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Deis T, Rossing K, Gustafsson F. Aortic Pulsatility Index: A New Haemodynamic Measure with Prognostic Value in Advanced Heart Failure. Card Fail Rev 2022; 8:e18. [PMID: 35620383 PMCID: PMC9127634 DOI: 10.15420/cfr.2022.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 02/27/2022] [Indexed: 11/04/2022] Open
Abstract
Aim: To test if the newly described haemodynamic variable, aortic pulsatility index (API), predicts long-term prognosis in advanced heart failure (HF). Methods: A single-centre study on 453 HF patients (median age: 51 years; left ventricular ejection fraction [LVEF]: 19% ± 9%) referred for right heart catheterisation. API was calculated as pulse pressure/pulmonary capillary wedge pressure. Results: Log(API) correlated significantly with central venous pressure (CVP; p<0.001) and cardiac index (p<0.001) in univariable regression analysis. CVP remained associated with log(API) in a multivariable analysis including cardiac index, heart rate, log(NT-proBNP [N-terminal proB-type natriuretic peptide]), LVEF, New York Heart Association (NYHA) class III or IV and sex (p=0.01). In univariable Cox models, log(API) was a significant predictor of freedom from the combined endpoint of death, left ventricular assist device implantation, total artificial heart implantation or heart transplantation (HR 0.33; (95% CI [0.22–0.49]); p<0.001) and all-cause mortality (HR 0.56 (95% CI [0.35–0.90]); p=0.015). After adjusting for age, sex, NYHA class III or IV and estimated glomerular filtration rate in multivariable Cox models, log(API) remained a significant predictor for the combined endpoint (HR 0.33; 95% CI [0.20–0.56]; p<0.001) and all-cause mortality (HR 0.49; 95% CI [0.26–0.96]; p=0.034). Conclusion: API was strongly associated with right-sided filling pressure and independently predicted freedom from the combined endpoint and all-cause mortality.
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Affiliation(s)
- Tania Deis
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Kasper Rossing
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
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The Utility of Pentraxin and Modified Prognostic Scales in Predicting Outcomes of Patients with End-Stage Heart Failure. J Clin Med 2022; 11:jcm11092567. [PMID: 35566693 PMCID: PMC9099900 DOI: 10.3390/jcm11092567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 04/23/2022] [Accepted: 04/29/2022] [Indexed: 12/10/2022] Open
Abstract
Risk stratification is an important element of management in patients with heart failure (HF). We aimed to determine factors associated with predicting outcomes in end-stage HF patients listed for heart transplantation (HT), with particular emphasis placed on pentraxin-3 (PXT-3). In addition, we investigated whether the combination of PTX-3 with the Heart Failure Survival Score (HFSS), the Seattle Heart Failure Model (SHFM), or the Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) improved the prognostic strength of these scales in the study population. We conducted a prospective analysis of 343 outpatients with end-stage HF who accepted the HT waiting list between 2015 and 2018. HFSS, SHFM, and MAGGIC scores were calculated for all patients. PTX3 was measured by sandwich enzyme-linked immunosorbent assay with a commercially available kit. The endpoints were death, left ventricular assist device implantation, and HT during the one-year follow-up. The median age was 56 (50−60) years, and 86.6% were male. During the follow-up period, 173 patients reached the endpoint. Independent risk factors associated with outcomes were ischemic etiology of HF [HR 1.731 (1.227−2.441), p = 0.0018], mean arterial pressure (MAP) [1.026 (1.010−1.042), p = 0.0011], body mass index (BMI) [1.055 (1.014−1.098), p = 0.0083], sodium [1.056 [(1.007−1.109), p = 0.0244] PTX-3 [1.187 (1.126−1.251, p < 0.0001) and N-terminal pro-brain natriuretic peptide (NT-proBNP) [HR 1.004 (1.000−1.008), p = 0.0259]. The HFSS-PTX-3, SHFM-PTX-3 and MAGGIC-PTX-3 scores had significantly higher predictive power [AUC = 0.951, AUC = 0.973; AUC = 0.956, respectively] than original scores [AUC for HFSS = 0.8481, AUC for SHFM = 0.7976, AUC for MAGGIC = 0.7491]. Higher PTX-3 and NT-proBNP concentrations, lower sodium concentrations, lower MAP and BMI levels, and ischemic etiology of HF are associated with worse outcomes in patients with end-stage HF. The modified SHFM-PTX-3, HFSS-PTX-3, and MAGGIC-PTX-3 scores provide effective methods of assessing the outcomes in the analyzed group.
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Naderi N, Naeini S, Tabandeh E, Taghavi S, Amin A, Mirtajaddini M, Omidvar R, Maleki M, Bakhshandeh H. The prognostic significance of the discordance between right- and left-side filling pressures in advanced heart failure: Data from the right heart catheterization registry of rajaie heart center (RHC-RHC Registry). Res Cardiovasc Med 2022. [DOI: 10.4103/rcm.rcm_56_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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4
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Hein SJ, Knoll M, Aus dem Siepen F, Furkel J, Schoenland S, Hegenbart U, Katus HA, Kristen AV, Konstandin M. Elevated interleukin-6 levels are associated with impaired outcome in cardiac transthyretin amyloidosis. World J Cardiol 2021; 13:55-67. [PMID: 33791079 PMCID: PMC7988596 DOI: 10.4330/wjc.v13.i3.55] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/19/2021] [Accepted: 02/12/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Elevated interleukin (IL)-6-levels have been described in familial variant transthyretin amyloidosis (ATTRv) associated polyneuropathy and heart failure. However, IL-6 in cardiac ATTR amyloidosis (ATTR-CM) and its prognostic value have not been investigated yet.
AIM We aim to study the correlation between IL-6 levels with clinical presentation (Gillmore-class) and outcome [heart transplantation or death (htx/death)], or the combined endpoint of cardiac decompensation or htx/death in ATTR-CM.
METHODS IL-6 levels of 106 ATTR-CM patients [54 wild-type ATTRwt, 52 ATTRv-CM], 15 asymptomatic carriers of ATTR mutations (aATTRv-CM) and 27 healthy donors were quantified using Luminex technology. Statistical analysis was performed using parametric survival regression models.
RESULTS We found that IL-6 levels from wild-type ATTR patients were significantly elevated compared to healthy controls, while aATTRv-CM carriers and ATTRv-CM patients did not show a significant difference. IL-6 levels showed significantly higher values in increasing Gillmore classes. Univariate analyses revealed association of low IL-6 levels with cardiac decompensation and htx/death [odds ratio: 0.26 (0.09-0.72), P = 0.01] and htx/death [odds ratio: 0.15 (0.04-0.58), P = 0.006]. However, in the multivariate model, no significant improvement of risk prediction was seen for IL-6, while established prognostic factors were significantly associated with outcome.
CONCLUSION Raised IL-6 levels correlate with clinical presentation and are associated with worse outcome in ATTR-CM but do not improve stratification in addition to established risk factors.
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Affiliation(s)
- Selina J Hein
- Department of Cardiology, Pneumology and Angiology, University Hospital Heidelberg, Heidelberg, BW 69120, Germany
| | - Maximilian Knoll
- Department of Radiation Oncology, Heidelberg Ion-Beam Therapy Center, German Cancer Research Center, University Hospital Heidelberg, Heidelberg, BW 69120, Germany
| | - Fabian Aus dem Siepen
- Department of Cardiology, Pneumology and Angiology, University Hospital Heidelberg, Heidelberg, BW 69120, Germany
| | - Jennifer Furkel
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, BW 69120, Germany
| | - Stefan Schoenland
- Department of Hematology, Oncology and Rheumatology, Amyloidosis Center, Heidelberg University Hospital, Heidelberg, BW 69120, Germany
| | - Ute Hegenbart
- Department of Hematology, Amyloidosis Center, Heidelberg University Hospital, Heidelberg, BW 69120, Germany
| | - Hugo A Katus
- Department of Cardiology, Medical University Hospital Heidelberg, Heidelberg, BW 69120, Germany
| | - Arnt V Kristen
- Department of Cardiology, Amyloidosis Center, University of Heidelberg, Heidelberg, BW 69120, Germany
| | - Mathias Konstandin
- Department of Cardiology, Medical University Hospital Heidelberg, Heidelberg, BW 69120, Germany
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5
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Elevated interleukin-6 levels are associated with impaired outcome in cardiac transthyretin amyloidosis. World J Cardiol 2021. [DOI: 10.4330/wjcc.v13.i3.55] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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6
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Okwose NC, Bouzas-Cruz N, Fernandez OG, Koshy A, Green T, Woods A, Robinson-Smith N, Tovey S, Mcdiarmid A, Parry G, Schueler S, Macgowan GA, Jakovljevic DG. Validity of Hemodynamic Monitoring Using Inert Gas Rebreathing Method in Patients With Chronic Heart Failure and Those Implanted With a Left Ventricular Assist Device. J Card Fail 2020; 27:414-418. [PMID: 33035686 DOI: 10.1016/j.cardfail.2020.09.479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/24/2020] [Accepted: 09/29/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The present study assessed agreement between resting cardiac output estimated by inert gas rebreathing (IGR) and thermodilution methods in patients with heart failure and those implanted with a left ventricular assist device (LVAD). METHODS AND RESULTS Hemodynamic measurements were obtained in 42 patients, 22 with chronic heart failure and 20 with implanted continuous flow LVAD (34 males, aged 50 ± 11 years). Measurements were performed at rest using thermodilution and IGR methods. Cardiac output derived by thermodilution and IGR were not significantly different in LVAD (4.4 ± 0.9 L/min vs 4.7 ± 0.8 L/min, P = .27) or patients with heart failure (4.4 ± 1.4 L/min vs 4.5 ± 1.3 L/min, P = .75). There was a strong relationship between thermodilution and IGR cardiac index (r = 0.81, P = .001) and stroke volume index (r = 0.75, P = .001). Bland-Altman analysis showed acceptable limits of agreement for cardiac index derived by thermodilution and IGR, namely, the mean difference (lower and upper limits of agreement) for patients with heart failure -0.002 L/min/m2 (-0.65 to 0.66 L/min/m2), and -0.14 L/min/m2 (-0.78 to 0.49 L/min/m2) for patients with LVAD. CONCLUSIONS IGR is a valid method for estimating cardiac output and should be used in clinical practice to complement the evaluation and management of chronic heart failure and patients with an LVAD.
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Affiliation(s)
- Nduka C Okwose
- Cardiovascular Research, Clinical and Translational and Biosciences Research Institutes, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Noelia Bouzas-Cruz
- Departments of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Oscar Gonzalez Fernandez
- Departments of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Aaron Koshy
- Departments of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Thomas Green
- Departments of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Andrew Woods
- Departments of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Nicola Robinson-Smith
- Departments of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sian Tovey
- Departments of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Adam Mcdiarmid
- Departments of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Gareth Parry
- Departments of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Stephan Schueler
- Departments of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Guy A Macgowan
- Cardiovascular Research, Clinical and Translational and Biosciences Research Institutes, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; Departments of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Djordje G Jakovljevic
- Cardiovascular Research, Clinical and Translational and Biosciences Research Institutes, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; Departments of Cardiology and Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK; Cardiovascular Research Division, Faculty of Health and Life Sciences, Coventry University, Coventry, UK.
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Szczurek W, Gąsior M, Skrzypek M, Szyguła-Jurkiewicz B. Apelin Improves Prognostic Value of HFSS (Heart Failure Survival Score) and MAGGIC (Meta-Analysis Global Group in Chronic Heart Failure) Scales in Ambulatory Patients with End-Stage Heart Failure. J Clin Med 2020; 9:jcm9072300. [PMID: 32698411 PMCID: PMC7408713 DOI: 10.3390/jcm9072300] [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: 06/21/2020] [Revised: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 11/16/2022] Open
Abstract
This prospective study aimed to determine the effect of adding apelin to the MAGGIC (Meta-Analysis Global Group In Chronic Heart Failure) and HFSS (Heart Failure Survival Score) scales for predicting one-year mortality in 240 ambulatory patients accepted for heart transplantation (HT) between 2015-2017. The study also investigated whether the combination of N-terminal pro-brain natriuretic peptide (NT-proBNP) with MAGGIC or HFSS improves the ability of these scales to effectively separate one-year survivors from non-survivors on the HT waiting list. The median age of the patients was 58.0 (51.50.0-64.0) years and 212 (88.3%) of them were male. Within a one year follow-up, 75 (31.2%) patients died. The area under the curves (AUC) for baseline parameters was as follows-0.7350 for HFSS, 0.7230 for MAGGIC, 0.7992 for apelin and 0.7028 for NT-proBNP. The HFSS-apelin score generated excellent power to predict the one-year survival, with the AUC of 0.8633 and a high sensitivity and specificity (80% and 78%, respectively). The predictive accuracy of MAGGIC-apelin score was also excellent (AUC: 0.8523, sensitivity of 75%, specificity of 79%). The addition of NT-proBNP to the HFSS model slightly improved the predictive power of this scale (AUCHFFSS-NT-proBNP: 0.7665, sensitivity 83%, specificity 60%), while it did not affect the prognostic strength of MAGGIC (AUCMAGGIC-NT-proBNP: 0.738, sensitivity 71%, specificity 69%). In conclusion, the addition of apelin to the HFSS and MAGGIC models significantly improved their ability to predict the one-year survival in patients with advanced HF. The MAGGIC-apelin and HFSS-apelin scores provide simple and powerful methods for risk stratification in end-stage HF patients. NT-proBNP slightly improved the prognostic power of HFSS, while it did not affect the predictive power of MAGGIC.
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Affiliation(s)
- Wioletta Szczurek
- Silesian Center for Heart Diseases in Zabrze,41-800 Zabrze, Poland
- Correspondence: ; Tel.: +48-694-138-970 or +48-323-733-860
| | - Mariusz Gąsior
- 3rd Department of Cardiology, School of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland; (M.G.); (B.S.-J.)
| | - Michał Skrzypek
- Department of Biostatistics, School of Public Health in Bytom, Medical University of Silesia, 40-055 Katowice, Poland;
| | - Bożena Szyguła-Jurkiewicz
- 3rd Department of Cardiology, School of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland; (M.G.); (B.S.-J.)
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Cao ZP, Xue JJ, Zhang Y, Tian MH, Xiao Y, Jia YQ, Zhu BL. Differential expression of B-type natriuretic peptide between left and right ventricles, with particular regard to sudden cardiac death. Mol Med Rep 2017; 16:4763-4769. [PMID: 28765973 PMCID: PMC5647027 DOI: 10.3892/mmr.2017.7136] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 07/14/2017] [Indexed: 01/11/2023] Open
Abstract
The aim of the present study was to investigate the differential expression of B-type natriuretic peptide (BNP) between the left and right ventricle (RV) in sudden cardiac death (SCD). A total of 26 forensic autopsy cases of sudden death (survival time <30 min, postmortem interval <48 h or frozen within 6 h following death) in the present institute were examined. The cases consisted of acute ischemic heart disease (AIHD, n=15) with/without apparent myocardial necrosis as a sign of infarction (acute myocardial infarction, n=6; ischemic heart disease, IHD, n=9), and arrhythmogenic right ventricular cardiomyopathy (ARVC/D, n=5), in addition to traffic accidents and high falls without any pre existing heart disease as control (C, total n=6). BNP was investigated in all cases by the colloidal gold method, hematoxylin-eosin staining, immunohistochemistry (IHC) and the molecular pathological method. The IHC results demonstrated that a positive BNP immunostaining was detected in all groups; however, there was no difference between different causes of death. Pericardial N-terminal (NT)-proBNP concentration was significantly increased in deaths resulting from AIHD and ARVC/D compared with control group. The relative quantification of BNP mRNA demonstrated that relative expression levels of BNP mRNA were significantly increased in the left ventricle (LV) in the AIHD group, and in the RV of the ARVC/D group. The relative quantification difference and ratio of BNP mRNA between LV and RV demonstrated a significantly greater value in the AIHD group compared with control group. BNP mRNA in myocardium and NT-proBNP concentration in pericardial fluid were elevated in SCD patients, and left ventricular dysfunction predominated in AIHD patients, whereas right ventricular dysfunction predominated in ARVC/D patients. The results of the present study suggest the possible use of molecular pathology of BNP for the determination of terminal cardiac function in SCD and analysis of its fatal mechanism in forensic practice.
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Affiliation(s)
- Zhi-Peng Cao
- Department of Forensic Pathology, School of Forensic Medicine of China Medical University, Shenyang, Liaoning 110122, P.R. China
| | - Jia-Jia Xue
- Department of Forensic Pathology, School of Forensic Medicine of China Medical University, Shenyang, Liaoning 110122, P.R. China
| | - Yuan Zhang
- Department of Forensic Pathology, School of Forensic Medicine of China Medical University, Shenyang, Liaoning 110122, P.R. China
| | - Mei-Hui Tian
- Department of Forensic Pathology, School of Forensic Medicine of China Medical University, Shenyang, Liaoning 110122, P.R. China
| | - Ying Xiao
- Department of Forensic Pathology, School of Forensic Medicine of China Medical University, Shenyang, Liaoning 110122, P.R. China
| | - Yu-Qing Jia
- Department of Forensic Pathology, School of Forensic Medicine of China Medical University, Shenyang, Liaoning 110122, P.R. China
| | - Bao-Li Zhu
- Department of Forensic Pathology, School of Forensic Medicine of China Medical University, Shenyang, Liaoning 110122, P.R. China
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Cao ZP, Zhang Y, Mi L, Luo XY, Tian MH, Zhu BL. The Expression of B-Type Natriuretic Peptide After CaCl2-Induced Arrhythmias in Rats. Am J Forensic Med Pathol 2017; 37:133-40. [PMID: 27258852 DOI: 10.1097/paf.0000000000000193] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
To investigate the patterns of B-type natriuretic peptide (BNP) expression after arrhythmia, BNP was assessed at different time points (0 minute, 10 minutes, 30 minutes, 1 hour, 3 hours, and 6 hours) in CaCl2-induced arrhythmia in rats through various methods such as immunohistochemistry, Western blotting, quantitative real-time polymerase chain reaction, and enzyme-linked immunosorbent assay. Immunohistochemistry results showed that the expression of BNP in the endocardium was higher than that in the epicardium in rats undergoing sustained arrhythmias. The BNP-to-GAPDH (glyceraldehyde-3-phosphate dehydrogenase) ratios determined by Western blotting analysis revealed no change at 0 minute but increased at 10 minutes and reached the first peak (0.48 [0.03]) at 30 minutes. After a brief decline, the second peak was observed at 6 hours (0.54 [0.03]). Similar patterns of BNP messenger RNA expression were also observed by quantitative real-time polymerase chain reaction. The plasma BNP concentrations did not change after initial bouts of cardiac arrhythmias but significantly increased 30 minutes after CaCl2 injections. The results demonstrate that arrhythmia causes an elevation of BNP in the myocardium and blood, and BNP messenger RNA increases in initial arrhythmia while its protein in myocardium and plasma does not; however, both of them were elevated after sustained arrhythmia. Such an elevated BNP expression, which is directly related to the severity and duration of the arrhythmias, may suggest the existence of fatal arrhythmia in sudden cardiac death.
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Affiliation(s)
- Zhi-Peng Cao
- From the Department of Forensic Pathology, School of Forensic Medicine, China Medical University, Shenyang, Liaoning Province, People's Republic of China
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Oremus M, Don-Wauchope A, McKelvie R, Santaguida PL, Hill S, Balion C, Booth R, Brown JA, Ali U, Bustamam A, Sohel N, Raina P. BNP and NT-proBNP as prognostic markers in persons with chronic stable heart failure. Heart Fail Rev 2015; 19:471-505. [PMID: 24986335 DOI: 10.1007/s10741-014-9439-6] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Prognosis permits clinicians to separate persons with heart failure (HF) into subgroups based on likely health outcomes. Treatment is partly guided by these likely outcomes. This systematic review explores whether brain natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) are independent predictors of prognosis in persons with chronic stable HF. We electronically searched Medline, Embase, AMED, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and CINAHL for English-language articles published between 1989 and mid-2012. We utilized trained reviewers and standardized forms to screen articles for inclusion and extracted data from included articles. All included studies were summarized in narrative and tabular form. We used the Hayden criteria to assess the risk of bias. Sixteen BNP publications and 88 NT-proBNP publications were included in the systematic review. BNP was positively associated with all-cause and HF mortality. NT-proBNP was positively associated with all-cause and cardiovascular mortality. BNP and NT-proBNP levels are useful for estimating prognosis in persons with chronic stable HF. Further research is required to establish optimal cutpoints and to assess whether prognostic effects differ by age, sex, or time period.
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Affiliation(s)
- Mark Oremus
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, MIP Suite 309A, Hamilton, ON, L8S 4K1, Canada
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11
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Lapointe M, Poirier P, Martin J, Bastien M, Auclair A, Cianflone K. Omentin changes following bariatric surgery and predictive links with biomarkers for risk of cardiovascular disease. Cardiovasc Diabetol 2014; 13:124. [PMID: 25139582 PMCID: PMC4142135 DOI: 10.1186/s12933-014-0124-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 08/05/2014] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Although no receptor has yet been identified, changes in circulating levels of the adipokine designated as Omentin have been demonstrated in obesity and related comorbidities such as cardiovascular disease, insulin resistance, metabolic syndrome and chronic inflammation. METHODS Changes in Omentin levels at 1 and 5 days and 6 and 12 months in response to biliopancreatic diversion with duodenal switch bariatric surgery were evaluated, specifically to investigate if changes preceded gain of insulin sensitivity. RESULTS Pre-operative plasma Omentin was not different between men (n = 18) vs women (n = 48), or diabetic status but correlated with body mass index (BMI). Altogether, Omentin increased as early as 24-h post-surgery, with changes maintained up to 1-year. Fifty-nine percent of subjects increased Omentin >10% by 24-H following surgery (OmentinINC p < 0.0001), while 18% of subjects decreased (OmentinDEC p < 0.0001), with changes maintained throughout one-year. These two groups had comparable age, sex distribution, diabetes, BMI, waist circumference and fat mass, however OmentinDEC had elevated levels of cardiovascular risk markers; homocysteine (p = 0.019), NT-proBNP (p = 0.006) and total bilirubin (p = 0.0001) while red blood cell (RBC) count was lower (p = 0.0005) over the one-year period. Omentin levels at 1-DAY also correlated with immune parameters (white blood cell count, % neutrophil, % monocytes, % lymphocytes). CONCLUSION OmentinDEC at 1 day following surgery may be a marker of cardiovascular "at-risk" group before weight loss or insulin sensitivity restoration.
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Affiliation(s)
| | | | | | | | | | - Katherine Cianflone
- Centre de Recherche de l'Institut Universitaire de Cardiologie & Pneumologie de Québec, Université Laval, Y4332, 2725 Chemin Ste-Foy, Québec G1V 4G5, QC, Canada.
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12
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Bauer R, Blain A, Greally E, Bushby K, Lochmüller H, Laval S, Straub V, MacGowan GA. Intolerance to β-blockade in a mouse model of δ-sarcoglycan-deficient muscular dystrophy cardiomyopathy. Eur J Heart Fail 2014; 12:1163-70. [DOI: 10.1093/eurjhf/hfq129] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Ralf Bauer
- Institute of Human Genetics; Newcastle University, International Center for Life; Newcastle upon Tyne UK
- Department of Cardiology, Angiology and Pneumology; University Hospital; Im Neuenheimer Feld 410, 69120 Heidelberg Germany
| | - Alison Blain
- Institute of Human Genetics; Newcastle University, International Center for Life; Newcastle upon Tyne UK
| | - Elizabeth Greally
- Institute of Human Genetics; Newcastle University, International Center for Life; Newcastle upon Tyne UK
| | - Kate Bushby
- Institute of Human Genetics; Newcastle University, International Center for Life; Newcastle upon Tyne UK
| | - Hanns Lochmüller
- Institute of Human Genetics; Newcastle University, International Center for Life; Newcastle upon Tyne UK
| | - Steve Laval
- Institute of Human Genetics; Newcastle University, International Center for Life; Newcastle upon Tyne UK
| | - Volker Straub
- Institute of Human Genetics; Newcastle University, International Center for Life; Newcastle upon Tyne UK
| | - Guy A. MacGowan
- Institute of Human Genetics; Newcastle University, International Center for Life; Newcastle upon Tyne UK
- Department of Cardiology; Freeman Hospital; Newcastle upon Tyne NE7 7DN UK
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Wegrzynowska-Teodorczyk K, Rudzinska E, Lazorczyk M, Nowakowska K, Banasiak W, Ponikowski P, Wozniewski M, Jankowska EA. Distance covered during a six-minute walk test predicts long-term cardiovascular mortality and hospitalisation rates in men with systolic heart failure: an observational study. J Physiother 2013; 59:177-87. [PMID: 23896333 DOI: 10.1016/s1836-9553(13)70182-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
QUESTION Does the distance covered during a 6-minute walk test predict risk of death or hospitalisation for cardiovascular reasons in men with stable heart failure over three years of follow-up? DESIGN Prospective observational study. PARTICIPANTS 243 men with stable systolic heart failure, with a mean age of 60 yr (SD 11) and left ventricular ejection fraction of 29% (SD 8). According to the New York Heart Association (NYHA) classification, 15% of the participants were in Class I, 44% in Class II, 37% in Class III, and 4% in class IV. OUTCOME MEASURES The exercise capacity of participants was measured using the 6-minute walk test. The participants were followed up for at least three years in the case of survivors. The primary end-points of the survival analyses included cardiovascular death or urgent cardiovascular hospitalisation. RESULTS During the 3-year follow-up, 44% of the participants died, and 69% died or required hospitalisation for cardiovascular reasons. A multivariate analysis showed that the shorter the distance covered in the 6-minute walk test, the greater the 1-year and 3-year mortality risk. Participants with a 6-minute walk test ≤ 468 m had a mortality hazard ratio of 3.22 (95% CI 1.17 to 8.86) at one year and 2.18 (95% CI 1.18 to 4.03) at three years. Multivariate analysis also showed that higher risk mortality or hospitalisation for cardiovascular reasons was predicted by a 6-minute walk distance ≤ 468m, with a hazard ratio of 2.77 (95% CI 1.30 to 5.88) at one year and 1.71 (95% CI 1.08 to 2.72) at three years. CONCLUSION The 6-minute walk test distance constitutes an independent predictor of mortality and mortality or hospitalisation for cardiovascular reasons in men with stable systolic heart failure.
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McDiarmid A, Gordon B, Wrightson N, Robinson-Smith N, Pillay T, Parry G, Schueler S, MacGowan GA. Hemodynamic, Echocardiographic, and Exercise-Related Effects of the HeartWare Left Ventricular Assist Device in Advanced Heart Failure. ACTA ACUST UNITED AC 2012; 19:11-5. [DOI: 10.1111/j.1751-7133.2012.00302.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Ibrahim ESH, Miller AB, White RD. The relationship between aortic stiffness and E/A filling ratio and myocardial strain in the context of left ventricular diastolic dysfunction in heart failure with normal ejection fraction: insights from magnetic resonance imaging. Magn Reson Imaging 2011; 29:1222-34. [PMID: 21907518 DOI: 10.1016/j.mri.2011.08.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Revised: 07/28/2011] [Accepted: 08/04/2011] [Indexed: 11/27/2022]
Abstract
The purpose of this study is to investigate the relationship between aortic stiffness and diastolic dysfunction in heart failure with normal ejection fraction (HFNEF) and compare the results to normal subjects using magnetic resonance imaging (MRI). Sixteen human subjects (eight HFNEF and eight volunteers) were scanned on a 3.0-T MRI system. Aortic stiffness was assessed using pulse wave velocity (PWV). Left ventricle (LV) diastolic function was assessed by the early/atrial (E/A) filling ratio and different myocardial strain components. The results showed that, in HFNEF, a major part of LV filling occurred later during the atrial filling phase. The E/A ratio was less than 1 in HFNEF and greater than 1 in volunteers. Left ventricular myocardial dynamic strain range (difference between end-diastolic and end-systolic strains) was reduced in HFNEF, with less relaxation (strain rate) during the diastolic phase. Aortic PWV was higher in HFNEF than in volunteers due to less vessel compliance. The E/A ratio and myocardial strain measurements showed inverse correlations with aortic stiffness in HFNEF. The resulting inter- and intraobserver variabilities showed no bias between repeated cardiovascular measurements. In conclusion, a comprehensive MRI exam was developed for assessing patients with HFNEF. Heart failure with normal EF is associated with impaired LV diastolic function and significant ventricular and aortic stiffening. The degree of aortic stiffness involvement suggests reduced aortic compliance as a major factor in HFNEF.
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