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Marqvard Sørensen L, Kofoed Petersen J, Emanuel Strange J, Østergaard L, Eifer Møller J, Schou M, Køber L, de Backer O, Fosbøl E. N-terminal pro-B-type natriuretic peptide levels pre-transcatheter aortic valve implantation and relationship with long-term outcomes. IJC HEART & VASCULATURE 2024; 52:101423. [PMID: 38784048 PMCID: PMC11112331 DOI: 10.1016/j.ijcha.2024.101423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/05/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024]
Abstract
Background Blood levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) has been suggested as a future guidance tool for the selection of patients for aortic valve replacement. This study aimed to examine how levels of NT-proBNP pre-transcatheter aortic valve implantation (TAVI) is associated with one-year rates of heart failure (HF) admission and mortality following TAVI. Methods With Danish nationwide registries, we identified all patients undergoing TAVI from 2014 to 2021 who had at least one recorded NT-pro-BNP measurement within one year before TAVI. Patients were compared by quartiles of pre-TAVI NT-proBNP: quartile 4 (high NT-proBNP group) vs quartile 1-3 (low NT-proBNP group). Comparisons of all-cause mortality and HF-admissions were conducted using Kaplan-Meier analysis, cumulative incidence, and Cox analysis, as appropriate. Results We identified 1,140 patients undergoing first-time TAVI with a recorded NT-pro-BNP; 846 (74.2 %) with a low NT-proBNP (<420 pmol/L) (55.0 % male, median age 81 year) and 294 (25.8 %) with a high NT-proBNP (≥420 pmol/L) (53.1 % male, median age 82 year). A high versus low NT-proBNP was associated with increased one-year cumulative incidence of HF-admissions (9.1 % vs. 23.1 %, adjusted HR 2.00 [95 % CI, 1.40-2.85]) and all-cause mortality (6.0 % vs. 14.6 %, adjusted HR 1.95 [95 % CI: 1.24-3.07]). A high NT-proBNP was associated with higher rates of outcomes irrespective of previously known atrial fibrillation, HF, chronic kidney disease, and hypertension. Conclusion In patients undergoing TAVI, a baseline NT-proBNP ≥ 420 pmol/L was associated with increased one-year rates of HF-admission and mortality post-TAVI and may be utilized to identify a high-risk population.
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Affiliation(s)
| | - Jeppe Kofoed Petersen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jarl Emanuel Strange
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lauge Østergaard
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jacob Eifer Møller
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Morten Schou
- Department of Cardiology, Herlev-Gentofte Hospital, Herlev, Denmark
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ole de Backer
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Emil Fosbøl
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Seoudy H, Shamekhi J, Voigtländer L, Ludwig S, Frank J, Kujat T, Bramlage P, Al-Kassou B, Sugiura A, Rangrez AY, Schofer N, Puehler T, Lutter G, Seiffert M, Nickenig G, Conradi L, Frey N, Westermann D, Sinning JM, Frank D. C-Reactive Protein to Albumin Ratio in Patients Undergoing Transcatheter Aortic Valve Replacement. Mayo Clin Proc 2022; 97:931-940. [PMID: 35410750 DOI: 10.1016/j.mayocp.2021.11.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 10/11/2021] [Accepted: 11/03/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate whether the serum C-reactive protein to albumin ratio (CAR) could be used for risk stratification of patients undergoing transcatheter aortic valve replacement (TAVR) for severe aortic stenosis (AS). PATIENTS AND METHODS Frailty is a predictor of poor outcomes in patients undergoing AS interventions. The CAR reflects key components of frailty (systemic inflammation and nutrition) and could potentially be implemented into assessment and management strategies for patients with AS. From March 1, 2010, through February 29, 2020, 1836 patients were prospectively enrolled in an observational TAVR database. Patients (prospective development cohort, n=763) were grouped into CAR quartiles to compare the upper quartile (CAR Q4) with the lower quartiles (CAR Q1-3). Primary end point was all-cause mortality. Results were verified in an independent retrospective cohort (n=1403). RESULTS The CAR Q4 had a higher prevalence of impaired left ventricular function, atrial fibrillation, diabetes, and cerebrovascular disease and a higher median logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) vs CAR Q1-3. After median follow-up of 15.0 months, all-cause mortality was significantly higher in CAR Q4 vs CAR Q1-3 (P<.001). In multivariable analyses, risk factors for all-cause mortality were CAR Q4 (>0.1632; hazard ratio, 1.45; 95% confidence interval, 1.05 to 2.00; P=.03), N-terminal pro-B-type natriuretic peptide Q4 (>3230 pg/mL [to convert to ng/L, multiply by 1), high-sensitivity troponin T Q4 (>0.0395 ng/mL [to convert to μg/L, multiply by 1]), above-median logistic EuroSCORE (16.1%), myocardial infarction, Acute Kidney Injury Network stage 3, and life-threatening bleeding. CONCLUSION Elevated CAR was associated with increased risk of all-cause mortality in patients undergoing transfemoral TAVR. The CAR, a simple, objective tool to assess frailty, could be incorporated into assessing patients with AS being considered for TAVR.
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Affiliation(s)
- Hatim Seoudy
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg, Kiel, Lübeck, Germany
| | - Jasmin Shamekhi
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Lisa Voigtländer
- Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg, Kiel, Lübeck, Germany
| | - Sebastian Ludwig
- Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg, Kiel, Lübeck, Germany
| | - Johanne Frank
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg, Kiel, Lübeck, Germany
| | - Tim Kujat
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Baravan Al-Kassou
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Atsushi Sugiura
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Ashraf Yusuf Rangrez
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg, Kiel, Lübeck, Germany
| | - Niklas Schofer
- Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Thomas Puehler
- Department of Cardiac and Vascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg, Kiel, Lübeck, Germany
| | - Georg Lutter
- Department of Cardiac and Vascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg, Kiel, Lübeck, Germany
| | - Moritz Seiffert
- Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg, Kiel, Lübeck, Germany
| | - Georg Nickenig
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Norbert Frey
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg, Kiel, Lübeck, Germany
| | - Dirk Westermann
- Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg, Kiel, Lübeck, Germany
| | - Jan-Malte Sinning
- Department of Medicine II, Heart Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Derk Frank
- Department of Internal Medicine III, Cardiology and Angiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg, Kiel, Lübeck, Germany.
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Kattih B, Carstens DC, Boeckling F, Rasper T, Pergola G, Dimmeler S, Vasa-Nicotera M, Zeiher AM, Mas-Peiro S. Low Circulating Musclin is Associated With Adverse Prognosis in Patients Undergoing Transcatheter Aortic Valve Implantation at Low-Intermediate Risk. J Am Heart Assoc 2022; 11:e022792. [PMID: 35229655 PMCID: PMC9075297 DOI: 10.1161/jaha.121.022792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background Musclin is an activity‐stimulated and cardioprotective myokine that attenuates pathological cardiac remodeling. Musclin deficiency, in turn, results in reduced physical endurance. The aim of this study was to assess the prognostic value of circulating musclin as a novel, putative biomarker to identify patients undergoing transcatheter aortic valve implantation (TAVI) who are at a higher risk of death. Methods and Results In this study, we measured systemic musclin levels in 368 patients undergoing TAVI who were at low to intermediate clinical risk (median EuroSCORE [European System for Cardiac Operative Risk Evaluation] II: 3.5; quartile 1–quartile, 2.2%–5.3%), whereby 209 (56.8%) patients were at low and 159 (43.2%) were at intermediate risk. Median preprocedural musclin levels were 2.7 ng/mL (quartile 1–quartile 3, 1.5–4.6 ng/mL). Musclin levels were dichotomized in low (<2.862 ng/mL, n=199 [54.1%]) or high (≥ 2.862 ng/mL, n=169 [45.9%]) groups using cutoff values determined by classification and regression tree analysis. The primary end point was 1‐year overall survival. Patients with low circulating musclin levels exhibited a significantly higher prevalence of frailty, low albumin values, hypertension, and history of stroke as well as higher N‐terminal pro‐B‐type natriuretic peptide. Low musclin levels significantly predicted risk of death in univariable (hazard ratio, 1.81; 95% CI, 1.00–3.53 [P=0.049]) and multivariable (adjusted hazard ratio, 2.45; 95% CI, 1.06–5.69 [P=0.037]) Cox regression analyses. Additionally, low musclin levels in combination with conventional EuroSCORE II suggested improved risk stratification in patients undergoing TAVI who were at low to intermediate clinical risk into subgroups with reduced 1‐year survival rates by log‐rank test (P for trend=0.003). Conclusions Circulating musclin is an independent predictor of 1‐year overall survival in patients undergoing TAVI. Combined with EuroSCORE II, circulating musclin might help to improve prediction of mortality in patients undergoing TAVI who are at low to intermediate clinical risk.
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Affiliation(s)
- Badder Kattih
- Department of Medicine, Cardiology Goethe University Hospital Frankfurt Germany.,German Centre for Cardiovascular ResearchPartner Site Frankfurt Rhine-Main Berlin Germany.,Institute for Cardiovascular Regeneration Goethe University Frankfurt am Main Germany
| | - Daniel C Carstens
- Department of Medicine, Cardiology Goethe University Hospital Frankfurt Germany.,Institute for Cardiovascular Regeneration Goethe University Frankfurt am Main Germany
| | - Felicitas Boeckling
- Department of Medicine, Cardiology Goethe University Hospital Frankfurt Germany.,German Centre for Cardiovascular ResearchPartner Site Frankfurt Rhine-Main Berlin Germany.,Institute for Cardiovascular Regeneration Goethe University Frankfurt am Main Germany
| | - Tina Rasper
- Department of Medicine, Cardiology Goethe University Hospital Frankfurt Germany
| | - Graziella Pergola
- Department of Medicine, Cardiology Goethe University Hospital Frankfurt Germany.,German Centre for Cardiovascular ResearchPartner Site Frankfurt Rhine-Main Berlin Germany
| | - Stefanie Dimmeler
- German Centre for Cardiovascular ResearchPartner Site Frankfurt Rhine-Main Berlin Germany.,Institute for Cardiovascular Regeneration Goethe University Frankfurt am Main Germany
| | - Mariuca Vasa-Nicotera
- Department of Medicine, Cardiology Goethe University Hospital Frankfurt Germany.,German Centre for Cardiovascular ResearchPartner Site Frankfurt Rhine-Main Berlin Germany
| | - Andreas M Zeiher
- Department of Medicine, Cardiology Goethe University Hospital Frankfurt Germany.,German Centre for Cardiovascular ResearchPartner Site Frankfurt Rhine-Main Berlin Germany
| | - Silvia Mas-Peiro
- Department of Medicine, Cardiology Goethe University Hospital Frankfurt Germany.,German Centre for Cardiovascular ResearchPartner Site Frankfurt Rhine-Main Berlin Germany
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Su Y, Hou JY, Zhang YJ, Ma GG, Hao GW, Luo JC, Luo Z, Tu GW. Serum N-terminal Pro-B-type Natriuretic Peptide Predicts Mortality in Cardiac Surgery Patients Receiving Renal Replacement Therapy. Front Med (Lausanne) 2020; 7:153. [PMID: 32457914 PMCID: PMC7225276 DOI: 10.3389/fmed.2020.00153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/07/2020] [Indexed: 02/05/2023] Open
Abstract
Background: N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a useful cardiac biomarker that is associated with acute kidney injury (AKI) and mortality after cardiac surgery. However, its prognostic value in cardiac surgical patients receiving renal replacement therapy (RRT) remains unclear. Objectives: Our study aimed to assess the prognostic value of NT-proBNP in patients with established AKI receiving RRT after cardiac surgery. Methods: A total of 163 cardiac surgical patients with AKI requiring RRT were enrolled in this study. Baseline characteristics, hemodynamic variables at RRT initiation, and NT-proBNP level before surgery, at RRT initiation, and on the first day after RRT were collected. The primary outcome was 28-day mortality after RRT initiation. Results: Serum NT-proBNP levels in non-survivors was markedly higher than survivors before surgery (median: 4,096 [IQR, 962.0-9583.8] vs. 1,339 [IQR, 446-5,173] pg/mL; P < 0.01), at RRT initiation (median: 10,366 [IQR, 5,668-20,646] vs. 3,779 [IQR, 1,799-11,256] pg/mL; P < 0.001), and on the first day after RRT (median: 9,055.0 [IQR, 4,392-24,348] vs. 5,255 [IQR, 2,134-9,175] pg/mL; P < 0.001). The area under the receiver operating characteristic curve of NT-proBNP before surgery, at RRT initiation, and on the first day after RRT for predicting 28-day mortality was 0.64 (95% CI, 0.55-0.73), 0.71 (95% CI, 0.63-0.79), and 0.68 (95% CI, 0.60-0.76), respectively. Consistently, Cox regression revealed that NT-proBNP levels before surgery (HR: 1.27, 95% CI, 1.06-1.52), at RRT initiation (HR: 1.11, 95% CI, 1.06-1.17), and on the first day after RRT (HR: 1.17, 95% CI, 1.11-1.23) were independently associated with 28-day mortality. Conclusions: Serum NT-proBNP was an independent predictor of 28-day mortality in cardiac surgical patients with AKI requiring RRT. The prognostic role of NT-proBNP needs to be confirmed in the future.
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Affiliation(s)
- Ying Su
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jun-yi Hou
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yi-jie Zhang
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Guo-guang Ma
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Guang-wei Hao
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jing-chao Luo
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhe Luo
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
- Department of Critical Care Medicine, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China
- *Correspondence: Zhe Luo
| | - Guo-wei Tu
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
- Guo-wei Tu
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