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High-sensitivity troponin T: a biomarker for diuretic response in decompensated heart failure patients. Cardiol Res Pract 2014; 2014:269604. [PMID: 25247106 PMCID: PMC4163417 DOI: 10.1155/2014/269604] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 08/04/2014] [Indexed: 11/17/2022] Open
Abstract
Background. Patients presenting with acutely decompensated heart failure (ADHF) and positive circulating cardiac troponins were found to be a high-risk cohort. The advent of high-sensitive troponins resulted in a detection of positive troponins in a great proportion of heart failure patients. However, the pathophysiological significance of this phenomenon is not completely clear. Objectives. The aim of this study is to determine the early evolution and clinical significance of high-sensitivity troponin T (hsTnT) in ADHF. Methods. Retrospective, secondary analysis of a prospective study including 100 patients with ADHF. Results. Globally, high-sensitivity troponin T decreased from day 1 to day 3 (P = 0,039). However, in the subgroup of patients who remained decompensated no significant differences in hsTnT from day 1 to day 3 were observed (P = 0,955), whereas in successfully compensated patients a significant reduction in hsTnT levels was observed (P = 0,025). High-sensitivity troponin T decrease was correlated with NTproBNP reduction (P = 0,007). Patients with hsTnT increase had longer length of stay (P = 0,033). Conclusions. Episodes of ADHF are associated with transient increases in the blood levels of hsTnT that are reduced with effective acute episode treatment. The decrease in hsTnT can translate less myocardial damage along with favourable ADHF treatment.
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52
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BNP and NT-proBNP as prognostic markers in persons with acute decompensated heart failure: a systematic review. Heart Fail Rev 2014; 19:453-70. [DOI: 10.1007/s10741-014-9442-y] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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53
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Incremental value of natriuretic peptide measurement in acute decompensated heart failure (ADHF): a systematic review. Heart Fail Rev 2014; 19:507-19. [DOI: 10.1007/s10741-014-9444-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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54
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Ghio S, Alessandrino G, Albertini R, Klersy C, Girardi B, Maggi G, Pazzano AS, Raineri C, Scelsi L, Visconti LO. Prognostic stratification of patients with chronic systolic heart failure using biomarkers and Doppler echocardiography. J Cardiovasc Med (Hagerstown) 2014; 15:470-5. [PMID: 24983266 DOI: 10.2459/jcm.0000000000000034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
AIMS To verify whether a combined assessment of left-ventricular filling pattern at Doppler echocardiography, plasma levels of brain natriuretic peptide (BNP) and high-sensitive troponin I (hsTnI) improves prognostic stratification in patients with chronic systolic heart failure. METHODS Three predictors of prognosis were evaluated in 200 consecutive outpatients with heart failure and left-ventricular ejection fraction 35% or less: left-ventricular filling pattern at Doppler echocardiography, BNP plasma levels and hsTnI plasma levels. RESULTS During a median follow-up period of 44 months, 15 deaths, two urgent cardiac transplantations, two episodes of ventricular fibrillation and 50 heart failure hospitalizations were observed. The end point of survival analysis was the composite of hard events and hospitalization for acute heart failure. At univariable analysis, the E-wave deceleration time at Doppler echocardiography and BNP plasma level on a continuous log-scale were significantly associated with event-free survival, whereas hsTnI plasma level was not statistically significant. A hierarchical multivariable analysis was performed including a restrictive left-ventricular filling pattern at Doppler as the first prognostic indicator; the subsequent addition of BNP plasma levels above 138 pg/ml (median value) and hsTnI above 0.018 ng/ml (median value) did not further improve prognostic stratification. CONCLUSION A restrictive left-ventricular filling pattern at Doppler echocardiography is the most important prognostic indicator in chronic heart failure patients. Plasma levels of BNP and hsTnI do not provide additional relevant information to identify patients at higher risk of cardiovascular outcomes.
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Affiliation(s)
- Stefano Ghio
- aDivisione di Cardiologia bServizio di Analisi Chimico Cliniche cDipartimento di Biometria ed Epidemiologia Clinica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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55
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Marti CN, Georgiopoulou VV, Kalogeropoulos AP. Acute heart failure: patient characteristics and pathophysiology. Curr Heart Fail Rep 2014; 10:427-33. [PMID: 23918642 DOI: 10.1007/s11897-013-0151-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The number of hospitalizations for acute heart failure (HF) continues to increase and it remains the most common discharge diagnosis among Medicare beneficiaries. Prognosis after hospitalization for HF is poor, with high in-hospital mortality and even higher post-discharge mortality and rehospitalization rates. It is a complex clinical syndrome that varies widely with respect to clinical presentation and underlying pathophysiology. This paper reviews what is documented in the literature regarding the known pathophysiologic mechanisms reported in patients hospitalized for HF.
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56
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Felker GM, Hasselblad V, Tang WW, Hernandez AF, Armstrong PW, Fonarow GC, Voors AA, Metra M, McMurray JJ, Butler J, Heizer GM, Dickstein K, Massie BM, Atar D, Troughton RW, Anker SD, Califf RM, Starling RC, O'Connor CM. Troponin I in acute decompensated heart failure: insights from the ASCEND-HF study. Eur J Heart Fail 2014; 14:1257-64. [DOI: 10.1093/eurjhf/hfs110] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- G. Michael Felker
- Duke Clinical Research Institute; Duke University Medical Center; Durham NC 27705 USA
| | - Vic Hasselblad
- Duke Clinical Research Institute; Duke University Medical Center; Durham NC 27705 USA
| | | | - Adrian F. Hernandez
- Duke Clinical Research Institute; Duke University Medical Center; Durham NC 27705 USA
| | | | - Gregg C. Fonarow
- Ahmanson-UCLA Cardiomyopathy Center; Ronald Reagan UCLA Medical Center; Los Angeles CA USA
| | | | - Marco Metra
- Institute of Cardiology; University of Brescia; Brescia Italy
| | | | - Javed Butler
- Cardiology Division; Emory University; Atlanta GA USA
| | - Gretchen M. Heizer
- Duke Clinical Research Institute; Duke University Medical Center; Durham NC 27705 USA
| | | | | | - Dan Atar
- Department of Cardiology; Oslo University Hospital Ulleval; Norway
- Institute for Clinical Medicine; University of Oslo; Norway
| | | | - Stefan D. Anker
- Department of Cardiology, Applied Cachexia Research; Charité Universitätsmedizin; Berlin Germany
- Centre for Clinical and Basic Research; IRCCS San Raffaele; Rome Italy
| | - Robert M. Califf
- Duke Translational Medicine Institute; Duke University Medical Center; Durham NC USA
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57
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Relation between Red Cell Distribution Width and Left Ventricular Function in Children with Heart Failure. ISRN PEDIATRICS 2014; 2014:234835. [PMID: 24660068 PMCID: PMC3934566 DOI: 10.1155/2014/234835] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 01/06/2014] [Indexed: 11/29/2022]
Abstract
Background. Most of the studies done on adults showed that red cell distribution width (RDW) can be used as a prognostic marker in patients with chronic heart failure. However, RDW has not been tested in children with heart failure. Methods and Results. 31 children with heart failure admitted to Cardiology Unit, Tanta University Hospital, during the period of January 2012 to December 2012 were included in this study, RDW as a component of routine blood count was evaluated and correlated to the echocardiographic parameters of left ventricle. The mean age of our cohort was 16.16 ± 14.97 months, congenital heart disease with left-to-right shunt represented 58.1% of the underlying causes of heart failure while dilated cardiomyopathy made 41.9%. The mean hemoglobin level was 9.14 ± 1.18 gm/dL; RDW level ranged from 10.7% to 27.7% with a mean of 16.01 ± 3.34. Hemoglobin was significantly correlated with RDW at any level. For the echo parameters, at cutoff point of 16.4%, RDW was significantly correlated with fraction shortening (FS), and A, E/A ratio, but it was not correlated with LVEDD, LVESD, and E/É at the same cutoff level. Conclusion. RDW, a simple, available test, can be used as a marker for the left ventricular function in children with heart failure until an echocardiography assessment for the patients is done.
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58
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Hanatani S, Izumiya Y, Takashio S, Kimura Y, Araki S, Rokutanda T, Tsujita K, Yamamoto E, Tanaka T, Yamamuro M, Kojima S, Tayama S, Kaikita K, Hokimoto S, Ogawa H. Circulating thrombospondin-2 reflects disease severity and predicts outcome of heart failure with reduced ejection fraction. Circ J 2014; 78:903-10. [PMID: 24500070 DOI: 10.1253/circj.cj-13-1221] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Thrombospondin-2 (TSP-2) is a matricellular protein found in human serum. Deletion of TSP-2 causes age-dependent dilated cardiomyopathy. We hypothesized that TSP-2 is a useful biomarker in patients with heart failure with reduced ejection fraction (HFrEF). METHODS AND RESULTS Serum TSP-2 was measured in 101 patients with HFrEF, and mortality and cardiovascular events were followed. Serum TSP-2 in the HFrEF group was significantly higher than in the non-HF group (n=17). Mean NYHA functional class was significantly higher in the high TSP-2 group (>median) than the low TSP-2 group (2.26 vs. 1.76, P=0.004). Circulating TSP-2 level was significantly associated with that of B-type natriuretic peptide (BNP; r=0.40, P<0.0001) on multivariate linear regression analysis. On Kaplan-Meier curve analysis the high TSP-2 group had a lower event-free rate than the low TSP-2 group (log-rank test, P=0.03). Multivariate Cox hazard analysis identified hemoglobin (hazard ratio [HR], 0.66; 95% confidence interval [CI]: 0.53-0.82, P<0.0001), and TSP-2 (ln[TSP-2]; HR, 3.34; 95% CI: 1.03-10.85, P=0.045) as independent predictors of adverse outcome. The area under the curve for 1-year events increased when TSP-2 was added to Framingham risk score (FRS; alone, 0.60) or BNP (alone, 0.69; FRS+TSP-2, 0.75; BNP+TSP-2, 0.76). CONCLUSIONS TSP-2 is a potentially useful biomarker for assessment of disease severity and prognosis in HFrEF.
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Affiliation(s)
- Shinsuke Hanatani
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences
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59
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Clinical significance of cardiac troponins I and T in acute heart failure. Eur J Heart Fail 2014; 10:772-9. [DOI: 10.1016/j.ejheart.2008.06.009] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2007] [Revised: 04/27/2008] [Accepted: 06/09/2008] [Indexed: 11/21/2022] Open
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60
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Ferreira JP, Santos M, Almeida S, Marques I, Bettencourt P, Carvalho H. Mineralocorticoid receptor antagonism in acutely decompensated chronic heart failure. Eur J Intern Med 2014; 25:67-72. [PMID: 24070521 DOI: 10.1016/j.ejim.2013.08.711] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 08/14/2013] [Accepted: 08/14/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND/OBJECTIVES Mineralocorticoid receptor antagonist (MRA) use in acutely decompensated chronic heart failure (ADCHF) may improve congestion through diuretic effect and prevent neurohormonal activation. We aimed to evaluate the clinical effect and safety of spironolactone in ADCHF. METHODS Prospective, experimental, single-center, and single-blinded trial. Patients were treated with: standard ADCHF therapy or oral spironolactone 50-100mg/d plus standard ADCHF therapy. RESULTS During a 1year period, 100 patients were enrolled, 50 included in the treatment group. Mean (SD) spironolactone dose (mg) at day 1 was 94.5±23.3 and at day 3 was 62.7±24.3. Worsening renal function (increase in pCr≥0.3mg/dL from day 1 to day 3) was more likely to occur in control group (20% vs. 4%; p=0.038), serum potassium did not differ between groups, and plasma NTproBNP had a significant decrease in spironolactone group at day 3 (median [IQR], 2488 [4579] vs. 1555 [1832]; p=0.05). Furthermore, a greater proportion of patients in the treatment group were free of congestion at day 3: less edema, rales, jugular venous pressure (JVP) and orthopnea (all, p<0.05). In addition, a significantly higher proportion of patients were on oral furosemide at day 3 (44% vs. 82%; p<0.001). CONCLUSIONS Our study supports the safety of high dose spironolactone in ADCHF and suggests a positive impact in the resolution of congestion. The important findings of our pilot study need to be confirmed in larger trials.
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Affiliation(s)
| | | | - Sofia Almeida
- Climate Change Impacts, Adaptation and Mitigation Research Group (CC-IAM), Faculdade de Ciências, Universidade de Lisboa, Portugal
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61
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Tachycardia after a heart failure hospitalization: another piece of the puzzle? JACC-HEART FAILURE 2013; 1:497-9. [PMID: 24622001 DOI: 10.1016/j.jchf.2013.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 10/28/2013] [Indexed: 11/24/2022]
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62
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Cardoso G, Aguiar C, Ventosa A, Rebocho MJ, Borges Santos M, Dores H, Adragão P, Mendes M. A rare case of persistent troponin elevation in a patient with chronic heart failure. Rev Port Cardiol 2013; 32:931-3. [PMID: 24239396 DOI: 10.1016/j.repc.2013.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 04/25/2013] [Indexed: 10/26/2022] Open
Abstract
We present the case of a woman diagnosed with hypertrophic cardiomyopathy who suffered a myocardial infarction when she was 28 years old, without coronary artery disease on coronary angiography. Two years later, she presented signs of heart failure and left ventricular systolic dysfunction with persistent troponin I elevation, followed by progressive worsening of ventricular dysfunction.
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Affiliation(s)
- Gonçalo Cardoso
- Serviço de Cardiologia, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Carnaxide, Portugal.
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63
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Abstract
Heart failure is a major burden to the health care system in terms of not only cost, but also morbidity and mortality. Appropriate use of biomarkers is critically important to allow rapid identification and optimal risk stratification and management of patients with both acute and chronic heart failure. This review will discuss the biomarkers that have the most diagnostic, prognostic, and therapeutic value in patients with heart failure. We will discuss established biomarkers such as natriuretic peptides as well as emerging biomarkers reflective of myocyte stress, myocyte injury, extracellular matrix injury, and both neurohormonal and cardio-renal physiology.
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64
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de Antonio M, Lupón J, Galán A, Vila J, Zamora E, Urrutia A, Díez C, Coll R, Altimir S, Bayes-Genis A. Head-to-head comparison of high-sensitivity troponin T and sensitive-contemporary troponin I regarding heart failure risk stratification. Clin Chim Acta 2013; 426:18-24. [DOI: 10.1016/j.cca.2013.08.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 07/25/2013] [Accepted: 08/15/2013] [Indexed: 11/25/2022]
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65
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Cardoso G, Aguiar C, Ventosa A, Rebocho MJ, Borges Santos M, Dores H, Adragão P, Mendes M. A rare case of persistent troponin elevation in a patient with chronic heart failure. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2013. [DOI: 10.1016/j.repce.2013.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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66
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Salah K, Kok WE, Eurlings LW, Bettencourt P, Pimenta JM, Metra M, Bayes-Genis A, Verdiani V, Bettari L, Lazzarini V, Damman P, Tijssen JG, Pinto YM. A novel discharge risk model for patients hospitalised for acute decompensated heart failure incorporating N-terminal pro-B-type natriuretic peptide levels: a European coLlaboration on Acute decompeNsated Heart Failure: ELAN-HF Score. Heart 2013; 100:115-25. [PMID: 24179162 DOI: 10.1136/heartjnl-2013-303632] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Models to stratify risk for patients hospitalised for acute decompensated heart failure (ADHF) do not include the change in N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels during hospitalisation. OBJECTIVE The aim of our study was to develop a simple yet robust discharge prognostication score including NT-proBNP for this notorious high-risk population. DESIGN Individual patient data meta-analyses of prospective cohort studies. SETTING Seven prospective cohorts with in total 1301 patients. PATIENTS Our study population was assembled from the seven studies by selecting those patients admitted because of clinically validated ADHF, discharged alive, and NT-proBNP measurements available at admission and at discharge. MAIN OUTCOME MEASURES The endpoints studied were all-cause mortality and a composite of all-cause mortality and/or first readmission for cardiovascular reason within 180 days after discharge. RESULTS The model that incorporated NT-proBNP levels at discharge as well as the changes in NT-proBNP during hospitalisation in addition to age ≥75 years, peripheral oedema, systolic blood pressure ≤115 mm Hg, hyponatremia at admission, serum urea of ≥15 mmol/L and New York Heart Association (NYHA) class at discharge, yielded the best C-statistic (area under the curve, 0.78, 95% CI 0.74 to 0.82). The addition of NT-proBNP to a reference model significantly improved prediction of mortality as shown by the net reclassification improvement (62%, p<0.001). A simplified model was obtained from the final Cox regression model by assigning weights to individual risk markers proportional to their relative risks. The risk score we designed identified four clinically significant subgroups. The pattern of increasing event rates with increasing score was confirmed in the validation group (BOT-AcuteHF, n=325, p<0.001). CONCLUSIONS In patients hospitalised for ADHF, the addition of the discharge NT-proBNP values as well as the change in NT-proBNP to known risk markers, generates a relatively simple yet robust discharge risk score that importantly improves the prediction of adverse events.
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Affiliation(s)
- Khibar Salah
- Heart failure Research Center & Department of Cardiology, Academic Medical Center, University of Amsterdam, , Amsterdam, The Netherlands
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67
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Ito K, Kawai M, Nakane T, Narui R, Hioki M, Tanigawa SI, Yamashita S, Inada K, Matsuo S, Date T, Yamane T, Yoshimura M. Serial measurements associated with an amelioration of acute heart failure: an analysis of repeated quantification of plasma BNP levels. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2013; 1:240-7. [PMID: 24062913 DOI: 10.1177/2048872612458580] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 07/28/2012] [Indexed: 12/14/2022]
Abstract
BACKGROUND The magnitude of improvement of acute heart failure achieved during treatment varies greatly among patients. We examined changes in the plasma B-type natriuretic peptide (BNP) levels of patients with acute heart failure and attempted to elucidate the clinical factors associated with amelioration of acute heart failure. METHODS AND RESULTS The study population consisted of 208 consecutive patients admitted to our institution with acute heart failure. We measured plasma BNP levels before and after treatment of acute heart failure and evaluated these levels based on median age, body mass index (BMI), creatinine (Cr) level, and left ventricular ejection fraction (EF). Plasma BNP levels before treatment were equivalent between the younger and older age groups; however, plasma BNP levels after treatment were higher in the older age group (p<0.01). Plasma BNP levels before treatment were significantly high in the lower BMI group (p<0.05) and the higher Cr group (p<0.01). Similarly, plasma BNP levels after treatment were high in both the lower BMI and higher Cr groups (p<0.01 for both). In the low EF group, plasma BNP levels before treatment were significantly high (p<0.01), while plasma BNP levels after treatment were equivalent to those in the high EF group. A multiple linear regression analysis revealed that Cr was positively correlated and BMI and EF were negatively correlated with plasma BNP levels before treatment; however, the contributions of age, BMI, and Cr in reducing plasma BNP levels were more significant after treatment. CONCLUSIONS The contributions of clinical factors working against amelioration of heart failure vary before and after treatment. Regarding plasma BNP levels, older age, very low BMI, and the presence of renal dysfunction eventually act to prevent amelioration of acute heart failure. Systolic dysfunction does not act against amelioration of acute heart failure.
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Affiliation(s)
- Keiichi Ito
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
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68
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Tolonen J, Lassus JPE, Siirila-Waris K, Tarvasmäki T, Pulkki K, Sund R, Peuhkurinen K, Nieminen MS, Harjola VP. The role of cardiorenal biomarkers for risk stratification in the early follow-up after hospitalisation for acute heart failure. Biomarkers 2013; 18:525-31. [DOI: 10.3109/1354750x.2013.821522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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69
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Zannad F, Stough WG, Regnault V, Gheorghiade M, Deliargyris E, Gibson CM, Agewall S, Berkowitz SD, Burton P, Calvo G, Goldstein S, Verheugt FW, Koglin J, O'Connor CM. Is thrombosis a contributor to heart failure pathophysiology? Possible mechanisms, therapeutic opportunities, and clinical investigation challenges. Int J Cardiol 2013; 167:1772-82. [DOI: 10.1016/j.ijcard.2012.12.018] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 12/06/2012] [Indexed: 12/21/2022]
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70
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Pascual-Figal DA, Caballero L, Sanchez-Mas J, Lax A. Prognostic markers for acute heart failure. ACTA ACUST UNITED AC 2013; 7:379-92. [DOI: 10.1517/17530059.2013.814638] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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71
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Braga JR, Tu JV, Austin PC, Chong A, You JJ, Farkouh ME, Ross HJ, Lee DS. Outcomes and Care of Patients With Acute Heart Failure Syndromes and Cardiac Troponin Elevation. Circ Heart Fail 2013; 6:193-202. [DOI: 10.1161/circheartfailure.112.000075] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background—
Cardiac troponins (cTn) may be elevated among patients with acute heart failure syndromes (AHFS). However, the optimal approach to management of AHFS with elevated cTn is unknown.
Methods and Results—
We compared the care and outcomes of 13 656 patients with AHFS seeking care in the emergency department stratified by presence (cTn+, n=1845, 13.5%) or absence (cTn−) of elevated troponin. Clinically abstracted data on patients who were admitted or discharged from the emergency department in Ontario, Canada (April 1999 to March 2001 and April 2004 to March 2007) were examined. In an exploratory 2:1 propensity-matched analysis, we examined whether early coronary revascularization (within 14 days of emergency department visit) was associated with survival, stratified by cTn status. For cTn+ AHFS, rates of coronary angiography (21.8 vs 11.4 patients/100 person-years;
P
<0.001) and coronary revascularization (8.8 vs 3.2 patients/100 person-years;
P
<0.001) were higher than cTn−. Instantaneous 30-day adjusted hazard ratios for cTn+ versus cTn− patients were 9.17 (95% confidence interval [CI], 8.31–10.12;
P
<0.001) for death, 5.14 (95% CI, 4.66–5.67;
P
<0.001) for cardiovascular readmission, and 13.08 (95% CI, 10.95–15.62;
P
<0.001) for ischemic heart disease hospitalization. In propensity-matched analysis of 143 individuals with cTn+ AHFS, early coronary revascularization was associated with reduced mortality (adjusted hazard ratio, 0.29; 95% CI, 0.09–0.92;
P
=0.036) compared with those who were not revascularized. Mortality was not significantly reduced among 210 cTn− patients undergoing early coronary revascularization (adjusted hazard ratio, 0.61; 95% CI, 0.36–1.03;
P
=0.065).
Conclusions—
Elevated cTn was associated with increased risk of death and cardiovascular hospitalizations. Highly selected cTn+ patients who underwent early coronary revascularization for obstructive coronary artery disease experienced improved survival.
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Affiliation(s)
- Juarez R. Braga
- From the Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Canada (J.R.B., M.E.F., H.J.R., D.S.L.); Institute for Clinical Evaluative Sciences, Toronto, Canada (J.V.T., P.C.A., A.C., J.J.Y., D.S.L.); Institute of Health Policy, Management, and Evaluation, Toronto, Canada (J.V.T., P.C.A., D.S.L.); Dalla Lana School of Public Health (P.C.A.), Division of Cardiology (J.V.T.), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada; Departments of
| | - Jack V. Tu
- From the Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Canada (J.R.B., M.E.F., H.J.R., D.S.L.); Institute for Clinical Evaluative Sciences, Toronto, Canada (J.V.T., P.C.A., A.C., J.J.Y., D.S.L.); Institute of Health Policy, Management, and Evaluation, Toronto, Canada (J.V.T., P.C.A., D.S.L.); Dalla Lana School of Public Health (P.C.A.), Division of Cardiology (J.V.T.), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada; Departments of
| | - Peter C. Austin
- From the Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Canada (J.R.B., M.E.F., H.J.R., D.S.L.); Institute for Clinical Evaluative Sciences, Toronto, Canada (J.V.T., P.C.A., A.C., J.J.Y., D.S.L.); Institute of Health Policy, Management, and Evaluation, Toronto, Canada (J.V.T., P.C.A., D.S.L.); Dalla Lana School of Public Health (P.C.A.), Division of Cardiology (J.V.T.), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada; Departments of
| | - Alice Chong
- From the Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Canada (J.R.B., M.E.F., H.J.R., D.S.L.); Institute for Clinical Evaluative Sciences, Toronto, Canada (J.V.T., P.C.A., A.C., J.J.Y., D.S.L.); Institute of Health Policy, Management, and Evaluation, Toronto, Canada (J.V.T., P.C.A., D.S.L.); Dalla Lana School of Public Health (P.C.A.), Division of Cardiology (J.V.T.), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada; Departments of
| | - John J. You
- From the Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Canada (J.R.B., M.E.F., H.J.R., D.S.L.); Institute for Clinical Evaluative Sciences, Toronto, Canada (J.V.T., P.C.A., A.C., J.J.Y., D.S.L.); Institute of Health Policy, Management, and Evaluation, Toronto, Canada (J.V.T., P.C.A., D.S.L.); Dalla Lana School of Public Health (P.C.A.), Division of Cardiology (J.V.T.), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada; Departments of
| | - Michael E. Farkouh
- From the Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Canada (J.R.B., M.E.F., H.J.R., D.S.L.); Institute for Clinical Evaluative Sciences, Toronto, Canada (J.V.T., P.C.A., A.C., J.J.Y., D.S.L.); Institute of Health Policy, Management, and Evaluation, Toronto, Canada (J.V.T., P.C.A., D.S.L.); Dalla Lana School of Public Health (P.C.A.), Division of Cardiology (J.V.T.), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada; Departments of
| | - Heather J. Ross
- From the Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Canada (J.R.B., M.E.F., H.J.R., D.S.L.); Institute for Clinical Evaluative Sciences, Toronto, Canada (J.V.T., P.C.A., A.C., J.J.Y., D.S.L.); Institute of Health Policy, Management, and Evaluation, Toronto, Canada (J.V.T., P.C.A., D.S.L.); Dalla Lana School of Public Health (P.C.A.), Division of Cardiology (J.V.T.), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada; Departments of
| | - Douglas S. Lee
- From the Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Canada (J.R.B., M.E.F., H.J.R., D.S.L.); Institute for Clinical Evaluative Sciences, Toronto, Canada (J.V.T., P.C.A., A.C., J.J.Y., D.S.L.); Institute of Health Policy, Management, and Evaluation, Toronto, Canada (J.V.T., P.C.A., D.S.L.); Dalla Lana School of Public Health (P.C.A.), Division of Cardiology (J.V.T.), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada; Departments of
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Sato Y, Fujiwara H, Takatsu Y. Cardiac troponin and heart failure in the era of high-sensitivity assays. J Cardiol 2012; 60:160-7. [PMID: 22867801 DOI: 10.1016/j.jjcc.2012.06.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 06/06/2012] [Accepted: 06/06/2012] [Indexed: 10/28/2022]
Abstract
The Joint European Society of Cardiology-American College of Cardiology Foundation-American Heart Association-World Heart Federation Task Force for the Redefinition of Myocardial Infarction recommends cardiac troponin (cTn)-T as a first-line biomarker, and suggests the use of the 99th percentile of a reference population with acceptable precision (i.e. a coefficient of variance≤10%) as a cut-off for the diagnosis of acute myocardial infarction. Recently developed troponin assays fulfill this analytical precision. While conventional cTnT assays have often been used as a positive or negative categorical variable, stepwise rises in high sensitivity (Hs)-cTnT in patients presenting with chronic heart failure (HF) have been associated with a progressive increase in the incidence of cardiovascular events. Similar observations have been made in the general population. Hs-cTnT at baseline and during follow-up is a powerful predictor of cardiac events in patients with HF and in the general population. Whether it is the ideal biomarker remains to be confirmed, however. We review the potential contributions of TnT assays in the assessment of risk of HF, in HF, and in myocardial diseases that cause HF.
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Affiliation(s)
- Yukihito Sato
- Department of Cardiovascular Medicine, Hyogo Prefecture Amagasaki Hospital, Hyogo, Japan.
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Rivara MB, Bajwa EK, Januzzi JL, Gong MN, Thompson BT, Christiani DC. Prognostic significance of elevated cardiac troponin-T levels in acute respiratory distress syndrome patients. PLoS One 2012; 7:e40515. [PMID: 22808179 PMCID: PMC3395687 DOI: 10.1371/journal.pone.0040515] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 06/11/2012] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Elevated levels of biochemical markers of myocardial necrosis have been associated with worsened outcomes in Acute Respiratory Distress Syndrome (ARDS), but there are few prospective data on this relationship. We investigated elevated cardiac troponin T (cTnT) levels and their relationship with outcome in patients with ARDS. METHODS A prospective cohort study of patients with ARDS was conducted at a tertiary-care academic medical center. Patients had blood taken within 48 hours of ARDS onset and assayed for cTnT. Patients were followed for the outcomes of 60-day mortality, number of organ failures, and days free of mechanical ventilation. Echocardiographic and electrocardiographic (ECG) data were analyzed for signs of myocardial ischemia, infarction, or other myocardial dysfunction. RESULTS 177 patients were enrolled, 70 of whom died (40%). 119 patients had detectable cTnT levels (67%). Median cTnT level was 0.03 ng/mL, IQR 0-0.10 ng/mL, and levels were higher among non-survivors (P = .008). Increasing cTnT level was significantly associated with increasing mortality (P = .008). The association between increasing cTnT level and mortality remained significant after adjustment in a multivariate model (HR(adj) = 1.45, 95% CI 1.17-1.81, P = .001). Elevated cTnT level was also associated with increased number of organ failures (P = .002), decreased number of days free of mechanical ventilation (P = .03), echocardiographic wall motion abnormalities (P = 0.001), and severity of tricuspid regurgitation (P = .04). There was no association between ECG findings of myocardial ischemia or infarction and elevated cTnT. CONCLUSIONS Elevated cTnT levels are common in patients with ARDS, and are associated with worsened clinical outcomes and certain echocardiographic abnormalities. No association was seen between cTnT levels and ECG evidence of coronary ischemia.
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Affiliation(s)
- Matthew B. Rivara
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Ednan K. Bajwa
- Pulmonary and Critical Care Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | - James L. Januzzi
- Cardiology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Michelle N. Gong
- Critical Care Division, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - B. Taylor Thompson
- Pulmonary and Critical Care Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - David C. Christiani
- Pulmonary and Critical Care Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, United States of America
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Marcadores biológicos: ¿qué aportan los péptidos natriuréticos? HIPERTENSION Y RIESGO VASCULAR 2012. [DOI: 10.1016/j.hipert.2012.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Combined use of high-sensitivity cardiac troponin T and N-terminal pro-B type natriuretic peptide improves measurements of performance over established mortality risk factors in chronic heart failure. Am Heart J 2012; 163:821-8. [PMID: 22607860 DOI: 10.1016/j.ahj.2012.03.004] [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] [Received: 01/16/2012] [Accepted: 03/12/2012] [Indexed: 11/22/2022]
Abstract
BACKGROUND Heart failure still maintains a high mortality. Biomarkers reflecting different pathophysiological pathways are under evaluation to better stratify the mortality risk. The objective was to assess high-sensitivity cardiac troponin T (hs-cTnT) in combination with N-terminal pro-B type natriuretic peptide (NT-proBNP) for risk stratification in a real-life cohort of ambulatory heart failure patients. METHODS We analyzed 876 consecutive patients (median age 70.3 years, median left ventricular ejection fraction 34%) treated at a heart failure unit. A combination of biomarkers reflecting myocyte injury (hs-cTnT) and myocardial stretch (NT-proBNP) was used in addition to an assessment based on established mortality risk factors (age, sex, left ventricular ejection fraction, New York Heart Association functional class, diabetes, estimated glomerular filtration rate, ischemic etiology, sodium, hemoglobin, β-blocker treatment, and angiotensin converting enzyme inhibitor or angiotensin II receptor blocker treatment). RESULTS During a median follow-up of 41.4 months, 311 patients died. In the multivariable Cox proportional hazards model, hs-cTnT and NT-proBNP were independent prognosticators (P = .003 each). The combined elevation of both biomarkers above cut-off values significantly increased the risk of death (HR 7.42 [95% CI, 5.23-10.54], P < .001). When hs-cTnT and NT-proBNP were individually included in a model with established mortality risk factors, measurements of performance significantly improved. Results obtained for hs-cTnT compared with NT-proBNP were superior according to comprehensive discrimination, calibration, and reclassification analysis (net reclassification indices of 7.7% and 1.5%, respectively). CONCLUSIONS hs-cTnT provides significant prognostic information in a real-life cohort of patients with chronic heart failure. Simultaneous addition of hs-cTnT and NT-proBNP into a model that includes established risk factors improves mortality risk stratification.
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Troponin T levels in patients with acute heart failure: clinical and prognostic significance of their detection and release during hospitalisation. Clin Res Cardiol 2012; 101:663-72. [DOI: 10.1007/s00392-012-0441-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Accepted: 03/01/2012] [Indexed: 10/28/2022]
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Abstract
Despite the continued growth of heart failure as a major public health problem, the development of new therapies for heart failure has slowed and recent studies have been neutral, suggesting the need for a reappraisal of the clinical research enterprise. Surrogate end points, defined as measurements that are used as substitutes for the more clinically meaningful end points, can play a valuable role in clinical trials by accelerating the timeline for determining appropriate dosages, efficacy, and safety. Biomarkers, such as the natriuretic peptides, have many of the characteristics of valid surrogates but have not been sufficiently validated for widespread use. Ongoing research into the role of biomarkers as surrogates may lead to better clinical trial design and more efficient development of new therapies for heart failure.
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Affiliation(s)
- G Michael Felker
- Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC 27705, USA.
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Oh J, Kang SM, Won H, Hong N, Kim SY, Park S, Lee SH, Jang Y, Chung N. Prognostic Value of Change in Red Cell Distribution Width 1 Month After Discharge in Acute Decompensated Heart Failure Patients. Circ J 2012; 76:109-16. [DOI: 10.1253/circj.cj-11-0664] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Jaewon Oh
- Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine
| | - Seok-Min Kang
- Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine
- Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine
| | - Hoyoun Won
- Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine
| | - Namki Hong
- Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine
| | - Soo-Young Kim
- Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine
| | - Sungha Park
- Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine
| | - Sang-Hak Lee
- Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine
| | - Yangsoo Jang
- Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine
- Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine
| | - Namsik Chung
- Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine
- Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine
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O'Connor CM, Fiuzat M, Lombardi C, Fujita K, Jia G, Davison BA, Cleland J, Bloomfield D, Dittrich HC, DeLucca P, Givertz MM, Mansoor G, Ponikowski P, Teerlink JR, Voors AA, Massie BM, Cotter G, Metra M. Impact of Serial Troponin Release on Outcomes in Patients With Acute Heart Failure. Circ Heart Fail 2011; 4:724-32. [DOI: 10.1161/circheartfailure.111.961581] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Christopher M. O'Connor
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (C.M.O., M.F.); the Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy (C.L., M.M.); Merck Research Laboratories, Rahway, NJ (K.F., G.J., D.B., H.D., P.D., G.M.); Momentum Research (B.D., G.C.), Durham, NC; University of Hull, United Kingdom (J.C.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.G.); Medical University, Clinical Military Hospital, Wroclaw,
| | - Mona Fiuzat
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (C.M.O., M.F.); the Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy (C.L., M.M.); Merck Research Laboratories, Rahway, NJ (K.F., G.J., D.B., H.D., P.D., G.M.); Momentum Research (B.D., G.C.), Durham, NC; University of Hull, United Kingdom (J.C.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.G.); Medical University, Clinical Military Hospital, Wroclaw,
| | - Carlo Lombardi
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (C.M.O., M.F.); the Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy (C.L., M.M.); Merck Research Laboratories, Rahway, NJ (K.F., G.J., D.B., H.D., P.D., G.M.); Momentum Research (B.D., G.C.), Durham, NC; University of Hull, United Kingdom (J.C.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.G.); Medical University, Clinical Military Hospital, Wroclaw,
| | - Kenji Fujita
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (C.M.O., M.F.); the Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy (C.L., M.M.); Merck Research Laboratories, Rahway, NJ (K.F., G.J., D.B., H.D., P.D., G.M.); Momentum Research (B.D., G.C.), Durham, NC; University of Hull, United Kingdom (J.C.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.G.); Medical University, Clinical Military Hospital, Wroclaw,
| | - Gang Jia
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (C.M.O., M.F.); the Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy (C.L., M.M.); Merck Research Laboratories, Rahway, NJ (K.F., G.J., D.B., H.D., P.D., G.M.); Momentum Research (B.D., G.C.), Durham, NC; University of Hull, United Kingdom (J.C.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.G.); Medical University, Clinical Military Hospital, Wroclaw,
| | - Beth A. Davison
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (C.M.O., M.F.); the Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy (C.L., M.M.); Merck Research Laboratories, Rahway, NJ (K.F., G.J., D.B., H.D., P.D., G.M.); Momentum Research (B.D., G.C.), Durham, NC; University of Hull, United Kingdom (J.C.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.G.); Medical University, Clinical Military Hospital, Wroclaw,
| | - John Cleland
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (C.M.O., M.F.); the Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy (C.L., M.M.); Merck Research Laboratories, Rahway, NJ (K.F., G.J., D.B., H.D., P.D., G.M.); Momentum Research (B.D., G.C.), Durham, NC; University of Hull, United Kingdom (J.C.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.G.); Medical University, Clinical Military Hospital, Wroclaw,
| | - Daniel Bloomfield
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (C.M.O., M.F.); the Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy (C.L., M.M.); Merck Research Laboratories, Rahway, NJ (K.F., G.J., D.B., H.D., P.D., G.M.); Momentum Research (B.D., G.C.), Durham, NC; University of Hull, United Kingdom (J.C.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.G.); Medical University, Clinical Military Hospital, Wroclaw,
| | - Howard C. Dittrich
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (C.M.O., M.F.); the Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy (C.L., M.M.); Merck Research Laboratories, Rahway, NJ (K.F., G.J., D.B., H.D., P.D., G.M.); Momentum Research (B.D., G.C.), Durham, NC; University of Hull, United Kingdom (J.C.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.G.); Medical University, Clinical Military Hospital, Wroclaw,
| | - Paul DeLucca
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (C.M.O., M.F.); the Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy (C.L., M.M.); Merck Research Laboratories, Rahway, NJ (K.F., G.J., D.B., H.D., P.D., G.M.); Momentum Research (B.D., G.C.), Durham, NC; University of Hull, United Kingdom (J.C.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.G.); Medical University, Clinical Military Hospital, Wroclaw,
| | - Michael M. Givertz
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (C.M.O., M.F.); the Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy (C.L., M.M.); Merck Research Laboratories, Rahway, NJ (K.F., G.J., D.B., H.D., P.D., G.M.); Momentum Research (B.D., G.C.), Durham, NC; University of Hull, United Kingdom (J.C.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.G.); Medical University, Clinical Military Hospital, Wroclaw,
| | - George Mansoor
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (C.M.O., M.F.); the Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy (C.L., M.M.); Merck Research Laboratories, Rahway, NJ (K.F., G.J., D.B., H.D., P.D., G.M.); Momentum Research (B.D., G.C.), Durham, NC; University of Hull, United Kingdom (J.C.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.G.); Medical University, Clinical Military Hospital, Wroclaw,
| | - Piotr Ponikowski
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (C.M.O., M.F.); the Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy (C.L., M.M.); Merck Research Laboratories, Rahway, NJ (K.F., G.J., D.B., H.D., P.D., G.M.); Momentum Research (B.D., G.C.), Durham, NC; University of Hull, United Kingdom (J.C.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.G.); Medical University, Clinical Military Hospital, Wroclaw,
| | - John R. Teerlink
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (C.M.O., M.F.); the Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy (C.L., M.M.); Merck Research Laboratories, Rahway, NJ (K.F., G.J., D.B., H.D., P.D., G.M.); Momentum Research (B.D., G.C.), Durham, NC; University of Hull, United Kingdom (J.C.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.G.); Medical University, Clinical Military Hospital, Wroclaw,
| | - Adriaan A. Voors
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (C.M.O., M.F.); the Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy (C.L., M.M.); Merck Research Laboratories, Rahway, NJ (K.F., G.J., D.B., H.D., P.D., G.M.); Momentum Research (B.D., G.C.), Durham, NC; University of Hull, United Kingdom (J.C.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.G.); Medical University, Clinical Military Hospital, Wroclaw,
| | - Barry M. Massie
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (C.M.O., M.F.); the Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy (C.L., M.M.); Merck Research Laboratories, Rahway, NJ (K.F., G.J., D.B., H.D., P.D., G.M.); Momentum Research (B.D., G.C.), Durham, NC; University of Hull, United Kingdom (J.C.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.G.); Medical University, Clinical Military Hospital, Wroclaw,
| | - Gad Cotter
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (C.M.O., M.F.); the Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy (C.L., M.M.); Merck Research Laboratories, Rahway, NJ (K.F., G.J., D.B., H.D., P.D., G.M.); Momentum Research (B.D., G.C.), Durham, NC; University of Hull, United Kingdom (J.C.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.G.); Medical University, Clinical Military Hospital, Wroclaw,
| | - Marco Metra
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (C.M.O., M.F.); the Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy (C.L., M.M.); Merck Research Laboratories, Rahway, NJ (K.F., G.J., D.B., H.D., P.D., G.M.); Momentum Research (B.D., G.C.), Durham, NC; University of Hull, United Kingdom (J.C.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.G.); Medical University, Clinical Military Hospital, Wroclaw,
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Boyer B, Hart KW, Sperling MI, Lindsell CJ, Collins SP. Biomarker changes during acute heart failure treatment. ACTA ACUST UNITED AC 2011; 18:91-7. [PMID: 22432555 DOI: 10.1111/j.1751-7133.2011.00256.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Biomarker changes may provide physicians with objective evidence of treatment efficacy in patients with acute decompensated heart failure (ADHF) and facilitate early hospital discharge. The authors hypothesize that mid-regional-pro-adrenomedullin (MR-proADM), C-terminal-pro-endothelin-1 (CT-pro-ET-1), and mid-regional-pro-atrial natriuretic peptide (MR-proANP) change during the first 24 hours of ADHF therapy. Eligible patients had an emergency department diagnosis of ADHF and fulfilled modified Framingham criteria. Clinical data, serum, and plasma values were collected at enrollment, 2 to 4 hours, and 12 to 24 hours after treatment. Changes in biomarker concentrations from baseline to 2 to 4 hours, baseline to 12 to 24 hours, and 2 to 4 to 12 to 24 hours were calculated. Fisher exact and Kruskal-Wallis tests were used for comparisons. Forty-eight patients were included. The median age was 62 years (range 40-88), 54% were men and 50% were white. More patients had changes in MR-pro-ANP levels in the first 2 to 4 hours after ADHF therapy compared with MR-proADM or CT-pro-ET-1 (36% vs 16% and 24%). However, 12 to 24 hours after therapy, similar proportions of patients had changes in MR-proANP, MR-proADM, and CT-proET-1 levels (47%, 41%, and 49%). In this preliminary study, patients with ADHF had measurable changes in MR-proANP, MR-proADM, and CT-pro-ET-1 24 hours after initial therapy. A study of association with clinical course and outcomes to determine the role of these markers in risk-stratification is warranted.
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Affiliation(s)
- Brent Boyer
- Medical University of South Carolina, Charleston, SC, USA
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Affiliation(s)
- Amy Gadoud
- Hull York Medical School, University of Hull, Hull HU6 7RX
| | - Miriam Johnson
- Palliative Medicine, Hull York Medical School, and Honorary Consultant, St Catherine's Hospice, Scarborough
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Albaghdadi M, Gheorghiade M, Pitt B. Mineralocorticoid receptor antagonism: therapeutic potential in acute heart failure syndromes. Eur Heart J 2011; 32:2626-33. [DOI: 10.1093/eurheartj/ehr170] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Noveanu M, Breidthardt T, Potocki M, Reichlin T, Twerenbold R, Uthoff H, Socrates T, Arenja N, Reiter M, Meissner J, Heinisch C, Stalder S, Mueller C. Direct comparison of serial B-type natriuretic peptide and NT-proBNP levels for prediction of short- and long-term outcome in acute decompensated heart failure. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2011; 15:R1. [PMID: 21208408 PMCID: PMC3222028 DOI: 10.1186/cc9398] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 09/09/2010] [Accepted: 01/05/2011] [Indexed: 12/20/2022]
Abstract
Introduction Monitoring treatment efficacy and assessing outcome by serial measurements of natriuretic peptides in acute decompensated heart failure (ADHF) patients may help to improve outcome. Methods This was a prospective multi-center study of 171 consecutive patients (mean age 80 73-85 years) presenting to the emergency department with ADHF. Measurement of BNP and NT-proBNP was performed at presentation, 24 hours, 48 hours and at discharge. The primary endpoint was one-year all-cause mortality; secondary endpoints were 30-days all-cause mortality and one-year heart failure (HF) readmission. Results During one-year follow-up, a total of 60 (35%) patients died. BNP and NT-proBNP levels were higher in non-survivors at all time points (all P < 0.001). In survivors, treatment reduced BNP and NT-proBNP levels by more than 50% (P < 0.001), while in non-survivors treatment did not lower BNP and NT-proBNP levels. The area under the ROC curve (AUC) for the prediction of one-year mortality increased during the course of hospitalization for BNP (AUC presentation: 0.67; AUC 24 h: 0.77; AUC 48 h: 0.78; AUC discharge: 0.78) and NT-proBNP (AUC presentation: 0.67; AUC 24 h: 0.73; AUC 48 h: 0.75; AUC discharge: 0.77). In multivariate analysis, BNP at 24 h (1.02 [1.01-1.04], P = 0.003), 48 h (1.04 [1.02-1.06], P < 0.001) and discharge (1.02 [1.01-1.03], P < 0.001) independently predicted one-year mortality, while only pre-discharge NT-proBNP was predictive (1.07 [1.01-1.13], P = 0.016). Comparable results could be obtained for the secondary endpoint 30-days mortality but not for one-year HF readmissions. Conclusions BNP and NT-proBNP reliably predict one-year mortality in patients with ADHF. Prognostic accuracy of both biomarker increases during the course of hospitalization. In survivors BNP levels decline more rapidly than NT-proBNP levels and thus seem to allow earlier assessment of treatment efficacy. Ability to predict one-year HF readmission was poor for BNP and NT-proBNP. Trial registration ClinicalTrials.gov identifier: NCT00514384.
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Affiliation(s)
- Markus Noveanu
- Department of Internal Medicine, University Hospital Basel, Petersgraben 4, 4053 Basel, Switzerland.
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85
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Troponin elevation in heart failure prevalence, mechanisms, and clinical implications. J Am Coll Cardiol 2010; 56:1071-8. [PMID: 20863950 DOI: 10.1016/j.jacc.2010.06.016] [Citation(s) in RCA: 353] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Accepted: 06/29/2010] [Indexed: 02/08/2023]
Abstract
Circulating biomarkers have become increasingly important in diagnosing and risk stratifying patients with heart failure (HF). While the natriuretic peptides have received much focus, there is increasing interest in the role of circulating cardiac troponin (cTn) in detecting myocardial injury (often subclinical) in those with HF. Accumulating evidence suggests that patients with chronic and acute HF may have measurable levels of circulating cTn, whose detection and magnitude may have prognostic implications. Furthermore, as new, more sensitive cTn assays are being developed, larger numbers of HF patients are found to have detectable cTn with a persistent relationship between magnitude and outcome. This knowledge improves our ability to understand the mechanism of worsening HF, improve risk stratification, and detect potential injury related to new therapeutics in HF. As investigators begin to understand the relationship of detectable cTn to HF outcomes, as well as temporal changes in its magnitude, and its relationship to other circulating biomarkers, more insight may be gained into the progressive nature of cardiac dysfunction and the transition from chronic compensated to acute decompensated HF. Ultimately, this information might allow physicians to guide therapy, choose appropriate therapeutics, and improve HF outcomes.
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86
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Affiliation(s)
- G. Michael Felker
- From the Duke Clinical Research Institute (G.M.F.), Durham, NC, and the University of California–San Diego (A.S.M.), San Diego, Calif
| | - Alan S. Maisel
- From the Duke Clinical Research Institute (G.M.F.), Durham, NC, and the University of California–San Diego (A.S.M.), San Diego, Calif
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87
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Routine laboratory results and thirty day and one-year mortality risk following hospitalization with acute decompensated heart failure. PLoS One 2010; 5:e12184. [PMID: 20808904 PMCID: PMC2923147 DOI: 10.1371/journal.pone.0012184] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2010] [Accepted: 07/15/2010] [Indexed: 11/23/2022] Open
Abstract
Introduction Several blood tests are performed uniformly in patients hospitalized with acute decompensated heart failure and are predictive of the outcomes: complete blood count, electrolytes, renal function, glucose, albumin and uric acid. We sought to evaluate the relationship between routine admission laboratory tests results, patient characteristics and 30-day and one-year mortality of patients admitted for decompensated heart failure and to construct a simple mortality prediction tool. Methods A retrospective population based study. Data from seven tertiary hospitals on all admissions with a principal diagnosis of heart failure during the years 2002–2005 throughout Israel were captured. Results 8,246 patients were included in the study cohort. Thirty day mortality rate was 8.5% (701 patients) and one-year mortality rate was 28.7% (2,365 patients). Addition of five routine laboratory tests results (albumin, sodium, blood urea, uric acid and WBC) to a set of clinical and demographic characteristics improved c-statistics from 0.76 to 0.81 for 30-days and from 0.72 to 0.76 for one-year mortality prediction (both p-values <0.0001). Three dichotomized abnormal laboratory results with highest odds ratio for one-year mortality (hypoalbuminaemia, hyponatremia and elevated blood urea) were used to construct a simple prediction score, capable of discriminating from 1.1% to 21.4% in 30-day and from 11.6% to 55.6% in one-year mortality rates between patients with a score of 0 (1,477 patients) vs. score of 3 (544 patients). Discussion A small set of abnormal routine laboratory results upon admission can risk-stratify and independently predict 30-day and one-year mortality in patients hospitalized with acute decompensated heart failure.
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88
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Jackson CE, Dalzell JR, Gardner RS. Prognostic utility of cardiac troponin in heart failure: a novel role for an established biomarker. Biomark Med 2010; 3:483-93. [PMID: 20477518 DOI: 10.2217/bmm.09.38] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Many individual variables are predictive of an increased risk of mortality and morbidity in heart failure. These include a range of data from patient demographics, clinical findings, comorbidities and invasive and noninvasive parameters. Some of these markers, for example the B-type natriuretic peptides, have been identified as independently predictive in large, robust, multivariable analyses. However, many markers have had less vigorous scrutiny and were identified in small cohorts after only univariate or limited multivariable analyses. Recently, cardiac troponins have emerged as potential biomarkers for patients with heart failure. In this article, we consider the utility of cardiac troponins in heart failure and propose what role they may play in improving the risk stratification of this disease.
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Affiliation(s)
- Colette E Jackson
- BHF Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow, G12 8TA, UK.
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Koide K, Yoshikawa T, Nagatomo Y, Kohsaka S, Anzai T, Meguro T, Ogawa S. Elevated troponin T on discharge predicts poor outcome of decompensated heart failure. Heart Vessels 2010; 25:217-22. [PMID: 20512449 DOI: 10.1007/s00380-009-1194-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Accepted: 08/07/2009] [Indexed: 11/30/2022]
Abstract
Persistent elevation of cardiac troponin T (cTnT) predicts an adverse clinical outcome in patients with chronic heart failure (HF), but the underlying mechanisms remain to be determined. We investigated the association between predischarge cTnT elevation and coexistent pathophysiology in patients with decompensated HF. Plasma cTnT levels were determined before discharge in 170 patients with decompensated HF. We divided the patients into a group that was positive for cTnT [cTnT(+) group, n = 40] and a group that was negative for cTnT [cTnT(-) group, n = 130]. Multivariate analysis showed that use of beta-blocker therapy (odds ratio [OR] = 0.236, P = 0.003), an elevated high-sensitivity C-reactive protein (hsCRP) level (OR = 3.731, P = 0.006), a high brain natriuretic peptide (BNP) level (OR = 3.570, P = 0.007), diabetes (OR = 3.090, P = 0.018), and anemia (OR = 2.330, P = 0.047) were independently associated with cTnT positivity. During a mean follow-up period of 441 days after discharge, total mortality (P < 0.001), cardiac death (P < 0.001), and exacerbation of HF requiring hospitalization (P = 0.007) were all more common in the cTnT(+) group than in the cTnT(-) group. Cox proportional hazards analysis showed that cTnT positivity was an independent predictor of total mortality (hazard ratio = 5.008, P = 0.004) in an age- and gender-matched model. Elevation of cTnT during convalescence was associated with lack of beta-blocker therapy, a high hsCRP level at discharge, a high BNP level at discharge, diabetes, and anemia, and a worse clinical outcome in patients with decompensated HF.
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Affiliation(s)
- Kimi Koide
- Cardiology Division, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
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90
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Metra M, Felker GM, Zacà V, Bugatti S, Lombardi C, Bettari L, Voors AA, Gheorghiade M, Dei Cas L. Acute heart failure: multiple clinical profiles and mechanisms require tailored therapy. Int J Cardiol 2010; 144:175-9. [PMID: 20537739 DOI: 10.1016/j.ijcard.2010.04.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2009] [Accepted: 04/02/2010] [Indexed: 11/16/2022]
Abstract
Acute heart failure (HF) is the most common diagnosis at discharge in patients aged >65years. It carries a dismal prognosis with a high in-hospital mortality and very high post-discharge mortality and re-hospitalization rates. It is a complex clinical syndrome that cannot be described as a single entity as it varies widely with respect to underlying pathophysiologic mechanisms, clinical presentations and, likely, treatments. It is the aim of this paper to describe some of the main clinical presentations of acute HF. Amongst them, we will consider de novo HF versus acutely decompensated chronic HF, HF caused, and/or worsened, by myocardial ischemia, acute HF with low, normal, or high systolic blood pressure, acute HF caused by lung congestion or fluid retention or fluid redistribution to the lungs, and acute HF with comorbidities (diabetes, anemia, renal insufficiency, etc.). Different pathophysiologic mechanisms and clinical presentations may coexist in the same patient. Identification and, whenever possible, treatment of underlying pathophysiologic mechanisms may become important for acute HF management.
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Affiliation(s)
- Marco Metra
- Cardiology, Department of Experimental and Applied Medicine, University of Brescia, Italy.
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91
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Masson S, Latini R, Carbonieri E, Moretti L, Rossi MG, Ciricugno S, Milani V, Marchioli R, Struck J, Bergmann A, Maggioni AP, Tognoni G, Tavazzi L. The predictive value of stable precursor fragments of vasoactive peptides in patients with chronic heart failure: data from the GISSI-heart failure (GISSI-HF) trial. Eur J Heart Fail 2010; 12:338-47. [DOI: 10.1093/eurjhf/hfp206] [Citation(s) in RCA: 119] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Serge Masson
- Department of Cardiovascular Research; Istituto di Ricerche Farmacologiche ‘Mario Negri’; via La Masa 19 20156 Milan Italy
| | - Roberto Latini
- Department of Cardiovascular Research; Istituto di Ricerche Farmacologiche ‘Mario Negri’; via La Masa 19 20156 Milan Italy
| | | | | | | | | | - Valentina Milani
- Department of Cardiovascular Research; Istituto di Ricerche Farmacologiche ‘Mario Negri’; via La Masa 19 20156 Milan Italy
| | - Roberto Marchioli
- Department of Clinical Pharmacology and Epidemiology; Consorzio Mario Negri Sud; Santa Maria Imbaro Italy
| | - Joachim Struck
- Research Department; B.R.A.H.M.S. Aktiengesellschaft; Hennigsdorf Germany
| | - Andreas Bergmann
- Research Department; B.R.A.H.M.S. Aktiengesellschaft; Hennigsdorf Germany
| | | | - Gianni Tognoni
- Department of Clinical Pharmacology and Epidemiology; Consorzio Mario Negri Sud; Santa Maria Imbaro Italy
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Iwanaga Y, Miyazaki S. Heart Failure, Chronic Kidney Disease, and Biomarkers - An Integrated Viewpoint -. Circ J 2010; 74:1274-82. [DOI: 10.1253/circj.cj-10-0444] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
PURPOSE OF REVIEW Natriuretic peptides are markers of heart failure and/or cardiac dysfunction that provide useful diagnostic and prognostic information in patients with dyspnea and/or respiratory failure in the emergency department. Cardiac troponins (cTn) have markedly simplified the diagnosis of myocardial infarction. In critically ill patients, conditions like coexisting organ dysfunction multiorgan involvement or altered synthesis/clearance may confound interpretation of designated biomarkers, including natriuretic peptides and cTn. This review focuses on recently published articles relating to the use of natriuretic peptides and cTn in critically ill patients. RECENT FINDINGS One new study addresses diagnostic utility of B-type natriuretic peptide to distinguish low-pressure pulmonary edema (acute lung injury/acute respiratory distress syndrome) from high-pressure (cardiogenic) pulmonary edema. Other studies highlight the prognostic value of natriuretic peptides either in unselected and general noncardiac ICU patients and reveal an important reason for elevated B-type natriuretic peptide levels in septic shock.Interesting data focusing on diagnostic and prognostic ability of systematic cTn screening measurements in ICU patients became available. SUMMARY Recent studies confirm the excellent prognostic value of natriuretic peptide measurements in ICU patients. Diagnostic properties of natriuretic peptide in ICU patients still remain ambiguous and require further evaluation. Systematic screening with cTn reveals more myocardial infarctions and provides important prognostic information.
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Affiliation(s)
- Markus Noveanu
- Department of Internal Medicine, University Hospital Basel, Basel, Switzerland.
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Metra M, Teerlink JR, Voors AA, Felker GM, Milo-Cotter O, Weatherley B, Dittrich H, Cotter G. Vasodilators in the treatment of acute heart failure: what we know, what we don't. Heart Fail Rev 2009; 14:299-307. [PMID: 19096932 PMCID: PMC2772958 DOI: 10.1007/s10741-008-9127-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2008] [Accepted: 11/25/2008] [Indexed: 12/13/2022]
Abstract
Although we have recently witnessed substantial progress in management and outcome of patients with chronic heart failure, acute heart failure (AHF) management and outcome have not changed over almost a generation. Vasodilators are one of the cornerstones of AHF management; however, to a large extent, none of those currently used has been examined by large, placebo-controlled, non-hemodynamic monitored, prospective randomized studies powered to assess the effects on outcomes, in addition to symptoms. In this article, we will discuss the role of vasodilators in AHF trying to point out which are the potentially best indications to their administration and which are the pitfalls which may be associated with their use. Unfortunately, most of this discussion is only partially evidence based due to lack of appropriate clinical trials. In general, we believe that vasodilators should be administered early to AHF patients with normal or high blood pressure (BP) at presentation. They should not be administered to patients with low BP since they may cause hypotension and hypoperfusion of vital organs, leading to renal and/or myocardial damage which may further worsen patients' outcome. It is not clear whether vasodilators have a role in either patients with borderline BP at presentation (i.e., low-normal) or beyond the first 1-2 days from presentation. Given the limitations of the currently available clinical trial data, we cannot recommend any specific agent as first line therapy, although nitrates in different formulations are still the most widely used in clinical practice.
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Affiliation(s)
- Marco Metra
- Section of Cardiovascular Diseases, Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy
| | - John R. Teerlink
- Department of Cardiology, San Francisco Veterans Affairs Medical Center and University of California, San Francisco, CA USA
| | - Adriaan A. Voors
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - G. Michael Felker
- Division of Cardiovascular Medicine, Duke Clinical Research Institute, Durham, NC USA
| | - Olga Milo-Cotter
- Momentum-Research Inc., 3100 Tower Blvd, Suite 802, Durham, NC 27707 USA
| | - Beth Weatherley
- Momentum-Research Inc., 3100 Tower Blvd, Suite 802, Durham, NC 27707 USA
| | | | - Gad Cotter
- Momentum-Research Inc., 3100 Tower Blvd, Suite 802, Durham, NC 27707 USA
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Vizzardi E, Chiari E, Faggiano P, D'Aloia A, Bordonali T, Metra M, Cas LD. Measurement of the myocardial performance index in ambulatory patients with heart failure: correlation with other clinical and echocardiographic parameters and independent prognostic value. Echocardiography 2009; 27:123-9. [PMID: 19765064 DOI: 10.1111/j.1540-8175.2009.00986.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Many echocardiographic parameters have been proposed for the assessment of the patients with heart failure (HF). Recently, the myocardial performance index (MPI) has been shown to be an accurate index of myocardial function. We assessed the correlation with other clinical and echocardiographic measurements and the prognostic value of MPI in patients with HF. METHODS AND RESULTS The MPI was assessed in 112 consecutive patients with persistent symptoms of HF (II-III NYHA class), sinus rhythm, LV systolic dysfunction (defined by an ejection fraction <or= 45%). At multivariable analysis, only NYHA class and ejection fraction were independently related to MPI. The severity of mitral regurgitation and MPI were the only parameters independently related to the incidence of death or cardiovascular hospitalizations. A MPI > 0.55 (median value) and medium to severe mitral regurgitation were associated with a relative risk of cardiovascular events of 18.7 (95% confidence interval [CI], 16.6-20.7; P < 0.005) and of 3.03 (95% CI, 2-4.1; P = 0.035), respectively. CONCLUSIONS In our patients with HF, MPI was the best predictor of cardiovascular events. Mitral regurgitation was the only other variable which had an additive prognostic value at multivariate analysis.
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Affiliation(s)
- Enrico Vizzardi
- Department of Experimental and Applied Medicine, Section of Cardiovascular Diseases, University of Brescia, Brescia, Italy.
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Relation Between Red Cell Distribution Width With Echocardiographic Parameters in Patients With Acute Heart Failure. J Card Fail 2009; 15:517-22. [DOI: 10.1016/j.cardfail.2009.01.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2008] [Revised: 01/07/2009] [Accepted: 01/12/2009] [Indexed: 11/19/2022]
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98
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Jaarsma T, Beattie JM, Ryder M, Rutten FH, McDonagh T, Mohacsi P, Murray SA, Grodzicki T, Bergh I, Metra M, Ekman I, Angermann C, Leventhal M, Pitsis A, Anker SD, Gavazzi A, Ponikowski P, Dickstein K, Delacretaz E, Blue L, Strasser F, McMurray J. Palliative care in heart failure: a position statement from the palliative care workshop of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2009; 11:433-43. [PMID: 19386813 DOI: 10.1093/eurjhf/hfp041] [Citation(s) in RCA: 362] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Heart failure is a serious condition and equivalent to malignant disease in terms of symptom burden and mortality. At this moment only a comparatively small number of heart failure patients receive specialist palliative care. Heart failure patients may have generic palliative care needs, such as refractory multifaceted symptoms, communication and decision making issues and the requirement for family support. The Advanced Heart Failure Study Group of the Heart Failure Association of the European Society of Cardiology organized a workshop to address the issue of palliative care in heart failure to increase awareness of the need for palliative care. Additional objectives included improving the accessibility and quality of palliative care for heart failure patients and promoting the development of heart failure-orientated palliative care services across Europe. This document represents a synthesis of the presentations and discussion during the workshop and describes recommendations in the area of delivery of quality care to patients and families, education, treatment coordination, research and policy.
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Affiliation(s)
- Tiny Jaarsma
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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Tsutamoto T, Kawahara C, Yamaji M, Nishiyama K, Fujii M, Yamamoto T, Horie M. Relationship between renal function and serum cardiac troponin T in patients with chronic heart failure. Eur J Heart Fail 2009; 11:653-8. [DOI: 10.1093/eurjhf/hfp072] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Takayoshi Tsutamoto
- Department of Cardiovascular and Respiratory Medicine; Shiga University of Medical Science; Tsukinowa, Seta Otsu 520-2192 Japan
| | - Chiho Kawahara
- Department of Cardiovascular and Respiratory Medicine; Shiga University of Medical Science; Tsukinowa, Seta Otsu 520-2192 Japan
| | - Masayuki Yamaji
- Department of Cardiovascular and Respiratory Medicine; Shiga University of Medical Science; Tsukinowa, Seta Otsu 520-2192 Japan
| | - Keizo Nishiyama
- Department of Cardiovascular and Respiratory Medicine; Shiga University of Medical Science; Tsukinowa, Seta Otsu 520-2192 Japan
| | - Masanori Fujii
- Department of Cardiovascular and Respiratory Medicine; Shiga University of Medical Science; Tsukinowa, Seta Otsu 520-2192 Japan
| | - Takashi Yamamoto
- Department of Cardiovascular and Respiratory Medicine; Shiga University of Medical Science; Tsukinowa, Seta Otsu 520-2192 Japan
| | - Minoru Horie
- Department of Cardiovascular and Respiratory Medicine; Shiga University of Medical Science; Tsukinowa, Seta Otsu 520-2192 Japan
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Cohen-Solal A, Logeart D, Huang B, Cai D, Nieminen MS, Mebazaa A. Lowered B-Type Natriuretic Peptide in Response to Levosimendan or Dobutamine Treatment Is Associated With Improved Survival in Patients With Severe Acutely Decompensated Heart Failure. J Am Coll Cardiol 2009; 53:2343-8. [DOI: 10.1016/j.jacc.2009.02.058] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Revised: 01/20/2009] [Accepted: 02/03/2009] [Indexed: 10/20/2022]
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