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Zhu X, Zhang P, Jiang H, Kuang J, Wu L. Using the Super Learner algorithm to predict risk of major adverse cardiovascular events after percutaneous coronary intervention in patients with myocardial infarction. BMC Med Res Methodol 2024; 24:59. [PMID: 38459490 PMCID: PMC10921576 DOI: 10.1186/s12874-024-02179-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 02/14/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND The primary treatment for patients with myocardial infarction (MI) is percutaneous coronary intervention (PCI). Despite this, the incidence of major adverse cardiovascular events (MACEs) remains a significant concern. Our study seeks to optimize PCI predictive modeling by employing an ensemble learning approach to identify the most effective combination of predictive variables. METHODS AND RESULTS We conducted a retrospective, non-interventional analysis of MI patient data from 2018 to 2021, focusing on those who underwent PCI. Our principal metric was the occurrence of 1-year postoperative MACEs. Variable selection was performed using lasso regression, and predictive models were developed using the Super Learner (SL) algorithm. Model performance was appraised by the area under the receiver operating characteristic curve (AUC) and the average precision (AP) score. Our cohort included 3,880 PCI patients, with 475 (12.2%) experiencing MACEs within one year. The SL model exhibited superior discriminative performance, achieving a validated AUC of 0.982 and an AP of 0.971, which markedly surpassed the traditional logistic regression models (AUC: 0.826, AP: 0.626) in the test cohort. Thirteen variables were significantly associated with the occurrence of 1-year MACEs. CONCLUSION Implementing the Super Learner algorithm has substantially enhanced the predictive accuracy for the risk of MACEs in MI patients. This advancement presents a promising tool for clinicians to craft individualized, data-driven interventions to better patient outcomes.
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Affiliation(s)
- Xiang Zhu
- Jiangxi Provincial Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, 461 BaYi St, Nanchang, 330006, People's Republic of China
| | - Pin Zhang
- School of Public Health and Management, Nanchang Medical College, Nanchang, People's Republic of China
| | - Han Jiang
- Department of Cardiology, Second Affiliated Hospital of Nanchang University, Nanchang, 330006, People's Republic of China
| | - Jie Kuang
- Jiangxi Provincial Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, 461 BaYi St, Nanchang, 330006, People's Republic of China
| | - Lei Wu
- Jiangxi Provincial Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, 461 BaYi St, Nanchang, 330006, People's Republic of China.
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Tually PJ, Currie G, Lenzo NP, Hendrie DV, Meadows JW, Janssen JHA. Potential utility of B-Type natriuretic peptides in secondary prevention following percutaneous coronary intervention in remote communities of Western Australia. Biomarkers 2023:1-8. [PMID: 37128799 DOI: 10.1080/1354750x.2023.2209705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Introduction: A third of all acute coronary events that present in the Australian population occur in patients with established coronary heart disease. This study assessed the prognostic value of combined B-type natriuretic peptides (BNP) measurement and quantitative myocardial perfusion scan (MPS) data for cardiac events (CE).Material and methods: This retrospective cohort study involved 133 patients from rural Western Australia. The cut-off for normality was 6.0 for qualitative summed difference scores (SDS) of MPS and 400 pg/mL for BNP.Results: Patients with no CE had a mean SDS and BNP (1.52 with a 95% CI of 0.34 to 2.69), (175.9 with a 95% CI of 112.7-239.1) that was lower than patients with CE (6.54 with 95% CI 4.18-9.89) (P = 0.0003), (669.1 with 95% CI 543.9-794.3) (P < 0.0001). The sensitivity and specificity of combined testing for predicting CE respectively were 79.6% and 86.3% for SDS, 84.6% and 94.1% for BNP, and 100% and 92.7% for SDS and BNP combined.Discussion and conclusion: Elevated BNP is marginally superior to MPS in predicting CEs in patients who have previously undergone percutaneous coronary intervention (PCI); however, MPS can identify the region of myocardium most at risk. Routine BNP monitoring in this subgroup may serve as secondary prevention by identifying subclinical disease.
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Affiliation(s)
- Peter J Tually
- Department of Nuclear Medicine, Telemed Health, 20 Maritana St, Kalgoorlie, 6430, WA Australia
- Centre for Population Health Research, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
| | - Geoff Currie
- School of Dentistry and Health Sciences, Charles Sturt University, Wagga Wagga, 2678 New South Wales, Australia
| | - Nat P Lenzo
- Department of Nuclear Medicine, Telemed Health, 20 Maritana St, Kalgoorlie, 6430, WA Australia
- School of Medicine, University of Western Australia, Crawley, Western Australia, Australia
| | - Delia V Hendrie
- Centre for Population Health Research, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
| | - Jack W Meadows
- Department of Nuclear Medicine, Telemed Health, 20 Maritana St, Kalgoorlie, 6430, WA Australia
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Olesen TB, Pareek M, Vishram-Nielsen JKK, Olsen MH. The influence of age and sex on the prognostic importance of traditional cardiovascular risk factors, selected circulating biomarkers and other markers of subclinical cardiovascular damage. Curr Opin Cardiol 2023; 38:21-31. [PMID: 36598446 DOI: 10.1097/hco.0000000000001005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE OF REVIEW There is an increasing need for improved risk stratification to better individualize cardiovascular preventive measures. Although age and sex are strong and easily obtained cardiovascular risk factors (CVRFs), their influence on the prognostic importance of other CVRF, circulating biomarkers and other markers of subclinical cardiovascular damage has not previously been systematically and critically appraised. Therefore, we have revisited the European MORGAM and the Danish MONI10 cohorts. RECENT FINDINGS Theoretically, the relative risk of many CVRF is expected to be lower in older healthy individuals due to a combination of selection bias by disease, higher absolute risk primarily due to older age, and the fact that the CVRF and markers may primarily influence or reflect early parts of the cardiovascular disease process. This influence of age may vary between sexes, as the cardiovascular disease process is delayed and possibly different in women compared with men. SUMMARY Adjusted for the remaining Systematic COronary Risk Evaluation (SCORE) CVRF, higher SBP, serum cholesterol, soluble urokinase-type plasminogen activator receptor, left ventricular mass index and atherosclerotic plaques were more closely associated with outcomes in individuals younger than 52 years with some sex-specific differences, whereas higher N-terminal pro-brain natriuretic peptide and urine albumin/creatine ratio were more closely associated with outcomes in subjects aged 61 or 71 years.
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Affiliation(s)
| | - Manan Pareek
- Centre for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen
| | - Julie K K Vishram-Nielsen
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen
- Centre for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark
| | - Michael Hecht Olsen
- Department of Internal Medicine 1, Steno Diabetes Centre Zealand, Holbaek Hospital, Holbaek
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Jarczok MN, Weimer K, Braun C, Williams DP, Thayer JF, Gündel HO, Balint EM. Heart rate variability in the prediction of mortality: A systematic review and meta-analysis of healthy and patient populations. Neurosci Biobehav Rev 2022; 143:104907. [DOI: 10.1016/j.neubiorev.2022.104907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 10/03/2022] [Accepted: 10/04/2022] [Indexed: 11/07/2022]
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Țica O, Țica O, Bunting KV, deBono J, Gkoutos GV, Popescu MI, Kotecha D. Post-mortem examination of high mortality in patients with heart failure and atrial fibrillation. BMC Med 2022; 20:331. [PMID: 36195871 PMCID: PMC9533594 DOI: 10.1186/s12916-022-02533-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 08/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence of combined heart failure (HF) and atrial fibrillation (AF) is rising, and these patients suffer from high rates of mortality. This study aims to provide robust data on factors associated with death, uniquely supported by post-mortem examination. METHODS A retrospective cohort study of hospitalized adults with a clinical diagnosis of HF and AF at a tertiary centre in Romania between 2014 and 2017. A standardized post-mortem examination was performed where death occurred within 24 h of admission, when the cause of death was not clear or by physician request. National records were used to collect mortality data, subsequently categorized and analysed as HF-related death, vascular death and non-cardiovascular death using Cox proportional hazards regression. RESULTS A total of 1009 consecutive patients with a mean age of 73 ± 11 years, 47% women, NYHA class 3.0 ± 0.9, left ventricular ejection fraction (LVEF) 40.1 ± 11.0% and 100% anticoagulated were followed up for 1.5 ± 0.9 years. A total of 291 (29%) died, with post-mortems performed on 186 (64%). Baseline factors associated with mortality were dependent on the cause of death. HF-related death in 136 (47%) was associated with higher NYHA class (hazard ratio [HR] 2.45 per one class increase, 95% CI 1.73-3.46; p < 0.001) and lower LVEF (0.95 per 1% increase, 0.93-0.97; p < 0.001). Vascular death occurred in 75 (26%) and was associated with hypertension (HR 2.83, 1.36-5.90; p = 0.005) and higher LVEF (1.08 per 1% increase, 1.05-1.11; p < 0.001). Non-cardiovascular death in 80 (28%) was associated with clinical obesity (HR 2.20, 1.21-4.00; p = 0.010) and higher LVEF (1.10 per 1% increase, 1.06-1.13; p < 0.001). Across all causes, there was no relationship between mortality and AF type (p = 0.77), HF type (p = 0.85) or LVEF (p = 0.58). CONCLUSIONS Supported by post-mortem data, the cause of death in HF and AF patients is heterogeneous, and the relationships with typical markers of mortality are critically dependent on the mode of death. The poor prognosis in this group demands further attention to improve management beyond anticoagulation.
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Affiliation(s)
- Otilia Țica
- Institute of Cardiovascular Sciences, Medical School, University of Birmingham, Vincent Drive, Birmingham, B15 2TT, UK.
- Cardiology Department, Emergency County Clinical Hospital of Oradea, Gheorghe Doja street, No 65, 410165, Oradea, Romania.
| | - Ovidiu Țica
- Pathology Department, Emergency County Clinical Hospital of Oradea, Gheorghe Doja street, no 65, 410165, Oradea, Romania
| | - Karina V Bunting
- Institute of Cardiovascular Sciences, Medical School, University of Birmingham, Vincent Drive, Birmingham, B15 2TT, UK
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, B15 2GW, UK
| | - Joseph deBono
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, B15 2GW, UK
| | - Georgios V Gkoutos
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, B15 2GW, UK
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, B15 2TT, UK
- Health Data Research (HDR)-UK Midlands, Institute of Translational Medicine, B15 2GW, Birmingham, UK
| | - Mircea I Popescu
- Cardiology Department, Emergency County Clinical Hospital of Oradea, Gheorghe Doja street, No 65, 410165, Oradea, Romania
| | - Dipak Kotecha
- Institute of Cardiovascular Sciences, Medical School, University of Birmingham, Vincent Drive, Birmingham, B15 2TT, UK.
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, B15 2GW, UK.
- Health Data Research (HDR)-UK Midlands, Institute of Translational Medicine, B15 2GW, Birmingham, UK.
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Ma Y, Qi Y, Li Q, Zhu S, Zhao W, Zhang Y. The Expression Significance of LPa, BNP, and McP-1 in CHD Patients and Their Relationship with Echocardiographic Parameters. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:5165203. [PMID: 36101804 PMCID: PMC9440810 DOI: 10.1155/2022/5165203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 07/13/2022] [Accepted: 08/01/2022] [Indexed: 11/17/2022]
Abstract
In order to investigate the expression levels of Lipoprotein A (LPa), B-type Natriuretic Peptide (BNP) and Monocyte chemoattractor Protein-1 (McP-1) in serum of patients with coronary heart disease (CHD) are used to detect significance and to analyze the correlation between these indicators and parameters of echocardiography. The clinical data of 132 CHD patients in our hospital from January 2021 to October 2021 are retrospectively analyzed and included in the CHD group. Another 100 healthy people who came to our hospital for general physical examination were selected as the control group. The expressions of Serum McP-1 and BNP are detected by the ELISA. The expression of Serum LPa is detected by immunoturbidimetry, and the expressions of SERUM McP-1, BNP, and LPa are compared between the two groups. The experiments show that the expressions of McP-1, BNP, and LPa in serum of control group are significantly lower than those of the CHD group (P < 0.05). Echocardiography results show that left ventricular ejection fraction (LVEF) in CHD group is significantly lower than that in control group, but left ventricular end-systolic volume (LVESV) and left ventricular end-diastolic volume (LVEDV) are significantly higher than those in control group (P < 0.05).
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Affiliation(s)
- Yunpeng Ma
- Deputy Chief Physician, Cardiovascular Surgery of First People's Hospital of Tianshui, Tianshui 741000, China
| | - Yinzun Qi
- Deputy Chief Physician, Cardiovascular Surgery of First People's Hospital of Tianshui, Tianshui 741000, China
| | - Qiang Li
- Deputy Chief Physician, Cardiovascular Surgery of First People's Hospital of Tianshui, Tianshui 741000, China
| | - Shuangxiong Zhu
- Deputy Chief Physician, Cardiovascular Surgery of First People's Hospital of Tianshui, Tianshui 741000, China
| | - Wenjie Zhao
- Deputy Chief Physician, Cardiovascular Surgery of First People's Hospital of Tianshui, Tianshui 741000, China
| | - Yu Zhang
- Deputy Chief Physician, Cardiovascular Surgery of First People's Hospital of Tianshui, Tianshui 741000, China
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Castro-Portillo E, López-Izquierdo R, Sanz-García A, Ortega GJ, Delgado-Benito JF, Castro Villamor MA, Sánchez-Soberón I, Del Pozo Vegas C, Martín-Rodríguez F. Role of prehospital point-of-care N-terminal pro-brain natriuretic peptide in acute life-threatening cardiovascular disease. Int J Cardiol 2022; 364:126-132. [PMID: 35716940 DOI: 10.1016/j.ijcard.2022.06.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/18/2022] [Accepted: 06/10/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The evidence about the use of natriuretic peptides (NP) to predict mortality in the pre-hospital setting is limited. The main objective of this study is to assess the ability of point-of-care testing (POCT) N-terminal portion of B-type natriuretic peptide (NT-proBNP) to predict 2-day in-hospital mortality of acute cardiovascular diseases (ACVD). METHODS We conducted a multicentric, prospective, observational study in adults with ACVD transferred by ambulance to emergency departments (ED). The primary outcome was 2-day in-hospital mortality. The discrimination capacity of the NT-proBNP was performed through a prediction model trained using a derivation cohort and evaluated by the area under the curve (AUC) of the receiver operating characteristic on a validation cohort. RESULTS A total of 1006 patients were recruited. The median age was 75 (IQR 63-84) years and 421 (41.85%) were females. The 2-day in-hospital mortality was 5.8% (58 cases). The predictive validity of NT-proBNP, for 2-day mortality reached the following AUC: 0.823 (95%CI: 0.758-0.889, p < 0.001), and the optimal specificity and sensitivity were 73.1 and 82.7. Predictive power of NT-proBNP obtained an AUC 0.549 (95%CI: 0.432-0.865, p 0.215) for acute heart failure, AUC 0.893 (95%CI: 0.617-0.97, p < 0.001) for ischemic heart disease, AUC 0.714 (95%CI: 0.55-0.87, p = 0.0069) for arrhythmia and AUC 0.927 (95%CI: 0.877-0.978, p < 0,001) for syncope. CONCLUSION POCT NT-proBNP has proven to be a strong predictor of early mortality in ACVD, showing an excellent predictive capacity in cases of syncope. However, this biomarker does not appear to be useful for predicting outcome in patients with acute heart failure.
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Affiliation(s)
| | - Raúl López-Izquierdo
- Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain; Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain; Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain
| | - Ancor Sanz-García
- Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain; Data Analysis Unit, Health Research Institute, Hospital de la Princesa, Madrid (IIS-IP), Spain.
| | - Guillermo J Ortega
- Data Analysis Unit, Health Research Institute, Hospital de la Princesa, Madrid (IIS-IP), Spain; CONICET, Argentina; Science and Technology department, National University of Quilmes, Argentina
| | - Juan F Delgado-Benito
- Advanced Life Support, Emergency Medical Services (SACYL), Valladolid, Spain; Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain
| | - Miguel A Castro Villamor
- Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain; Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain
| | | | - Carlos Del Pozo Vegas
- Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain; Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain; Emergency Department, Hospital Clínico Universitario, Valladolid, Spain
| | - Francisco Martín-Rodríguez
- Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain; Advanced Life Support, Emergency Medical Services (SACYL), Valladolid, Spain; Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain
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Fan L, Zhang ZL, Tang JN, Guo QQ, Zhang JC, Cheng MD, Song FH, Liu ZY, Wang K, Jiang LZ, Yue XT, Bai Y, Dai XY, Zheng RJ, Zheng YY, Zhang JY. The age, NT-proBNP, and Ejection Fraction Score as a Novel Predictor of Clinical Outcomes in CAD Patients After PCI. Clin Appl Thromb Hemost 2022; 28:10760296221113345. [PMID: 35903893 PMCID: PMC9340326 DOI: 10.1177/10760296221113345] [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] [Indexed: 11/24/2022] Open
Abstract
Background Previous evidences have been proved that age, N-terminal pro-B-type
natriuretic peptide (NT-proBNP), and ejection fraction are tightly
associated with the long-term outcomes in patients suffered from coronary
artery disease (CAD). Therefore, the present study aimed to assess the
prognosis value of age, NT-proBNP, and ejection fraction (ABEF) score in CAD
patients who underwent percutaneous coronary intervention (PCI). Methods Observational cohort methodology was used in this study which enrolled
totally 3561 patients. And the patients were followed up regularly for
37.59 ± 22.24 months. Patients were classed into three groups based on the
tertiles of ABEF sore: first tertile (<5.06, n = 831), second tertile
(5.06-6.25, n = 839), and third tertile (≥ 6.25, n = 834). The ABEF score
was calculated as follows: age (years)/ejection fraction (%) + NT-proBNP
(NT-proBNP<177pg/mL was 1, 177≤NT-proBNP≥524pg/mL was 2 and
NT-proBNP > 524pg/mL is 3). The association between ABEF score and
adverse prognosis, including all-cause death (ACD), cardiac death (CD),
major adverse cardiovascular events (MACEs) and major adverse cardiac and
cerebrovascular events (MACCEs), in patients who underwent PCI was
analyzed. Results According to the risk category of ABEF score, the incidences of ACD
(P < .001), CD (P < .001) and
MACCEs (P = .021) among the three groups showed significant
differences. Multivariate Cox regression analysis suggested that the
respective risks of ACD and CD were increased 3.013 folds (hazard risk
[HR] = 4.013 [95% confidence interval [CI]: 1.922-8.378],
P < .001) and 4.922 folds ([HR] = 5.922 [95% [CI]:
2.253-15.566], P < .001) in the third tertile compared
with those in the first tertile. Kaplan-Meier survival analyses showed that
the cumulative risks of ACD,CD and MACCEs in patients with the high ABEF
score tended to increase. Conclusion The present study indicated ABEF score was a novel biomarker suitable for
predicting adverse prognosis in patients after PCI, which may be used for
early recognition and risk stratification.
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Affiliation(s)
- Lei Fan
- Department of Cardiology, 12636First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Laboratory of Cardiac Injury and Repair of Henan Province, Zhengzhou, China
| | - Zeng-Lei Zhang
- Department of Cardiology, 12636First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Laboratory of Cardiac Injury and Repair of Henan Province, Zhengzhou, China
| | - Jun-Nan Tang
- Department of Cardiology, 12636First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Laboratory of Cardiac Injury and Repair of Henan Province, Zhengzhou, China
| | - Qian-Qian Guo
- Department of Cardiology, 12636First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Laboratory of Cardiac Injury and Repair of Henan Province, Zhengzhou, China
| | - Jian-Chao Zhang
- Department of Cardiology, 12636First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Laboratory of Cardiac Injury and Repair of Henan Province, Zhengzhou, China
| | - Meng-Die Cheng
- Department of Cardiology, 12636First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Laboratory of Cardiac Injury and Repair of Henan Province, Zhengzhou, China
| | - Feng-Hua Song
- Department of Cardiology, 12636First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Laboratory of Cardiac Injury and Repair of Henan Province, Zhengzhou, China
| | - Zhi-Yu Liu
- Department of Cardiology, 12636First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Laboratory of Cardiac Injury and Repair of Henan Province, Zhengzhou, China
| | - Kai Wang
- Department of Cardiology, 12636First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Laboratory of Cardiac Injury and Repair of Henan Province, Zhengzhou, China
| | - Li-Zhu Jiang
- Department of Cardiology, 12636First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Laboratory of Cardiac Injury and Repair of Henan Province, Zhengzhou, China
| | - Xiao-Ting Yue
- Department of Cardiology, 12636First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Laboratory of Cardiac Injury and Repair of Henan Province, Zhengzhou, China
| | - Yan Bai
- Department of Cardiology, 12636First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Laboratory of Cardiac Injury and Repair of Henan Province, Zhengzhou, China
| | - Xin-Ya Dai
- Department of Cardiology, 12636First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Laboratory of Cardiac Injury and Repair of Henan Province, Zhengzhou, China
| | - Ru-Jie Zheng
- Department of Cardiology, 12636First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Laboratory of Cardiac Injury and Repair of Henan Province, Zhengzhou, China
| | - Ying-Ying Zheng
- Department of Cardiology, 12636First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Laboratory of Cardiac Injury and Repair of Henan Province, Zhengzhou, China.,Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, P.R., China
| | - Jin-Ying Zhang
- Department of Cardiology, 12636First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Key Laboratory of Cardiac Injury and Repair of Henan Province, Zhengzhou, China
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Bunting KV, Gill SK, Sitch A, Mehta S, O'Connor K, Lip GY, Kirchhof P, Strauss VY, Rahimi K, Camm AJ, Stanbury M, Griffith M, Townend JN, Gkoutos GV, Karwath A, Steeds RP, Kotecha D. Improving the diagnosis of heart failure in patients with atrial fibrillation. Heart 2021; 107:902-908. [PMID: 33692093 PMCID: PMC8142420 DOI: 10.1136/heartjnl-2020-318557] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/21/2021] [Accepted: 01/25/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To improve the echocardiographic assessment of heart failure in patients with atrial fibrillation (AF) by comparing conventional averaging of consecutive beats with an index-beat approach, whereby measurements are taken after two cycles with similar R-R interval. METHODS Transthoracic echocardiography was performed using a standardised and blinded protocol in patients enrolled in the RATE-AF (RAte control Therapy Evaluation in permanent Atrial Fibrillation) randomised trial. We compared reproducibility of the index-beat and conventional consecutive-beat methods to calculate left ventricular ejection fraction (LVEF), global longitudinal strain (GLS) and E/e' (mitral E wave max/average diastolic tissue Doppler velocity), and assessed intraoperator/interoperator variability, time efficiency and validity against natriuretic peptides. RESULTS 160 patients were included, 46% of whom were women, with a median age of 75 years (IQR 69-82) and a median heart rate of 100 beats per minute (IQR 86-112). The index-beat had the lowest within-beat coefficient of variation for LVEF (32%, vs 51% for 5 consecutive beats and 53% for 10 consecutive beats), GLS (26%, vs 43% and 42%) and E/e' (25%, vs 41% and 41%). Intraoperator (n=50) and interoperator (n=18) reproducibility were both superior for index-beats and this method was quicker to perform (p<0.001): 35.4 s to measure E/e' (95% CI 33.1 to 37.8) compared with 44.7 s for 5-beat (95% CI 41.8 to 47.5) and 98.1 s for 10-beat (95% CI 91.7 to 104.4) analyses. Using a single index-beat did not compromise the association of LVEF, GLS or E/e' with natriuretic peptide levels. CONCLUSIONS Compared with averaging of multiple beats in patients with AF, the index-beat approach improves reproducibility and saves time without a negative impact on validity, potentially improving the diagnosis and classification of heart failure in patients with AF.
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Affiliation(s)
- Karina V Bunting
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Cardiology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Simrat K Gill
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Cardiology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Alice Sitch
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Samir Mehta
- University of Birmingham Clinical Trials Unit, Birmingham, UK
| | - Kieran O'Connor
- Cardiology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Gregory Yh Lip
- Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Paulus Kirchhof
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Kazem Rahimi
- Deep Medicine, Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - A John Camm
- Cardiology Clinical Academic Group - Molecular & Clinical Sciences Institute, St George's University of London, London, UK
| | | | - Michael Griffith
- Cardiology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jonathan N Townend
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Cardiology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Georgios V Gkoutos
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Health Data Research (HDR)-UK Midlands, Birmingham, UK
| | - Andreas Karwath
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Richard P Steeds
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Cardiology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Dipak Kotecha
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Cardiology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Health Data Research (HDR)-UK Midlands, Birmingham, UK
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10
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Yousefi F, Movahedpour A, Shabaninejad Z, Ghasemi Y, Rabbani S, Sobnani-Nasab A, Mohammadi S, Hajimoradi B, Rezaei S, Savardashtaki A, Mazoochi M, Mirzaei H. Electrochemical-Based Biosensors: New Diagnosis Platforms for Cardiovascular Disease. Curr Med Chem 2020; 27:2550-2575. [DOI: 10.2174/0929867326666191024114207] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 09/05/2019] [Accepted: 09/12/2019] [Indexed: 02/05/2023]
Abstract
One of the major reasons for mortality throughout the world is cardiovascular diseases.
Therefore, bio-markers of cardiovascular disease are of high importance to diagnose and manage procedure.
Detecting biomarkers provided a promising procedure in developing bio-sensors. Fast, selective,
portable, accurate, inexpensive, and sensitive biomarker sensing instruments will be necessary for
detecting and predicting diseases. One of the cardiac biomarkers may be ordered as C-reactive proteins,
lipoprotein-linked phospho-lipase, troponin I or T, myoglobin, interleukin-6, interleukin-1, tumor necrosis
factor alpha, LDL and myeloperoxidase. The biomarkers are applied to anticipate cardio-vascular
illnesses. Initial diagnoses of these diseases are possible by several techniques; however, they are laborious
and need costly apparatus. Current researches designed various bio-sensors for resolving the respective
issues. Electrochemical instruments and the proposed bio-sensors are preferred over other
methods due to its inexpensiveness, mobility, reliability, repeatability. The present review comprehensively
dealt with detecting biomarkers of cardiovascular disease through electro-chemical techniques.
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Affiliation(s)
- Fatemeh Yousefi
- Department of Biological Sciences, Faculty of Genetics, Tarbiat Modares University, Tehran, Iran
| | - Ahmad Movahedpour
- Department of Medical Biotechnology, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Shabaninejad
- Department of Biological Sciences, Faculty of Nanotechnology, Tarbiat Modares University, Tehran, Iran
| | - Younes Ghasemi
- Department of Medical Biotechnology, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahram Rabbani
- Research Center for Advanced Technologies in Cardiovascular Medicine, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Sobnani-Nasab
- Social Determinants of Health (SDH) Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Soheila Mohammadi
- Pharmaceutical Sciences Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Behzad Hajimoradi
- Cardiology Department of Shohaday-e-Tajrish Hospital Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran
| | - Samaneh Rezaei
- Department of Medical Biotechnology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Savardashtaki
- Department of Medical Biotechnology, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Majid Mazoochi
- Department of Cardiology, Cardiac Electrophysiology Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Hamed Mirzaei
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, Iran
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11
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Aoyanagi H, Nochioka K, Sakata Y, Miura M, Shiroto T, Abe R, Kasahara S, Sato M, Fujihashi T, Yamanaka S, Hayashi H, Sugimura K, Takahashi J, Miyata S, Shimokawa H. Temporal changes in left ventricular ejection fraction and their prognostic impacts in patients with Stage B heart failure. Int J Cardiol 2020; 306:123-132. [PMID: 32113664 DOI: 10.1016/j.ijcard.2020.02.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 02/03/2020] [Accepted: 02/14/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND We have recently demonstrated that left ventricular ejection fraction (LVEF) dynamically changes over time with prognostic impacts in Stage C/D patients, namely, those who have a current or past history of heart failure (HF). However, it is unknown whether this is also the case in asymptomatic Stage B patients, namely, those who have a risk of HF, but do not have a history of HF. METHODS In our CHART-2 Study (N = 10,219), we enrolled 4005 Stage B patients and divided them into 3 groups by LVEF; preserved EF (pEF, LVEF ≥50%, N = 3526), mid-range EF (mrEF, LVEF 41-49%, N = 302), and reduced EF (rEF, LVEF ≤40%, N = 177). We examined the prognostic impacts of LVEF transitions among the 3 groups in comparison with 4477 patients with Stage C/D HF. RESULTS Stage B were characterized by less severe clinical status and better prognosis compared with Stage C/D. Stage B in mrEF and rEF at baseline dynamically transitioned to other groups at 1-year, whereas those in pEF unchanged; at 1-year, mrEF transitioned to pEF/rEF by 50/16%, and rEF transitioned to pEF/mrEF by 25/31%, respectively, whereas pEF transitioned to mrEF/rEF by only 3.6/0.7%, respectively, which were consistent with findings in findings with Stage C/D. Although LVEF decrease was directly associated with all-cause mortality in both the Stage B and Stage C/D with pEF, factors related to LVEF changes were different between the 2 groups. CONCLUSIONS In Stage B, LVEF dynamically changes with prognostic impacts as in Stage C/D, whereas different determination factors may be involved in the 2 stages. CLINICAL TRIAL REGISTRATION Chronic Heart Failure Analysis and Registry in the Tohoku District (CHART)-2 (NCT00418041).
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Affiliation(s)
- Hajime Aoyanagi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Kotaro Nochioka
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Japan; Big Data Medicine Center, Tohoku University, Japan
| | - Yasuhiko Sakata
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Japan; Big Data Medicine Center, Tohoku University, Japan.
| | - Masanobu Miura
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Takashi Shiroto
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Ruri Abe
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Shintaro Kasahara
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Masayuki Sato
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Takahide Fujihashi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Shinsuke Yamanaka
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Hideka Hayashi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Koichiro Sugimura
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | - Jun Takahashi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Japan
| | | | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Japan; Big Data Medicine Center, Tohoku University, Japan; Department of Evidence-based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Japan
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12
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Head-to-Head Comparison of the Incremental Predictive Value of The Three Established Risk Markers, Hs-troponin I, C-Reactive Protein, and NT-proBNP, in Coronary Artery Disease. Biomolecules 2020; 10:biom10030394. [PMID: 32143410 PMCID: PMC7175104 DOI: 10.3390/biom10030394] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 02/22/2020] [Accepted: 02/29/2020] [Indexed: 12/19/2022] Open
Abstract
Risk stratification among patients with coronary artery disease (CAD) is of considerable interest to potentially guide secondary preventive therapies. Cardiac troponins as well as C-reactive protein (hsCRP) and natriuretic peptides have emerged as biomarkers for risk stratification. The question remains if one of these biomarkers is superior in predicting adverse outcomes. Thus, we perform a head-to-head comparison between high-sensitivity troponin I (hsTnI), hsCRP, and N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with CAD. Plasma levels were measured in a cohort of 2193 patients with documented CAD. The main outcome measures were cardiovascular (CV) death and/or nonfatal myocardial infarction (MI). During a median follow-up of 3.8 years, all three biomarkers were associated with cardiovascular death and/or MI. After adjustments for conventional cardiovascular risk factors, the hazard ratio (HR) per standard deviation (SD) for the prediction of CV death and/or nonfatal MI was 1.39 [95% CI: 1.24–1.57, p < 0.001] for hsTnI, 1.41 [95% CI: 1.24–1.60, p < 0.001] for hsCRP, and 1.64 [95% CI: 1.39–1.92, p < 0.001] for NT-proBNP. However, upon further adjustments for the other two biomarkers, only NT-proBNP was still associated with the combined endpoint with an HR of 1.47 [95% CI: 1.19–1.82, p < 0.001]. Conclusively, NT-proBNP is reliably linked to CV death and MI in patients with CAD and provides incremental value beyond hsCRP and hsTnI.
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13
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Prognostic Value of NT-proBNP After Ischemic Stroke: A Systematic Review and Meta-analysis of Prospective Cohort Studies. J Stroke Cerebrovasc Dis 2020; 29:104659. [PMID: 32067852 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104659] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 01/06/2020] [Accepted: 01/10/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Many studies have evaluated the relationship between N-terminal pro-brain natriuretic peptide (NT-proBNP) and its prognostic value in ischemic stroke. However, a widespread consensus has not been reached. Therefore, we completed a meta-analysis to evaluate the prognostic significance of NT-proBNP for mortality and functional outcome in patients with ischemic stroke. METHODS We performed a systematic search and review using the PubMed and EMBASE databases to identify literature that reported a correlation between NT-proBNP and mortality and functional outcome in ischemic stroke patients. RESULTS Eleven studies inclusive of 10,498 patients met the inclusion criteria. Elevated plasma NT-proBNP levels were associated with increased risk of mortality in ischemic stroke patients (all-cause mortality: odds ratio [OR] = 2.43, 95% confidence interval [CI] 1.62-3.64, P < .001, I2=74.3%; cardiovascular mortality: OR = 2.01, 95% CI 1.55-2.61, P < .001, I2 = 42.6%). In addition, unfavorable functional outcomes were observed in patients with higher levels of NT-proBNP (OR = 1.68, 95% CI 1.13-2.50, P = .01, I2 = 90.8%) after ischemic stroke. CONCLUSIONS This meta-analysis demonstrates that NT-proBNP could be a predictor of mortality and functional outcome in ischemic stroke patients.
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