONS In patients with ALI/ARDS, intraindividual NT-proBNP changes correlated with RV afterload following OLA, thereby serving as a potential marker for RV dysfunction after OLA.
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Affiliation(s)
- Byung Hoon Park
- Pulmonary and Critical Care Division, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 120-752, South Korea
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Speksnijder L, Rutten JH, van den Meiracker AH, de Bruin RJ, Lindemans J, Hop WC, Visser W. Amino-terminal pro-brain natriuretic peptide (NT-proBNP) is a biomarker of cardiac filling pressures in pre-eclampsia. Eur J Obstet Gynecol Reprod Biol 2010; 153:12-5. [DOI: 10.1016/j.ejogrb.2010.06.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Revised: 05/24/2010] [Accepted: 06/27/2010] [Indexed: 12/01/2022]
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Arterial stiffness as determinant of increased amino terminal pro-B-type natriuretic peptide levels in individuals with and without cardiovascular disease – the Rotterdam Study. J Hypertens 2010; 28:2061-7. [DOI: 10.1097/hjh.0b013e32833c96bb] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Schachner T, Wiedemann D, Fetz H, Laufer G, Kocher A, Bonaros N. Influence of preoperative serum N-terminal pro-brain type natriuretic peptide on the postoperative outcome and survival rates of coronary artery bypass patients. Clinics (Sao Paulo) 2010; 65:1239-45. [PMID: 21340210 PMCID: PMC3020332 DOI: 10.1590/s1807-59322010001200004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Accepted: 09/07/2010] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The N-terminal fragment of pro-brain type natriuretic peptide (NT-proBNP) is an established biomarker for cardiac failure. OBJECTIVE To determine the influence of preoperative serum NT-proBNP on postoperative outcome and mid-term survival in patients undergoing coronary artery bypass grafting (CABG). METHODS In 819 patients undergoing isolated CABG surgery preoperative serum NT-proBNP levels were measured. NT-proBNP was correlated with various postoperative outcome parameters and survival rate after a median follow-up time of 18 (0.5-44) months. Risk factors of mortality were identified using χ², Mann-Whitney test, and Cox regression. RESULTS NT-proBNP levels > 430 ng/ml and > 502 ng/ml predicted hospital and overall mortality (p < 0.05), with an incidence of 1.6% and 4%, respectively. Kaplan-Meier analysis revealed decreased survival rates in patients with NT-proBNP > 502 ng/ml (p = 0.001). Age, preoperative serum creatinine, diabetes, chronic obstructive pulmonary disease, low left ventricular ejection fraction and BNP levels >502 ng/ml were isolated as risk factors for overall mortality. Multivariate Cox regression analysis, including the known factors influencing NT-proBNP levels, identified NT-proBNP as an independent risk factor for mortality (OR = 3.079 (CI = 1.149-8.247), p = 0.025). Preoperative NT-proBNP levels >502 ng/ml were associated with increased ventilation time (p = 0.005), longer intensive care unit stay (p=0.001), higher incidence of postoperative hemofiltration (p = 0.001), use of intra-aortic balloon pump (p < 0.001), and postoperative atrial fibrillation (p = 0.031) CONCLUSION Preoperative NT-proBNP levels > 502 ng/ml predict mid-term mortality after isolated CABG and are associated with significantly higher hospital mortality and perioperative complications.
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Romano S, Necozione S, Guarracini L, Fratini S, Cisternino P, di Orio F, Penco M. Accuracy of N-terminal pro-brain natriuretic peptide in the identification of left ventricular dysfunction in high-risk asymptomatic patients. J Cardiovasc Med (Hagerstown) 2009; 10:238-44. [PMID: 19262210 DOI: 10.2459/jcm.0b013e3283212ee0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The role of natriuretic peptides in the screening of left ventricular dysfunction is still unclear. The aim of this study was to assess the usefulness of N-terminal pro-brain natriuretic peptide (NT-proBNP) measurement in asymptomatic patients at high risk of developing left ventricular dysfunction. METHODS One hundred and thirty-four consecutive ambulatory patients (mean age 56.1 +/- 7 years) were studied and selected on the basis of a history of hypertension of at least 5 years. Systolic dysfunction was defined as an ejection fraction of 45% or less. Statistical analysis was performed by both parametric and nonparametric approaches. Diagnostic accuracy was evaluated by receiver operating characteristic analysis. RESULTS Echocardiography showed normal left ventricular function in 40 patients, diastolic dysfunction in 80 patients and systolic dysfunction in 14 patients. NT-proBNP levels were significantly higher in patients with systolic dysfunction (356.1 +/- 294.8 vs. 85.2 +/- 85.8 pg/ml; P < 0.05). Receiver operating characteristic analysis showed a high value of the area under the curve (0.89) for the detection of systolic dysfunction with a sensitivity of 83% and a specificity of 80% for a cut-off value of 114 pg/ml and with a negative predictive value of 0.98. CONCLUSION In asymptomatic patients at high risk for heart failure because of a history of hypertension, the measurement of NT-proBNP levels may represent a useful screening test for left ventricular systolic dysfunction. Therefore, more expensive examinations, such as echocardiography, may be restricted only to patients with higher NT-proBNP levels.
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Affiliation(s)
- Silvio Romano
- Department of Internal Medicine and Public Health, University of L'Aquila, Italy.
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