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Moreyra C, Moreyra E, Rozich JD. Heart Failure With Preserved Ejection Fraction: Will Cardiac Magnetic Imaging Impact on Diagnosis, Treatment, and Outcomes?: Explaining the Need for Advanced Imaging to Clinical Stakeholders. Cardiol Rev 2024; 32:371-377. [PMID: 36576375 DOI: 10.1097/crd.0000000000000494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Clinicians frequently equate symptoms of volume overload to heart failure (HF) but such generalization may preclude diagnostic or etiologic precision essential to optimizing outcomes. HF itself must be specified as the disparate types of cardiac pathology have been traditionally surmised by examination of left ventricular (LV) ejection fraction (EF) as either HF with preserved LVEF (HFpEF-LVEF >50%) or reduced LVEF of (HFrEF-LVEF <40%). More recent data support a third, potentially transitional HF subtype, but therapy, assessment, and prognosis have been historically dictated within the corresponding LV metrics determined by echocardiography. The present effort asks whether this historically dominant role of echocardiography is now shifting slightly, becoming instead a shared if not complimentary test. Will there be a gradual increasing profile for cardiac magnetic resonance as the attempt to further refine our understanding, diagnostic accuracy, and outcomes for HFpEF is attempted?
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Affiliation(s)
- Camila Moreyra
- From the Cardiology Department, Sanatorium Allende, Córdoba, Argentina
| | - Eduardo Moreyra
- From the Cardiology Department, Sanatorium Allende, Córdoba, Argentina
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Sex-related differences in plasma amino acids of patients with ST-elevation myocardial infarction and glycine as risk marker of acute heart failure with preserved ejection fraction. Amino Acids 2022; 54:1295-1310. [PMID: 35779172 DOI: 10.1007/s00726-022-03182-0] [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: 12/07/2021] [Accepted: 06/14/2022] [Indexed: 11/01/2022]
Abstract
Nowadays, the problem of preventing acute heart failure (AHF) in patients with ST-elevation myocardial infarction (STEMI) and preserved left-ventricular ejection fraction (pLVEF) is still not completely resolved, especially in late-presented patients. The purpose of study was: (1) assessment of free plasma amino acid (PAA) alterations in STEMI patients [not receiving reperfusion therapy (RT)], depending on sex and LVEF; (2) analysis of development of late/persistent AHF more than 48 h after admission (pAHF) in STEMI patients with pLVEF depending on PAA levels. This prospective cohort study included 92 STEMI patients (33 women and 59 men), not receiving RT. The free PAA were investigated by ion-exchange liquid-column chromatography. The women had significantly higher PAA levels than men in general cohort and cohort with pLVEF (n = 69). There were associations between female sex and pAHF in general cohort (OR 3.7, p = 0.004) and cohort with pLVEF (OR 11.4, p = 0.0001) by logistic regression. The association between pAHF and glycine level [OR 2.5, p < 0.0001; AUC 0.84, p < 0.0001; 86.7% sensitivity and 77.8% specificity for > 2.6 mg/dL] was revealed in cohort with pLVEF (including female and male). Glycine remained a predictor of pAHF with pLVEF by multivariable logistic regression adjusting for comorbidities, demographic and clinical variables. Higher rate of pAHF in female than in male STEMI patients with pLVEF is associated with higher plasma glycine in women. The glycine level may be genetically determinated by female sex. The plasma glycine > 2.6 mg/dL is a predictor of pAHF in STEMI with pLVEF (including female and male).
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Bayes-Genis A, Cediel G, Domingo M, Codina P, Santiago E, Lupón J. Biomarkers in Heart Failure with Preserved Ejection Fraction. Card Fail Rev 2022; 8:e20. [PMID: 35815256 PMCID: PMC9253965 DOI: 10.15420/cfr.2021.37] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/02/2022] [Indexed: 12/23/2022] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous disorder developing from multiple aetiologies with overlapping pathophysiological mechanisms. HFpEF diagnosis may be challenging, as neither cardiac imaging nor physical examination are sensitive in this situation. Here, we review biomarkers of HFpEF, of which the best supported are related to myocardial stretch and injury, including natriuretic peptides and cardiac troponins. An overview of biomarkers of inflammation, extracellular matrix derangements and fibrosis, senescence, vascular dysfunction, anaemia/iron deficiency and obesity is also provided. Finally, novel biomarkers from -omics technologies, including plasma metabolites and circulating microRNAs, are outlined briefly. A cardiac-centred approach to HFpEF diagnosis using natriuretic peptides seems reasonable at present in clinical practice. A holistic approach including biomarkers that provide information on the non-cardiac components of the HFpEF syndrome may enrich our understanding of the disease and may be useful in classifying HFpEF phenotypes or endotypes that may guide patient selection in HFpEF trials.
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Affiliation(s)
- Antoni Bayes-Genis
- Heart Institute, University Hospital Germans Trias i Pujol, Badalona, Spain; Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain; CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Germán Cediel
- Heart Institute, University Hospital Germans Trias i Pujol, Badalona, Spain; CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Mar Domingo
- Heart Institute, University Hospital Germans Trias i Pujol, Badalona, Spain; CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Pau Codina
- Heart Institute, University Hospital Germans Trias i Pujol, Badalona, Spain; CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Evelyn Santiago
- Heart Institute, University Hospital Germans Trias i Pujol, Badalona, Spain; CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Josep Lupón
- Heart Institute, University Hospital Germans Trias i Pujol, Badalona, Spain; CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
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Zhou L, Guo Z, Wang B, Wu Y, Li Z, Yao H, Fang R, Yang H, Cao H, Cui Y. Risk Prediction in Patients With Heart Failure With Preserved Ejection Fraction Using Gene Expression Data and Machine Learning. Front Genet 2021; 12:652315. [PMID: 33828587 PMCID: PMC8019773 DOI: 10.3389/fgene.2021.652315] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/02/2021] [Indexed: 12/27/2022] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) has become a major health issue because of its high mortality, high heterogeneity, and poor prognosis. Using genomic data to classify patients into different risk groups is a promising method to facilitate the identification of high-risk groups for further precision treatment. Here, we applied six machine learning models, namely kernel partial least squares with the genetic algorithm (GA-KPLS), the least absolute shrinkage and selection operator (LASSO), random forest, ridge regression, support vector machine, and the conventional logistic regression model, to predict HFpEF risk and to identify subgroups at high risk of death based on gene expression data. The model performance was evaluated using various criteria. Our analysis was focused on 149 HFpEF patients from the Framingham Heart Study cohort who were classified into good-outcome and poor-outcome groups based on their 3-year survival outcome. The results showed that the GA-KPLS model exhibited the best performance in predicting patient risk. We further identified 116 differentially expressed genes (DEGs) between the two groups, thus providing novel therapeutic targets for HFpEF. Additionally, the DEGs were enriched in Gene Ontology terms and Kyoto Encyclopedia of Genes and Genomes pathways related to HFpEF. The GA-KPLS-based HFpEF model is a powerful method for risk stratification of 3-year mortality in HFpEF patients.
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Affiliation(s)
- Liye Zhou
- Division of Health Management, School of Management, Shanxi Medical University, Taiyuan, China
| | - Zhifei Guo
- Division of Health Management, School of Management, Shanxi Medical University, Taiyuan, China
| | - Bijue Wang
- Division of Health Management, School of Management, Shanxi Medical University, Taiyuan, China
| | - Yongqing Wu
- Division of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Zhi Li
- Department of Hematology, Taiyuan Central Hospital of Shanxi Medical University, Taiyuan, China
| | - Hongmei Yao
- Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Ruiling Fang
- Division of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Haitao Yang
- Division of Health Statistics, School of Public Health, Hebei Medical University, Shijiazhuang, China
| | - Hongyan Cao
- Division of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China.,Key Laboratory of Major Disease Risk Assessment, Shanxi Medical University, Taiyuan, China
| | - Yuehua Cui
- Department of Statistics and Probability, Michigan State University, East Lansing, MI, United States
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McHugh K, DeVore AD, Wu J, Matsouaka RA, Fonarow GC, Heidenreich PA, Yancy CW, Green JB, Altman N, Hernandez AF. Heart Failure With Preserved Ejection Fraction and Diabetes: JACC State-of-the-Art Review. J Am Coll Cardiol 2020; 73:602-611. [PMID: 30732715 DOI: 10.1016/j.jacc.2018.11.033] [Citation(s) in RCA: 173] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 11/09/2018] [Accepted: 11/13/2018] [Indexed: 01/08/2023]
Abstract
Heart failure with preserved ejection fraction (HFpEF) is now the most common form of HF, affecting over 3 million adults in the United States alone. HFpEF is a heterogenous syndrome. One important phenotype may be related to comorbid conditions, including diabetes mellitus (DM). DM has a prevalence of approximately 45% in HFpEF, but characteristics and outcomes of this population are poorly understood. In this review, the authors summarize data from several clinical trials of HFpEF therapeutics and provide original data from a large cohort using the Get With The Guidelines-HF registry, which together suggest that DM is associated with increased morbidity and long-term mortality in HFpEF. The authors then discuss several common pathological mechanisms in HFpEF and DM, including sodium retention, metabolic derangements, impaired skeletal muscle function, and potential therapeutic targets. As the understanding of comorbid HFpEF and DM improves, it is hoped clinicians will be better equipped to offer effective, patient-centered treatments.
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Affiliation(s)
- Kelly McHugh
- Department of Medicine, Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
| | - Adam D DeVore
- Department of Medicine, Division of Cardiology, Duke University School of Medicine, Durham, North Carolina; Department of Medicine, Division of Cardiology, Duke Clinical Research Institute, Durham, North Carolina
| | - Jingjing Wu
- Department of Medicine, Division of Cardiology, Duke Clinical Research Institute, Durham, North Carolina
| | - Roland A Matsouaka
- Department of Medicine, Division of Cardiology, Duke Clinical Research Institute, Durham, North Carolina
| | - Gregg C Fonarow
- Department of Medicine, Division of Cardiology, Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, California
| | - Paul A Heidenreich
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California; Department of Medicine, Division of Cardiology, Stanford University, Stanford, California
| | - Clyde W Yancy
- Department of Medicine, Division of Cardiology, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - Jennifer B Green
- Department of Medicine, Division of Endocrinology, Duke University School of Medicine, Durham, North Carolina; Department of Medicine, Division of Endocrinology, Duke Clinical Research Institute, Durham, North Carolina
| | - Natasha Altman
- Department of Medicine, Division of Cardiology, University of Colorado-Denver, Aurora, Colorado
| | - Adrian F Hernandez
- Department of Medicine, Division of Cardiology, Duke University School of Medicine, Durham, North Carolina; Department of Medicine, Division of Cardiology, Duke Clinical Research Institute, Durham, North Carolina.
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Shah S, Toreyin H, Gungor CB, Hasler J. A Real-Time Vital-Sign Monitoring in the Physical Domain on a Mixed-Signal Reconfigurable Platform. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2019; 13:1690-1699. [PMID: 31670678 DOI: 10.1109/tbcas.2019.2949778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This work presents a mixed-signal physical-compu-tation-electronics for monitoring three vital signs; namely heart rate, blood pressure, and blood oxygen saturation; from electrocardiography, arterial blood pressure, and photoplethysmography signals in real-time. The computational circuits are implemented on a reconfigurable and programmable signal-processing platform, namely field-programmable analog array (FPAA). The design leverages the core enabling technology of FPAA, namely floating-gate CMOS devices, and an on-chip low-power microcontroller to achieve energy-efficiency while not compromising accuracy. The custom physical-computation-electronics operating in CMOS subthreshold region, performs low-level (i.e., physiologically-relevant feature extraction) and high-level (i.e., detecting arrhythmia) signal processing in an energy-efficient manner. The on-chip microcontroller is used (1) in the programming mode for controlling the charge storage at the analog-memory elements to introduce patient-dependency into the system and (2) in the run mode to quantify the vital signs. The system has been validated against digital computation results from MATLAB using datasets collected from three healthy subjects and datasets from the MIT/BIH open source database. Based on all recordings in the MIT/BIH database, ECG R-peak detection sensitivity is 94.2%. The processor detects arrhythmia in three MIT/BIH recordings with an average sensitivity of 96.2%. The cardiac processor achieves an average percentage mean error bounded by 3.75%, 6.27%, and 7.3% for R-R duration, systolic blood pressure, and oxygen saturation level calculations; respectively. The power consumption of the ECG, blood-pressure and photo-plethysmography processing circuitry are 126 nW, 251 nW and 1.44 μW respectively in a 350 nm process. Overall, the cardiac processor consumes 1.82 μW.
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Liu T, Cai JP, Zhang LQ, Sun N, Cui J, Wang H, Yang JF. The mechanism of RNA oxidation involved in the development of heart failure. Free Radic Res 2019; 53:910-921. [PMID: 31401895 DOI: 10.1080/10715762.2019.1646424] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Heart failure (HF) has become a global public health problem due to its unclear pathogenesis. Our previous studies have found that RNA oxidation is associated with the occurrence and development of a variety of chronic diseases in the elderly, but whether RNA oxidation is related to the pathogenesis of HF remains unclear. Male Dahl salt-sensitive rats (DSSR) were divided into 8% NaCl groups and 0.3% NaCl groups. The blood pressure of DSSR, HE staining of cardiac tissue, cardiac function index of colour Doppler echocardiography and plasma N-terminal probrain Natriuretic Peptide (NT-ProBNP) were used to evaluate the model making. The levels of 8-hydroxyguanosine (8-oxoGsn) and 8-hydroxydeoxyguanosine (8-oxodGsn) in myocardium and urine of DSSR were determined by high-performance liquid chromatography-mass spectrometry (LC-MS/MS). The expression of ERK-MAPK pathway and MTH1 was detected by Western blot (WB). Rats in the 8% NaCl group developed heart failure symptoms such as increased blood pressure, myocardial hypertrophy, decreased diastolic function, and increased plasma NT-ProBNP. The content of 8-oxoGsn in urine and heart tissue also increased, which was positively correlated with the related indicators of heart failure. This process is also accompanied by the sequential activation of ERK-MAPK pathway molecules and the increase of MTH1. The mechanism of RNA oxidation and inhibition is related to the occurrence and development of HF, which may be involved through ERK-MAPK pathway.
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Affiliation(s)
- Tong Liu
- Graduate School of Peking Union Medical College , Beijing , China.,Department of Cardiology, Beijing Hospital, National Centre of Gerontology , Beijing , China.,Peking Union Medical College, Chinese Academy of Medical Science , Beijing , China
| | - Jian-Ping Cai
- The MOH Key Laboratory of Geriatrics, Beijing Hospital, National Center of Gerontology, Chinese Academy of Medical Science , Beijing , China
| | - Li-Qun Zhang
- The MOH Key Laboratory of Geriatrics, Beijing Hospital, National Center of Gerontology, Chinese Academy of Medical Science , Beijing , China
| | - Ning Sun
- Department of Cardiology, Beijing Hospital, National Centre of Gerontology , Beijing , China
| | - Ju Cui
- The MOH Key Laboratory of Geriatrics, Beijing Hospital, National Center of Gerontology, Chinese Academy of Medical Science , Beijing , China
| | - Hua Wang
- Department of Cardiology, Beijing Hospital, National Centre of Gerontology , Beijing , China
| | - Jie-Fu Yang
- Graduate School of Peking Union Medical College , Beijing , China.,Department of Cardiology, Beijing Hospital, National Centre of Gerontology , Beijing , China.,Peking Union Medical College, Chinese Academy of Medical Science , Beijing , China
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9
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Du W, Piek A, Schouten EM, de Kolk CWV, Mueller C, Mebazaa A, A.Voors A, de Boer RA, Silljé HH. Plasma levels of heart failure biomarkers are primarily a reflection of extracardiac production. Theranostics 2018; 8:4155-4169. [PMID: 30128044 PMCID: PMC6096401 DOI: 10.7150/thno.26055] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 06/27/2018] [Indexed: 12/15/2022] Open
Abstract
Plasma heart failure (HF) biomarkers, like natriuretic peptides, are important in diagnosis, prognosis and HF treatment. Several novel HF biomarkers have been identified, including Gal-3, GDF-15 and TIMP-1, but their clinical potential remains vague. Here we investigated plasma biomarker levels in relation to tissue expression and structural and functional cardiac changes. Methods: Cardiac remodeling, cardiac function, and plasma and tissue biomarker levels were investigated in mice after myocardial infarction induced by temporal and permanent LAD ligation (tLAD and pLAD). In addition, a pressure overload model induced by transverse aortic constriction (TAC) and an obese/hypertensive HFpEF-like mouse model were investigated. Results: Plasma levels of ANP and its cardiac expression were strictly associated with cardiac remodeling and function. Gal-3, GDF-15 and TIMP-1 cardiac expressions were also related to cardiac remodeling and function, but not their plasma levels. Only directly after myocardial infarction could elevated plasma levels of Gal-3 and TIMP-1 be detected. Eight weeks after infarction, plasma levels were not elevated despite enhanced cardiac expression and low EF (18.3±3.3%, pLAD). Plasma levels of TIMP-1 and GDF-15 were elevated after TAC, but this also correlated with increased lung expression and congestion. In obese-hypertensive mice, elevated plasma levels of Gal-3, GDF-15 and TIMP1 were associated with increased adipose tissue expression and not with cardiac function. Conclusions: The Gal-3, GDF-15 and TIMP-1 plasma pool levels are hardly influenced by dynamic changes in cardiac expression. These biomarkers are not specific for indices of cardiac remodeling, but predominantly reflect stress in other affected tissues and hence provide health information beyond the heart.
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Barroso MC, Boehme P, Kramer F, Mondritzki T, Koehler T, Gülker JE, Karoff M, Dinh W. Endostatin a Potential Biomarker for Heart Failure with Preserved Ejection Fraction. Arq Bras Cardiol 2017; 109:448-456. [PMID: 28977054 PMCID: PMC5729781 DOI: 10.5935/abc.20170144] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 07/24/2017] [Indexed: 12/26/2022] Open
Abstract
Background Endostatin is a circulating endogenous angiogenesis inhibitor preventing
neovascularization. Previous studies demonstrated the prognostic value of
Endostatin among patients with heart failure with reduced ejection fraction
(HFrEF). However, the role of Endostatin among patients with heart failure
with preserved ejection fraction (HFpEF) remains unclear. Objective This study aimed to investigate the association between serum Endostatin
levels, natriuretic peptide levels and the severity of left ventricular
diastolic dysfunction and the diagnosis of HFpEF. Methods Endostatin serum concentrations were measured in 301 patients comprising 77
HFpEF patients, 169 patients with asymptomatic left ventricular diastolic
dysfunction (ALVDD), and 55 controls with normal cardiac function. Results Endostatin serum levels were significantly elevated in patients with HFpEF
(median/interquartile range 179.0 [159-220]) and ALVDD (163.8 [145.4-191.3])
compared to controls (149.1 [130.6-176.9]), p < 0.001 and p = 0.004,
respectively) and significant correlated with N-terminal pro B-type
natriuretic peptide (NT-proBNP). Conclusions This hypothesis-generating pilot study gives first evidence that Endostatin
correlates with the severity of diastolic dysfunction and may become a novel
biomarker for HFpEF. We hypothesize a rise in Endostatin levels may reflect
inhibition of adaptive angiogenesis and adverse cardiac remodeling.
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Affiliation(s)
- Michael Coll Barroso
- Klinik Königsfeld der Deutschen Rentenversicherung Westfalen in Ennepetal (NRW) - University Hospital
| | | | - Frank Kramer
- Bayer AG - Drug Discovery - Experimental Medicine
| | - Thomas Mondritzki
- Bayer AG - Drug Discovery - Therapeutic Research Groups Cardiovascular III
| | - Till Koehler
- Department of Cardiology - HELIOS Clinic Wuppertal - University Hospital Witten/Herdecke
| | | | - Martin Karoff
- Klinik Königsfeld der Deutschen Rentenversicherung Westfalen in Ennepetal (NRW) - University Hospital
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Rubattu S, Triposkiadis F. Resetting the neurohormonal balance in heart failure (HF): the relevance of the natriuretic peptide (NP) system to the clinical management of patients with HF. Heart Fail Rev 2017; 22:279-288. [PMID: 28378286 PMCID: PMC5438418 DOI: 10.1007/s10741-017-9605-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The natriuretic peptide (NP) system, which includes atrial natriuretic peptide, B-type natriuretic peptide, and C-type natriuretic peptide, has an important role in cardiovascular homeostasis, promoting a number of physiological effects including diuresis, vasodilation, and inhibition of the renin-angiotensin-aldosterone system. Heart failure (HF) is associated with defects in NP processing and synthesis, and there is a strong relationship between NP levels and disease state. NPs are useful biomarkers in HF, and their use in diagnosis and evaluation of prognosis is well established, particularly in patients with HF with reduced ejection fraction (HFrEF). There has also been interest in their use to guide disease management and therapeutic decision making. An understanding of NPs in HF has also resulted in interest in synthetic NPs for the treatment of HF and in treatments that target neprilysin, a protease that degrades NPs. A novel drug, the angiotensin receptor neprilysin inhibitor sacubitril/valsartan (LCZ696), which simultaneously inhibits neprilysin and blocks the angiotensin II type I receptor, was shown to have a favorable efficacy and safety profile in patients with HFrEF and has been approved for use in such patients in Europe and the USA. In light of the development of treatments that target neprilysin and of recent data in relation to synthetic NPs, it is timely to review the current understanding of the role of NPs in HF and their use in diagnosis, evaluating prognosis and guiding treatment, as well as their place in HF therapy.
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Affiliation(s)
- Speranza Rubattu
- Department of Clinical and Molecular Medicine, School of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Pozzilli, Italy.
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Triposkiadis FK. Biomarkers in Heart Failure with Preserved Ejection Fraction: Problems and Opportunities. Cardiology 2016; 136:228-229. [PMID: 27825157 DOI: 10.1159/000452653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 10/13/2016] [Indexed: 11/19/2022]
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