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Sahu S, Shah DN, Vempati R, Kandhi PR, Parmar MP, Bethanabotla S, Gadgil S, Chandra P, Malipatil SN, Patel Y, Natarajan B, Bingi TC. Rapid N-Terminal Pro-B-Type Natriuretic Peptide (NT-proBNP) Kit as a Differentiating Tool for Acute Dyspnea in a Resource-Limited Setting. Cureus 2023; 15:e48306. [PMID: 38058332 PMCID: PMC10697234 DOI: 10.7759/cureus.48306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/05/2023] [Indexed: 12/08/2023] Open
Abstract
Introduction Dyspnea is among the most prevalent symptoms experienced by patients presenting as an emergency. The underlying etiology is often a cardiovascular or pulmonary condition, of which heart failure is recognized as a major contributor. The differentials are primarily established based on the patient's clinical presentation and physical examinations but are not conclusive. Of the various investigations undertaken to determine the cause of dyspnea, the biomarker N-Terminal Pro-B-Type Natriuretic Peptide (NT-proBNP) was found to be significantly associated with heart failure. Its level has been proven to be in direct correlation with the severity of the disease. This study demonstrates the usability of an economical rapid test kit in measuring NT-ProBNP levels to help differentiate the cause of dyspnea in the presenting patient in a resource-limited setting. Methodology We studied 115 participants from a tertiary care center in India, which included 70 males and 45 females aged ≤30 to ≥75 years, presenting with shortness of breath. Rapid NT-ProBNP tests were conducted alongside recording their symptoms, vitals, examination findings, and other parameters. They were also classified according to New York Heart Association (NYHA) Classification, and further investigated. Results The study elucidated the efficacy and accuracy of the rapid kits in determining NT-ProBNP levels, and its relation with the severity and prognosis of heart failure. The kits utilized had a sensitivity of greater than 93% for ruling out heart failure as a cause of dyspnea, and a sensitivity of greater than 96% for ruling out elevated NT-ProBNP levels in general. Other parameters such as presenting symptoms and vitals were also analyzed, establishing a correlation with NT-ProBNP levels. Conclusion This study guided us in understanding the effective utilization of the rapid testing kits for emergency care, minimizing the burden on other limited resources. The lower cost and ease of use would serve as a quick means of reaching a conclusive diagnosis, especially in an emergency, which in turn would aid in receiving timely and specific treatment. These kits could act as a stepping stone in creating a sustainable and efficient healthcare system for patients as well as healthcare workers.
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Affiliation(s)
- Sweta Sahu
- Surgery, JJM (Jagadguru Jayadeva Murugarajendra) Medical College, Davanagere, IND
| | - Devarsh N Shah
- Medicine and Surgery, Medical College Baroda, Vadodara, IND
| | - Roopeessh Vempati
- Internal Medicine, Gandhi Medical College, Secunderabad, IND
- Cardiology, Heart & Vascular Institute, Detroit, USA
| | | | - Mihirkumar P Parmar
- Internal Medicine, Gujarat Medical Education and Research Society, Vadnagar, IND
| | | | - Shardool Gadgil
- Medicine and Surgery, Lokmanya Tilak Municipal General Hospital and Medical College, Mumbai, IND
| | - Prerna Chandra
- Internal Medicine, Deccan College of Medical Sciences, Hyderabad, IND
| | | | - Yash Patel
- Internal Medicine, Gujarat Medical Education and Research Society, Vadnagar, IND
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Reshmi KS, Oommen MS, Belgundi P, Paul T, Mehta AA. Prognostic role of N-terminal prohormone of brain natriuretic peptide for patients in the medical intensive care unit with severe sepsis. Lung India 2021; 38:438-441. [PMID: 34472521 PMCID: PMC8509162 DOI: 10.4103/lungindia.lungindia_138_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Sepsis is an important cause of mortality in intensive care units worldwide. The increased levels of N-terminal prohormone of brain natriuretic peptide (NT-pro BNP) are related with dysfunction of the cardiovascular system and systemic inflammation. It is uncertain whether this increase reflects sepsis-related cardiac dysfunction that translates to poorer outcomes. AIMS AND OBJECTIVES The primary aim of this study was to evaluate the prognostic role of NT-pro BNP on the outcome and duration of hospital stay of patients admitted with sepsis. The secondary objective was to identify other associated risk factors for mortality in sepsis. PATIENTS AND METHODS The patients who presented to emergency room with diagnosis of suspected sepsis were studied. Risk factors associated with outcome were studied by univariate analysis. The variables having statistical significance were further included in multivariate analysis to identify the independent predictors of mortality. RESULTS A total of 215 patients with sepsis were included in this study. In univariate analyses, NT-pro BNP, procalcitonin, need of mechanical ventilation (MV), blood culture positivity, chronic kidney disease-chronic liver disease CKD-CLD, and diabetes mellitus were predictors of prolonged hospital stay, and it was same for multivariate analysis excluding procalcitonin. In univariate analysis, NT-pro BNP, MV, and DM were risk factors associated with mortality but in multivariate analysis showed significance only with MV and DM. CONCLUSION There was a statistically significant correlation between NT-pro BNP levels and mortality. The other factors associated with increased mortality were diabetes mellitus and need of MV. In addition to the above factors, the presence of CKD and CLD was associated with increased duration of hospital stay. There was concordance between increased NT-pro BNP and elevated trop I, s creatinine, need of MV, and CKD.
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Affiliation(s)
- K S Reshmi
- Department of Respiratory Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | | | | | - Tisa Paul
- Department of Respiratory Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Asmita Anilkumar Mehta
- Department of Respiratory Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala, India
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Hou Y, Yuan P, Fu Y, Zhang Q, Gao L, Wei Y, Zheng X, Feng W. Geniposide from Gardenia jasminoides var. radicans Makino Attenuates Myocardial Injury in Spontaneously Hypertensive Rats via Regulating Apoptotic and Energy Metabolism Signalling Pathway. DRUG DESIGN DEVELOPMENT AND THERAPY 2021; 15:949-962. [PMID: 33688169 PMCID: PMC7937395 DOI: 10.2147/dddt.s292107] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 02/10/2021] [Indexed: 12/15/2022]
Abstract
Introduction Hypertension is closely related to myocardial injury. Long-term hypertension can cause myocardial injury. Therefore, it is very important to find drugs to treat myocardial injury caused by hypertension. The aim of present study is to investigate the effects and mechanisms of geniposide on myocardial injuries in spontaneously hypertensive rats (SHR) and H9c2 cells induced by NaCl solution. Materials and Methods Male Wistar-Kyoto (WKY) and SHR rats were given different doses of geniposide (25 mg/kg/d or 50 mg/kg/d) or distilled water for three consecutive weeks. Meanwhile, an H9c2 cell line-injury model was established using a solution of 150 µmol/L NaCl for 8 h. The cardiac function and related indexes of rats were detected. Results The results showed that geniposide decreased the levels of COI and COIII, which promoted the phosphorylation of AMPK (p-AMPK) and enhanced the energy metabolism pathway. Geniposide improved myocardial apoptosis by regulating apoptotic proteins (p38, BAX and Bcl-2). Finally, heart function was regulated, and the markers of myocardial injury were decreased. Geniposide increased the viability of H9c2 cells treated with the NaCl solution and decreased the rate of apoptosis by regulating the levels of apoptotic proteins. Geniposide could activate energy metabolism signalling pathway (AMPK/SirT1/FOXO1) and reduce H9c2 cell apoptosis. Conclusion Our results showed that the mechanisms by which geniposide improves myocardial injury in SHR may be through regulating the energy metabolism signalling pathway (AMPK/SirT1/FOXO1) and improving myocardial apoptosis by regulating apoptotic proteins.
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Affiliation(s)
- Ying Hou
- College of Pharmacy, Henan University of Chinese Medicine, Zhengzhou, People's Republic of China
| | - Peipei Yuan
- College of Pharmacy, Henan University of Chinese Medicine, Zhengzhou, People's Republic of China
| | - Yang Fu
- College of Pharmacy, Henan University of Chinese Medicine, Zhengzhou, People's Republic of China
| | - Qi Zhang
- College of Pharmacy, Henan University of Chinese Medicine, Zhengzhou, People's Republic of China
| | - Liyuan Gao
- College of Pharmacy, Henan University of Chinese Medicine, Zhengzhou, People's Republic of China
| | - Yaxin Wei
- College of Pharmacy, Henan University of Chinese Medicine, Zhengzhou, People's Republic of China
| | - Xiaoke Zheng
- College of Pharmacy, Henan University of Chinese Medicine, Zhengzhou, People's Republic of China.,Engineering and Technology Center for Chinese Medicine Development of Henan Province, Henan Science and Technology Department, Zhengzhou, 450046, People's Republic of China
| | - Weisheng Feng
- College of Pharmacy, Henan University of Chinese Medicine, Zhengzhou, People's Republic of China.,Engineering and Technology Center for Chinese Medicine Development of Henan Province, Henan Science and Technology Department, Zhengzhou, 450046, People's Republic of China
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KARACA KARAGÖZ Z, ŞAHİN İ, KANAT BH, KURT F. HİPERTİROİDİLİ HASTALARDA TEDAVİNİN BEYİN NATRİÜRETİK PEPTİD DÜZEYİNE ETKİSİ. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2020. [DOI: 10.17517/ksutfd.799133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Medranda GA, Salhab K, Schwartz R, Green SJ. Prognostic Implications of Baseline B-type Natriuretic Peptide in Patients Undergoing Transcatheter Aortic Valve Implantation. Am J Cardiol 2020; 130:94-99. [PMID: 32665134 DOI: 10.1016/j.amjcard.2020.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 12/21/2022]
Abstract
B-type natriuretic peptide (BNP) levels have been shown to predict outcomes in surgical aortic valve replacement patients. BNP levels have not been well studied in patients undergoing transcatheter aortic valve implantation (TAVI). The purpose of this study is to define the utility of baseline BNP levels in predicting short-term outcomes after TAVI. In this retrospective, observational, study from 2012 to 2019, we reviewed data on 1297 low-risk, intermediate-risk and high-risk patients who underwent TAVI. Patients were dichotomized into those with baseline BNP levels above or below 500 pg/ml. Our primary outcome was a composite of inpatient stroke and death. Our secondary outcome was a composite of 30-day stroke, death and readmission. There were 975 patients with a baseline BNP level of <500 pg/ml and of those, 2% had our primary composite outcome and 13% of patients had our secondary composite outcome. There were 322 patients with a baseline BNP level of ≥500 pg/ml and of those, 6% had our primary composite outcome and 19% of patients had our secondary composite outcome. Those with a baseline BNP level ≥500 pg/ml were 3.47 times more likely (confidence of interval [CI] 1.727, 6.993, p = 0.0005) to have our primary composite outcome and were 1.72 times more likely (CI 1.186, 2.506, p = 0.0043) to have our secondary composite outcome. In conclusion, after adjustments for discrepant baseline characteristics, baseline BNP levels were independently predictive of a composite of inpatient stroke or death and a composite of 30-day stroke, death or readmission after TAVI. Those low, intermediate and high-risk patients whose baseline BNP is ≥500 pg/ml may ultimately require closer post-TAVI monitoring.
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Affiliation(s)
| | - Khaled Salhab
- New York University Winthrop Hospital, Mineola, New York
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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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Schrage B, Geelhoed B, Niiranen TJ, Gianfagna F, Vishram‐Nielsen JKK, Costanzo S, Söderberg S, Ojeda FM, Vartiainen E, Donati MB, Magnussen C, Di Castelnuovo A, Camen S, Kontto J, Koenig W, Blankenberg S, de Gaetano G, Linneberg A, Jørgensen T, Zeller T, Kuulasmaa K, Tunstall‐Pedoe H, Hughes M, Iacoviello L, Salomaa V, Schnabel RB. Comparison of Cardiovascular Risk Factors in European Population Cohorts for Predicting Atrial Fibrillation and Heart Failure, Their Subsequent Onset, and Death. J Am Heart Assoc 2020; 9:e015218. [PMID: 32351154 PMCID: PMC7428582 DOI: 10.1161/jaha.119.015218] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Differences in risk factors for atrial fibrillation (AF) and heart failure (HF) are incompletely understood. Aim of this study was to understand whether risk factors and biomarkers show different associations with incident AF and HF and to investigate predictors of subsequent onset and mortality. Methods and Results In N=58 693 individuals free of AF/HF from 5 population‐based European cohorts, Cox regressions were used to find predictors for AF, HF, subsequent onset, and mortality. Differences between associations were estimated using bootstrapping. Median follow‐up time was 13.8 years, with a mortality of 15.7%. AF and HF occurred in 5.0% and 5.4% of the participants, respectively, with 1.8% showing subsequent onset. Age, male sex, myocardial infarction, body mass index, and NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) showed similar associations with both diseases. Antihypertensive medication and smoking were stronger predictors of HF than AF. Cholesterol, diabetes mellitus, and hsCRP (high‐sensitivity C‐reactive protein) were associated with HF, but not with AF. No variable was exclusively associated with AF. Population‐attributable risks were higher for HF (75.6%) than for AF (30.9%). Age, male sex, body mass index, diabetes mellitus, and NT‐proBNP were associated with subsequent onset, which was associated with the highest all‐cause mortality risk. Conclusions Common risk factors and biomarkers showed different associations with AF and HF, and explained a higher proportion of HF than AF risk. As the subsequent onset of both diseases was strongly associated with mortality, prevention needs to be rigorously addressed and remains challenging, as conventional risk factors explained only 31% of AF risk.
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Affiliation(s)
- Benedikt Schrage
- Department of CardiologyUniversity Heart and Vascular Center HamburgHamburgGermany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/LuebeckGermany
| | - Bastiaan Geelhoed
- Department of CardiologyUniversity Heart and Vascular Center HamburgHamburgGermany
| | - Teemu J. Niiranen
- Division of MedicineTurku University Hospital and University of TurkuTurkuFinland
- National Institute for Health and WelfareHelsinkiFinland
| | - Francesco Gianfagna
- Research Center in Epidemiology and Preventive MedicineDepartment of Medicine and SurgeryUniversity of InsubriaVareseItaly
- Mediterranea CardiocentroNapoliItaly
| | - Julie K. K. Vishram‐Nielsen
- Center for Cardiac, Vascular, Pulmonary and Infectious DiseasesRigshospitaletUniversity Hospital of CopenhagenDenmark
- Center for Clinical Research and PreventionBispebjerg and Frederiksberg HospitalThe Capital Region of DenmarkCopenhagenDenmark
| | - Simona Costanzo
- Department of Epidemiology and PreventionIRCCS NeuromedPozzilli (IS)Italy
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, and Heart CentreUmeå UniversityUmeåSweden
| | - Francisco M. Ojeda
- Department of CardiologyUniversity Heart and Vascular Center HamburgHamburgGermany
| | | | | | - Christina Magnussen
- Department of CardiologyUniversity Heart and Vascular Center HamburgHamburgGermany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/LuebeckGermany
| | | | - Stephan Camen
- Department of CardiologyUniversity Heart and Vascular Center HamburgHamburgGermany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/LuebeckGermany
| | - Jukka Kontto
- National Institute for Health and WelfareHelsinkiFinland
| | - Wolfgang Koenig
- Deutsches Herzzentrum MünchenTechnische Universität MünchenGermany
- DZHK (German Centre for Cardiovascular Research), partner site Munich Heart AllianceMunichGermany
- Institute of Epidemiology and Medical BiometryUniversity of UlmGermany
| | - Stefan Blankenberg
- Department of CardiologyUniversity Heart and Vascular Center HamburgHamburgGermany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/LuebeckGermany
| | | | - Allan Linneberg
- Department of Clinical MedicineFaculty of Health and Medical SciencesUniversity of CopenhagenDenmark
- Center for Clinical Research and PreventionBispebjerg and Frederiksberg HospitalThe Capital Region of DenmarkCopenhagenDenmark
| | - Torben Jørgensen
- Center for Clinical Research and PreventionBispebjerg and Frederiksberg HospitalThe Capital Region of DenmarkCopenhagenDenmark
| | - Tanja Zeller
- Department of CardiologyUniversity Heart and Vascular Center HamburgHamburgGermany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/LuebeckGermany
| | - Kari Kuulasmaa
- National Institute for Health and WelfareHelsinkiFinland
| | - Hugh Tunstall‐Pedoe
- Cardiovascular Epidemiology UnitInstitute of Cardiovascular ResearchUniversity of DundeeUnited Kingdom
| | - Maria Hughes
- Centre of Excellence for Public HealthQueen′s University Belfast,BelfastNorthern Ireland
| | - Licia Iacoviello
- Research Center in Epidemiology and Preventive MedicineDepartment of Medicine and SurgeryUniversity of InsubriaVareseItaly
- Department of Epidemiology and PreventionIRCCS NeuromedPozzilli (IS)Italy
| | - Veikko Salomaa
- National Institute for Health and WelfareHelsinkiFinland
| | - Renate B. Schnabel
- Department of CardiologyUniversity Heart and Vascular Center HamburgHamburgGermany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/LuebeckGermany
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Ahmed AM, Mohamed NAEG, Abdelhamid EM, Taha RI, Abo-Hashish MMA. N-terminal pro-brain natriuretic peptide as a biomarker for differentiating cardiac and pulmonary disease in term neonates with respiratory distress. J Saudi Heart Assoc 2020; 32:65-70. [PMID: 33154894 PMCID: PMC7640609 DOI: 10.37616/2212-5043.1011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 10/21/2019] [Accepted: 12/04/2019] [Indexed: 01/06/2023] Open
Abstract
Objective Brain natriuretic peptide (BNP) is synthesized in the cardiac ventricles and released in response to volume or pressure load. The aim of the study was to determine whether plasma level of N-terminal pro BNP (NT-pro BNP) can distinguish between cardiac and pulmonary disease (PD) among neonates with respiratory distress (RD). Patients and methods The study included 48 term neonates in the first month of life with signs of RD. They were recruited from Neonatal Intensive Care Unit of Al-Galaa Teaching Hospital. Twenty-six healthy neonates were included as a control group. The degree of RD was assessed using Silverman–Anderson score. Chest X-ray, echocardiography, and laboratory measurement of NT-pro BNP were performed. Results According to the underlying disease, neonates with RD were divided into 28 neonates with PD and 20 neonates with congenital heart disease (CHD). Regardless the etiology of RD, NT-pro BNP was significantly higher in the RD group than in the control (p = 0.001). There was a significant difference between and within the three groups regarding NT-pro BNP (p = 0.001). NT-pro BNP was significantly higher in the CHD group than in the PD group (p = 0.001). There was a significant difference between and within RD subgroups. The NT-pro BNP is a very useful test for identification of CHD in neonates with RD. Area under the receiver operating characteristic curve for CHD was 0.857 (p = 0.01), sensitivity 66%, specificity 85%, and cutoff point was 24.5 pg/mL. The area under the curve for PD was 0.646 (p = 0.1) with poor sensitivity and specificity, indicating that NT-pro BNP is a poor test for identification of PD in neonates with RD. Conclusion Term neonates with RD have increased plasma levels of NT-pro BNP. NT-pro BNP is a very good test for identification of CHD in neonates with RD, in comparison with PD. Therefore, plasma NT-pro BNP can be used to differentiate between cardiac and pulmonary cause of RD.
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N-terminal pro-B-type natriuretic peptide levels in children: comparison in cardiac and non-cardiac diseases. Cardiol Young 2020; 30:500-504. [PMID: 32102709 DOI: 10.1017/s1047951120000402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND N-terminal pro-B-type natriuretic peptide (NT-proBNP), a well-known marker of cardiac disease, may be elevated in acute infections and other non-cardiac diseases. The aim of this study was to evaluate NT-proBNP levels in cardiac and non-cardiac diseases and found out the patient's clinical status that affects the NT-proBNP levels. METHODS NT-proBNP levels were measured in three groups of children: a cardiac disease group, an infectious disease group, and a non-cardiac, non-infectious disease group. RESULT In total, 348 children were enrolled, including 134 patients (38.5%) with cardiac disease, 170 patients (48.9%) with infectious disease, and 44 patients (12.6%) with non-cardiac, non-infectious disease. The NT-proBNP level of the cardiac disease group (median: 548 pg/mL; range: 5-35,000 pg/mL) was significantly higher than that of the infectious disease group (median: 193 pg/mL; range: 10-35,000 pg/mL) and the non-cardiac, non-infectious disease group (median: 280 pg/mL; range: 6-35,000 pg/mL). Regarding clinical status, the NT-proBNP levels were significantly higher in patients who needed mechanical ventilation support, oxygen therapy, or inotropic medication or had a change in mental status than in other patients. However, the systemic inflammatory response syndrome and mortality were not related to the NT-proBNP level. CONCLUSION Among heterogeneous group of children, NT-proBNP level can be a useful marker of cardiac disease. Furthermore, the NT-proBNP levels were related to patients' clinical deteriorations, such as shock rather than the inflammatory status of patients.
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Horodinschi RN, Bratu OG, Dediu GN, Pantea Stoian A, Motofei I, Diaconu CC. Heart failure and chronic obstructive pulmonary disease: a review. Acta Cardiol 2020; 75:97-104. [PMID: 30650022 DOI: 10.1080/00015385.2018.1559485] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Heart failure (HF) and chronic obstructive pulmonary disease (COPD) are important causes of morbidity and mortality worldwide. The association between the two conditions have significant systemic effects and a chronic, progressive evolution, affecting exercise tolerance and quality of life. The diseases share common risk factors, such as smoking, advanced age, and low-grade systemic inflammation. The majority of symptoms and physical signs, such as dyspnoea, orthopnea, nocturnal cough, exercise intolerance, muscle weakness may coexist in both pathologies. Thus, the differential clinical diagnosis between exacerbation of COPD and HF decompensation may be difficult. Natriuretic peptides are sensitive biomarkers of HF, used mostly to exclude HF if their values are less than 100 pg/mL for Brain Natriuretic Peptide (BNP), respectively less than 300 pg/mL for N-terminal-pro Brain Natriuretic Peptide (NT-proBNP). Natriuretic peptides are very useful in emergency, for the differential diagnosis of acute dyspnoea. Echocardiography is the standard imaging technique of HF diagnosis and should be performed in all patients with potential HF. Treatment of patients with both HF and COPD should include drugs that prolong survival in HF, such as angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, cardioselective beta1-blockers, aldosterone antagonists, and long-acting bronchodilators (an antimuscarinic rather than a beta2-agonist). The prognosis of patients with both diseases is worse than in patients with only one of the two conditions. These patients represent a continuous challenge of diagnosis and treatment for the clinicians and require a close monitoring of cardiopulmonary function.
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Affiliation(s)
- Ruxandra-Nicoleta Horodinschi
- Internal Medicine Clinic, Clinical Emergency Hospital of Bucharest, Bucharest, Romania
- “ Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Ovidiu Gabriel Bratu
- “ Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Emergency Universitary Central Military Hospital, Bucharest, Romania
| | - Giorgiana Nicoleta Dediu
- “ Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Internal Medicine Clinic, “Sf. Ioan” Clinical Emergency Hospital, Bucharest, Romania
| | | | - Ion Motofei
- “ Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Emergency Clinical Hospital “Sf. Pantelimon”, Bucharest, Romania
| | - Camelia Cristina Diaconu
- Internal Medicine Clinic, Clinical Emergency Hospital of Bucharest, Bucharest, Romania
- “ Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
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Jin N, Wang Y, Liu L, Xue F, Jiang T, Xu M. Dysregulation of the Renin-Angiotensin System and Cardiometabolic Status in Mice Fed a Long-Term High-Fat Diet. Med Sci Monit 2019; 25:6605-6614. [PMID: 31523052 PMCID: PMC6738017 DOI: 10.12659/msm.914877] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background This study aimed to investigate the renin-angiotensin system (RAS) and cardiometabolic status in mice fed a long-term high-fat diet (HFD). Material/Methods C57BL/6J mice were randomly assigned to the control group on a normal diet (ND) (n=15) and the HFD group (n=15). Serum biomarkers were measured, including total cholesterol (TC), triglyceride (TG), insulin, glycated hemoglobin (HbA1c), brain natriuretic peptide (BNP), renin, angiotensin-converting enzyme (ACE), angiotensin II (Ang-II), Ang-II type 1 receptor (AT1R), and aldosterone. Cardiac histology was measured by the cross-sectional area (CSA) of cardiomyocytes and collagen deposition. Levels of myocardial intercalated disc (ICD) proteins and mRNA were analyzed by Western blot and real-time quantitative polymerase chain reaction (RT-qPCR), respectively. The localization of ICD proteins was evaluated by immunohistochemistry (IHC). Results Compared with ND, HFD resulted in increased blood glucose, body weight, TC, TG, HbA1c, insulin, and BNP and levels of serum ACE, Ang-II, aldosterone, AT1R, cardiomyocyte CSA, and interstitial collagen in the myocardium compared. Also, HFD significantly down-regulated connexin-43, and upregulated β-catenin, N-cadherin, and plakoglobin in the hearts of HFD mice compared with ND mice. However, the deposition of ICD proteins was not changed in the hearts of HFD mice compared with ND mice. Conclusions Long-term HFD in mice resulted in left ventricular hypertrophy, interstitial fibrosis, dysregulation of RAS, and abnormal expression of ICD proteins compared with ND mice, but did not affect the distribution of cardiomyocyte ICD proteins. Long-term HFD resulted in cardiac remodeling and altered expression of ICD proteins through RAS activation.
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Affiliation(s)
- Nana Jin
- Key Laboratory of Neuroregeneration of Jiangsu and Ministry of Education of China, Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu, China (mainland)
| | - Yu Wang
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China (mainland)
| | - Lin Liu
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China (mainland)
| | - Feng Xue
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China (mainland)
| | - Tingbo Jiang
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China (mainland)
| | - Mingzhu Xu
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, China (mainland)
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Dimiati H, Wahab AS, Juffrie M, Julia M, Gani BA. Study of NT-proBNP and Hs-Troponin I biomarkers for early detection of children's heart function of proteinenergy malnutrition. Pediatr Rep 2019; 11:7997. [PMID: 31214302 PMCID: PMC6549000 DOI: 10.4081/pr.2019.7997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 04/11/2019] [Indexed: 11/23/2022] Open
Abstract
The Protein Energy Malnutrition (PEM) is the condition of a lack of carbohydrate and protein stores in the body that trigger chronic failure nutrient intake and body maintenance function caused to impact the heart functions. The NT-pro-BNP and Hs- Troponin I proteins were found as the indicator of cardiac dysfunction. The sixty subjects of PEM, analyzed by standard of Indonesia Healt Ministry as well as nutritional status. The blood electrolytes examined by laboratory assay and the levels of Hs-Troponin 1 and NT-Pro-BNP were analyzed by Immune-Chromatography method. Assessing of the ventricular mass with the seeing the peak of the diastolic flow rate of left ventricular that estimated by the curve of the receiver operating characteristic and the area under the curve (P<0.05). The result has shown that the PEM decreased in the left ventricular mass for impaired heart function and systolic disorder. The Hs- Troponin I (90.9%) has better sensitivity than NT-pro-BNP (85.5%) if the merger of those markers possesses the lowest sensitivity (81.8%). These proteins have good biomarkers in heart function, mainly in cases where PEM is present.
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Affiliation(s)
- Herlina Dimiati
- Cardiology Division, Pediatric Health Department, Faculty of Medicine, Universitas Syiah Kuala-RSUZA Hospital, Banda Aceh
| | - Abdus Samik Wahab
- Pediatric Health Department, Faculty of Medicine, Gadjah Mada University, Yogyakarta
| | - Mohammad Juffrie
- Pediatric Health Department, Faculty of Medicine, Gadjah Mada University, Yogyakarta
| | - Madarina Julia
- Pediatric Health Department, Faculty of Medicine, Gadjah Mada University, Yogyakarta
| | - Basri A Gani
- Oral Biology Department, Faculty of Dentistry, Universitas Syiah Kuala, Darussalam Banda Aceh, Indonesia
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13
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Mihailovici AR, Donoiu I, Gheonea DI, Mirea O, Târtea GC, Buşe M, Calborean V, Obleagă C, Pădureanu V, Istrătoaie O. NT-proBNP and Echocardiographic Parameters in Liver Cirrhosis - Correlations with Disease Severity. Med Princ Pract 2019; 28:000499930. [PMID: 30995644 PMCID: PMC6771067 DOI: 10.1159/000499930] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 03/27/2019] [Indexed: 11/19/2022] Open
Abstract
determined. Liver disease severity in patients with cirrhosis was established by Child-Pugh class, MELD score and presence/absence of ascites. Results: Plasma levels of NT-proBNP were significantly higher in cirrhotic patients than in the healthy subjects. NT-proBNP levels were also significantly elevated in Child-Pugh class C patients compared to those in class B and A. Left atrium size, diastolic function, left ventricular wall thickness and left ventricular ejection fraction were significantly altered in cirrhotic patients compared to controls. Advanced cirrhosis and high levels of NT-proBNP were significantly associated with increased left atrium volume and signs of cardiac diastolic dysfunction. We also observed significant differences between quartile groups of MELD score for the following: NT-proBNP, Troponin I, left atrium volume, left ventricle wall thickness, lateral wall and septum systolic tissue doppler velocities and global longitudinal strain. Conclusion: NT-proBNP is increased in patients with cirrhosis and is correlated with the severity of liver disease as established by Child-Pugh class, MELD score and presence of ascites.
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Affiliation(s)
| | - Ionuț Donoiu
- Department of Cardiology, University of Medicine and Pharmacy, Craiova, Romania
| | - Dan Ionuț Gheonea
- Research Center of Gastroenterology and Hepatology, Craiova, Romania
| | - Oana Mirea
- Department of Cardiology, University of Medicine and Pharmacy, Craiova, Romania
| | | | - Maria Buşe
- Department of Cardiology, Emergency County Hospital, Craiova, Romania
| | | | - Cosmin Obleagă
- Department of Surgery, University of Medicine and Pharmacy, Craiova, Romania
| | - Vlad Pădureanu
- Department of Internal Medicine, University of Medicine and Pharmacy, Craiova, Romania
| | - Octavian Istrătoaie
- Department of Cardiology, University of Medicine and Pharmacy, Craiova, Romania
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14
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Wilkins MD, Turner BL, Rivera KR, Menegatti S, Daniele M. Quantum dot enabled lateral flow immunoassay for detection of cardiac biomarker NT-proBNP. SENSING AND BIO-SENSING RESEARCH 2018. [DOI: 10.1016/j.sbsr.2018.10.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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15
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Kawagoe C, Sato Y, Toida T, Nakagawa H, Yamashita Y, Fukuda A, Iwatsubo S, Fujimoto S. N-terminal-pro-B-type-natriuretic peptide associated with 2-year mortality from both cardiovascular and non-cardiovascular origins in prevalent chronic hemodialysis patients. Ren Fail 2018; 40:127-134. [PMID: 29457529 PMCID: PMC6014467 DOI: 10.1080/0886022x.2018.1437047] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
N-terminal-pro-B-type-natriuretic peptide (NT-proBNP) was a predictive marker of cardiovascular disease (CVD)-related death in chronic dialysis patients. NT-proBNP was also correlated with markers of inflammation, malnutrition and protein-energy wasting. We hypothesized whether NT-proBNP was also associated with non-CVD death in chronic dialysis patients. A prospective observational study for incidence of death in chronic dialysis patients was conducted. Prevalent chronic dialysis patients (n = 1310) were enrolled and followed for 24 months. One hundred forty-four deaths were recorded. Area under the curve using ROC analysis for NT-proBNP showed: all causes of death (0.761), CVD-related (0.750), infection and malignancy-related (0.702) and others and unknown (0.745). After adjusting for age, sex, hemodialysis vintage, cardiothoracic ratio, mean pre-dialysis systolic blood pressure, dry weight and basal kidney disease, the hazard ratios (95% confidence intervals) per 1-log NT-proBNP calculated using multivariate Cox analysis were: all causes of death, 3.83 (2.51–5.85); CVD-related, 4.30 (2.12–8.75); infection and malignancy-related, 2.41 (1.17-4.93); and others and unknown origin, 5.63 (2.57–12.37). NT-proBNP was significantly associated not only with CVD-relate but also with non-CVD-related deaths in this population of prevalent chronic dialysis patients.
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Affiliation(s)
- Chihiro Kawagoe
- a Dialysis Division , University of Miyazaki Hospital , Miyazaki , Japan
| | - Yuji Sato
- a Dialysis Division , University of Miyazaki Hospital , Miyazaki , Japan
| | - Tatsunori Toida
- b Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine , University of Miyazaki , Miyazaki , Japan
| | - Hideto Nakagawa
- a Dialysis Division , University of Miyazaki Hospital , Miyazaki , Japan
| | - Yasuhiro Yamashita
- c Department of Internal Medicine, Division of Circulatory and Body Fluid Regulation, Faculty of Medicine , University of Miyazaki , Miyazaki , Japan
| | - Akihiro Fukuda
- a Dialysis Division , University of Miyazaki Hospital , Miyazaki , Japan
| | - Shuji Iwatsubo
- c Department of Internal Medicine, Division of Circulatory and Body Fluid Regulation, Faculty of Medicine , University of Miyazaki , Miyazaki , Japan
| | - Shouichi Fujimoto
- b Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine , University of Miyazaki , Miyazaki , Japan
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16
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Kontos MC, Lanfear DE, Gosch K, Daugherty SL, Heidenriech P, Spertus JA. Prognostic Value of Serial N-Terminal Pro-Brain Natriuretic Peptide Testing in Patients With Acute Myocardial Infarction. Am J Cardiol 2017; 120:181-185. [PMID: 28599802 DOI: 10.1016/j.amjcard.2017.04.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 04/05/2017] [Accepted: 04/05/2017] [Indexed: 12/11/2022]
Abstract
Natriuretic peptides (NPs) are important predictors of outcomes in patients with acute myocardial infarction (AMI) but can change over time. The association of patterns of NP changes after AMI on outcomes is less clear. We measured N-terminal pro-brain natriuretic peptide (NT-proBNP) during the AMI admission and at 1 month in a prospective AMI registry. Outcomes included 1-year readmission and 2-year mortality. An elevated NT-proBNP was defined using age-specific criteria. Patients were classified into 3 groups (low/low [referent group], high/low, high/high) based on NT-proBNP value at enrollment and 1 month. The incremental predictive value of NT-proBNP was determined after adjusting for 6-month GRACE risk score, diabetes, and ejection fraction <40%. Among 773 patients, 303 (38%) were low/low, 240 (30%), and were high/high, 230 (29%) were high/low. Two-year mortality was highest in high/high patients but similar in the high/low and low/low patients (13.1% vs 2.7% and 2.3%, respectively). Similarly, readmission was significantly more likely in the high/high versus the high/low and low/low groups. After adjustment, mortality was significantly higher in the high/high group (hazard ratio 4.02, 95% CI 1.67 to 9.66) compared with the low/low group, although readmission was no longer statistically different (hazard ratio 1.37, 95% CI 0.93 to 2.03). In conclusion, a persistently elevated NT-proBNP assessed 1 month after discharge was associated with a higher risk of mortality in patient with AMI. Postdischarge risk stratification using NT-proBNP has the potential to identify higher risk patients after AMI.
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17
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Gong Y, Hu J, Choi JR, You M, Zheng Y, Xu B, Wen T, Xu F. Improved LFIAs for highly sensitive detection of BNP at point-of-care. Int J Nanomedicine 2017; 12:4455-4466. [PMID: 28670119 PMCID: PMC5479264 DOI: 10.2147/ijn.s135735] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Heart failure (HF) has become a major cause of morbidity and mortality with a significant global economic burden. Although well-established clinical tests could provide early diagnosis, access to these tests is limited in developing countries, where a relatively higher incidence of HF is present. This has prompted an urgent need for developing a cost-effective, rapid and robust diagnostic tool for point-of-care (POC) detection of HF. Lateral flow immunoassay (LFIA) has found widespread applications in POC diagnostics. However, the low sensitivity of LFIA limits its ability to detect important HF biomarkers (e.g., brain natriuretic peptide [BNP]) that are normally present in low concentration in blood. To address this issue, we developed an improved LFIA by optimizing the gold nanoparticle (GNP)–antibody conjugate conditions (e.g., the conjugate pH and the amount of added antibody), the diameter of GNP and the concentration of antibody embedded on the test line and modifying the structure of test strip. Through these improvements, the proposed test strip enabled the detection of BNP down to 0.1 ng/mL within 10–15 min, presenting ~15-fold sensitivity enhancement over conventional lateral flow assay. We also successfully applied our LFIA in the analysis of BNP in human serum samples, highlighting its potential use for clinical assessment of HF. The developed LFIA for BNP could rapidly rule out HF with the naked eye, offering tremendous potential for POC test and personalized medicine.
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Affiliation(s)
- Yan Gong
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University.,Bioinspired Engineering and Biomechanics Center (BEBC), Xi'an Jiaotong University.,Xi'an Diandi Biotech Company
| | - Jie Hu
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University.,Bioinspired Engineering and Biomechanics Center (BEBC), Xi'an Jiaotong University
| | - Jane Ru Choi
- Bioinspired Engineering and Biomechanics Center (BEBC), Xi'an Jiaotong University
| | - Minli You
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University.,Bioinspired Engineering and Biomechanics Center (BEBC), Xi'an Jiaotong University
| | - Yamin Zheng
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University.,Bioinspired Engineering and Biomechanics Center (BEBC), Xi'an Jiaotong University
| | - Bo Xu
- School of Finance and Economics, Xi'an Jiaotong University, Xi'an, People's Republic of China
| | | | - Feng Xu
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University.,Bioinspired Engineering and Biomechanics Center (BEBC), Xi'an Jiaotong University
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18
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Talha S, Charloux A, Piquard F, Geny B. Brain natriuretic peptide and right heart dysfunction after heart transplantation. Clin Transplant 2017; 31. [PMID: 28314080 DOI: 10.1111/ctr.12969] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2017] [Indexed: 02/04/2023]
Abstract
Heart transplantation (HT) should normalize cardiac endocrine function, but brain natriuretic peptide (BNP) levels remain elevated after HT, even in the absence of left ventricular hemodynamic disturbance or allograft rejection. Right ventricle (RV) abnormalities are common in HT recipients (HTx), as a result of engraftment process, tricuspid insufficiency, and/or repeated inflammation due to iterative endomyocardial biopsies. RV function follow-up is vital for patient management as RV dysfunction is a recognized cause of in-hospital death and is responsible for a worse prognosis. Interestingly, few and controversial data are available concerning the relationship between plasma BNP levels and RV functional impairment in HTx. This suggests that infra-clinical modifications, such as subtle immune system disorders or hypoxic conditions, might influence BNP expression. Nevertheless, due to other altered circulating molecular forms of BNP, a lack of specificity of BNP assays is described in heart failure patients. This phenomenon could exist in HT population and could explain elevated BNP plasmatic levels despite a normal RV function. In clinical practice, intra-individual change in BNP over time, rather than absolute BNP values, might be more helpful in detecting right cardiac dysfunction in HTx.
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Affiliation(s)
- Samy Talha
- Department of Physiology and Functional Explorations, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Equipe d'Accueil 3072, Université de Strasbourg, Strasbourg, France
| | - Anne Charloux
- Department of Physiology and Functional Explorations, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Equipe d'Accueil 3072, Université de Strasbourg, Strasbourg, France
| | - François Piquard
- Equipe d'Accueil 3072, Université de Strasbourg, Strasbourg, France
| | - Bernard Geny
- Department of Physiology and Functional Explorations, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Equipe d'Accueil 3072, Université de Strasbourg, Strasbourg, France
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Ranđelović-Krstić V, Krstić B, Veresić J, Matunović R, Grdinić A. DETERMINING BNP AND NT PRO-BNP IN PATIENTS WITH THE ACUTE CORONARY SYNDROME. ACTA MEDICA MEDIANAE 2016. [DOI: 10.5633/amm.2016.0403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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20
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N-terminal pro b-type natriuretic peptide (NT-pro-BNP) -based score can predict in-hospital mortality in patients with heart failure. Sci Rep 2016; 6:29590. [PMID: 27411951 PMCID: PMC4944149 DOI: 10.1038/srep29590] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 06/22/2016] [Indexed: 12/15/2022] Open
Abstract
Serum N-terminal pro b-type natriuretic peptide (NT-pro-BNP) testing is recommended in the patients with heart failure (HF). We hypothesized that NT-pro-BNP, in combination with other clinical factors in terms of a novel NT-pro BNP-based score, may provide even better predictive power for in-hospital mortality among patients with HF. A retrospective study enrolled adult patients with hospitalization-requiring HF who fulfilled the predefined criteria during the period from January 2011 to December 2013. We proposed a novel scoring system consisting of several independent predictors including NT-pro-BNP for predicting in-hospital mortality, and then compared the prognosis-predictive power of the novel NT-pro BNP-based score with other prognosis-predictive scores. A total of 269 patients were enrolled in the current study. Factors such as "serum NT-pro-BNP level above 8100 mg/dl," "age above 79 years," "without taking angiotensin converting enzyme inhibitors/angiotensin receptor blocker," "without taking beta-blocker," "without taking loop diuretics," "with mechanical ventilator support," "with non-invasive ventilator support," "with vasopressors use," and "experience of cardio-pulmonary resuscitation" were found as independent predictors. A novel NT-pro BNP-based score composed of these risk factors was proposed with excellent predictability for in-hospital mortality. The proposed novel NT-pro BNP-based score was extremely effective in predicting in-hospital mortality in HF patients.
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21
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Gong H, Wang X, Shi YJ, Shang WJ, Ling YI, Pan LJ, Shi HM. Correlation between brain natriuretic peptide levels and the prognosis of patients with left ventricular diastolic dysfunction. Exp Ther Med 2016; 11:2583-2589. [PMID: 27313677 DOI: 10.3892/etm.2016.3203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 01/19/2016] [Indexed: 11/06/2022] Open
Abstract
The present study aimed to investigate the association between brain natriuretic peptide (BNP) levels and the prognosis of patients with left ventricular (LV) diastolic dysfunction. A total of 708 inpatients with cardiovascular disease (mean age, 66 years; 395 males and 313 females) were grouped according to initial BNP and were followed-up for 20-51 months (average, 30.86 months) until endpoint events occurred. Endpoints were defined as mortality or readmission due to cardiovascular disease, or mortality due to any other reason. A total of 67 and 77 events were reported in the BNP ≤80 pg/ml and BNP >80 pg/ml groups, respectively. The occurrence rate of the endpoint was significantly higher in the BNP >80 pg/ml group, as compared with the BNP ≤80 pg/ml group (26.28 vs. 16.14%; relative risk=1.63). Furthermore, the durations of patient survival were significantly shorter in the BNP >80 pg/ml group, as compared with the BNP ≤80 pg/ml group (P=0.0006), and patient survival decreased as BNP levels rose (P=0.0074). Among the 708 patients, 677 underwent echocardiographic detection at the same time. No significant correlation was detected between BNP levels and survival time in 178 patients with normal LV diastolic function [mitral Doppler flow, early diastolic (E)/late diastolic (A)>1] (P=0.2165); whereas a negative correlation was determined in 499 patients with LVD dysfunction (E/A≤1) (Spearman's rho=-0.0899; P=0.0447). The prognoses of patients with elevated BNP levels were correspondingly worse in the present study and these correlations were demonstrated to be significant in patients with LV diastolic dysfunction. Therefore, BNP levels may be used to predict the prognosis of patients with cardiovascular disease.
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Affiliation(s)
- Hui Gong
- Department of Internal Medicine, Division of Cardiology, Huashan Hospital of Fudan University, Shanghai 200040, P.R. China
| | - Xin Wang
- Department of Medicine and Therapeutics, Division of Cardiology, Jinshan Hospital of Fudan University, Shanghai 200540, P.R. China
| | - Yi-Jun Shi
- Department of Medicine and Therapeutics, Division of Cardiology, Jinshan Hospital of Fudan University, Shanghai 200540, P.R. China
| | - Wen-Jing Shang
- Department of Medicine and Therapeutics, Division of Cardiology, Jinshan Hospital of Fudan University, Shanghai 200540, P.R. China
| | - Y I Ling
- Department of Medicine and Therapeutics, Division of Cardiology, Jinshan Hospital of Fudan University, Shanghai 200540, P.R. China
| | - Li-Jian Pan
- Department of Medicine and Therapeutics, Division of Cardiology, Jinshan Hospital of Fudan University, Shanghai 200540, P.R. China
| | - Hai-Ming Shi
- Department of Internal Medicine, Division of Cardiology, Huashan Hospital of Fudan University, Shanghai 200040, P.R. China
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22
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Brozaitiene J, Mickuviene N, Podlipskyte A, Burkauskas J, Bunevicius R. Relationship and prognostic importance of thyroid hormone and N-terminal pro-B-Type natriuretic peptide for patients after acute coronary syndromes: a longitudinal observational study. BMC Cardiovasc Disord 2016; 16:45. [PMID: 26892923 PMCID: PMC4757967 DOI: 10.1186/s12872-016-0226-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 02/12/2016] [Indexed: 12/26/2022] Open
Abstract
Background Altered thyroid function and increased rates of N-terminal pro-B-Type natriuretic peptide (NT-pro-BNP) are highly prevalent in coronary artery disease (CAD) patients with heart failure, and are associated with unfavorable prognosis. This study was undertaken to examine the relationship and prognostic impact of thyroid hormones, inflammatory biomarkers, and NT-pro-BNP on long-term outcomes in patients after acute coronary syndrome (ACS). Methods The study comprised of 642 patients (age 58 ± 10 years, 77 % male) attending an in-patient cardiac rehabilitation program after experiencing ACS. Patients were evaluated for demographic, clinical and CAD risk factors as well as thyroid hormones (e.g., fT3, fT4 level, fT3/fT4 ratio), inflammatory biomarkers (hs-CRP, IL-6) and NT-pro-BNP levels. Data on fT3/fT4 ratio and NT-pro-BNP levels were not normally distributed and were natural-log transformed (ln). Both all-cause (cumulative) and cardiac-related mortality were considered the primary outcomes of interest. Results According to the Cox model, age, NYHA class, (ln)NT-pro-BNP levels (HR 1.53, 95 % CI 1.13–2.07), fT4 level (HR 1.15, 95 % CI 1.04–1.27), and (ln)fT3/fT4 ratio (HR 0.08, 95 % CI 0.02–0.32) were the most important predictors of all-cause mortality among CAD patients after ACS. Similarly, age, NYHA class, (ln)NT-pro-BNP levels (HR 1.62, 95 % CI 1.11–2.36), fT4 (HR 1.15, 95 % CI 1.02–1.29) and (ln)fT3/fT4 ratio (HR 0.10, 95 % CI 0.02–0.55) independently predicted cardiac-related mortality. Kaplan-Meier analyses provided significant prognostic information with the highest risk for all-cause mortality in the low cut off measures of fT3/fT4 ratio <0.206 and NT-pro-BNP ≥290.4 ng/L (HR 2.03, 95 % CI 1.39–2.96) and fT4 level >12.54 pg/ml (HR = 2.34, 95 % CI 1.05–5.18). There was no association between hs-CRP, IL-6 and mortality in CAD patients after ACS. Conclusions Thyroid hormones (i.e., fT4 level and fT3/fT4 ratio) together with NT-pro-BNP level may be valuable and simple predictors of long-term outcomes of CAD patients after experiencing ACS.
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Affiliation(s)
- Julija Brozaitiene
- Behavioral Medicine Institute, Lithuanian University of Health Sciences, Palanga, Lithuania.
| | - Narseta Mickuviene
- Behavioral Medicine Institute, Lithuanian University of Health Sciences, Palanga, Lithuania.
| | - Aurelija Podlipskyte
- Behavioral Medicine Institute, Lithuanian University of Health Sciences, Palanga, Lithuania.
| | - Julius Burkauskas
- Behavioral Medicine Institute, Lithuanian University of Health Sciences, Palanga, Lithuania.
| | - Robertas Bunevicius
- Behavioral Medicine Institute, Lithuanian University of Health Sciences, Palanga, Lithuania.
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23
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Effect of Carvedilol on Serum Heart-type Fatty Acid-binding Protein, Brain Natriuretic Peptide, and Cardiac Function in Patients With Chronic Heart Failure. J Cardiovasc Pharmacol 2016; 65:480-4. [PMID: 25945865 DOI: 10.1097/fjc.0000000000000217] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To observe the changes of serum heart-type fatty acid-binding protein (h-FABP) and brain natriuretic peptide (BNP) in children with chronic heart failure (CHF) and evaluate the effects of carvedilol. METHODS A total of 36 patients with CHF, including 17 of endocardial fibroelastosis and 19 of dilated cardiomyopathy, were enrolled and were randomly divided into a carvedilol treatment group (group A) and a conventional treatment group (group B). Group A (n = 16) was treated with carvedilol and conventional treatment and group B (n = 20) was managed with conventional treatment only. Thirty healthy children were enrolled as controls. The concentrations of serum h-FABP and BNP were measured by enzyme-linked immunosorbent assay, and the left ventricular end-systolic diameter, left ventricular end-diastolic diameter, left ventricular ejection fraction (LVEF), left ventricular fractional shortening (LVFS), and cardiac index (CI) were measured by echocardiography. RESULTS The concentrations of serum h-FABP and BNP in patients with CHF were significantly higher than in the control group (21.7 ± 4.3 ng/mL vs. 6.3 ± 1.7 ng/mL, 582.4 ± 180.6 pg/mL vs.31.2 ± 9.8 pg/mL, all P < 0.01), positively correlated with the degree of heart failure (all P < 0.01), and were both higher in groups endocardial fibroelastosis and dilated cardiomyopathy than in the control group (all P < 0.01), but there was no statistically significant difference between the 2 groups (P > 0.05). h-FABP concentration in patients with CHF was positively correlated with BNP (r = 0.78, P < 0.01) but negatively correlated with LVEF, LVFS, and CI (r = -0.65, -0.64, and -0.71, respectively; all P < 0.01). BNP concentration was also negatively correlated with LVEF, LVFS, and CI (r = -0.75, -0.61, and -0.79, respectively; all P<0.01). After treatment with carvedilol, the serum concentrations of h-FABP and BNP in group A were lower than in group B, and the magnitude of heart rate reduction, improvement of LVEF, LVFS, and CI, and reduction of left ventricular end-systolic diameter and left ventricular end-diastolic diameter in group A were all greater than in group B (all P < 0.01). Treatment with carvedilol had no adverse events. CONCLUSIONS Serum concentrations of h-FABP and BNP can be used as biomarkers to evaluate the severity of heart failure, and carvedilol can significantly improve heart function in children with CHF.
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Hu D, Liu Y, Tao H, Gao J. Clinical value of plasma B-type natriuretic peptide assay in pediatric pneumonia accompanied by heart failure. Exp Ther Med 2015; 10:2175-2179. [PMID: 26668612 DOI: 10.3892/etm.2015.2781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 06/30/2015] [Indexed: 12/31/2022] Open
Abstract
Previous studies have shown that B-type natriuretic peptide (BNP) is useful in differentiating cardiac from pulmonary causes of dyspnea in adults. To date, international guidelines have recommended measurements of circulating BNP as a biomarker for diagnostic and prognostic purposes, as well as therapeutic monitoring, in adults with cardiac diseases, particularly those suffering from acute and chronic heart failure (HF). The aim of the present study was to investigate the differential diagnostic and therapeutic analysis of BNP levels assayed in pediatric pneumonia accompanied by HF. The clinical data of 80 patients with pneumonia, aged 1-3 years, were analyzed. The patients were divided into two groups: Simple pneumonia (46 cases) and pneumonia accompanied by HF (34 cases). All patients underwent two plasma BNP assays: The first one upon admission to the hospital and the second one prior to discharge. The plasma BNP levels of 20 healthy children were used as the negative control. Plasma BNP levels were measured using the Triage® BNP automated immunoassay systems and reagents. Statistical analysis showed that the plasma BNP levels of the patients upon admission were higher in the pneumonia accompanied by HF group compared with those in the simple pneumonia group (750±120 vs. 135±50 pg/ml; P<0.05). In addition, in the pneumonia accompanied by HF group, the plasma BNP levels of the patients were higher upon admission to the hospital than they were prior to discharge (750±120 vs. 115±45 pg/ml; P<0.05); therefore, plasma BNP may comprise a sensitive diagnostic and therapeutic evaluative marker for pediatric patients with pneumonia accompanied by HF. This finding could prove invaluable in the clinical diagnosis and treatment of the disease.
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Affiliation(s)
- Dan Hu
- Department of Pediatrics, The First People's Hospital of Zhangjiagang, Zhangjiagang, Jiangsu 215600, P.R. China
| | - Yang Liu
- Department of Pediatrics, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - Huixian Tao
- Department of Pediatrics, The First People's Hospital of Zhangjiagang, Zhangjiagang, Jiangsu 215600, P.R. China
| | - Jinping Gao
- Department of Pediatrics, The First People's Hospital of Zhangjiagang, Zhangjiagang, Jiangsu 215600, P.R. China
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Snipsøyr MG, Ludvigsen M, Petersen E, Wiggers H, Honoré B. A systematic review of biomarkers in the diagnosis of infective endocarditis. Int J Cardiol 2015; 202:564-70. [PMID: 26447663 DOI: 10.1016/j.ijcard.2015.09.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 09/11/2015] [Accepted: 09/19/2015] [Indexed: 11/30/2022]
Abstract
Timely diagnosis of bacterial infective endocarditis (IE) is crucial, as mortality remains high in this severe bacterial infection, currently without any distinct biological markers. Our goal was to evaluate potential diagnostic biomarkers by reviewing current literature. The MEDLINE, Embase and Scopus databases were searched for articles published from 1980 through June 2015 restricted to English, Norwegian, Danish and Swedish. Eighteen studies qualified, providing a review of the most promising candidates for future studies. Several studies are inconclusive, since they are characterized by using improper control groups. Patients with IE have bacteremia, and control groups should therefore be patients with bacteremia without IE. Based on current research, N-terminal-pro-B-type natriuretic peptide (NT-proBNP) alone or in combination with Cystatin C (Cys C), lipopolysaccharide-binding protein (LBP), troponins, aquaporin-9 (AQP9), S100 calcium binding protein A11 (S100A11), E-selectin (CD62E) and VCAM-1 (CD54) and interleukin-6 (IL-6) are potential biomarkers for future studies.
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Affiliation(s)
- Magnus G Snipsøyr
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark; Department of Infectious Diseases, Aarhus University Hospital, Skejby, Denmark; Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Maja Ludvigsen
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Eskild Petersen
- Department of Infectious Diseases, Aarhus University Hospital, Skejby, Denmark
| | - Henrik Wiggers
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | - Bent Honoré
- Department of Biomedicine, Aarhus University, Aarhus, Denmark.
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Jin CD, Kim MH, Guo LZ, Li SH, Han JY. Falsely high B-type natriuretic peptide concentration in patients without heart failure attributed to AxSYM assay: case series of eight subjects. ESC Heart Fail 2015; 2:37-39. [PMID: 28834642 PMCID: PMC5746958 DOI: 10.1002/ehf2.12024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 01/19/2015] [Accepted: 02/12/2015] [Indexed: 12/03/2022] Open
Abstract
We report a case series of eight subjects complaining of non‐specific chest pain without heart failure, but with apparent high concentrations of plasma B‐type natriuretic peptide (BNP). No positive clinical characteristics were identified in physical examinations, cardiac imaging, laboratory findings, or pulmonary function tests. However, we observed unusually high BNP values when analysing blood samples of the patients using the AxSYM assay, and this was not supported by readings from Triage® or ADVIA Centaur® assays on the same samples, which showed BNP within the normal range. We believe that the possibility for false readings for high BNP levels in healthy individuals measured by AxSYM assay should be taken into account by physicians in clinical practice to avoid medical errors.
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Affiliation(s)
- Cai De Jin
- Department of Cardiology, College of Medicine, Dong-A University, Busan, Korea.,Global Clinical Trial Center, Dong-A University Hospital, Busan, Korea
| | - Moo Hyun Kim
- Department of Cardiology, College of Medicine, Dong-A University, Busan, Korea.,Global Clinical Trial Center, Dong-A University Hospital, Busan, Korea
| | - Long Zhe Guo
- Department of Cardiology, College of Medicine, Dong-A University, Busan, Korea.,Global Clinical Trial Center, Dong-A University Hospital, Busan, Korea
| | - Shu Hua Li
- Department of Laboratory Medicine, College of Medicine, Dong-A University Hospital, Busan, Korea
| | - Jin-Yeong Han
- Department of Laboratory Medicine, College of Medicine, Dong-A University Hospital, Busan, Korea
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JUHL-OLSEN P, JAKOBSEN CJ, RASMUSSEN LA, BHAVSAR R, KLAABORG KE, FREDERIKSEN CA, SLOTH E. Effects of levosimendan in patients with left ventricular hypertrophy undergoing aortic valve replacement. Acta Anaesthesiol Scand 2015; 59:65-77. [PMID: 25348510 DOI: 10.1111/aas.12425] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 09/16/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND Left ventricular hypertrophy is associated with adverse outcomes, including death, during cardiac surgery. This may be facilitated by an increased oxygen demand and diastolic dysfunction. Levosimendan augments haemodynamics without further oxygen consumption and improves echocardiographic indices of diastolic dysfunction. This study aimed to describe the haemodynamic effects of short-term pre- and intra-operative levosimendan infusion including advanced echocardiographic measures of diastolic and systolic heart function. METHODS The study was randomised, double-blinded and placebo-controlled performed at a single-centre university hospital. Patients with left ventricular hypertrophy and ejection fraction > 45% scheduled for single procedure aortic valve replacement were included and randomised to infusion of either levosimendan 0.1 μg/kg/min or placebo from 4 h before anaesthesia to the end of surgery. Outcome measures were echocardiographic indices of left ventricular diastolic function: E/e' (primary endpoint), e', e'/a' and indices of systolic function: longitudinal strain, ejection fraction and s'. Patients were followed until 6 months after surgery. In addition, invasive haemodynamic measures were obtained perioperatively. RESULTS The trial was prematurely terminated due to an overall high incidence of post-operative atrial fibrillation (15/20, P = 0.002) after inclusion of 20 patients. The relative decrease in perioperative cardiac index was lower (P = 0.016) in the levosimendan group. There was no difference in E/e', and similar results were found for all measures of systolic function. CONCLUSION Short-term levosimendan caused a transient relative increase in cardiac index, but no effect was seen on the first post-operative day and up to 6 months post-operatively with indices of systolic and diastolic heart function.
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Affiliation(s)
- P. JUHL-OLSEN
- Department of Anaesthesiology and Intensive Care; Aarhus University Hospital; Aarhus Denmark
- Department of Clinical Medicine; Aarhus University; Aarhus Denmark
| | - C.-J. JAKOBSEN
- Department of Anaesthesiology and Intensive Care; Aarhus University Hospital; Aarhus Denmark
| | - L. A. RASMUSSEN
- Department of Anaesthesiology and Intensive Care; Aarhus University Hospital; Aarhus Denmark
| | - R. BHAVSAR
- Department of Anaesthesiology and Intensive Care; Aarhus University Hospital; Aarhus Denmark
| | - K.-E. KLAABORG
- Department of Thoracic and Vascular Surgery; Aarhus University Hospital; Aarhus Denmark
| | - C. A. FREDERIKSEN
- Department of Anaesthesiology and Intensive Care; Aarhus University Hospital; Aarhus Denmark
- Department of Clinical Medicine; Aarhus University; Aarhus Denmark
| | - E. SLOTH
- Department of Anaesthesiology and Intensive Care; Aarhus University Hospital; Aarhus Denmark
- Department of Clinical Medicine; Aarhus University; Aarhus Denmark
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Heschl S, Colantonio C, Pieske B, Toller W. [Perioperative care of patients with diastolic heart failure. Interface to anesthesia]. Anaesthesist 2014; 63:951-7. [PMID: 25501914 DOI: 10.1007/s00101-014-2404-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Diastolic heart failure leads to an increase in perioperative morbidity and mortality. The prevalence of this disease is rising and multiple risk factors have already been identified. Besides higher age and female gender, arterial hypertension, diabetes mellitus and coronary artery disease in particular have to be considered. Clinical examination and laboratory analyses are important for preoperative evaluation; however, echocardiography plays the most important role in the diagnostics of diastolic heart failure. The transmitral flow profile can be used to differentiate the grades of diastolic dysfunction using the ratio between early passive ventricular filling (E) and late active filling due to atrial contraction (A). Data concerning the ideal anesthesia technique are for the most part lacking; however, the application of thoracic epidural anesthesia seems to be beneficial. A great deal of attention has to be paid to the intraoperative volume status of patients with diastolic dysfunction as hypovolemia and hypervolemia can both have detrimental effects. Arrhythmias and major changes in blood pressure put this special group of patients at additional risks.
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Affiliation(s)
- S Heschl
- Universitätsklinik für Anästhesiologie und Intensivmedizin, Klin. Abteilung für Herz-, Thorax-, Gefäßchirurgische Anästhesiologie und Intensivmedizin, Medizinische Universität Graz, Auenbruggerplatz 29, 8036, Graz, Österreich,
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Kidher E, Harling L, Ashrafian H, Naase H, Francis DP, Evans P, Athanasiou T. Aortic stiffness as a marker of cardiac function and myocardial strain in patients undergoing aortic valve replacement. J Cardiothorac Surg 2014; 9:102. [PMID: 24938692 PMCID: PMC4075977 DOI: 10.1186/1749-8090-9-102] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 06/12/2014] [Indexed: 02/01/2023] Open
Abstract
Background Cardiac function and myocardial strain are affected by cardiac afterload, which is in part due to the stiffness of the aortic wall. In this study, we hypothesize that aortic pulse wave velocity (PWV) as a marker of aortic stiffness correlates with conventional clinical and biochemical markers of cardiac function and perioperative myocardial strain in aortic valve replacement (AVR). Methods Patients undergoing AVR for aortic stenosis between June 2010 and August 2012 were recruited for inclusion in this study. PWV, NYHA class and left ventricular (LV) function were assessed pre-operatively. PWV was analysed both as a continuous and dichotomous variable according to age-standardized reference values. B-type natriuretic peptide (BNP) was measured pre-operatively, and at 3 h and 18-24 h after cardiopulmonary bypass (CPB). NYHA class, leg edema, and LV function were recorded at follow-up (409 ± 159 days). Results Fifty-six patients (16 females) with a mean age of 71 ± 8.4 years were included, with 50 (89%) patients completing follow-up. The NYHA class of PWV-norm patients was significantly lower than PWV-high patients both pre- and post-operatively. Multiple logistic regression also highlighted PWV-cut off as an independent predictor of NYHA class pre- and post-operatively (OR 8.3, 95%CI [2.27,33.33] and OR 14.44, 95%CI [1.49,139.31] respectively). No significant relationship was observed between PWV and either LV function or plasma BNP. Conclusion In patients undergoing AVR for aortic stenosis, PWV is independently related to pre- and post-operative NYHA class but not to LV function or BNP. These findings provisionally support the use of perioperative PWV as a non-invasive marker of clinical functional status, which when used in conjunction with biomarkers of myocardial strain such as BNP, may provide a holistic functional assessment of patients undergoing aortic valve surgery. However, in order for PWV assessment to be translated into clinical practice and utilised as more than simply a research tool, further validation is required in the form of larger prospective studies specifically designed to assess the relationship between PWV and these functional clinical outcomes.
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Affiliation(s)
| | - Leanne Harling
- The Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, 10th Floor, QEQM Wing, St Mary's Campus, London W2 1NY, UK.
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Dynamic detection of N-terminal pro-B-type natriuretic peptide helps to predict the outcome of patients with major trauma. Eur J Trauma Emerg Surg 2014; 41:57-64. [PMID: 26038166 DOI: 10.1007/s00068-014-0406-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 05/06/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION NT-proBNP and BNP have been demonstrated to be prognostic markers in cardiac disease and sepsis. However, the prognostic value and the dynamic changes of BNP or NT-proBNP in trauma patients remain unclear. The present study was conducted to investigate the dynamic changes of NT-proBNP in patients with major trauma (injury severity score ≥16), determine whether NT-proBNP could be used as a simple index to predict mortality in major trauma patients. METHODS This prospective observational study included 60 patients with major trauma. Serum NT-proBNP levels were measured on the 1st, 3rd and 7th day after injury The NT-proBNP levels in survivors were compared with those in non-survivors. The efficacy of NT-proBNP to predict survival was analyzed using receiver operating characteristic curves. An analysis of correlations between NT-proBNP and various factors, including injury severity score, Glasgow coma score, acute physiology and chronic health evaluation II, central venous pressure, creatine kinase-MB, cardiac troponin I and procalcitonin (PCT) was performed. NT-proBNP levels in patients with traumatic brain injury were compared with those in patients without traumatic brain injury. A comparison of NT-proBNP levels between patients with and without sepsis was also performed at each time point. RESULTS NT-proBNP levels in non-survivors were significantly higher than those in survivors at all the indicated time points. In the group of non-survivors, NT-proBNP levels on the 7th day were markedly higher than those on the 1st day. In contrast, NT-proBNP levels in survivors showed a reduction over time. The efficacy of NT-proBNP to predict survival was analyzed using ROC curves, and there was no difference in the area under the ROC between NT-proBNP and APACHE II/ISS at the three time points. A significant correlation was found between NT-proBNP and ISS on the 1st day, NT-proBNP and CK-MB, Tn-I and APACHE II on the 3rd day, NT-proBNP and PCT on the 7th day. There were no significant differences in NT-proBNP levels between patients with or without brain trauma at all the indicated time points. NT-proBNP levels in patients with sepsis were significantly higher than those in patients without sepsis at all the indicated time points. CONCLUSION These findings suggest that dynamic detection of serum NT-proBNP might help to predict death in patients with major trauma. A high level of NT-proBNP at admission or maintained for several days after trauma indicates poor survival.
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Gong H, Wang X, Ling Y, Shi Y, Shi H. Prognostic value of brain natriuretic peptide in patients with heart failure and reserved left ventricular systolic function. Exp Ther Med 2014; 7:1506-1512. [PMID: 24926333 PMCID: PMC4043600 DOI: 10.3892/etm.2014.1635] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 03/11/2014] [Indexed: 11/05/2022] Open
Abstract
Brain natriuretic peptide (BNP) is used as a prognostic biomarker for patients with heart failure (HF) in clinical practice, however, the correlation between BNP levels and the prognosis of HF in patients with reserved left ventricular systolic function (RLVSF) is not clear. Thus, the aim of the present study was to evaluate the added value of BNP in the prognosis of HF patients with RLVSF. Inpatients with cardiovascular disease (mean age, 65.7 years; male, 790; female, 625) admitted to the Division of Cardiology at Jinshan Hospital of Fudan University (Shanghai, China) between June 2006 and December 2009 underwent follow-up examinations. Plasma BNP levels were analyzed and measurements of the left ventricular ejection fraction (LVEF) were performed by echocardiography. Evaluations of the patients with HF were performed according to the New York Heart Association (NYHA) classification system. The duration of the follow-up period ranged between 21 and 63 months (average duration, 35.8 months) and key events included cardiovascular mortality, readmission due to cardiovascular disease or mortality due to other reasons. Survival times decreased with increasing BNP levels in all the follow-up patients (Spearman's ρ, -0.1877; P<0.0001). Among the 1,415 patients, 1,312 underwent echocardiographic detection. A total of 395 patients with NYHA classes II-IV and a LVEF ≥45% were selected. The incidence of compound endpoint events was significantly higher in the patients that had BNP levels of >100 pg/ml when compared with the patients that had BNP levels of ≤100 pg/ml (37.07 vs. 23.93%; relative risk, 1.55); consequently the survival times were significantly reduced (P=0.0039). A negative correlation was identified between the BNP levels and the survival times in these patients (Spearman's ρ, -0.1738; P=0.0005). These results indicated that the levels of BNP may be used to predict the prognosis of patients with cardiovascular disease. The prognoses of patients with higher BNP levels were worse compared with the patients with lower BNP levels. Furthermore, significant correlations were confirmed in the HF patients with RLVSF.
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Affiliation(s)
- Hui Gong
- Division of Cardiology, Department of Medicine, Huashan Hospital of Fudan University, Shanghai 200040, P.R. China
| | - Xin Wang
- Division of Cardiology, Department of Medicine, Jinshan Hospital of Fudan University, Shanghai 201508, P.R. China
| | - Yi Ling
- Division of Cardiology, Department of Medicine, Jinshan Hospital of Fudan University, Shanghai 201508, P.R. China
| | - Yijun Shi
- Division of Cardiology, Department of Medicine, Jinshan Hospital of Fudan University, Shanghai 201508, P.R. China
| | - Haiming Shi
- Division of Cardiology, Department of Medicine, Huashan Hospital of Fudan University, Shanghai 200040, P.R. China
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Dynamics of the liver stiffness value using transient elastography during the perioperative period in patients with valvular heart disease. PLoS One 2014; 9:e92795. [PMID: 24670988 PMCID: PMC3966817 DOI: 10.1371/journal.pone.0092795] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 02/25/2014] [Indexed: 12/17/2022] Open
Abstract
Background/Aims Liver congestion due to heart failure in patients with valvular heart disease (VHD) can result in an overestimate of the liver stiffness (LS) as assessed by transient elastography (TE). This prospective pilot study investigated the dynamics of LS during the perioperative valve operation period. Methods Thirty-two patients who underwent a valve operation (case) and 12 who underwent a varicose vein operation (control) were prospectively enrolled. LS and cardiologic parameters at three time points [baseline, post-operative day (POD)7, and POD90] were collected. Results LS at three time points were consistently higher in the case group than those in the control group, although all participants did not show evidence of underlying chronic liver disease (all P<0.05). In the case group, LS at POD7 increased slightly from the LS at baseline (median 7.9→8.4 kPa, P = 0.816), whereas LS at POD90 decreased significantly from the LS at POD7 (median 8.4→6.0 kPa; P = 0.026). LS was significantly correlated with N-terminal-pro brain natriuretic peptide (NT-proBNP) (ρ = 0.412), left ventricular ejection fraction (ρ = −0.494), and central venous pressure during the operation (ρ = 0.555) at baseline (all P<0.05). LS was significantly correlated with NT-proBNP (ρ = 0.526) and right ventricular pressure (ρ = 0.572) at POD7, whereas LS was significantly correlated with NT-proBNP (ρ = 0.590) at POD90 (all P<0.05). Conclusions LS can be overestimated in patients with VHD due to hepatic congestion. However, LS can be dynamically reversed during the perioperative period reflecting the restoration of cardiac function after a successful operation.
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Cappellin E, Gatti R, Antonelli G, Soldà G, Ragazzi E, Palo EFD, Spinella P. Natriuretic peptide fragments as possible biochemical markers of hypertension in the elderly. J Cardiovasc Med (Hagerstown) 2013; 14:308-13. [DOI: 10.2459/jcm.0b013e3283536517] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Jiang K, Shah K, Daniels L, Maisel AS. Review on natriuretic peptides: where we are, where we are going. ACTA ACUST UNITED AC 2013; 2:1137-53. [PMID: 23496424 DOI: 10.1517/17530059.2.10.1137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Tremendous advances have been made in our understanding of the pathophysiology and treatment of congestive heart failure. However, diagnosis of the disease still remains difficult, even with a comprehensive physical examination. Symptoms such as dyspnea are nonspecific and insensitive indicators for heart failure, which can go largely undetected. Several studies have suggested the need for new diagnostic capabilities, especially with the increasing prevalence of heart failure in the US. The discovery of natriuretic peptides as diagnostic biomarkers has been one of the most critical advances for the management of heart failure. Both B-type natriuretic peptide and N-terminal pro-B-type natriuretic peptide have the potential to diagnose heart failure, assess prognostic risk of rehospitalization and mortality, and even help guide treatment. Their relative cost-effectiveness and availability have also facilitated their acceptance into many emergency departments, clinics and in-patient units as standard care when evaluating patients with suspected heart failure. Our understanding of the natriuretic peptide system is still in its infancy, but natriuretic peptides have emerged as important diagnostic and prognostic tools that have generated interest in finding broader applications for their use. OBJECTIVE The purpose of this review is to discuss the clinical approaches and future applications of natriuretic peptides in diagnosing and managing treatment of congestive heart failure. METHOD A comprehensive review of studies to assess the utility of natriuretic peptides for diagnosis and prognosis of heart failure and other conditions. CONCLUSION Natriuretic peptides are powerful tools to aid the physician in the diagnosis, prognosis and management of heart failure in both in-patient and out-patient settings. However, natriuretic peptides should be used as an adjunct test as many circumstances can also influence changes in natriuretic peptide levels.
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Affiliation(s)
- Kevin Jiang
- VA San Diego Medical Center and the University of California, Division of Cardiology, Department of Medicine, VAMC, 3350 La Jolla Village Dr, San Diego, CA 92161, USA +1 858 552 8585 ; +1 858 552 7490 ;
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Kurtzwald-Josefson E, Hochhauser E, Katz G, Porat E, Seidman JG, Seidman CE, Chepurko Y, Shainberg A, Eldar M, Arad M. Exercise training improves cardiac function and attenuates arrhythmia in CPVT mice. J Appl Physiol (1985) 2012; 113:1677-83. [PMID: 23042908 DOI: 10.1152/japplphysiol.00818.2012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a lethal ventricular arrhythmia evoked by physical or emotional stress. Recessively inherited CPVT is caused by either missense or null-allele mutations in the cardiac calsequestrin (CASQ2) gene. It was suggested that defects in CASQ2 cause protein deficiency and impair Ca(2+) uptake to the sarcoplasmic reticulum and Ca(2+)-dependent inhibition of ryanodine channels, leading to diastolic Ca(2+) leak, after-depolarizations, and arrhythmia. To examine the effect of exercise training on left ventricular remodeling and arrhythmia, CASQ2 knockout (KO) mice and wild-type controls underwent echocardiography and heart rhythm telemetry before and after 6 wk of training by treadmill exercise. qRT-PCR and Western blotting were used to measure gene and protein expression. Left ventricular fractional shortening was impaired in KO (33 ± 5 vs. 51 ± 7% in controls, P < 0.05) and improved after training (43 ± 12 and 51 ± 9% in KO and control mice, respectively, P = nonsignificant). The exercise tolerance was low in KO mice (16 ± 1 vs. 29 ± 2 min in controls, P < 0.01), but improved in trained animals (26 ± 2 vs. 30 ± 3 min, P = nonsignificant). The hearts of KO mice had a higher basal expression of the brain natriuretic peptide gene. After training, the expression of natriuretic peptide genes markedly decreased, with no difference between KO and controls. Exercise training was not associated with a change in ventricular tachycardia prevalence, but appeared to reduce arrhythmia load, as manifested by a decrease in ventricular beats during stress. We conclude that, in KO mice, which recapitulate the phenotype of human CPVT2, exercise training is well tolerated and could offer a strategy for heart conditioning against stress-induced arrhythmia.
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Affiliation(s)
- Efrat Kurtzwald-Josefson
- Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Corsetti R, Lombardi G, Barassi A, Lanteri P, Colombini A, D'Eril GM, Banfi G. Cardiac indexes, cardiac damage biomarkers and energy expenditure in professional cyclists during the Giro d'Italia 3-weeks stage race. Biochem Med (Zagreb) 2012; 22:237-46. [PMID: 22838189 PMCID: PMC4062341 DOI: 10.11613/bm.2012.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction The study of cardiac response to strenuous and continuous exercise is crucial to understanding the physiology of endurance. N-terminal proB-type natriuretic peptide (NT-proBNP) is a potential marker for monitoring myocardial wall stress, and troponins (TnT and TnI) are widely used in the diagnosis of cardiac ischemia and infarction. Strenuous exercise may generate transitory ischemia, myocardial stress, and diastolic left ventricular dysfunction, inducing the increased production of both these biomarkers. We measured changes in NT-proBNP and TnT in elite cyclists during a 3-week stage race, a model of strenuous exercise. Materials and methods: The study population was 9 professional cyclists participating in the 2011 Giro d’Italia. Pre-analytical and analytical phases scrupulously followed official recommendations. Anthropometric data, net energy expenditure and cardiac indexes (rate, diastolic and systolic blood pressure) were recorded. Blood samples were drawn pre-race (day −1) and at days 12 and 22; NT-proBNP and highly sensitive-troponin (Hs-TnT) concentrations were assayed and corrected for plasma volume changes. Results: Body-mass index decreased and energy expenditure increased by 52% during the race. NT-proBNP concentrations increased [day −1: 23.52 ng/L (9.67–34.33); day 12: 63.46 ng/L (22.15–93.31); P = 0.039; day 22: 89.26 ng/L (34.66–129.78) vs. day −1; P < 0.001] and correlated with heart rate (r = −0.51; P = 0.006), systolic pressure (r = 0.39; P = 0.046) and energy expenditure (r = 0.70; P < 0.001). TnT concentrations did not vary, but a widened TnT amplitude distribution was observed. Conclusions: Increases in NT-proBNP correlated with higher energy expenditure over a 3-week cycling stage race, possibly indicating myocardial stress.
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Affiliation(s)
- Roberto Corsetti
- Liquigas-Cannondale Pro-cycling Team, Medical Board, Faenza, Italia
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Prakaschandra DR, Esterhuizen T, Naidoo DP. The time-course changes of NT-proBNP and tissue Doppler indices in patients undergoing mitral valve replacement. Cardiovasc J Afr 2012; 23:200-5. [PMID: 22614663 PMCID: PMC3721922 DOI: 10.5830/cvja-2011-057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Accepted: 09/15/2011] [Indexed: 11/09/2022] Open
Abstract
Background In severe mitral regurgitation, a subset of patients who are asymptomatic may develop left ventricular decompensation before changes in echocardiographic parameters become evident. Since N-terminal brain natriuretic peptide (NT-proBNP) is used to detect early heart failure, we hypothesised that NT-proBNP would be activated in patients with mitral regurgitation. Methods Patients submitted to surgery were prospectively evaluated over eight months in the Department of Cardiology at Inkosi Albert Luthuli Central Hospital. Control patients with severe mitral regurgitation were obtained from the outpatient clinic. In order to define their value in identifying left ventricular decompensation, NT-proBNP levels and tissue Doppler imaging (TDI) indices were simultaneously measured and compared with conventional echocardiographic indices at baseline and this was repeated at one week and at six weeks after valve replacement. Results Mean NT-proBNP levels were markedly elevated pre-operatively in all surgical cases compared to controls (p = 0.0001). The diastolic E-mitral/E-annulus ratio, measured using TDI, was higher in the study group, indicating higher left ventricular filling pressure present in the study group. NT-proBNP levels increased further at one week after surgery and subsided at the six-week follow-up visit to levels similar to the control group. The TDI diastolic ratio also decreased at one week, and increased slightly again at the six-week follow up. These changes were accompanied by significant reduction in left atrium and left ventricular chamber dimensions with an increase in the ejection fraction from one to six weeks. Conclusion Marked differences in mean NT-proBNP levels and TDI ratios between the study and control groups suggest that using TDI and NT-proBNP assays may detect covert left ventricular decompensation.
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Affiliation(s)
- D R Prakaschandra
- Department of Biomedical and Clinical Technology, Durban University of Technology, University of KwaZulu-Natal, Durban, South Africa.
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The N-terminal pro-B-type natriuretic peptide as a predictor of disease progression in patients with pericardial effusion. Int J Cardiol 2012; 157:192-6. [DOI: 10.1016/j.ijcard.2010.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Revised: 11/23/2010] [Accepted: 12/04/2010] [Indexed: 11/23/2022]
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Aydemir O, Aydemir C, Sarikabadayi YU, Altug N, Erdeve O, Uras N, Oguz SS, Dilmen U. The role of plasma N-terminal pro-B-type natriuretic peptide in predicting the severity of transient tachypnea of the newborn. Early Hum Dev 2012; 88:315-9. [PMID: 21955499 DOI: 10.1016/j.earlhumdev.2011.08.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 08/11/2011] [Accepted: 08/19/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND/AIM Transient tachypnea of the newborn (TTN) is a consequence of inadequate neonatal lung fluid clearance. Natriuretic peptides play an important role in the regulation of extracellular fluid volume. The aim of the study was to investigate the relation between plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and TTN, and to find out its role in predicting disease severity. METHODS A prospective controlled study involving 67 infants with TTN and 33 controls ≥34 weeks gestational age was conducted. Study and control groups were compared for plasma NT-proBNP levels measured on the 6th, 24th, 72nd and 120th hours of life. Cardiac systolic functions were evaluated by echocardiography. RESULTS NT-proBNP levels were significantly higher in neonates with TTN compared to controls at 6th, 24th, 72nd and 120th hours (p<0.001). NT-proBNP levels at 24th and 72nd hours were significantly higher in infants with prolonged tachypnea (p=0.007 and p=0.03) and in those who required respiratory support (p=0.006 and p<0.001). Tachypnea duration was correlated with NT-proBNP levels at 24h (r=0.41, p=0.001). At a cut-off value of 6575 pg/ml, NT-proBNP had a sensitivity of 85% and specificity of 64% to predict mechanical ventilation requirement. Cardiac systolic functions were normal in all TTN patients. CONCLUSION Plasma NT-proBNP levels are increased in neonates with TTN. Measurement of plasma NT-proBNP can be useful for predicting infants who will have prolonged tachypnea and mechanical ventilation requirement.
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Affiliation(s)
- Ozge Aydemir
- Department of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey.
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ZHANG JUN, ZHAO GUANGDAN, YU XIAOLING, PAN XIAOMING. Intravenous diuretic and vasodilator therapy reduce plasma brain natriuretic peptide levels in acute exacerbation of chronic obstructive pulmonary disease. Respirology 2012; 17:715-20. [DOI: 10.1111/j.1440-1843.2012.02162.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Takatsuki S, Wagner BD, Ivy DD. B-type natriuretic peptide and amino-terminal pro-B-type natriuretic peptide in pediatric patients with pulmonary arterial hypertension. CONGENIT HEART DIS 2012; 7:259-67. [PMID: 22325151 DOI: 10.1111/j.1747-0803.2011.00620.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES B-type natriuretic peptide (BNP) and the amino-terminal fragment (NTproBNP) correlate with clinical variables, but have not been simultaneously studied in a large number of pediatric patients with pulmonary arterial hypertension (PAH). The purpose of our investigation was to compare BNP and NTproBNP with clinical indicators of disease in a pediatric PAH population for which biomarkers are much needed. DESIGN We retrospectively compared BNP and NTproBNP levels with exercise capacity, echocardiographic data, and hemodynamics in PAH patients under 21 years old. Two hundred sixty-three blood samples from 88 pediatric PAH patients were obtained, with BNP and NTproBNP drawn at the same time. RESULTS There was a correlation between BNP and NTproBNP with mean pulmonary arterial pressure/mean systemic arterial pressure ratio (r= 0.40, P < .01; r= 0.45, P < .01; respectively), mean right atrial pressure (r= 0.48, P < .01; r= 0.48, P < .01), and tricuspid regurgitant velocity (r= 0.36, P < .01; r= 0.41, P < .01). BNP and NTproBNP are associated with 6-minute walk distance, mean pulmonary arterial pressure, mean pulmonary arterial pressure/mean systemic arterial pressure ratio, mean right atrial pressure, pulmonary vascular resistance index, and tricuspid regurgitant velocity when investigated longitudinally. On the average, a 1-unit increase in log BNP or NTproBNP was associated with 4.5 units × m(2) or 3.4 units × m(2) increase in pulmonary vascular resistance index, respectively. There was a strong correlation between log BNP and log NTproBNP measurements (r= 0.87, P < .01). CONCLUSION In pediatric PAH, BNP and NTProBNP are strongly correlated and predict changes in clinical variables and hemodynamics. In a cross-sectional analysis, NTproBNP correlated with echocardiographic and exercise data better than BNP; NTproBNP showed less within patient variability over time; therefore, NTproBNP can add additional information toward predicting these clinical measurements.
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Affiliation(s)
- Shinichi Takatsuki
- Department of Pediatrics, University of Colorado Denver School of Medicine, Children's Hospital Colorado, Aurora, CO 80045, USA.
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Abstract
The New Hip Thing: Flying halfway around the globe for a new hip. Diagnostics & Cardiovascular Disease - Helping to Curtail Rising Numbers. Frequent Monitoring of Atrial Fibrillation Patients and Anticoagulants. Eco-friendlily Yours: The Way Forward. TauRx enters collaborative R&D agreement with Bayer Schering Pharma. Major New Asean Health and Well-Being Study.
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Tasevska-Dinevska G, Kennedy L, Cline-Iwarson A, Cline C, Erhardt L, Willenheimer R. Gender differences in variables related to B-natriuretic peptide, left ventricular ejection fraction and mass, and peak oxygen consumption, in patients with heart failure. Int J Cardiol 2011; 149:364-71. [DOI: 10.1016/j.ijcard.2010.02.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2009] [Revised: 01/25/2010] [Accepted: 02/10/2010] [Indexed: 10/19/2022]
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Masaki Y, Shimada K, Kojima T, Miyauchi K, Inoue K, Kiyanagi T, Hiki M, Fukao K, Hirose K, Ohsaka H, Kume A, Miyazaki T, Ohmura H, Ohsaka A, Daida H. Clinical significance of the measurements of plasma N-terminal pro-B-type natriuretic peptide levels in patients with coronary artery disease who have undergone elective drug-eluting stent implantation. J Cardiol 2011; 57:303-10. [DOI: 10.1016/j.jjcc.2011.01.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Revised: 01/23/2011] [Accepted: 01/29/2011] [Indexed: 11/25/2022]
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Moses EJ, Mokhtar SA, Hamzah A, Abdullah BS, Yusoff NM. Usefulness of N-Terminal-Pro-B-Type Natriuretic Peptide as a Screening Tool for Identifying Pediatric Patients With Congenital Heart Disease. Lab Med 2011. [DOI: 10.1309/lmw0u87cothxgelf] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Talha S, Charloux A, Enache I, Piquard F, Geny B. Mechanisms involved in increased plasma brain natriuretic peptide after heart transplantation. Cardiovasc Res 2011; 89:273-281. [DOI: 10.1093/cvr/cvq331] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
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Battal F, Ermis B, Aktop Z, Can M, Demirel F. Early cardiac abnormalities and serum N-terminal pro B-type natriuretic peptide levels in obese children. J Pediatr Endocrinol Metab 2011; 24:723-6. [PMID: 22145463 DOI: 10.1515/jpem.2011.285] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate early cardiac abnormalities in obese children by the conventional echocardiography and to verify whether N-terminal pro B-type natriuretic peptide (NT-proBNP) differ between obese and healthy children. METHODS We started this study with 68 obese children and 35 healthy controls matched for age and sex. Body mass index (BMI) was calculated. Children with a BMI > or = 95th percentile were considered obese. Thirty children in the obese group were also diagnosed with metabolic syndrome, according to the International Diabetes Federation criteria. Standard echocardiographic study was performed on each patient and control subject. Diastolic filling parameters were evaluated using pulsed-wave tissue Doppler method. Blood samples were taken at 8 a.m. to study blood biochemistry tests, including insulin, lipids, glucose, and NT-proBNP. Serum NT-proBNP levels were measured by a solid-phase, enzyme-labeled chemiluminescent immunometric assay. Homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. Children with HOMA-IR > 3.16 were considered insulin-resistant. RESULTS There were diastolic filling abnormalities in obese children, as shown by a decreased mitral valve early filling (E) wave/late filling (A) ratio and a prolongation in E-wave deceleration time. The levels of NT-proBNP were not statistically different among the groups. The levels of NT-proBNP were not different between obese children with and without metabolic syndrome, those with and without hypertension, and those with and without insulin resistance, respectively. CONCLUSION Although there were diastolic filling abnormalities in obese children, their NT-proBNP levels were not different from healthy controls. It seems that there is no diagnostic value in NT-proBNP levels between obese children and healthy controls.
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Affiliation(s)
- Fatih Battal
- Department of Pediatrics, Karaelmas University, Zonguldak, Turkey
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Beleigoli A, Diniz M, Nunes M, Barbosa M, Fernandes S, Abreu M, Ribeiro A. Reduced brain natriuretic peptide levels in class III obesity: the role of metabolic and cardiovascular factors. Obes Facts 2011; 4:427-32. [PMID: 22248992 PMCID: PMC6444748 DOI: 10.1159/000335174] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Brain natriuretic peptide (BNP) has potent lipolytic action and, probably, a role in the biological mechanisms of obesity. Clinically, high levels are found in subjects with heart failure (HF). Low levels and inverse relation to BMI lead to questioning of its clinical utility in obese subjects, but heterogeneous results are found in severe obesity. METHODS In order to describe BNP behavior and its metabolic and cardiovascular determinants in class III obesity, we performed BNP measurement as well as clinical and echocardiographic evaluation of 89 subjects from two public hospitals in Brazil. Multivariate logistic ordinal regression with BNP tertiles as the dependent variable was performed. RESULTS Mean (± SD) age and BMI (± SD) was 44 ± 11.5 years and 53.2 ± 7.9 kg/m(2), respectively. 72 (81%) participants were women, and 18 (20%) had HF. Median BNP was 9.5 pg/ml(Q1 4.9; Q3 21.2 pg/ml). 30% of BNP values were below the detection limit of the method. In multivariate analysis, left atrial volume (LAV) was the only determinant of BNP levels (p 0.002) with odds-ratio of 1.1 (95% CI 1.03-1.16). CONCLUSION BNP levels are low in severe obesity, even in subjects with HF. LAV, which marks diastolic dysfunction, determines BNP levels, but not BMI and metabolic abnormalities.
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Kanlop N, Shinlapawittayatorn K, Sungnoon R, Weerateerangkul P, Chattipakorn S, Chattipakorn N. Cilostazol attenuates ventricular arrhythmia induction and improves defibrillation efficacy in swine. Can J Physiol Pharmacol 2010; 88:422-8. [PMID: 20555410 DOI: 10.1139/y09-127] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Previous reports demonstrated that cilostazol, a phosphodiesterase 3 inhibitor, affected cellular electrophysiology and reduced episodes of ventricular fibrillation (VF) in patients with Brugada syndrome. However, its effects on VF induction and defibrillation efficacy have never been investigated. We tested the hypothesis that cilostazol increases the VF threshold (VFT) and decreases the upper limit of vulnerability (ULV) and the defibrillation threshold (DFT). A total of 48 pigs were randomly assigned to defibrillation and VF induction studies. The diastolic pacing threshold (DPT), VFT, ULV, DFT, and effective refractory period were determined before and after the infusion of cilostazol at 6 mg/kg, 3 mg/kg, or vehicle. The DPT was significantly increased after administration of 3 and 6 mg/kg cilostazol. The ULV and DFT were significantly decreased after administration of 6 mg/kg cilostazol only. The ULV in the 6 mg/kg group had 12% lower peak voltage and 25% lower total energy, and the DFT had 13% lower peak voltage and 25% lower total energy. The VFT was not altered in any experimental group. This study shows that cilostazol administration significantly increased the DPT, which was associated with significantly reduced DFT and ULV.
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Affiliation(s)
- Natnicha Kanlop
- Cardiac Electrophysiology Unit, Department of Physiology, and Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Feola M, Valeri L, Menditto E, Nervo E, Bianco F, Aspromonte N, Valle R, Visconti G. Comparison between immunoradiometric and fluorimetric brain natriuretic peptide determination in patients with congestive heart failure. J Endocrinol Invest 2010; 33:554-8. [PMID: 20160469 DOI: 10.1007/bf03346647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
UNLABELLED This study compared two different methods, namely the immunoradiometric (IRMA) and fluorimetric (FIA), in order to determine plasma brain natriuretic peptide (BNP) in congestive heart failure (CHF) patients. METHODS CHF in-patients underwent echocardiography and plasma BNP determination using both two methods. The echocardiograms analysed left ventricular end-systolic (LVESV) and end-diastolic (LVEDV) volumes and systolic dysfunction [left ventricular ejection fraction (LVEF) <50%]. RESULTS Seventy-three (71% males, age 67 ± 9.6 yr) patients were enrolled, 31.5% affected by valvular heart disease. The mean LVEF was 39.8 ± 14.1%; in 26 (35%) a hypertensive etiology emerged. The immunoradiometric assay (IRMA) BNP was found to be significantly lower than the FIA determination 116.5 ± 149 pg/ml vs 267.3 ± 285.6 pg/ml; p=0.0001) and the two methods were closely correlated (r=0.89; p=0.00001). Logistic regression demonstrated a significant correlation between BNP, LVEF, and LVESV/LVEDV (r=-0.45, p=0.0003; r=-0.48, p=0.00001; r=0.22 p=0.003; r=0.34 p=0.0001; r=0.13 p=0.02; r=0.28 p=0.001 IRMA and FIA, respectively). IRMA BNP and FIA BNP significantly increased according to the worsening functional class [from 34.3 ± 60.2 pg/ml in NYHA (New York Heart Association) I to 555.5 ± 273.1 pg/ml in NYHA IV; from 86.1 ± 162.1 pg/ml in NYHA I to 1070 ± 42.2 pg/ml in NYHA IV, respectively]. In severe systolic dysfunction (LVEF<30%), receiver operating characteristic analysis revealed a satisfactorily sensitivity and specificity using a cut-off point of 50.6 pg/ml with IRMA and 243 pg/ml with FIA. In mild systolic dysfunction (LVEF<50%), a good sensitivity and specificity using a cut-off point of 42 pg/ml with IRMA and 182 pg/ml with FIA emerged. CONCLUSIONS In CHF patients both BNP methods correlated with NYHA class, LVEF, and ventricular volumes.
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Affiliation(s)
- M Feola
- Cardiovascular Rehabilitation-Heart Failure Unit, SS. Trinità Hospital, Via Ospedale 4, 12045 Fossano, Italy.
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