NT-proBNP and Echocardiographic Parameters in Patients with Acute Heart Failure

Intact fibroblast growth factor 23 levels and outcome prediction in patients with acute heart failure

Elevated fibroblast growth factor 23 (FGF23) levels are associated with adverse outcome in populations with cardiovascular disease and chronic kidney failure. It is unclear if FGF23 has significance in prognosis estimation in patients with acute heart failure (HF) when compared to traditional risk estimation tools. Serum levels of intact FGF23 were assessed in 139 patients admitted to the Intermediate Care Unit of a tertiary hospital for acute HF. Patients were followed-up for one year. After exclusion of patients who were lost to follow-up, data outliers, and patients with sampling errors, the final study cohort comprised 133 patients. The Seattle Heart Failure (SHF) Model was used to estimate one-year survival. FGF23 levels correlated with HF severity and were strongly associated with one-year mortality. Associations between one-year outcome and FGF23, assessed on day 1 after admission, were still evident after multivariable adjustment (OR 15.07; 95%CI 1.75-129.79; p = 0.014). FGF23 levels predicted the one-year outcome with similar accuracy as the SHF Model, both if assessed on day 1 and on day 2 after admission (FGF23d1: AUC 0.784; 95%CI 0.669-0.899; FGF23d2: AUC 0.766; 95%CI 0.631-0.901; SHF: AUC 0.771; 95%CI 0.651-0.891). The assessment of FGF23 in patients with acute HF might help identify high-risk patients that are more prone to complications, need a closer follow-up and more aggressive treatment.

N-terminal pro-Brain natriuretic peptide as a useful biomarker for monitoring prognosis in patients with cardiac valve replacement

BACKGROUND

N-terminal pro-Brain natriuretic peptide (NT-proBNP) is an important biomarker to indicate cardiac function, but its significance in cardiac surgery is still unclear.

OBJECTIVE

To explore clinical significance of serum NT-proBNP and their dynamic characteristics in patients with cardiac valve replacement (CVR).

METHODS

Dynamically detecting pre-operative and postoperative serum NT-proBNP on Elecsys 2010 in 60 CVR patients.

RESULTS

(1) There was a good relationship between pre-operative NT-proBNP and pre-operative NYHA classification, ejection fraction, fractional shortening, or between postoperative 1 day log [NT-proBNP] and postoperative ICU time, correlation coefficients were respectively 0.426 (P=0.001), -0.465 (P=0.001), -0.463 (P=0.002), and 0.453 (P=0.006). (2) Pre-operative NT-proBNP would be higher in multivalves damage or mitral lesions patients than that in single valve damage or aortic lesions. It indicated NT-proBNP>1,352 pg/ml could discriminate multivalves damage in Rheumatic Heart Diseases (RHD) patients (sensitivity: 0.742; specificity: 0.64); and NT-proBNP>549.12 pg/ml could differentiate mitral lesions and aortic lesions (sensitivity: 0.92; specificity: 0.75). However, pre-operative serum NT-proBNP for differentiating atrial fibrillation and sinus arrhythmia was not most efficient (AUC=0.655; P=0.044). (3) Perioperative NT-proBNP in CVR patients was characterized by early postoperative NT-proBNP increasing and late postoperative NT-proBNP decreasing. The peak of postoperation NT-proBNP was at postoperative 7 days.

CONCLUSIONS

Serum NT-proBNP was not only a good biomarker to effectively evaluate heart function but also to evaluate the cardiac valve damage in RHD patients, and postoperative NT-proBNP dynamic determination, especially detecting postoperative 1 day, 7 days and 14 days NT-proBNP would be more useful to evaluate prognosis of CVR patients.