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Lenz M, Krychtiuk KA, Brekalo M, Draxler DF, Pavo N, Hengstenberg C, Huber K, Hülsmann M, Heinz G, Wojta J, Speidl WS. Soluble neprilysin and survival in critically ill patients. ESC Heart Fail 2022; 9:1160-1166. [PMID: 35040286 PMCID: PMC8934932 DOI: 10.1002/ehf2.13787] [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: 06/22/2021] [Revised: 11/08/2021] [Accepted: 12/13/2021] [Indexed: 11/30/2022] Open
Abstract
Background Critically ill patients admitted to an intensive care unit (ICU) exhibit a high mortality rate irrespective of the initial cause of hospitalization. Neprilysin, a neutral endopeptidase degrading an array of vasoactive peptides became a drug target within the treatment of heart failure with reduced ejection fraction. The aim of this study was to analyse whether circulating levels of neprilysin at ICU admission are associated with 30 day mortality. Methods and results In this single‐centre prospective observational study, 222 consecutive patients admitted to a tertiary ICU at a university hospital were included. Blood was drawn at admission and soluble neprilysin levels were measured using ELISA. In the total cohort, soluble neprilysin levels did not differ according to survival status after 30 days as well as type of admission. However, in patients after surgery or heart valve intervention, 30 day survivors exhibited significantly lower circulating neprilysin levels as compared to those who died within 30 days (660.2, IQR: 156.4–2512.5 pg/mL vs. 6532.6, IQR: 1840.1–10 000.0 pg/mL; P = 0.02). Soluble neprilysin predicted mortality independently from age, gender, and commonly used scores of risk‐prediction (EuroSCORE II, STS‐score, and SAPS II score). Additionally, soluble neprilysin was markedly elevated in patients with sepsis and septic shock (P < 0.05). Conclusion At the time of ICU admission, circulating levels of neprilysin independently predicted 30 day mortality in patients following cardiac surgery or heart valve intervention, but not in critically ill medical patients. Furthermore, patients suffering from sepsis and septic shock displayed significantly increased circulating neprilysin levels.
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Affiliation(s)
- Max Lenz
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Spitalgasse 23, Vienna, 1090, Austria.,Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria
| | - Konstantin A Krychtiuk
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Spitalgasse 23, Vienna, 1090, Austria.,Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria
| | - Mira Brekalo
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Spitalgasse 23, Vienna, 1090, Austria
| | - Dominik F Draxler
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Spitalgasse 23, Vienna, 1090, Austria
| | - Noemi Pavo
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Spitalgasse 23, Vienna, 1090, Austria
| | - Christian Hengstenberg
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Spitalgasse 23, Vienna, 1090, Austria
| | - Kurt Huber
- Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria.,3rd Medical Department, Wilhelminenhospital, Vienna, Austria
| | - Martin Hülsmann
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Spitalgasse 23, Vienna, 1090, Austria
| | - Gottfried Heinz
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Spitalgasse 23, Vienna, 1090, Austria
| | - Johann Wojta
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Spitalgasse 23, Vienna, 1090, Austria.,Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria.,Core Facilities, Medical University of Vienna, Vienna, Austria
| | - Walter S Speidl
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Spitalgasse 23, Vienna, 1090, Austria
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Prausmüller S, Spinka G, Arfsten H, Stasek S, Rettl R, Bartko PE, Goliasch G, Strunk G, Riebandt J, Mascherbauer J, Bonderman D, Hengstenberg C, Hülsmann M, Pavo N. Relevance of Neutrophil Neprilysin in Heart Failure. Cells 2021; 10:2922. [PMID: 34831146 PMCID: PMC8616455 DOI: 10.3390/cells10112922] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/24/2021] [Accepted: 10/25/2021] [Indexed: 02/06/2023] Open
Abstract
Significant expression of neprilysin (NEP) is found on neutrophils, which present the transmembrane integer form of the enzyme. This study aimed to investigate the relationship of neutrophil transmembrane neprilysin (mNEP) with disease severity, adverse remodeling, and outcome in HFrEF. In total, 228 HFrEF, 30 HFpEF patients, and 43 controls were enrolled. Neutrophil mNEP was measured by flow-cytometry. NEP activity in plasma and blood cells was determined for a subset of HFrEF patients using mass-spectrometry. Heart failure (HF) was characterized by reduced neutrophil mNEP compared to controls (p < 0.01). NEP activity on peripheral blood cells was almost 4-fold higher compared to plasma NEP activity (p = 0.031) and correlated with neutrophil mNEP (p = 0.006). Lower neutrophil mNEP was associated with increasing disease severity and markers of adverse remodeling. Higher neutrophil mNEP was associated with reduced risk for mortality, total cardiovascular hospitalizations, and the composite endpoint of both (p < 0.01 for all). This is the first report describing a significant role of neutrophil mNEP in HFrEF. The biological relevance of neutrophil mNEP and exact effects of angiotensin-converting-enzyme inhibitors (ARNi) at the neutrophil site have to be determined. However, the results may suggest early initiation of ARNi already in less severe HF disease, where effects of NEP inhibition may be more pronounced.
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Affiliation(s)
- Suriya Prausmüller
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (S.P.); (G.S.); (H.A.); (S.S.); (R.R.); (P.E.B.); (G.G.); (J.M.); (D.B.); (C.H.); (N.P.)
| | - Georg Spinka
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (S.P.); (G.S.); (H.A.); (S.S.); (R.R.); (P.E.B.); (G.G.); (J.M.); (D.B.); (C.H.); (N.P.)
| | - Henrike Arfsten
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (S.P.); (G.S.); (H.A.); (S.S.); (R.R.); (P.E.B.); (G.G.); (J.M.); (D.B.); (C.H.); (N.P.)
| | - Stefanie Stasek
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (S.P.); (G.S.); (H.A.); (S.S.); (R.R.); (P.E.B.); (G.G.); (J.M.); (D.B.); (C.H.); (N.P.)
| | - Rene Rettl
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (S.P.); (G.S.); (H.A.); (S.S.); (R.R.); (P.E.B.); (G.G.); (J.M.); (D.B.); (C.H.); (N.P.)
| | - Philipp Emanuel Bartko
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (S.P.); (G.S.); (H.A.); (S.S.); (R.R.); (P.E.B.); (G.G.); (J.M.); (D.B.); (C.H.); (N.P.)
| | - Georg Goliasch
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (S.P.); (G.S.); (H.A.); (S.S.); (R.R.); (P.E.B.); (G.G.); (J.M.); (D.B.); (C.H.); (N.P.)
| | - Guido Strunk
- Department of Entrepreneurship and Economic Education, Faculty of Business and Economics, Technical University Dortmund, 44227 Dortmund, Germany;
| | - Julia Riebandt
- Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, 1090 Vienna, Austria;
| | - Julia Mascherbauer
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (S.P.); (G.S.); (H.A.); (S.S.); (R.R.); (P.E.B.); (G.G.); (J.M.); (D.B.); (C.H.); (N.P.)
- Department of Internal Medicine III, Division of Cardiology, Karl Landsteiner University of Health Sciences, University Hospital St. Pölten, 3500 Krems, Austria
| | - Diana Bonderman
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (S.P.); (G.S.); (H.A.); (S.S.); (R.R.); (P.E.B.); (G.G.); (J.M.); (D.B.); (C.H.); (N.P.)
- Department of Internal Medicine V, Division of Cardiology, Clinic Favoriten, 1100 Vienna, Austria
| | - Christian Hengstenberg
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (S.P.); (G.S.); (H.A.); (S.S.); (R.R.); (P.E.B.); (G.G.); (J.M.); (D.B.); (C.H.); (N.P.)
| | - Martin Hülsmann
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (S.P.); (G.S.); (H.A.); (S.S.); (R.R.); (P.E.B.); (G.G.); (J.M.); (D.B.); (C.H.); (N.P.)
| | - Noemi Pavo
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (S.P.); (G.S.); (H.A.); (S.S.); (R.R.); (P.E.B.); (G.G.); (J.M.); (D.B.); (C.H.); (N.P.)
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Cordero A, Martínez Rey-Rañal E, Moreno MJ, Escribano D, Moreno-Arribas J, Quintanilla MA, Zuazola P, Núñez J, Bertomeu-González V. Predictive Value of Pro-BNP for Heart Failure Readmission after an Acute Coronary Syndrome. J Clin Med 2021; 10:1653. [PMID: 33924437 PMCID: PMC8069470 DOI: 10.3390/jcm10081653] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/30/2021] [Accepted: 04/06/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND N-terminal pro-brain natural peptide (NT-pro-BNP) is a well-established biomarker of tissue congestion and has prognostic value in patients with heart failure (HF). Nonetheless, there is scarce evidence on its predictive capacity for HF re-admission after an acute coronary syndrome (ACS). We performed a prospective, single-center study in all patients discharged after an ACS. HF re-admission was analyzed by competing risk regression, taking all-cause mortality as a competing event. Results are presented as sub-hazard ratios (sHR). Recurrent hospitalizations were tested by negative binomial regression, and results are presented as incidence risk ratio (IRR). RESULTS Of the 2133 included patients, 528 (24.8%) had HF during the ACS hospitalization, and their pro-BNP levels were higher (3220 pg/mL vs. 684.2 pg/mL; p < 0.001). In-hospital mortality was 2.9%, and pro-BNP was similarly higher in these patients. Increased pro-BNP levels were correlated to increased risk of HF or death during the hospitalization. Over follow-up (median 38 months) 243 (11.7%) patients had at least one hospital readmission for HF and 151 (7.1%) had more than one. Complete revascularization had a preventive effect on HF readmission, whereas several other variables were associated with higher risk. Pro-BNP was independently associated with HF admission (sHR: 1.47) and readmission (IRR: 1.45) at any age. Significant interactions were found for the predictive value of pro-BNP in women, diabetes, renal dysfunction, STEMI and patients without troponin elevation. CONCLUSIONS In-hospital determination of pro-BNP is an independent predictor of HF readmission after an ACS.
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Affiliation(s)
- Alberto Cordero
- Cardiology Department, Hospital Universitario de San Juan, 03550 Alicante, Spain; (E.M.R.-R.); (M.J.M.); (D.E.); (J.M.-A.); (M.A.Q.); (P.Z.); (V.B.-G.)
- Unidad de Investigación en Cardiología, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), 46020 Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV CB16/11/00226-CB16/11/00420), 28028 Madrid, Spain;
| | - Elías Martínez Rey-Rañal
- Cardiology Department, Hospital Universitario de San Juan, 03550 Alicante, Spain; (E.M.R.-R.); (M.J.M.); (D.E.); (J.M.-A.); (M.A.Q.); (P.Z.); (V.B.-G.)
| | - María J. Moreno
- Cardiology Department, Hospital Universitario de San Juan, 03550 Alicante, Spain; (E.M.R.-R.); (M.J.M.); (D.E.); (J.M.-A.); (M.A.Q.); (P.Z.); (V.B.-G.)
| | - David Escribano
- Cardiology Department, Hospital Universitario de San Juan, 03550 Alicante, Spain; (E.M.R.-R.); (M.J.M.); (D.E.); (J.M.-A.); (M.A.Q.); (P.Z.); (V.B.-G.)
- Unidad de Investigación en Cardiología, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), 46020 Valencia, Spain
| | - José Moreno-Arribas
- Cardiology Department, Hospital Universitario de San Juan, 03550 Alicante, Spain; (E.M.R.-R.); (M.J.M.); (D.E.); (J.M.-A.); (M.A.Q.); (P.Z.); (V.B.-G.)
- Unidad de Investigación en Cardiología, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), 46020 Valencia, Spain
| | - Maria A. Quintanilla
- Cardiology Department, Hospital Universitario de San Juan, 03550 Alicante, Spain; (E.M.R.-R.); (M.J.M.); (D.E.); (J.M.-A.); (M.A.Q.); (P.Z.); (V.B.-G.)
| | - Pilar Zuazola
- Cardiology Department, Hospital Universitario de San Juan, 03550 Alicante, Spain; (E.M.R.-R.); (M.J.M.); (D.E.); (J.M.-A.); (M.A.Q.); (P.Z.); (V.B.-G.)
| | - Julio Núñez
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV CB16/11/00226-CB16/11/00420), 28028 Madrid, Spain;
- Cardiology Department, Hospital Clínico Universitario, 46010 Valencia, Spain
- Instituto de Investigación Sanitaria (INCLIVA), Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain
| | - Vicente Bertomeu-González
- Cardiology Department, Hospital Universitario de San Juan, 03550 Alicante, Spain; (E.M.R.-R.); (M.J.M.); (D.E.); (J.M.-A.); (M.A.Q.); (P.Z.); (V.B.-G.)
- Unidad de Investigación en Cardiología, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), 46020 Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV CB16/11/00226-CB16/11/00420), 28028 Madrid, Spain;
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4
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Lau K, Malik A, Foroutan F, Buchan TA, Daza JF, Sekercioglu N, Orchanian-Cheff A, Alba AC. Resting Heart Rate as an Important Predictor of Mortality and Morbidity in Ambulatory Patients With Heart Failure: A Systematic Review and Meta-Analysis. J Card Fail 2020; 27:349-363. [PMID: 33171294 DOI: 10.1016/j.cardfail.2020.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 10/30/2020] [Accepted: 11/04/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Resting heart rate is a risk factor of adverse heart failure outcomes; however, studies have shown controversial results. This meta-analysis evaluates the association of resting heart rate with mortality and hospitalization and identifies factors influencing its effect. METHODS AND RESULTS We systematically searched electronic databases in February 2019 for studies published in 2005 or before that evaluated the resting heart rate as a primary predictor or covariate of multivariable models of mortality and/or hospitalization in adult ambulatory patients with heart failure. Random effects inverse variance meta-analyses were performed to calculate pooled hazard ratios. The Grading of Recommendations, Assessment, Development and Evaluation approach was used to assess evidence quality. Sixty-two studies on 163,445 patients proved eligible. Median population heart rate was 74 bpm (interquartile range 72-76 bpm). A 10-bpm increase was significantly associated with increased risk of all-cause mortality (hazard ratio 1.10, 95% confidence interval 1.08-1.13, high quality). Overall, subgroup analyses related to patient characteristics showed no changes to the effect estimate; however, there was a strongly positive interaction with age showing increasing risk of all-cause mortality per 10 bpm increase in heart rate. CONCLUSIONS High-quality evidence demonstrates increasing resting heart rate is a significant predictor of all-cause mortality in ambulatory patients with heart failure on optimal medical therapy, with consistent effect across most patient factors and an increased risk trending with older age.
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Affiliation(s)
- Kimberley Lau
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Abdullah Malik
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Farid Foroutan
- McMaster University, Hamilton, Ontario, Canada; Ted Rogers Centre for Heart Research, University Health Network, Toronto, Ontario, Canada
| | - Tayler A Buchan
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, Ontario, Canada
| | | | | | - Ani Orchanian-Cheff
- Library and Information Services, University Health Network, Toronto, Ontario, Canada
| | - Ana C Alba
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, Ontario, Canada.
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Abstract
PURPOSE OF REVIEW Describe the mechanisms that may influence change in measured natriuretic peptide levels when using the neprilysin inhibitor sacubitril to treat a patient with heart failure. RECENT FINDINGS Prior to the introduction of the neprilysin inhibitor sacubitril as part of a chemical combination with the angiotensin receptor blocker valsartan shown to reduce mortality and heart failure hospitalizations in patients with heart failure with reduced ejection fraction, the natriuretic peptide assays for B-type natriuretic peptide (BNP) and the amino-terminal proBNP (NT-proBNP) assays were shown to have similar diagnostic accuracy to differentiate heart failure from other etiologies of shortness of breath. Sacubitril/valsartan use has been shown to result in a modest and chronic elevation of BNP while reducing levels of NT-prBNP. This review explores the potential impact of these findings on interpreting natriuretic peptide results for diagnosis and prognosis, as well as explore the challenges associated with the heterogeneity of this finding, highlighting the impact of inhibiting neprilysin, a non-specific endopeptidase with multiple target sites within BNP and other proteins. With increased uptake of sacubitril/valsartan expected in patients with heart failure, interpretation of natriuretic peptide assays becomes somewhat more complex, particularly for BNP. However, knowing a baseline steady-state concentration and using the same assay can assist with BNP interpretation for diagnosis and prognosis.
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6
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Prausmüller S, Arfsten H, Spinka G, Freitag C, Bartko PE, Goliasch G, Strunk G, Pavo N, Hülsmann M. Plasma Neprilysin Displays No Relevant Association With Neurohumoral Activation in Chronic HFrEF. J Am Heart Assoc 2020; 9:e015071. [PMID: 32427034 PMCID: PMC7428996 DOI: 10.1161/jaha.119.015071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Neprilysin is a transmembrane endopeptidase involved in the breakdown of a variety of vasoactive peptides and serves as a therapeutic target in heart failure with reduced ejection fraction (HFrEF). This study aimed to investigate the relationship of circulating neprilysin with neurohumoral activation and the impact of plasma neprilysin activity on prognosis in HFrEF. Methods and Results A total of 369 chronic HFrEF patients were enrolled prospectively. Plasma neprilysin concentration and activity were determined by a specific ELISA and a fluorometric method. The association between plasma neprilysin and heart failure (HF) severity, neurohumoral activation, ie norepinephrine and absolute renin concentration, as well as all‐cause mortality was assessed. Median plasma neprilysin concentrations and activity levels were 413 pg/mL (interquartile range 0–4111) and 2.36 nmol/mL per minute (interquartile range 1.16–4.59). No correlation could be shown between plasma neprilysin concentrations and activity (rs=0.09, P=0.088). Plasma neprilysin activity correlated with HF severity reflected by New York Heart Association stage (P=0.003) and tertiles of N‐terminal pro‐B‐type natriuretic peptide (P<0.001), whereas neprilysin concentrations did not (P=0.220; P=0.849). There was no relevant relationship between plasma neprilysin concentrations and activity, with neurohumoral activation reflected by absolute renin concentration (rs=−0.02, P=0.648; rs=0.03, P=0.574) or norepinephrine levels (rs=−0.06, P=0.248; rs=0.20, P<0.001). Neither circulating neprilysin concentrations nor activity were associated with outcome. Conclusions Plasma neprilysin concentrations and activity are not directly related to neurohumoral activation, indicating that neprilysin regulation is either more complex or not correctly mirrored by circulating neprilysin as a biomarker. Circulating neprilysin concentrations and activity were not associated with overall survival, implicating limited prognostic value of plasma neprilysin measurements in HFrEF patients.
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Affiliation(s)
- Suriya Prausmüller
- Department of Internal Medicine II Division of Cardiology Medical University of Vienna Vienna Austria
| | - Henrike Arfsten
- Department of Internal Medicine II Division of Cardiology Medical University of Vienna Vienna Austria
| | - Georg Spinka
- Department of Internal Medicine II Division of Cardiology Medical University of Vienna Vienna Austria
| | - Claudia Freitag
- Department of Internal Medicine II Division of Cardiology Medical University of Vienna Vienna Austria
| | - Philipp E Bartko
- Department of Internal Medicine II Division of Cardiology Medical University of Vienna Vienna Austria
| | - Georg Goliasch
- Department of Internal Medicine II Division of Cardiology Medical University of Vienna Vienna Austria
| | | | - Noemi Pavo
- Department of Internal Medicine II Division of Cardiology Medical University of Vienna Vienna Austria
| | - Martin Hülsmann
- Department of Internal Medicine II Division of Cardiology Medical University of Vienna Vienna Austria
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7
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Revuelta-López E, Núñez J, Gastelurrutia P, Cediel G, Januzzi JL, Ibrahim NE, Emdin M, VanKimmenade R, Pascual-Figal D, Núñez E, Gommans F, Lupón J, Bayés-Genís A. Neprilysin inhibition, endorphin dynamics, and early symptomatic improvement in heart failure: a pilot study. ESC Heart Fail 2020; 7:559-566. [PMID: 32045114 PMCID: PMC7160502 DOI: 10.1002/ehf2.12607] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 11/26/2019] [Accepted: 12/09/2019] [Indexed: 12/11/2022] Open
Abstract
Aim Sacubitril/valsartan is a first‐in‐class angiotensin receptor‐neprilysin inhibitor developed for the treatment of heart failure with reduced ejection fraction. Its benefits are achieved through the inhibition of neprilysin (NEP) and the specific blockade of the angiotensin receptor AT1. The many peptides metabolized by NEP suggest multifaceted potential consequences of its inhibition. We sought to evaluate the short‐term changes in serum endorphin (EP) values and their relation with patients' physical functioning after initiation of sacubitril/valsartan treatment. Methods and results A total of 105 patients with heart failure with reduced ejection fraction, who were candidates for sacubitril/valsartan treatment, were included in this prospective, observational, multicentre, and international study. In a first visit, and in agreement with current guidelines, treatment with angiotensin‐converting enzyme inhibitors or angiotensin receptor blocker was replaced by sacubitril/valsartan because of clinical indication by the responsible physician. By protocol, patients were reevaluated at 30 days after the start of sacubitril/valsartan. Serum levels of α‐ (α‐EP), γ‐Endorphin (γ‐EP), and soluble NEP (sNEP) were measured using enzyme‐linked immunoassays. New York Heart Association (NYHA) functional class was used as an indicator of patient's functional status. Baseline median levels of circulating α‐EP, γ‐EP, and sNEP were 582 (160–772), 101 (37–287), and 222 pg/mL (124–820), respectively. There was not a significant increase in α‐EP nor γ‐EP serum values after sacubitril/valsartan treatment (P value = 0.194 and 0.102, respectively). There were no significant differences in sNEP values between 30 days and baseline (P value = 0.103). Medians (IQR) of Δα‐EP, Δγ‐EP, and ΔsNEP between 30 days and baseline were 9.3 (−34 − 44), −3.0 (−46.0 − 18.9), and 0 units (−16.4 − 157.0), respectively. In a pre–post sacubitril/valsartan treatment comparison, there was a significant improvement in NYHA class, with 36 (34.3%) patients experiencing improvement by at least one NYHA class category. Δα‐EP and ΔsNEP showed to be significantly associated with NYHA class after 30 days of treatment (P = 0.014 and P < 0.001, respectively). Δα‐EP was linear and significantly associated with NYHA class improvement after 30 days of sacubitril/valsartan treatment. Conclusions These preliminary data suggest that beyond the haemodynamic benefits achieved with sacubitril/valsartan, the altered cleavage of endorphin peptides by NEP inhibition may participate in patients' symptoms improvement.
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Affiliation(s)
- Elena Revuelta-López
- Heart Failure and Cardiac Regeneration (ICREC) Research Program, Health Science Research Institute Germans Trias i Pujol (IGTP), Badalona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, (CIBERCV,), Madrid, Spain
| | - Julio Núñez
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, (CIBERCV,), Madrid, Spain.,Cardiology Department, Hospital Clínico Universitario, Universitat de València, INCLIVA, Valencia, Spain; INCLIVA; Universitat de València, Valencia, Spain
| | - Paloma Gastelurrutia
- Heart Failure and Cardiac Regeneration (ICREC) Research Program, Health Science Research Institute Germans Trias i Pujol (IGTP), Badalona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, (CIBERCV,), Madrid, Spain
| | - Germán Cediel
- Cardiology Service and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - James L Januzzi
- Division of Cardiology, Massachusetts General Hospital and Cardiometabolic Trials, Baim Institute for Clinical Research, Boston, Massachusetts, MA, USA
| | - Nasrien E Ibrahim
- Division of Cardiology, Massachusetts General Hospital and Cardiometabolic Trials, Baim Institute for Clinical Research, Boston, Massachusetts, MA, USA
| | - Michele Emdin
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Fondazione Toscana Gabriele Monasterio, Pisa, Italy; Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Roland VanKimmenade
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Domingo Pascual-Figal
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, (CIBERCV,), Madrid, Spain.,Cardiology Department, Hospital Virgen de la Arrixaca, Universidad de Murcia, Murcia, Spain
| | - Eduardo Núñez
- Cardiology Department, Hospital Clínico Universitario, Universitat de València, INCLIVA, Valencia, Spain; INCLIVA; Universitat de València, Valencia, Spain
| | - Frank Gommans
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Josep Lupón
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, (CIBERCV,), Madrid, Spain.,Cardiology Service and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Antoni Bayés-Genís
- Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares, (CIBERCV,), Madrid, Spain.,Cardiology Service and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
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8
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Alawi LF, Emberesh SE, Owuor BA, Chodavarapu H, Fadnavis R, El‐Amouri SS, Elased KM. Effect of hyperglycemia and rosiglitazone on renal and urinary neprilysin in db/db diabetic mice. Physiol Rep 2020; 8:e14364. [PMID: 32026607 PMCID: PMC7002536 DOI: 10.14814/phy2.14364] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 01/08/2020] [Accepted: 01/10/2020] [Indexed: 12/11/2022] Open
Abstract
Alteration in renin-angiotensin system (RAS) has been implicated in the pathophysiology of diabetic kidney disease (DKD). The deleterious actions of angiotensin II (Ang II) could be antagonized by the formation of Ang-(1-7), generated by the actions of angiotensin-converting enzyme 2 (ACE2) and neprilysin (NEP). NEP degrades several peptides, including natriuretic peptides, bradykinin, amyloid beta, and Ang I. Although combination of Ang II receptor and NEP inhibitor treatment benefits patients with heart failure, the role of NEP in renal pathophysiology is a matter of active research. NEP pathway is a potent enzyme in Ang I to Ang-(1-7) conversion in the kidney of ACE2-deficient mice, suggesting a renoprotective role of NEP. The aim of the study is to test the hypothesis that chronic hyperglycemia downregulates renal NEP protein expression and activity in db/db diabetic mice and treatment with rosiglitazone normalizes hyperglycemia, renal NEP expression, and attenuates albuminuria. Mice received rosiglitazone (20 mg kg-1 day-1 ) for 10 weeks. Western blot analysis, immunohistochemistry, and enzyme activity revealed a significant decrease in renal and urinary NEP expression and activity in 16-wk db/db mice compared with lean control (p < .0001). Rosiglitazone also attenuated albuminuria and increased renal and urinary NEP expressions (p < .0001). In conclusion, data support the hypothesis that diabetes decreases intrarenal NEP, which could have a pivotal role in the pathogenesis of DKD. Urinary NEP may be used as an index of intrarenal NEP status. The renoprotective effects of rosiglitazone could be mediated by upregulation of renal NEP expression and activity in db/db diabetic mice.
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Affiliation(s)
- Laale F. Alawi
- Department of Pharmacology and ToxicologyBoonshoft School of MedicineWright State UniversityDaytonOHUSA
| | - Sana E. Emberesh
- Department of Pharmacology and ToxicologyBoonshoft School of MedicineWright State UniversityDaytonOHUSA
| | - Brenda A. Owuor
- Department of Pharmacology and ToxicologyBoonshoft School of MedicineWright State UniversityDaytonOHUSA
| | - Harshita Chodavarapu
- Department of Pharmacology and ToxicologyBoonshoft School of MedicineWright State UniversityDaytonOHUSA
| | - Rucha Fadnavis
- Department of Pharmacology and ToxicologyBoonshoft School of MedicineWright State UniversityDaytonOHUSA
| | - Salim S. El‐Amouri
- Boonshoft School of MedicineDepartment of NeuroscienceCell Biology and PhysiologyWright State UniversityDaytonOHUSA
| | - Khalid M. Elased
- Department of Pharmacology and ToxicologyBoonshoft School of MedicineWright State UniversityDaytonOHUSA
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9
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Ramanathan K, Padmanabhan G. Soluble neprilysin: A versatile biomarker for heart failure, cardiovascular diseases and diabetic complications-A systematic review. Indian Heart J 2020; 72:14-19. [PMID: 32423555 PMCID: PMC7231860 DOI: 10.1016/j.ihj.2020.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 12/09/2019] [Accepted: 01/27/2020] [Indexed: 12/11/2022] Open
Abstract
The potential role of soluble neprilysin (sNEP) as a biomarker has been poorly documented. Hence, the present systematic review emphasizes to explore sNEP as an emerging biomarker for heart failure (HF), cardiovascular diseases, diabetic kidney diseases, and so on. A systematic review was performed using an online database search in PubMed, Science Direct, Scopus, and Cochrane Library. Articles reporting biomarker's performance to diagnose various diseases in human participants were included. The results of the search outcome were 4723 articles. Based on the inclusion criteria of the systematic review, finally, 12 articles fulfilled the selection criteria. In these studies, 8 cohort study, 2 cross-sectional study, 1 case-control, and 1 prospective cohort study were identified. All these studies clearly suggested sNEP as a potential biomarker for diagnosis of various diseases (HF, cardiovascular diseases, diabetic kidney diseases, metabolic syndrome). sNEP may be a potential biomarker for HF, cardiovascular diseases, diabetic kidney disease, and so on.
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Affiliation(s)
- Kumaresan Ramanathan
- Department of Medical Biochemistry, Division of Biomedical Sciences, School of Medicine, College of Health Sciences, Mekelle University (Ayder Campus), Mekelle, Ethiopia.
| | - Giri Padmanabhan
- Kidney Care, C50,10th B Cross, Thillai Nagar, Tiruchirappalli, India.
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10
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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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11
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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: 3] [Impact Index Per Article: 0.6] [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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12
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Yoshihisa A, Yokokawa T, Misaka T, Oikawa M, Kobayashi A, Yamaki T, Sugimoto K, Kunii H, Nakazato K, Takeishi Y. Soluble neprilysin does not correlate with prognosis in pulmonary hypertension. ESC Heart Fail 2019; 6:291-296. [PMID: 30681298 PMCID: PMC6437424 DOI: 10.1002/ehf2.12404] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 12/12/2018] [Indexed: 12/11/2022] Open
Abstract
AIMS It has been reported that circulating soluble neprilysin (sNEP), which catalyses the degradation of several vasodilator peptides such as natriuretic peptides, predicts prognosis in heart failure patients with reduced ejection fraction. Hypoxia-induced decrease in NEP expression in lungs has been reported. However, the associations between sNEP and haemodynamic parameters, as well as the prognostic impact of sNEP in pulmonary hypertension (PH), remain unclear. We aimed to clarify the relationships between sNEP and natriuretic peptide, haemodynamics (e.g. parameters of echocardiography and right heart catheter) or prognosis in PH patients. METHODS AND RESULTS First, we examined the associations between sNEP levels and natriuretic peptide, echocardiography, or right heart catheter in PH patients (mean pulmonary artery pressure ≥ 25 mmHg and pulmonary artery wedge pressure ≤ 15 mm Hg on the basis of right heart catheterization, n = 79). Next, we followed up the patients for all-cause mortality. Laboratory data revealed no significant correlations between sNEP and B-type natriuretic peptide (R = 0.022, P = 0.872), N-terminal proBNP (R = -0.018, P = 0.872), and high-sensitivity troponin I (R = 0.206, P = 0.107). Regarding the parameters of echocardiography and right heart catheter, there were no significant correlations between sNEP and left ventricular ejection fraction (R = -0.036, P = 0.764), right ventricular fractional area change (R = -0.259, P = 0.064), tricuspid valve pressure gradient (R = -0.037, P = 0.767), and any of the right heart catheter parameters. In the Kaplan-Meier analysis (mean follow-up, 1284 days, log-rank P = 0.531), all-cause mortality rates were comparable between the higher NEP group (sNEP ≥ median levels of 1.45 ng/mL, n = 39) and the lower NEP group (sNEP < 1.45 ng/mL, n = 40). In the Cox proportional hazard analysis, sNEP was not a predictor of all-cause mortality (hazard ratio 0.902, 95% CI 0.674-1.207, P = 0.487) in PH patients. CONCLUSIONS Circulating sNEP does not correlate with natriuretic peptide, haemodynamic parameters, or prognosis in patients with PH.
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Affiliation(s)
- Akiomi Yoshihisa
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan.,Department of Advanced Cardiac Therapeutics, Fukushima Medical University, Fukushima, Japan
| | - Tetsuro Yokokawa
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan.,Department of Pulmonary Hypertension, Fukushima Medical University, Fukushima, Japan
| | - Tomofumi Misaka
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan.,Department of Advanced Cardiac Therapeutics, Fukushima Medical University, Fukushima, Japan
| | - Masayoshi Oikawa
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Atsushi Kobayashi
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Takayoshi Yamaki
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Koichi Sugimoto
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan.,Department of Pulmonary Hypertension, Fukushima Medical University, Fukushima, Japan
| | - Hiroyuki Kunii
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Kazuhiko Nakazato
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
| | - Yasuchika Takeishi
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
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13
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Abstract
Obtaining routine preoperative laboratory tests increases health care costs and has been listed, by the Choosing Wisely Campaign, as one of the top 5 practices anesthesiologists should avoid. Routine testing without clinical indication is not cost-effective and could cause harm and unnecessary delays. Abnormal findings are more likely to be false positive and costly to pursue, introduce new risks, and increase anxiety for the patient. Preoperative testing need to be performed only following a targeted history and physical examination, factoring severity of surgery, and comorbidities such that the benefit of the test outweighs risk.
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Affiliation(s)
- Angela F Edwards
- Department of Anesthesiology, Wake Forest University School of Medicine, Medical Center Boulevard, 9 CSB Janeway Tower, Winston-Salem, NC 27157, USA.
| | - Daniel J Forest
- Preoperative Assessment Clinic, Department of Anesthesiology, Wake Forest University School of Medicine, Medical Center Boulevard, 9 CSB Janeway Tower, Winston-Salem, NC 27157, USA
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14
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Moliner P, Lupón J, Barallat J, de Antonio M, Domingo M, Núñez J, Zamora E, Galán A, Santesmases J, Pastor C, Bayes-Genis A. Bio-profiling and bio-prognostication of chronic heart failure with mid-range ejection fraction. Int J Cardiol 2018; 257:188-192. [DOI: 10.1016/j.ijcard.2018.01.119] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 01/24/2018] [Accepted: 01/26/2018] [Indexed: 11/24/2022]
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15
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Núñez J, Núñez E, Barallat J, Bodí V, Miñana G, Pastor MC, Sanchis J, Lupón J, Bayes-Genis A. Serum Neprilysin and Recurrent Admissions in Patients With Heart Failure. J Am Heart Assoc 2017; 6:e005712. [PMID: 28862951 PMCID: PMC5586428 DOI: 10.1161/jaha.117.005712] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 07/06/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Our aim was to evaluate the association between the soluble form of neprilysin (sNEP) levels and long-term all-cause, cardiovascular, and acute heart failure (AHF) recurrent admissions in an ambulatory cohort of patients with heart failure. sNEP has emerged as a new biomarker with promising implications for prognosis and therapy in patients with heart failure. Reducing the recurrent admission rate of heart failure patients has become an important target of public health planning strategies. METHODS AND RESULTS We measured sNEP levels in 1021 consecutive ambulatory heart failure patients. End points were the number of all-cause, cardiovascular, and AHF hospitalizations during follow-up. We used covariate-adjusted incidence rate ratios to identify associations. At a median follow-up of 3.4 years (interquartile range: 1.8-5.7), 391 (38.3%) patients died, 477 (46.7%) patients had 1901 all-cause admissions, 324 (31.7%) patients had 770 cardiovascular admissions, and 218 (21.4%) patients had 488 AHF admissions. The medians for sNEP and amino-terminal pro-brain natriuretic peptide were 0.64 ng/mL (interquartile range: 0.39-1.22) and 1248 pg/mL (interquartile range: 538-2825), respectively. In a multivariate setting, the adjusted incidence rate ratios for the top (>1.22 ng/mL) versus the bottom (≤0.39 ng/mL) quartiles of sNEP were 1.37 (95% confidence interval: 1.03-1.82), P=0.032; 1.51 (95% confidence interval: 1.10-2.06), P=0.010; and 1.51 (95% confidence interval: 1.05-2.16), P=0.026 for all-cause, cardiovascular, and AHF admissions, respectively. CONCLUSIONS Elevated sNEP levels predicted an increased risk of recurrent all-cause, cardiovascular, and AHF admissions in ambulatory patients with heart failure.
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Affiliation(s)
- Julio Núñez
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Valencia, Spain
- Departamento de Medicina, Universitat de València, Spain
- CIBER Cardiovascular, Madrid, Spain
| | - Eduardo Núñez
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Valencia, Spain
- Departamento de Medicina, Universitat de València, Spain
| | - Jaume Barallat
- Biochemistry Service, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Vicent Bodí
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Valencia, Spain
- Departamento de Medicina, Universitat de València, Spain
| | - Gema Miñana
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Valencia, Spain
- Departamento de Medicina, Universitat de València, Spain
- CIBER Cardiovascular, Madrid, Spain
| | - M Cruz Pastor
- Biochemistry Service, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Juan Sanchis
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Valencia, Spain
- Departamento de Medicina, Universitat de València, Spain
- CIBER Cardiovascular, Madrid, Spain
| | - Josep Lupón
- CIBER Cardiovascular, Madrid, Spain
- Cardiology Department and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Department of Medicine, Autonomous University of Barcelona, Spain
| | - Antoni Bayes-Genis
- CIBER Cardiovascular, Madrid, Spain
- Cardiology Department and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Department of Medicine, Autonomous University of Barcelona, Spain
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16
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Álvarez-García J, Salamanca-Bautista P, Ferrero-Gregori A, Montero-Pérez-Barquero M, Puig T, Aramburu-Bodas Ó, Vázquez R, Formiga F, Delgado J, Arias-Jiménez JL, Vives-Borrás M, Cerqueiro González JM, Manzano L, Cinca J. Impacto pronóstico de la especialidad en el paciente ambulatorio con insuficiencia cardiaca: un análisis emparejado de los registros REDINSCOR y RICA. Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2016.09.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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17
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Álvarez-García J, Salamanca-Bautista P, Ferrero-Gregori A, Montero-Pérez-Barquero M, Puig T, Aramburu-Bodas Ó, Vázquez R, Formiga F, Delgado J, Arias-Jiménez JL, Vives-Borrás M, Cerqueiro González JM, Manzano L, Cinca J. Prognostic Impact of Physician Specialty on the Prognosis of Outpatients With Heart Failure: Propensity Matched Analysis of the REDINSCOR and RICA Registries. ACTA ACUST UNITED AC 2017; 70:347-354. [PMID: 28189543 DOI: 10.1016/j.rec.2016.12.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 09/19/2016] [Indexed: 12/16/2022]
Abstract
INTRODUCTION AND OBJECTIVES The specialty treating patients with heart failure (HF) has a prognostic impact in the hospital setting but this issue remains under debate in the ambulatory environment. We aimed to compare the clinical profile and outcomes of outpatients with HF treated by cardiologists or internists. METHODS We analyzed the clinical, electrocardiogram, laboratory, and echocardiographic data of 2 prospective multicenter Spanish cohorts of outpatients with HF treated by cardiologists (REDINSCOR, n=2150) or by internists (RICA, n=1396). Propensity score matching analysis was used to test the influence of physician specialty on outcome. RESULTS Cardiologist-treated patients were often men, were younger, and had ischemic etiology and reduced left ventricular ejection fraction (LVEF). Patients followed up by internists were predominantly women, were older, and a higher percentage had preserved LVEF and associated comorbidities. The 9-month mortality was lower in the REDINSCOR cohort (11.6% vs 16.9%; P<.001), but the 9-month HF-readmission rates were similar (15.7% vs 16.9%; P=.349). The propensity matching analysis selected 558 pairs of comparable patients and continued to show significantly lower 9-month mortality in the cardiology cohort (12.0% vs 18.8%; RR, 0.64; 95% confidence interval [95%CI], 0.48-0.85; P=.002), with no relevant differences in the 9-month HF-readmission rate (18.1% vs 17.2%; RR, 0.95; 95%CI, 0.74-1.22; P=.695). CONCLUSIONS Age, sex, LVEF and comorbidities were major determinants of specialty-related referral in HF outpatients. An in-depth propensity matched analysis showed significantly lower 9-month mortality in the cardiologist cohort.
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Affiliation(s)
- Jesús Álvarez-García
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, IIb-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain.
| | | | - Andreu Ferrero-Gregori
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, IIb-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | | | - Teresa Puig
- Servicio de Epidemiología y Salud Pública, Hospital de la Santa Creu i Sant Pau, IIb-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Óscar Aramburu-Bodas
- Servicio de Medicina Interna, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Rafael Vázquez
- Servicio de Cardiología, Hospital Puerta del Mar, Cádiz, Spain
| | - Francesc Formiga
- Servicio de Medicina Interna, IDIBELL, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Juan Delgado
- Servicio de Cardiología, Hospital 12 de Octubre, Madrid, Spain
| | | | - Miquel Vives-Borrás
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, IIb-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | | | - Luis Manzano
- Servicio de Medicina Interna, Hospital Ramón y Cajal, Madrid, Spain
| | - Juan Cinca
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, IIb-SantPau, Universidad Autónoma de Barcelona, Barcelona, Spain
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18
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19
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Núñez J, Núñez E, Miñana G, Carratalá A, Sanchis J, Lupón J, Barallat J, Pastor MC, Pascual-Figal D, Bayés-Genís A. Serum neprilysin and recurrent hospitalizations after acute heart failure. Int J Cardiol 2016; 220:742-4. [PMID: 27393859 DOI: 10.1016/j.ijcard.2016.06.271] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 06/27/2016] [Indexed: 11/18/2022]
Affiliation(s)
- Julio Núñez
- Servicio de Cardiología, Hospital Clínico Universitario, Universitat de Valencia, Valencia, Spain.
| | - Eduardo Núñez
- Servicio de Cardiología, Hospital Clínico Universitario, Universitat de Valencia, Valencia, Spain
| | - Gema Miñana
- Servicio de Cardiología, Hospital Clínico Universitario, Universitat de Valencia, Valencia, Spain
| | - Arturo Carratalá
- Servicio de Bioquímica, Hospital Clínico Universitario, Universitat de Valencia, Valencia, Spain
| | - Juan Sanchis
- Servicio de Cardiología, Hospital Clínico Universitario, Universitat de Valencia, Valencia, Spain
| | - Josep Lupón
- Servicio de Cardiología, Hospital Universitari Germas Trias i Pujol, Badalona, Spain
| | - Jaume Barallat
- Servicio de Bioquímica, Hospital Universitari Germas Trias i Pujol, Badalona, Spain
| | - Maria Cruz Pastor
- Servicio de Bioquímica, Hospital Universitari Germas Trias i Pujol, Badalona, Spain
| | | | - Antoni Bayés-Genís
- Servicio de Cardiología, Hospital Universitari Germas Trias i Pujol, Badalona, Spain
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20
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Bayes-Genis A, Lupón J. Neprilysin: Indications, Expectations, and Challenges. ACTA ACUST UNITED AC 2016; 69:647-9. [PMID: 27264488 DOI: 10.1016/j.rec.2016.04.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 04/11/2016] [Indexed: 02/03/2023]
Affiliation(s)
- Antoni Bayes-Genis
- Servicio de Cardiología y Unidad de Insuficiencia Cardiaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Josep Lupón
- Servicio de Cardiología y Unidad de Insuficiencia Cardiaca, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
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Lupón J, Bayes-Genis A. Neprilysin Plasma Concentrations: A New Prognostic Marker in Heart Failure. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2016; 69:535-536. [PMID: 27049285 DOI: 10.1016/j.rec.2016.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 01/29/2016] [Indexed: 06/05/2023]
Affiliation(s)
- Josep Lupón
- Unitat d'Insuficiència Cardiaca, Servei de Cardiologia, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antoni Bayes-Genis
- Unitat d'Insuficiència Cardiaca, Servei de Cardiologia, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Concentraciones plasmáticas de neprilisina: un nuevo marcador pronóstico en la insuficiencia cardiaca. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2016.01.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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23
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Richards AM. Concentraciones plasmáticas de neprilisina: ¿un nuevo marcador pronóstico en la insuficiencia cardiaca? Rev Esp Cardiol 2015. [DOI: 10.1016/j.recesp.2015.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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24
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Richards AM. Plasma Neprilysin Concentrations: A New Prognostic Marker in Heart Failure? ACTA ACUST UNITED AC 2015; 68:1053-5. [PMID: 26547589 DOI: 10.1016/j.rec.2015.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 09/11/2015] [Indexed: 10/22/2022]
Affiliation(s)
- A Mark Richards
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand, and Cardiovascular Research Institute, National University of Singapore, Singapore.
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