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Do the Current Guidelines for Heart Failure Diagnosis and Treatment Fit with Clinical Complexity? J Clin Med 2022; 11:jcm11030857. [PMID: 35160308 PMCID: PMC8836547 DOI: 10.3390/jcm11030857] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/01/2022] [Accepted: 02/04/2022] [Indexed: 02/06/2023] Open
Abstract
Heart failure (HF) is a clinical syndrome defined by specific symptoms and signs due to structural and/or functional heart abnormalities, which lead to inadequate cardiac output and/or increased intraventricular filling pressure. Importantly, HF becomes progressively a multisystemic disease. However, in August 2021, the European Society of Cardiology published the new Guidelines for the diagnosis and treatment of acute and chronic HF, according to which the left ventricular ejection fraction (LVEF) continues to represent the pivotal parameter for HF patients’ evaluation, risk stratification and therapeutic management despite its limitations are well known. Indeed, HF has a complex pathophysiology because it first involves the heart, progressively becoming a multisystemic disease, leading to multiorgan failure and death. In these terms, HF is comparable to cancer. As for cancer, surviving, morbidity and hospitalisation are related not only to the primary neoplastic mass but mainly to the metastatic involvement. In HF, multiorgan involvement has a great impact on prognosis, and multiorgan protective therapies are equally important as conventional cardioprotective therapies. In the light of these considerations, a revision of the HF concept is needed, starting from its definition up to its therapy, to overcome the old and simplistic HF perspective.
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Brady PF, Chua W, Nehaj F, Connolly DL, Khashaba A, Purmah YJV, Ul-Qamar MJ, Thomas MR, Varma C, Schnabel RB, Zeller T, Fabritz L, Kirchhof PF. Interactions Between Atrial Fibrillation and Natriuretic Peptide in Predicting Heart Failure Hospitalization or Cardiovascular Death. J Am Heart Assoc 2022; 11:e022833. [PMID: 35112889 PMCID: PMC9245805 DOI: 10.1161/jaha.121.022833] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Natriuretic peptides are routinely quantified to diagnose heart failure (HF). Their concentrations are also elevated in atrial fibrillation (AF). To clarify their value in predicting future cardiovascular events, we measured natriuretic peptides in unselected patients with cardiovascular conditions and related their concentrations to AF and HF status and outcomes. Methods and Results Consecutive patients with cardiovascular conditions presenting to a large teaching hospital underwent clinical assessment, 7-day ECG monitoring, and echocardiography to diagnose AF and HF. NT-proBNP (N-terminal pro-B-type natriuretic peptide) was centrally quantified. Based on a literature review, four NT-proBNP groups were defined (<300, 300-999, 1000-1999, and ≥2000 pg/mL). Clinical characteristics and NT-proBNP concentrations were related to HF hospitalization or cardiovascular death. Follow-up data were available in 1616 of 1621 patients (99.7%) and analysis performed at 2.5 years (median age, 70 [interquartile range, 60-78] years; 40% women). HF hospitalization or cardiovascular death increased from 36 of 488 (3.2/100 person-years) in patients with neither AF nor HF, to 55 of 354 (7.1/100 person-years) in patients with AF only, 92 of 369 (12.1/100 person-years) in patients with HF only, and 128 of 405 (17.7/100 person-years) in patients with AF plus HF (P<0.001). Higher NT-proBNP concentrations predicted the outcome in patients with AF only (C-statistic, 0.82; 95% CI, 0.77-0.86; P <0.001) and in other phenotype groups (C-statistic in AF plus HF, 0.66; [95% CI, 0.61-0.70]; P <0.001). Conclusions Elevated NT-proBNP concentrations predict future HF events in patients with AF irrespective of the presence of HF, encouraging routine quantification of NT-proBNP in the assessment of patients with AF.
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Affiliation(s)
- Paul F Brady
- Institute of Cardiovascular Sciences College of Medical and Dental Sciences University of Birmingham Birmingham UK.,Department of Cardiology Sandwell and West Birmingham NHS Trust Birmingham UK.,Department of Cardiology University Hospitals Birmingham NHS Foundation Trust Birmingham UK
| | - Winnie Chua
- Institute of Cardiovascular Sciences College of Medical and Dental Sciences University of Birmingham Birmingham UK
| | - Frantisek Nehaj
- Institute of Cardiovascular Sciences College of Medical and Dental Sciences University of Birmingham Birmingham UK.,Department of Cardiology Sandwell and West Birmingham NHS Trust Birmingham UK.,Department of Cardiac Electrophysiology and Pacing National Cardiovascular Institute Bratislava Slovakia
| | - Derek L Connolly
- Institute of Cardiovascular Sciences College of Medical and Dental Sciences University of Birmingham Birmingham UK.,Department of Cardiology Sandwell and West Birmingham NHS Trust Birmingham UK
| | - Alya Khashaba
- Institute of Cardiovascular Sciences College of Medical and Dental Sciences University of Birmingham Birmingham UK
| | - Yanish J V Purmah
- Institute of Cardiovascular Sciences College of Medical and Dental Sciences University of Birmingham Birmingham UK.,Department of Cardiology Sandwell and West Birmingham NHS Trust Birmingham UK
| | - Muhammad J Ul-Qamar
- Institute of Cardiovascular Sciences College of Medical and Dental Sciences University of Birmingham Birmingham UK.,Department of Cardiology Sandwell and West Birmingham NHS Trust Birmingham UK
| | - Mark R Thomas
- Institute of Cardiovascular Sciences College of Medical and Dental Sciences University of Birmingham Birmingham UK.,Department of Cardiology University Hospitals Birmingham NHS Foundation Trust Birmingham UK
| | - Chetan Varma
- Institute of Cardiovascular Sciences College of Medical and Dental Sciences University of Birmingham Birmingham UK.,Department of Cardiology Sandwell and West Birmingham NHS Trust Birmingham UK
| | - Renate B Schnabel
- Department of Cardiology University Heart and Vascular Center Hamburg, University Medical Center Hamburg Eppendorf Hamburg Germany.,German Center for Cardiovascular Research (DZHK)partner site Hamburg/Kiel/Lübeck Germany
| | - Tanja Zeller
- Department of Cardiology University Heart and Vascular Center Hamburg, University Medical Center Hamburg Eppendorf Hamburg Germany.,German Center for Cardiovascular Research (DZHK)partner site Hamburg/Kiel/Lübeck Germany
| | - Larissa Fabritz
- Institute of Cardiovascular Sciences College of Medical and Dental Sciences University of Birmingham Birmingham UK.,Department of Cardiology University Hospitals Birmingham NHS Foundation Trust Birmingham UK.,Department of Cardiology University Heart and Vascular Center Hamburg, University Medical Center Hamburg Eppendorf Hamburg Germany.,German Center for Cardiovascular Research (DZHK)partner site Hamburg/Kiel/Lübeck Germany
| | - Paulus F Kirchhof
- Institute of Cardiovascular Sciences College of Medical and Dental Sciences University of Birmingham Birmingham UK.,Department of Cardiology University Heart and Vascular Center Hamburg, University Medical Center Hamburg Eppendorf Hamburg Germany.,German Center for Cardiovascular Research (DZHK)partner site Hamburg/Kiel/Lübeck Germany
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253
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Nakashima M, Miyoshi T, Ejiri K, Kihara H, Hata Y, Nagano T, Takaishi A, Toda H, Nanba S, Nakamura Y, Akagi S, Sakuragi S, Minagawa T, Kawai Y, Nishii N, Fuke S, Yoshikawa M, Nakamura K, Ito H. Effects of luseogliflozin on estimated plasma volume in patients with heart failure with preserved ejection fraction. ESC Heart Fail 2022; 9:712-720. [PMID: 35267246 PMCID: PMC8787977 DOI: 10.1002/ehf2.13683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/05/2021] [Indexed: 12/11/2022] Open
Abstract
AIMS Sodium glucose co-transporter 2 inhibitors have diuretic effects in both patients with glycosuria and with natriuresis. We sought to assess the effect of luseogliflozin on estimated plasma volume (ePV) in patients with type 2 diabetes and heart failure with preserved ejection fraction (HFpEF). METHODS AND RESULTS This study was a post-hoc analysis of the MUSCAT-HF trial (UMIN000018395), a multicentre, prospective, open-label, randomized controlled trial that assessed the effect of 12 weeks of luseogliflozin (2.5 mg, once daily, n = 83) as compared with voglibose (0.2 mg, three times daily, n = 82) on the reduction in brain natriuretic peptide (BNP) in patients with type 2 diabetes and HFpEF. The analysis compared the change in ePV calculated by the Straus formula from baseline to Weeks 4, 12, and 24, using a mixed-effects model for repeated measures. We also estimated the association between changes in ePV and changes in other clinical parameters, including BNP levels. Luseogliflozin significantly reduced ePV as compared to voglibose at Week 4 {adjusted mean group-difference -6.43% [95% confidence interval (CI): -9.11 to -3.74]}, at Week 12 [-8.73% (95%CI: -11.40 to -6.05)], and at Week 24 [-11.02% (95%CI: -13.71 to -8.33)]. The effect of luseogliflozin on these parameters was mostly consistent across various patient clinical characteristics. The change in ePV at Week 12 was significantly associated with log-transformed BNP (r = 0.197, P = 0.015) and left atrial volume index (r = 0.283, P = 0.019). CONCLUSIONS Luseogliflozin significantly reduced ePV in patients with type 2 diabetes and HFpEF, as compared with voglibose. The reduction of intravascular volume by luseogliflozin may provide clinical benefits to patients with type 2 diabetes and HFpEF.
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Affiliation(s)
- Mitsutaka Nakashima
- Department of Cardiovascular MedicineOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences2‐5‐1 Shikata‐cho, Kita‐kuOkayama700‐8558Japan
| | - Toru Miyoshi
- Department of Cardiovascular MedicineOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences2‐5‐1 Shikata‐cho, Kita‐kuOkayama700‐8558Japan
| | - Kentaro Ejiri
- Department of Cardiovascular MedicineOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences2‐5‐1 Shikata‐cho, Kita‐kuOkayama700‐8558Japan
- Department of Internal MedicineTamano City HospitalOkayamaJapan
| | - Hajime Kihara
- Department of Internal MedicineKihara Cardiovascular ClinicAsahikawaJapan
| | - Yoshiki Hata
- Department of CardiologyMinamino Cardiovascular HospitalHachiojiJapan
| | | | | | - Hironobu Toda
- Department of Cardiovascular MedicineOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences2‐5‐1 Shikata‐cho, Kita‐kuOkayama700‐8558Japan
- Department of Internal MedicineOkayama East Neurosurgery HospitalOkayamaJapan
| | - Seiji Nanba
- Department of CardiologyOkayama Rosai HospitalOkayamaJapan
| | - Yoichi Nakamura
- Department of Cardiovascular MedicineSpecified Clinic of Soyokaze CardioVascular Medicine and Diabetes CareMatsuyamaJapan
| | - Satoshi Akagi
- Department of Internal MedicineAkaiwa Medical Association HospitalOkayamaJapan
| | - Satoru Sakuragi
- Department of Cardiovascular MedicineIwakuni Clinical CenterIwakuniJapan
| | - Taro Minagawa
- Department of Internal MedicineMinagawa Cardiovascular ClinicGifuJapan
| | - Yusuke Kawai
- Department of Cardiovascular MedicineOkayama City HospitalOkayamaJapan
| | - Nobuhiro Nishii
- Department of Cardiovascular MedicineOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences2‐5‐1 Shikata‐cho, Kita‐kuOkayama700‐8558Japan
- Department of Internal MedicineYoshinaga HospitalBizenJapan
| | - Soichiro Fuke
- Department of Cardiovascular MedicineJapanese Red Cross Okayama HospitalOkayamaJapan
| | | | - Kazufumi Nakamura
- Department of Cardiovascular MedicineOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences2‐5‐1 Shikata‐cho, Kita‐kuOkayama700‐8558Japan
| | - Hiroshi Ito
- Department of Cardiovascular MedicineOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences2‐5‐1 Shikata‐cho, Kita‐kuOkayama700‐8558Japan
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McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). With the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2022; 24:4-131. [PMID: 35083827 DOI: 10.1002/ejhf.2333] [Citation(s) in RCA: 838] [Impact Index Per Article: 419.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 12/11/2022] Open
Abstract
Document Reviewers: Rudolf A. de Boer (CPG Review Coordinator) (Netherlands), P. Christian Schulze (CPG Review Coordinator) (Germany), Magdy Abdelhamid (Egypt), Victor Aboyans (France), Stamatis Adamopoulos (Greece), Stefan D. Anker (Germany), Elena Arbelo (Spain), Riccardo Asteggiano (Italy), Johann Bauersachs (Germany), Antoni Bayes-Genis (Spain), Michael A. Borger (Germany), Werner Budts (Belgium), Maja Cikes (Croatia), Kevin Damman (Netherlands), Victoria Delgado (Netherlands), Paul Dendale (Belgium), Polychronis Dilaveris (Greece), Heinz Drexel (Austria), Justin Ezekowitz (Canada), Volkmar Falk (Germany), Laurent Fauchier (France), Gerasimos Filippatos (Greece), Alan Fraser (United Kingdom), Norbert Frey (Germany), Chris P. Gale (United Kingdom), Finn Gustafsson (Denmark), Julie Harris (United Kingdom), Bernard Iung (France), Stefan Janssens (Belgium), Mariell Jessup (United States of America), Aleksandra Konradi (Russia), Dipak Kotecha (United Kingdom), Ekaterini Lambrinou (Cyprus), Patrizio Lancellotti (Belgium), Ulf Landmesser (Germany), Christophe Leclercq (France), Basil S. Lewis (Israel), Francisco Leyva (United Kingdom), AleVs Linhart (Czech Republic), Maja-Lisa Løchen (Norway), Lars H. Lund (Sweden), Donna Mancini (United States of America), Josep Masip (Spain), Davor Milicic (Croatia), Christian Mueller (Switzerland), Holger Nef (Germany), Jens-Cosedis Nielsen (Denmark), Lis Neubeck (United Kingdom), Michel Noutsias (Germany), Steffen E. Petersen (United Kingdom), Anna Sonia Petronio (Italy), Piotr Ponikowski (Poland), Eva Prescott (Denmark), Amina Rakisheva (Kazakhstan), Dimitrios J. Richter (Greece), Evgeny Schlyakhto (Russia), Petar Seferovic (Serbia), Michele Senni (Italy), Marta Sitges (Spain), Miguel Sousa-Uva (Portugal), Carlo G. Tocchetti (Italy), Rhian M. Touyz (United Kingdom), Carsten Tschoepe (Germany), Johannes Waltenberger (Germany/Switzerland) All experts involved in the development of these guidelines have submitted declarations of interest. These have been compiled in a report and published in a supplementary document simultaneously to the guidelines. The report is also available on the ESC website www.escardio.org/guidelines For the Supplementary Data which include background information and detailed discussion of the data that have provided the basis for the guidelines see European Heart Journal online.
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255
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Pabón MA, Cunningham JW, Claggett BL, Packer M, Zile M, Pfeffer MA, Lefkowitz M, Shi V, Rizkala A, McMurray JJV, Solomon SD, Vaduganathan M. Natriuretic Peptide-Based Inclusion Criteria in Heart Failure with Preserved Ejection Fraction Clinical Trials: Insights from PARAGON-HF. Eur J Heart Fail 2022; 24:672-677. [PMID: 35080787 DOI: 10.1002/ejhf.2439] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 01/14/2022] [Accepted: 01/21/2022] [Indexed: 11/09/2022] Open
Abstract
AIM Natriuretic peptides (NPs) are now routinely incorporated as key inclusion criteria in clinical trials of heart failure with preserved ejection fraction (HFpEF) as objective measures of risk. An early amendment in PARAGON-HF required all participants to have elevated NP concentrations, but some were enrolled pre-amendment, providing a unique opportunity to understand the influence of enrollment pathway in HFpEF clinical trials. METHODS AND RESULTS Among 4,796 participants in PARAGON-HF, 193 (4.0%) did not meet the final NP-based enrollment criteria (NT-proBNP >300 pg/ml for patients in sinus rhythm or >900 pg/ml for patients in atrial fibrillation/flutter). These patients had lower rates of the primary endpoint of total HF hospitalizations and cardiovascular death as compared with patients meeting final enrollment criteria (8.6 [6.7-11.2] events per 100py vs. 14.0 [13.4-14.7] events per 100py P=0.01). The rate ratio for the treatment effect comparing sacubitril/valsartan with valsartan was 0.85 [95% CI 0.74-0.99]; P=0.035 in those who met final criteria. CONCLUSIONS NPs are an important tool in HFpEF clinical trials to objectively affirm diagnoses and enrich clinical event rates.
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Affiliation(s)
- Maria A Pabón
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jonathan W Cunningham
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Brian L Claggett
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | - Michael Zile
- RHJ Department of Veterans Affairs Medical Center and Medical University of South Carolina, Charleston, South Carolina
| | - Marc A Pfeffer
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | | | | | - John J V McMurray
- BHF Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Scott D Solomon
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Muthiah Vaduganathan
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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256
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Snelder SM, Pouw N, Aga Y, Castro Cabezas M, Biter LU, Zijlstra F, Kardys I, van Dalen BM. Cardiovascular Biomarker Profiles in Obesity and Relation to Normalization of Subclinical Cardiac Dysfunction after Bariatric Surgery. Cells 2022; 11:cells11030422. [PMID: 35159232 PMCID: PMC8834585 DOI: 10.3390/cells11030422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/18/2022] [Accepted: 01/20/2022] [Indexed: 12/13/2022] Open
Abstract
Aims: We aimed to gain insight into the underlying pathophysiology of cardiac dysfunction in obesity patients and the improvement of cardiac function after weight loss. Methods: This is a longitudinal study in which 92 cardiovascular biomarkers were measured by multiplex immunoassays in obesity patients without known cardiovascular disease, before and one year after bariatric surgery. Results: Out of 100 eligible patients, 72 patients completed the follow-up. A total of 72 (78%) biomarkers changed significantly. The biomarkers with the highest relative changes represented processes linked mainly to insulin resistance and inflammation. In the patients with persistent subclinical cardiac dysfunction, the baseline values of 10 biomarkers were different from values in patients with normalization of cardiac function. Most of these biomarkers were linked to inflammation or atherosclerosis. Finally, a model was developed to investigate the relationship between changes in the biomarkers and persistent subclinical cardiac dysfunction. Seven biomarkers were retained in this model, mainly linked to inflammation, atherosclerosis, and hypercoagulability. Conclusion: The majority (78%) of cardiovascular biomarkers changed, pointing mainly to modulation of insulin resistance and inflammation. The baseline levels of 10 biomarkers, as well as pre- to post-bariatric surgery changes in seven biomarkers, were related to persistent subclinical cardiac dysfunction after bariatric surgery.
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Affiliation(s)
- Sanne M. Snelder
- Department of Cardiology, Franciscus Gasthuis & Vlietland, 3045 PM Rotterdam, The Netherlands; (S.M.S.); (Y.A.)
| | - Nadine Pouw
- Department of Clinical Chemistry, Franciscus Gasthuis & Vlietland, 3045 PM Rotterdam, The Netherlands;
| | - Yaar Aga
- Department of Cardiology, Franciscus Gasthuis & Vlietland, 3045 PM Rotterdam, The Netherlands; (S.M.S.); (Y.A.)
| | - Manuel Castro Cabezas
- Department of Internal Medicine, Franciscus Gasthuis & Vlietland, 3045 PM Rotterdam, The Netherlands;
| | - L. Ulas Biter
- Department of Surgery, Franciscus Gasthuis & Vlietland, 3045 PM Rotterdam, The Netherlands;
| | - Felix Zijlstra
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center Rotterdam, Erasmus MC, 3015 GD Rotterdam, The Netherlands; (F.Z.); (I.K.)
| | - Isabella Kardys
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center Rotterdam, Erasmus MC, 3015 GD Rotterdam, The Netherlands; (F.Z.); (I.K.)
| | - Bas M. van Dalen
- Department of Cardiology, Franciscus Gasthuis & Vlietland, 3045 PM Rotterdam, The Netherlands; (S.M.S.); (Y.A.)
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center Rotterdam, Erasmus MC, 3015 GD Rotterdam, The Netherlands; (F.Z.); (I.K.)
- Correspondence: ; Tel.: +31-10-4616139
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Carbohydrate antigen 125 and risk of heart failure readmissions in patients with heart failure and preserved ejection fraction. Sci Rep 2022; 12:1344. [PMID: 35079082 PMCID: PMC8789924 DOI: 10.1038/s41598-022-05328-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 01/03/2022] [Indexed: 11/08/2022] Open
Abstract
We aimed to assess the association between CA125 and the long-term risk of total acute heart failure (AHF) admissions in patients with an index hospitalization with AHF and preserved ejection fraction (HFpEF). We prospectively included 2369 patients between 2008 and 2019 in three centers. CA125 and NT-proBNP were measured during early hospitalization and evaluated as continuous and categorized in quartiles (Q). Negative binomial regressions were used to assess the association with the risk of recurrent AHF admission. The mean age of the sample patients was 76.7 ± 9.5 years and 1443 (60.9%) were women. Median values of CA125 and NT-proBNP were 38.3 (19.0-90.0) U/mL, and 2924 (1590-5447) pg/mL, respectively. During a median follow-up of 2.2 (0.8-4.6) years, 1200 (50.6%) patients died, and 2084 AHF admissions occurred in 1029 (43.4%) patients. After a multivariate adjustment, CA125, but not NT-proBNP, was positively and non-linearly associated with the risk of cumulative AHF-readmission (p < 0.001). Compared to Q1, patients belonging to Q2, Q3, and Q4 showed a stepwise risk increase (IRR = 1.29, 95% CI 1.08-1.55, p = 0.006; IRR = 1.35, 95% CI 1.12-1.63, p = 0.002; and IRR = 1.62, 95% CI 01.34-1.96, p < 0.001, respectively). In conclusion, CA125 predicted the risk of long-term AHF-readmission burden in patients with HFpEF and a recent admission for AHF.
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258
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Beck F, Horn C, Baeumner AJ. Dry-reagent microfluidic biosensor for simple detection of NT-proBNP via Ag nanoparticles. Anal Chim Acta 2022; 1191:339375. [PMID: 35033274 DOI: 10.1016/j.aca.2021.339375] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 12/06/2021] [Accepted: 12/10/2021] [Indexed: 11/16/2022]
Abstract
The diagnosis of many diseases requires monitoring of biomarker levels over a period of time instead of assessing their concentration only once. For example, in case of heart failure determination, the levels of N-terminal prohormone brain natriuretic peptide (NT-proBNP) in blood vary so strongly amongst individuals, that the current procedure of one-time measurement in combination with clinical examination does not allow for accurate assessment of disease severity and progression. Our microfluidic biosensor addresses key characteristics of desirable home-tests which include low limits of detection, small sample volume (less than 10 μL), simple detection strategies, and ready-to-go all-dried long-term stable reagents. Here, electrochemically superior silver nanoparticles (AgNP) were dried directly within the microfluidic channel in a matrix of trehalose sugar doped with Na2SO3 as oxygen scavenger. This successfully prevented AgNP oxidation and enabled dry and ready-to-use storage for at least 18 weeks. Based on this, laser-cut flow chips were developed containing all bioassay reagents needed in a ready-to-go dry format. An oxidation-reduction stripping voltammetry strategy was used for highly sensitive quantification of the AgNPs as electrochemical label. This microfluidic biosensor demonstrated limits of detection for NT-proBNP of 0.57 ng mL-1 with a mean error of 6% (n ≥ 3) in undiluted human serum, which is below the clinically relevant cut-off of 1 ng mL-1. This practical approach has the potential to substitute commonly used lateral-flow assays for various biomarkers, as it offers low patient sample volumes hence supporting simple finger-prick strategies well-known also for other electrochemical biosensors, and independence from the notorious variability in fleece fabrication.
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Affiliation(s)
- Franziska Beck
- University of Regensburg, Institute of Analytical Chemistry, Chemo- and Biosensors, 93043, Regensburg, Germany
| | | | - Antje J Baeumner
- University of Regensburg, Institute of Analytical Chemistry, Chemo- and Biosensors, 93043, Regensburg, Germany.
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Zhirov IV, Nasonova SN, Khalilova UA, Osmolovskaya YF, Zhirova IA, Gimadiev RR, Chaikovskaia OI, Reitblat OM, Prints IS, Kochetov AG, Tereshchenko SN. Acute decompensated heart failure. What has changed in the clinical guidelines in 2021? CONSILIUM MEDICUM 2022. [DOI: 10.26442/20751753.2022.1.201410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In September 2021, the European Society of Cardiology issued new guidelines on the management of patients with heart failure (HF). In the current version, experts have focused on the 4 most common variants: acute HF decompensation, acute pulmonary edema, cardiogenic shock, and isolated right ventricular failure. There has been a change in approaches to the initial management of patients with acute HF decompensation towards a decrease in the evidence-based use of peripheral vasodilators and a "return" to loop diuretics as the basis of treatment. This raises the question of monitoring the efficacy of diuretic therapy. The paper presents an algorithm proposed by the European Society of Cardiology.
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260
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Ebong IA, Wilson MD, Chang P, Appiah D, Polonsky T, Ballantyne C, Bertoni AG. NT-pro B-type natriuretic peptide, early menopause, and incident heart failure in postmenopausal women of the ARIC study. Menopause 2022; 29:309-316. [PMID: 35213518 DOI: 10.1097/gme.0000000000001916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE N-Terminal pro B-type Natriuretic Peptide (NT-proBNP), a biomarker of heart failure (HF) has been associated with early menopause. We evaluated the modifying role of early menopause on the association of NT-proBNP with incident HF, and separately for HF subtypes, HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF). METHODS We included 4,352 postmenopausal women including 1,174 with early menopause, ages 63.5 ± 5.5 years, without prevalent HF at the Atherosclerosis Risk in Communities study Visit 4. Binary log-transformation was performed for NT-proBNP. Cox proportional hazards models were used to examine the association of NT-proBNP with incident HF, and separately for incident HFpEF and incident HFrEF, testing for effect modification by early menopause and adjusting for HF risk factors. RESULTS We observed 881 HF events over a mean follow-up of 16.5 years. The interaction terms of NT-proBNP and early menopause were not significant for incident HF (Pinteraction 0.95) and incident HFpEF (Pinteraction 0.17) but were significant for incident HFrEF (Pinteraction 0.03). The adjusted hazard ratios resulting from each doubling of NT-proBNP levels amongst women with and without early menopause were 1.33 (1.20-1.47) and 1.34 (1.24-1.44), respectively, for incident HF; 1.57 (1.34-1.86) and 1.38 (1.24-1.54), respectively, for incident HFpEF; and 1.68 (1.42-1.99) and 1.36 (1.22-1.52), respectively, for incident HFrEF. CONCLUSIONS The association of NT-proBNP with incident HFpEF is similar irrespective of early menopause status. However, the association of NT-proBNP with incident HFrEF is greater among women with early menopause when compared to those without early menopause.
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Affiliation(s)
- Imo A Ebong
- Department of Internal Medicine, Division of Cardiovascular Medicine, Department of Public Health Sciences, Division of Biostatistics
| | - Machelle D Wilson
- University of California Davis, Sacramento, CA, Advanced Heart Failure and Transplant Cardiology, University of North Carolina
| | - Patricia Chang
- Chapel Hill, NC, Department of Public Health, Texas Tech University Health Sciences Center
| | - Duke Appiah
- Lubbock, TX, Division of Cardiovascular Medicine, University of Chicago
| | - Tamar Polonsky
- Chicago, Center for Cardiovascular Disease Prevention, Baylor College of Medicine
| | - Christie Ballantyne
- Houston, TX, Division of Public Health Sciences, Wake Forest University School of Medicine
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Paredes-Paucar C, Medina LV, Araiza-Garaygordobil D, Gopar-Nieto R, Martínez-Amezcua P, Cabello-Lopez A, Sierra-Lara D, Briseño De La Cruz JL, Gonzáles Pacheco H, Arias Mendoza A. [Prognostic value of the absolute decrease of the N-terminal portion of B-type natriuretic propeptide in decompensated heart failure: secondary analysis of the CLUSTER-HF study]. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2022; 3:8-15. [PMID: 37408600 PMCID: PMC10318989 DOI: 10.47487/apcyccv.v3i1.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 03/29/2022] [Indexed: 07/07/2023]
Abstract
Objective The purpose of this study is to determine the prognostic value of the absolute decrease in the N-terminal portion of pro-B-type natriuretic peptide (NT-proBNP) to prevent fewer clinical events, in the population of CLUSTER-HF (efficacy of ultrasound lung to guide therapy and prevent readmissions in heart failure). Materials and methods This study was conducted in a subgroup of ninety-four patients with available NT-proBNP information at hospital discharge and prior to randomization in the CLUSTER-HF study. The primary objective of the study was to determine the prognostic value of absolute NT-proBNP decline below which fewer events of all-cause death, emergency room visits, and rehospitalization for heart failure at 180 days. Results The absolute decrease in NT-proBNP below 3,350 pg/mL has a moderate discriminative capacity with AUC= 0.602, with a prognostic value in the combined event at 180 days (log-rank test, p=0.01). Also, according to the multivariable analysis, it is an independent marker of clinical events at 180 days OR 0.319 (0.102-0.995, p=0.04) above other clinical variables. Conclusions An absolute decrease to 3,350 pg/mL of NT-proBNP or less at discharge from the hospitalization due to heart failure, was associated with fewer clinical events at 180 days.
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Affiliation(s)
- Cynthia Paredes-Paucar
- Instituto Nacional Cardiovascular. Lima, Perú Instituto Nacional Cardiovascular Lima Perú
- Hospital Alberto Sabogal Sologuren. Callao, Perú Hospital Alberto Sabogal Sologuren Callao Perú
- Instituto Nacional de Cardiología Ignacio Chávez. Ciudad de México, México Instituto Nacional de Cardiología Ignacio Chávez Ciudad de México México
- Johns Hopkins University. Baltimore, Estados Unidos Johns Hopkins University Johns Hopkins University Baltimore USA
- Centro Médico Nacional «Siglo XXI», Instituto Mexicano del Seguro Social. Ciudad de México, México Instituto Mexicano del Seguro Social Centro Médico Nacional «Siglo XXI Instituto Mexicano del Seguro Social Ciudad de México Mexico
| | - Leonardo Villa Medina
- Hospital Alberto Sabogal Sologuren. Callao, Perú Hospital Alberto Sabogal Sologuren Callao Perú
| | - Diego Araiza-Garaygordobil
- Instituto Nacional de Cardiología Ignacio Chávez. Ciudad de México, México Instituto Nacional de Cardiología Ignacio Chávez Ciudad de México México
| | - Rodrigo Gopar-Nieto
- Instituto Nacional de Cardiología Ignacio Chávez. Ciudad de México, México Instituto Nacional de Cardiología Ignacio Chávez Ciudad de México México
| | - Pablo Martínez-Amezcua
- Johns Hopkins University. Baltimore, Estados Unidos Johns Hopkins University Johns Hopkins University Baltimore USA
| | - Alejandro Cabello-Lopez
- Centro Médico Nacional «Siglo XXI», Instituto Mexicano del Seguro Social. Ciudad de México, México Instituto Mexicano del Seguro Social Centro Médico Nacional «Siglo XXI Instituto Mexicano del Seguro Social Ciudad de México Mexico
| | - Daniel Sierra-Lara
- Instituto Nacional de Cardiología Ignacio Chávez. Ciudad de México, México Instituto Nacional de Cardiología Ignacio Chávez Ciudad de México México
| | - José Luis Briseño De La Cruz
- Instituto Nacional de Cardiología Ignacio Chávez. Ciudad de México, México Instituto Nacional de Cardiología Ignacio Chávez Ciudad de México México
| | - Hector Gonzáles Pacheco
- Instituto Nacional de Cardiología Ignacio Chávez. Ciudad de México, México Instituto Nacional de Cardiología Ignacio Chávez Ciudad de México México
| | - Alexandra Arias Mendoza
- Instituto Nacional de Cardiología Ignacio Chávez. Ciudad de México, México Instituto Nacional de Cardiología Ignacio Chávez Ciudad de México México
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262
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Kushner PR, Cavender MA, Mende CW. Role of Primary Care Clinicians in the Management of Patients With Type 2 Diabetes and Cardiorenal Diseases. Clin Diabetes 2022; 40:401-412. [PMID: 36381309 PMCID: PMC9606551 DOI: 10.2337/cd21-0119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Individuals with type 2 diabetes are at increased risk of both renal and cardiovascular events. The convergence of type 2 diabetes, chronic kidney disease, and cardiovascular disease, including heart failure, requires management by a multidisciplinary health care team. Primary care clinicians are likely to be the first and most frequent point of contact for individuals with type 2 diabetes who are at high risk of cardiorenal disease and therefore play a pivotal role in early diagnosis, establishment of effective treatment strategies, and coordination of care. This article presents a clinical perspective with multidisciplinary collaboration on a patient case representative of those seen in routine clinical practice. The authors assess reasons why patients may not receive evidence-based care and identify opportunities to initiate therapies that reduce cardiovascular and renal events in the primary care setting.
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Affiliation(s)
- Pamela R. Kushner
- University of California, Irvine, CA
- Corresponding author: Pamela R. Kushner,
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263
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OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6526431. [DOI: 10.1093/ejcts/ezac053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 12/14/2021] [Accepted: 01/25/2022] [Indexed: 11/12/2022] Open
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Omary C, Wright P, Kumarasamy MA, Franks N, Esper G, Mouzon HB, Barrolle S, Horne K, Cranmer J. Using Routinely Collected Electronic Health Record Data to Predict Readmission and Target Care Coordination. J Healthc Qual 2022; 44:11-22. [PMID: 34294659 DOI: 10.1097/jhq.0000000000000318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Patients with chronic renal failure (CRF) are at high risk of being readmitted to hospitals within 30 days. Routinely collected electronic health record (EHR) data may enable hospitals to predict CRF readmission and target interventions to increase quality and reduce readmissions. We compared the ability of manually extracted variables to predict readmission compared with EHR-based prediction using multivariate logistic regression on 1 year of admission data from an academic medical center. Categorizing three routinely collected variables (creatinine, B-type natriuretic peptide, and length of stay) increased readmission prediction by 30% compared with paper-based methods as measured by C-statistic (AUC). Marginal effects analysis using the final multivariate model provided patient-specific risk scores from 0% to 44.3%. These findings support the use of routinely collected EHR data for effectively stratifying readmission risk for patients with CRF. Generic readmission risk tools may be evidence-based but are designed for general populations and may not account for unique traits of specific patient populations-such as those with CRF. Routinely collected EHR data are a rapid, more efficient strategy for risk stratifying and strategically targeting care. Earlier risk stratification and reallocation of clinician effort may reduce readmissions. Testing this risk model in additional populations and settings is warranted.
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265
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de la Espriella R, Bayés-Genís A, Llàcer P, Palau P, Miñana G, Santas E, Pellicer M, González M, Górriz JL, Bodi V, Sanchis J, Núñez J. Prognostic value of NT-proBNP and CA125 across glomerular filtration rate categories in acute heart failure. Eur J Intern Med 2022; 95:67-73. [PMID: 34507853 DOI: 10.1016/j.ejim.2021.08.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/17/2021] [Accepted: 08/27/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND This study aimed to evaluate whether glomerular filtration rate (eGFR) during admission modifies the predictive value of plasma amino-terminal pro-brain natriuretic peptide (NT-proBNP) and carbohydrate antigen 125 (CA125) in patients hospitalized for acute heart failure (AHF). METHODS We retrospectively evaluated 4595 patients consecutively discharged after admission for AHF at three tertiary-care hospitals from January 2008 through October 2019. To investigate the effect of kidney function on the association of NT-proBNP and CA125 with 1-year mortality (all-cause and cardiovascular mortality), we stratified patients according to four eGFR categories: <30 mL•min-1•1.73 m-2, 30-44 mL•min-1•1.73 m-2, 44-59 mL•min-1•1.73 m-2, and ≥60 mL•min-1•1.73 m-2. Biomarkers were assessed within the first 24 hours following admission. RESULTS At 1-year follow-up, 748 of 4595 (16.3%) patients died after discharge (of all deaths, 575 [12.5%] were cardiovascular). After multivariate adjustment, both NT-proBNP and CA125 remained independently associated with a higher risk of death when modeled as main effects (P<0.001). However, we found a differential prognostic effect of NT-proBNP across eGFR categories for both endpoints (all-cause mortality, P-value for interaction=0.002; CV mortality, P-value for interaction=0.001). Whereas NT-proBNP was positively and linearly associated with mortality in the subset of patients with normal or mildly reduced eGFR, its predictive ability progressively decreased at the lower extreme of eGFR (<45 mL•min-1•1.73 m-2). In contrast, the association between CA125 and survival remained consistent across all eGFR categories (all-cause mortality, P-value for interaction=0.559; CV mortality, P-value for interaction=0.855). CONCLUSIONS In patients with AHF and severely reduced eGFR, CA125 outperforms NT-proBNP in predicting 1-year mortality.
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Affiliation(s)
- Rafael de la Espriella
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain
| | - Antoni Bayés-Genís
- CIBER Cardiovascular, Madrid, Spain; Cardiology Department and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona. Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Pau Llàcer
- Internal Medicine Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Patricia Palau
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain
| | - Gema Miñana
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain
| | - Enrique Santas
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain
| | - Mauricio Pellicer
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain
| | - Miguel González
- Nephrology Department. Hospital Clínico Universitario de Valencia, Universitat de València. Valencia, INCLIVA, Valencia, Spain
| | - José Luis Górriz
- Nephrology Department. Hospital Clínico Universitario de Valencia, Universitat de València. Valencia, INCLIVA, Valencia, Spain
| | - Vicent Bodi
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain; CIBER Cardiovascular, Madrid, Spain
| | - Juan Sanchis
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain; CIBER Cardiovascular, Madrid, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain; CIBER Cardiovascular, Madrid, Spain.
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Goryacheva OA, Ponomaryova TD, Drozd DD, Kokorina AA, Rusanova TY, Mishra PK, Goryacheva IY. Heart failure biomarkers BNP and NT-proBNP detection using optical labels. Trends Analyt Chem 2022. [DOI: 10.1016/j.trac.2021.116477] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Wang L, Zhao YT. Development and Validation of a Prediction Model for Irreversible Worsened Cardiac Function in Patients With Acute Decompensated Heart Failure. Front Cardiovasc Med 2021; 8:785587. [PMID: 34957263 PMCID: PMC8702716 DOI: 10.3389/fcvm.2021.785587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/19/2021] [Indexed: 12/23/2022] Open
Abstract
Background: Irreversible worsening of cardiac function is an adverse event associated with significant morbidity among patients with acute decompensated heart failure (ADHF). We aimed to develop a parsimonious model which is simple to use in clinical settings for the prediction of the risk of irreversible worsening of cardiac function. Methods: A total of 871 ADHF patients were enrolled in this study. Data for each patient were collected from the medical records. Irreversible worsening of cardiac function included cardiac death within 30-days of patient hospitalization, implantation of a left ventricular assistance device, or emergency heart transplantation. We performed LASSO regression for variable selection to derive a multivariable logistic regression model. Five candidate predictors were selected to derive the final prediction model. The prediction model was verified using C-statistics, calibration curve, and decision curve. Results: Irreversible worsening of cardiac function occurred in 7.8% of the patients. Advanced age, NYHA class, high blood urea nitrogen, hypoalbuminemia, and vasopressor use were its strongest predictors. The prediction model showed good discrimination C-statistic value, 0.866 (95% CI, 0.817-0.907), which indicated good identical calibration and clinical efficacy. Conclusion: In this study, we developed a prediction model and nomogram to estimate the risk of irreversible worsening of cardiac function among ADHF patients. The findings may provide a reference for clinical physicians for detection of irreversible worsening of cardiac function and enable its prompt management.
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Affiliation(s)
- Lei Wang
- Department of Cardiology, Aerospace Center Hospital, Beijing, China
| | - Yun-Tao Zhao
- Department of Cardiology, Aerospace Center Hospital, Beijing, China
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268
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Role of Clinical Characteristics and Biomarkers at Admission to Predict One-Year Mortality in Elderly Patients with Pneumonia. J Clin Med 2021; 11:jcm11010105. [PMID: 35011845 PMCID: PMC8745347 DOI: 10.3390/jcm11010105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND A hospitalization for community-acquired pneumonia results in a decrease in long-term survival in elderly patients. We assessed biomarkers at admission to predict one-year mortality in a cohort of elderly patients with pneumonia. METHODS A prospective observational study included patients >65 years hospitalized with pneumonia. Assessment of PSI, CURB-65, and biomarkers (C-reactive protein (CRP), procalcitonin (PCT), NT-pro-B-type natriuretic peptide (NT-proBNP), interleukin (IL)-6 and -8, tumor necrosis factor alpha (TNF-α), serum amyloid A (SAA), neopterin (NP), myeloperoxidase (MPO), anti-apolipoprotein A-1 IgG (anti-apoA-1), and anti-phosphorylcholine IgM (anti-PC IgM)) was used to calculate prognostic values for one-year mortality using ROC curve analyses. Post hoc optimal cutoffs with corresponding sensitivity (SE) and specificity (SP) were determined using the Youden index. RESULTS A total of 133 patients were included (median age 83 years [IQR: 78-89]). Age, dementia, BMI, NT-proBNP (AUROC 0.65 (95% CI: 0.55-0.77)), and IL-8 (AUROC 0.66 (95% CI: 0.56-0.75)) were significantly associated with mortality, with NT-proBNP (HR 1.01 (95% CI 1.00-1.02) and BMI (HR 0.92 (95% CI 0.85-1.000) being independent of age, gender, comorbidities, and PSI with Cox regression. At the cutoff value of 2200 ng/L, NT-proBNP had 67% sensitivity and 70% specificity. PSI and CURB-65 were not associated with mortality. CONCLUSIONS NT-proBNP levels upon admission and BMI displayed the highest prognostic accuracy for one-year mortality and may help clinicians to identify patients with poor long-term prognosis.
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Tomasoni D, Adamo M, Metra M. December 2021 at a glance: focus on medical treatment, valvular heart disease and prognostic models. Eur J Heart Fail 2021; 23:1993-1994. [PMID: 34935252 DOI: 10.1002/ejhf.1896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 12/05/2021] [Accepted: 12/08/2021] [Indexed: 11/07/2022] Open
Affiliation(s)
- Daniela Tomasoni
- Cardiac Catheterization Laboratory and Cardiology, Cardio-Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marianna Adamo
- Cardiac Catheterization Laboratory and Cardiology, Cardio-Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marco Metra
- Cardiac Catheterization Laboratory and Cardiology, Cardio-Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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Stretti L, Zippo D, Coats AJS, Anker MS, von Haehling S, Metra M, Tomasoni D. A year in heart failure: an update of recent findings. ESC Heart Fail 2021; 8:4370-4393. [PMID: 34918477 PMCID: PMC9073717 DOI: 10.1002/ehf2.13760] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 11/28/2021] [Accepted: 12/01/2021] [Indexed: 12/22/2022] Open
Abstract
Major changes have occurred in these last years in heart failure (HF) management. Landmark trials and the 2021 European Society of Cardiology guidelines for the diagnosis and treatment of HF have established four classes of drugs for treatment of HF with reduced ejection fraction: angiotensin‐converting enzyme inhibitors or an angiotensin receptor‐neprilysin inhibitor, beta‐blockers, mineralocorticoid receptor antagonists, and sodium‐glucose co‐transporter 2 inhibitors, namely, dapagliflozin or empagliflozin. These drugs consistently showed benefits on mortality, HF hospitalizations, and quality of life. Correction of iron deficiency is indicated to improve symptoms and reduce HF hospitalizations. AFFIRM‐AHF showed 26% reduction in total HF hospitalizations with ferric carboxymaltose vs. placebo in patients hospitalized for acute HF (P = 0.013). The guanylate cyclase activator vericiguat and the myosin activator omecamtiv mecarbil improved outcomes in randomized placebo‐controlled trials, and vericiguat is now approved for clinical practice. Treatment of HF with preserved ejection fraction (HFpEF) was a major unmet clinical need until this year when the results of EMPEROR‐Preserved (EMPagliflozin outcomE tRial in Patients With chrOnic HFpEF) were issued. Compared with placebo, empagliflozin reduced by 21% (hazard ratio, 0.79; 95% confidence interval, 0.69 to 0.90; P < 0.001), the primary outcome of cardiovascular death or HF hospitalization. Advances in the treatment of specific phenotypes of HF, including atrial fibrillation, valvular heart disease, cardiomyopathies, cardiac amyloidosis, and cancer‐related HF, also occurred. Coronavirus disease 2019 (COVID‐19) pandemic still plays a major role in HF epidemiology and management. All these aspects are highlighted in this review.
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Affiliation(s)
- Lorenzo Stretti
- Cardiology, Cardio-Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Dauphine Zippo
- Cardiology, Cardio-Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | | | - Markus S Anker
- Department of Cardiology (CBF), Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Marco Metra
- Cardiology, Cardio-Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Daniela Tomasoni
- Cardiology, Cardio-Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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271
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Januzzi JL, Tan X, Yang L, Brady JE, Yang M, Banka P, Lautsch D. N-terminal pro-B-type natriuretic peptide testing patterns in patients with heart failure with reduced ejection fraction. ESC Heart Fail 2021; 9:87-99. [PMID: 34918487 PMCID: PMC8787988 DOI: 10.1002/ehf2.13749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/20/2021] [Accepted: 11/18/2021] [Indexed: 11/23/2022] Open
Abstract
Aims The N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) is a commonly used biomarker in heart failure for diagnosis and prognostication. We aimed to determine the prevalence of NT‐proBNP testing, distribution of NT‐proBNP concentrations, and factors associated with receiving an NT‐proBNP test in patients with heart failure with reduced ejection fraction (HFrEF), including the subset with a worsening heart failure event (WHFE). Methods and results This was a retrospective cohort study using two US databases: (i) the de‐identified Humana Research Database between January 2015 and December 2018 and (ii) the Veradigm PINNACLE Registry® between July 2013 and September 2017. We included adult patients with a confirmed diagnosis of HFrEF. In each data source, a subgroup of patients with a WHFE was identified, where a WHFE was defined as a heart failure‐related hospitalization or receipt of intravenous diuretics. Bivariate and multivariate analyses were conducted to assess factors associated with receiving NT‐proBNP testing. In Cohort 1 (n = 249 238), 9.2% of patients with HFrEF and 10.8% of patients with a WHFE received NT‐proBNP testing. When restricted to patients with at least one laboratory claim, 11.3% of patients with HFrEF and 13.2% of those with a WHFE received NT‐proBNP testing. In Cohort 2 (n = 91 444), 2.3% of patients with HFrEF were tested. Median (inter‐quartile range) NT‐proBNP concentrations among patients with HFrEF were 1399 (423–4087) pg/mL in Cohort 1 and 394 (142–688) pg/mL in Cohort 2. Median (inter‐quartile range) NT‐proBNP concentrations in the subset of patients with a WHFE in each cohort were 2209 (740–5894) and 464 (174–783) pg/mL, respectively. In Cohort 1, 13.4% of all HFrEF patients receiving NT‐proBNP testing and 18.9% of patients with a WHFE had NT‐proBNP values >8000 pg/mL; in Cohort 2, these percentages were 1.0% and 2.5%, respectively. Conclusions In US clinical practice, NT‐proBNP testing was not frequently performed in patients with HFrEF. NT‐proBNP concentrations varied across data sources and subpopulations within HFrEF.
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Affiliation(s)
- James L Januzzi
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Baim Institute for Clinical Research, Boston, MA, USA
| | - Xi Tan
- Merck & Co., Inc., Kenilworth, NJ, USA
| | | | | | - Mei Yang
- Merck & Co., Inc., Kenilworth, NJ, USA
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272
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Ma M, Luo Q, Dong X, Cui S, Hocher B, Zeng S, Liang W, Li Q, Chen X, Chen X, Meng Y, Lu Y, Yang D, Yin L. N-terminal prohormone B-type natriuretic peptide variability acts as a predictor of poor prognosis in patients with cardiorenal syndrome type 2. Bioengineered 2021; 12:12407-12419. [PMID: 34905428 PMCID: PMC8810077 DOI: 10.1080/21655979.2021.2005219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study aims to explore the effect of N-terminal pro-brain natriuretic peptide (NT-proBNP) variability (mean absolute difference of the log2 NT-proBNP level measured in hospital) on the prognosis of patients with cardiorenal syndrome (CRS) type 2. Patients with CRS type 2 were retrospectively included. The varied NT-proBNP indications were analyzed. They were NT-proBNP I(pre-treatment), NT-proBNP II(post-treatment), NT-proBNP II/I, ΔNT-proBNP, log2 (NT-proBNP) variability and mean log2 (NT-proBNP). A logistic regression model and survival curves (Kaplan–Meier analysis) were built to identify independent predictors associated with poor prognosis. The primary outcomes were major adverse renal and cardiac events. The secondary outcome was all-cause mortality. From 2012 to 2016, 136 patients were included in this study with 69 (50.7%) had high log2 (NT-proBNP) variability level. The optimal cutoff level for each NT-proBNP indication that predicts poor prognosis was calculated, and the area under curves ranged from 0.668 to 0.891 with different indications. Kaplan–Meier analysis revealed that there was significantly correlated with prevalence of primary outcomes and NT-proBNP variability. The hazard ratios (HRs) ranged from 1.67 to 6.61 with different indications. The multivariate regression analyses also identified the risk of the primary outcomes were associated with elevated NT-proBNP values, except NT-proBNP I. The odds ratio (ORs) ranged from 1.83 to 6.61 with different indications. When analyzing the relationship between NT-proBNP variability and all-cause mortality, the results were the same. NT-proBNP variability might serve as an independent predictor for poor prognosis and all-cause mortality in patients with CRS type 2.
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Affiliation(s)
- Mingming Ma
- Institute of Nephrology and Blood Purification, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
| | - Qiao Luo
- Institute of Nephrology and Blood Purification, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
| | - Xiangnan Dong
- Institute of Nephrology and Blood Purification, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
| | - Shuang Cui
- Institute of Nephrology and Blood Purification, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
| | - Berthold Hocher
- Fifth Department of Medicine (Nephrology/Endocrinology/Rheumatology), University Medical Centre Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Shufei Zeng
- Institute of Nephrology and Blood Purification, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
| | - Wenxue Liang
- Institute of Nephrology and Blood Purification, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
| | - Qiang Li
- Department of Nephrology, Dongguan Hospital of Traditional Chinese Medicine, Dongguan, China
| | - Xiaoyi Chen
- Institute of Nephrology and Blood Purification, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
| | - Xin Chen
- Institute of Nephrology and Blood Purification, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
| | - Yu Meng
- Institute of Nephrology and Blood Purification, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
| | - Yongping Lu
- Institute of Nephrology and Blood Purification, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
| | - Deguang Yang
- Department of Cardiology, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
| | - Lianghong Yin
- Institute of Nephrology and Blood Purification, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
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273
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Herrmann J, Lenihan D, Armenian S, Barac A, Blaes A, Cardinale D, Carver J, Dent S, Ky B, Lyon AR, López-Fernández T, Fradley MG, Ganatra S, Curigliano G, Mitchell JD, Minotti G, Lang NN, Liu JE, Neilan TG, Nohria A, O'Quinn R, Pusic I, Porter C, Reynolds KL, Ruddy KJ, Thavendiranathan P, Valent P. Defining cardiovascular toxicities of cancer therapies: an International Cardio-Oncology Society (IC-OS) consensus statement. Eur Heart J 2021; 43:280-299. [PMID: 34904661 PMCID: PMC8803367 DOI: 10.1093/eurheartj/ehab674] [Citation(s) in RCA: 200] [Impact Index Per Article: 66.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/28/2021] [Accepted: 09/10/2021] [Indexed: 12/16/2022] Open
Abstract
The discipline of Cardio-Oncology has seen tremendous growth over the past decade. It is devoted to the cardiovascular (CV) care of the cancer patient, especially to the mitigation and management of CV complications or toxicities of cancer therapies, which can have profound implications on prognosis. To that effect, many studies have assessed CV toxicities in patients undergoing various types of cancer therapies; however, direct comparisons have proven difficult due to lack of uniformity in CV toxicity endpoints. Similarly, in clinical practice, there can be substantial differences in the understanding of what constitutes CV toxicity, which can lead to significant variation in patient management and outcomes. This document addresses these issues and provides consensus definitions for the most commonly reported CV toxicities, including cardiomyopathy/heart failure and myocarditis, vascular toxicity, and hypertension, as well as arrhythmias and QTc prolongation. The current document reflects a harmonizing review of the current landscape in CV toxicities and the definitions used to define these. This consensus effort aims to provide a structure for definitions of CV toxicity in the clinic and for future research. It will be important to link the definitions outlined herein to outcomes in clinical practice and CV endpoints in clinical trials. It should facilitate communication across various disciplines to improve clinical outcomes for cancer patients with CV diseases.
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Affiliation(s)
- Joerg Herrmann
- Corresponding author. Tel: +1 507 284 2904, Fax: +1 507 293 0107,
| | - Daniel Lenihan
- International Cardio-Oncology Society, 465 Lucerne Ave., Tampa, FL 33606, USA
| | - Saro Armenian
- City of Hope Comprehensive Cancer Center, Department of Population Sciences, 500 E Duarte Rd, Duarte, CA 91010, USA
| | - Ana Barac
- MedStar Heart and Vascular Institute, Georgetown University, 10 Irving Street Northwest Suite NW, Washington, DC 20010, USA
| | - Anne Blaes
- University of Minnesota, Division of Hematology/Oncology, 420 Delaware Street SE, Minneapolis, MN 55455, USA
| | - Daniela Cardinale
- Cardioncology Unit, European Institute of Oncology, IRCCS, Via Adamello 16, 20139 Milan, Italy
| | - Joseph Carver
- Abraham Cancer Center, University of Pennsylvania, Philadelphia, 3400 Civic Center Boulevard, Pavilion 2nd Floor, Philadelphia, PA 19104, USA
| | - Susan Dent
- Duke Cancer Institute, Department of Medicine, Duke University, 20 Duke Medicine Circle, Durham, NA 27704, USA
| | - Bonnie Ky
- Division of Cardiology, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Alexander R Lyon
- Cardio-Oncology Service, Royal Brompton Hospital, Imperial College, Sydney St, London SW3 6NP, United Kingdom
| | - Teresa López-Fernández
- Division of Cardiology; Cardiac Imaging and Cardio-Oncology Unit; La Paz University Hospital, IdiPAZ Research Institute, CIBER CV, C. de Pedro Rico, 6, 28029 Madrid, Spain
| | - Michael G Fradley
- Division of Cardiology, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Sarju Ganatra
- Cardio-Oncology Program, Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, 41 Burlington Mall Road, Burlington, MA 01805, USA
| | - Giuseppe Curigliano
- Department of Oncology and Hemato-Oncology, University of Milano, Via Festa del Perdono 7. 20122 Milano, Italy,European Institute of Oncology, IRCCS, Via Adamello 16, 20139 Milan, Italy
| | - Joshua D Mitchell
- Cardio-Oncology Center of Excellence, Washington University, 4921 Parkview Pl, St. Louis, MO 63110, USA
| | - Giorgio Minotti
- Department of Medicine, University Campus Bio-Medico, Via Álvaro del Portillo, 21, 00128 Roma, Italy
| | - Ninian N Lang
- British Heart Foundation Centre for Cardiovascular Sciences, University of Glasgow, 126 University Place, Glasgow, G12 8TA Scotland, United Kingdom
| | - Jennifer E Liu
- Memorial Sloan Kettering Cancer Center, Department of Medicine/Cardiology Service, 1275 York Ave, New York, NY 10065, USA
| | - Tomas G Neilan
- Cardio-oncology Program, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
| | - Anju Nohria
- Cardio-Oncology Program, Brigham and Women’s Hospital and Dana Farber Cancer Institute, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Rupal O'Quinn
- Division of Cardiology, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Iskra Pusic
- Washington University School of Medicine, Division of Oncology, 4921 Parkview Place, St. Louis, MO 63110, USA
| | - Charles Porter
- Cardiovascular Medicine, Cardio-Oncology Unit, University of Kansas Medical Center, 4000 Cambridge Street, Kansas City, KS 66160, USA
| | - Kerry L Reynolds
- Massachusetts General Hospital Cancer Center, Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
| | - Kathryn J Ruddy
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55902, USA
| | - Paaladinesh Thavendiranathan
- Department of Medicine, Division of Cardiology, Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Centre, University Health Network, University of Toronto, 585 University Ave, Toronto, ON M5G 2N2, Canada
| | - Peter Valent
- Department of Internal Medicine I, Division of Hematology and Hemostaseology and Ludwig Boltzmann Institute for Hematology and Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
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274
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Gao W, Fan J, Sun D, Yang M, Guo W, Tao L, Zheng J, Zhu J, Wang T, Ren J. Heart Failure Probability and Early Outcomes of Critically Ill Patients With COVID-19: A Prospective, Multicenter Study. Front Cardiovasc Med 2021; 8:738814. [PMID: 34901205 PMCID: PMC8660969 DOI: 10.3389/fcvm.2021.738814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 10/28/2021] [Indexed: 01/08/2023] Open
Abstract
Background: The relationship between cardiac functions and the fatal outcome of coronavirus disease 2019 (COVID-19) is still largely underestimated. We aim to explore the role of heart failure (HF) and NT-proBNP in the prognosis of critically ill patients with COVID-19 and construct an easy-to-use predictive model using machine learning. Methods: In this multicenter and prospective study, a total of 1,050 patients with clinical suspicion of COVID-19 were consecutively screened. Finally, 402 laboratory-confirmed critically ill patients with COVID-19 were enrolled. A “triple cut-point” strategy of NT-proBNP was applied to assess the probability of HF. The primary outcome was 30-day all-cause in-hospital death. Prognostic risk factors were analyzed using the least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression, further formulating a nomogram to predict mortality. Results: Within a 30-day follow-up, 27.4% of the 402 patients died. The mortality rate of patients with HF likely was significantly higher than that of the patient with gray zone and HF unlikely (40.8% vs. 25 and 16.5%, respectively, P < 0.001). HF likely [Odds ratio (OR) 1.97, 95% CI 1.13–3.42], age (OR 1.04, 95% CI 1.02–1.06), lymphocyte (OR 0.36, 95% CI 0.19–0.68), albumin (OR 0.92, 95% CI 0.87–0.96), and total bilirubin (OR 1.02, 95% CI 1–1.04) were independently associated with the prognosis of critically ill patients with COVID-19. Moreover, a nomogram was developed by bootstrap validation, and C-index was 0.8 (95% CI 0.74–0.86). Conclusions: This study established a novel nomogram to predict the 30-day all-cause mortality of critically ill patients with COVID-19, highlighting the predominant role of the “triple cut-point” strategy of NT-proBNP, which could assist in risk stratification and improve clinical sequelae.
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Affiliation(s)
- Weibo Gao
- Department of Emergency, Peking University People's Hospital, Beijing, China
| | - Jiasai Fan
- Department of Cardiology, Heart Failure Center, China-Japan Friendship Hospital, Beijing, China
| | - Di Sun
- Department of Cardiology, Heart Failure Center, China-Japan Friendship Hospital, Beijing, China
| | - Mengxi Yang
- Department of Cardiology, Heart Failure Center, China-Japan Friendship Hospital, Beijing, China
| | - Wei Guo
- Trauma Center, Peking University People's Hospital, Beijing, China
| | - Liyuan Tao
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Jingang Zheng
- Department of Cardiology, Heart Failure Center, China-Japan Friendship Hospital, Beijing, China
| | - Jihong Zhu
- Department of Emergency, Peking University People's Hospital, Beijing, China
| | - Tianbing Wang
- Trauma Center, Peking University People's Hospital, Beijing, China
| | - Jingyi Ren
- Department of Cardiology, Heart Failure Center, China-Japan Friendship Hospital, Beijing, China
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275
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Wang J, Shen B, Feng X, Zhang Z, Liu J, Wang Y. A Review of Prognosis Model Associated With Cardiogenic Shock After Acute Myocardial Infarction. Front Cardiovasc Med 2021; 8:754303. [PMID: 34957245 PMCID: PMC8702644 DOI: 10.3389/fcvm.2021.754303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/21/2021] [Indexed: 01/08/2023] Open
Abstract
Objective: Cardiogenic shock seriously affects the survival rate of patients. However, few prognostic models are concerned with the score of cardiogenic shock, and few clinical studies have validated it. In order to optimize the diagnosis and treatment of myocardial infarction complicated with cardiogenic shock and facilitate the classification of clinical trials, the prognosis score model is urgently needed. Methods: Cardiogenic shock, severe case, prognosis score, myocardial infarction and external verification were used as the search terms to search PubMed, Embase, Web of Science, Cochrane, EBSCO (Medline), Scopus, BMC, NCBI, Oxford Academy, Science Direct, and other databases for pertinent studies published up until 1 August 2021. There are no restrictions on publication status and start date. Filter headlines and abstracts to find articles that may be relevant. The list of references for major studies was reviewed to obtain more references. Results and Conclusions: The existing related models are in urgent need of more external clinical verifications. In the meanwhile, with the development of molecular omics and the clinical need for optimal treatment of CS, it is urgent to establish a prognosis model with higher differentiation and coincidence rates.
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Affiliation(s)
| | | | | | | | | | - Yushi Wang
- Department of Cardiology, The First Hospital of Jilin University, Changchun, China
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276
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Trends in Frailty and Use of Evidence-Based Pharmacotherapy for Heart Failure in Australian Hospitalised Patients: An Observational Study. J Clin Med 2021; 10:jcm10245780. [PMID: 34945076 PMCID: PMC8704527 DOI: 10.3390/jcm10245780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/06/2021] [Accepted: 12/09/2021] [Indexed: 11/16/2022] Open
Abstract
Frailty increases morbidity and mortality in heart failure (HF) patients. Current risk-adjustment models do not include frailty-status and the relationship between frailty and pharmacotherapy is unclear. This study explored trends in frailty over time and its relationship with prescription of heart failure specific pharmacotherapy in hospitalised HF patients. We used the Hospital Frailty Risk Score (HFRS) to determine frailty status of patients ≥18 years admitted between 2015-2019 at two tertiary hospitals in Australia. Patients with an HFRS ≥ 5 were classified as frail. In the 3706 patients with a mean (SD) age of 76.1 (14.4) years, 876 (23.6%) were classified as frail. HFRS was weakly correlated with age (r = 0.16) and Charlson-index (r = 0.35) (both p values < 0.001). Whilst frailty was more common in older HF patients (28.9% of patients ≥80 years), 15.1% of patients ≤65 years of age were also found to be frail. The proportion of frail patients increased from 19.4% in 2015 to 29.2% in 2019 despite no significant change in age during this period. The proportion of patients who received heart failure specific pharmacotherapy decreased from 86.7% in 2015 to 82.9% in 2019 (p value = 0.03) and frail patients were significantly less likely to be prescribed HF specific pharmacotherapy than non-frail patients (77.4% vs. 85.9%, p < 0.001).
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277
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Ullmo J, Cruz-Lemini M, Sánchez-García O, Bos-Real L, Fernandez De La Llama P, Calero F, Domínguez-Gallardo C, Garrido-Gimenez C, Trilla C, Carreras-Costa F, Sionis A, Mora J, García-Osuna Á, Ordoñez-Llanos J, Llurba E. Cardiac dysfunction and remodeling regulated by anti-angiogenic environment in patients with preeclampsia: the ANGIOCOR prospective cohort study protocol. BMC Pregnancy Childbirth 2021; 21:816. [PMID: 34879854 PMCID: PMC8653611 DOI: 10.1186/s12884-021-04263-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/10/2021] [Indexed: 11/16/2022] Open
Abstract
Background Cardiovascular diseases (CVD) are cause of increased morbidity and mortality in spite of advances for diagnosis and treatment. Changes during pregnancy affect importantly the maternal CV system. Pregnant women that develop preeclampsia (PE) have higher risk (up to 4 times) of clinical CVD in the short- and long-term. Predominance of an anti-angiogenic environment during pregnancy is known as main cause of PE, but its relationship with CV complications is still under research. We hypothesize that angiogenic factors are associated to maternal cardiac dysfunction/remodeling and that these may be detected by new cardiac biomarkers and maternal echocardiography. Methods Prospective cohort study of pregnant women with high-risk of PE in first trimester screening, established diagnosis of PE during gestation, and healthy pregnant women (total intended sample size n = 440). Placental biochemical and biophysical cardiovascular markers will be assessed in the first and third trimesters of pregnancy, along with maternal echocardiographic parameters. Fetal cardiac function at third trimester of pregnancy will be also evaluated and correlated with maternal variables. Maternal cardiac function assessment will be determined 12 months after delivery, and correlation with CV and PE risk variables obtained during pregnancy will be evaluated. Discussion The study will contribute to characterize the relationship between anti-angiogenic environment and maternal CV dysfunction/remodeling, during and after pregnancy, as well as its impact on future CVD risk in patients with PE. The ultimate goal is to improve CV health of women with high-risk or previous PE, and thus, reduce the burden of the disease. Trial registration NCT04162236
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Affiliation(s)
- Johana Ullmo
- Obstetrics and Gynecology Department, Santa Creu i Sant Pau University Hospital & Universitat Autònoma, Barcelona, Spain.,Woman and Perinatal Health Research Group, Sant Pau Biomedical Research Institute (IIB-Sant Pau), Sant Pau University Hospital, Barcelona, Spain
| | - Monica Cruz-Lemini
- Obstetrics and Gynecology Department, Santa Creu i Sant Pau University Hospital & Universitat Autònoma, Barcelona, Spain.,Woman and Perinatal Health Research Group, Sant Pau Biomedical Research Institute (IIB-Sant Pau), Sant Pau University Hospital, Barcelona, Spain.,Maternal and Child Health and Development Network (SAMID), RD16/0022/0015, Instituto de Salud Carlos III, Madrid, Spain
| | - Olga Sánchez-García
- Woman and Perinatal Health Research Group, Sant Pau Biomedical Research Institute (IIB-Sant Pau), Sant Pau University Hospital, Barcelona, Spain.,Maternal and Child Health and Development Network (SAMID), RD16/0022/0015, Instituto de Salud Carlos III, Madrid, Spain
| | - Lidia Bos-Real
- Woman and Perinatal Health Research Group, Sant Pau Biomedical Research Institute (IIB-Sant Pau), Sant Pau University Hospital, Barcelona, Spain.,Cardiology Department, Santa Creu i Sant Pau University Hospital, Barcelona, Spain
| | - Patricia Fernandez De La Llama
- Woman and Perinatal Health Research Group, Sant Pau Biomedical Research Institute (IIB-Sant Pau), Sant Pau University Hospital, Barcelona, Spain.,Nephrology Department, Hypertension and Prevention of Kidney Damage Unit, Fundació Puigvert, Barcelona, Spain
| | - Francesca Calero
- Woman and Perinatal Health Research Group, Sant Pau Biomedical Research Institute (IIB-Sant Pau), Sant Pau University Hospital, Barcelona, Spain.,Nephrology Department, Hypertension and Prevention of Kidney Damage Unit, Fundació Puigvert, Barcelona, Spain
| | - Carla Domínguez-Gallardo
- Obstetrics and Gynecology Department, Santa Creu i Sant Pau University Hospital & Universitat Autònoma, Barcelona, Spain.,Woman and Perinatal Health Research Group, Sant Pau Biomedical Research Institute (IIB-Sant Pau), Sant Pau University Hospital, Barcelona, Spain
| | - Carmen Garrido-Gimenez
- Obstetrics and Gynecology Department, Santa Creu i Sant Pau University Hospital & Universitat Autònoma, Barcelona, Spain.,Woman and Perinatal Health Research Group, Sant Pau Biomedical Research Institute (IIB-Sant Pau), Sant Pau University Hospital, Barcelona, Spain
| | - Cristina Trilla
- Obstetrics and Gynecology Department, Santa Creu i Sant Pau University Hospital & Universitat Autònoma, Barcelona, Spain.,Woman and Perinatal Health Research Group, Sant Pau Biomedical Research Institute (IIB-Sant Pau), Sant Pau University Hospital, Barcelona, Spain
| | | | - Alessandro Sionis
- Cardiology Department, Santa Creu i Sant Pau University Hospital, Barcelona, Spain
| | - Josefina Mora
- Woman and Perinatal Health Research Group, Sant Pau Biomedical Research Institute (IIB-Sant Pau), Sant Pau University Hospital, Barcelona, Spain.,Biochemistry Department, Santa Creu i Sant Pau University Hospital & Universitat Autònoma, Barcelona, Spain
| | - Álvaro García-Osuna
- Woman and Perinatal Health Research Group, Sant Pau Biomedical Research Institute (IIB-Sant Pau), Sant Pau University Hospital, Barcelona, Spain.,Fundació per la Bioquímica i la Patología Molecular, Biochemistry Department, Santa Creu i Sant Pau University Hospital & Universitat Autònoma, Barcelona, Spain
| | - Jordi Ordoñez-Llanos
- Biochemistry Department, Santa Creu i Sant Pau University Hospital & Universitat Autònoma, Barcelona, Spain.,Fundació per la Bioquímica i la Patología Molecular, Biochemistry Department, Santa Creu i Sant Pau University Hospital & Universitat Autònoma, Barcelona, Spain
| | - Elisa Llurba
- Obstetrics and Gynecology Department, Santa Creu i Sant Pau University Hospital & Universitat Autònoma, Barcelona, Spain. .,Woman and Perinatal Health Research Group, Sant Pau Biomedical Research Institute (IIB-Sant Pau), Sant Pau University Hospital, Barcelona, Spain. .,Maternal and Child Health and Development Network (SAMID), RD16/0022/0015, Instituto de Salud Carlos III, Madrid, Spain.
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278
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Llàcer P, Núñez J, Manzano L, Cepeda Rodrigo JM, Salamanca Bautista P, Guzmán García M, Trullás Vila JC, Quirós López R, López Reboiro ML, Montero-Pérez-Barquero M. Carbohydrate antigen 125 (CA125) as a prognostic marker in the elderly with acute heart failure and preserved ejection fraction. Med Clin (Barc) 2021; 159:164-170. [PMID: 34895749 DOI: 10.1016/j.medcli.2021.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Carbohydrate antigen 125 (CA125) has emerged as a new biomarker in heart failure. The objective of the study is to determine whether serum CA125 levels predict total mortality and readmissions at one year in patients >70 years old with acute heart failure (AHF) and preserved ejection fraction (PEF). METHODS Multicenter prospective observational study, which included 359 patients (mean age 81.5 years). The primary endpoint was total all-cause mortality and total readmissions for AHF at 1 year. A negative binomial regression technique was used to evaluate the association between CA125 and both endpoints. RESULTS At one year of follow-up, 87 deaths (24.2%) were registered. The patients in the lower quartile of CA125 had a lower crude mortality rate (14.4%, 26.7, 26.7, 29.2; p=0.09). After multivariate analysis, the CA125 value was positively associated with a higher risk (p=0.009). Such association was also positive but borderline significant for the risk of readmissions (p=0.089). CONCLUSIONS In a population older than 70 years hospitalized for AHF with PEF, elevated levels of CA125 are associated with an increased risk of death at one year of follow-up. The association with readmission for AHF was more uncertain. Low levels of CA125 identifies a subgroup at low-risk.
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Affiliation(s)
- Pau Llàcer
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, España.
| | - Julio Núñez
- Servicio de Cardiología, Hospital Clínico Universitario, Universitat de Valéncia, INCLIVA, Valencia, España; CIBER Cardiovascular, Madrid, España
| | - Luis Manzano
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, España; Departamento de Medicina y Especialidades Médicas, Facultad de Medicina y Ciencias de la Salud, Universidad de Alcalá, IRYCIS, Madrid, España
| | | | | | | | - Joan Carles Trullás Vila
- Servicio de Medicina Interna, Hospital d'Olot i comarcal de la Garrtoxa, Girona, Universitat de Vic - Universitat Central de Catalunya, Barcelona, España
| | - Raúl Quirós López
- Servicio de Medicina Interna, Hospital de la Costa del Sol, Marbella, Málaga, España
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279
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Werhahn SM, Becker C, Mende M, Haarmann H, Nolte K, Laufs U, Zeynalova S, Löffler M, Dagres N, Husser D, Dörr M, Gross S, Felix SB, Petersmann A, Herrmann-Lingen C, Binder L, Scherer M, Hasenfuß G, Pieske B, Edelmann F, Wachter R. NT-proBNP as a marker for atrial fibrillation and heart failure in four observational outpatient trials. ESC Heart Fail 2021; 9:100-109. [PMID: 34850596 PMCID: PMC8788004 DOI: 10.1002/ehf2.13703] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 10/10/2021] [Accepted: 10/29/2021] [Indexed: 01/04/2023] Open
Abstract
Aims Heart failure (HF) and atrial fibrillation (AF) frequently coexist and are both associated with increased levels of N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP). It is known that AF impairs the diagnostic accuracy of NT‐proBNP for HF. The aim of the present study was to compare the diagnostic and predictive accuracy of NT‐proBNP for HF and AF in stable outpatients with cardiovascular risk factors. Methods and results Data were obtained from the DIAST‐CHF trial, a prospective cohort study that recruited individuals with cardiovascular risk factors and followed them up for 12 years. Data were validated in three independent population‐based cohorts using the same inclusion/exclusion criteria: LIFE‐Adult (n = 2869), SHIP (n = 2013), and SHIP‐TREND (n = 2408). Serum levels of NT‐proBNP were taken once at baseline. The DIAST‐CHF study enrolled 1727 study participants (47.7% female, mean age 66.9 ± 8.1 years). At baseline, patients without AF or HF (n = 1375) had a median NT‐proBNP of 94 pg/mL (interquartile range 51;181). In patients with AF (n = 93), NT‐proBNP amounted to 667 (215;1130) pg/mL. It was significantly higher than in the first group (P < 0.001) and compared with those with only HF [n = 201; 158 (66;363) pg/mL; P < 0.001]. The highest levels of NT‐proBNP [868 (213;1397) pg/mL] were measured in patients with concomitant HF and AF (n = 58; P < 0.001 vs. control and vs. HF, P = 1.0 vs. AF). In patients with AF, NT‐proBNP levels did not differ between those with HF and preserved ejection fraction (EF) > 50% [n = 38; 603 (175;1070) pg/mL] and those without HF (P = 1.0). Receiver‐operating characteristic curves of NT‐proBNP showed a similar area under the curve (AUC) for the detection of AF at baseline (0.84, 95% CI [0.79–0.88]) and for HF with EF < 50% (0.78 [0.72–0.85]; P = 0.18). The AUC for HF with EF > 50% was significantly lower (0.61 [0.56–0.65]) than for AF (P = 0.001). During follow‐up, AF was newly diagnosed in 157 (9.1%) and HF in 141 (9.6%) study participants. NT‐proBNP was a better predictor of incident AF during the first 2 years (AUC: 0.79 [0.75–0.83]) than of newly diagnosed HF (0.59 [0.55–0.63]; P < 0.001). Data were validated in three independent population‐based cohorts (LIFE‐Adult, n = 2869; SHIP, n = 2013; and SHIP‐TREND, n = 2408). Conclusions In stable outpatients, NT‐proBNP is a better marker for prevalent and incident AF than for HF. In AF patients, the diagnostic value of NT‐proBNP for HF with EF > 50% is very limited.
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Affiliation(s)
- Stefanie M Werhahn
- Clinic for Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Christian Becker
- Clinic for Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany
| | - Meinhard Mende
- Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University Hospital Leipzig, Leipzig, Germany
| | - Helge Haarmann
- Clinic for Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany
| | - Kathleen Nolte
- Clinic for Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany
| | - Ulrich Laufs
- Department of Cardiology, University Hospital, Leipzig University, Leipzig, Germany
| | - Samira Zeynalova
- Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University Hospital Leipzig, Leipzig, Germany.,LIFE Research Center for Civilization Diseases, Leipzig, Germany
| | - Markus Löffler
- Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University Hospital Leipzig, Leipzig, Germany.,LIFE Research Center for Civilization Diseases, Leipzig, Germany
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center, Leipzig, Germany
| | - Daniela Husser
- Department of Electrophysiology, Heart Center, Leipzig, Germany
| | - Marcus Dörr
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany
| | - Stefan Gross
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany
| | - Stephan B Felix
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany
| | - Astrid Petersmann
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Christoph Herrmann-Lingen
- German Centre for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany.,Department of Psychosomatic Medicine and Psychotherapy, University of Oldenburg Medical Centre, Oldenburg, Germany
| | - Lutz Binder
- German Centre for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany.,Institute for Clinical Chemistry/UMG-Laboratories, University Medical Center Göttingen, Göttingen, Germany
| | - Martin Scherer
- Department of Primary Medical Care, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Gerd Hasenfuß
- Clinic for Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Burkert Pieske
- Department of Cardiology, Charité University Medicine, Campus Virchow Klinikum, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany.,German Heart Center, Berlin, Germany
| | - Frank Edelmann
- Clinic for Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany.,Department of Cardiology, Charité University Medicine, Campus Virchow Klinikum, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
| | - Rolf Wachter
- Clinic for Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany.,Department of Cardiology, University Hospital, Leipzig University, Leipzig, Germany
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280
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Drapkina OM, Shepel RN, Dzhioeva ON. Natriuretic peptides: new challenges — new solutions. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2021. [DOI: 10.15829/1728-8800-2021-3102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Natriuretic peptides (NPs) are one of the most significant biomarkers, the practical use of which increases, and their diagnostic and prognostic value in patients with various chronic noncommunicable diseases is beyond doubt. Since the discovery of these markers, research has been actively carried out to study the biological and pathophysiological roles of NPs in a wide range of diseases, including hypertension and heart failure (HF). These studies showed that A-type and B-type NPs are hormones secreted by the heart in response to pre- or afterload, which prevent high blood pressure and fluid retention. In addition, C-type NPs are produced by the vascular endothelium and act as a local a mediator with angioprotective properties. Since the NP system is a natural antagonist of the sympathoadrenal and renin-angiotensinaldosterone systems, it is interesting to study novel strategies to use new drug classes for hypertension. These drugs are neprilysin inhibitors, which destroys NPs; their action is to enhance the synthesis of endogenous peptides. Dual angiotensin receptor and neprilysin inhibition is widespread in clinical practice in patients with heart failure with reduced ejection fraction. Neprilysin inhibition has also been shown to be an effective strategy for hypertensive patients. The article discusses the role and value of NP system in the dia - gnosis of heart failure and blood pressure regulation, and also considers new promising directions for neprilysin inhibition and activation of endogenous NP synthesis.
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Affiliation(s)
- O. M. Drapkina
- National Medical Research Center for Therapy and Preventive Medicine;
Moscow State University of Medicine and Dentistry
| | - R. N. Shepel
- National Medical Research Center for Therapy and Preventive Medicine;
Moscow State University of Medicine and Dentistry
| | - O. N. Dzhioeva
- National Medical Research Center for Therapy and Preventive Medicine;
Moscow State University of Medicine and Dentistry
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281
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Ruan Y, Chao S, Hu X, Lu L, Lin Y, Wang Q, Zheng Y, Li J, Ding N. FN3 Domain Displaying Double Epitopes: A Cost-Effective Strategy for Producing Substitute Antigens. Front Mol Biosci 2021; 8:742617. [PMID: 34820421 PMCID: PMC8607273 DOI: 10.3389/fmolb.2021.742617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 10/18/2021] [Indexed: 12/15/2022] Open
Abstract
Construction of substitute antigens based on alternative scaffold proteins is a promising strategy in bioassay technology. In this study, we proposed a strategy for constructing substitute antigens derived from 10th human fibronectin type III (FN3) using two peptide epitopes of terminal pro-brain natriuretic peptide (NT-proBNP) as an example. The base sequences encoding the two antigenic epitopes of NT-proBNP were recombined into the FG loop region and the C-terminus of FN3, fused by 4 GS or polyN linker. The fusion proteins (named FN3-epitopes-4GS and FN3-epitopes-polyN, respectively) were expressed and purified cost-effectively using an Escherichia coli expression system. The immunoreactivity of recombinant substitutes was preliminarily confirmed by western blot analysis using epitope-specific antibodies. The sandwich enzyme-linked immunosorbent assay demonstrated that either FN3-epitopes-polyN or FN3-epitopes-4GS was highly sensitive, and FN3-epitopes-polyN exhibited better kinetics to specific antibodies than FN3-epitopes-4GS, showing a linear dose-response relationship in the concentration range of 0.06–12.85 ng/ml, which suggest that the polyN linker was more suitable for constructing the FN3-based substitute antigens compared to the 4 GS linker. Furthermore, the serum stability test and differential scanning calorimetry analysis showed that the recombinant FN3-epitopes-polyN maintained the original stability of FN3. Therefore, it was confirmed that FN3 could be engineered to construct a stable biomacromolecular substitute for displaying double epitopes of antigen proteins, such as NT-proBNP. In summary, a cost-effective strategy to produce NT-proBNP substitute antigens with good immunoreactivity and physicochemical stability was established in this work, which may provide potential uses for the production of other substitute antigens in the future.
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Affiliation(s)
- Yao Ruan
- Xi'an International Medical Center Hospital, Xi'an, China.,Medical College, Dalian University, Dalian, China.,Xi'an Engineering Technology Research Center for Cardiovascular Active Peptides, Xi'an, China
| | | | - Xuejun Hu
- Medical College, Dalian University, Dalian, China
| | - Longzhen Lu
- Medical College, Dalian University, Dalian, China
| | - Yue Lin
- Medical College, Dalian University, Dalian, China
| | - Qian Wang
- Medical College, Dalian University, Dalian, China
| | - Yang Zheng
- Medical College, Dalian University, Dalian, China
| | - Junming Li
- Department of Clinical Laboratory, Yuhuangding Hospital, Yantai, China
| | - Ning Ding
- Medical College, Dalian University, Dalian, China
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282
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Butt JH, Adamson C, Docherty KF, de Boer RA, Petrie MC, Inzucchi SE, Kosiborod MN, Maria Langkilde A, Lindholm D, Martinez FA, Bengtsson O, Schou M, O'Meara E, Ponikowski P, Sabatine MS, Sjöstrand M, Solomon SD, Jhund PS, McMurray JJV, Køber L. Efficacy and Safety of Dapagliflozin in Heart Failure With Reduced Ejection Fraction According to N-Terminal Pro-B-Type Natriuretic Peptide: Insights From the DAPA-HF Trial. Circ Heart Fail 2021; 14:e008837. [PMID: 34802253 DOI: 10.1161/circheartfailure.121.008837] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Effective therapies for HFrEF usually reduce NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels, and it is important to establish whether new treatments are effective across the range of NT-proBNP. METHODS We evaluated both these questions in the DAPA-HF (Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure) trial. Patients in New York Heart Association functional class II to IV with a left ventricular ejection fraction ≤40% and a NT-proBNP level ≥600 pg/mL (≥600 ng/L; ≥400 pg/mL if hospitalized for HF within the previous 12 months or ≥900 pg/mL if atrial fibrillation/flutter) were eligible. The primary outcome was the composite of an episode of worsening HF or cardiovascular death. RESULTS Of the 4744 randomized patients, 4742 had an available baseline NT-proBNP measurement (median, 1437 pg/mL [interquartile range, 857-2650 pg/mL]). Compared with placebo, treatment with dapagliflozin significantly reduced NT-proBNP from baseline to 8 months (absolute least-squares mean reduction, -303 pg/mL [95% CI, -457 to -150 pg/mL]; geometric mean ratio, 0.92 [95% CI, 0.88-0.96]). Dapagliflozin reduced the risk of worsening HF or cardiovascular death, irrespective of baseline NT-proBNP quartile; the hazard ratio for dapagliflozin versus placebo, from lowest to highest quartile was 0.43 (95% CI, 0.27-0.67), 0.77 (0.56-1.04), 0.78 (0.60-1.01), and 0.78 (0.64-0.95); P for interaction=0.09. Consistent benefits were observed for all-cause mortality. Compared with placebo, dapagliflozin increased the proportion of patients with a meaningful improvement (≥5 points) in Kansas City Cardiomyopathy Questionnaire total symptom score (P for interaction=0.99) and decreased the proportion with a deterioration ≥5 points (P for interaction=0.87) across baseline NT-proBNP quartiles. CONCLUSIONS In patients with HFrEF, dapagliflozin reduced NT-proBNP by 300 pg/mL after 8 months of treatment compared with placebo. In addition, dapagliflozin reduced the risk of worsening HF and death, and improved symptoms, across the spectrum of baseline NT-proBNP levels included in DAPA-HF. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03036124.
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Affiliation(s)
- Jawad H Butt
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (J.H.B., L.K.)
| | - Carly Adamson
- BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (C.A., K.F.D., M.C.P., P.S.J., J.J.V.M.)
| | - Kieran F Docherty
- BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (C.A., K.F.D., M.C.P., P.S.J., J.J.V.M.)
| | - Rudolf A de Boer
- Department of Cardiology, University Medical Center and University of Groningen, the Netherlands (R.A.d.B.)
| | - Mark C Petrie
- BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (C.A., K.F.D., M.C.P., P.S.J., J.J.V.M.)
| | - Silvio E Inzucchi
- Section of Endocrinology, Yale School of Medicine, New Haven, CT (S.E.I.)
| | - Mikhail N Kosiborod
- Saint Luke's Mid America Heart Institute, University of Missouri, Kansas City (M.N.K.).,The George Institute for Global Health, University of New South Wales, Sydney, Australia (M.N.K.)
| | - Anna Maria Langkilde
- Late Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden (A.M.L., D.L., O.B., M. Sjöstrand)
| | - Daniel Lindholm
- Late Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden (A.M.L., D.L., O.B., M. Sjöstrand)
| | | | - Olof Bengtsson
- Late Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden (A.M.L., D.L., O.B., M. Sjöstrand)
| | - Morten Schou
- Department of Cardiology, Herlev-Gentofte University Hospital, Herlev, Denmark (M. Schou)
| | - Eileen O'Meara
- Montreal Heart Institute, Université de Montréal, Quebec, Canada (E.O.)
| | - Piotr Ponikowski
- Center for Heart Diseases, University Hospital, Wroclaw Medical University, Poland (P.P.)
| | - Marc S Sabatine
- TIMI Study Group (M.S.S.), Brigham and Women's Hospital, Boston, MA.,Division of Cardiovascular Medicine (M.S.S., S.D.S.), Brigham and Women's Hospital, Boston, MA
| | - Mikaela Sjöstrand
- Late Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden (A.M.L., D.L., O.B., M. Sjöstrand)
| | - Scott D Solomon
- Division of Cardiovascular Medicine (M.S.S., S.D.S.), Brigham and Women's Hospital, Boston, MA
| | - Pardeep S Jhund
- BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (C.A., K.F.D., M.C.P., P.S.J., J.J.V.M.)
| | - John J V McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (C.A., K.F.D., M.C.P., P.S.J., J.J.V.M.)
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (J.H.B., L.K.)
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283
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Chronic Kidney Disease and Heart Failure-Everyday Diagnostic Challenges. Diagnostics (Basel) 2021; 11:diagnostics11112164. [PMID: 34829511 PMCID: PMC8624132 DOI: 10.3390/diagnostics11112164] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/18/2021] [Accepted: 11/19/2021] [Indexed: 01/10/2023] Open
Abstract
Is advanced chronic kidney disease (CKD) a cardiac “no man’s land”? Chronic heart failure (HF) is widely believed to be one of the most serious medical challenges of the 21st century. Moreover, the number of patients with CKD is increasing. To date, patients with estimated glomerular filtration rates <30 mL/min/1.73 m2 have frequently been excluded from large, randomized clinical trials. Although this situation is slowly changing, in everyday practice we continue to struggle with problems that are not clearly addressed in the guidelines. This literature review was conducted by an interdisciplinary group, which comprised a nephrologist, internal medicine specialists, and cardiologist. In this review, we discuss the difficulties in ruling out HF for patients with advanced CKD and issues regarding the cardiotoxicity of dialysis fistulas and the occurrence of pulmonary hypertension in patients with CKD. Due to the recent publication of the new HF guidelines by the European Society of Cardiology, this is a good time to address these difficult issues. Contrary to appearances, these are not niche issues, but problems that affect many patients.
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284
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Krasnikova OV, Nemirova SV, Medvedev AP, Gordetsov AS. Infrared Spectroscopy in Differential Diagnosis of Pulmonary Embolism. Sovrem Tekhnologii Med 2021; 12:64-69. [PMID: 34795981 PMCID: PMC8596252 DOI: 10.17691/stm2020.12.3.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Indexed: 11/14/2022] Open
Abstract
The aim of the study was to assess the effectiveness of infrared spectroscopy for verification of pulmonary embolism (PE) and a number of similar diseases. Materials and Methods Infrared spectroscopy was used to investigate blood serum of 19 healthy volunteers and 30 patients with intraoperatively confirmed PE as well as with chronic obstructive pulmonary disease (COPD) (n=10), pneumonia (n=10), tuberculosis (n=10), lung abscess (n=10) and lung cancer (n=10), acute disorder of cerebral circulation (ADCC) (n=10), ischemic heart disease (IHD) (n=10). Peak height ratios of absorption band were taken as diagnostic parameters (cm-1/сm-1): P1 - 1160/1165; P2 - 1165/1070; P3 - 1165/1150; P4 - 1165/1050; P5 - 1100/1050; P6 - 1025/1165. These parameters of IR spectrum are significant for the given nosology. Results The calculated indicators have demonstrated statistically significant difference of IR spectra parameters for the studied nosologies (p<0.001) even on the small samples supplementing each other and enabling step-by-step exclusion of lung abscess and pulmonary tuberculosis, COPD and pneumonia, cancer, IHD, ADCC, and PE.The presented radar charts, built with consideration of the values of all peak height ratios of the absorption bands with diagnostically significant maxima, provided the possibility to visualize the IR profiles making the differentiation of PE and its clinical analogs not only more objective and reliable but also more explicit and compelling. Conclusion Infrared spectroscopy is a potentially effective method of PE differential diagnosis. Sample expansion will allow researchers to evaluate the sensitivity and specificity of this technique compared to the existing standard schemes of PE verification.
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Affiliation(s)
- O V Krasnikova
- Associate Professor, Department of General Chemestry; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - S V Nemirova
- Associate Professor, Department of Hospital Surgery named after B.A. Korolyov; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - A P Medvedev
- Professor, Department of Hospital Surgery named after B.A. Korolyov; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - A S Gordetsov
- Professor, Head of the Department of General Chemestry Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
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285
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Vecchi AL, Muccioli S, Marazzato J, Mancinelli A, Iacovoni A, De Ponti R. Prognostic Role of Subclinical Congestion in Heart Failure Outpatients: Focus on Right Ventricular Dysfunction. J Clin Med 2021; 10:jcm10225423. [PMID: 34830705 PMCID: PMC8625381 DOI: 10.3390/jcm10225423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/01/2021] [Accepted: 11/16/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND subclinical pulmonary and peripheral congestion is an emerging concept in heart failure, correlated with a worse prognosis. Very few studies have evaluated its prognostic impact in an outpatient setting and its relationship with right-ventricular dysfunction. The study aims to investigate subclinical congestion in chronic heart failure outpatients, exploring the close relationship between the right heart-pulmonary unit and peripheral congestion. MATERIALS AND METHODS in this observational study, 104 chronic HF outpatients were enrolled. The degree of congestion and signs of elevated filling pressures of the right ventricle were evaluated by physical examination and a transthoracic ultrasound to define multiparametric right ventricular dysfunction, estimate the right atrial pressure and the pulmonary artery systolic pressure. Outcome data were obtained by scheduled visits and phone calls. RESULTS ultrasound signs of congestion were found in 26% of patients and, among this cohort, half of them presented as subclinical, affecting their prognosis, revealing a linear correlation between right ventricular/arterial coupling, the right-chambers size and ultrasound congestion. Right ventricular dysfunction, TAPSE/PAPS ratio, clinical and ultrasound signs of congestion have been confirmed to be useful predictors of outcome. CONCLUSIONS subclinical congestion is widespread in the heart failure outpatient population, significantly affecting prognosis, especially when right ventricular dysfunction also occurs, suggesting a strict correlation between the heart-pulmonary unit and volume overload.
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Affiliation(s)
- Andrea Lorenzo Vecchi
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy; (J.M.); (R.D.P.)
- Correspondence:
| | - Silvia Muccioli
- Department of Cardiology, Mauriziano Umberto I Hospital, 10128 Torino, Italy;
| | - Jacopo Marazzato
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy; (J.M.); (R.D.P.)
| | - Antonella Mancinelli
- Department of Cardiology, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy; (A.M.); (A.I.)
| | - Attilio Iacovoni
- Department of Cardiology, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy; (A.M.); (A.I.)
| | - Roberto De Ponti
- Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy; (J.M.); (R.D.P.)
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286
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Wang S, Li M, Wang X, Luo J, Zou Y, Hu Y, Liu X, Ao H, Yao X, Li C, Yang T. The Ratio of NT-proBNP to CysC 1.53 Predicts Heart Failure in Patients With Chronic Kidney Disease. Front Cardiovasc Med 2021; 8:731864. [PMID: 34869631 PMCID: PMC8632768 DOI: 10.3389/fcvm.2021.731864] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/15/2021] [Indexed: 12/28/2022] Open
Abstract
Background: The N-terminal pro B type natriuretic peptide (NT-proBNP) is important for prognosis of heart failure in patients with chronic kidney disease (CKD). However, the NT-proBNP level is easily affected by renal insufficiency, which limits its clinical use. Methods: This study included 396 patients with CKD. Plasma levels of NT-proBNP and cystatin C (CysC) were measured during hospitalization. The echocardiographic parameters were also detected. Patients were divided into the heart failure group and control group according to the European Society of Cardiology Guideline on Chronic Heart Failure 2021. Multiple modeling analysis of the values of NT-proBNP and CysC, including NT-proBNP/Cyscn and NT-proBNP/nCysC was performed. The receiver operating characteristic (ROC) curve, combined with the cardiac function, was used to determine the formula with the best diagnostic efficiency. Then, the sensitivity and specificity of new predictors for cardiac insufficiency in CKD patients were calculated. Pearson correlation analysis was used to analyze the relationship between new predictors and the NT-proBNP level. The clinical data of CKD patients from another local hospital were used to validate the new predictors and the cut-off values. Results: An elevated NT-proBNP/CysC1.53 ratio was an independent risk factor for cardiac dysfunction in CKD and the best predictor derived from multiple modeling analysis. There was no correlation between the NT-proBNP/CysC1.53 ratio and the NT-proBNP level (r = 0.376, p = 6.909). The area under the ROC curve for the NT-proBNP/CysC1.53 ratio was 0.815 (95% confidence interval: 0.772-0.858), and for a cut-off point of 847.964, this ratio had a sensitivity of 78.24%, and a specificity of 69.44%. When applied to the data of CKD patients from another local hospital, the NT-proBNP to CysC1.53 ratio had a sensitivity of 70.27% and a specificity of 67.74%. Conclusion: The NT-proBNP to CysC1.53 ratio was superior to NT-proBNP alone for predicting cardiac dysfunction in patients with CKD.
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Affiliation(s)
- Sheng Wang
- Department of Clinical Laboratory, The Third Clinical Medical College of the Three Gorges University, Gezhouba Central Hospital of Sinopharm, Yichang, China
| | - Ming Li
- Department of Nephrology, The Third Clinical Medical College of the Three Gorges University, Gezhouba Central Hospital of Sinopharm, Yichang, China
| | - Xiangyu Wang
- Department of Neurology, The Third Clinical Medical College of the Three Gorges University, Gezhouba Central Hospital of Sinopharm, Yichang, China
| | - Jing Luo
- Department of Medical Business, The Third Clinical Medical College of the Three Gorges University, Gezhouba Central Hospital of Sinopharm, Yichang, China
| | - Yulin Zou
- Department of Pharmacy, The Third Clinical Medical College of the Three Gorges University, Gezhouba Central Hospital of Sinopharm, Yichang, China
| | - Yang Hu
- Department of Pain and Rehabilitation, The Third Clinical Medical College of the Three Gorges University, Gezhouba Central Hospital of Sinopharm, Yichang, China
| | - Xingtai Liu
- Department of Clinical Laboratory, The Third Clinical Medical College of the Three Gorges University, Gezhouba Central Hospital of Sinopharm, Yichang, China
| | - Hua Ao
- Department of Nephrology, The Third Clinical Medical College of the Three Gorges University, Gezhouba Central Hospital of Sinopharm, Yichang, China
| | - Xueer Yao
- Department of Ultrasound, The Third Clinical Medical College of the Three Gorges University, Gezhouba Central Hospital of Sinopharm, Yichang, China
| | - Chufeng Li
- Department of Clinical Laboratory, The Third Clinical Medical College of the Three Gorges University, Gezhouba Central Hospital of Sinopharm, Yichang, China
| | - Tingting Yang
- Department of Endocrinology, The Third Clinical Medical College of the Three Gorges University, Gezhouba Central Hospital of Sinopharm, Yichang, China
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287
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Byrne J. Critical thinking and diagnostic reasoning of the heart and cardiovascular system. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2021; 30:1172-1176. [PMID: 34761982 DOI: 10.12968/bjon.2021.30.20.1172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This is the second of two articles exploring assessment and clinical reasoning of conditions relating to the heart and cardiovascular system in the context of emergency care. In the last article, the structure and function of the heart was reviewed, and reference made to many of the conditions that may affect the heart. In addition, the common presenting complaints of cardiac conditions were highlighted, together with important aspects of the history for each symptom. The full cardiac examination was outlined. In this article, some of the common cardiac conditions will be discussed. These will be linked to common findings in the history, examination, and investigations.
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Affiliation(s)
- Jill Byrne
- Advanced Clinical Practitioner-Emergency department, Belfast Health and Social Care Trust
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288
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Obokata M, Reddy YNV, Melenovsky V, Sorimachi H, Jarolim P, Borlaug BA. Uncoupling between intravascular and distending pressures leads to underestimation of circulatory congestion in obesity. Eur J Heart Fail 2021; 24:353-361. [PMID: 34755429 DOI: 10.1002/ejhf.2377] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/15/2021] [Accepted: 11/01/2021] [Indexed: 12/20/2022] Open
Abstract
AIMS Patients with obesity frequently present with dyspnoea. Biomarkers that reflect wall stress are often used to evaluate circulatory congestion and help determine whether dyspnoea is of cardiac causes. Patients with obesity display greater external restraint on the heart, which may alter relationships between intravascular pressures and stress markers. METHODS AND RESULTS Subjects with unexplained dyspnoea (n = 212) underwent cardiac catheterization with simultaneous echocardiography. Blood sampling was performed in a subset (n = 58). Relationships between echocardiographic and blood biomarkers of circulatory congestion and directly-measured haemodynamics were compared between participants with severe obesity [body mass index (BMI) ≥35 kg/m2 , Group B) and those without (BMI <35 kg/m2 , Group A). Circulatory congestion was assessed by pulmonary capillary wedge pressure (PCWP), and vascular distending pressure was assessed by left ventricular transmural pressure (LVTMP). As compared to Group A, participants in Group B displayed higher PCWP relative to N-terminal pro-B-type natriuretic peptide, mid-regional pro-atrial natriuretic peptide (MR-proANP), troponin T, and growth differentiation factor-15 (all p < 0.01). In contrast, the relationships between LVTMP and the biomarkers were superimposable. Echocardiographic biomarkers revealed the same pattern: PCWP was higher for any E/e' ratio in Group B compared to Group A, but the relationship between LVTMP and E/e' was similar. In contrast, levels of C-terminal pro-endothelin-1 and MR-proADM were more robustly correlated with PCWP (r = 0.67 and r = 0.62, both p < 0.0001), with no differential relationship based upon BMI. CONCLUSIONS Non-invasive haemodynamic markers underestimate circulatory congestion in patients with obesity, an effect that appears related to uncoupling between cardiac wall stress and intravascular pressures. This may lead to systematic under-recognition of congestion in patients with obesity.
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Affiliation(s)
- Masaru Obokata
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.,Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yogesh N V Reddy
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Vojtech Melenovsky
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.,Institute for Clinical and Experimental Medicine-IKEM, Prague, Czech Republic
| | - Hidemi Sorimachi
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Petr Jarolim
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Barry A Borlaug
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
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289
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Arjamaa O. The Endocrine Heart: Natriuretic Peptides and Oxygen Metabolism in Cardiac Diseases. CJC Open 2021; 3:1149-1152. [PMID: 34746728 PMCID: PMC8551400 DOI: 10.1016/j.cjco.2021.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 04/14/2021] [Indexed: 01/15/2023] Open
Abstract
Circulating natriuretic peptides are widely used as tools in the diagnosis and follow-up of cardiac diseases, and their use has been increasing throughout other medical branches. After 40 years and more than 40,000 publications, their function in healthy human adults of reproductive age appears to remain confusing—with every physiology and pharmacology textbook telling a different story. In cardiology, mechanical load upon the heart is generally regarded as the condition that regulates the synthesis and release of natriuretic peptides. The key issue in cardiology remains how mechanical activity and oxygen consumption are related, and yet no published paper has shown that mechanical load does not increase oxygen consumption, as wall tension is a major determinant of myocardial oxygen consumption. However, this relationship has been largely neglected in studies on natriuretic peptides. Based on published papers, an outline is presented of how oxygen metabolism, related to mechanical stress, could play an important role in the pathophysiology of natriuretic peptides. The natriuretic peptide system might enhance oxygen transport by causing diuresis, natriuresis, and water transfer from the intra- to extravascular space, resulting in volume contraction and hemoconcentration, thus indirectly promoting the transfer of oxygen into tissues and organs. Mechanical stress and oxygen consumption are 2 sides of the same coin. The relationship between mechanical stress and oxygen metabolism, in the particular case of natriuretic peptides, represents a new avenue for clinical studies and will better explain the results of studies that have been published previously.
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Affiliation(s)
- Olli Arjamaa
- Biodiversity Unit, University of Turku, Turku, Finland
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290
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Gruson D, Adamantidou C, Ahn SA, Rousseau MF. Heart-type fatty acid binding protein is related to severity and established cardiac biomarkers of heart failure. ADVANCES IN LABORATORY MEDICINE 2021; 2:541-549. [PMID: 37360894 PMCID: PMC10197378 DOI: 10.1515/almed-2021-0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/11/2021] [Indexed: 06/28/2023]
Abstract
Objectives To determine concentrations of heart-type fatty acid-binding protein (HFABP) in patients with heart failure with reduced ejection fraction (HFrEF) and its potential value for prognostic assessment. Methods Circulating levels of HFABP were measured with an automated chemiluminescent immunoassay in 25 healthy volunteers and 60 HFrEF patients. Results Concentrations of HFABP were significantly increased in heart failure patients in comparison to healthy volunteers. HFABP levels were significantly correlated to New York Heart Association classes and to established biomarkers of cardiac dysfunction and remodeling (amino-terminal pro-B-type natriuretic peptide [NT-proBNP], fibroblast growth factor 23, and galectin-3). HFABP concentrations were also predictive of cardiovascular (CV) death and combination with NT-proBNP might be synergistic for risk assessment. Conclusions HFABP levels are increased in HFrEF patients, related to adverse CV outcomes, and might assist physicians for patient's management.
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Affiliation(s)
- Damien Gruson
- Pôle de recherche en Endocrinologie, Diabète et Nutrition, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires St-Luc and Université Catholique de Louvain, Brussels, Belgium
- Department of Clinical Biochemistry, Cliniques Universitaires St-Luc and Université Catholique de Louvain, Brussels, Belgium
| | - Christina Adamantidou
- Division of Cardiology, Cliniques Universitaires St-Luc and Pôle de recherche cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Sylvie A. Ahn
- Division of Cardiology, Cliniques Universitaires St-Luc and Pôle de recherche cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Michel F. Rousseau
- Division of Cardiology, Cliniques Universitaires St-Luc and Pôle de recherche cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
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291
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Tomasdottir M, Held C, Wallentin L, Hijazi Z. Natriuretic peptides and incident atrial fibrillation. Am Heart J 2021; 241:120. [PMID: 34600608 DOI: 10.1016/j.ahj.2021.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Maria Tomasdottir
- Department of Medical Sciences, Cardiology, Uppsala University, Sweden
| | - Claes Held
- Department of Medical Sciences, Cardiology, Uppsala University, Sweden; Uppsala Clinical Research Center, Uppsala University, Sweden
| | - Lars Wallentin
- Department of Medical Sciences, Cardiology, Uppsala University, Sweden; Uppsala Clinical Research Center, Uppsala University, Sweden
| | - Ziad Hijazi
- Department of Medical Sciences, Cardiology, Uppsala University, Sweden; Uppsala Clinical Research Center, Uppsala University, Sweden.
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292
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Tomasoni D, Adamo M, Metra M. October 2021 at a glance: focus on imaging, biomarkers and comorbidities. Eur J Heart Fail 2021; 23:1569-1571. [PMID: 34713551 DOI: 10.1002/ejhf.1892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Daniela Tomasoni
- Cardiology and Cardiac Catheterization Laboratory, Cardio-Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marianna Adamo
- Cardiology and Cardiac Catheterization Laboratory, Cardio-Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marco Metra
- Cardiology and Cardiac Catheterization Laboratory, Cardio-Thoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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293
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Harada T, Araki T, Sunaga H, Kagami K, Yoshida K, Kato T, Kawakami R, Tomono J, Wada N, Iso T, Kurabayashi M, Obokata M. Pathophysiological and diagnostic importance of fatty acid-binding protein 1 in heart failure with preserved ejection fraction. Sci Rep 2021; 11:21175. [PMID: 34707207 PMCID: PMC8551161 DOI: 10.1038/s41598-021-00760-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/18/2021] [Indexed: 01/08/2023] Open
Abstract
Elevated intracardiac pressure at rest and/or exercise is a fundamental abnormality in heart failure with preserved ejection fraction (HFpEF). Fatty acid-binding protein 1 (FABP1) is proposed to be a sensitive biomarker for liver injury. We sought to determine whether FABP1 at rest would be elevated in HFpEF and would correlate with echocardiographic markers of intracardiac pressures at rest and during exercise. In this prospective study, subjects with HFpEF (n = 22) and control subjects without HF (n = 23) underwent resting FABP1 measurements and supine bicycle exercise echocardiography. Although levels of conventional hepatic enzymes were similar between groups, FABP1 levels were elevated in HFpEF compared to controls (45 [25–68] vs. 18 [14–24] ng/mL, p = 0.0008). FABP1 levels were correlated with radiographic and blood-based markers of congestion, hemodynamic derangements during peak exercise (E/e’, r = 0.50; right atrial pressure, r = 0.35; pulmonary artery systolic pressure, r = 0.46), reduced exercise cardiac output (r = − 0.49), and poor exercise workload achieved (r = − 0.40, all p < 0.05). FABP1 distinguished HFpEF from controls with an area under the curve of 0.79 (p = 0.003) and had an incremental diagnostic value over the H2FPEF score (p = 0.007). In conclusion, FABP1 could be a novel hepatic biomarker that associates with hemodynamic derangements, reduced cardiac output, and poor exercise capacity in HFpEF.
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Affiliation(s)
- Tomonari Harada
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Takeshi Araki
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Hiroaki Sunaga
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan.,Center for Liberal Arts and Sciences, Ashikaga University, Ashikaga, Tochigi, Japan
| | - Kazuki Kagami
- Division of Cardiovascular Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Kuniko Yoshida
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Toshimitsu Kato
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Ryo Kawakami
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Junichi Tomono
- Department of Rehabilitation Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Naoki Wada
- Department of Rehabilitation Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Tatsuya Iso
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Masahiko Kurabayashi
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Masaru Obokata
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan.
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294
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Wang J, Zhang S, Di L. Acute myocardial infarction therapy: in vitro and in vivo evaluation of atrial natriuretic peptide and triphenylphosphonium dual ligands modified, baicalin-loaded nanoparticulate system. Drug Deliv 2021; 28:2198-2204. [PMID: 34662253 PMCID: PMC8525923 DOI: 10.1080/10717544.2021.1989086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Myocardial infarction (MI) is one of the most common ischemic heart diseases. It is very essential to explore new types of cardioprotective drugs delivery systems in this area. Objective The aim of the present study was to investigate the protective effect of baicalin (BA) and puerarin (PU) against acute MI rat models. BA and PU co-loaded nanoparticulate system were developed to improve bioavailability of the drugs, to prolong retention time in vivo and to enhance the protective effect. Methods In the present study, ANP and TPP contained ligands were synthesized. ANP/TPP-BN-LPNs were prepared and its physico-chemical properties were evaluated. The MI therapy efficiency of ANP/TPP-BN-LPNs was assessed in rats after intravenous injection. Single ligand contained LPNs, no ligand contained LPNs, and BN solution formulations were also prepared and used for the comparison. Results ANP/TPP-BN-LPNs were uniform and spheroidal particles. The size of ANP/TPP-BN-LPNs was 98.5 ± 2.9 nm, with a zeta potential of –19.5 ± 1.9 mV. The dual ligands modified LPNs exhibited significantly improved therapeutic efficiency compared with the single ligand modified LPNs and other systems. In vivo infarct therapy studies in rats proved that ANP/TPP-BN-LPNs were a promising system for efficient delivery of cardiovascular drugs for the treatment of cardiovascular diseases. Conclusions ANP/TPP-BN-LPNs could be used as a long-circulating and heart-targeting drug delivery system.
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Affiliation(s)
- Jie Wang
- Intervention Center, Linyi People's Hospital Beicheng New District Hospital, Linyi, PR China
| | - Shouwen Zhang
- Cardiology Pacing and Electrophysiology Ward, Linyi People's Hospital Beicheng New District Hospital, Linyi, PR China
| | - Lizhe Di
- Oral Cavity Clinic, Linyi People's Hospital, Linyi, PR China
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295
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Fujisawa R, Okada K, Kaga S, Murayama M, Nakabachi M, Yokoyama S, Nishino H, Tanemura A, Masauzi N, Motoi K, Ishizaka S, Chiba Y, Tsujinaga S, Iwano H, Anzai T. Prognostic value of an echocardiographic index reflecting right ventricular operating stiffness in patients with heart failure. Heart Vessels 2021; 37:583-592. [PMID: 34655317 DOI: 10.1007/s00380-021-01960-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 10/01/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE We recently reported a noninvasive method for the assessment of right ventricular (RV) operating stiffness that is obtained by dividing the atrial-systolic descent of the pulmonary artery-RV pressure gradient (PRPGDAC) derived from the pulmonary regurgitant velocity by the tricuspid annular plane movement during atrial contraction (TAPMAC). Here, we investigated whether this parameter of RV operating stiffness, PRPGDAC/TAPMAC, is useful for predicting the prognosis of patients with heart failure (HF). METHODS We retrospectively included 127 hospitalized patients with HF who underwent an echocardiographic examination immediately pre-discharge. The PRPGDAC/TAPMAC was measured in addition to standard echocardiographic parameters. Patients were followed until 2 years post-discharge. The endpoint was the composite of cardiac death, readmission for acute decompensation, and increased diuretic dose due to worsening HF. RESULTS 58 patients (46%) experienced the endpoint during follow-up. Univariable and multivariable Cox regression analyses demonstrated that the PRPGDAC/TAPMAC was associated with the endpoint. In a Kaplan-Meier analysis, the event rate of the greater PRPGDAC/TAPMAC group was significantly higher than that of the lesser PRPGDAC/TAPMAC group. In a sequential Cox analysis for predicting the endpoint's occurrence, the addition of PRPGDAC/TAPMAC to the model including age, sex, NYHA functional classification, brain natriuretic peptide level, and several echocardiographic parameters including tricuspid annular plane systolic excursion significantly improved the predictive power for prognosis. CONCLUSION A completely noninvasive index of RV operating stiffness, PRPGDAC/TAPMAC, was useful for predicting prognoses in patients with HF, and it showed an incremental prognostic value over RV systolic function.
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Affiliation(s)
- Ryosuke Fujisawa
- Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Kazunori Okada
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan.
| | - Sanae Kaga
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Michito Murayama
- Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan.,Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan
| | - Masahiro Nakabachi
- Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan
| | - Shinobu Yokoyama
- Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan
| | - Hisao Nishino
- Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan
| | - Asuka Tanemura
- Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan
| | - Nobuo Masauzi
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Ko Motoi
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Suguru Ishizaka
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yasuyuki Chiba
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shingo Tsujinaga
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroyuki Iwano
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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296
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Civera J, de la Espriella R, Heredia R, Miñana G, Santas E, Conesa A, Mollar A, Sastre C, Martínez A, Villaescusa A, Núñez J. Efficacy and Safety of Subcutaneous Infusion of Non-formulated Furosemide in Patients with Worsening Heart Failure: a Real-World Study. J Cardiovasc Transl Res 2021; 15:644-652. [PMID: 34642870 PMCID: PMC9213343 DOI: 10.1007/s12265-021-10173-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 09/10/2021] [Indexed: 11/16/2022]
Abstract
We aimed to evaluate the efficacy (short-term changes in surrogates of decongestion) and safety following the ambulatory administration of subcutaneous furosemide (SCF) in patients with WHF. Fifty-five ambulatory patients were treated with SCF administered by an elastomeric pump for at least 72 h. Surrogates of congestion were assessed at baseline, 72 h, and 30 days. Spot urinary sodium (uNa+) was assessed at baseline, 24-48-72 h, and 30 days. The median (IQI) of NT-proBNP and uNa+ at baseline was 5218 pg/mL (2856-10878) and 68±3 mmol/L, respectively. Following administration of SCF (median dose of 100 mg/daily), we found a sustained increase in uNa+ during the first 72 h of treatment compared to baseline, paralleled with evidence of decongestion at 72 h, and 30 days. No significant safety concerns were observed. SCF was an effective and safe diuretic strategy for outpatient congestion management.
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Affiliation(s)
- Jose Civera
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Av. Blasco Ibáñez 17, 46010, Valencia, Spain.,Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Rafael de la Espriella
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Av. Blasco Ibáñez 17, 46010, Valencia, Spain.,Departamento de Medicina, Universitat de València, Valencia, Spain.,CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain
| | - Raquel Heredia
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Av. Blasco Ibáñez 17, 46010, Valencia, Spain.,Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Gema Miñana
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Av. Blasco Ibáñez 17, 46010, Valencia, Spain.,Departamento de Medicina, Universitat de València, Valencia, Spain.,CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain
| | - Enrique Santas
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Av. Blasco Ibáñez 17, 46010, Valencia, Spain.,Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Adriana Conesa
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Av. Blasco Ibáñez 17, 46010, Valencia, Spain.,Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Anna Mollar
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Av. Blasco Ibáñez 17, 46010, Valencia, Spain.,Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Clara Sastre
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Av. Blasco Ibáñez 17, 46010, Valencia, Spain.,Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Ana Martínez
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Av. Blasco Ibáñez 17, 46010, Valencia, Spain.,Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Amparo Villaescusa
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Av. Blasco Ibáñez 17, 46010, Valencia, Spain.,Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Av. Blasco Ibáñez 17, 46010, Valencia, Spain. .,Departamento de Medicina, Universitat de València, Valencia, Spain. .,CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain.
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297
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Yurista SR, Nguyen CT, Rosenzweig A, de Boer RA, Westenbrink BD. Ketone bodies for the failing heart: fuels that can fix the engine? Trends Endocrinol Metab 2021; 32:814-826. [PMID: 34456121 DOI: 10.1016/j.tem.2021.07.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/20/2021] [Accepted: 07/26/2021] [Indexed: 01/08/2023]
Abstract
Accumulating evidence suggests that the failing heart reverts energy metabolism toward increased utilization of ketone bodies. Despite many discrepancies in the literature, evidence from both bench and clinical research demonstrates beneficial effects of ketone bodies in heart failure. Ketone bodies are readily oxidized by cardiomyocytes and can provide ancillary fuel for the energy-starved failing heart. In addition, ketone bodies may help to restore cardiac function by mitigating inflammation, oxidative stress, and cardiac remodeling. In this review, we hypothesize that a therapeutic approach intended to restore cardiac metabolism through ketone bodies could both refuel and 'repair' the failing heart.
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Affiliation(s)
- Salva R Yurista
- Cardiovascular Research Center, Cardiology Division, Corrigan Minehan Heart Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Christopher T Nguyen
- Cardiovascular Research Center, Cardiology Division, Corrigan Minehan Heart Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Anthony Rosenzweig
- Cardiovascular Research Center, Cardiology Division, Corrigan Minehan Heart Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Rudolf A de Boer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - B Daan Westenbrink
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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298
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Sukun A, Cekic B. Assessment of BNP and BDNF results in elective endovascular cerebral aneurysm treatment. Ir J Med Sci 2021; 191:1899-1903. [PMID: 34586564 DOI: 10.1007/s11845-021-02791-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 09/21/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND B-type natriuretic peptide (BNP) levels increase with an increase in intracranial pressure. A decrease in BNP levels has been found to be associated with patient positive prognosis. Brain-derived neurotrophic factor (BDNF) levels decrease in patients with acute stroke. AIMS To compare the BNP and BDNF values in serum before and after elective endovascular cerebral aneurysm treatment (ECAT). METHODS A total of 50 patients who underwent elective ECAT were included in the study. Exclusion criteria were determined to be history of heart failure or heart attack (n = 8), renal failure (n = 5), subarachnoid hemorrhage (n = 4), or previous aneurysm clip procedure (n = 3). Intravenous blood samples were obtained from 30 patients who underwent elective ECAT before and after treatment. After centrifugation, the BNP and BDNF values in serum were obtained with the ELISA method and compared. RESULTS This study included 19 female and 11 male patients, aged between 24 and 75 years. The average age of the patients was 51.27 ± 13.31 years. The median BDNF values did not change significantly after ECAT (before the endovascular procedure: 3.1 ± 1.3 pg/dl; after the endovascular procedure: 2.8 ± 0.9 pg/dl, p = 0.16). Median BNP levels decreased significantly after ECAT (before the endovascular procedure: 617.50 ± 483.11 pg/ml; after the endovascular procedure: 395.00 ± 352.15 pg/ml, p < 0.001). CONCLUSIONS After elective endovascular cerebral aneurysm treatment, the BNP values in serum decreased significantly, and the BDNF values in serum did not change significantly.
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Affiliation(s)
- Abdullah Sukun
- Department of Radiology, Kars Harakani State Hospital, Kars Harakani Devlet Hastanesi, Yenisehir Mah, İsmail Aytemiz Blv. No: 55 36200, Kars, Turkey.
| | - Bulent Cekic
- Department of Radiology, Antalya Education and Research Hospital, Antalya, Turkey
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299
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Cihakova D, Streiff MB, Menez SP, Chen TK, Gilotra NA, Michos ED, Marr KA, Karaba AH, Robinson ML, Blair PW, Dioverti MV, Post WS, Cox AL, R Antar AA. High-value laboratory testing for hospitalized COVID-19 patients: a review. Future Virol 2021. [PMID: 34567235 PMCID: PMC8457535 DOI: 10.2217/fvl-2020-0316] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 09/03/2021] [Indexed: 01/08/2023]
Abstract
We present here an evidence-based review of the utility, timing, and indications for laboratory test use in the domains of inflammation, cardiology, hematology, nephrology and co-infection for clinicians managing the care of hospitalized COVID-19 patients. Levels of IL-6, CRP, absolute lymphocyte count, neutrophils and neutrophil-to-lymphocyte ratio obtained upon admission may help predict the severity of COVID-19. Elevated LDH, ferritin, AST, and d-dimer are associated with severe illness and mortality. Elevated cardiac troponin at hospital admission can alert clinicians to patients at risk for cardiac complications. Elevated proBNP may help distinguish a cardiac complication from noncardiac etiologies. Evaluation for co-infection is typically unnecessary in nonsevere cases but is essential in severe COVID-19, intensive care unit patients, and immunocompromised patients. Doctors managing the complex care of individuals with COVID-19 need timely evidence to guide which lab tests to send to predict outcomes and prevent and treat COVID-19 complications involving the heart, blood clots, the kidney, and other infections that occur during the hospital course. Several lab tests such as IL-6, CRP and white blood cell subset counts may help predict the severity of COVID-19 during the patient’s hospital course if obtained when the patient first presents to the hospital. Other tests such as LDH, ferritin and AST are also associated with severe illness and mortality but have less evidence for their utility beyond IL-6, CRP and other tests. A test related to blood coagulation, d-dimer, is also associated with COVID-19 severity, and it may be used if the patient is suspected of having a blood clot. Two heart biomarkers – cardiac troponin and proBNP – may help doctors diagnose and manage heart-related complications of COVID-19. Patients in the hospital with COVID-19 may be susceptible to other infections, but testing for these is most useful in patients with severe disease, such as those in the intensive care unit. Specific recommendations for testing for viral, bacterial and fungal infections are presented here. The judicious use of laboratory testing can help identify patients at high risk for severe or critical COVID-19 and aid in prevention, diagnosis and treatment of common COVID-19 complications.
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Affiliation(s)
- Daniela Cihakova
- Department of Pathology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA
| | - Michael B Streiff
- Department of Medicine, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
| | - Steven P Menez
- Department of Medicine, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
| | - Teresa K Chen
- Department of Medicine, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
| | - Nisha A Gilotra
- Department of Medicine, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
| | - Erin D Michos
- Department of Medicine, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
| | - Kieren A Marr
- Department of Medicine, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
| | - Andrew H Karaba
- Department of Medicine, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
| | - Matthew L Robinson
- Department of Medicine, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
| | - Paul W Blair
- Department of Medicine, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA.,Austere environments Consortium for Enhanced Sepsis Outcomes, Henry M. Jackson Foundation, 6700 Rockledge Drive, Bethesda, MD 20817, USA
| | - Maria V Dioverti
- Department of Medicine, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
| | - Wendy S Post
- Department of Medicine, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
| | - Andrea L Cox
- Department of Medicine, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
| | - Annukka A R Antar
- Department of Medicine, Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD 21205, USA
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Miric D, Barac A, Capkun V, Bakovic D. Right ventricular free wall strain in acutely decompensated heart failure patients with ischemic and non-ischemic cardiomyopathy. Echocardiography 2021; 38:1747-1753. [PMID: 34555211 DOI: 10.1111/echo.15205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 07/09/2021] [Accepted: 08/23/2021] [Indexed: 11/29/2022] Open
Abstract
AIMS Right ventricular (RV) dysfunction is a predictor of adverse outcomes among patients with HF with reduced ejection fraction (HFrEF); however, differences in RV parameters in HFrEF patients with ischemic (ICM) and non-ischemic cardiomyopathies (NICM) are not well understood. We investigated echocardiographic characteristics, including RV strain, in patients with acute decompensated heart failure (ADHF) and compared patients with ICM and NICM etiology. METHODS Consecutive patients who presented with ADHF and NYHA class III-IV were prospectively enrolled if they had LVEF < 40% and history of ICM or NICM. All patients underwent clinical exam, laboratory evaluation and 2-D echocardiographic assessment of the left ventricular (LV) and RV function, LV and RV global longitudinal strain (LVGLS, RVGLS), and RV free wall strain (RVfwLS). RESULTS Of 84 patients, 44 had ICM and 40 NICM. The groups had similar blood pressure, NT-proBNP, and echocardiographic parameters of LV function including LVGLS. Absolute RVGLS values were lower than RVfwLS values in both groups. Patients with NICM had significantly lower RVfwLS, but not RVGLS, compared to patients with ICM (-13% to -17%, p = 0.006). Similar differences in RVfwLS were seen in patients in NYHA class III (NICM vs ICM: -13% and -17%, respectively, 95% CI: -8.5 to -.5) and NYHA class IV (NICM vs ICM: -13.8% and -17%, respectively, 95% CI: -6.4 to -.59). CONCLUSION Among patients hospitalized with ADHF, patients with nonischemic etiology compared with the patients with ICM, have more severe RV dysfunction measured by RVfwLS, despite similar extent of LV impairment and the same functional limitation class.
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Affiliation(s)
- Dino Miric
- Department of Cardiovascular Diseases, Division of Heart Failure, University Hospital Split, Split, Croatia
| | - Ana Barac
- MedStar Heart and Vascular Institute, Georgetown University, Washington DC, USA
| | - Vesna Capkun
- Department of Nuclear Medicine, University Hospital Split, Split, Croatia.,University of Split School of Medicine, Split, Croatia
| | - Darija Bakovic
- Department of Cardiovascular Diseases, Division of Heart Failure, University Hospital Split, Split, Croatia.,University of Split School of Medicine, Split, Croatia
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