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Pascual-Figal DA, Hernández-Vicente A, Pastor-Pérez F, Martínez-Sellés M, Solé-González E, Alvarez-García J, García-Pavía P, Varela-Román A, Sánchez PL, Delgado JF, Noguera-Velasco JA, Bayes-Genis A. N-terminal pro-B-type natriuretic peptide post-discharge monitoring in the management of patients with heart failure and preserved ejection fraction - a randomized trial: The NICE study. Eur J Heart Fail 2024. [PMID: 38606524 DOI: 10.1002/ejhf.3222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/26/2024] [Accepted: 03/17/2024] [Indexed: 04/13/2024] Open
Abstract
AIMS There is a lack of specific studies assessing the impact of natriuretic peptide monitoring in the post-discharge management of patients with heart failure (HF) and preserved ejection fraction (HFpEF), throughout the vulnerable phase following acute HF hospitalization. The NICE study aims to assess the clinical benefit of incorporating N-terminal pro-B-type natriuretic peptide (NT-proBNP) into the post-discharge management of HFpEF patients. METHODS AND RESULTS Individuals admitted with HFpEF (left ventricular ejection fraction >50%) were included in a multicentre randomized controlled study employing an open-label design with event blinding (NCT02807168). Upon discharge, 157 patients were randomly allocated to either NT-proBNP monitoring (n = 79) or no access to NT-proBNP (control group, n = 78) during pre-scheduled visits at 2, 4 and 12 weeks. Clinical endpoints were evaluated at 6 months. The primary endpoint of HF rehospitalizations occurred in 12.1% patients, without significant differences observed between the NT-proBNP monitoring group (12.8%) and the control group (11.4%) (hazard ratio [HR] 1.15, 95% confidence interval [CI] 0.47-2.81, p = 0.760). Regarding secondary endpoints, the NT-proBNP monitoring group demonstrated a significantly lower risk of death (1.3% vs. 10.1%; HR 0.12, 95% CI 0.02-0.09), whereas non-HF hospitalizations (12.8% vs. 19.0%, p = 0.171) and any adverse clinical event (26.9% vs. 36.7%, p = 0.17) did not reach statistical significance. Awareness of NT-proBNP levels were associated with higher doses of diuretics and renin-angiotensin system inhibitors (angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers) in the NT-proBNP monitoring group. CONCLUSIONS Post-discharge monitoring of NT-proBNP in HFpEF patients did not exhibit an association with reduced rates of HF hospitalization in this study. Nonetheless, it appears to enhance global clinical management by optimizing medical therapies and contributing to improved overall survival.
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Affiliation(s)
- Domingo A Pascual-Figal
- Hospital Virgen de la Arrixaca, Universidad de Murcia, IMIB-Pascual Parrilla, Murcia, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- CIBERCV, Madrid, Spain
| | | | - Francisco Pastor-Pérez
- Hospital Virgen de la Arrixaca, Universidad de Murcia, IMIB-Pascual Parrilla, Murcia, Spain
- CIBERCV, Madrid, Spain
| | - Manuel Martínez-Sellés
- CIBERCV, Madrid, Spain
- Hospital Gregorio Marañón, Universidad Europea, Universidad Complutense, Madrid, Spain
| | | | | | - Pablo García-Pavía
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- CIBERCV, Madrid, Spain
- Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, Madrid, Spain
| | - Alfonso Varela-Román
- CIBERCV, Madrid, Spain
- Hospital Clínico Universitario de Santiago, A Coruña, Spain
| | - Pedro Luis Sánchez
- CIBERCV, Madrid, Spain
- Hospital Clinico de Salamanca-IBSAL, Universidad de Salamanca, Salamanca, Spain
| | - Juan F Delgado
- CIBERCV, Madrid, Spain
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Jose A Noguera-Velasco
- Hospital Virgen de la Arrixaca, Universidad de Murcia, IMIB-Pascual Parrilla, Murcia, Spain
| | - Antoni Bayes-Genis
- CIBERCV, Madrid, Spain
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
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Said F, Arnott C, Voors AA, Heerspink HJL, Ter Maaten JM. Prediction of new-onset heart failure in patients with type 2 diabetes derived from ALTITUDE and CANVAS. Diabetes Obes Metab 2024. [PMID: 38584567 DOI: 10.1111/dom.15592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/16/2024] [Accepted: 03/21/2024] [Indexed: 04/09/2024]
Abstract
AIM To create and validate a prediction model to identify patients with type 2 diabetes (T2D) at high risk of new-onset heart failure (HF), including those treated with a sodium-glucose cotransporter-2 (SGLT2) inhibitor. METHODS A prediction model was developed from the Aliskiren Trial in Type 2 Diabetes Using Cardiorenal Endpoints (ALTITUDE), a trial in T2D patients with albuminuria or cardiovascular disease. We included 5081 patients with baseline N-terminal pro B-type natriuretic peptide (NT-proBNP) measurement and no history of HF. The model was developed using Cox regression and validated externally in the placebo arm of the Canagliflozin Cardiovascular Assessment Study (CANVAS), which included 996 participants with T2D and established cardiovascular disease or high cardiovascular risk, and in patients treated with canagliflozin. RESULTS ALTITUDE participants (mean age 64 ± 9.8 years) had a median serum NT-proBNP level of 157 (25th-75th percentile 70-359) pg/mL. Higher NT-proBNP level, troponin T (TnT) level and body mass index (BMI) emerged as significant and independent predictors of new-onset HF in both cohorts. The model further contained urinary albumin-to-creatinine ratio, glycated haemoglobin, age, haematocrit, and use of calcium channel blockers. A prediction model including these variables had a C-statistic of 0.828 (95% confidence interval [CI] 0.801-0.855) in ALTITUDE and 0.800 (95% CI 0.720-0.880) in CANVAS. The C-statistic of this model increased to 0.847 (95% CI 0.792-0.902) in patients after 1 year of canagliflozin treatment. CONCLUSION In patients with T2D, higher NT-proBNP level, TnT level and BMI are independent and externally validated predictors of new-onset HF, including patients using an SGLT2 inhibitor. This newly developed model may identify patients at high risk of new-onset HF, contributing to early recognition and possibly prevention.
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Affiliation(s)
- Fatema Said
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Clare Arnott
- The George Institute for Global Health, Sydney, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Adriaan A Voors
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hiddo J L Heerspink
- The George Institute for Global Health, Sydney, Australia
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jozine M Ter Maaten
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Ferrannini G, Benson L, Lautsch D, Dahlström U, Lund LH, Savarese G, Carrero JJ. N-terminal pro-B-type natriuretic peptide concentrations, testing and associations with worsening heart failure events. ESC Heart Fail 2024; 11:759-771. [PMID: 38115625 DOI: 10.1002/ehf2.14613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/23/2023] [Accepted: 11/16/2023] [Indexed: 12/21/2023] Open
Abstract
AIMS In patients with heart failure (HF), we aimed to assess (i) the time trends in N-terminal pro-B-type natriuretic peptide (NT-proBNP) testing; (ii) patient characteristics associated with NT-proBNP testing; (iii) distribution of NT-proBNP levels, focusing on the subgroups with (WHFE) vs. without (NWHFE) a worsening HF event, defined as an HF hospitalization; and (iv) changes of NT-proBNP levels over time. METHODS AND RESULTS NT-proBNP testing and levels were investigated in HF patients enrolled in the Swedish Heart Failure Registry (SwedeHF) linked with the Stockholm CREAtinine Measurements project from January 2011 to December 2018. Index date was the first registration in SwedeHF. Patterns of change in NT-proBNP levels before (in the previous 6 ± 3 months) and after (in the following 6 ± 3 months) the index date were categorized as follows: (i) <3000 ng/L at both measurements = stable low; (ii) <3000 ng/L at the first measurement and ≥3000 ng/L at the second measurement = increased; (iii) ≥3000 ng/L at the first measurement and <3000 ng/L at the second measurement = decreased; and (iv) ≥3000 ng/L at both measurements = stable high. Univariable and multivariable logistic regression models, expressed as odds ratios (ORs) and 95% confidence intervals (95% CIs), were performed to assess the associations between (i) clinical characteristics and NT-proBNP testing and (ii) changes in NT-proBNP from 6 months prior to the index date and the index date and a WHFE. Consistency analyses were performed in HF with reduced ejection fraction (HFrEF) alone. A total of 4424 HF patients were included (median age 74 years, women 34%, HFrEF 53%), 33% with a WHFE. NT-proBNP testing increased over time, up to 55% in 2018, and was almost two-fold as frequent, and time to testing was less than half, in patients with WHFE vs. NWHFE. Independent predictors of testing were WHFE, higher heart rate, diuretic use, and preserved ejection fraction. Median NT-proBNP was 3070 ng/L (Q1-Q3: 1220-7395), approximately three-fold higher in WHFE vs. NWHFE. Compared with stable low NT-proBNP levels, increased (OR 4.27, 95% CI 2.47-7.37) and stable high levels (OR 2.48, 95% CI 1.58-3.88) were independently associated with a higher risk of WHFE. Results were consistent in the HFrEF population. CONCLUSIONS NT-proBNP testing increased over time but still was only performed in half of the patients. Testing was associated with a WHFE, with features of more severe HF and for differential diagnosis purposes. Increased and stable high levels were associated with a WHFE. Overall, our data highlight the potential benefits of carrying further implementation of NT-proBNP testing in clinical practice.
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Affiliation(s)
- Giulia Ferrannini
- Division of Cardiology, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Norrbacka S1:02, SE-17176, Stockholm, Sweden
- Internal Medicine Unit, Södertälje Hospital, Södertälje, Sweden
| | - Lina Benson
- Division of Cardiology, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Norrbacka S1:02, SE-17176, Stockholm, Sweden
| | | | - Ulf Dahlström
- Division of Cardiology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Lars H Lund
- Division of Cardiology, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Norrbacka S1:02, SE-17176, Stockholm, Sweden
- Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Norrbacka S1:02, SE-17176, Stockholm, Sweden
- Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Juan Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Garcia-Pavia P, Grogan M, Kale P, Berk JL, Maurer MS, Conceição I, Di Carli M, Solomon SD, Chen C, Yureneva E, Vest J, Gillmore JD. Impact of vutrisiran on exploratory cardiac parameters in hereditary transthyretin-mediated amyloidosis with polyneuropathy. Eur J Heart Fail 2024; 26:397-410. [PMID: 38321786 DOI: 10.1002/ejhf.3138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/10/2023] [Accepted: 12/31/2023] [Indexed: 02/08/2024] Open
Abstract
AIMS HELIOS-A was a Phase 3, open-label study of vutrisiran, an RNA interference therapeutic, in patients with hereditary transthyretin (ATTRv) amyloidosis with polyneuropathy. This analysis evaluated vutrisiran's impact on exploratory cardiac endpoints in HELIOS-A patients. METHODS AND RESULTS Patients were randomized 3:1 to subcutaneous vutrisiran 25 mg every 3 months or intravenous patisiran 0.3 mg/kg every 3 weeks (reference group) for 18 months. Exploratory cardiac endpoints included change from baseline in N-terminal prohormone of brain-type natriuretic peptide (NT-proBNP) and echocardiographic parameters versus external placebo (APOLLO study). The modified intent-to-treat (mITT) population comprised randomized patients receiving any study drug (n = 122). A cardiac subpopulation with evidence of cardiac amyloid involvement (n = 40) was prespecified. 99mTc scintigraphy exploratory assessments in a planned vutrisiran-treated cohort at select sites were compared with baseline. At Month 18, vutrisiran demonstrated beneficial effects on NT-proBNP versus external placebo in the mITT and cardiac subpopulations (adjusted geometric mean fold change ratio [95% confidence interval] 0.480 [0.383-0.600], p = 9.606 × 10-10 and 0.491 [0.337-0.716], p = 0.0004, respectively). Benefits or trends towards benefit in echocardiographic parameters versus external placebo were observed for both populations. In 99mTc scintigraphy assessments, 32/47 (68.1%) and 31/48 (64.6%) patients exhibited reduced normalized left ventricular total uptake and heart-to-contralateral lung ratio, respectively. Perugini grade was reduced or unchanged versus baseline in 55/57 (96.5%) evaluable patients. No increase in cardiac adverse events was observed with vutrisiran versus external placebo. CONCLUSIONS Vutrisiran demonstrated evidence of potential benefit on cardiac manifestations in patients with ATTRv amyloidosis with polyneuropathy, with an acceptable safety profile.
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Affiliation(s)
- Pablo Garcia-Pavia
- Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- Universidad Francisco de Vitoria (UFV), Pozuelo de Alarcon, Spain
| | - Martha Grogan
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Parag Kale
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, TX, USA
| | - John L Berk
- Amyloidosis Center, Boston Medical Center, Boston University, Boston, MA, USA
| | - Mathew S Maurer
- Division of Cardiology, Department of Medicine, Center for Advanced Cardiac Care, Columbia University Irving Medical Center, New York, NY, USA
| | - Isabel Conceição
- Centro Hospitalar Universitário Lisboa Norte, Hospital de Santa Maria and Faculdade de Medicina, Lisbon, Portugal
| | - Marcelo Di Carli
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA
| | | | | | - John Vest
- Alnylam Pharmaceuticals, Cambridge, MA, USA
| | - Julian D Gillmore
- National Amyloidosis Centre, University College London, Royal Free Hospital, London, UK
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van der Vaart A, Bakker SJL, Laverman GD, van Dijk PR, de Borst MH. NT-proBNP Mediates the Association Between FGF23 and All-Cause Mortality in Individuals With Type 2 Diabetes. J Am Heart Assoc 2023; 12:e031873. [PMID: 38014662 PMCID: PMC10727346 DOI: 10.1161/jaha.123.031873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/27/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND FGF23 (fibroblast growth factor 23) is associated with a higher mortality risk in type 2 diabetes, but the mechanism is unclear. We aimed to study whether NT-proBNP (N-terminal pro-brain natriuretic peptide) mediates the association between FGF23 and mortality. METHODS AND RESULTS We analyzed C-terminal FGF23 and NT-proBNP levels in 399 patients with type 2 diabetes. Cox regression analyses were performed, followed by mediation analyses using Structural Equation Modeling. During follow-up of 9.2 [7.6-11.3] years, 117 individuals died. FGF23 was associated with all-cause mortality, independent of potential confounders (fully adjusted hazard ratio [HR], 2.32 [95% CI, 1.21-4.43], P=0.01). The association was lost upon further adjustment for NT-proBNP (HR, 1.84; 95% CI, 0.91-3.73). NT-proBNP accounted for 26% of the mediation effect between FGF23 and all-cause mortality. CONCLUSIONS These findings suggest that a higher FGF23 level is associated with increased mortality in individuals with type 2 diabetes through an effect on volume homeostasis.
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Affiliation(s)
- Amarens van der Vaart
- Department of Internal Medicine, Division of NephrologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
- Department of Internal Medicine, Division of EndocrinologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - Stephan J. L. Bakker
- Department of Internal Medicine, Division of NephrologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - Gozewijn D. Laverman
- Division of Nephrology, Department of Internal MedicineZiekenhuisgroep TwenteHengeloThe Netherlands
| | - Peter R. van Dijk
- Department of Internal Medicine, Division of EndocrinologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - Martin H. de Borst
- Department of Internal Medicine, Division of NephrologyUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
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Chaikijurajai T, Demirjian S, Tang WHW. Prognostic Value of Natriuretic Peptide Levels for Adverse Renal Outcomes in Patients With Moderate to Severe Acute Kidney Injury With or Without Heart Failure. J Am Heart Assoc 2023; 12:e031453. [PMID: 37889206 PMCID: PMC10727411 DOI: 10.1161/jaha.123.031453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/04/2023] [Indexed: 10/28/2023]
Abstract
Background Natriuretic peptides have been recommended as biomarkers for the diagnosis and prognosis of patients with heart failure and are often elevated in the setting of acute kidney injury. We sought to demonstrate the associations between increased baseline NT-proBNP (N-terminal pro-B-type natriuretic peptide) and adverse renal outcomes in patients with moderate-to-severe acute kidney injury. Methods and Results We reviewed electronic medical records of consecutive patients with acute kidney injury stage 2 and 3 admitted to the Cleveland Clinic between September 2011 and December 2021. Patients with NT-proBNP levels collected before renal consultation or dialysis initiation were included. Adverse renal outcomes included dialysis requirement and dialysis dependence defined as patients undergoing dialysis within 72 hours before hospital discharge or in-hospital mortality. In our study cohort (n=3811), 2521 (66%) patients underwent dialysis, 1619 (42%) patients became dialysis dependent, and 1325 (35%) patients had in-hospital mortality. After adjusting for cardiorenal risk factors, compared with the lowest quartile, the highest quartile of NT-proBNP (≥18 215 pg/mL) was associated with increased likelihood of dialysis requirement (adjusted odds ratio [OR], 2.36 [95% CI, 1.87-2.99]), dialysis dependence (adjusted OR, 1.89 [95% CI, 2.53-1.34]), and in-hospital mortality (adjusted OR, 1.34 [95% CI, 1.01-1.34]). Conclusions Increased NT-proBNP was associated with an increased risk of dialysis requirement, becoming dialysis dependent, and in-hospital mortality in patients with moderate-to-severe acute kidney injury.
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Affiliation(s)
- Thanat Chaikijurajai
- Kaufman Center for Heart Failure Treatment and RecoveryHeart Vascular and Thoracic Institute, Cleveland ClinicClevelandOH
- Department of MedicineUniversity of Minnesota Medical SchoolMinneapolisMN
| | - Sevag Demirjian
- Glickman Urological and Kidney Institute, Cleveland ClinicClevelandOH
| | - W. H. Wilson Tang
- Kaufman Center for Heart Failure Treatment and RecoveryHeart Vascular and Thoracic Institute, Cleveland ClinicClevelandOH
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Fang M, Wang D, Tang O, McEvoy JW, Echouffo-Tcheugui JB, Christenson RH, Selvin E. Subclinical Cardiovascular Disease in US Adults With and Without Diabetes. J Am Heart Assoc 2023:e029083. [PMID: 37254959 PMCID: PMC10381986 DOI: 10.1161/jaha.122.029083] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Background We characterized the burden and prognostic value of subclinical cardiovascular disease (CVD) assessed by cardiac biomarkers among adults with and without diabetes in the general US population. Methods and Results We measured hs-cTnT (high-sensitivity cardiac troponin T) and NT-proBNP (N-terminal pro-B-type natriuretic peptide) in stored serum samples from the 1999 to 2004 National Health and Nutrition Examination Survey. Among US adults without a history of CVD (n=10 304), we estimated the prevalence of elevated hs-cTnT (≥14 ng/L) and NT-proBNP (≥125 pg/mL) in those with and without diabetes. We examined the associations between elevated hs-cTnT and NT-proBNP with all-cause and CVD mortality after adjustment for demographics and traditional CVD risk factors. The crude prevalence of subclinical CVD (elevated hs-cTnT or NT-proBNP) was ≈2 times higher in adults with (versus without) diabetes (33.4% versus 16.1%). After age adjustment, elevated hs-cTnT, but not elevated NT-proBNP, was more common in those with diabetes, overall and across age, sex, race and ethnicity, and weight status. The prevalence of elevated hs-cTnT was significantly higher in those with longer diabetes duration and worse glycemic control. In persons with diabetes, elevated hs-cTnT and NT-proBNP were independently associated with all-cause mortality (adjusted hazard ratio [HR], 1.77 [95% CI, 1.33-2.34] and HR, 1.78 [95% CI, 1.26-2.51]) and CVD mortality (adjusted HR, 1.54 [95% CI, 0.83-2.85] and HR, 2.46 [95% CI, 1.31-4.60]). Conclusions Subclinical CVD affects ≈1 in 3 US adults with diabetes and confers substantial risk for mortality. Routine testing of cardiac biomarkers may be useful for assessing and monitoring risk in persons with diabetes.
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Affiliation(s)
| | - Dan Wang
- Johns Hopkins University Baltimore MD
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8
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Abstract
Background We recently reported aberrant processing and localization of the precursor PNC (pro-N-cadherin) protein in failing heart tissues and detected elevated PNC products in the plasma of patients with heart failure. We hypothesize that PNC mislocalization and subsequent circulation is an early event in the pathogenesis of heart failure, and therefore circulating PNC is an early biomarker of heart failure. Methods and Results In collaboration with the Duke University Clinical and Translational Science Institute's MURDOCK (Measurement to Understand Reclassification of Disease of Cabarrus and Kannapolis) study, we queried enrolled individuals and sampled 2 matched cohorts: a cohort of individuals with no known heart failure at the time of serum collection and no heart failure development in the following 13 years (n=289, cohort A) and a matching cohort of enrolled individuals who had no known heart failure at the time of serum collection but subsequently developed heart failure within the following 13 years (n=307, cohort B). Serum PNC and NT-proBNP (N-terminal pro B-type natriuretic peptide) concentrations in each population were quantified by ELISA. We detected no significant difference in NT-proBNP rule-in or rule-out statistics between the 2 cohorts at baseline. In participants who developed heart failure, serum PNC is significantly elevated relative to those who did not report development of heart failure (P<0.0001). Receiver operating characteristic analyses of PNC demonstrate diagnostic value for subclinical heart failure. Additionally, PNC has diagnostic potential when comparing participants with no reported heart failure risk factors from cohort A to at-risk participants from cohort B over the 13-year follow-up. Participants whose PNC levels measure >6 ng/mL have a 41% increased risk of all-cause mortality independent of age, body mass index, sex, NT-proBNP, blood pressure, previous heart attack, and coronary artery disease (P=0.044, n=596). Conclusions These data suggest that PNC is an early marker of heart failure and has the potential to identify patients who would benefit from early therapeutic intervention.
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Affiliation(s)
| | | | - Ishaan Puranam
- Department of Biomedical Engineering Duke University Pratt School of Engineering Durham NC
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Stein EJ, Fearon WF, Elmariah S, Kim JB, Kapadia S, Kumbhani DJ, Gillam L, Whisenant B, Quader N, Zajarias A, Welt FG, Bavry AA, Coylewright M, Piana RN, Mallugari RR, Clark DE, Patel JN, Gonzales H, Gupta DK, Vatterott A, Jackson N, Huang S, Lindman BR. Left Ventricular Hypertrophy and Biomarkers of Cardiac Damage and Stress in Aortic Stenosis. J Am Heart Assoc 2022; 11:e023466. [PMID: 35301869 PMCID: PMC9075421 DOI: 10.1161/jaha.121.023466] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Left ventricular hypertrophy (LVH) is associated with increased mortality risk and rehospitalization after transcatheter aortic valve replacement among those with severe aortic stenosis. Whether cardiac troponin (cTnT) and NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) risk stratify patients with aortic stenosis and without LVH is unknown. Methods and Results In a multicenter prospective registry of 923 patients with severe aortic stenosis undergoing transcatheter aortic valve replacement, we included 674 with core‐laboratory‐measured LV mass index, cTnT, and NT‐proBNP. LVH was defined by sex‐specific guideline cut‐offs and elevated biomarker levels were based on age and sex cut‐offs. Adjusted Cox proportional hazards models evaluated associations between LVH and biomarkers and all‐cause death out to 5 years. Elevated cTnT and NT‐proBNP were present in 82% and 86% of patients with moderate/severe LVH, respectively, as compared with 66% and 69% of patients with no/mild LVH, respectively (P<0.001 for each). After adjustment, compared with no/mild LVH, moderate/severe LVH was associated with an increased hazard of mortality (adjusted hazard ratio [aHR], 1.34; 95% CI 1.01–1.77, P=0.043). cTnT and NT‐proBNP each risk stratified patients with moderate/severe LVH (P<0.05). In a model with both biomarkers and LVH included, elevated cTnT (aHR, 2.08; 95% CI 1.45–3.00, P<0.001) and elevated NT‐proBNP (aHR, 1.46; 95% CI 1.00–2.11, P=0.049) were each associated with increased mortality risk, whereas moderate/severe LVH was not (P=0.15). Conclusions Elevations in circulating cTnT and NT‐proBNP are more common as LVH becomes more pronounced but are also observed in those with no/minimal LVH. As measures of maladaptive remodeling and cardiac injury, cTnT and NT‐proBNP predict post‐transcatheter aortic valve replacement mortality better than LV mass index. These findings may have important implications for risk stratification and treatment of patients with aortic stenosis.
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Affiliation(s)
- Elliot J Stein
- Department of Medicine Vanderbilt University Medical Center Nashville TN
| | - William F Fearon
- Division of Cardiology Department of Medicine Stanford Medical Center Palo Alto CA
| | - Sammy Elmariah
- Division of Cardiology Department of Medicine Massachusetts General Hospital Boston MA
| | - Juyong B Kim
- Division of Cardiology Department of Medicine Stanford Medical Center Palo Alto CA
| | - Samir Kapadia
- Division of Cardiology Department of Medicine Cleveland Clinic Foundation Cleveland OH
| | - Dharam J Kumbhani
- Division of Cardiology Department of Medicine University of Texas Southwestern Medical Center Dallas TX
| | - Linda Gillam
- Division of Cardiology Department of Medicine Morristown Medical Center Morristown NJ
| | - Brian Whisenant
- Division of Cardiology Department of Medicine Intermountain Heart Institute Murray UT
| | - Nishath Quader
- Division of Cardiology Department of Medicine Barnes-Jewish Hospital St. Louis MO
| | - Alan Zajarias
- Division of Cardiology Department of Medicine Barnes-Jewish Hospital St. Louis MO
| | - Frederick G Welt
- Division of Cardiology Department of Medicine University of Utah Hospital Salt Lake City UT
| | - Anthony A Bavry
- Division of Cardiology Department of Medicine University of Texas Southwestern Medical Center Dallas TX
| | - Megan Coylewright
- Department of Cardiovascular Medicine The Erlanger Heart and Lung Institute Chattanooga TN
| | - Robert N Piana
- Division of Cardiology Department of Medicine Vanderbilt University Medical Center Nashville TN
| | - Ravinder R Mallugari
- Division of Cardiology Department of Medicine Vanderbilt University Medical Center Nashville TN
| | - Daniel E Clark
- Division of Cardiology Department of Medicine Vanderbilt University Medical Center Nashville TN
| | - Jay N Patel
- Division of Cardiology Department of Medicine Vanderbilt University Medical Center Nashville TN
| | - Holly Gonzales
- Division of Cardiology Department of Medicine Vanderbilt University Medical Center Nashville TN
| | - Deepak K Gupta
- Division of Cardiology Department of Medicine Vanderbilt University Medical Center Nashville TN
| | - Anna Vatterott
- Division of Cardiology Department of Medicine Barnes-Jewish Hospital St. Louis MO
| | - Natalie Jackson
- Division of Cardiology Department of Medicine Vanderbilt University Medical Center Nashville TN.,Structural Heart and Valve Center Vanderbilt University Medical Center Nashville TN
| | - Shi Huang
- Department of Biostatistics Vanderbilt University School of Medicine Nashville TN
| | - Brian R Lindman
- Division of Cardiology Department of Medicine Vanderbilt University Medical Center Nashville TN.,Structural Heart and Valve Center Vanderbilt University Medical Center Nashville TN
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10
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O'Donnell C, Ashland MD, Vasti EC, Lu Y, Chang AY, Wang P, Daniels LB, de Lemos JA, Morrow DA, Rodriguez F, O'Brien CG. N-Terminal Pro-B-Type Natriuretic Peptide as a Biomarker for the Severity and Outcomes With COVID-19 in a Nationwide Hospitalized Cohort. J Am Heart Assoc 2021; 10:e022913. [PMID: 34889112 PMCID: PMC9075235 DOI: 10.1161/jaha.121.022913] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Currently, there is limited research on the prognostic value of NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) as a biomarker in COVID‐19. We proposed the a priori hypothesis that an elevated NT‐proBNP concentration at admission is associated with increased in‐hospital mortality. Methods and Results In this prospective, observational cohort study of the American Heart Association’s COVID‐19 Cardiovascular Disease Registry, 4675 patients hospitalized with COVID‐19 were divided into normal and elevated NT‐proBNP cohorts by standard age‐adjusted heart failure thresholds, as well as separated by quintiles. Patients with elevated NT‐proBNP (n=1344; 28.7%) were older, with more cardiovascular risk factors, and had a significantly higher rate of in‐hospital mortality (37% versus 16%; P<0.001) and shorter median time to death (7 versus 9 days; P<0.001) than those with normal values. Analysis by quintile of NT‐proBNP revealed a steep graded relationship with mortality (7.1%–40.2%; P<0.001). NT‐proBNP was also associated with major adverse cardiac events, intensive care unit admission, intubation, shock, and cardiac arrest (P<0.001 for each). In subgroup analyses, NT‐proBNP, but not prior heart failure, was associated with increased risk of in‐hospital mortality. Adjusting for cardiovascular risk factors with presenting vital signs, an elevated NT‐proBNP was associated with 2‐fold higher adjusted odds of death (adjusted odds ratio [OR], 2.23; 95% CI, 1.80–2.76), and the log‐transformed NT‐proBNP with other biomarkers projected a 21% increased risk of death for each 2‐fold increase (adjusted OR, 1.21; 95% CI, 1.08–1.34). Conclusions Elevated NT‐proBNP levels on admission for COVID‐19 are associated with an increased risk of in‐hospital mortality and other complications in patients with and without heart failure.
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Affiliation(s)
- Christian O'Donnell
- Department of Anesthesiology, Perioperative, and Pain Medicine Stanford University School of Medicine Stanford CA.,Department of Medicine Stanford University School of Medicine Stanford CA
| | - Melanie D Ashland
- Stanford Cancer Institute Stanford University School of Medicine Stanford CA
| | - Elena C Vasti
- Department of Medicine Stanford University School of Medicine Stanford CA
| | - Ying Lu
- Stanford Cancer Institute Stanford University School of Medicine Stanford CA.,Department of Biomedical Data Science Stanford University School of Medicine Stanford CA
| | - Andrew Y Chang
- Division of Cardiovascular Medicine The Stanford Prevention Research Center The Cardiovascular Institute Stanford University School of Medicine Stanford CA
| | - Paul Wang
- Division of Cardiovascular Medicine The Stanford Prevention Research Center The Cardiovascular Institute Stanford University School of Medicine Stanford CA
| | - Lori B Daniels
- Division of Cardiovascular Medicine University of California San Diego CA
| | - James A de Lemos
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
| | - David A Morrow
- Cardiovascular Division Department of Medicine Brigham and Women's HospitalHarvard Medical School Boston MA
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine The Stanford Prevention Research Center The Cardiovascular Institute Stanford University School of Medicine Stanford CA
| | - Connor G O'Brien
- Division of Cardiovascular Medicine University of California San Francisco San Francisco CA
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11
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Amin A, Eftekhar SP, Ziaie N, Roudbari S, Salehi P, Jalali F, Jafaripour I, Ghaffari S, Mohseni Salehi M, Ebadi R. Clinically suspected myocarditis in COVID-19 patients: Case series and review of the literature. Clin Case Rep 2021; 9:e05236. [PMID: 34963812 PMCID: PMC8710561 DOI: 10.1002/ccr3.5236] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/19/2021] [Accepted: 12/09/2021] [Indexed: 12/14/2022] Open
Abstract
This Study describes eleven patients positive for severe acute respiratory syndrome coronavirus 2. In our cases, females and younger patients developed more severe disease. In contrast, improvement in left ventricular ejection fraction and N-terminal prohormone brain natriuretic peptide within the first week of treatment contributed to promising outcomes.
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Affiliation(s)
- Ahmad Amin
- Rajaie Cardiovascular Medical and Research CenterIran University of Medical SciencesTehranIran
| | | | - Naghmeh Ziaie
- Department of CardiologyBabol University of Medical SciencesBabolIran
| | - Soudeh Roudbari
- Rajaie Cardiovascular Medical and Research CenterIran University of Medical SciencesTehranIran
| | - Pegah Salehi
- Rajaie Cardiovascular Medical and Research CenterIran University of Medical SciencesTehranIran
| | - Farzad Jalali
- Department of CardiologyBabol University of Medical SciencesBabolIran
| | - Iraj Jafaripour
- Department of CardiologyBabol University of Medical SciencesBabolIran
| | - Sanaz Ghaffari
- Department of CardiologyShiraz University of Medical SciencesShirazIran
| | - Maryam Mohseni Salehi
- Department of CardiologyAhvaz Jundishapur University of Medical SciencesAndimeshkIran
| | - Reza Ebadi
- Department of CardiologyShiraz University of Medical SciencesShirazIran
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12
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Rahsepar AA, Bluemke DA, Habibi M, Liu K, Kawel-Boehm N, Ambale-Venkatesh B, Fernandes VRS, Rosen BD, Lima JAC, Carr JC. Association of Pro-B-Type Natriuretic Peptide With Cardiac Magnetic Resonance-Measured Global and Regional Cardiac Function and Structure Over 10 Years: The MESA Study. J Am Heart Assoc 2021; 10:e019243. [PMID: 33821688 PMCID: PMC8174164 DOI: 10.1161/jaha.120.019243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) is widely used to diagnose and manage patients with heart failure. We aimed to investigate associations between NT‐proBNP levels and development of global and regional myocardial impairment, dyssynchrony, and risk of developing myocardial scar over time. Methods and Results We included 2416 adults (45–84 years) without baseline clinical cardiovascular disease from MESA (Multi‐Ethnic Study of Atherosclerosis). NT‐proBNP was assessed at baseline (2000–2002). Cardiac magnetic resonance–measured left ventricular parameters were assessed at baseline and year 10 (2010–2012). Tagged cardiac magnetic resonance and myocardial dyssynchrony were assessed. We used linear and logistic regression models to study the relationships between quartiles of NT‐proBNP levels and outcome variables. Left ventricular parameters decreased over time. After 10‐year follow‐up and adjusting for cardiovascular disease risk factors, people in the highest quartile had significantly greater decline in left ventricular ejection fraction (−1.60%; 95% CI, −2.26 to −0.94; P<0.01) and smaller decline in left ventricular end systolic volume index (−0.47 mL/m2; 95% CI, −1.18 to 0.23; P<0.01) compared with those in the lowest quartile. Individuals in the highest quartile had more severe risk factor adjusted global, mid, and apical regional dyssynchrony compared with those in the lowest, second, and third quartiles (all P‐trend<0.05). Compared with the lowest‐quartile group, the adjusted odds ratios for having myocardial scar was 1.3 (95% CI, 0.7–2.2) for quartile 2; 1.2 (95% CI, 0.6–2.3) for quartile 3; and 2.7 (95% CI, 1.4–5.5) for quartile 4 (P‐trend=0.012) for the total sample. Conclusions Among participants without baseline clinical cardiovascular disease, higher baseline NT‐proBNP concentration was significantly associated with subclinical changes in developing myocardial dysfunction, more severe cardiac dyssynchrony, and higher odds of having myocardial scar over a 10‐year period independent of traditional cardiovascular disease risk factors.
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Affiliation(s)
- Amir Ali Rahsepar
- Department of Radiology Feinberg School of Medicine Northwestern University Chicago IL.,Department of Radiology Yale New-Haven HealthBridgeport Hospital Bridgeport CT
| | - David A Bluemke
- Department of Radiology University of Wisconsin, School of Medicine and Public Health Madison WI
| | | | - Kiang Liu
- Department of Preventive Medicine Feinberg School of Medicine Northwestern University Chicago IL
| | - Nadine Kawel-Boehm
- Department of Radiology Kantonsspital Graubuenden Chur Switzerland.,Institute for Diagnostic Interventional and Pediatric Radiology (DIPR) Inselspital Bern University HospitalUniversity of Bern Switzerland
| | | | | | - Boaz D Rosen
- Department of Cardiology Johns Hopkins University Baltimore MD
| | - Joao A C Lima
- Department of Cardiology Johns Hopkins University Baltimore MD
| | - James C Carr
- Department of Radiology Feinberg School of Medicine Northwestern University Chicago IL
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13
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Allen CJ, Joseph J, Patterson T, Hammond-Haley M, McConkey HZR, Prendergast BD, Marber M, Redwood SR. Baseline NT-proBNP Accurately Predicts Symptom Response to Transcatheter Aortic Valve Implantation. J Am Heart Assoc 2020; 9:e017574. [PMID: 33241754 PMCID: PMC7763793 DOI: 10.1161/jaha.120.017574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Up to 30% of patients undergoing transcatheter aortic valve implantation (TAVI) experience minimal symptomatic benefit or die within 1 year, indicating an urgent need for enhanced patient selection. Previous analyses of baseline NT‐proBNP (N‐terminal pro‐brain natriuretic peptide) and TAVI outcomes have assumed a linear relationship, yielding conflicting results. We reexamined the relationship between baseline NT‐proBNP and symptomatic improvement after TAVI. Methods and Results Symptom status, clinical and echocardiographic data, and baseline NT‐proBNP were reviewed from 144 consecutive patients undergoing TAVI for severe symptomatic aortic stenosis. The primary end point was change in New York Heart Association functional class at 1 year. There was a nonlinear, inverted‐U relationship between log‐baseline NT‐proBNP and post‐TAVI change in NYHA class (R2=0.4559). NT‐proBNP thresholds of <800 and >10 000 ng/L accurately predicted no symptomatic improvement at 1 year (sensitivity 88%, specificity 83%, positive predictive value 72%, negative predictive value 93%). In adjusted analyses, baseline NT‐proBNP outside this “sweet‐spot” range was the only factor independently associated with poor functional outcome (high: NT‐proBNP >10 000 ng/L, odds ratio [OR], 65; 95% CI, 6–664; low: NT‐proBNP <800 ng/L, OR, 73; 95% CI, 7–738). Conclusions Baseline NT‐proBNP is a useful prognostic marker to predict poor symptom relief after TAVI and may indicate when intervention is likely to be futile. Both low (<800 ng/L) and very high (>10 000 ng/L) levels are strongly associated with poor functional outcome, suggesting an alternative cause for symptoms in the former scenario and an irrevocably diseased left ventricle in the latter. Further evaluation of this relationship is warranted.
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Affiliation(s)
- Christopher J Allen
- Cardiovascular Division St. Thomas HospitalKing's College London London United Kingdom.,Department of Cardiology Guys' and St Thomas NHS Foundation Trust London United Kingdom
| | - Jubin Joseph
- Cardiovascular Division St. Thomas HospitalKing's College London London United Kingdom.,Department of Cardiology Guys' and St Thomas NHS Foundation Trust London United Kingdom
| | - Tiffany Patterson
- Cardiovascular Division St. Thomas HospitalKing's College London London United Kingdom.,Department of Cardiology Guys' and St Thomas NHS Foundation Trust London United Kingdom
| | - Matthew Hammond-Haley
- Department of Cardiology Guys' and St Thomas NHS Foundation Trust London United Kingdom
| | - Hannah Z R McConkey
- Cardiovascular Division St. Thomas HospitalKing's College London London United Kingdom.,Department of Cardiology Guys' and St Thomas NHS Foundation Trust London United Kingdom
| | - Bernard D Prendergast
- Department of Cardiology Guys' and St Thomas NHS Foundation Trust London United Kingdom
| | - Michael Marber
- Cardiovascular Division St. Thomas HospitalKing's College London London United Kingdom.,Department of Cardiology Guys' and St Thomas NHS Foundation Trust London United Kingdom
| | - Simon R Redwood
- Cardiovascular Division St. Thomas HospitalKing's College London London United Kingdom.,Department of Cardiology Guys' and St Thomas NHS Foundation Trust London United Kingdom
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14
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Jujić A, Melander O, Nilsson PM, Malan L, Fedorowski A, Magnusson M. NT-proBNP and metabolic risk factors in a bi-ethnic cohort: the Ambulatory Blood Pressure in African prospective cohort study. Cardiovasc J Afr 2020; 31:291-297. [PMID: 33180090 DOI: 10.5830/cvja-2020-017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 06/16/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND We explored the association of N-terminal probrain natriuretic peptide (NT-proBNP) with metabolic traits in a bi-ethnic African-Caucasian cohort. METHODS Baseline examinations of the Sympathetic activity and Ambulatory Blood Pressure in African (SABPA) prospective cohort study were performed between 2008 and 2009, and re-examination after a three-year follow up in South African teachers (black African, n = 194; Caucasian, n = 203). RESULTS Each one standard deviation increment of NT-proBNP was significantly inversely associated with body mass index ( β -1.01), glycated haemoglobin ( β -0.14 %), waist circumference (β -1.82), HOMA-IR (β -0.47), insulin (β -1.66) and triglyceride levels (β -0.04). Each one standard deviation increment of NT-proBNP was also associated with reduced odds of incident diabetes, and subjects within the highest quartile of NT-proBNP were at lowest risk (OR: 0.24; 95% CI: 0.06-0.96; p = 0.041). CONCLUSIONS In the SABPA cohort, Africans and Caucasians had similar NT-proBNP levels; however, the associations for Africans were stronger. Those findings suggest that BNP may affect the propensity for metabolic disturbances differently in Africans and Caucasians.
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Affiliation(s)
- Amra Jujić
- Department of Clinical Sciences, Skane University Hospital, Lund University, Malmö, Sweden; Department of Cardiology, Skane University Hospital, Lund University, Malmö, Sweden.
| | - Olle Melander
- Department of Clinical Sciences, Skane University Hospital, Lund University, Malmö, Sweden; Centre of Emergency Medicine, Skane University Hospital, Malmö, Sweden
| | - Peter M Nilsson
- Department of Clinical Sciences, Skane University Hospital, Lund University, Malmö, Sweden
| | - Leoné Malan
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom Campus, South Africa
| | - Artur Fedorowski
- Department of Clinical Sciences, Skane University Hospital, Lund University, Malmö, Sweden; Department of Cardiology, Skane University Hospital, Lund University, Malmö, Sweden
| | - Martin Magnusson
- Department of Clinical Sciences, Skane University Hospital, Lund University, Malmö, Sweden; Hypertension in Africa Research Team (HART), North-West University, Potchefstroom Campus, South Africa; Department of Cardiology, Skane University Hospital, Lund University, Malmö, Sweden; Wallenberg Centre for Molecular Medicine, Lund University, Malmö, Sweden
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15
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Vaishnav J, Chasler JE, Lee YJ, Ndumele CE, Hu JR, Schulman SP, Russell SD, Sharma K. Highest Obesity Category Associated With Largest Decrease in N-Terminal Pro-B-Type Natriuretic Peptide in Patients Hospitalized With Heart Failure With Preserved Ejection Fraction. J Am Heart Assoc 2020; 9:e015738. [PMID: 32750299 PMCID: PMC7792252 DOI: 10.1161/jaha.119.015738] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Heart failure with preserved ejection fraction (HFpEF) constitutes half of hospitalized heart failure cases and is commonly associated with obesity. The role of natriuretic peptide levels in hospitalized obese patients with HFpEF, however, is not well defined. We sought to evaluate change in NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels by obesity category and related clinical outcomes in patients with HFpEF hospitalized for acute heart failure. Methods and Results A total of 89 patients with HFpEF hospitalized with acute decompensated heart failure were stratified into 3 obesity categories: nonobese (body mass index [BMI] <30.0 kg/m2, 19%), obese (BMI 30.0-39.9 kg/m2, 29%), and severely obese (BMI ≥40.0 kg/m2, 52%), and compared for percent change in NT-proBNP during hospitalization and clinical outcomes. Clinical characteristics were compared between patients with normal NT-proBNP (≤125 pg/mL) and elevated NT-proBNP. Admission NT-proBNP was inversely related to BMI category (nonobese, 2607 pg/mL [interquartile range, IQR: 2112-5703]; obese, 1725 pg/mL [IQR: 889-3900]; and severely obese, 770.5 pg/mL [IQR: 128-1268]; P<0.01). Severely obese patients had the largest percent change in NT-proBNP with diuresis (-64.8% [95% CI, -85.4 to -38.9] versus obese -40.4% [95% CI, -74.3 to -12.0] versus nonobese -46.9% [95% CI, -57.8 to -37.4]; P=0.03). Nonobese and obese patients had significantly worse 1-year survival compared with severely obese patients (63% versus 76% versus 95%, respectively; P<0.01). Patients with normal NT-proBNP (13%) were younger, with higher BMI, less atrial fibrillation, and less structural heart disease than those with elevated NT-proBNP. Conclusions In hospitalized patients with HFpEF, NT-proBNP was inversely related to BMI with the largest decrease in NT-proBNP seen in the highest obesity category. These findings have implications for the role of NT-proBNP in the diagnosis and assessment of treatment response in obese patients with HFpEF.
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Affiliation(s)
- Joban Vaishnav
- Department of Medicine Division of Cardiology Johns Hopkins University School of Medicine Baltimore MD
| | - Jessica E Chasler
- Department of Medicine Division of Cardiology Johns Hopkins University School of Medicine Baltimore MD
| | - Yizhen J Lee
- Department of Medicine Division of Cardiology Johns Hopkins University School of Medicine Baltimore MD
| | - Chiadi E Ndumele
- Department of Medicine Division of Cardiology Johns Hopkins University School of Medicine Baltimore MD
| | - Jiun-Ruey Hu
- Bloomberg School of Public Health Johns Hopkins University Baltimore MD
| | - Steven P Schulman
- Department of Medicine Division of Cardiology Johns Hopkins University School of Medicine Baltimore MD
| | - Stuart D Russell
- Department of Medicine Division of Cardiology Duke University Durham NC
| | - Kavita Sharma
- Department of Medicine Division of Cardiology Johns Hopkins University School of Medicine Baltimore MD
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16
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Whitman IR, Vittinghoff E, DeFilippi CR, Gottdiener JS, Alonso A, Psaty BM, Heckbert SR, Hoogeveen RC, Arking DE, Selvin E, Chen LY, Dewland TA, Marcus GM. NT -pro BNP as a Mediator of the Racial Difference in Incident Atrial Fibrillation and Heart Failure. J Am Heart Assoc 2020; 8:e010868. [PMID: 30912456 PMCID: PMC6509704 DOI: 10.1161/jaha.118.010868] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Blacks harbor more cardiovascular risk factors than whites, but experience less atrial fibrillation (AF). Conversely, whites may have a lower risk of heart failure (CHF). N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) levels are higher in whites, predict incident AF, and have diuretic effects in the setting of increased ventricular diastolic pressures, potentially providing a unifying explanation for these racial differences. Methods and Results We used data from the CHS (Cardiovascular Health Study) to determine the degree to which baseline NT‐proBNP levels mediate the relationships between race and incident AF and CHF by comparing beta estimates between models with and without NT‐proBNP. The ARIC (Atherosclerosis Risk in Communities) study was used to assess reproducibility. Among 4731 CHS (770 black) and 12 418 ARIC (3091 black) participants, there were 1277 and 1253 incident AF events, respectively. Whites had higher baseline NT‐proBNP (CHS: 40% higher than blacks; 95% CI, 29–53; ARIC: 39% higher; 95% CI, 33–46) and had a greater risk of incident AF compared with blacks (CHS: adjusted hazard ratio, 1.60; 95% CI, 1.31–1.93; ARIC: hazard ratio, 1.93; 95% CI, 1.57–2.27). NT‐proBNP levels explained a significant proportion of the racial difference in AF risk (CHS: 36.2%; 95% CI, 23.2–69.2%; ARIC: 24.6%; 95% CI, 14.8–39.6%). Contrary to our hypothesis, given an increased risk of CHF among whites in CHS (adjusted hazard ratio, 1.20; 95% CI, 1.05–1.47) and the absence of a significant association between race and CHF in ARIC (adjusted hazard ratio, 1.07; 95% CI, 0.94–1.23), CHF‐related mediation analyses were not performed. Conclusions A substantial portion of the relationship between race and AF was statistically explained by baseline NT‐proBNP levels. No consistent relationship between race and CHF was observed. See Editorial by Richards
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Affiliation(s)
- Isaac R Whitman
- 1 Section of Cardiac Electrophysiology Lewis Katz School of Medicine at Temple University Philadelphia Pennsylvania USA
| | - Eric Vittinghoff
- 2 Department of Epidemiology and Biostatistics University of California, San Francisco San Francisco California USA
| | | | - John S Gottdiener
- 3 Division of Cardiology University of Maryland Baltimore Maryland USA
| | - Alvaro Alonso
- 4 Department of Epidemiology Rollins School of Public Health Emory University Atlanta Georgia USA
| | - Bruce M Psaty
- 5 Cardiovascular Health Research Unit Departments of Medicine, Epidemiology, and Health Services University of Washington Seattle Washington USA.,6 Kaiser Permanente Washington Health Research Institute Seattle Washington USA
| | - Susan R Heckbert
- 7 Department of Epidemiology University of Washington, School of Public Health Seattle Washington USA
| | - Ron C Hoogeveen
- 8 Division of Atherosclerosis and Vascular Medicine Baylor College of Medicine Houston Texas USA
| | - Dan E Arking
- 9 McKusick-Nathans Institute of Genetic Medicine Johns Hopkins University Baltimore Maryland USA
| | - Elizabeth Selvin
- 10 Division of Cardiovascular and Clinical Epidemiology Johns Hopkins University Baltimore Maryland USA
| | - Lin Y Chen
- 11 Cardiovascular Division University of Minnesota Minneapolis and Saint Paul, Minnesota USA
| | - Thomas A Dewland
- 12 Knight Cardiovascular Institute Oregon Health & Science University Portland Oregon USA
| | - Gregory M Marcus
- 13 Division of Cardiac Electrophysiology University of California, San Francisco San Francisco California USA
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17
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Landry KK, Judd SE, Kleindorfer DO, Howard G, Howard VJ, Zakai NA, Cushman M. N-Terminal pro-B-type natriuretic peptide and stroke risk across a spectrum of cerebrovascular disease: The REasons for Geographic and Racial Differences in Stroke cohort. Res Pract Thromb Haemost 2020; 4:893-901. [PMID: 32685900 PMCID: PMC7354407 DOI: 10.1002/rth2.12365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 04/08/2020] [Accepted: 04/20/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND N-terminal pro-B-type natriuretic peptide (NT-proBNP), a commonly used clinical marker of cardiac function, is associated with the presence of stroke symptoms and is a strong risk factor for future atrial fibrillation, stroke, and all-cause mortality. Few data are available on the association between NT-proBNP levels and stroke recurrence. OBJECTIVE We studied the relationship between NT-proBNP and risk of future ischemic stroke across the continuum of preexisting cerebrovascular conditions: asymptomatic, prior stroke symptoms, prior transient ischemic attack (TIA), and prior stroke. METHODS The Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort enrolled 30,239 black and white Americans aged 45 years and older from 2003 to 2007. With 5.4 years follow-up, baseline NT-proBNP was measured in 892 participants who developed ischemic stroke and a 4328-person cohort random sample. Hazard ratios of stroke by baseline NT-proBNP were calculated in groups based on the presence of prebaseline cerebrovascular conditions. RESULTS In the fully adjusted model, elevated NT-proBNP was associated with stroke risk in participants without a preexisting cerebrovascular condition (hazard ratio [HR], 2.32; 95% confidence interval [CI], 1.84-2.94) and in participants with a history of stroke symptoms (HR, 1.67; 95% CI, 1.01-2.78) or transient ischemic attack (HR, 2.66; 95% CI, 1.00-7.04) but not among those with prior stroke (HR, 1.26; 95% CI, 0.71-2.21). CONCLUSIONS These findings support the potential for NT-proBNP testing to identify people who are at highest risk for future stroke.
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Affiliation(s)
| | - Suzanne E. Judd
- Department of BiostatisticsUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | | | - George Howard
- Department of BiostatisticsUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Virginia J. Howard
- Department of EpidemiologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Neil A. Zakai
- Department of MedicineLarner College of Medicine at the University of VermontBurlingtonVermontUSA
- Department of Pathology and Laboratory MedicineLarner College of Medicine at the University of VermontBurlingtonVermontUSA
| | - Mary Cushman
- Department of MedicineLarner College of Medicine at the University of VermontBurlingtonVermontUSA
- Department of Pathology and Laboratory MedicineLarner College of Medicine at the University of VermontBurlingtonVermontUSA
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18
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Seoudy H, Frank J, Neu M, Güßefeld N, Klaus Y, Freitag-Wolf S, Lambers M, Lutter G, Dempfle A, Rangrez AY, Kuhn C, Frey N, Frank D. Periprocedural Changes of NT-proBNP Are Associated With Survival After Transcatheter Aortic Valve Implantation. J Am Heart Assoc 2020; 8:e010876. [PMID: 30686097 PMCID: PMC6405592 DOI: 10.1161/jaha.118.010876] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Cardiovascular biomarkers constitute promising tools for improved risk stratification and prediction of outcome in patients undergoing transcatheter aortic valve implantation. We examined the association of periprocedural changes of NT‐proBNP (N‐terminal pro–B‐type natriuretic peptide) with survival after transcatheter aortic valve implantation. Methods and Results NT‐proBNP levels were measured in 704 patients before transcatheter aortic valve implantation and at discharge. Patients were grouped as responders and nonresponders depending on an NT‐proBNP–based ratio (postprocedural NT‐proBNP at discharge/preprocedural NT‐proBNP). Overall, 376 of 704 patients showed a postprocedural decrease in NT‐proBNP levels (NT‐proBNP ratio <1). Responders and nonresponders differed significantly regarding median preprocedural (2822 versus 1187 pg/mL, P<0.001) and postprocedural (1258 versus 3009 pg/mL, P<0.001) NT‐proBNP levels. Patients in the nonresponder group showed higher prevalence of atrial fibrillation (47.0% versus 39.4%, P=0.042), arterial hypertension (94.2% versus 87.5%, P=0.002), renal impairment (77.4% versus 69.1%, P=0.013), and peripheral artery disease (24.4% versus 14.6%, P=0.001). In contrast, patients in the responder group had higher prevalence of moderately reduced left ventricular ejection fraction (17.3% versus 11.0%, P=0.017), lower calculated aortic valve area (0.7 versus 0.8 cm2, P<0.001), and higher mean pressure gradient (41 versus 35 mm Hg, P<0.001). Median follow‐up was 22.6 months. Kaplan–Meier analysis showed a highly significant survival benefit for the responder group compared with the nonresponder group (log‐rank test, P<0.001). Conclusions A ratio based on periprocedural changes of NT‐proBNP is a simple tool for better risk stratification and is associated with survival in patients after transcatheter aortic valve implantation.
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Affiliation(s)
- Hatim Seoudy
- 1 Department of Internal Medicine III, Cardiology and Angiology University Hospital Schleswig-Holstein Kiel Germany
| | - Johanne Frank
- 1 Department of Internal Medicine III, Cardiology and Angiology University Hospital Schleswig-Holstein Kiel Germany
| | - Markus Neu
- 1 Department of Internal Medicine III, Cardiology and Angiology University Hospital Schleswig-Holstein Kiel Germany
| | - Nathalie Güßefeld
- 1 Department of Internal Medicine III, Cardiology and Angiology University Hospital Schleswig-Holstein Kiel Germany
| | - Yannic Klaus
- 1 Department of Internal Medicine III, Cardiology and Angiology University Hospital Schleswig-Holstein Kiel Germany
| | - Sandra Freitag-Wolf
- 2 Institute of Medical Informatics and Statistics Kiel University University Hospital Schleswig-Holstein Kiel Germany
| | - Moritz Lambers
- 1 Department of Internal Medicine III, Cardiology and Angiology University Hospital Schleswig-Holstein Kiel Germany.,3 Department of Cardiology and Angiology Contilia Heart and Vascular Centre Elisabeth-Krankenhaus Essen Germany
| | - Georg Lutter
- 4 Department of Cardiovascular Surgery University Hospital Schleswig-Holstein Kiel Germany.,5 DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck Kiel Germany
| | - Astrid Dempfle
- 2 Institute of Medical Informatics and Statistics Kiel University University Hospital Schleswig-Holstein Kiel Germany
| | - Ashraf Yusuf Rangrez
- 1 Department of Internal Medicine III, Cardiology and Angiology University Hospital Schleswig-Holstein Kiel Germany.,5 DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck Kiel Germany
| | - Christian Kuhn
- 1 Department of Internal Medicine III, Cardiology and Angiology University Hospital Schleswig-Holstein Kiel Germany.,5 DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck Kiel Germany
| | - Norbert Frey
- 1 Department of Internal Medicine III, Cardiology and Angiology University Hospital Schleswig-Holstein Kiel Germany.,5 DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck Kiel Germany
| | - Derk Frank
- 1 Department of Internal Medicine III, Cardiology and Angiology University Hospital Schleswig-Holstein Kiel Germany.,5 DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck Kiel Germany
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19
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Salah K, Stienen S, Moons AHM, Bakx ALM, van Pol PE, Kortz RAM, Ferreira JP, Marques I, Schroeder-Tanka JM, Keijer JT, Bayes-Genis A, Pinto YM, Tijssen JG, Kok WE. External Validation of the ELAN-HF Score, Predicting 6-Month All-Cause Mortality in Patients Hospitalized for Acute Decompensated Heart Failure. J Am Heart Assoc 2019; 8:e010309. [PMID: 31296084 PMCID: PMC6662127 DOI: 10.1161/jaha.118.010309] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background Our aim was to calibrate and externally revalidate the ELAN‐HF (European Collaboration on Acute Decompensated Heart Failure) score, to confirm and improve on a previous external validation of the risk score. Methods and Results The ELAN‐HF score predicts 6‐month all‐cause mortality in patients hospitalized for acute decompensated heart failure using absolute and percentage change of NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) levels in addition to clinical variables. For the external validation, we used the PRIMA II (Can NT‐proBNP–Guided Therapy During Hospital Admission for Acute Decompensated Heart Failure Reduce Mortality and Readmissions?) trial. For both data sets, observed versus predicted mortality was compared for the 4 risk categories; and the mean predicted mortality was plotted against the observed mortality with calculation of a correlation coefficient and SEE. The model discriminant ability was determined by comparing the C‐statistics for both data sets. The predicted versus actual 6‐month mortality values in the derivation cohort were 3.7% versus 3.6% for the low‐risk category, 9.4% versus 9.2% for the intermediate‐risk category, 24.2% versus 23.5% for the high‐risk category, and 54.2% versus 51.1% for the very‐high‐risk category. The correlation between predicted and observed mortality by deciles was 0.92, with an SEE of ±4%. In the validation cohort, predicted versus actual 6‐month mortality values were 3.0% versus 2.2% for the low‐risk category, 9.4% versus 8.2% for the intermediate‐risk category, 25.0% versus 22.9% for the high‐risk category, and 56.8% versus 53.6% for the very‐high‐risk category. The correlation between predicted and actual mortality by quintiles was 0.99, with an SEE of ±2%. There was no significant difference in C‐statistic between the derivation cohort (0.78; 95% CI, 0.74–0.82) and the validation cohort (0.77; 95% CI, 0.69–0.84; P=0.693). Conclusions Our study confirms that the ELAN‐HF score predicts accurately 6‐month mortality in patients hospitalized for acute decompensated heart failure with the use of easily obtained characteristics.
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Affiliation(s)
- Khibar Salah
- 1 Heart Center Department of Clinical and Experimental Cardiology Amsterdam Cardiovascular Sciences Amsterdam University Medical Center University of Amsterdam Amsterdam the Netherlands.,2 Department of Radiology and Nuclear Medicine Radboud University Medical Center Nijmegen the Netherlands
| | - Susan Stienen
- 1 Heart Center Department of Clinical and Experimental Cardiology Amsterdam Cardiovascular Sciences Amsterdam University Medical Center University of Amsterdam Amsterdam the Netherlands.,3 INSERM Centre d'Investigations Cliniques Plurithématique Université de Lorraine CHRU de Nancy Nancy France
| | - Andreas H M Moons
- 4 Department of Cardiology Onze Lieve Vrouwe Gasthuis (OLVG) Amsterdam the Netherlands
| | - Adrianus L M Bakx
- 5 Department of Cardiology BovenIJ ziekenhuis Amsterdam the Netherlands
| | - Petra E van Pol
- 6 Department of Cardiology Alrijne ziekenhuis Leiderdorp the Netherlands
| | - R A Mikael Kortz
- 7 Department of Cardiology Flevoziekenhuis Almere the Netherlands
| | - João Pedro Ferreira
- 8 Cardiovascular Research and Development Unit Department of Physiology and Cardiothoracic Surgery Faculty of Medicine University of Porto Porto Portugal.,9 INSERM Centre d'Investigations Cliniques Plurithématique 1433 INSERM U1116 Université de Lorraine CHRU de Nancy F-CRIN INI-CRCT Nancy France
| | - Irene Marques
- 10 Department of Internal Medicine Centro Hospitalar do Porto Instituto de Ciências Biomédicas de Abel Salazar University of Porto Porto Portugal
| | | | - Jan T Keijer
- 12 Department of Cardiology Tergooiziekenhuizen Blaricum the Netherlands
| | - Antoni Bayes-Genis
- 13 Department of Cardiology Hospital Universitari Germans Trias i Pujol Barcelona Spain
| | - Yigal M Pinto
- 1 Heart Center Department of Clinical and Experimental Cardiology Amsterdam Cardiovascular Sciences Amsterdam University Medical Center University of Amsterdam Amsterdam the Netherlands
| | - Jan G Tijssen
- 1 Heart Center Department of Clinical and Experimental Cardiology Amsterdam Cardiovascular Sciences Amsterdam University Medical Center University of Amsterdam Amsterdam the Netherlands
| | - Wouter E Kok
- 1 Heart Center Department of Clinical and Experimental Cardiology Amsterdam Cardiovascular Sciences Amsterdam University Medical Center University of Amsterdam Amsterdam the Netherlands
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20
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Juraschek SP, Daya N, Appel LJ, Miller ER, McEvoy JW, Matsushita K, Ballantyne CM, Selvin E. Orthostatic Hypotension and Risk of Clinical and Subclinical Cardiovascular Disease in Middle-Aged Adults. J Am Heart Assoc 2018; 7:JAHA.118.008884. [PMID: 29735525 PMCID: PMC6015335 DOI: 10.1161/jaha.118.008884] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Although orthostatic hypotension (OH) is a well‐recognized manifestation of neuropathy and hypovolemia, its contribution to cardiovascular disease (CVD) risk is controversial. Methods and Results Participants with OH, defined as a decrease in blood pressure (systolic ≥20 mm Hg or diastolic ≥10 mm Hg) from the supine to standing position, were identified during the first visit of the ARIC (Atherosclerosis Risk in Communities) Study (1987–1989) within 2 minutes of standing. All participants were followed up for the development of myocardial infarction, heart failure, stroke, fatal coronary heart disease (CHD), any CHD (combination of silent, nonfatal, and fatal CHD or cardiac procedures), and all‐cause mortality. Participants were assessed for carotid intimal thickness and plaque during the first visit. Detectable high‐sensitivity troponin T (≥5 ng/L) and elevated NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide; ≥100 pg/mL) were determined in blood collected during the second visit (1990–1992). All associations were adjusted for known CVD risk factors. In 9139 participants (57% women; 23% black; mean age, 54±5.7 years), 3% had OH. During follow‐up (median, 26 years), OH was associated with myocardial infarction (hazard ratio [HR], 1.88; 95% confidence interval [CI], 1.44–2.46), congestive heart failure (HR, 1.65; 95% CI, 1.34–2.04), stroke (HR, 1.83; 95% CI, 1.35–2.48), fatal CHD (HR, 2.77; 95% CI, 1.93–3.98), any CHD (HR, 2.00; 95% CI, 1.64–2.44), and all‐cause mortality (HR, 1.68; 95% CI, 1.45–1.95). OH was also associated with carotid intimal thickness (β, 0.05 mm; 95% CI, 0.04–0.07 mm), carotid plaque (odds ratio, 1.51; 95% CI, 1.18–1.93), detectable high‐sensitivity troponin T (odds ratio, 1.49; 95% CI, 1.16–1.93), and elevated NT‐proBNP (odds ratio, 1.92; 95% CI, 1.48–2.49). Conclusions OH identified in community‐dwelling middle‐aged adults was associated with future CVD events and subclinical CVD. Further research is necessary to establish a causal role for OH in the pathogenesis of CVD.
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Affiliation(s)
- Stephen P Juraschek
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA .,Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, MD.,Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.,The Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, MD.,Johns Hopkins Medical Institutions, Baltimore, MD
| | - Natalie Daya
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, MD.,Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.,Johns Hopkins Medical Institutions, Baltimore, MD
| | - Lawrence J Appel
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, MD.,Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.,Johns Hopkins Medical Institutions, Baltimore, MD
| | - Edgar R Miller
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, MD.,Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.,Johns Hopkins Medical Institutions, Baltimore, MD
| | - John William McEvoy
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, MD.,Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.,Johns Hopkins Medical Institutions, Baltimore, MD
| | - Kunihiro Matsushita
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, MD.,Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.,Johns Hopkins Medical Institutions, Baltimore, MD
| | - Christie M Ballantyne
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX.,Houston Methodist DeBakey Heart and Vascular Center, Houston, TX
| | - Elizabeth Selvin
- Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, MD.,Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.,Johns Hopkins Medical Institutions, Baltimore, MD
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21
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Bettencourt P, Fonseca C, Franco F, Andrade A, Brito D. Interpretation of B-type natriuretic peptides in the era of angiotensin receptor-neprilysin inhibitors. Rev Port Cardiol 2017; 36:881-884. [PMID: 29225105 DOI: 10.1016/j.repc.2017.09.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 09/29/2017] [Indexed: 12/28/2022] Open
Abstract
Assessment of serum levels of natriuretic peptides, especially the amino-terminal portion (NT-proBNP) and the carboxy-terminal portion (BNP) of pro-B-type natriuretic peptide, has had a highly significant clinical impact on the diagnosis and prognostic stratification of patients with heart failure (HF). They are now an instrument with recognized value in this context and several studies have demonstrated their value in tailoring therapy for these patients. Following the recent advent of angiotensin receptor-neprilysin inhibitors (ARNIs), there is a need to review how these two biomarkers are interpreted in HF. The use of ARNIs is associated with a reduction in NT-proBNP but an increase in BNP levels. The authors of this concise article review the interpretation of natriuretic peptide levels in the light of the most recent evidence.
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Affiliation(s)
| | - Cândida Fonseca
- Unidade de Insuficiência Cardíaca, Serviço de Medicina III, H. S. Francisco Xavier, CHLO, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Fátima Franco
- Unidade Tratamento IC Avançada (UTICA), Serviço de Cardiologia, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Aurora Andrade
- Serviço Cardiologia, Hospital Tâmega e Vale Sousa, Penafiel, Portugal
| | - Dulce Brito
- Serviço de Cardiologia, CHLN, CCUL, Centro Académico de Medicina de Lisboa, Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal
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22
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Olesen LL, Andersen A. ECG as a first step in the detection of left ventricular systolic dysfunction in the elderly. ESC Heart Fail 2015; 3:44-52. [PMID: 27774266 PMCID: PMC5061087 DOI: 10.1002/ehf2.12067] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 08/20/2015] [Accepted: 09/07/2015] [Indexed: 11/27/2022] Open
Abstract
Aims Due to the demographic development there is an increasing number of senior citizens with left ventricular systolic dysfunction (LVSD), defined as ejection fraction (EF) < 40%. Unfortunately there are under‐diagnosis and under‐treatment in the elderly of this serious condition. Echocardiography is the gold standard to diagnose LVSD, but access is limited. Simple screening methods may ensure reduction of undetected cases, and this study investigates if electrocardiogram (ECG) can be used to screen for LVSD in the geriatric population. Methods and results A total of 260 persons aged 75 to 92 years had an echocardiography, a 12 leads ECG, and NT‐proBNP; 61 had EF < 40%, and of these 60 had an abnormal ECG. EF < 40% was significantly related to atrial fibrillation (A), pacing (P), LBBB (L), Q‐waves (Q), and QRS duration ≥ 120 ms (D). EF < 40%, atrial fibrillation, pacing, and LBBB were related to NT‐proBNP > 35 pmol/L. When APL was absent, NT‐proBNP had discriminatory value regarding LVSD in the presence of Q‐waves or QRS duration > 120 ms. Algorithms to screen for LVSD had sensitivity >90% and specificity >80% and claimed at least one of five (A/P/L/Q/D), one of 4 (A/P/L/Q), or one of three (A/Q/D) ECG changes. The optimal algorithm to reduce the need for diagnostic echocardiographies included four (A/P/L/Q) ECG changes and measurement of NT‐proBNP when Q‐waves were the only ECG change present. Conclusions Ninety percent of LVSD may be detected, and when there is atrial fibrillation, pacing or LBBB, or QRS ≥ 120 ms/Q‐waves and NT‐proBNP>35 pmol/L, a diagnostic echocardiography should be considered.
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Affiliation(s)
- Line Lisbeth Olesen
- Department of Cardiology Copenhagen University Hospital (Roskilde) and Roskilde Hospital Roskilde Denmark
| | - Andreas Andersen
- Department of Cardiology Copenhagen University Hospital (Roskilde) and Roskilde Hospital Roskilde Denmark
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23
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Schellings DAAM, Adiyaman A, Giannitsis E, Hamm C, Suryapranata H, Ten Berg JM, Hoorntje JCA, Van't Hof AWJ. Early discharge after primary percutaneous coronary intervention: the added value of N-terminal pro-brain natriuretic peptide to the Zwolle Risk Score. J Am Heart Assoc 2014; 3:e001089. [PMID: 25389283 PMCID: PMC4338696 DOI: 10.1161/jaha.114.001089] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background The Zwolle Risk Score (ZRS) identifies ST‐elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PPCI) eligible for early discharge. We aimed to investigate whether baseline N‐terminal pro–brain natriuretic peptide (NT‐proBNP) is also able to identify these patients and could improve future risk strategies. Methods and Results PPCI patients included in the Ongoing Tirofiban in Myocardial Infarction Evaluation (On‐TIME) II study were candidates (N=861). We analyzed whether ZRS and baseline NT‐proBNP predicted 30‐day mortality and assessed the occurrence of major adverse cardiac events (MACEs) and major bleeding. Receiver operating characteristic curve analysis was used to assess discriminative accuracy for ZRS, NT‐pro‐BNP, and their combination. After multiple imputation, 845 patients were included. Both ZRS >3 (hazard ratio [HR]=9.42; P<0.001) and log NT‐pro‐BNP (HR=2.61; P<0.001) values were associated with 30‐day mortality. On multivariate analysis, both the ZRS (HR=1.41; 95% confidence interval [CI]=1.27 to 1.56; P<0.001) and log NT‐proBNP (HR=2.09; 95% CI=1.59 to 2.74; P<0.001) independently predicted death at 30 days. The area under the curve for 30‐day mortality for combined ZRS/NT‐proBNP was 0.94 (95% CI=0.90 to 0.99), with optimal predictive values of a ZRS ≥2 and a NT‐proBNP value of ≥200 pg/mL. Using these cut‐off values, 64% of the study population could be identified as very low risk with zero mortality at 30 days follow‐up and low occurrence of MACEs and major bleeding between 48 hours and 10 days (1.3% and 0.6%, respectively). Conclusion Baseline NT‐proBNP identifies a large group of low‐risk patients who may be eligible for early (48‐ to 72‐hour) discharge, whereas optimal predictive accuracy is reached by the combination of both baseline NT‐proBNP and ZRS.
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Affiliation(s)
- Dirk A A M Schellings
- Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (D.M.S., A.A., H.S., J.A.H., A.J.H.)
| | - Ahmet Adiyaman
- Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (D.M.S., A.A., H.S., J.A.H., A.J.H.)
| | | | - Christian Hamm
- Department of Cardiology, Kerckhoff Klinik, Bad Nauheim, Germany (C.H.)
| | - Harry Suryapranata
- Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (D.M.S., A.A., H.S., J.A.H., A.J.H.) Department of Cardiology, Radboud University, Nijmegen, The Netherlands (H.S.)
| | - Jurrien M Ten Berg
- Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands (J.M.B.)
| | - Jan C A Hoorntje
- Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (D.M.S., A.A., H.S., J.A.H., A.J.H.)
| | - Arnoud W J Van't Hof
- Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands (D.M.S., A.A., H.S., J.A.H., A.J.H.)
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24
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Mishra RK, Beatty AL, Jaganath R, Regan M, Wu AHB, Whooley MA. B-type natriuretic peptides for the prediction of cardiovascular events in patients with stable coronary heart disease: the Heart and Soul Study. J Am Heart Assoc 2014; 3:jah3626. [PMID: 25053234 PMCID: PMC4310375 DOI: 10.1161/jaha.114.000907] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Brain‐type natriuretic peptide (BNP) and the amino‐terminal fragment of its prohormone (NT‐proBNP) are known predictors of cardiovascular outcomes in patients with coronary heart disease; however, the relative prognostic value of these 2 biomarkers for secondary events remains unclear. Methods and Results In 983 participants with stable coronary heart disease, we evaluated the association of BNP and NT‐proBNP with time to hospitalization for heart failure, nonfatal myocardial infarction, stroke or transient ischemic attack, cardiovascular death, and combined major adverse cardiovascular events (MACE). During an average follow‐up of 6.5±3.3 years, both BNP and NT‐proBNP were associated with increased risk of MACE in a multivariable‐adjusted model (hazard ratio per standard deviation of log BNP: 1.58; 95% CI: 1.32 to 1.89; hazard ratio per standard deviation of log NT‐proBNP: 1.84; 95% CI: 1.52 to 2.24). When added to traditional risk factors, NT‐proBNP predicted MACE better than BNP (C statistic: 0.76 versus 0.72, P<0.001). Similarly, the addition of NT‐proBNP resulted in a greater net reclassification improvement for predicting MACE than the addition of BNP (65% for NT‐proBNP, 56% for BNP). Conclusions Both BNP and NT‐proBNP were significant predictors of MACE in stable coronary heart disease; however, NT‐proBNP was superior to BNP for net risk reclassification for MACE.
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Affiliation(s)
- Rakesh K Mishra
- Department of Medicine, University of California, San Francisco, California (R.K.M., A.L.B., R.J., M.A.W.) San Francisco Veterans Affairs Medical Center, San Francisco, California (R.K.M., M.R., M.A.W.)
| | - Alexis L Beatty
- Department of Medicine, University of California, San Francisco, California (R.K.M., A.L.B., R.J., M.A.W.)
| | - Rajesh Jaganath
- Department of Medicine, University of California, San Francisco, California (R.K.M., A.L.B., R.J., M.A.W.)
| | - Mathilda Regan
- San Francisco Veterans Affairs Medical Center, San Francisco, California (R.K.M., M.R., M.A.W.)
| | - Alan H B Wu
- Departments of Pathology & Laboratory Medicine, University of California, San Francisco, California (A.H.W.)
| | - Mary A Whooley
- Department of Medicine, University of California, San Francisco, California (R.K.M., A.L.B., R.J., M.A.W.) San Francisco Veterans Affairs Medical Center, San Francisco, California (R.K.M., M.R., M.A.W.)
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