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Teramoto K, Tay WT, Tromp J, Ouwerkerk W, Teng TK, Chandramouli C, Liew OW, Chong J, Poppe KK, Lund M, Devlin G, Troughton RW, Doughty RN, Richards AM, Lam CSP. Longitudinal NT-proBNP: Associations With Echocardiographic Changes and Outcomes in Heart Failure. J Am Heart Assoc 2024; 13:e032254. [PMID: 38639333 PMCID: PMC11179931 DOI: 10.1161/jaha.123.032254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 03/01/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND The relationship of serial NT-proBNP (N-terminal pro-B-type natriuretic peptide) measurements with changes in cardiac features and outcomes in heart failure (HF) remains incompletely understood. We determined whether common clinical covariates impact these relationships. METHODS AND RESULTS In 2 nationwide observational populations with HF, the relationship of serial NT-proBNP measurements with serial echocardiographic parameters and outcomes was analyzed, further stratified by HF with reduced versus preserved left ventricular ejection fraction, inpatient versus outpatient enrollment, age, obesity, chronic kidney disease, atrial fibrillation, and attainment of ≥50% guideline-recommended doses of renin-angiotensin system inhibitors and β-blockers. Among 1911 patients (mean±SD age, 65.1±13.4 years; 26.6% women; 62% inpatient and 38% outpatient), NT-proBNP declined overall, with more rapid declines among inpatients, those with obesity, those with atrial fibrillation, and those attaining ≥50% guideline-recommended doses. Each doubling of NT-proBNP was associated with increases in left ventricular volume (by 6.1 mL), E/e' (transmitral to mitral annular early diastolic velocity ratio) (by 1.4 points), left atrial volume (by 3.6 mL), and reduced left ventricular ejection fraction (by -2.1%). The effect sizes of these associations were lower among patients with HF with preserved ejection fraction, atrial fibrillation, or advanced age (Pinteraction<0.001). A landmark analysis identified that an SD increase in NT-proBNP over 6 months was associated with a 27% increase in the risk of the composite event of HF hospitalization or all-cause death between 6 months and 2 years (adjusted hazard ratio, 1.27 [95% CI, 1.15-1.40]; P<0.001). CONCLUSIONS The relationships between NT-proBNP and structural/functional remodeling differed by age, presence of atrial fibrillation, and HF phenotypes. The association of increased NT-proBNP with increased risk of adverse outcomes was consistent in all subgroups.
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Affiliation(s)
- Kanako Teramoto
- Department of BiostatisticsNational Cerebral and Cardiovascular CenterOsakaJapan
| | - Wan Ting Tay
- National Heart Research Institute Singapore, National Heart Centre SingaporeSingapore
| | - Jasper Tromp
- Duke‐NUS Medical SchoolSingapore
- Saw Swee Hock School of Public HealthNational University of Singapore, The National University Health SystemSingapore
| | - Wouter Ouwerkerk
- National Heart Research Institute Singapore, National Heart Centre SingaporeSingapore
- Department of DermatologyAmsterdam Medical CenterAmsterdamthe Netherlands
| | - Tiew‐Hwa Katherine Teng
- National Heart Research Institute Singapore, National Heart Centre SingaporeSingapore
- Duke‐NUS Medical SchoolSingapore
- School of Allied HealthUniversity of Western AustraliaPerthAustralia
| | - Chanchal Chandramouli
- National Heart Research Institute Singapore, National Heart Centre SingaporeSingapore
- Duke‐NUS Medical SchoolSingapore
| | - Oi Wah Liew
- Department of MedicineCardiovascular Research Institute, National University of SingaporeSingapore
| | - Jenny Chong
- Department of MedicineCardiovascular Research Institute, National University of SingaporeSingapore
| | - Katrina K. Poppe
- Department of Medicine, Heart Health Research GroupUniversity of AucklandAucklandNew Zealand
| | - Mayanna Lund
- Department of CardiologyMiddlemore HospitalAucklandNew Zealand
| | - Gerry Devlin
- Heart Foundation of New ZealandAucklandNew Zealand
| | | | - Robert N. Doughty
- Department of Medicine, Heart Health Research GroupUniversity of AucklandAucklandNew Zealand
- Green Lane Cardiovascular ServiceAuckland City HospitalAucklandNew Zealand
| | - Arthur Mark Richards
- Department of MedicineCardiovascular Research Institute, National University of SingaporeSingapore
- Christchurch Heart Institute, University of OtagoChristchurchNew Zealand
| | - Carolyn S. P. Lam
- National Heart Research Institute Singapore, National Heart Centre SingaporeSingapore
- Duke‐NUS Medical SchoolSingapore
- Department of CardiologyUniversity Medical Center GroningenGroningenthe Netherlands
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Tian L, Li X, Zhang J, Tian X, Wan X, Yao D, Luo B, Huang Q, Deng Y, Xiang W. Influence of Body Mass Index on the Prognostic Value of N-Terminal Pro-B-Type Natriuretic Peptide Level in Chinese Patients with Heart Failure. Int Heart J 2024; 65:47-54. [PMID: 38296579 DOI: 10.1536/ihj.23-461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
N-terminal pro-B-type natriuretic peptide (NT-proBNP) is an essential biomarker for the prediction of heart failure (HF), but its prognostic ability across body mass index (BMI) categories needs to be clarified. Our study aimed to explore the association between BMI and NT-proBNP and assess the effect of BMI on the prognostic ability of NT-proBNP in Chinese patients with HF. We retrospectively analyzed clinical data from the FuWai Hospital HF Center in Beijing, China. According to the Chinese adult BMI standard, 1,508 patients with HF were classified into four groups: underweight (BMI < 18.5 kg/m2), normal weight (BMI 18.5-23.9 kg/m2, as a reference category), overweight (BMI 24-27.9 kg/m2), and obesity (BMI ≥ 28 kg/m2). NT-proBNP was examined for its prognostic role in adverse events as an endpoint. BMI was independently and negatively associated with NT-proBNP (β = -0.074; P < 0.001), and NT-proBNP levels tended to decrease as BMI increased across the different BMI categories. The results of our study differ from those of other studies of European-American populations. In this study, NT-proBNP was a weak predictor of a 4-year adverse prognosis in underweight patients (BMI < 18.5 kg/m2). In other BMI categories, NT-proBNP was an independent predictor of adverse events in HF. BMI and sex significantly affected the optimal threshold for NT-proBNP to predict the risk of adverse events. There is a negative correlation between BMI and NT-proBNP, and NT-proBNP independently predicts adverse HF events in patients with a BMI of ≥ 18.5 kg/m2. The optimal risk prediction cutoffs are lower in patients who are overweight and obese.
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Affiliation(s)
- Lingfang Tian
- Key Laboratory of Electronic and Information Engineering, State Ethnic Affairs Commission, Southwest Minzu University
| | - Xiangkui Li
- School of Computer Science and Technology, Harbin University of Science and Technology
| | - Jian Zhang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University
| | - Xinhui Tian
- Key Laboratory of Electronic and Information Engineering, State Ethnic Affairs Commission, Southwest Minzu University
| | - Xiaolei Wan
- Key Laboratory of Electronic and Information Engineering, State Ethnic Affairs Commission, Southwest Minzu University
| | - Dengju Yao
- School of Computer Science and Technology, Harbin University of Science and Technology
| | - Bin Luo
- Sichuan Huhui Software CO.,LTD
| | - Qinzhen Huang
- Key Laboratory of Electronic and Information Engineering, State Ethnic Affairs Commission, Southwest Minzu University
| | - Yansong Deng
- Key Laboratory of Electronic and Information Engineering, State Ethnic Affairs Commission, Southwest Minzu University
| | - Wei Xiang
- Key Laboratory of Electronic and Information Engineering, State Ethnic Affairs Commission, Southwest Minzu University
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Ye B, Zhao Q, Fan J, Li X, Shan C, Liu F, Song N, Zhu J, Xia M, Liu Y, Yang Y. RBP4-based Multimarker Score: A Prognostic Tool for Adverse Cardiovascular Events in Acute Coronary Syndrome Patients. J Clin Endocrinol Metab 2023; 108:3111-3121. [PMID: 37402630 DOI: 10.1210/clinem/dgad389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/12/2023] [Accepted: 06/27/2023] [Indexed: 07/06/2023]
Abstract
CONTEXT Retinol binding protein 4 (RBP4) has been implicated in the progression of cardiovascular diseases. However, its association with major adverse cardiovascular events (MACEs) in patients with acute coronary syndrome (ACS) remains obscure. OBJECTIVE Here, we examined the prognostic value of baseline RBP4 and its derived multimarker score for MACEs in ACS patients. METHODS A total of 826 patients with ACS were consecutively recruited from the department of cardiology and prospectively followed up for a median of 1.95 years (interquartile range, 1.02-3.25 years). Plasma RBP4 was measured using enzyme-linked immunosorbent assay. Adjusted associations between RBP4 and its derived multimarker score (1 point was assigned when RBP4 ≥ 38.18μg/mL, left ventricular ejection fraction [LVEF] ≤ 55%, N-terminal pro-B-type natriuretic peptide [NT-proBNP] ≥ 450 ng/L, estimated glomerular filtration rate [eGFR] ≤ 90 mL/min/1.73 m2, and age ≥60) with MACEs were analyzed. RESULTS In total, 269 ACS patients (32.57%) experienced MACEs. When patients were grouped by multimarker score (0-1, n = 315; 2-3, n = 406; 4-5, n = 105), there was a significant graded association between RBP4-based multimarker score and risk of MACEs (intermediate score (2-3): HRadj: 1.80; 95% CI, 1.34-2.41; high score (4-5): HRadj: 3.26; 95% CI, 2.21-4.81) and its components (P < .05 for each). Moreover, the prognostic and discriminative value of the RBP4-derived multimarker score remained robust in ACS patients with various high-risk anatomical or clinical characteristics. CONCLUSION The RBP4-derived 5-item score serves as a useful risk stratification and decision support for secondary prevention in patients with ACS.
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Affiliation(s)
- Bingqi Ye
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, and Department of Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510000, P.R. China
| | - Qian Zhao
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830001, P.R. China
- Xinjiang Key Laboratory of Cardiovascular Disease Research, Clinical Medical Research Institute of Xinjiang Medical University, Urumqi 830001, P.R. China
| | - Jiahua Fan
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, and Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou 510000, P.R. China
| | - Xiaomei Li
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830001, P.R. China
- Xinjiang Key Laboratory of Cardiovascular Disease Research, Clinical Medical Research Institute of Xinjiang Medical University, Urumqi 830001, P.R. China
| | - Chunfang Shan
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830001, P.R. China
| | - Fen Liu
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830001, P.R. China
- Xinjiang Key Laboratory of Cardiovascular Disease Research, Clinical Medical Research Institute of Xinjiang Medical University, Urumqi 830001, P.R. China
| | - Ning Song
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830001, P.R. China
- Xinjiang Key Laboratory of Cardiovascular Disease Research, Clinical Medical Research Institute of Xinjiang Medical University, Urumqi 830001, P.R. China
| | - Jiajun Zhu
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830001, P.R. China
| | - Min Xia
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, and Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou 510000, P.R. China
| | - Yan Liu
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, and Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou 510000, P.R. China
| | - Yining Yang
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830001, P.R. China
- Xinjiang Key Laboratory of Cardiovascular Disease Research, Clinical Medical Research Institute of Xinjiang Medical University, Urumqi 830001, P.R. China
- Department of Cardiology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, P.R. China
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Zhao HL, Gao XL, Liu YH, Li SL, Zhang Q, Shan WC, Zheng Q, Zhou J, Liu YZ, Liu L, Guo N, Tian HS, Wei QM, Hu XT, Cui YK, Geng X, Wang Q, Cui W. Validation and derivation of short-term prognostic risk score in acute decompensated heart failure in China. BMC Cardiovasc Disord 2022; 22:307. [PMID: 35799104 PMCID: PMC9264535 DOI: 10.1186/s12872-022-02743-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 07/01/2022] [Indexed: 12/02/2022] Open
Abstract
Background Few prognostic risk scores (PRSs) have been routinely used in acute decompensated heart failure (ADHF). We, therefore, externally validated three published PRSs (3A3B, AHEAD, and OPTIME-CHF) and derived a new PRS to predict the short-term prognosis in ADHF. Methods A total of 4550 patients from the Heb-ADHF registry in China were randomly divided into the derivation and validation cohorts (3:2). Discrimination of each PRS was assessed by the area under the receiver operating characteristic curve (AUROC). Logistic regression was exploited to select the predictors and create the new PRS. The Hosmer–Lemeshow goodness-of-fit test was used to assess the calibration of the new PRS. Results The AUROCs of the 3A3B, AHEAD, and OPTIME-CHF score in the derivation cohort were 0.55 (95% CI 0.53–0.57), 0.54 (95% CI 0.53–0.56), and 0.56 (95% CI 0.54–0.57), respectively. After logistic regression analysis, the new PRS computed as 1 × (diastolic blood pressure < 80 mmHg) + 2 × (lymphocyte > 1.11 × 109/L) + 1 × (creatinine > 80 μmol/L) + 2 × (blood urea nitrogen > 21 mg/dL) + 1 × [BNP 500 to < 1500 pg/mL (NT-proBNP 2500 to < 7500 pg/mL)] or 3 × [BNP ≥ 1500 (NT-proBNP ≥ 7500) pg/mL] + 3 × (QRS fraction of electrocardiogram < 55%) + 4 × (ACEI/ARB not used) + 1 × (rhBNP used), with a better AUROC of 0.67 (95% CI 0.64–0.70) and a good calibration (Hosmer–Lemeshow χ2 = 3.366, P = 0.186). The results in validation cohort verified these findings. Conclusions The short-term prognostic values of 3A3B, AHEAD, and OPTIME-CHF score in ADHF patients were all poor, while the new PRS exhibited potential predictive ability. We demonstrated the QRS fraction of electrocardiogram as a novel predictor for the short-term outcomes of ADHF for the first time. Our findings might help to recognize high-risk ADHF patients.
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Affiliation(s)
- Hong-Liang Zhao
- First Division, Department of Cardiology, The Second Hospital of Hebei Medical University, Heping West Road No. 215, Shijiazhuang, 050000, Hebei province, China.,Department of Cardiology, The First Hospital of Hebei Medical University, Shijiazhuang, 050031, Hebei province, China
| | - Xiao-Li Gao
- Department of Cardiology, Huabei Petroleum Administration Bureau General Hospital, Renqiu, 062552, Hebei Province, China
| | - Ying-Hua Liu
- Department of Cardiology, Huabei Petroleum Administration Bureau General Hospital, Renqiu, 062552, Hebei Province, China
| | - Sen-Lin Li
- Department of Cardiology, Zhangjiakou First Hospital, Zhangjiakou, 075000, Hebei Province, China
| | - Qi Zhang
- Department of Cardiology, Baoding First Central Hospital, Baoding, 071000, Hebei Province, China
| | - Wei-Chao Shan
- Department of Cardiology, Affiliated Hospital of Chengde Medical University, Chengde, 067000, Hebei Province, China
| | - Qun Zheng
- Department of Cardiology, Hengshui People's Hospital, Hengshui, 053000, Hebei Province, China
| | - Jiang Zhou
- Department of Cardiology, Chengde Central Hospital, Chengde, 067024, Hebei Province, China
| | - Yong-Zheng Liu
- Department of Cardiology, Qinhuangdao First Hospital, Qinhuangdao, 066099, Hebei Province, China
| | - Li Liu
- Department of Cardiology, Qinhuangdao First Hospital, Qinhuangdao, 066099, Hebei Province, China
| | - Nan Guo
- Department of Cardiology, Cangzhou Central Hospital, Cangzhou, 061011, Hebei Province, China
| | - Hong-Sen Tian
- Department of Cardiology, Handan Central Hospital, Handan, 056000, Hebei Province, China
| | - Qing-Min Wei
- Department of Cardiology, Xingtai People's Hospital, Xingtai, 054001, Hebei Province, China
| | - Xi-Tian Hu
- Department of Cardiology, Shijiazhuang People's Hospital, Shijiazhuang, 050011, Hebei Province, China
| | - Ying-Kai Cui
- Department of Cardiology, The 252nd Hospital of People's Liberation Army, Baoding, 071000, Hebei Province, China
| | - Xue Geng
- First Division, Department of Cardiology, The Second Hospital of Hebei Medical University, Heping West Road No. 215, Shijiazhuang, 050000, Hebei province, China
| | - Qian Wang
- First Division, Department of Cardiology, The Second Hospital of Hebei Medical University, Heping West Road No. 215, Shijiazhuang, 050000, Hebei province, China
| | - Wei Cui
- First Division, Department of Cardiology, The Second Hospital of Hebei Medical University, Heping West Road No. 215, Shijiazhuang, 050000, Hebei province, China.
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5
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van der Meulen M, den Boer S, du Marchie Sarvaas GJ, Blom N, Ten Harkel ADJ, Breur HMPJ, Rammeloo LAJ, Tanke R, Bogers AJJC, Helbing WA, Boersma E, Dalinghaus M. Predicting outcome in children with dilated cardiomyopathy: the use of repeated measurements of risk factors for outcome. ESC Heart Fail 2021; 8:1472-1481. [PMID: 33547769 PMCID: PMC8006605 DOI: 10.1002/ehf2.13233] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 01/18/2021] [Accepted: 01/23/2021] [Indexed: 12/02/2022] Open
Abstract
Aims We aimed to determine whether in children with dilated cardiomyopathy repeated measurement of known risk factors for death or heart transplantation (HTx) during disease progression can identify children at the highest risk for adverse outcome. Methods and results Of 137 children we included in a prospective cohort, 36 (26%) reached the study endpoint (SE: all‐cause death or HTx), 15 (11%) died at a median of 0.09 years [inter‐quartile range (IQR) 0.03–0.7] after diagnosis, and 21 (15%) underwent HTx at a median of 2.9 years [IQR 0.8–6.1] after diagnosis. Median follow‐up was 2.1 years [IQR 0.8–4.3]. Twenty‐three children recovered at a median of 0.6 years [IQR 0.5–1.4] after diagnosis, and 78 children had ongoing disease at the end of the study. Children who reached the SE could be distinguished from those who did not, based on the temporal evolution of four risk factors: stunting of length growth (−0.42 vs. −0.02 length Z‐score per year, P < 0.001), less decrease in N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) (−0.26 vs. −1.06 2log pg/mL/year, P < 0.01), no decrease in left ventricular internal diastolic dimension (LVIDd; 0.24 vs. −0.60 Boston Z‐score per year, P < 0.01), and increase in New York University Pediatric Heart Failure Index (NYU PHFI; 0.49 vs. −1.16 per year, P < 0.001). When we compared children who reached the SE with those with ongoing disease (leaving out the children who recovered), we found similar results, although the effects were smaller. In univariate analysis, NT‐proBNP, length Z‐score, LVIDd Z‐score, global longitudinal strain (%), NYU PHFI, and age >6 years at presentation (all P < 0.001) were predictive of adverse outcome. In multivariate analysis, NT‐proBNP appeared the only independent predictor for adverse outcome, a two‐fold higher NT‐proBNP was associated with a 2.8 times higher risk of the SE (hazard ratio 2.78, 95% confidence interval 1.81–3.94, P < 0.001). Conclusions The evolution over time of NT‐proBNP, LVIDd, length growth, and NYU PHFI identified a subgroup of children with dilated cardiomyopathy at high risk for adverse outcome. In this sample, with a limited number of endpoints, NT‐proBNP was the strongest independent predictor for adverse outcome.
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Affiliation(s)
- Marijke van der Meulen
- Department of Pediatric Cardiology, Erasmus MC, University Medical Center Rotterdam, Dr Molewaterplein 60, PO Box 2060, Rotterdam, 3000 CB, The Netherlands
| | - Susanna den Boer
- Department of Pediatric Cardiology, Erasmus MC, University Medical Center Rotterdam, Dr Molewaterplein 60, PO Box 2060, Rotterdam, 3000 CB, The Netherlands
| | - Gideon J du Marchie Sarvaas
- Department of Pediatric Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Nico Blom
- Leiden University Medical Center, Department of Pediatric Cardiology, University of Leiden, Leiden, The Netherlands.,Academic Medical Center, Department of Pediatric Cardiology, University of Amsterdam, Amsterdam, The Netherlands
| | - Arend D J Ten Harkel
- Leiden University Medical Center, Department of Pediatric Cardiology, University of Leiden, Leiden, The Netherlands
| | - Hans M P J Breur
- Department of Pediatric Cardiology, University of Utrecht, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lukas A J Rammeloo
- Department of Pediatric Cardiology, Free University of Amsterdam, Free University Medical Center, Amsterdam, The Netherlands
| | - Ronald Tanke
- Department of Pediatric Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Willem A Helbing
- Department of Pediatric Cardiology, Erasmus MC, University Medical Center Rotterdam, Dr Molewaterplein 60, PO Box 2060, Rotterdam, 3000 CB, The Netherlands.,Department of Pediatric Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Eric Boersma
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Michiel Dalinghaus
- Department of Pediatric Cardiology, Erasmus MC, University Medical Center Rotterdam, Dr Molewaterplein 60, PO Box 2060, Rotterdam, 3000 CB, The Netherlands
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6
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Brunner-La Rocca HP. What do we need to better understand the role of biomarkers in heart failure? Int J Cardiol 2020; 304:93-94. [PMID: 31955978 DOI: 10.1016/j.ijcard.2020.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 01/09/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Hans-Peter Brunner-La Rocca
- Department of Cardiology, Maastricht University Medical Centre, P.O. Box 5800, 6202AZ Maastricht, the Netherlands.
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7
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Infante AN, Koo CCY, Yip A, Lim YH, Yeo WT, Quek ST, Lim TW, Seow SC, Chai P, Ong CC, Teo L, Singh D, Kojodjojo P. Magnetic resonance imaging of dilated cardiomyopathy: prognostic benefit of identifying late gadolinium enhancement in Asian patients. Singapore Med J 2019; 62:347-352. [PMID: 31820004 DOI: 10.11622/smedj.2019166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Risk stratification in dilated cardiomyopathy (DCM) is imprecise, relying largely on echocardiographic left ventricular ejection fraction (LVEF) and severity of heart failure symptoms. Adverse cardiovascular events are increased by the presence of myocardial scarring. Late gadolinium enhancement (LGE) on cardiovascular magnetic resonance (CMR) imaging is the gold standard for identifying myocardial scars. We examined the association between LGE on CMR imaging and adverse clinical outcomes during long-term follow-up of Asian patients with DCM. METHODS Consecutive patients with DCM undergoing CMR imaging at a single Asian academic medical centre between 2005 and 2015 were recruited. Clinical outcomes were tracked using comprehensive electronic medical records and mortality was determined by cross-linkages with national registries. Presence and distribution of LGE on CMR imaging were determined by investigators blinded to patient outcomes. Primary endpoint was a composite of heart failure hospitalisations, appropriate implantable cardioverter-defibrillator shocks and cardiovascular mortality. RESULTS Of 86 patients, 64.0% had LGE (80.2% male; mean LVEF 30.1% ± 12.7%). Mid-wall fibrosis (71.7%) was the most common pattern of LGE distribution. Over a mean follow-up period of 4.9 ± 3.2 years, 19 (34.5%) patients with LGE reached the composite endpoint compared to 4 (12.9%) patients without LGE (p = 0.01). Presence of LGE, but not echocardiographic LVEF, independently predicted the primary endpoint (hazard ratio 4.15 [95% confidence interval 1.28-13.50]; p = 0.02). CONCLUSION LGE presence independently predicted adverse clinical events in Asian patients with DCM. Routine use of CMR imaging to characterise the myocardial substrate is recommended for enhanced risk stratification and should strongly influence clinical management.
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Affiliation(s)
- Anna Nogue Infante
- Department of Biomedical Engineering, Universitat Pompeu Fabra, Barcelona, Spain
| | | | - Alfred Yip
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Ying Ha Lim
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Wee Tiong Yeo
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Swee Tian Quek
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - Toon Wei Lim
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Swee Chong Seow
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Ping Chai
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Ching Ching Ong
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - Lynette Teo
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - Devinder Singh
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Pipin Kojodjojo
- Department of Cardiology, National University Heart Centre Singapore, Singapore
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8
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Lam CSP, Li YH, Bayes-Genis A, Ariyachaipanich A, Huan DQ, Sato N, Kahale P, Cuong TM, Dong Y, Li X, Zhou Y. The role of N-terminal pro-B-type natriuretic peptide in prognostic evaluation of heart failure. J Chin Med Assoc 2019; 82:447-451. [PMID: 31180944 DOI: 10.1097/jcma.0000000000000102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Heart failure (HF) is a growing challenge in the Asia Pacific region. N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a well-established tool for diagnosis of HF; however, it is relatively underutilized in predicting adverse outcomes in HF. Multiple studies have demonstrated the prognostic role of NT-proBNP in HF. A single value of NT-proBNP >5000 pg/mL predicts a worse outcome in hospitalized patients with HF with reduced ejection fraction (HFrEF). In stable outpatients with HFrEF, NT-proBNP > 1000 pg/mL predicts a poorer prognosis. NT-proBNP provides the same prognostic information in patients with HF with preserved ejection fraction (HFpEF) as in those with HFrEF. An expert panel composed of cardiologists mainly from Asia Pacific region was convened to discuss the utility of NT-proBNP in HF prognostication. This article summarizes available scientific evidence and consensus recommendations from the meeting.
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Affiliation(s)
- Carolyn S P Lam
- National Heart Centre Singapore and Duke-National University of Singapore, Singapore
- University Medical Centre Groningen, Groningen, The Netherlands
- The George Institute for Global Health, Newtown New South Wales, Australia
| | - Yi-Heng Li
- National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, ROC
| | | | | | - Do Quang Huan
- Heart Institute of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Naoki Sato
- Nippon Medical School Musashi-Kosugi Hospital, Kanagawa, Japan
| | | | - Ta Manh Cuong
- Vietnam Heart Institute, Bach Mai Hospital, Hanoi, Vietnam
| | | | - Xinli Li
- Jiangsu Province Hospital, Nanjing, China
| | - Yanli Zhou
- Jiangsu Province Hospital, Nanjing, China
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9
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Tromp J, Richards AM, Tay WT, Teng THK, Yeo PSD, Sim D, Jaufeerally F, Leong G, Ong HY, Ling LH, van Veldhuisen DJ, Jaarsma T, Voors AA, van der Meer P, de Boer RA, Lam CSP. N-terminal pro-B-type natriuretic peptide and prognosis in Caucasian vs. Asian patients with heart failure. ESC Heart Fail 2018; 5:279-287. [PMID: 29380931 PMCID: PMC5880675 DOI: 10.1002/ehf2.12252] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 11/19/2017] [Accepted: 11/27/2017] [Indexed: 01/09/2023] Open
Abstract
Aims N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) is the most frequently used biomarker in heart failure (HF), but its prognostic utility across ethnicities is unclear. Methods and results This study included 546 Caucasians with HF from the Coordinating Study Evaluating Outcomes of Advising and Counseling in Heart Failure and 578 Asians with HF from the Singapore Heart Failure Outcomes and Phenotypes study. NT‐proBNP was measured at discharge after HF hospitalization. The studied outcome was a composite of all‐cause mortality and HF hospitalization at 18 months. Compared with Caucasian patients, Asian patients were younger (63 ± 12 vs. 71 ± 11 years); less often female (26% vs. 39%); and had lower body mass index (26 vs. 27 kg/m2), better renal function (61 ± 37 vs. 54 ± 20 mL/min/1.73 m2), lower rates of atrial fibrillation (25% vs. 46%), strikingly higher rates of diabetes (59% vs. 30%), and higher rates of hypertension (76% vs. 44%). Despite these clear inter‐group differences in individual drivers of NT‐proBNP, average levels were similar in Asians [2709 (1350, 6302) pg/mL] and Caucasians [2545 (1308, 5484) pg/mL] (P = 0.514). NT‐proBNP was strongly associated with outcome [hazard ratio 1.28 (per doubling), 95% confidence interval 1.18–1.39, P < 0.001], regardless of ethnicity (Pinteraction = 0.719). NT‐proBNP was similarly associated with outcome in HF with reduced and preserved ejection fraction in Asian (Pinteraction = 0.776) and Caucasian patients (Pinteraction = 0.558). Conclusions NT‐proBNP has similar prognostic performance in Asians and Caucasians with HF despite ethnic differences in known clinical determinants of plasma NT‐proBNP.
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Affiliation(s)
- Jasper Tromp
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.,National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - Arthur Mark Richards
- Cardiovascular Research Institute, National University Heart Centre, Singapore, Singapore.,Christchurch Heart Institute, University of Otago, Dunedin, New Zealand
| | - Wan Ting Tay
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - Tiew-Hwa K Teng
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.,School of Population Health, University of Western Australia, Nedlands, WA, Australia
| | | | - David Sim
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | | | | | | | - Lieng Hsi Ling
- Cardiovascular Research Institute, National University Heart Centre, Singapore, Singapore
| | - Dirk J van Veldhuisen
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Tiny Jaarsma
- Department of Social and Welfare Studies, Faculty of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Adriaan A Voors
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Peter van der Meer
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Rudolf A de Boer
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Carolyn S P Lam
- Cardiovascular Research Institute, National University Heart Centre, Singapore, Singapore.,National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.,Duke-National University of Singapore, Singapore, Singapore
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