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Budts W, Roos-Hesselink J, Rädle-Hurst T, Eicken A, McDonagh TA, Lambrinou E, Crespo-Leiro MG, Walker F, Frogoudaki AA. Treatment of heart failure in adult congenital heart disease: a position paper of the Working Group of Grown-Up Congenital Heart Disease and the Heart Failure Association of the European Society of Cardiology. Eur Heart J 2016; 37:1419-27. [PMID: 26787434 DOI: 10.1093/eurheartj/ehv741] [Citation(s) in RCA: 143] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 12/14/2015] [Indexed: 12/11/2022] Open
Affiliation(s)
- Werner Budts
- Congenital and Structural Cardiology, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium
| | - Jolien Roos-Hesselink
- Department of Cardiology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Tanja Rädle-Hurst
- Department of Pediatric Cardiology, Saarland University Medical Center, Homburg, Germany
| | | | | | - Ekaterini Lambrinou
- Department of Nursing, School of Health Sciences Cyprus University of Technology, Limassol, Cyprus
| | - Maria G Crespo-Leiro
- Advanced Heart Failure and Heart Transplantation Unit, Cardiology Service, Hospital Universitario A Coruña, La Coruña, Spain
| | - Fiona Walker
- Centre for Grown-Up Congenital Heart Disease, St Bartholomews Hospital, London, UK
| | - Alexandra A Frogoudaki
- Adult Congenital Heart Clinic, Second Cardiology Department, ATTIKON University Hospital and Athens University, Athens, Greece
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102
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Schurgers LJ, Burgmaier M, Ueland T, Schutters K, Aakhus S, Hofstra L, Gullestad L, Aukrust P, Hellmich M, Narula J, Reutelingsperger CP. Circulating annexin A5 predicts mortality in patients with heart failure. J Intern Med 2016. [PMID: 26223343 DOI: 10.1111/joim.12396] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Natriuretic peptides are currently used to predict mortality in patients with heart failure (HF). However, novel independent biomarkers are needed to improve risk stratification in these patients. We hypothesized that annexin A5 (anxA5) would be highly expressed by organs which are generally affected by HF and that circulating anxA5 levels would predict mortality in HF patients. METHODS We prospectively determined the diagnostic value of anxA5, N-terminal pro-B-type natriuretic peptide (NT-proBNP), C-reactive protein (CRP) and estimated glomerular filtration rate (eGFR) to predict mortality in 180 HF patients during a median follow-up of 3.6 years. Studies were conducted with anxA5(-/-) mice to investigate the underlying mechanisms. RESULTS AnxA5 levels were significantly elevated in HF patients compared to healthy control subjects. Cox regression analysis demonstrated that anxA5, NT-proBNP and eGFR all predict mortality independently. AnxA5 significantly improved the diagnostic efficiency of NT-proBNP alone (improvement of c-statistic from 0.662 to 0.705, P < 0.001) and also combined with eGFR and CRP (improvement of c-statistic from 0.675 to 0.738, P < 0.001) to predict mortality in the Cox regression model. Receiver operating characteristic curve analysis showed that anxA5 predicted 3-year survival (area under curve 0.708) with an optimal cut-off value of 2.24 ng mL(-1) . Using anxA5(-/-) mice, we demonstrated that anxA5 is highly expressed in organs that are often affected by HF including lung, kidney, liver and spleen. Lysis of these organs in vitro resulted in a marked and significant increase in anxA5 concentrations. CONCLUSION AnxA5 improves the diagnostic efficiency of conventional biomarkers to predict mortality in HF patients. Whereas natriuretic peptides originate from the myocardium, high circulating anxA5 levels in patients with HF are likely to reflect peripheral organ damage secondary to HF.
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Affiliation(s)
- L J Schurgers
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - M Burgmaier
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands.,Department of Internal Medicine, University Hospital of the RWTH Aachen, Aachen, Germany
| | - T Ueland
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, University of Oslo, Oslo, Norway
| | - K Schutters
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - S Aakhus
- Department of Cardiology, Oslo University Hospital Rikshospitalet, University of Oslo, Oslo, Norway
| | - L Hofstra
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - L Gullestad
- Department of Cardiology, Oslo University Hospital Rikshospitalet, University of Oslo, Oslo, Norway
| | - P Aukrust
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, University of Oslo, Oslo, Norway.,Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, University of Oslo, Oslo, Norway
| | - M Hellmich
- Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany
| | - J Narula
- Cardiovascular Institute, Mount Sinai School of Medicine, New York, NY, USA
| | - C P Reutelingsperger
- Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
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103
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Bhandari SS, Narayan H, Jones DJ, Suzuki T, Struck J, Bergmann A, Squire IB, Ng LL. Plasma growth hormone is a strong predictor of risk at 1 year in acute heart failure. Eur J Heart Fail 2015; 18:281-9. [DOI: 10.1002/ejhf.459] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 10/08/2015] [Accepted: 10/22/2015] [Indexed: 11/08/2022] Open
Affiliation(s)
- Sanjay S. Bhandari
- Department of Cardiovascular Sciences; University of Leicester; Leicester UK
- NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital; University of Leicester; Leicester UK
| | - Hafid Narayan
- Department of Cardiovascular Sciences; University of Leicester; Leicester UK
- NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital; University of Leicester; Leicester UK
| | - Donald J.L. Jones
- Department of Cardiovascular Sciences; University of Leicester; Leicester UK
- NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital; University of Leicester; Leicester UK
- Department of Cancer Studies, Leicester Royal Infirmary; University of Leicester; Leicester UK
| | - Toru Suzuki
- Department of Cardiovascular Sciences; University of Leicester; Leicester UK
- NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital; University of Leicester; Leicester UK
| | | | | | - Iain B. Squire
- Department of Cardiovascular Sciences; University of Leicester; Leicester UK
- NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital; University of Leicester; Leicester UK
| | - Leong L. Ng
- Department of Cardiovascular Sciences; University of Leicester; Leicester UK
- NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital; University of Leicester; Leicester UK
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104
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Abdeen Y, Sen P, Safdar S, Katapally R, Arqoob AA, Macbruce D, Shaaban H, Adelman M. The usefulness of brain natriuretic peptide level in diagnosis and prognosis of patients admitted to critical care unit with shortness of breath. J Emerg Trauma Shock 2015; 8:205-9. [PMID: 26604526 PMCID: PMC4626937 DOI: 10.4103/0974-2700.166611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Brain Natriuretic Peptide (BNP) is a polypeptide secreted by the ventricles as a response to cardio-myocyte stretching. Due to its cardiac origin and correlation with volume overload it has been successfully used for a long time in diagnosing and prognosticating Cardiogenic Pulmonary Edema. Materials and Methods: In this retrospective cohort study, an attempt was made to observe any correlation between admission BNP levels with APACHE II scores and length of ICU stay, in patients admitted with dyspnea to the ICU of a community based hospital. Results/Conclusion: This study showed no significant correlation between length of stay in an ICU and admission BNP levels in dyspneic patients. Independent variables such as age and gender failed to show any coorelation either.
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Affiliation(s)
- Yazan Abdeen
- Department of Critical Care, Saint Michael's Medical Center, Newark, New Jersey, USA ; Department of Internal Medicine, Saint Michael's Medical Center, Newark, New Jersey, USA
| | - Parijat Sen
- Department of Critical Care, Saint Michael's Medical Center, Newark, New Jersey, USA ; Department of Internal Medicine, Saint Michael's Medical Center, Newark, New Jersey, USA
| | - Syed Safdar
- Department of Critical Care, Saint Michael's Medical Center, Newark, New Jersey, USA ; Department of Internal Medicine, Saint Michael's Medical Center, Newark, New Jersey, USA
| | - Ram Katapally
- Department of Critical Care, Saint Michael's Medical Center, Newark, New Jersey, USA ; Department of Internal Medicine, Saint Michael's Medical Center, Newark, New Jersey, USA
| | - Ahmad Abu Arqoob
- Department of Critical Care, Saint Michael's Medical Center, Newark, New Jersey, USA ; Department of Internal Medicine, Saint Michael's Medical Center, Newark, New Jersey, USA
| | - Daphne Macbruce
- Department of Critical Care, Saint Michael's Medical Center, Newark, New Jersey, USA ; Department of Internal Medicine, Saint Michael's Medical Center, Newark, New Jersey, USA
| | - Hamid Shaaban
- Department of Critical Care, Saint Michael's Medical Center, Newark, New Jersey, USA ; Department of Internal Medicine, Saint Michael's Medical Center, Newark, New Jersey, USA
| | - Marc Adelman
- Department of Critical Care, Saint Michael's Medical Center, Newark, New Jersey, USA ; Department of Internal Medicine, Saint Michael's Medical Center, Newark, New Jersey, USA
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105
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Usefulness of N-Terminal Pro-Brain Natriuretic Peptide to Predict Mortality in Adults With Congenital Heart Disease. Am J Cardiol 2015; 116:1425-30. [PMID: 26404943 DOI: 10.1016/j.amjcard.2015.07.070] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 07/30/2015] [Accepted: 07/30/2015] [Indexed: 11/21/2022]
Abstract
Natriuretic peptides are often elevated in congenital heart disease (CHD); however, the clinical impact on mortality is unclear. The aim of our study was to evaluate the prognostic value of N-terminal pro-brain natriuretic peptide (NT-proBNP) in the prediction of all-cause mortality in adults with different CHD. In this prospective longitudinal mortality study, we evaluated NT-proBNP in 1,242 blood samples from 646 outpatient adults with stable CHD (mean age 35 ± 12 years; 345 women). Patients were followed up for 6 ± 3 (1 to 10) years. The mortality rate was 5% (35 patients, mean age 40 ± 14 years, 17 women). Median NT-proBNP (pg/ml) was 220 in the whole cohort, 203 in survivors, and 1,548 in deceased patients. The best discrimination value for mortality prediction was 630 pg/ml with 74% sensitivity and 84% specificity. During the follow-up, the survival rate was 65% for those with median NT-proBNP ≥630 pg/ml and 94% for NT-proBNP <630 pg/ml; p <0.0001. There was only 1% mortality among 388 patients with at least 1 NT-proBNP value ≤220 pg/ml compared with 41% mortality among 54 patients with at least 1 NT-proBNP value >1,548 pg/ml. Even the first (baseline) measurements of NT-proBNP were strongly associated with a high risk of death (log10 NT-proBNP had hazard ratio 7, p <0.0001). In conclusion, NT-proBNP assessment is a useful and simple tool for the prediction of mortality in long-term follow-up of adults with CHD.
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106
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Sedaghat-Hamedani F, Kayvanpour E, Frankenstein L, Mereles D, Amr A, Buss S, Keller A, Giannitsis E, Jensen K, Katus HA, Meder B. Biomarker Changes after Strenuous Exercise Can Mimic Pulmonary Embolism and Cardiac Injury—A Metaanalysis of 45 Studies. Clin Chem 2015; 61:1246-55. [DOI: 10.1373/clinchem.2015.240796] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 06/18/2015] [Indexed: 11/06/2022]
Abstract
Abstract
BACKGROUND
Biomarkers are well established for diagnosis of myocardial infarction [cardiac troponins, high-sensitivity cardiac troponins (hs-cTn)], exclusion of acute and chronic heart failure [B-type natriuretic peptide (BNP), N-terminal proBNP (NT-proBNP)] and venous thromboembolism (d-dimers). Several studies have demonstrated acute increases in cardiac biomarkers and altered cardiac function after strenuous sports that can pretend a cardiovascular emergency and interfere with state-of-the-art clinical assessment.
METHODS
We performed a systematic review and metaanalysis of biomarker and cardiovascular imaging changes after endurance exercise. We searched for observational studies published in the English language from 1997 to 2014 that assessed these biomarkers or cardiac function and morphology directly after endurance exercise. Of 1787 identified abstracts, 45 studies were included.
RESULTS
Across all studies cardiac troponin T (cTnT) exceeded the cutoff value (0.01 ng/mL) in 51% (95% CI, 37%–64%) of participants. The measured pooled changes from baseline for high-sensitivity cTnT (hs-cTnT) were +26 ng/L (95% CI, 5.2–46.0), for cTnI +40 ng/L (95% CI, 21.4; 58.0), for BNP +10 ng/L (95% CI, 4.3; 16.6), for NT-proBNP +67 ng/L (95% CI, 49.9; 84.7), and for d-dimer +262 ng/mL (95% CI, 165.9; 358.7). Right ventricular end diastolic diameter increased and right ventricular ejection fraction as well as the ratio of the early to late transmitral flow velocities decreased after exercise, while no significant changes were observed in left ventricular ejection fraction.
CONCLUSIONS
Current cardiovascular biomarkers (cTnT, hs-cTnT, BNP, NT-proBNP, and d-dimer) that are used in clinical diagnosis of pulmonary embolism, acute coronary syndrome, and heart failure are prone to alterations due to strenuous exercise. Hence, it is necessary to take previous physical exercise into account when a cardiac emergency is suspected.
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Affiliation(s)
- Farbod Sedaghat-Hamedani
- Department of Medicine III, University of Heidelberg, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Germany
| | - Elham Kayvanpour
- Department of Medicine III, University of Heidelberg, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Germany
| | - Lutz Frankenstein
- Department of Medicine III, University of Heidelberg, Heidelberg, Germany
| | - Derliz Mereles
- Department of Medicine III, University of Heidelberg, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Germany
| | - Ali Amr
- Department of Medicine III, University of Heidelberg, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Germany
| | - Sebastian Buss
- Department of Medicine III, University of Heidelberg, Heidelberg, Germany
| | - Andreas Keller
- Chair for Clinical Bioinformatics, Saarland University, Saarbrücken, Germany
| | | | - Katrin Jensen
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Hugo A Katus
- Department of Medicine III, University of Heidelberg, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Germany
| | - Benjamin Meder
- Department of Medicine III, University of Heidelberg, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Germany
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107
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N-terminal pro-beta-type natriuretic peptide (NT-proBNP) can be considered a valuable predictor of heart rejection. Indian J Thorac Cardiovasc Surg 2015. [DOI: 10.1007/s12055-015-0398-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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108
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Sakuragi S, Ichikawa K, Yamada K, Tanimoto M, Miki T, Otsuka H, Yamamoto K, Kawamoto K, Katayama Y, Tanakaya M, Ito H. An increase in the coronary calcification score is associated with an increased risk of heart failure in patients without a history of coronary artery disease. J Cardiol 2015; 67:358-64. [PMID: 26254962 DOI: 10.1016/j.jjcc.2015.06.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 06/21/2015] [Accepted: 06/26/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND The presence of coronary artery calcification (CAC) and its severity predict future cardiovascular events and is used for risk stratification. However, the association of CAC with heart failure (HF) in patients without a history of coronary artery disease (CAD) remains unclear. This study aimed to determine the correlations of CAC with N-terminal pro-B-type natriuretic peptide (NT-proBNP) and HF events in patients without a history of CAD or HF. METHODS From June 2010 to June 2013, a total of 487 patients without a history of CAD and HF were enrolled. All of the patients underwent plane multi-detector computed tomography. They were divided into four categories according to CAC scores: ≤10, 11-100, 101-400, and ≥401. RESULTS The proportion of patients with high NT-proBNP levels increased with CAC categories (p<0.0001). The CAC score was associated with NT-proBNP levels ≥400pg/ml, with an odds ratio of 2.901 (95% confidence interval: 1.368-6.151, p=0.0055) for CAC scores ≥401 compared with CAC scores of 0-10 after adjustment for confounding factors. During the follow-up period of 497±315 days, nine patients were admitted for HF. Kaplan-Meier analysis showed that patients with CAC scores ≥401 had a lower rate of freedom from admission for HF with cumulative incidences of 0.4%, 1%, 2%, and 8% for CAC scores of 0-10, 11-100, 101-400, and ≥401, respectively (p<0.0001). Increasing CAC scores were associated with an increase in incidence of admission for HF, with a hazard ratio of 10.371 for CAC scores ≥401 (95% CI: 1.062-101.309, p=0.0443) compared with CAC scores of 0-10 after adjustment for risk factors. CONCLUSION Severe CAC is an independent determinant of high NT-proBNP levels and a predictor of admission for HF in a population without a history of CAD or HF.
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Affiliation(s)
- Satoru Sakuragi
- Department of Cardiovascular Medicine, Iwakuni Clinical Center, Iwakuni, Japan.
| | - Keishi Ichikawa
- Department of Cardiovascular Medicine, Iwakuni Clinical Center, Iwakuni, Japan
| | - Keiji Yamada
- Department of Cardiovascular Medicine, Iwakuni Clinical Center, Iwakuni, Japan
| | - Masafumi Tanimoto
- Department of Cardiovascular Medicine, Iwakuni Clinical Center, Iwakuni, Japan
| | - Takashi Miki
- Department of Cardiovascular Medicine, Iwakuni Clinical Center, Iwakuni, Japan
| | - Hiroaki Otsuka
- Department of Cardiovascular Medicine, Iwakuni Clinical Center, Iwakuni, Japan
| | - Kazuhiko Yamamoto
- Department of Cardiovascular Medicine, Iwakuni Clinical Center, Iwakuni, Japan
| | - Kenji Kawamoto
- Department of Cardiovascular Medicine, Iwakuni Clinical Center, Iwakuni, Japan
| | - Yusuke Katayama
- Department of Cardiovascular Medicine, Iwakuni Clinical Center, Iwakuni, Japan
| | - Machiko Tanakaya
- Department of Cardiovascular Medicine, Iwakuni Clinical Center, Iwakuni, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medical and Dentistry, Okayama, Japan
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Li G, Lu WH, Wu XW, Cheng J, Ai R, Zhou ZH, Tang ZZ. Admission hypoxia-inducible factor 1α levels and in-hospital mortality in patients with acute decompensated heart failure. BMC Cardiovasc Disord 2015. [PMID: 26223692 PMCID: PMC4518524 DOI: 10.1186/s12872-015-0073-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Hypoxia-inducible factor 1 (HIF-1) is a critical regulator for cellular oxygen balance. Myocardial hypoxia can induce the increased expression of HIF-1α. Our goals were to evaluate the value of HIF-1α in predicting death of patients with acute decompensated heart failure (ADHF) and describe the in vivo relationship between serum HIF-1α and N-terminal-pro-brain natriuretic peptide (NT-proBNP) levels. METHOD We included 296 patients who were consecutively admitted to the emergency department for ADHF. The primary end point was in-hospital death. The patients were categorized as HFrEF (patients with reduced systolic function) and HFpEF (patients with preserved systolic function) groups. RESULTS In our patients, the median admission HIF-1α level was 2.95 ± 0.85 ng/ml. The HIF-1α level was elevated significantly in HFrEF patients and deceased patients compared with HFpEF patients and patients who survived. The HIF-1α level was positively correlated with NT-proBNP and cardiac troponin T levels, and negatively correlated with left ventricular ejection fraction and systolic blood pressure. Kaplan-Meier curves revealed a significant increase in in-hospital mortality in ADHF patients with higher HIF-1α levels. Multivariable Cox regression analysis showed that HIF-1α levels were not correlated with the short-term prognosis of ADHF patients. CONCLUSIONS This is the first study to evaluate the circulating levels of HIF-1α in ADHF patients. Serum HIF-1α levels may reflect a serious state in patients with ADHF. Due to the limitations of the study, serum HIF-1α levels were not correlated with the in-hospital mortality based on regression analysis. Further studies are needed to demonstrate the diagnostic and/or prognostic role of HIF-1α as a risk biomarker in patients with ADHF.
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Affiliation(s)
- Gang Li
- Emergency Department, Wuhan General Hospital of Guangzhou Military Command, Wuhan, 430074, China.
| | - Wei-hua Lu
- Emergency Department, Wuhan General Hospital of Guangzhou Military Command, Wuhan, 430074, China.
| | - Xiao-wei Wu
- Department of Thoracic Surgery, TongJi Hospital, TongJi Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Jian Cheng
- Emergency Department, Wuhan General Hospital of Guangzhou Military Command, Wuhan, 430074, China.
| | - Rong Ai
- College of Foreign Language, Huazhong Agriculture University, Wuhan, China.
| | - Zi-hua Zhou
- Institute of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China.
| | - Zhong-zhi Tang
- Emergency Department, Wuhan General Hospital of Guangzhou Military Command, Wuhan, 430074, China.
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Lang NN, Wong CM, Dalzell JR, Jansz S, Leslie SJ, Gardner RS. The ease of use and reproducibility of the Alere™ Heart Check System: a comparison of patient and healthcare professional measurement of BNP. Biomark Med 2015; 8:791-6. [PMID: 25224935 DOI: 10.2217/bmm.14.48] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIMS The aim of the study was to examine the ease of use and the reproducibility of a novel point-of-care BNP measurement system when used by patients and healthcare providers (HCP). PATIENTS & METHODS Patients with symptomatic heart failure were recruited from outpatient clinics at four hospitals. They were provided with brief training and instructional material for the use of the point-of-care BNP measurement system. Finger-prick blood BNP concentration was measured by the HCP and the patient (n = 150). Ease of use and reproducibility of the system were assessed. RESULTS In total, 80% of the 164 patients who completed a questionnaire on the ease of use of the system found it easy to operate. There was excellent correlation of BNP measurement compared between patients and HCP (r = 0.966; p < 0.001). CONCLUSION Patients find the Alere Heart Check BNP measurement system easy to operate. BNP concentration measurements obtained by patients show excellent correlation with those obtained by healthcare providers.
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Affiliation(s)
- Ninian N Lang
- Scottish Advanced Heart Failure Service, Golden Jubilee National Hospital, Agamemnon Street, Clydebank, Glasgow, G81 4DY, UK
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111
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Al-Zaiti SS, Fallavollita JA, Canty JM, Carey MG. The prognostic value of discordant T waves in lead aVR: A simple risk marker of sudden cardiac arrest in ischemic cardiomyopathy. J Electrocardiol 2015; 48:887-92. [PMID: 26233648 DOI: 10.1016/j.jelectrocard.2015.06.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Simple and reliable ECG marker(s) for sudden cardiac arrest (SCA) could be very useful in assessing high-risk populations. Since ischemic repolarization abnormalities in the left ventricular (LV) apex are strongly correlated with discordant T waves in lead aVR, we sought to evaluate the clinical and prognostic significance of this feature in ischemic cardiomyopathy. METHODS The PAREPET trial enrolled patients with ischemic cardiomyopathy eligible for a primary prevention implantable cardiac defibrillator (ICD). Those with persistent pacing or left bundle branch block were excluded. Amplitudes of T/aVR were automatically computed from median ECG beats at enrollment and endpoints were blindly adjudicated. RESULTS The sample was mainly composed of older men (n=138, age 65±12, 91% male, EF 29±9%). At enrollment, amplitude of T/aVR significantly correlated with EF, indexed LV end-diastolic volume, B-type natriuretic peptide (BNP), regional scar volume, and PET-quantified denervated myocardium. After a median follow up of 4.2years, there were 23 (17%) adjudicated SCA. In multivariate analysis, the presence of discordant T/aVR (>0mm, n=42, 30%) was a significant and independent predictor of SCA (hazard ratio 2.0 [95% CI 1.0-4.9]) and cardiac death (hazard ratio 1.9 [95% CI 1.0-3.7]). CONCLUSIONS In subjects with ischemic cardiomyopathy, discordant T waves in lead aVR are associated with high-risk clinical parameters including lower ejection fraction, greater ventricular volume, higher BNP, and more denervated myocardium. Furthermore, discordant T/aVR remained an independent predictor of SCA and cardiovascular mortality even after accounting for these prognostic factors.
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Affiliation(s)
| | - James A Fallavollita
- VA WNY Health Care System at Buffalo, Buffalo, NY, USA; Clinical Translational Research Center, Buffalo, NY, USA; Department of Medicine, University at Buffalo, Buffalo, NY, USA
| | - John M Canty
- VA WNY Health Care System at Buffalo, Buffalo, NY, USA; Clinical Translational Research Center, Buffalo, NY, USA; Department of Medicine, University at Buffalo, Buffalo, NY, USA; Department of Physiology & Biophysics, University at Buffalo, Buffalo, NY, USA; Department of Biomedical Engineering, University at Buffalo, Buffalo, NY, USA
| | - Mary G Carey
- University of Rochester Medical Center, Rochester, NY, USA
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112
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Feola M, Testa M, Leto L, Rosso GL. The predictive value of non-invasive cardiac output at rest in discharged heart failure patients. Int J Cardiol 2015; 188:50-1. [PMID: 25885750 DOI: 10.1016/j.ijcard.2015.04.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 04/03/2015] [Indexed: 11/19/2022]
Affiliation(s)
- Mauro Feola
- Cardiovascular Rehabilitation-Heart Failure Unit, Ospedale SS Trinita', Fossano, Italy.
| | - Marzia Testa
- School of Geriatry Universita' degli Studi Torino, Italy
| | - Laura Leto
- School of Geriatry Universita' degli Studi Torino, Italy
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Sahingozlu T, Karadas U, Eliacik K, Bakiler AR, Ozdemir Karadas N, Kanik MA, Baran M. Brain natriuretic peptide: the reason of respiratory distress is heart disease or lung disease? Am J Emerg Med 2015; 33:697-700. [DOI: 10.1016/j.ajem.2015.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Revised: 02/02/2015] [Accepted: 02/02/2015] [Indexed: 11/27/2022] Open
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Sakuragi S, Ichikawa K, Yamada K, Tanimoto M, Miki T, Otsuka H, Yamamoto K, Kawamoto K, Katayama Y, Tanakaya M, Ito H. Serum cystatin C level is associated with left atrial enlargement, left ventricular hypertrophy and impaired left ventricular relaxation in patients with stage 2 or 3 chronic kidney disease. Int J Cardiol 2015; 190:287-92. [PMID: 25932809 DOI: 10.1016/j.ijcard.2015.04.189] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 04/21/2015] [Accepted: 04/22/2015] [Indexed: 01/15/2023]
Abstract
BACKGROUND Cystatin C is an endogenous marker of kidney function that overcomes the limitations of serum creatinine. High serum cystatin C levels have been associated with increased cardiovascular mortality and morbidity. In this cross-sectional study, we aimed to determine the associations between serum cystatin C levels and structural and functional cardiac changes in patients with stage 2 or 3 chronic kidney disease (CKD). METHODS AND RESULTS We enrolled 429 consecutive patients (aged 24-97 years) with CKD stage 2 or 3 and left ventricular (LV) ejection fraction (LVEF)>40%. Echocardiographic parameters, including LV mass index (LVMI), early diastolic mitral annulus velocity (e' velocity), left atrial volume index (LAVI), and N-terminal of the prohormone brain natriuretic peptide (NT-proBNP) were measured. Patients were categorized into quartiles according to serum cystatin C levels. Cystatin C was associated with LAVI (p=0.0055), LVEF (p=0.0432), LVMI (p=0.0409), e' (p=0.0051), E/e' (p=0.0027), and log-transformed NT-proBNP (p<0.0001) according to multivariate linear regression analysis, after adjustment for confounding factors including creatinine-based estimated glomerular filtration rate (eGFRcreat) and urinary albumin to creatinine ratio. Incidence of eccentric and concentric hypertrophy increased with increasing cystatin C (Q1, 38%; Q2 49%; Q3, 51%; Q4, 66%, p=0.0008), mainly because of increasing concentric hypertrophy (Q1, 30%; Q2, 39%; Q3, 39%; Q4, 51%, p=0.0187). CONCLUSION A high serum cystatin C is strongly associated with structural cardiac abnormalities such as LVH and left atrial enlargement, impaired LV relaxation, and an increased NT-proBNP, independently of eGFRcreat in patients with stage 2 or 3 CKD.
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Affiliation(s)
- Satoru Sakuragi
- Department of Cardiovascular Medicine, Iwakuni Clinical Center, Iwakuni, Japan.
| | - Keishi Ichikawa
- Department of Cardiovascular Medicine, Iwakuni Clinical Center, Iwakuni, Japan
| | - Keiji Yamada
- Department of Cardiovascular Medicine, Iwakuni Clinical Center, Iwakuni, Japan
| | - Masafumi Tanimoto
- Department of Cardiovascular Medicine, Iwakuni Clinical Center, Iwakuni, Japan
| | - Takashi Miki
- Department of Cardiovascular Medicine, Iwakuni Clinical Center, Iwakuni, Japan
| | - Hiroaki Otsuka
- Department of Cardiovascular Medicine, Iwakuni Clinical Center, Iwakuni, Japan
| | - Kazuhiko Yamamoto
- Department of Cardiovascular Medicine, Iwakuni Clinical Center, Iwakuni, Japan
| | - Kenji Kawamoto
- Department of Cardiovascular Medicine, Iwakuni Clinical Center, Iwakuni, Japan
| | - Yusuke Katayama
- Department of Cardiovascular Medicine, Iwakuni Clinical Center, Iwakuni, Japan
| | - Machiko Tanakaya
- Department of Cardiovascular Medicine, Iwakuni Clinical Center, Iwakuni, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medical and Dentistry, Okayama, Japan
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Hellman Y, Malik AS, Lin H, Shen C, Wang IW, Wozniak TC, Hashmi ZA, Pickrell J, Jani M, Caccamo MA, Gradus-Pizlo I, Hadi A. B-Type Natriuretic Peptide Levels Predict Ventricular Arrhythmia Post Left Ventricular Assist Device Implantation. Artif Organs 2015; 39:1051-5. [PMID: 25864448 DOI: 10.1111/aor.12486] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
B-type natriuretic peptide (BNP) levels have been shown to predict ventricular arrhythmia (VA) and sudden death in patients with heart failure. We sought to determine whether BNP levels before left ventricular assist device (LVAD) implantation can predict VA post LVAD implantation in advanced heart failure patients. We conducted a retrospective study consisting of patients who underwent LVAD implantation in our institution during the period of May 2009-March 2013. The study was limited to patients receiving a HeartMate II or HeartWare LVAD. Acute myocardial infarction patients were excluded. We compared between the patients who developed VA within 15 days post LVAD implantation to the patients without VA. A total of 85 patients underwent LVAD implantation during the study period. Eleven patients were excluded (five acute MI, four without BNP measurements, and two discharged earlier than 13 days post LVAD implantation). The incidence of VA was 31%, with 91% ventricular tachycardia (VT) and 9% ventricular fibrillation. BNP remained the single most powerful predictor of VA even after adjustment for other borderline significant factors in a multivariate logistic regression model (P < 0.05). BNP levels are a strong predictor of VA post LVAD implantation, surpassing previously described risk factors such as age and VT in the past.
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Affiliation(s)
- Yaron Hellman
- Krannert Institute of Cardiology, IU School of Medicine, Indianapolis, IN, USA
| | - Adnan S Malik
- Krannert Institute of Cardiology, IU School of Medicine, Indianapolis, IN, USA
| | - Hongbo Lin
- Department of Biostatistics, IU School of Medicine, Indianapolis, IN, USA
| | - Changyu Shen
- Department of Biostatistics, IU School of Medicine, Indianapolis, IN, USA
| | - I-Wen Wang
- IU Health Cardiovascular Surgeons, Indianapolis, IN, USA
| | | | | | - Jeanette Pickrell
- Krannert Institute of Cardiology, IU School of Medicine, Indianapolis, IN, USA
| | - Milena Jani
- Krannert Institute of Cardiology, IU School of Medicine, Indianapolis, IN, USA
| | - Marco A Caccamo
- Krannert Institute of Cardiology, IU School of Medicine, Indianapolis, IN, USA
| | - Irmina Gradus-Pizlo
- Krannert Institute of Cardiology, IU School of Medicine, Indianapolis, IN, USA
| | - Azam Hadi
- Krannert Institute of Cardiology, IU School of Medicine, Indianapolis, IN, USA
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Shalaby AA, Abraham WT, Fonarow GC, Bersohn MM, Gorcsan J, Lee LY, Halilovic J, Saba S, Maisel A, Singh JP, Sonel A, Kadish A. Association of BNP and Troponin Levels with Outcome among Cardiac Resynchronization Therapy Recipients. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:581-90. [PMID: 25677851 DOI: 10.1111/pace.12610] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 01/14/2015] [Accepted: 02/09/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND We conducted a prospective multicenter study to assess the prognostic value of combined baseline preimplant plasma levels of the biomarkers cardiac troponin T (TnT) and B-type natriuretic peptide (BNP) among cardiac resynchronization therapy (CRT) with or without defibrillator capability (CRT-D) recipients. METHODS At CRT-D implant, patients were stratified based on detectable TnT (≥0.01 ng/mL) and elevated BNP (predefined as >440 pg/mL) levels. Patients were classified into three groups: high (both detectable TnT and high BNP), intermediate (either detectable TnT or high BNP), or low (nondetectable TnT and low BNP). Patients were followed for 12 months. Survival curves free from mortality or heart failure hospitalizations (HFH) were assessed. To assess the predictive value of biomarker category, we constructed a multivariate Cox regression model, including the covariates of age, New York Heart Association class, left ventricular ejection fraction (LVEF), and QRS duration. RESULTS A total of 267 patients (age 66 ± 12 years, males 80%, LVEF 25% ± 8%, ischemic cardiomyopathy 52%, QRSd 155 ± 26 ms) were studied. After 1 year, there were 13 deaths and 25 HFH events. A significant difference in event-free survival among the three groups was observed, with high and intermediate categories having worse survival than low (log-rank test, P < 0.001). In the multivariate model, risk category was a significant predictor of outcome: hazard ratios were 7.34 (95% confidence interval [CI]: 2.48-21.69) and 2.50 (95% confidence interval [CI]: 1.04-6.04) for high-risk and intermediate-risk groups, respectively (P < 0.0001). CONCLUSION Among CRT-D recipients, baseline TnT and BNP values alone or in combination provide significant prognostic value for the outcome of mortality or HFH.
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Affiliation(s)
- Alaa A Shalaby
- University of Pittsburgh, Pittsburgh, Pennsylvania; VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
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Biomarkers in electrophysiology: role in arrhythmias and resynchronization therapy. J Interv Card Electrophysiol 2015; 43:31-44. [PMID: 25715916 DOI: 10.1007/s10840-015-9982-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 02/04/2015] [Indexed: 01/03/2023]
Abstract
Circulating biomarkers related to inflammation, neurohormones, myocardial stress, and necrosis have been associated with commonly encountered arrhythmic disorders such as atrial fibrillation (AF) and more malignant processes including ventricular arrhythmias (VA) and sudden cardiac death (SCD). Both direct and indirect biomarkers implicated in the heart failure cascade have potential prognostic value in patients undergoing cardiac resynchronization therapy (CRT). This review will focus on the role of biomarkers in AF, history of SCD, and CRT with an emphasis to improve clinical risk assessment for arrhythmias and patient selection for device therapy. Notably, information obtained from biomarkers may supplement traditional diagnostic and imaging techniques, thus providing an additional benefit in the management of patients.
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118
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Stähli BE, Gebhard C, Saleh L, Falk V, Landmesser U, Nietlispach F, Maisano F, Lüscher TF, Maier W, Binder RK. N-terminal pro-B-type natriuretic peptide-ratio predicts mortality after transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2015; 85:1240-7. [DOI: 10.1002/ccd.25788] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 12/06/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Barbara E. Stähli
- Department of Cardiology; University Heart Center; Zurich Switzerlan
| | - Cathérine Gebhard
- Department of Cardiology; University Heart Center; Zurich Switzerlan
| | - Lanja Saleh
- Institute of Clinical Chemistry, University Hospital Zurich; Zurich Switzerland
| | - Volkmar Falk
- Departement of Cardiovascular Surgery; University Heart Center; Zurich Switzerlan
| | - Ulf Landmesser
- Department of Cardiology; University Heart Center; Zurich Switzerlan
| | | | - Francesco Maisano
- Departement of Cardiovascular Surgery; University Heart Center; Zurich Switzerlan
| | - Thomas F. Lüscher
- Department of Cardiology; University Heart Center; Zurich Switzerlan
| | - Willibald Maier
- Department of Cardiology; University Heart Center; Zurich Switzerlan
| | - Ronald K. Binder
- Department of Cardiology; University Heart Center; Zurich Switzerlan
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119
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Misumi I, Nishida Y, Honda T, Kurokawa H, Yasuda H, Kaikita K, Hokimoto S, Ogawa H. Markedly High B-type Natriuretic Peptide Level in a Patient with Duchenne Muscular Dystrophy and Left Ventricular Non-Compaction. Intern Med 2015; 54:2197-200. [PMID: 26328646 DOI: 10.2169/internalmedicine.54.3960] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A boy with Duchenne muscular dystrophy was admitted to our hospital due to a transient loss of consciousness. Transthoracic echocardiography revealed left ventricular (LV) dilatation and diffuse hypokinesis of the LV wall. The LV wall was thin, and both non-compaction of the LV wall and marked thinning of the posterior LV wall resulting from a lesion were observed. The plasma B-type natriuretic peptide (BNP) level ultimately increased to 7,795 pg/mL, and the patient died of cardiac arrest following ventricular tachycardia. Severe heart failure, a critical condition, and thinning of the LV wall may have contributed to the markedly high plasma BNP level in this case.
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Affiliation(s)
- Ikuo Misumi
- Department of Cardiology, Kumamoto Saisyunsou Hospital, Japan
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120
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Which biomarkers do clinicians need for diagnosis and management of heart failure with reduced ejection fraction? Clin Chim Acta 2014; 443:9-16. [PMID: 25447693 DOI: 10.1016/j.cca.2014.10.046] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 10/24/2014] [Accepted: 10/27/2014] [Indexed: 11/21/2022]
Abstract
While there have been significant recent advances in the medical management of chronic HF (including the use of beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and aldosterone blockers), the ability to characterize, monitor, and predict a patient's response to HF therapy is poor. Risk stratification is important in patients with chronic heart failure and enables informed decisions about treatment and end-of-life care. Clinical parameters, such as advanced age, higher NYHA functional class, reduced left ventricular ejection fraction, lower body mass index, renal dysfunction, and anemia have all been associated with poor outcomes in HF. More recently, heart failure biomarkers have considerably changed the way we take care of our HF patients. BNP and NT-proBNP are endorsed by current guidelines and are now the gold standard biomarkers to confirm the diagnosis and to evaluate the prognosis of heart failure. Studies on natriuretic peptide-guided HF therapy look promising. Novel biomarkers, such soluble ST2, growth differentiation factor-15, highly sensitive troponins and Galectin-3, show potential in assessing prognosis beyond the established natriuretic peptides, but their role in the clinical care of the patient is still partially defined and more studies are needed.
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121
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Franke J, Lindmark A, Hochadel M, Zugck C, Koerner E, Keppler J, Ehlermann P, Winkler R, Zahn R, Katus HA, Senges J, Frankenstein L. Gender aspects in clinical presentation and prognostication of chronic heart failure according to NT-proBNP and the Heart Failure Survival Score. Clin Res Cardiol 2014; 104:334-41. [PMID: 25373384 DOI: 10.1007/s00392-014-0786-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 10/28/2014] [Indexed: 12/30/2022]
Abstract
AIMS We performed a prospective multi-center study to assess gender-specific differences in the predictive value of the measured level of NT-proBNP and the calculated Heart Failure Survival Score (HFSS). METHODS Baseline characteristics and follow-up data up to 5 years from 2,019 men and 530 women diagnosed with chronic heart failure (CHF) due to ischemic heart disease or dilated cardiomyopathy were prospectively compared. Death from any cause constituted the endpoint of the study. NT-proBNP was measured and HFSS calculated according to standard methods. Survival of men and women according to level of NT-proBNP and HFSS was analyzed in logistic regression models. RESULTS Median NT-proBNP level in men was 1,394 ng/l (IQR 516-3,406 ng/l) and 1,168 ng/l (IQR 444-2,830 ng/l) in women (p = n.s.). Median HFSS value was 8.4 (IQR 7.7-9.1) and 8.5 (8.0-9.1) in men and women, respectively. NT-proBNP levels and HFSS score correlated well with survival rates in both genders (p for interaction = 0.22 for NT-proBNP and 0.93 for HFSS). The all-cause death rates were similar in men and women. CONCLUSION Despite a number of gender-specific differences in CHF and the general predominance of men measured levels of NT-proBNP and HFSS score can be utilized for risk stratification with similar informative value in men and women.
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Affiliation(s)
- Jennifer Franke
- Department of Cardiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany,
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Nayer J, Aggarwal P, Galwankar S. Utility of point-of-care testing of natriuretic peptides (brain natriuretic peptide and n-terminal pro-brain natriuretic peptide) in the emergency department. Int J Crit Illn Inj Sci 2014; 4:209-15. [PMID: 25337482 PMCID: PMC4200546 DOI: 10.4103/2229-5151.141406] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Rapid and accurate diagnosis of a patient with an acute disease is a challenge for emergency physicians. Natriuretic peptides have emerged as important tools for diagnosis, risk stratification and therapeutic decision making for some categories of emergency patients. Brain natriuretic peptide (BNP) is a member of a four natriuretic peptides family that shares a common 17-peptide ring structure. Atrial natriuretic peptide, C-natriuretic peptide (CNP), and D-type natriuretic peptide are the other natriuretic peptide, which share the same common 17-peptide ring structure. The N-terminal fragment of pro-BNP, N-terminal pro-brain natriuretic peptide (NT-proBNP) consists of 76 amino acids, which is biologically inert, while the active component BNP contains 32 amino acids. BNP and NT-proBNP are secreted in the plasma in equimolar quantities and are frequently used in the diagnosis of congestive heart failure, and distinguishing between patients with dyspnea of cardiac or pulmonary origin. Both natriuretic peptides have also been evaluated for use in the assessment and management of several other conditions including sepsis, cirrhosis of liver and renal failure. However, one should remember that the values of natriuretic peptides are affected by age and weight of the patients, and presence of several comorbidities such as chronic renal failure, type 2 diabetes mellitus, anemia, pulmonary embolism, and acute coronary syndrome. Values of these peptides also vary depending on the type of test used. The performance characteristics of these natriuretic peptides vary depending on the patients on whom they are used. Therefore determination of reference values for these peptides represents a challenge.
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Affiliation(s)
- Jamshed Nayer
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Praveen Aggarwal
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sagar Galwankar
- Department of Emergency Medicine, University of South Florida and Winter Haven Hospital, Florida, USA
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CXCL16 is a novel diagnostic marker and predictor of mortality in inflammatory cardiomyopathy and heart failure. Int J Cardiol 2014; 176:896-903. [DOI: 10.1016/j.ijcard.2014.08.033] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 06/27/2014] [Accepted: 08/05/2014] [Indexed: 11/18/2022]
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124
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Srivatsan V, George M, Shanmugam E. Utility of galectin-3 as a prognostic biomarker in heart failure: where do we stand? Eur J Prev Cardiol 2014; 22:1096-110. [PMID: 25268020 DOI: 10.1177/2047487314552797] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 09/04/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Heart failure (HF) continues to be an illness of daunting proportions with a four- year mortality touching 50%. Biomarkers for prognosticating patients with heart failure have generated immense interest. Several studies have been conducted on a novel biomarker, galectin-3 to assess its prognostic effect in heart failure populations. However, the studies have generated conflicting results. Hence a systematic review was done to assess the utility of galectin-3 as a prognostic biomarker in HF. DESIGN This study was a systematic review. METHODS A literature search was done using terms 'galectin-3 and heart' and 'galectin-3 and heart failure' in MEDLINE, Science Direct, Scopus, Springer Link, Cochrane Library and Google Scholar for original articles using a predefined inclusion/exclusion criteria. RESULTS Altogether 27 original articles were selected for the systematic review. Multivariate analysis showed galectin-3 to be ineffective in predicting all-cause mortality and cardiovascular mortality especially under the influence of factors such as estimated glomerular filtration rate (eGFR), left ventricular ejection fraction (LVEF) and N-terminal pro-B-type natriuretic peptide (NTproBNP). Galectin-3 was not found to be superior to NTproBNP, sST2, GDF-15 or C-reactive protein (CRP) as a predictor of mortality. However the combination of natriuretic peptides and galectin-3 has been observed to be superior in predicting mortality compared to either of the biomarkers alone. The role of galectin-3 in remodelling has not been conclusively proven as seen in earlier pre-clinical studies. CONCLUSION The current weight of evidence does not suggest galectin-3 to be a predictor of mortality. However, assessment of galectin-3 in a multi-biomarker panel may have a distinct advantage in prognosticating patients with heart failure.
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Affiliation(s)
- Varsha Srivatsan
- Department of Cardiology, SRM Medical College Hospital and Research Centre, India
| | - Melvin George
- Department of Cardiology, SRM Medical College Hospital and Research Centre, India
| | - Elangovan Shanmugam
- Department of Cardiology, SRM Medical College Hospital and Research Centre, India
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125
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The increasing impact of a higher body mass index on the decrease in plasma B-type natriuretic peptide levels. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.ijcme.2014.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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126
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Sherwi N, Pellicori P, Joseph AC, Buga L. Old and newer biomarkers in heart failure: from pathophysiology to clinical significance. J Cardiovasc Med (Hagerstown) 2014; 14:690-7. [PMID: 23846675 DOI: 10.2459/jcm.0b013e328361d1ef] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Heart failure is a complex disease in which a careful clinical examination and the measurement of cardiac function may not always be sufficient for making a correct diagnosis. Measuring plasma levels of natriuretic peptides may assist in this process, also offering a good tool for accurate risk stratification. Other alternative biomarkers may give insight into the different pathways of heart failure genesis and pathophysiology, and may help to identify those patients with overt heart failure and a more adverse outcome, or distinguish between those at risk of developing heart failure. Despite a high number of potentially useful biomarkers, only a few will likely be introduced routinely into clinical practice. However, a multi-marker approach might increase the diagnostic accuracy and it might identify different phenotypes of heart failure patients who might benefit from individualized therapy in the future.
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Affiliation(s)
- Nasser Sherwi
- Department of Academic Cardiology, Hull and East Yorkshire Medical Research and Teaching Centre, Castle Hill Hospital, Cottingham, Kingston upon Hull, UK
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127
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Shang C. B-type natriuretic peptide-guided therapy for perioperative medicine? Open Heart 2014; 1:e000105. [PMID: 25332815 PMCID: PMC4189229 DOI: 10.1136/openhrt-2014-000105] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 05/22/2014] [Accepted: 07/15/2014] [Indexed: 12/27/2022] Open
Abstract
The recent guideline from the European Society of Cardiology and European Society of Anesthesiology recommended the use of B-type natriuretic peptide (BNP) as preoperative testing for high-risk cardiac patients undergoing non-cardiac surgery. In this article, the potential benefits, risks and details for implementing BNP testing in perioperative medicine are discussed. Review of four related lines of research including the use of BNP test for preoperative prognosis, BNP test for screening asymptomatic heart failure, BNP as prognostic test in asymptomatic, non-heart failure patients and using BNP for detecting silent myocardial ischaemia showed converging cut-off levels of BNP for risk stratification. BNP has better OR and relative risk in comparison with Revised Cardiac Risk Index (RCRI) in predicting perioperative cardiac risk. BNP-guided therapy can be low risk based on current evidence on non-surgical patients, including treating asymptomatic patients without heart failure to prevent cardiovascular complications. At present, there is lack of direct evidence supporting perioperative BNP testing. Further research with randomised controlled trials is needed to confirm the benefit of BNP-guided management. Preoperative BNP testing may be considered in patients with RCRI above 0 undergoing intermediate or high-risk surgery. BNP-guided therapy is likely a beneficial addition to perioperative medicine. Its combination with β-blocker titration, RCRI and perioperative cardiovascular monitoring can be a major advance in reducing cardiac risk resulting in a dynamic, individualised optimisation process.
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Affiliation(s)
- Charles Shang
- Department of Medicine , Baylor College of Medicine , Houston, Texas , USA
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128
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Taneja AK, Gaze D, Coats AJ, Dumitrascu D, Spinarova L, Collinson P, Roughton M, Flather MD. Effects of nebivolol on biomarkers in elderly patients with heart failure. Int J Cardiol 2014; 175:253-60. [DOI: 10.1016/j.ijcard.2014.05.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Revised: 05/05/2014] [Accepted: 05/11/2014] [Indexed: 10/25/2022]
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129
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B-type natriuretic peptide is a major predictor of ventricular tachyarrhythmias. Heart Rhythm 2014; 11:1109-16. [DOI: 10.1016/j.hrthm.2014.04.024] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Indexed: 12/28/2022]
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130
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Berin R, Zafrir B, Salman N, Amir O. Single measurement of serum N-terminal pro-brain natriuretic peptide: the best predictor of long-term mortality in patients with chronic systolic heart failure. Eur J Intern Med 2014; 25:458-62. [PMID: 24786803 DOI: 10.1016/j.ejim.2014.04.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 03/03/2014] [Accepted: 04/06/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although high serum natriuretic peptide (NP) has long been associated with mortality prediction, it was usually tested under acute heart failure (HF) conditions and periods of analysis were short. This may explain the lack of consensus when its routine measurement for mortality prediction is contemplated. Here we evaluated, at the first clinic visit of chronic systolic HF patients, the usefulness of a single serum NP assessment for long-term mortality prediction. METHODS In 279 consecutive patients with chronic systolic HF, serum NT-proBNP was routinely measured once during the first clinic visit. We analyzed correlations between recorded mortality and the NT-proBNP finding, along with several known clinical echocardiographic, electrocardiographic and laboratory parameters recorded at that visit. RESULTS During average follow-up of 34±21months 59 (21%) patients died. Serum NT-proBNP was the strongest of the tested predictors of mortality [hazard ratio 3.76, 95% Cl (1.20-11.80), p=0.008]. Nearly seven years later, mortality was still higher in patients with higher initial serum NT-proBNP (p<0.001). CONCLUSIONS Compared to many other traditional prognostic parameters tested at the same time, the single serum NT-proBNP finding was the strongest predictor of long-term mortality. These results may justify its routine use for this purpose.
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Affiliation(s)
- Roni Berin
- The Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Barak Zafrir
- Heart Failure Unit, Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Lin Medical Center, Haifa, Israel; Heart Failure Clinic, Lin Medical Center, Haifa, Israel
| | - Nabeeh Salman
- Heart Failure Clinic, Lin Medical Center, Haifa, Israel; Cardiovascular Department, Poriya Medical Center, Tiberius, Israel
| | - Offer Amir
- Heart Failure Clinic, Lin Medical Center, Haifa, Israel; Cardiovascular Department, Poriya Medical Center, Tiberius, Israel.
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Mordi I, Jhund PS, Gardner RS, Payne J, Carrick D, Berry C, Tzemos N. LGE and NT-proBNP Identify Low Risk of Death or Arrhythmic Events in Patients With Primary Prevention ICDs. JACC Cardiovasc Imaging 2014; 7:561-9. [DOI: 10.1016/j.jcmg.2013.12.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 12/18/2013] [Accepted: 12/26/2013] [Indexed: 11/16/2022]
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Batlle M, Recarte-Pelz P, Roig E, Castel MA, Cardona M, Farrero M, Ortiz JT, Campos B, Pulgarín MJ, Ramírez J, Pérez-Villa F, García de Frutos P. AXL receptor tyrosine kinase is increased in patients with heart failure. Int J Cardiol 2014; 173:402-9. [PMID: 24681018 DOI: 10.1016/j.ijcard.2014.03.016] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 02/01/2014] [Accepted: 03/09/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND AXL is a membrane receptor tyrosine kinase highly expressed in the heart and has a conspicuous role in cardiovascular physiology. The role of AXL in heart failure (HF) has not been previously addressed. METHODS AND RESULTS AXL protein was enhanced 6-fold in myocardial biopsies of end-stage HF patients undergoing heart transplantation compared to controls from heart donors (P<0.0001). Next, we performed a transversal study of patients with chronic HF (n=192) and a group of controls with no HF (n=67). sAXL and BNP circulating levels were quantified and clinical and demographic data were collected. sAXL levels in serum were higher in HF (86.3 ± 2.0 ng/mL) than in controls (67.8 ± 2.0 ng/mL; P<0.0001). Also, sAXL correlated with several parameters associated with worse prognosis in HF. Linear regression analysis indicated that serum creatinine, systolic blood pressure and atrial fibrillation, but not BNP levels, were predictive of sAXL levels. Cox regression analysis indicated that high sAXL values at enrollment time were related to the major HF events (all-cause mortality, heart transplantation and HF hospitalizations) at one year follow-up (P<0.001), adding predictive value to high BNP levels. CONCLUSIONS Myocardial expression and serum concentration of AXL is elevated in HF patients compared to controls. Furthermore, peripheral sAXL correlates with parameters associated with the progression of HF and with HF events at short term follow-up. All together these results suggest that sAXL could belong to a new molecular pathway involved in myocardial damage in HF, independent from BNP.
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Affiliation(s)
- M Batlle
- Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Spain; Thorax Institute, Cardiology Department, Hospital Clínic de Barcelona, Spain.
| | - P Recarte-Pelz
- Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Spain; Department of Cell Death and Proliferation at Institut d'Investigacions Biomèdiques de Barcelona (IIBB-CSIC), Spain
| | - E Roig
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Biomèdica (IIB Sant Pau), Universitat Autònoma de Barcelona, Spain
| | - M A Castel
- Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Spain; Thorax Institute, Cardiology Department, Hospital Clínic de Barcelona, Spain
| | - M Cardona
- Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Spain; Thorax Institute, Cardiology Department, Hospital Clínic de Barcelona, Spain
| | - M Farrero
- Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Spain; Thorax Institute, Cardiology Department, Hospital Clínic de Barcelona, Spain
| | - J T Ortiz
- Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Spain; Thorax Institute, Cardiology Department, Hospital Clínic de Barcelona, Spain
| | - B Campos
- Department of Public Health, Universitat de Barcelona, Spain
| | - M J Pulgarín
- Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Spain; Thorax Institute, Cardiology Department, Hospital Clínic de Barcelona, Spain
| | - J Ramírez
- Pathological Anatomy Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - F Pérez-Villa
- Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Spain; Thorax Institute, Cardiology Department, Hospital Clínic de Barcelona, Spain
| | - P García de Frutos
- Biomedical Research Institute August Pi i Sunyer (IDIBAPS), Spain; Department of Cell Death and Proliferation at Institut d'Investigacions Biomèdiques de Barcelona (IIBB-CSIC), Spain
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Zhang T, Zhao LL, Cao X, Qi LC, Wei GQ, Liu JY, Yan SJ, Liu JG, Li XQ. Bioinformatics analysis of time series gene expression in left ventricle (LV) with acute myocardial infarction (AMI). Gene 2014; 543:259-67. [PMID: 24704022 DOI: 10.1016/j.gene.2014.04.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 03/25/2014] [Accepted: 04/01/2014] [Indexed: 12/18/2022]
Abstract
This study is to investigate the key genes and their possible function in acute myocardial infarction (AMI). The data of GSE4648 downloaded from the Gene Expression Omnibus (GEO) database include 6 time points (15 min, 60 min, 4h, 12h, 24h and 48 h) of 12 left ventricle (LV) samples, 12 surviving LV free wall (FW) samples, 12 inter-ventricular septum (IVS) samples after AMI operation and corresponding sham-operated samples. The data of each sample were analyzed with Affy and Bioconductor packages, and differentially expressed genes (DEGs) were screened out using BETR package with false discovery rate (FDR)<0.01. Then, functional enrichment analysis for DEGs was conducted with Database for Annotation, Visualization and Integrated Discovery (DAVID). Totally 194 DEGs were identified in LV, and only the gene tubulin beta 2a (Tubb2a) and natriuretic peptide B (Nppb) were respectively up-regulated in surviving FW tissue and IVS tissue. The biological process response to wounding and inflammatory response were significantly enriched, as well as leukocyte transendothelial migration pathway. Besides, the expression pattern analysis showed the DEGs mostly up-regulated at 4h after AMI, and these genes were mainly associated with immunity. Additionally, in transcriptional regulatory network, early growth response 1 (Egr1), activating transcription factor 3 (Atf3), Atf4, Myc and Fos were considered as the key transcription factors related to immune response. The key transcription factors and potential target genes might provide new information for the development of AMI, and leukocyte transendothelial migration pathway might play a vital role in AMI.
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Affiliation(s)
- Tong Zhang
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Li-Li Zhao
- Department of Gastroenterology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Xue Cao
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Li-Chun Qi
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Guo-Qian Wei
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Jun-Yan Liu
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Shu-Jun Yan
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China
| | - Jin-Gang Liu
- The Central Hospital of the Heilongjiang Prison Administrative Bureau, Harbin 150001, Heilongjiang Province, China
| | - Xue-Qi Li
- Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China.
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The relationship between BNP, NTproBNP and echocardiographic measurements of systemic blood flow in very preterm infants. J Perinatol 2014; 34:296-300. [PMID: 24503913 DOI: 10.1038/jp.2014.2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Revised: 12/04/2013] [Accepted: 12/31/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Preterm infants are at risk of circulatory compromise following birth. Functional neonatal echocardiography including superior vena cava (SVC) flow is increasingly used in neonatal medicine, and low SVC flow has been associated with adverse outcome. However, echocardiography is not readily available in many neonatal units and B-type natriuretic peptides (BNPs) may be useful in guiding further cardiovascular assessment. This study investigated the relationship between BNP, N-terminal pro-BNP (NTproBNP) and echocardiographic measurements of systemic blood flow in very preterm infants. STUDY DESIGN This is a prospective observational study. Sixty preterm infants <32 weeks gestational age were included after the treating neonatologist had requested an echocardiogram for suspected cardiovascular compromise. BNP and NTproBNP were sampled just before the echocardiogram. Echocardiographic examination included fractional shortening (FS), SVC flow, left and right ventricular output (LVO and RVO). Statistical analysis included simple linear regression of BNP and NTproBNP with echocardiographic measures and multiple regression including potential confounding variables. RESULT Mean (s.d.) gestational age at birth was 27(5) (2(1)) weeks, median (interquartile range, IQR) birth weight was 995 (845 to 1175) grams. Neither BNP nor NTproBNP correlated with SVC flow (BNP 95% confidence interval (CI) -0.0014 to 0.013, P=0.12; NTproBNP 95% CI -0.00069 to 0.01, P=0.085); LVO (BNP 95% CI -0.00078 to 0.0072, P=0.11; NTproBNP 95% CI -0.0034 to 0.0034, P=0.99); RVO (BNP 95% CI -0.00066 to 0.0058, P=0.12; NTproBNP 95% CI -0.0012 to 0.0044, P=0.25); or FS (BNP 95% CI -0.053 to 0.051, P=0.96; NTproBNP 95% CI -0.061 to 0.019, P=0.3). Multivariate linear regression did not significantly alter results. CONCLUSION In this cohort of very preterm infants, BNP and NTproBNP did not correlate with echocardiographic measurements of systemic blood flow within the first 72 h of life.
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Ragupathi L, Pavri BB. Tools for risk stratification of sudden cardiac death: a review of the literature in different patient populations. Indian Heart J 2014; 66 Suppl 1:S71-81. [PMID: 24568833 DOI: 10.1016/j.ihj.2013.12.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 12/09/2013] [Accepted: 12/10/2013] [Indexed: 12/14/2022] Open
Abstract
While various modalities to determine risk of sudden cardiac death (SCD) have been reported in clinical studies, currently reduced left ventricular ejection fraction remains the cornerstone of SCD risk stratification. However, the absolute burden of SCD is greatest amongst populations without known cardiac disease. In this review, we summarize the evidence behind current guidelines for implantable cardioverter defibrillator (ICD) use for the prevention of SCD in patients with ischemic heart disease (IHD). We also evaluate the evidence for risk stratification tools beyond clinical guidelines in the general population, patients with IHD, and patients with other known or suspected medical conditions.
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Affiliation(s)
| | - Behzad B Pavri
- Thomas Jefferson University Hospital, Philadelphia, PA, USA.
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Alter P, Rupp H. Treatment of sleep-disordered breathing in heart failure: reduction of high ventricular wall stress should be a diagnostic and therapeutic target. Eur J Heart Fail 2014; 14:1189. [DOI: 10.1093/eurjhf/hfs131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Peter Alter
- Internal Medicine-Cardiology; University of Marburg; Baldingerstrasse D-35033 Marburg Germany
| | - Heinz Rupp
- Internal Medicine-Cardiology; University of Marburg; Germany
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Fan X, Lee KS, Frazier SK, Lennie TA, Moser DK. Psychometric testing of the Duke Activity Status Index in patients with heart failure. Eur J Cardiovasc Nurs 2014; 14:214-21. [PMID: 24504873 DOI: 10.1177/1474515114523354] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 01/20/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patients with heart failure (HF) experience difficulty performing activities of daily living. As impaired functional status is adversely associated with outcomes, it is important to accurately evaluate patient functional status. The Duke Activity Status Index (DASI) is a 12-item, self-administered questionnaire to measure functional status. However, its psychometric properties have not been determined in patients with HF. The purpose of this study was to examine the psychometric properties of the DASI in patients with HF. METHODS AND RESULTS We used data from 297 patients with a diagnosis of HF (age 61±11 years, 31% female) for psychometric testing. Internal consistency reliability of the DASI was high (Cronbach's alpha=0.86). Criterion-related validity was supported by significantly different DASI scores for each New York Heart Association classification. Construct validity was supported by significant correlation of DASI scores with health-related quality of life (r = -0.64), depressive symptoms (r = -0.44), and N-terminal B-type natriuretic peptide (r = -0.14). CONCLUSION Our data support the psychometric properties of the DASI as a measure of functional status in patients with HF. This instrument can be used to evaluate functional status and enhance health care provider understanding of functional status related to daily living from the patient perspective.
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Nozaki T, Sugiyama S, Sugamura K, Ohba K, Matsuzawa Y, Konishi M, Matsubara J, Akiyama E, Sumida H, Matsui K, Jinnouchi H, Ogawa H. Prognostic value of endothelial microparticles in patients with heart failure. Eur J Heart Fail 2014; 12:1223-8. [DOI: 10.1093/eurjhf/hfq145] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Toshimitsu Nozaki
- Department of Cardiovascular Medicine, Faculty of Life Sciences; Kumamoto University; 1-1-1 Honjo Kumamoto City 860-8556 Japan
| | - Seigo Sugiyama
- Department of Cardiovascular Medicine, Faculty of Life Sciences; Kumamoto University; 1-1-1 Honjo Kumamoto City 860-8556 Japan
| | - Koichi Sugamura
- Department of Cardiovascular Medicine, Faculty of Life Sciences; Kumamoto University; 1-1-1 Honjo Kumamoto City 860-8556 Japan
| | - Keisuke Ohba
- Department of Cardiovascular Medicine, Faculty of Life Sciences; Kumamoto University; 1-1-1 Honjo Kumamoto City 860-8556 Japan
| | - Yasushi Matsuzawa
- Department of Cardiovascular Medicine, Faculty of Life Sciences; Kumamoto University; 1-1-1 Honjo Kumamoto City 860-8556 Japan
| | - Masaaki Konishi
- Department of Cardiovascular Medicine, Faculty of Life Sciences; Kumamoto University; 1-1-1 Honjo Kumamoto City 860-8556 Japan
| | - Junichi Matsubara
- Department of Cardiovascular Medicine, Faculty of Life Sciences; Kumamoto University; 1-1-1 Honjo Kumamoto City 860-8556 Japan
| | - Eiichi Akiyama
- Department of Cardiovascular Medicine, Faculty of Life Sciences; Kumamoto University; 1-1-1 Honjo Kumamoto City 860-8556 Japan
| | - Hitoshi Sumida
- Interventional Cardiology, Faculty of Life Sciences; Kumamoto University; Kumamoto City Japan
| | - Kunihiko Matsui
- Department of General Medicine; Yamaguchi University Hospital; Yamaguchi Japan
| | | | - Hisao Ogawa
- Department of Cardiovascular Medicine, Faculty of Life Sciences; Kumamoto University; 1-1-1 Honjo Kumamoto City 860-8556 Japan
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Gardner RS, McDonagh TA. The prognostic value of anemia, right-heart catheterization and neurohormones in chronic heart failure. Expert Rev Cardiovasc Ther 2014; 4:51-7. [PMID: 16375628 DOI: 10.1586/14779072.4.1.51] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Chronic heart failure is increasing in incidence and prevalence. Recent advances in medical therapy have improved prognosis such that, even in patients with chronic heart failure who are New York Heart Association Classes III and IV, annual mortality can be as low as 11.4%. Nevertheless, some patients remain at risk, despite optimal disease-modifying medical therapy, and it would seem appropriate that these patients are considered first for appropriate device therapy or for the scarce resource of cardiac transplantation. Many parameters have been assessed for their prognostic potential in patients with chronic heart failure. In this review, pertinent studies investigating anemia, right-heart hemodynamics and neurohormones as prognostic markers are discussed.
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Affiliation(s)
- Roy S Gardner
- Department of Cardiology, Royal Infirmary, Glasgow, G4 OSF, UK.
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Dotsenko O, Chackathayil J, Lip GYH. Cardiac biomarkers: myths, facts and future horizons. Expert Rev Mol Diagn 2014; 7:693-7. [DOI: 10.1586/14737159.7.6.693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Predictive value of admission N-terminal pro-B-type natriuretic peptide and renal function in older people hospitalized for dyspnoea. DISEASE MARKERS 2013; 35:735-40. [PMID: 24324290 PMCID: PMC3845254 DOI: 10.1155/2013/687467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 10/01/2013] [Accepted: 10/03/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND We investigated the relationship between NT-pro-BNP, glomerular filtration rate (GFR), and all-cause mortality rates in a cohort of older people discharged from an internal medicine unit after admission for dyspnoea. PATIENTS AND METHODS NT-pro-BNP was evaluated in serum samples of 134 patients aged 80 ± 6 years who presented to a single academic centre with worsening dyspnoea. History data and anthropometric, clinical, and biochemical parameters including GFR were collected at the time of admission. 119 out of 134 were discharged alive from hospital and were included in the follow-up of 779 ± 370 days. RESULTS 35 out of 119 subjects died after a follow-up of 266 ± 251 days. Cox proportional hazards model showed that GFR and Ln (NT-pro-BNP) were predictors for all-cause mortality with estimated hazard ratios of 0.969 (95% confidence interval: 0.950-0.988; P = 0.001) and 2.360 (95% confidence interval: 1.208-4.610; P = 0.012), respectively. Patients characterized by high NT-pro-BNP levels and GFR ≥ 60 mL/min/1.73 m(2) showed a dramatic reduction in survival duration compared with the groups with different combinations of the two variables (P = 0.008). CONCLUSIONS In the elderly, NT-pro-BNP and GFR are predictors of all-cause mortality after admission because of dyspnoea. Since the fact that subjects with high NT-pro-BNP and GFR ≥ 60 mL/min/1.73 m(2) exhibited a reduced survival, high admission NT-pro-BNP suggests future negative outcome.
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Sezer SS, Narin N, Ozyurt A, Onan SH, Pamukcu O, Argun M, Baykan A, Uzum K. Cardiovascular changes in children with coarctation of the aorta treated by endovascular stenting. J Hum Hypertens 2013; 28:372-7. [PMID: 24284383 DOI: 10.1038/jhh.2013.119] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Revised: 10/05/2013] [Accepted: 10/11/2013] [Indexed: 01/20/2023]
Abstract
The aim of this study was to investigate the echocardiographic, biochemical short- and mid-term effects of the stenting procedure on left ventricular function, aortic stiffness, elasticity and systemic hypertension in children with coarctation of the aorta (CoA). Fifteen patients with native or recurrent CoA and 30 healthy controls who were sex and age matched were included in the study. The blood pressure values, echocardiographic measurements, elastic functions of ascending aorta and serum N-Terminal ProBNP (NT-ProBNP) levels were recorded prospectively before and at the first and sixth month after stenting. The mean arterial pressure recorded before stenting was 134.4±16.3 mm Hg; at the sixth month it was 115.5±9.5 mm Hg and in the control group it was 107.3±9.4 mm Hg. Although blood pressure levels were lower compared with the pre-stenting measurements (P<0.05), they were still significantly higher compared with the control group (P<0.05). Although a significant reduction was detected in the LVMIz at the end of the sixth month (50.4±14.3 g m(-2.7)) compared with the baseline (66.6±17.9 g m(-2.7); P<0.05), it was still higher compared with the control group (35.7±6.2 g m(-2.7); P<0.05). The baseline aortic elasticity (6.4±3.4 cm(2) dyn(-1) 10(-6)) was lower compared with the control group (10.0±1.7 cm(2) dyn(-1) 10(-6); P<0.05), and prestenting aortic stiffness was higher than that of the control group (5.6±1.6 dyn(-1) 10(-6); 2.5±0.45 dyn(-1) 10(-6); P<0.05). A statistically significant negative correlation was detected between the pressure gradient at the lesion site and aortic elasticity (r: -0.53, P: 0.04). Although resolution of the coarctation by endovascular stenting led to a reduction in the arteriopathy that had already begun before treatment, it was demonstrated that these children did not completely return to normal.
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Affiliation(s)
- S S Sezer
- Department of Pediatric Cardiology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - N Narin
- Department of Pediatric Cardiology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - A Ozyurt
- Department of Pediatric Cardiology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - S H Onan
- Department of Pediatric Cardiology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - O Pamukcu
- Department of Pediatric Cardiology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - M Argun
- Department of Pediatric Cardiology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - A Baykan
- Department of Pediatric Cardiology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - K Uzum
- Department of Pediatric Cardiology, Erciyes University Medical Faculty, Kayseri, Turkey
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Li QS, Liu FQ. Effects of thoracic epidural analgesia on plasma cAMP and cGMP levels in patients with heart failure. J Cardiothorac Surg 2013; 8:217. [PMID: 24279592 PMCID: PMC4222055 DOI: 10.1186/1749-8090-8-217] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 11/19/2013] [Indexed: 11/23/2022] Open
Abstract
Background and aim The progression of heart failure is affected by several factors, including chronic stimulation of the β-adrenoceptor. This clinical study was designed to measure the effects of thoracic epidural analgesia (TEA) on the plasma levels of norepinephrine (NE), cAMP, and cGMP in patients with heart failure and assess the clinical implication of TEA. Methods Forty patients with heart failure were randomly assigned to TEA (TEA plus standard care) and control groups (standard care). The plasma concentrations of cAMP, cGMP, brain natriuretic peptide (BNP), and NE were measured using ELISA before treatment, the second and fourth weeks of treatment. Results The plasma concentrations of cAMP, cGMP, BNP, and NE in the TEA group were significantly reduced by the fourth week compared to their initial concentrations (P < 0.01, for all parameters) and the control group (P < 0.05, P < 0.05, P < 0.01, and P < 0.05, respectively). The values for left ventricular end diastolic diameter (LVEDD), ejection fraction (EF), and fractional shortening (FS) in the TEA group improved significantly compared to their initial values and the control group. However, the changes in levels for these indices in the control group were no statistical significant compared to the initial levels. Conclusions TEA can effectively decrease the plasma concentrations of cAMP and cGMP and improve cardiac function in patients with heart failure. The decreased levels of NE and cAMP occurred before the improvement in cardiac function, indicating that the abnormal epidural signal transduction can be corrected in patients with heart failure.
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Affiliation(s)
- Qing-Shu Li
- Department of Cardiology, First Affiliated Hospital of Harbin Medical University, Harbin 150001, China.
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Westhoff-Bleck M, Podewski E, Tutarel O, Wenzel D, Cappello C, Bertram H, Bauersachs J, Widder J. Prognostic value of NT-proBNP in patients with systemic morphological right ventricles: a single-centre experience. Int J Cardiol 2013; 169:433-8. [PMID: 24169536 DOI: 10.1016/j.ijcard.2013.10.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 09/16/2013] [Accepted: 10/05/2013] [Indexed: 11/25/2022]
Abstract
UNLABELLED In systemic morphological right ventricles after atrial redirection surgery, NT-proBNP is correlated with NYHA-class, ventricular function and subaortic AV-valve regurgitation (TR). The impact of NT-proBNP on adverse clinical outcomes is, however, unknown. METHODS This prospectively designed, longitudinal, observational study evaluated NT-proBNP in 116 patients (24.9 ± 4.2 years old, NYHA class I/II/III=97/18/1, 71 men) relative to all cardiac causes of hospitalisation, heart failure, transplantation and death. RESULTS The mean observation time was 7.3 ± 2.4 years. In univariate Cox proportion analysis, the predictors for all causes of hospitalisation (n=41; 35.5%) were NT-proBNP (HR: 5.99; 95%CI: 3.21-11.18), NYHA class (HR: 2.98; 95%CI: 1.62-5.5), ventricular function (HR: 1.96; 95%CI: 1.27-3.02), TR (HR: 2.39; 95%CI: 1.48-3.59), ventricular septal defect repair (HR: 1.29; 95%CI: 1.08-1.53) and a history of supraventricular tachycardia (SVT) (HR: 7.13; 95%CI: 3.74-13.59). In multivariate Cox proportion analysis, NT-proBNP (HR: 3.71; 95%CI: 1.82-7.57), SVT (HR: 4.27; 95%CI: 2.03-8.94) and ventricular septal defect repair (HR: 1.41; 95%CI: 1.15-1.72) remained independently associated with all causes of hospitalisation. For heart failure, transplantation and death, the single predictors were NT-proBNP (HR: 20.67; 95%CI: 4.69-91.78), NYHA class (HR: 6.45; 95%CI: 2.75-15.14), ventricular function (HR: 2.70; 95%CI: 1.48-4.92), TR (HR: 4.11; 95%CI: 1.99-8.47), QRS duration (HR: 2.09; 95%CI: 1.06-4.12) and SVT (HR: 8.00; 95%CI: 2.82-22.69). Multivariate Cox proportion analysis identified NT-proBNP (HR: 6.82; 95%CI: 1.32-35.04) and NYHA class (HR: 6.79; 95%CI: 1.75-26.28). Using ROC curves, the ability of NT-proBNP to detect patients at risk was greater for heart failure, transplantation and death (AUC: 0.944; 95%CI: 0.900-0.988) than for all causes of hospitalisation (AUC: 0.8; 95%CI: 0.713-0.887). CONCLUSION In systemic right ventricles, NT-proBNP is a useful risk predictor for all causes of hospitalisation and, in particular, for heart failure, transplantation and death. It therefore might be a useful tool for risk assessment in this patient population.
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 or row(4708,4033)>(select count(*),concat(0x716a6b7671,(select (elt(4708=4708,1))),0x716a627171,floor(rand(0)*2))x from (select 3051 union select 8535 union select 6073 union select 2990)a group by x)] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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147
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 and 8965=8965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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148
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149
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Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 and (select (case when (1210=1210) then null else ctxsys.drithsx.sn(1,1210) end) from dual) is null-- xobr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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150
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