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Choi IJ, Lim S, Hwang Y, Lee D, Lee WJ, Lee KY, Kim MJ, Jeon DS. Soluble neprilysin and long-term clinical outcomes in patients with coronary artery disease undergoing percutaneous coronary intervention: a retrospective cohort study. BMC Cardiovasc Disord 2020; 20:360. [PMID: 32762650 PMCID: PMC7409669 DOI: 10.1186/s12872-020-01636-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/20/2020] [Indexed: 12/11/2022] Open
Abstract
Background Neprilysin has an essential role in regulating fluid balance and vascular resistance, and neprilysin inhibitors have shown beneficial effects in patients with heart failure. However, the potential predictive value of neprilysin levels as a biomarker for cardiovascular risk remains unclear. The aim of this study was to assess the prognostic value of soluble neprilysin (sNEP) levels in patients with ischemic heart disease. Methods Neprilysin levels were measured in 694 consecutive patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI). These patients were classified into two groups according to their serum levels of neprilysin and categorized into the lower neprilysin group (n = 348) and the higher neprilysin group (n = 346). The primary clinical endpoint was all-cause mortality, and the secondary endpoint was a composite of major adverse cardiac events (MACE). Results The median sNEP level was 76.0 pg/ml. The median sNEP levels were higher in patients with left ventricular ejection fraction (LVEF) ≥40% (77.6 pg/ml, interquartile range 46.6–141.3) than in those with LVEF < 40% (70.0 pg/ml, interquartile range 47.1–100.6; P = 0.032). Among all patients, each clinical outcome and MACE did not differ significantly according to the groups divided into median, tertile, or quartile of sNEP levels during a median follow-up of 28.4 months. We did not find a significant relationship between sNEP levels and clinical outcomes in multivariate Cox regression analysis. Among patients with LVEF < 40%, an increased sNEP level was associated with a higher rate of all-cause death (adjusted hazard ratio 2.630, 95% confidence interval 1.049–6.595, P = 0.039). Conclusion Serum sNEP levels are not associated with long-term mortality or cardiovascular outcomes after PCI in patients with CAD. In the LVEF < 40% group, increased sNEP levels may be associated with a higher risk of all-cause death.
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Affiliation(s)
- Ik Jun Choi
- Division of Cardiology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sungmin Lim
- Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 271, Cheonbo-ro, Uijeongbu-si, Gyeonggi-do, 11765, Seoul, Republic of Korea.
| | - Youngdeok Hwang
- Paul H. Chook Department of Information Systems and Statistics, Baruch College, CUNY, New York, NY, USA
| | - Dongjae Lee
- Division of Cardiology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Won Jik Lee
- Division of Cardiology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kwan Yong Lee
- Division of Cardiology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Mi-Jeong Kim
- Division of Cardiology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Doo Soo Jeon
- Division of Cardiology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Feygina EE, Katrukha AG, Semenov AG. Neutral Endopeptidase (Neprilysin) in Therapy and Diagnostics: Yin and Yang. BIOCHEMISTRY (MOSCOW) 2019; 84:1346-1358. [PMID: 31760922 DOI: 10.1134/s0006297919110105] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Neprilysin (NEP) is a zinc-dependent metalloproteinase that exists in organisms in both transmembrane and soluble forms. NEP substrates are involved in regulating the cardiovascular and nervous systems. In this review, we discuss some of the biochemical characteristics and physiological functions of this enzyme with special emphasis on the use of NEP as a therapeutic target. The history and various physiological aspects of applying NEP inhibitors for treating heart failure and attempts to increase NEP activity when treating Alzheimer's disease using gene and cell therapies are described. Another important issue discussed is the role of NEP as a potential marker for predicting the risk of cardiovascular disease complications. The diagnostic and prognostic performance of soluble NEP in various types of heart failure is analyzed and presented. We also discuss the methods and approaches for measuring NEP activity for prognosis and diagnosis, as well as a possible new role of natriuretic peptides (NEP substrates) in cardiovascular diagnostics.
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Affiliation(s)
- E E Feygina
- HyTest Ltd., Turku, 20520, Finland. .,Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, 119991, Russia
| | - A G Katrukha
- HyTest Ltd., Turku, 20520, Finland.,Lomonosov Moscow State University, Faculty of Biology, Moscow, 119991, Russia
| | - A G Semenov
- HyTest Ltd., Turku, 20520, Finland.,Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, 119991, Russia
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Yoshihisa A, Yokokawa T, Ichijo Y, Kimishima Y, Kanno Y, Misaka T, Sato T, Oikawa M, Kobayashi A, Yamaki T, Sugimoto K, Kunii H, Takeishi Y. Soluble Neprilysin ― Cardiac Function and Outcome in Hypertrophic Cardiomyopathy ―. Circ Rep 2019; 1:261-267. [PMID: 33693148 PMCID: PMC7889477 DOI: 10.1253/circrep.cr-19-0034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background:
Circulating soluble neprilysin (sNEP) predicts outcome in heart failure (HF) patients with reduced ejection fraction (EF), but not in those with preserved EF. We examined sNEP in patients with hypertrophic cardiomyopathy (HCM), and their correlations with other biomarkers, cardiac function, and clinical outcome. Methods and Results:
We examined the associations between sNEP and the laboratory and echocardiography parameters in the HCM patients (n=93). Regarding the laboratory data, sNEP had a significant positive correlation with B-type natriuretic peptide (BNP; R=0.326, P=0.003), but not with troponin I. As for the echocardiographic parameters, sNEP negatively correlated with left ventricular EF (R=−0.283, P=0.009) and right ventricular fractional area change (R=−0.277, P=0.012), but not with left ventricular mass. Next, we prospectively followed up on the patients for cardiac events, including worsening HF or cardiac death, and all-cause mortality. On Kaplan-Meier analysis (mean follow-up, 1,021 days), the cardiac event rate and all-cause mortality were similar between the higher sNEP group (sNEP ≥median level of 1.43 ng/mL, n=46) and lower sNEP group (sNEP <1.43 ng/mL, n=47). On Cox proportional hazard analysis, sNEP was not a predictor of cardiac event or all-cause mortality. Conclusions:
Soluble neprilysin appears to correlate with BNP and cardiac systolic function, but it is not significantly associated with prognosis in HCM patients.
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Affiliation(s)
- Akiomi Yoshihisa
- Department of Cardiovascular Medicine, Fukushima Medical University
- Department of Advanced Cardiac Therapeutics, Fukushima Medical University
| | - Tetsuro Yokokawa
- Department of Cardiovascular Medicine, Fukushima Medical University
- Department of Pulmonary Hypertension, Fukushima Medical University
| | - Yasuhiro Ichijo
- Department of Cardiovascular Medicine, Fukushima Medical University
| | - Yusuke Kimishima
- Department of Cardiovascular Medicine, Fukushima Medical University
| | - Yuki Kanno
- Department of Cardiovascular Medicine, Fukushima Medical University
| | - Tomofumi Misaka
- Department of Cardiovascular Medicine, Fukushima Medical University
- Department of Advanced Cardiac Therapeutics, Fukushima Medical University
| | - Takamasa Sato
- Department of Cardiovascular Medicine, Fukushima Medical University
| | - Masayoshi Oikawa
- Department of Cardiovascular Medicine, Fukushima Medical University
| | | | - Takayoshi Yamaki
- Department of Cardiovascular Medicine, Fukushima Medical University
| | - Koichi Sugimoto
- Department of Cardiovascular Medicine, Fukushima Medical University
- Department of Pulmonary Hypertension, Fukushima Medical University
| | - Hiroyuki Kunii
- Department of Cardiovascular Medicine, Fukushima Medical University
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Zhang ZL, Li R, Yang FY, Xi L. Natriuretic peptide family as diagnostic/prognostic biomarker and treatment modality in management of adult and geriatric patients with heart failure: remaining issues and challenges. J Geriatr Cardiol 2018; 15:540-546. [PMID: 30344534 PMCID: PMC6188938 DOI: 10.11909/j.issn.1671-5411.2018.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/14/2018] [Accepted: 08/14/2018] [Indexed: 12/30/2022] Open
Abstract
B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP), the key members of natriuretic peptide family have been recommended as the gold standard biomarkers for the diagnosis and prognosis of heart failure (HF) according to the current clinical guidelines. However, recent studies have revealed many previously unrecognized features about the natriuretic peptide family, including more accurate utilization of BNP and NT-proBNP in diagnosing HF. The pathophysiological mechanisms behind natriuretic peptide release, breakdown, and clearance are very complex and the diverse nature of circulating natriuretic peptides and fragments makes analytical detection particularly challenging. In addition, a new class of drug therapy, which works via natriuretic peptide family, has also been considered promising for cardiology application. Under this context, our present mini-review aims at providing a critical analysis on these new progresses on BNP and NT-proBNP with a special emphasis on their use in geriatric cardiology settings. We have focused on several remaining issues and challenges regarding the clinical utilization of BNP and NT-proBNP, which include: (1) Different prevalence and diagnostic/prognostic values of BNP isoforms; (2) methodological issues on detection of BNP; (3) glycosylation of proBNP and its effect on biomarker testing; (4) specificity and comparability of BNP/NT-proBNP resulted from different testing platforms; (5) new development of natriuretic peptides as HF treatment modality; (6) BNP paradox in HF; and (7) special considerations of using BNP/NT-proBNP in elderly HF patients. These practical discussions on BNP/NT-proBNP may be instrumental for the healthcare providers in critically interpreting laboratory results and effective management of the HF patients.
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Affiliation(s)
- Zhen-Lu Zhang
- Department of Clinical Laboratory, Wuhan Asia Heart Hospital, Wuhan University, Wuhan, China
| | - Ran Li
- Department of Clinical Laboratory, Wuhan Asia Heart Hospital, Wuhan University, Wuhan, China
| | - Fei-Yan Yang
- Department of Cardiology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lei Xi
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA, United States
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Chouihed T, Manzo-Silberman S, Peschanski N, Charpentier S, Elbaz M, Savary D, Bonnefoy-Cudraz E, Laribi S, Henry P, Girerd N, Zannad F, El Khoury C. Management of suspected acute heart failure dyspnea in the emergency department: results from the French prospective multicenter DeFSSICA survey. Scand J Trauma Resusc Emerg Med 2016; 24:112. [PMID: 27639971 PMCID: PMC5026775 DOI: 10.1186/s13049-016-0300-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 08/26/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An appropriate diagnostic process is crucial for managing patients with acute heart failure (AHF) in emergency department (ED). Our study aims to describe the characteristics and therapeutic management of patients admitted to the ED for dyspnea suspected to have AHF, their in-hospital pathway of care and their in-hospital outcome. METHODS Consecutive patients admitted in 26 French ED for dyspnea suspected to be the consequence of AHF, prior to in hospital diagnostic test, were prospectively included at the time of their admission in the DeFSSICA Survey. Clinical characteristics at admission were recorded by the ED physicians. At discharge from ED, patients were categorized as AHF or non-AHF based on the final diagnosis reported in the discharge summary. The completeness of the data was controlled by the local investigator. RESULTS From 16/6/2014 to 7/7/2014, 699 patients were included, of whom 537 (77 %) had a final diagnosis of AHF at discharge. Patients with AHF were older (median 83 vs 79 years, p = 0.0007), more likely to have hypertension (71 % vs 57 %, p = 0.002), chronic HF (54 % vs 37 %, p = 0.0004), atrial fibrillation (45 % vs 34 %, p = 0.02) and history of hospitalization for AHF in the previous year (40 % vs 18 %, p < 0.0001) when compared to patients without AHF. Furosemide and oxygen were used in approximately 2/3 of the patients in the ED (respectively 75 and 68 %) whereas nitrates were in 19 % of the patients. Diagnostic methods used to confirm AHF included biochemistry (100 %), pro-B-type natriuretic peptide (90 %), electrocardiography (98 %), chest X-ray (94 %), and echography (15 %) which only 18 % of lung ultrasound. After the ED visit, 13 % of AHF patients were transferred to the intensive care unit, 28 % in cardiology units and 12 % in geriatric units. In-hospital mortality was lower in AHF vs non-AHF patients (5.6 % vs 14 %, p = 0.003). DISCUSSION DeFSSICA, a large French observational survey of acute HF, provides information on HF presentation and the French pathway of care. Patients in DeFSSICA were elderly, with a median age of 83 years. Compared with the French OFICA study, patients in DeFSSICA were more likely to have hypertension (71 % vs 62 %) and atrial fibrillation (45 % vs 38 %). As atrial fibrillation and a rapid heart rate have been closely linked to mortality, detection of atrial fibrillation should be considered systematically.The limited use of nitrates in DeFSSICA may be related to the median SBP of 140 (121-160) mmHg. However, our use of nitrates was similar to those in the EAHFE (20.7 %) and OPTIMIZE-HF (14.3 %) registries. In line with guidelines, the proportions of patients who underwent ECG, biological analysis, or chest X-ray were all >90 % in DeFSSICA. Similarly, BNP or pro-BNP was measured in 93 % of patients, compared with 82 % of patients in the OFICA study. Although BNP may be helpful when the diagnosis of HF is in doubt, ultrasound remains the gold standard. The use of ultrasound in the ED has been reported to accelerate the diagnosis of HF and the initiation of treatment, and shorten the length of stay. In-hospital mortality of HF patients in DeFSSICA was 6.4 %, slightly lower than in the OFICA study (8.2 %). Improved interdisciplinary cooperation has been highlighted as a key factor for the improvement of HF patient care. CONCLUSIONS DeFSSICA shows that patients admitted for dyspnea suspected to be the consequence of AHF are mostly elderly. The diagnosis of AHF is difficult to ascertain based on clinical presentation in patients with dyspnea. Novel diagnostic techniques such as thoracic ultrasound are warranted to provide the right treatment to the right patients in the ED as early as possible.
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Affiliation(s)
- Tahar Chouihed
- Emergency Department, University Hospital of Nancy, Nancy, France
- INSERM, Centre d’Investigations Cliniques 9501, Université de Lorraine, CHU de Nancy, Institut Lorrain du Cœur et des Vaisseaux, Nancy, France
- INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN network, Nancy, France
- INSERM UMR-S 1116, Université Lorraine Nancy I, Nancy, France
| | - Stéphane Manzo-Silberman
- Department of Cardiology, Lariboisière Hospital, Paris, France
- INSERM UMR-S 942, Université Paris-Diderot, Sorbonne Paris Cité, Paris, France
| | - Nicolas Peschanski
- Emergency Department, University Hospital of Rouen, Rouen, France
- University of Rouen-Normandy, INSERM UMR-U1096, Rouen, France
| | - Sandrine Charpentier
- Emergency Department, Rangueil University Hospital, Toulouse, France
- INSERM, U1027, Toulouse, France
- Université Toulouse III – Paul Sabatier, Toulouse, France
| | - Meyer Elbaz
- Department of Cardiology, Rangueil Hospital, Toulouse, France
| | - Dominique Savary
- Emergency Department and Intensive Care Unit, Annecy-Genevois, Metz-Tessy, France
| | | | - Said Laribi
- Department of Cardiology, Lariboisière Hospital, Paris, France
- INSERM UMR-S 942, Université Paris-Diderot, Sorbonne Paris Cité, Paris, France
| | - Patrick Henry
- INSERM UMR-S 942, Université Paris-Diderot, Sorbonne Paris Cité, Paris, France
- Emergency Medicine Department, University Hospital of Tours, Paris, France
| | - Nicolas Girerd
- INSERM, Centre d’Investigations Cliniques 9501, Université de Lorraine, CHU de Nancy, Institut Lorrain du Cœur et des Vaisseaux, Nancy, France
- INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN network, Nancy, France
| | - Faiez Zannad
- INSERM, Centre d’Investigations Cliniques 9501, Université de Lorraine, CHU de Nancy, Institut Lorrain du Cœur et des Vaisseaux, Nancy, France
- INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN network, Nancy, France
| | - Carlos El Khoury
- Emergency Department and RESCUe Network, Lucien Hussel Hospital, Vienne, France
- Univ. Lyon, Claude Bernard Lyon 1 University, HESPER EA 7425, Lyon, France
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Goliasch G, Pavo N, Zotter-Tufaro C, Kammerlander A, Duca F, Mascherbauer J, Bonderman D. Soluble neprilysin does not correlate with outcome in heart failure with preserved ejection fraction. Eur J Heart Fail 2016; 18:89-93. [DOI: 10.1002/ejhf.435] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 09/26/2015] [Accepted: 09/27/2015] [Indexed: 01/08/2023] Open
Affiliation(s)
- Georg Goliasch
- Department of Internal Medicine II; Medical University of Vienna; Austria
| | - Noemi Pavo
- Department of Internal Medicine II; Medical University of Vienna; Austria
| | | | | | - Franz Duca
- Department of Internal Medicine II; Medical University of Vienna; Austria
| | - Julia Mascherbauer
- Department of Internal Medicine II; Medical University of Vienna; Austria
| | - Diana Bonderman
- Department of Internal Medicine II; Medical University of Vienna; Austria
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