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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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Mancusi C, Basile C, Spaccarotella C, Gargiulo G, Fucile I, Paolillo S, Gargiulo P, Santoro C, Manzi L, Marzano F, Ambrosino P, De Luca N, Esposito G. Novel Strategies in Diagnosing Heart Failure with Preserved Ejection Fraction: A Comprehensive Literature Review. High Blood Press Cardiovasc Prev 2024; 31:127-140. [PMID: 38489152 PMCID: PMC11043114 DOI: 10.1007/s40292-024-00629-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 01/26/2024] [Indexed: 03/17/2024] Open
Abstract
Heart failure (HF) with preserved ejection fraction (HFpEF) is a prevalent global condition affecting approximately 50% of the HF population. With the aging of the worldwide population, its incidence and prevalence are expected to rise even further. Unfortunately, until recently, no effective medications were available to reduce the high mortality and hospitalization rates associated with HFpEF, making it a significant unmet need in cardiovascular medicine. Although HFpEF is commonly defined as HF with normal ejection fraction and elevated left ventricular filling pressure, performing invasive hemodynamic assessments on every individual suspected of having HFpEF is neither feasible nor practical. Consequently, several clinical criteria and diagnostic tools have been proposed to aid in diagnosing HFpEF. Overall, these criteria and tools are designed to assist healthcare professionals in identifying and evaluating patients who may have HFpEF based on a combination of signs, symptoms, biomarkers, and non-invasive imaging findings. By employing these non-invasive diagnostic approaches, clinicians can make informed decisions regarding the best pharmacological and rehabilitation strategies for individuals with suspected HFpEF. This literature review aims to provide an overview of all currently available methods for diagnosing and monitoring this disabling condition.
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Affiliation(s)
- Costantino Mancusi
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy.
| | - Christian Basile
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Carmen Spaccarotella
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Giuseppe Gargiulo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Ilaria Fucile
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Stefania Paolillo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Paola Gargiulo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Lina Manzi
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Federica Marzano
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Pasquale Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, Scientific Directorate of Telese Terme Institute, Telese, Italy
| | - Nicola De Luca
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy.
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Núñez-Marín G, Iraola D, Lorenzo M, de la Espriella R, Villar S, Santas E, Miñana G, Sanchis J, Carratalá A, Miró Ò, Bayés-Genís A, Núñez J. An update on utilising brain natriuretic peptide for risk stratification, monitoring and guiding therapy in heart failure. Expert Rev Mol Diagn 2023:1-13. [PMID: 37216616 DOI: 10.1080/14737159.2023.2216386] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/04/2023] [Accepted: 05/16/2023] [Indexed: 05/24/2023]
Abstract
INTRODUCTION Heart failure (HF) is a dominant health problem with an overall poor prognosis. Natriuretic peptides (NPs) are upregulated in HF as a compensatory mechanism. They have extensively been used for diagnosis and risk stratification. AREAS COVERED This review addresses the history and physiology of NPs in order to understand their current role in clinical practice. It further provides a detailed and updated narrative review on the utility of those biomarkers for risk stratification, monitoring, and guiding therapy in HF. EXPERT OPINION NPs show excellent predictive ability in heart failure patients, both in acute and chronic settings. Understanding their pathophysiology and their modifications in specific situations is key for an adequate interpretation in specific clinical scenarios in which their prognostic value may be weaker or less well evaluated. To better promote risk stratification in HF, NPs should be integrated with other predictive tools to develop multiparametric risk models. Both inequalities of access to NPs and evidence caveats and limitations will need to be addressed by future research in the coming years.
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Affiliation(s)
- Gonzalo Núñez-Marín
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia. Valencia, Spain. Valencia, Spain
| | - Diego Iraola
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia. Valencia, Spain. Valencia, Spain
| | - Miguel Lorenzo
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia. Valencia, Spain. Valencia, Spain
| | - Rafael de la Espriella
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia. Valencia, Spain. Valencia, Spain
| | - Sandra Villar
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia. Valencia, Spain. Valencia, Spain
| | - Enrique Santas
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia. Valencia, Spain. Valencia, Spain
| | - Gema Miñana
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia. Valencia, Spain. Valencia, Spain
| | - Juan Sanchis
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia. Valencia, Spain. Valencia, Spain
| | - Arturo Carratalá
- Clinical Chemistry Department, Hospital Clínico Universitario, INCLIVA
| | - Òscar Miró
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Antoni Bayés-Genís
- Cardiology Department, Hospital Universitari Germas Trias i Pujol. Badalona, Spain
- CIBER Cardiovascular, Madrid, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia. Valencia, Spain. Valencia, Spain
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
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Jia X, Al Rifai M, Hoogeveen R, Echouffo-Tcheugui JB, Shah AM, Ndumele CE, Virani SS, Bozkurt B, Selvin E, Ballantyne CM, Nambi V. Association of Long-term Change in N-Terminal Pro-B-Type Natriuretic Peptide With Incident Heart Failure and Death. JAMA Cardiol 2023; 8:222-230. [PMID: 36753229 PMCID: PMC9909572 DOI: 10.1001/jamacardio.2022.5309] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 12/02/2022] [Indexed: 02/09/2023]
Abstract
Importance Most studies, especially in primary prevention patients, have evaluated N-terminal B-type natriuretic peptide (NT-proBNP) at one time point. Evaluation of change in NT-proBNP may improve risk stratification for incident cardiovascular events. Objective To assess the association between change in NT-proBNP and risk for incident heart failure (HF) and death. Design, Setting, and Participants Participants were recruited from 4 US communities enrolled in the Atherosclerosis Risk in Community (ARIC) study. Individuals who attended ARIC visits 2 and 4 (approximately 6 years apart) with measurements of NT-proBNP and without prevalent HF were included. Assays of NT-proBNP were conducted between 2011 and 2013, and analysis took place between July 2021 and October 2022. Exposures The primary exposure variable was NT-proBNP change between visits 2 and 4, modeled as change categories (<125 pg/mL or ≥125 pg/mL) and as percent change. Main Outcomes and Measures The primary outcome measures were incident HF hospitalization and all-cause death. The association between changes in cardiovascular risk factors with change in NT-proBNP was further assessed. Results A total of 9776 individuals (mean [SD] age, 57.1 [5.7] years at visit 2; 5523 [56.5%] women) were included in the study. Compared with participants with NT-proBNP level less than 125 pg/mL at both visits, participants with NT-proBNP level of 125 pg/mL or higher at both visits had an increase in incident HF (adjusted hazard ratio [HR], 2.40 [95% CI, 2.00-2.88]) and mortality risk (HR, 1.68 [95% CI, 1.47-1.91). Participants with NT-proBNP levels of 125 pg/mL or higher at visit 2 and less than 125 pg/mL at visit 4 had similar risk for HF and death (HR, 1.01 [95% CI, 0.71-1.43]; HR, 0.79 [95% CI, 0.61-1.01]) compared with the group with NT-proBNP levels of less than 125 pg/mL at both visits. The percent change in NT-proBNP was positively associated with HF and death (HR, 1.06 [95% CI, 1.02-1.10]; HR, 1.05 [95% CI, 1.03-1.08] per 1-SD increase, respectively). Change in systolic blood pressure, low-density lipoprotein cholesterol, triglyceride level, body mass index, and estimated glomerular filtration rate were significantly associated with change in NT-proBNP. Conclusions and Relevance In this study, 6-year change in NT-proBNP reflected dynamic change in risk for HF events and death among community-dwelling adults without prevalent clinical HF. These results support the utility of serial NT-proBNP measurements to improve risk stratification of patients with pre-HF.
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Affiliation(s)
- Xiaoming Jia
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Mahmoud Al Rifai
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
- now with Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas
| | - Ron Hoogeveen
- Division of Atherosclerosis and Vascular Medicine, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Justin B. Echouffo-Tcheugui
- Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins Bayview Medical Center, Baltimore, Maryland
| | - Amil M. Shah
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Chiadi E. Ndumele
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Salim S. Virani
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
- Division of Atherosclerosis and Vascular Medicine, Department of Medicine, Baylor College of Medicine, Houston, Texas
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Biykem Bozkurt
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Christie M. Ballantyne
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
- Division of Atherosclerosis and Vascular Medicine, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Vijay Nambi
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
- Division of Atherosclerosis and Vascular Medicine, Department of Medicine, Baylor College of Medicine, Houston, Texas
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
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5
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Lower Circulating Cell-Free Mitochondrial DNA Is Associated with Heart Failure in Type 2 Diabetes Mellitus Patients. CARDIOGENETICS 2023. [DOI: 10.3390/cardiogenetics13010003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
Cell-free nuclear (cf-nDNA) and mitochondrial (cf-mDNA) DNA are released from damaged cells in type 2 diabetes mellitus (T2DM) patients, contributing to adverse cardiac remodeling, vascular dysfunction, and inflammation. The purpose of this study was to correlate the presence and type of cf-DNAs with HF in T2DM patients. A total of 612 T2DM patients were prescreened by using a local database, and 240 patients (120 non-HF and 120 HF individuals) were ultimately selected. The collection of medical information, including both echocardiography and Doppler imagery, as well as the assessment of biochemistry parameters and the circulating biomarkers, were performed at baseline. The N-terminal brain natriuretic pro-peptide (NT-proBNP) and cf-nDNA/cf-mtDNA levels were measured via an ELISA kit and real-time quantitative PCR tests, respectively. We found that HF patients possessed significantly higher levels of cf-nDNA (9.9 ± 2.5 μmol/L vs. 5.4 ± 2.7 μmol/L; p = 0.04) and lower cf-mtDNA (15.7 ± 3.3 μmol/L vs. 30.4 ± 4.8 μmol/L; p = 0.001) than those without HF. The multivariate log regression showed that the discriminative potency of cf-nDNA >7.6 μmol/L (OR = 1.07; 95% CI = 1.03–1.12; p = 0.01) was higher that the NT-proBNP (odds ratio [OR] = 1.10; 95% confidence interval [CI] = 1.04–1.19; p = 0.001) for HF. In conclusion, we independently established that elevated levels of cf-nDNA, originating from NT-proBNP, were associated with HF in T2DM patients.
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Morfino P, Aimo A, Castiglione V, Vergaro G, Emdin M, Clerico A. Biomarkers of HFpEF: Natriuretic Peptides, High-Sensitivity Troponins and Beyond. J Cardiovasc Dev Dis 2022; 9:jcdd9080256. [PMID: 36005420 PMCID: PMC9409788 DOI: 10.3390/jcdd9080256] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/02/2022] [Accepted: 08/04/2022] [Indexed: 11/28/2022] Open
Abstract
Heart failure (HF) is a significant cause of morbidity and mortality worldwide. HF with preserved ejection fraction (HFpEF) is a complex syndrome, often participated by several cardiac and extracardiac conditions, including chronic kidney disease, pulmonary disease, anaemia and advanced age. Circulating biomarkers reflecting pathophysiological pathways involved in HFpEF development and progression may assist clinicians in early diagnosis and management of this condition. Natriuretic peptides (NPs) are cardioprotective hormones released by cardiomyocytes in response to pressure or volume overload and in response to activation of neuro-endocrine-immune system. The relevance of B-type NP (BNP) and N-terminal pro-B-type NP (NT-proBNP) for diagnosis and risk stratification has been extensively demonstrated, and these biomarkers are emerging tools for population screening and as guides to the start of treatment in subclinical HF. On the contrary, conflicting evidence exists on the value of NPs to guide HF therapy. Among the other biomarkers, high-sensitivity troponins and soluble suppression of tumorigenesis-2 are the most promising biomarkers for risk stratification, predicting outcome independently from NPs. In this review, some novel biomarkers are being tested in such clinical scenario, more tightly linked to specific pathophysiological processes of cardiac damage.
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Affiliation(s)
- Paolo Morfino
- Interdisciplinary Center of Health Sciences, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
| | - Alberto Aimo
- Interdisciplinary Center of Health Sciences, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, 56127 Pisa, Italy
| | - Vincenzo Castiglione
- Interdisciplinary Center of Health Sciences, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, 56127 Pisa, Italy
| | - Giuseppe Vergaro
- Interdisciplinary Center of Health Sciences, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, 56127 Pisa, Italy
| | - Michele Emdin
- Interdisciplinary Center of Health Sciences, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, 56127 Pisa, Italy
| | - Aldo Clerico
- Interdisciplinary Center of Health Sciences, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, 56127 Pisa, Italy
- Correspondence:
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Januzzi JL, Butler J, Zannad F, Filippatos G, Ferreira JP, Pocock SJ, Sattar N, Verma S, Vedin O, Iwata T, Brueckmann M, Packer M, Anker SD. Prognostic Implications of N-Terminal Pro-B-Type Natriuretic Peptide and High-Sensitivity Cardiac Troponin T in EMPEROR-Preserved. JACC. HEART FAILURE 2022; 10:512-524. [PMID: 35670067 DOI: 10.1016/j.jchf.2022.05.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/17/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT) are associated with disease severity and outcomes among patients with heart failure (HF) with preserved ejection fraction. OBJECTIVES The authors evaluated associations between both biomarkers and clinical outcomes in the EMPEROR-Preserved (Empagliflozin Outcome Trial in Patients with Chronic Heart Failure with Preserved Ejection Fraction) trial. METHODS Of 5,988 study participants, 5,986 (99.9%) and 5,825 (97.3%) had available baseline NT-proBNP and hs-cTnT; postbaseline NT-proBNP was also available. Baseline characteristics were expressed by biomarker quartiles. The effect of empagliflozin on cardiovascular death/ HF hospitalization, the individual components, total HF hospitalizations, slope of decline of estimated glomerular filtration rate (eGFR), and a composite renal endpoint were examined across biomarker quartiles. Change in NT-proBNP across study visits as a function of treatment assignment was also assessed. RESULTS Higher baseline NT-proBNP and hs-cTnT concentrations were associated with more comorbidities and worse HF severity. Incidence rates for cardiac and renal outcomes were 2- to 5-fold higher among those in the highest vs lowest NT-proBNP or hs-cTnT quartiles. Empagliflozin consistently reduced the risk for cardiovascular events and reduced slope of eGFR decline across NT-proBNP or hs-cTnT quartiles. Empagliflozin treatment modestly lowered NT-proBNP; by 100 weeks, the adjusted mean difference in NT-proBNP from placebo was 7%. Increase in NT-proBNP from baseline to 12 weeks was strongly associated with risk of cardiovascular death/HF hospitalization. CONCLUSIONS The benefit of empagliflozin on cardiac outcomes and decline of eGFR is preserved across the wide range of baseline NT-proBNP and hs-cTnT evaluated. Empagliflozin modestly reduces NT-proBNP in HF with preserved ejection fraction. (EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure With Preserved Ejection Fraction [EMPEROR-Preserved]; NCT03057951).
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Affiliation(s)
- James L Januzzi
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, and Baim Institute for Clinical Research, Boston, Massachusetts, USA.
| | - Javed Butler
- Department of Medicine, University of Mississippi School of Medicine, Jackson, Mississippi, USA
| | - Faiez Zannad
- Université de Lorraine, Inserm INI-CRCT, CHRU, Nancy, France
| | - Gerasimos Filippatos
- National and Kapodistrian University of Athens School of Medicine, Athens University Hospital Attikon, Athens, Greece
| | - João Pedro Ferreira
- Université de Lorraine, Inserm, Centre d'Investigation Clinique Plurithématique, CHRU de Nancy, Nancy, France; UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Stuart J Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Naveed Sattar
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Subodh Verma
- Division of Cardiac Surgery, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Ola Vedin
- Boehringer-Ingelheim AB, Stockholm, Sweden
| | - Tomoko Iwata
- Boehringer Ingelheim Pharma GmbH and Co KG, Biberach, Germany
| | - Martina Brueckmann
- Boehringer Ingelheim International GmbH, Ingelheim, Germany; First Department of Medicine, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas, USA; Imperial College, London, United Kingdom
| | - Stefan D Anker
- Department of Cardiology (CVK), and the Berlin Institute of Health Center for Regenerative Therapies, German Centre for Cardiovascular Research Partner Site Berlin, Charité Universitätsmedizin, Berlin, Germany
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Varadarajan V, Ambale-Venkatesh B, Hong SY, Habibi M, Ashikaga H, Wu CO, Chen LY, Heckbert SR, Bluemke DA, Lima JAC. Association of Longitudinal Changes in NT-proBNP With Changes in Left Atrial Volume and Function: MESA. Am J Hypertens 2021; 34:626-635. [PMID: 33491080 DOI: 10.1093/ajh/hpab018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/28/2020] [Accepted: 01/20/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The mechanism of left atrial (LA) remodeling is poorly understood. The aim of this longitudinal study was to investigate whether changes in NT-proBNP levels relate to alterations of LA structure and function over time in a multiethnic population. METHODS From the prospective cohort study, the Multi-Ethnic Study of Atherosclerosis, our analysis included 1,838 participants who underwent cardiac magnetic resonance imaging at the baseline and 10-year examinations, had NT-proBNP levels available at both time points, and did not develop heart failure, myocardial infarction, and/or atrial fibrillation. Multivariable linear regression was used to analyze the association between NT-proBNP level (log-transformed) at the 2 time points and change in LA volumes, LA emptying fractions (total, active, and passive), and LA longitudinal strain. Log NT-proBNP was categorized into Low-Low (N = 681), Low-High (N = 238), High-Low (N = 237), and High-High (N = 682) based on the median value at both time points. RESULTS With the Low-Low group as the reference group, the High-High group experienced a greater increase in LA maximum and minimum indexed volumes: 3.1 ml/m2 (95% confidence interval 1.98, 4.20) and 2.7 ml/m2 (1.89, 3.51), respectively. The High-High group also experienced a greater decrease in LA total, passive, active emptying fraction, and longitudinal strain: -3.3% (-4.46, -2.11), -0.9% (-1.80, -0.02), -4.2% (-5.55, -2.76), and -2.3% (-3.80, -0.72), respectively. The Low-High group had similar associations, but the effect sizes were not as high. CONCLUSIONS Adverse LA remodeling over 10 years of follow-up strongly correlates with prolonged elevated levels of intracardiac stress, as assessed by NT-proBNP levels.
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Affiliation(s)
| | | | - Seo Young Hong
- Office of the Director, Center for Scientific Review, National Institutes of Health, Bethesda, Maryland, USA
| | - Mohammadali Habibi
- Department of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Hiroshi Ashikaga
- Department of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Colin O Wu
- Department of Medicine, National Heart, Lung and Blood Institute, Bethesda, Maryland, USA
| | - Lin Y Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Susan R Heckbert
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - David A Bluemke
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
| | - Joao A C Lima
- Department of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
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Bettencourt P, Chora I, Silva F, Lourenço P, Peacock WF. Acute on chronic heart failure-Which variations on B-type natriuretic peptide levels? J Am Coll Emerg Physicians Open 2021; 2:e12448. [PMID: 34179876 PMCID: PMC8212562 DOI: 10.1002/emp2.12448] [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: 10/09/2020] [Revised: 01/18/2021] [Accepted: 01/27/2021] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Natriuretic peptides are useful diagnostic and prognostic markers in patients presenting to the emergency department (ED) with acute shortness of breath. However, B-type natriuretic peptide (BNP) level represents a single snapshot in time, while changes relative to a patient's baseline may be useful in risk stratification. We aimed to define the variation of BNP levels between chronic stable and acute decompensated heart failure (ADHF) that is associated with significant clinical outcomes. METHODS We performed a retrospective cohort chart review study of chronic heart failure (HF) patients followed in an outpatient clinic from 2010 to 2013. Inclusion criteria were available hospital and clinic BNP levels and at least 1 year of follow-up care. ADHF was defined as a hospital admission for acute HF. Dry BNP was defined as its concentration after >3 months of optimal treatment and no variations in New York Heart Association class. Dry BNP was compared to the BNP at a subsequent ED visit that was associated with hospitalization because of ADHF. RESULTS Overall, 253 patients were included. Their median (interquartile range [IQR]) dry BNP was 191(83-450) pg/mL. There were 67 ADHF admissions, occurring 15 ± 15 months after patient's dry BNP was established. At subsequent ED admission, the median (IQR) BNP was 1505 (72-2620) pg/mL. Patients requiring inpatient admission had a BNP ∼250% higher than their stable BNP (404 vs 164 pg/mL, p < 0.001). CONCLUSIONS In this group of chronic stable HF patients, a doubling of BNP was observed in patients who required hospitalization for acute decompensated HF. BNP doubling may represent a useful parameter to reflect clinically relevant acute decompensated HF.
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Affiliation(s)
- Paulo Bettencourt
- Centro Hospitalar de São João EPEDepartment of Internal MedicinePortoPortugal
- Unidade de Investigaçao Cardiovascular‐UnICFaculdade de MedicinaUniversidade do PortoPortoPortugal
- Hospital CUF PortoDepartment of Internal MedicinePortoPortugal
| | - Inês Chora
- Centro Hospitalar de São João EPEDepartment of Internal MedicinePortoPortugal
- Unidade de Investigaçao Cardiovascular‐UnICFaculdade de MedicinaUniversidade do PortoPortoPortugal
- Hospital Pedro HispanoDepartment of Internal MedicineUnidade Local de Saúde de MatosinhosSenhora da HoraPortugal
| | - Filipa Silva
- Centro Hospitalar de São João EPEDepartment of Internal MedicinePortoPortugal
- Unidade de Investigaçao Cardiovascular‐UnICFaculdade de MedicinaUniversidade do PortoPortoPortugal
| | - Patrícia Lourenço
- Centro Hospitalar de São João EPEDepartment of Internal MedicinePortoPortugal
- Unidade de Investigaçao Cardiovascular‐UnICFaculdade de MedicinaUniversidade do PortoPortoPortugal
| | - W. Frank Peacock
- Emergency Department, Ben Taub mGeneral HospitalBaylor College of MedicineHoustonTexasUSA
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10
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Yao Y, Feng L, Sun Y, Wang S, Sun J, Hu B. Myocardial fibrosis combined with NT-proBNP improves the accuracy of survival prediction in ADHF patients. BMC Cardiovasc Disord 2021; 21:264. [PMID: 34049488 PMCID: PMC8164226 DOI: 10.1186/s12872-021-02083-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 05/21/2021] [Indexed: 12/20/2022] Open
Abstract
Background Soluble suppression of tumorigenesis-2 (sST2), Procollagen Type III N-Terminal Peptid (PIIINP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) have been verified their role in predicting survival in acutely decompensated heart failure (ADHF). However, whether their combination could improve more specific and sensitive prognostic information than NT-proBNP alone remains unclear. Methods This was a prospective study, in which 217 ADHF patients at admission were enrolled from November 2018 and August 2019 (mean age 66.18 years ± 13.60, 63.98% male). The blood samples were collected to measure the concentrations of NT-proBNP, sST2 and PIIINP in the first 24 h of hospitalizations. All-cause mortality was registered for all patients after they were discharge over a median period of 339 days. Results In univariate Cox analysis, the three biomarkers were predictive of short-term mortality of ADHF patients. After adjusted for some clinical variables including age, admission systolic blood pressure, peripheral edema on admission, history of chronic obstructive pulmonary disease, admission sodium < 135 mmol/L, admission hemoglobin, NT-proBNP, sST2 and PIIINP was significantly associated with the poor outcome (hazard ratio [HR] 1.32, 95% confidence interval [CI] 1.14–1.53, P < 0.01; HR 1.21, 95% CI 1.03–1.43, P = 0.020; HR 1.40, 95% CI 1.08–1.81, P = 0.011). After added with Log2 PIIINP, but not Log2 sST2, the area under the curves (AUC) in the model of clinical variables and Log2 NT-proBNP could increase from 0.79 to 0.85 (95% CI 0.0071–0.10, P = 0.024). Furthermore, compared with the model of clinical variables, Log2 NT-proBNP, the improvement in the prognostic model of clinical variables, Log2 NT-proBNP and Log2 PIIINP had statistical significance [net reclassification improvement (NRI) 0.31, P = 0.018; integrated discrimination improvement (IDI) 0.068, P < 0.01]. Conclusions NT-proBNP, sST2 and PIIINP are independent prognostic factors for all-cause mortality in ADHF patients. Furthermore, the combination of NT-proBNP and PIIINP may provide incremental prognostic value over NT-proBNP in the survival of ADHF patients.
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Affiliation(s)
- Yiling Yao
- Department of Cardiology, Zhongshan People Hospital, Sun Yat-Sen University, No. 2 Sunwen East Road, Zhongshan, 528400, Guangdong, People's Republic of China
| | - Li Feng
- Department of Cardiology, Zhongshan People Hospital, Sun Yat-Sen University, No. 2 Sunwen East Road, Zhongshan, 528400, Guangdong, People's Republic of China.
| | - Yanxiang Sun
- Department of Cardiology, Zhongshan People Hospital, Sun Yat-Sen University, No. 2 Sunwen East Road, Zhongshan, 528400, Guangdong, People's Republic of China
| | - Shifei Wang
- Department of Cardiology, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Jie Sun
- Department of Cardiology, Zhongshan People Hospital, Sun Yat-Sen University, No. 2 Sunwen East Road, Zhongshan, 528400, Guangdong, People's Republic of China
| | - Bing Hu
- Department of Cardiology, Zhongshan People Hospital, Sun Yat-Sen University, No. 2 Sunwen East Road, Zhongshan, 528400, Guangdong, People's Republic of China
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11
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Nakagawa A, Yasumura Y, Yoshida C, Okumura T, Tateishi J, Yoshida J, Tamaki S, Yano M, Hayashi T, Nakagawa Y, Yamada T, Nakatani D, Hikoso S, Sakata Y. Distinctive prognostic factor of heart failure with preserved ejection fraction stratified with admission blood pressure. ESC Heart Fail 2021; 8:3145-3155. [PMID: 33998166 PMCID: PMC8318465 DOI: 10.1002/ehf2.13420] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/03/2021] [Accepted: 05/02/2021] [Indexed: 12/28/2022] Open
Abstract
Aims The prognostic importance of admission systolic blood pressure (SBP) in heart failure with preserved ejection fraction (HFpEF) is elusive. We aimed to clarify the pathophysiological differences between patients categorized with admission SBP among HFpEF patients. Methods and results We studied 1008 inpatients from PURSUIT‐HFpEF, a multicentre prospective observational registry. We classified patients as having elevated (>140 mmHg), preserved (90–140 mmHg), or low (<90 mmHg) admission SBP. Most cases had elevated (n = 584) or preserved (n = 420) SBP; the four cases with low SBP were excluded. Univariable Cox regression testing revealed that preserved SBP patients had a higher risk of a composite of cardiac death and heart failure re‐hospitalization [hazard ratio (HR) 1.48, 95% confidence interval (CI) 1.14–1.92, P = 0.0035] than elevated SBP patients. In multivariable Cox regression models, while prior heart failure hospitalization (HR 1.36, 95% CI 1.01–2.84, P = 0.0453), atrial fibrillation (HR 1.82, 95% CI 1.10–2.99, P = 0.0209), and N‐terminal pro‐B‐type natriuretic peptide (HR 1.94, 95% CI 1.10–3.43, P = 0.0229) at discharge were significantly associated with adverse outcomes in elevated SBP patients, N‐terminal pro‐B‐type natriuretic peptide (HR 2.06, 95% CI 1.04–4.07, P = 0.0373) and right ventricular‐pulmonary artery uncoupling reflected by the tricuspid annular plane systolic excursion/pulmonary artery systolic pressure ratio (HR 0.19, 95% CI 0.05–0.65, P = 0.0075) at discharge were significant prognostic factors in preserved SBP patients. Conclusions Patients with preserved admission SBP had significant higher risks for adverse outcomes than those with elevated SBP in HFpEF. Tricuspid annular plane systolic excursion/pulmonary artery systolic pressure was the distinctive prognostic factor between the two groups.
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Affiliation(s)
- Akito Nakagawa
- Division of Cardiovascular Medicine, Amagasaki-Chuo Hospital, 1-12-1 Shioe, Amagasaki, Hyogo, 661-0976, Japan.,Department of Medical Informatics, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yoshio Yasumura
- Division of Cardiovascular Medicine, Amagasaki-Chuo Hospital, 1-12-1 Shioe, Amagasaki, Hyogo, 661-0976, Japan
| | - Chikako Yoshida
- Division of Cardiovascular Medicine, Amagasaki-Chuo Hospital, 1-12-1 Shioe, Amagasaki, Hyogo, 661-0976, Japan
| | - Takahiro Okumura
- Division of Cardiovascular Medicine, Amagasaki-Chuo Hospital, 1-12-1 Shioe, Amagasaki, Hyogo, 661-0976, Japan
| | - Jun Tateishi
- Division of Cardiovascular Medicine, Amagasaki-Chuo Hospital, 1-12-1 Shioe, Amagasaki, Hyogo, 661-0976, Japan
| | - Junichi Yoshida
- Division of Cardiovascular Medicine, Amagasaki-Chuo Hospital, 1-12-1 Shioe, Amagasaki, Hyogo, 661-0976, Japan
| | - Shunsuke Tamaki
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Masamichi Yano
- Division of Cardiology, Osaka Rosai Hospital, Osaka, Japan
| | | | - Yusuke Nakagawa
- Division of Cardiology, Kawanishi City Hospital, Kawanishi, Japan
| | - Takahisa Yamada
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Daisaku Nakatani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Shungo Hikoso
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
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12
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Application of Guideline-Based Echocardiographic Assessment of Left Atrial Pressure to Heart Failure with Preserved Ejection Fraction. J Am Soc Echocardiogr 2020; 34:455-464. [PMID: 33359021 DOI: 10.1016/j.echo.2020.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/16/2020] [Accepted: 12/14/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Early, noninvasive identification of patients with heart failure with preserved ejection fraction (HFpEF) with congestion may allow timely tailoring of decongestive therapies. The 2016 American Society of Echocardiography and European Association of Cardiovascular Imaging guidelines provide an algorithm to assess for elevated left atrial pressure (LAP); the associations of echocardiographic LAP with clinical status and disease progression in patients with HFpEF are unclear. METHODS Participants in the Phosphodiesterase-5 Inhibition to Improve Clinical Status and Exercise Capacity in HFpEF trial were categorized into one of four prespecified guideline-based echocardiographic LAP categories: (1) normal, (2) elevated, (3) atrial fibrillation (AF) at the time of echocardiography, or (4) indeterminate. Associations of echocardiographic LAP categories with baseline exercise capacity, change in exercise capacity, and change in N-terminal pro-B-type natriuretic peptide over 24 weeks were evaluated. RESULTS Of 216 participants, 199 underwent mitral inflow Doppler echocardiography for LAP categorization. Participants with elevated echocardiographic LAP (n = 81) or AF (n = 57) were older and had a higher prevalence of kidney dysfunction. Compared with the normal echocardiographic LAP group (n = 28), elevated echocardiographic LAP and AF were each independently associated with a greater reduction in peak oxygen consumption over 24 weeks after adjusting for baseline values and clinical covariates (β for elevated echocardiographic LAP = -1.55 [95% CI, -2.59 to -0.51], P = .004; β for AF = -1.33 [95% CI, -2.49 to -0.17], P = .03). Indeterminate echocardiographic LAP (n = 33) was also independently associated with a reduction in exercise capacity at 24 weeks compared with normal echocardiographic LAP (β = -1.35; 95% CI, -2.51 to -0.19; P = .02). Finally, elevated echocardiographic LAP and AF were significantly associated with increases in N-terminal pro-B-type natriuretic peptide over 24 weeks compared with normal echocardiographic LAP. CONCLUSIONS In patients with chronic HFpEF, elevated echocardiographic LAP and indeterminate echocardiographic LAP, as defined by contemporary guidelines, and AF were each independently associated with a reduction in exercise capacity compared with normal echocardiographic LAP. These findings suggest the potential utility of noninvasive LAP assessment in patients with HFpEF for tailoring treatments that decrease congestion.
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13
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Zheng H, Cui Y, Li K, Zhang J, Qu J, Shi H, Li L, Xia H, Chen X, Liang H. The association between the pattern of change in N-terminal pro-B-type natriuretic peptide and short-term outcomes in children undergoing surgery for congenital heart disease. Interact Cardiovasc Thorac Surg 2020; 32:601-606. [PMID: 33313833 DOI: 10.1093/icvts/ivaa310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 10/19/2020] [Accepted: 10/31/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES This study aimed to determine whether changes in perioperative N-terminal pro-B-type natriuretic peptide (NT-proBNP) are associated with short-term outcomes in children undergoing surgery for congenital heart disease (CHD). METHODS We retrospectively included 873 consecutive children with CHD after cardiac surgery. NT-proBNP concentrations were collected from each child prior to and at 1, 12, 36 and 72 h after surgery. The patients had postsurgical follow-ups at 30, 90 and 180 days. The end point was postoperative composite adverse events. RESULTS The patients were classified into 3 groups using joint latent class mixture time-to-event models: (i) relatively stable (86.7%), (ii) decreasing (7.2%) and (iii) increasing (6.1%). In total, 257 (29.4%) adverse events occurred. The joint latent class mixture time-to-event models showed that increasing NT-proBNP was strongly associated with adverse events, with adjusted hazard ratio of 2.33 (95% confidence interval 1.52-3.60). Multinomial logistic regression showed that the variables associated with the pattern of change were age, weight at surgery, mode of delivery and cardiopulmonary bypass time. CONCLUSIONS The pattern of dynamic postsurgical changes in NT-proBNP may facilitate outcome stratification and identification of a high risk for adverse events.
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Affiliation(s)
- Haiqing Zheng
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yanqin Cui
- Cardiac Intensive Care Unit, Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Kuanrong Li
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jiexin Zhang
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jiangbo Qu
- Cardiac Intensive Care Unit, Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Hui Shi
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - LiJuan Li
- Cardiac Intensive Care Unit, Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Huimin Xia
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xinxin Chen
- Cardiac Intensive Care Unit, Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Huiying Liang
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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14
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Malachias MVB, Jhund PS, Claggett BL, Wijkman MO, Bentley‐Lewis R, Chaturvedi N, Desai AS, Haffner SM, Parving H, Prescott MF, Solomon SD, De Zeeuw D, McMurray JJV, Pfeffer MA. NT-proBNP by Itself Predicts Death and Cardiovascular Events in High-Risk Patients With Type 2 Diabetes Mellitus. J Am Heart Assoc 2020; 9:e017462. [PMID: 32964800 PMCID: PMC7792415 DOI: 10.1161/jaha.120.017462] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background NT-proBNP (N-terminal pro-B-type natriuretic peptide) improves the discriminatory ability of risk-prediction models in type 2 diabetes mellitus (T2DM) but is not yet used in clinical practice. We assessed the discriminatory strength of NT-proBNP by itself for death and cardiovascular events in high-risk patients with T2DM. Methods and Results Cox proportional hazards were used to create a base model formed by 20 variables. The discriminatory ability of the base model was compared with that of NT-proBNP alone and with NT-proBNP added, using C-statistics. We studied 5509 patients (with complete data) of 8561 patients with T2DM and cardiovascular and/or chronic kidney disease who were enrolled in the ALTITUDE (Aliskiren in Type 2 Diabetes Using Cardiorenal Endpoints) trial. During a median 2.6-year follow-up period, 469 patients died and 768 had a cardiovascular composite outcome (cardiovascular death, resuscitated cardiac arrest, nonfatal myocardial infarction, stroke, or heart failure hospitalization). NT-proBNP alone was as discriminatory as the base model for predicting death (C-statistic, 0.745 versus 0.744, P=0.95) and the cardiovascular composite outcome (C-statistic, 0.723 versus 0.731, P=0.37). When NT-proBNP was added, it increased the predictive ability of the base model for death (C-statistic, 0.779 versus 0.744, P<0.001) and for cardiovascular composite outcome (C-statistic, 0.763 versus 0.731, P<0.001). Conclusions In high-risk patients with T2DM, NT-proBNP by itself demonstrated discriminatory ability similar to a multivariable model in predicting both death and cardiovascular events and should be considered for risk stratification. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT00549757.
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Affiliation(s)
- Marcus V. B. Malachias
- Cardiovascular DivisionBrigham & Women’s HospitalHarvard Medical SchoolBostonMA
- Faculdade Ciências Médicas de Minas GeraisFundação Educacional Lucas MachadoBelo HorizonteMinas GeraisBrazil
| | - Pardeep S. Jhund
- Institute of Cardiovascular and Medical SciencesUniversity of GlasgowUnited Kingdom
| | - Brian L. Claggett
- Cardiovascular DivisionBrigham & Women’s HospitalHarvard Medical SchoolBostonMA
| | - Magnus O. Wijkman
- Cardiovascular DivisionBrigham & Women’s HospitalHarvard Medical SchoolBostonMA
- Department of Internal Medicine and Department of Health, Medicine and Caring SciencesLinköping UniversityNorrköpingSweden
| | | | - Nishi Chaturvedi
- MRC Unit for Lifelong Health and Ageing at UCLInstitute for Cardiovascular SciencesUniversity College LondonLondonUnited Kingdom
| | - Akshay S. Desai
- Cardiovascular DivisionBrigham & Women’s HospitalHarvard Medical SchoolBostonMA
| | - Steven M. Haffner
- Department of Medicine and Clinical EpidemiologyUniversity of Texas Health Science CenterSan AntonioTX
| | - Hans‐Henrik Parving
- Department of Medical EndocrinologyRigshospitaletUniversity of CopenhagenDenmark
| | | | - Scott D. Solomon
- Cardiovascular DivisionBrigham & Women’s HospitalHarvard Medical SchoolBostonMA
| | - Dick De Zeeuw
- Department of Clinical Pharmacy and PharmacologyUniversity Medical Center GroningenUniversity of Groningenthe Netherlands
| | - John J. V. McMurray
- Institute of Cardiovascular and Medical SciencesUniversity of GlasgowUnited Kingdom
| | - Marc A. Pfeffer
- Cardiovascular DivisionBrigham & Women’s HospitalHarvard Medical SchoolBostonMA
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15
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Vaduganathan M, McMurray JJV, Solomon SD. Angiotensin receptor-neprilysin inhibition in heart failure with preserved ejection fraction: lessons from PARAGON-HF. Eur J Heart Fail 2020; 22:1525-1530. [PMID: 32741093 DOI: 10.1002/ejhf.1976] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 07/30/2020] [Indexed: 01/04/2023] Open
Affiliation(s)
- Muthiah Vaduganathan
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA, USA
| | - John J V McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Scott D Solomon
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA, USA
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16
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Oeun B, Nakatani D, Hikoso S, Kojima T, Dohi T, Kitamura T, Okada K, Sunaga A, Kida H, Yamada T, Uematsu M, Yasumura Y, Higuchi Y, Mano T, Nagai Y, Fuji H, Mizuno H, Sakata Y. Factors Associated With Elevated N-Terminal Pro B-Type Natriuretic Peptide Concentrations at the Convalescent Stage and 1-Year Outcomes in Patients With Heart Failure With Preserved Ejection Fraction. Circ Rep 2020; 2:400-408. [PMID: 33693261 PMCID: PMC7819653 DOI: 10.1253/circrep.cr-20-0051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background: Little is known about factors associated with elevated N-terminal pro B-type natriuretic peptide (NT-proBNP) at the convalescent stage and their effects on 1-year outcomes in patients with heart failure with preserved ejection fraction (HFpEF). Methods and Results: This study included 469 patients with HFpEF. Elevated NT-proBNP was defined as the highest quartile. The first 3 quartiles (Q1-Q3) were combined together for comparison with the fourth quartile (Q4). Median NT-proBNP concentrations in Q1-Q3 and Q4 were 669 and 3,504 pg/mL, respectively. Multivariate logistic regression analysis revealed that low albumin (odds ratio [OR] 2.44; 95% confidence interval [CI] 1.35-4.39; P=0.003), low estimated glomerular filtration rate (OR 5.83; 95% CI 3.46-9.83; P<0.001), high C-reactive protein (OR 2.09; 95% CI 1.21-3.63; P=0.009), and atrial fibrillation at discharge (OR 2.33; 95% CI 1.40-3.89; P=0.001) were associated with elevated NT-proBNP. Cumulative rates of all-cause mortality and heart failure rehospitalization were significantly higher in Q4 than in Q1-Q3 (P=0.001 and P<0.001, respectively). Incidence and hazard ratios of these adverse events increased when the number of associated factors for elevated NT-proBNP clustered together (P<0.001 and P=0.002, respectively). Conclusions: In addition to atrial fibrillation, extracardiac factors (malnutrition, renal impairment and inflammation) were associated with elevated NT-proBNP at the convalescent stage, and led to poor prognosis in patients with HFpEF.
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Affiliation(s)
- Bolrathanak Oeun
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine Suita Japan
| | - Daisaku Nakatani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine Suita Japan
| | - Shungo Hikoso
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine Suita Japan
| | - Takayuki Kojima
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine Suita Japan
| | - Tomoharu Dohi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine Suita Japan
| | - Tetsuhisa Kitamura
- Department of Environmental Medicine and Population Sciences, Osaka University Graduate School of Medicine Suita Japan
| | - Katsuki Okada
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine Suita Japan
| | - Akihiro Sunaga
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine Suita Japan
| | - Hirota Kida
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine Suita Japan
| | - Takahisa Yamada
- Division of Cardiology, Osaka General Medical Center Osaka Japan
| | - Masaaki Uematsu
- Division of Cardiology, National Hospital Organization, Osaka National Hospital Osaka Japan
| | - Yoshio Yasumura
- Division of Cardiology, Amagasaki Chuo Hospital Amagasaki Japan
| | | | - Toshiaki Mano
- Division of Cardiology, Kansai Rosai Hospital Amagasaki Japan
| | - Yoshiyuki Nagai
- Division of Cardiology, Rinku General Medical Center Izumisano Japan
| | - Hisakazu Fuji
- Division of Cardiology, Kobe Ekisaikai Hospital Kobe Japan
| | - Hiroya Mizuno
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine Suita Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine Suita Japan
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17
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Cunningham JW, Vaduganathan M, Claggett BL, Zile MR, Anand IS, Packer M, Zannad F, Lam CSP, Janssens S, Jhund PS, Kober L, Rouleau J, Shah SJ, Chopra VK, Shi VC, Lefkowitz MP, Prescott MF, Pfeffer MA, McMurray JJV, Solomon SD. Effects of Sacubitril/Valsartan on N-Terminal Pro-B-Type Natriuretic Peptide in Heart Failure With Preserved Ejection Fraction. JACC. HEART FAILURE 2020; 8:372-381. [PMID: 32241619 DOI: 10.1016/j.jchf.2020.03.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 02/25/2020] [Accepted: 03/05/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The authors sought to evaluate the prognostic significance of baseline N-terminal pro-B-type natriuretic peptide (NT-proBNP), whether NT-proBNP modified the treatment response to sacubitril/valsartan, and the treatment effect of sacubitril/valsartan on NT-proBNP overall and in key subgroups. BACKGROUND Sacubitril/valsartan reduces NT-proBNP in heart failure (HF) with both reduced and preserved ejection fraction (EF), but did not significantly reduce total HF hospitalizations and cardiovascular death compared with valsartan in patients with HF with preserved EF (HFpEF). METHODS In the PARAGON-HF (Efficacy and Safety of LCZ696 Compared to Valsartan, on Morbidity and Mortality in Heart Failure Patients With Preserved Ejection Fraction) trial, 4,796 patients with HFpEF and elevated NT-proBNP were randomized to sacubitril/valsartan or valsartan. NT-proBNP was measured at screening in all patients and at 5 subsequent times in >2,700 patients: before, between, and after sequential valsartan and sacubitril/valsartan run-in periods, and 16 and 48 weeks post-randomization. RESULTS Median NT-proBNP was 911 pg/ml (interquartile range: 464 to 1,613 pg/ml) at screening. Screening NT-proBNP was strongly associated with the primary endpoint, total HF hospitalizations and cardiovascular death (rate ratio [RR]: 1.68 per log increase in NT-proBNP, 95% confidence interval [CI]: 1.53 to 1.85; p < 0.001). This relationship was stronger in patients with atrial fibrillation (adjusted RR: 2.33 [95% CI: 1.89 to 2.87] vs. 1.58 [95% CI: 1.42 to 1.75] in patients without atrial fibrillation; p interaction <0.001) and weaker in obese patients (adjusted RR: 1.50 [95% CI: 1.31 to 1.71] vs. 1.92 [95% CI: 1.70 to 2.17] in nonobese patients; p interaction <0.001). Screening NT-proBNP did not modify the treatment effect of sacubitril/valsartan compared with valsartan (p interaction = 0.96). Sacubitril/valsartan reduced NT-proBNP by 19% (95% CI: 14% to 23%; p < 0.001) compared with valsartan 16 weeks post-randomization, with similar reductions in men (20%) and women (18%), and in patients with left ventricular EF ≤57% (20%) and >57% (18%). Decreases in NT-proBNP predicted lower subsequent risk of the primary endpoint. CONCLUSIONS Baseline NT-proBNP predicted HF events but did not modify the sacubitril/valsartan treatment effect in patients with HFpEF. Sacubitril/valsartan reduced NT-proBNP consistently in men and women, and in patients with lower or higher EF. (Efficacy and Safety of LCZ696 Compared to Valsartan, on Morbidity and Mortality in Heart Failure Patients With Preserved Ejection Fraction [PARAGON-HF]; NCT01920711).
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Affiliation(s)
- Jonathan W Cunningham
- Brigham and Women's Hospital, Division of Cardiovascular, Boston, Massachusetts. https://twitter.com/JonWCunningham
| | - Muthiah Vaduganathan
- Brigham and Women's Hospital, Division of Cardiovascular, Boston, Massachusetts. https://twitter.com/mvaduganathan
| | - Brian L Claggett
- Brigham and Women's Hospital, Division of Cardiovascular, Boston, Massachusetts
| | - Michael R Zile
- RHJ Department of Veterans Affairs Medical Center and Medical University of South Carolina, Charleston, South Carolina
| | - Inder S Anand
- VA Medical Center and University of Minnesota, Minneapolis, Minnesota
| | | | - Faiez Zannad
- Centre d'Investigations Cliniques-Plurithématique 1433, and INSERM U1116, CHRU, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| | - Carolyn S P Lam
- National Heart Centre Singapore and Duke-National University of Singapore, Singapore; Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; The George Institute for Global Health, Australia
| | - Stefan Janssens
- Department of Cardiology, University Hospitals, Leuven, Belgium
| | - Pardeep S Jhund
- BHF Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Lars Kober
- Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Jean Rouleau
- Montreal Heart Institute and Université de Montréal, Montreal, Canada
| | - Sanjiv J Shah
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Vijay K Chopra
- Heart Failure Unit, Medanta Medicity, Gurugram, Haryana, India
| | | | | | | | - Marc A Pfeffer
- Brigham and Women's Hospital, Division of Cardiovascular, Boston, Massachusetts
| | - John J V McMurray
- BHF Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Scott D Solomon
- Brigham and Women's Hospital, Division of Cardiovascular, Boston, Massachusetts.
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Ferreira JP, Dewan P, Jhund PS, Lorenzo-Almorós A, Duarte K, Petrie MC, Carson PE, McKelvie R, Komajda M, Zile M, Zannad F, McMurray JJV. Covariate adjusted reanalysis of the I-Preserve trial. Clin Res Cardiol 2020; 109:1358-1365. [DOI: 10.1007/s00392-020-01632-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 03/11/2020] [Indexed: 11/24/2022]
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19
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Lunney M, Ruospo M, Natale P, Quinn RR, Ronksley PE, Konstantinidis I, Palmer SC, Tonelli M, Strippoli GFM, Ravani P. Pharmacological interventions for heart failure in people with chronic kidney disease. Cochrane Database Syst Rev 2020; 2:CD012466. [PMID: 32103487 PMCID: PMC7044419 DOI: 10.1002/14651858.cd012466.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Approximately half of people with heart failure have chronic kidney disease (CKD). Pharmacological interventions for heart failure in people with CKD have the potential to reduce death (any cause) or hospitalisations for decompensated heart failure. However, these interventions are of uncertain benefit and may increase the risk of harm, such as hypotension and electrolyte abnormalities, in those with CKD. OBJECTIVES This review aims to look at the benefits and harms of pharmacological interventions for HF (i.e., antihypertensive agents, inotropes, and agents that may improve the heart performance indirectly) in people with HF and CKD. SEARCH METHODS We searched the Cochrane Kidney and Transplant Register of Studies through 12 September 2019 in consultation with an Information Specialist and using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. SELECTION CRITERIA We included randomised controlled trials of any pharmacological intervention for acute or chronic heart failure, among people of any age with chronic kidney disease of at least three months duration. DATA COLLECTION AND ANALYSIS Two authors independently screened the records to identify eligible studies and extracted data on the following dichotomous outcomes: death, hospitalisations, worsening heart failure, worsening kidney function, hyperkalaemia, and hypotension. We used random effects meta-analysis to estimate treatment effects, which we expressed as a risk ratio (RR) with 95% confidence intervals (CI). We assessed the risk of bias using the Cochrane tool. We applied the GRADE methodology to rate the certainty of evidence. MAIN RESULTS One hundred and twelve studies met our selection criteria: 15 were studies of adults with CKD; 16 studies were conducted in the general population but provided subgroup data for people with CKD; and 81 studies included individuals with CKD, however, data for this subgroup were not provided. The risk of bias in all 112 studies was frequently high or unclear. Of the 31 studies (23,762 participants) with data on CKD patients, follow-up ranged from three months to five years, and study size ranged from 16 to 2916 participants. In total, 26 studies (19,612 participants) reported disaggregated and extractable data on at least one outcome of interest for our review and were included in our meta-analyses. In acute heart failure, the effects of adenosine A1-receptor antagonists, dopamine, nesiritide, or serelaxin on death, hospitalisations, worsening heart failure or kidney function, hyperkalaemia, hypotension or quality of life were uncertain due to sparse data or were not reported. In chronic heart failure, the effects of angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB) (4 studies, 5003 participants: RR 0.85, 95% CI 0.70 to 1.02; I2 = 78%; low certainty evidence), aldosterone antagonists (2 studies, 34 participants: RR 0.61 95% CI 0.06 to 6.59; very low certainty evidence), and vasopressin receptor antagonists (RR 1.26, 95% CI 0.55 to 2.89; 2 studies, 1840 participants; low certainty evidence) on death (any cause) were uncertain. Treatment with beta-blockers may reduce the risk of death (any cause) (4 studies, 3136 participants: RR 0.69, 95% CI 0.60 to 0.79; I2 = 0%; moderate certainty evidence). Treatment with ACEi or ARB (2 studies, 1368 participants: RR 0.90, 95% CI 0.43 to 1.90; I2 = 97%; very low certainty evidence) had uncertain effects on hospitalisation for heart failure, as treatment estimates were consistent with either benefit or harm. Treatment with beta-blockers may decrease hospitalisation for heart failure (3 studies, 2287 participants: RR 0.67, 95% CI 0.43 to 1.05; I2 = 87%; low certainty evidence). Aldosterone antagonists may increase the risk of hyperkalaemia compared to placebo or no treatment (3 studies, 826 participants: RR 2.91, 95% CI 2.03 to 4.17; I2 = 0%; low certainty evidence). Renin inhibitors had uncertain risks of hyperkalaemia (2 studies, 142 participants: RR 0.86, 95% CI 0.49 to 1.49; I2 = 0%; very low certainty). We were unable to estimate whether treatment with sinus node inhibitors affects the risk of hyperkalaemia, as there were few studies and meta-analysis was not possible. Hyperkalaemia was not reported for the CKD subgroup in studies investigating other therapies. The effects of ACEi or ARB, or aldosterone antagonists on worsening heart failure or kidney function, hypotension, or quality of life were uncertain due to sparse data or were not reported. Effects of anti-arrhythmic agents, digoxin, phosphodiesterase inhibitors, renin inhibitors, sinus node inhibitors, vasodilators, and vasopressin receptor antagonists were very uncertain due to the paucity of studies. AUTHORS' CONCLUSIONS The effects of pharmacological interventions for heart failure in people with CKD are uncertain and there is insufficient evidence to inform clinical practice. Study data for treatment outcomes in patients with heart failure and CKD are sparse despite the potential impact of kidney impairment on the benefits and harms of treatment. Future research aimed at analysing existing data in general population HF studies to explore the effect in subgroups of patients with CKD, considering stage of disease, may yield valuable insights for the management of people with HF and CKD.
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Affiliation(s)
- Meaghan Lunney
- University of CalgaryDepartment of Community Health Sciences3330 Hospital Drive NWCalgaryAlbertaCanadaT2N 4N1
| | - Marinella Ruospo
- The University of SydneySydney School of Public HealthSydneyAustralia
- University of BariDepartment of Emergency and Organ TransplantationBariItaly
| | - Patrizia Natale
- The University of SydneySydney School of Public HealthSydneyAustralia
- University of BariDepartment of Emergency and Organ TransplantationBariItaly
| | - Robert R Quinn
- University of CalgaryDepartment of Community Health Sciences3330 Hospital Drive NWCalgaryAlbertaCanadaT2N 4N1
- Cumming School of Medicine, University of CalgaryDepartment of MedicineCalgaryCanada
| | - Paul E Ronksley
- University of CalgaryDepartment of Community Health Sciences3330 Hospital Drive NWCalgaryAlbertaCanadaT2N 4N1
| | - Ioannis Konstantinidis
- University of Pittsburgh Medical CenterDepartment of Medicine3459 Fifth AvenuePittsburghPAUSA15213
| | - Suetonia C Palmer
- Christchurch Hospital, University of OtagoDepartment of Medicine, NephrologistChristchurchNew Zealand
| | - Marcello Tonelli
- Cumming School of Medicine, University of CalgaryDepartment of MedicineCalgaryCanada
| | - Giovanni FM Strippoli
- The University of SydneySydney School of Public HealthSydneyAustralia
- University of BariDepartment of Emergency and Organ TransplantationBariItaly
- The Children's Hospital at WestmeadCochrane Kidney and Transplant, Centre for Kidney ResearchWestmeadNSWAustralia2145
| | - Pietro Ravani
- University of CalgaryDepartment of Community Health Sciences3330 Hospital Drive NWCalgaryAlbertaCanadaT2N 4N1
- Cumming School of Medicine, University of CalgaryDepartment of MedicineCalgaryCanada
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Ostovaneh MR, Moazzami K, Yoneyama K, A Venkatesh B, Heckbert SR, Wu CO, Shea S, Post WS, Fitzpatrick AL, Burke GL, Bahrami H, Sanchez OA, Daniels LB, Michos ED, Bluemke DA, Lima JAC. Change in NT-proBNP (N-Terminal Pro-B-Type Natriuretic Peptide) Level and Risk of Dementia in Multi-Ethnic Study of Atherosclerosis (MESA). Hypertension 2019; 75:316-323. [PMID: 31865797 DOI: 10.1161/hypertensionaha.119.13952] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cross-sectionally measured NT-proBNP (N-terminal pro-B-type natriuretic peptide) is related to incident dementia. However, data linking changes in NT-proBNP to risk of future dementia are lacking. We aimed to examine the association of change in NT-proBNP over 3.2 years with incident dementia. We included 4563 participants in MESA (Multi-Ethnic Study of Atherosclerosis) prospective cohort who were free of cardiovascular disease at enrollment, had NT-proBNP level measured at MESA exams 1 (baseline, 2000-2002) and 3 (2004-2005), and had no diagnosis of dementia before exam 3. The association of change in NT-proBNP level between MESA exams 1 through 3 and all-cause hospitalized dementia (by International Classification of Diseases, Ninth Revision, codes) after MESA exam 3 (2004-2005) through 2015 was assessed using competing-risks Cox proportional hazard regression analysis. During 45 522 person-years of follow-up, 223 dementia cases were documented. Increase in log-NT-proBNP from MESA exams 1 through 3 was positively associated with incidence of dementia (multivariable hazard ratio, 1.28 [95% CI, 1.001-1.64]; P=0.049). An increase of at least 25% in NT-proBNP level from MESA exam 1 through 3 was associated with a 55% (P=0.02) increase in the risk of dementia in multivariable analysis. Addition of temporal NT-proBNP change to a model including risk factors and baseline NT-proBNP improved the prediction of dementia (Harrell C statistic from 0.85 to 0.87, P=0.049). Increase in NT-proBNP is independently associated with future all-cause hospitalized dementia and offers a moderately better predictive performance for risk of dementia compared with risk factors and baseline NT-proBNP. Clinical Trial Registration- URL: https://www.clinicaltrials.gov. Unique identifier: NCT00005487.
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Affiliation(s)
- Mohammad R Ostovaneh
- From the Division of Cardiology, Johns Hopkins University, Baltimore, MD (M.R.O., K.M., K.Y., B.A.V., W.S.P., E.D.M., J.A.C.L.).,Department of Medicine, Penn State College of Medicine, Hershey, PA (M.R.O.)
| | - Kasra Moazzami
- From the Division of Cardiology, Johns Hopkins University, Baltimore, MD (M.R.O., K.M., K.Y., B.A.V., W.S.P., E.D.M., J.A.C.L.).,Department of Cardiology, Emory University, Atlanta, GA (K.M.)
| | - Kihei Yoneyama
- From the Division of Cardiology, Johns Hopkins University, Baltimore, MD (M.R.O., K.M., K.Y., B.A.V., W.S.P., E.D.M., J.A.C.L.).,St. Marianna University School of Medicine, Kawasaki, Japan (K.Y.)
| | - Bharath A Venkatesh
- From the Division of Cardiology, Johns Hopkins University, Baltimore, MD (M.R.O., K.M., K.Y., B.A.V., W.S.P., E.D.M., J.A.C.L.)
| | - Susan R Heckbert
- Departments of Epidemiology (S.R.H.), University of Washington, Seattle
| | - Colin O Wu
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, Bethesda, MD (C.O.W.)
| | - Steven Shea
- Departments of Medicine (S.S.), Columbia University, New York, NY.,Epidemiology (S.S.), Columbia University, New York, NY
| | - Wendy S Post
- From the Division of Cardiology, Johns Hopkins University, Baltimore, MD (M.R.O., K.M., K.Y., B.A.V., W.S.P., E.D.M., J.A.C.L.)
| | - Annette L Fitzpatrick
- Family Medicine (A.L.F.), University of Washington, Seattle.,Epidemiology and Global Health (A.L.F.), University of Washington, Seattle
| | - Gregory L Burke
- Division of Public Health Sciences, Wake Forest University, Winston-Salem, NC (G.L.B.)
| | - Hossein Bahrami
- Division of Cardiovascular Medicine, University of Southern California, Los Angles, CA (H.B.)
| | | | - Lori B Daniels
- Department of Medicine, Division of Cardiovascular Medicine, University of California, San Diego (L.B.D.)
| | - Erin D Michos
- From the Division of Cardiology, Johns Hopkins University, Baltimore, MD (M.R.O., K.M., K.Y., B.A.V., W.S.P., E.D.M., J.A.C.L.)
| | - David A Bluemke
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison (D.A.B.)
| | - João A C Lima
- From the Division of Cardiology, Johns Hopkins University, Baltimore, MD (M.R.O., K.M., K.Y., B.A.V., W.S.P., E.D.M., J.A.C.L.)
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21
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Long-term Prognostic Value of Estimated Plasma Volume in Heart Failure with Preserved Ejection Fraction. Sci Rep 2019; 9:14369. [PMID: 31591412 PMCID: PMC6779908 DOI: 10.1038/s41598-019-50427-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 08/28/2019] [Indexed: 12/12/2022] Open
Abstract
Plasma volume, estimated by several indirect methods, has been viewed as a biological surrogate for intravascular fluid status. The clinical implication of estimated plasma volume status (ePVS) for long term outcomes in heart failure with preserved ejection fraction (HFpEF) remains unclear. We investigate the prognostic value of ePVS calculated by Strauss formula and its association with cardiovascular events and mortality in a prospective HFpEF cohort. There were 449 individuals met the inclusion criteria of our cohort. Estimated plasma volume variation (ΔePVS) and its instantaneous derivatives were calculated by the Strauss formula. Our study endpoints were events of heart failure hospitalization and mortality. Kaplan–Meier estimates and Cox regression analysis were applied to determine the power of ΔePVS and baseline ePVS in predicting long term cardiovascular outcomes. Both baseline ePVS and ΔePVS were independent predictors of heart failure hospitalization and mortality. Kaplan-Meier estimates of these outcomes stratified by optimal cut-off value showed that HFpEF individuals with higher baseline ePVS and ΔePVS were associated with elevated risk of composite endpoint of heart failure hospitalization and mortality. This study demonstrated the prognostic value of a novel biological surrogate, instantaneous derivatives ePVS, in predicting long term cardiovascular outcomes in HFpEF population. Monitoring instantaneous plasma volume may assist in identifying patients at high risk for future cardiovascular events. Further prospective studies validating the role of ePVS in predicting long-term prognosis in patients with HFpEF are warranted.
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22
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Perera K, Ademi Z, Liew D, Zomer E. Sacubitril-valsartan versus enalapril for acute decompensated heart failure: a cost-effectiveness analysis. Eur J Prev Cardiol 2019; 28:966-972. [DOI: 10.1177/2047487319878953] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 09/08/2019] [Indexed: 11/16/2022]
Abstract
Abstract
Background
The Comparison of Sacubitril–Valsartan versus Enalapril on Effect on NT-proBNP in Patients Stabilised from an Acute Heart Failure Episode (PIONEER-HF) trial demonstrated significant reductions in N-terminal pro-B-type natriuretic peptide. Our study explored the cost-effectiveness of the use of sacubitril-valsartan versus enalapril in acute decompensated heart failure from the Australian healthcare perspective.
Methods
A Markov model was designed using data from the PIONEER-HF trial to model the clinical progress and costs of patients over a lifetime time horizon. The model consisted of three health states: ‘alive and event-free’, ‘alive after non-fatal hospitalisation for acute decompensated heart failure’ or ‘dead’. Costs and utilities were estimated from published sources. The cost of sacubitril-valsartan (per the Australian pharmaceutical benefits schedule) was AU$7.08/day. Outcomes of interest were the incremental cost-effectiveness ratios in terms of cost per quality-adjusted life year gained and cost per year of life saved. Cost and benefits were discounted at 5.0% per annum.
Results
Compared to enalapril, sacubitril-valsartan was estimated to cost an additional AU$7464 (discounted) per person, but lead to 0.127 years of life saved (discounted) and 0.096 quality-adjusted life years gained (discounted) over a lifetime analysis. These equated to incremental cost-effectiveness ratios of AU$58,629/year of life saved (US$41,795, EU€58,629, GBP£32,001) and AU$77,889/quality-adjusted life year gained (US$55,526, EU€49,202, GBP£42,504). We have assumed a threshold of AU$50,000/quality-adjusted life year gained to suggest cost-effectiveness.
Conclusions
At its current acquisition price, sacubitril-valsartan in comparison to enalapril is not likely to be cost-effective in the management of acute decompensated heart failure in Australia. A price reduction of more than 25% would confer cost-effectiveness.
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Affiliation(s)
- Kanila Perera
- School of Public Health and Preventive Medicine, Monash University, Australia
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Australia
| | - Ella Zomer
- School of Public Health and Preventive Medicine, Monash University, Australia
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23
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Mueller C, McDonald K, de Boer RA, Maisel A, Cleland JG, Kozhuharov N, Coats AJ, Metra M, Mebazaa A, Ruschitzka F, Lainscak M, Filippatos G, Seferovic PM, Meijers WC, Bayes‐Genis A, Mueller T, Richards M, Januzzi JL. Heart Failure Association of the European Society of Cardiology practical guidance on the use of natriuretic peptide concentrations. Eur J Heart Fail 2019; 21:715-731. [DOI: 10.1002/ejhf.1494] [Citation(s) in RCA: 250] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/04/2019] [Accepted: 04/23/2019] [Indexed: 12/11/2022] Open
Affiliation(s)
- Christian Mueller
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB)University Hospital Basel, University of Basel Basel Switzerland
| | - Kenneth McDonald
- Department of CardiologySt. Vincent's University Hospital Dublin Ireland
| | - Rudolf A. de Boer
- University of Groningen, University Medical CenterGroningen, Department of Cardiology The Netherlands
| | | | - John G.F. Cleland
- Robertson Institute of Biostatistics and Clinical Trials UnitUniversity of Glasgow Glasgow UK
| | - Nikola Kozhuharov
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB)University Hospital Basel, University of Basel Basel Switzerland
| | - Andrew J.S. Coats
- University of Warwick Coventry UK
- Monash University Melbourne Australia
- Pharmacology, Centre of Clinical and Experimental Medicine, San Raffaele Pisana Scientific Institute Rome Italy
| | - Marco Metra
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of Brescia Brescia Italy
| | - Alexandre Mebazaa
- Université de Paris, APHP Département d'Anethésie‐Réanimation Hôpitaux Universitaires Saint Louis Lariboisière Paris France
| | - Frank Ruschitzka
- Department of Cardiology, University Heart CentreUniversity Hospital Zurich Zurich Switzerland
| | - Mitja Lainscak
- Department of Internal MedicineGeneral Hospital Murska Sobota Murska Sobota Slovenia
- Faculty of MedicineUniversity of Ljubljana Slovenia
| | - Gerasimos Filippatos
- Department of Cardiology, Athens University Hospital AttikonUniversity of Athens Greece
- University of CyprusMedical School Nicosia Cyprus
| | | | - Wouter C. Meijers
- University of Groningen, University Medical CenterGroningen, Department of Cardiology The Netherlands
| | - Antoni Bayes‐Genis
- Heart InstituteHospital Universitari Germans Trias i Pujol, CIBERCV Barcelona Spain
- Department of MedicineAutonomous University of Barcelona Barcelona Spain
| | - Thomas Mueller
- Department of Clinical PathologyHospital of Bolzano Bolzano Italy
| | - Mark Richards
- Christchurch Heart InstituteUinversity of Otago New Zealand
- Cardiovascular Research InstituteNational University of Singapore Singapore
| | - James L. Januzzi
- Cardiology Division of the Department of MedicineMassachusetts General Hospital, Harvard Medical School Boston MA USA
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24
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Hoffmann J, Behnes M, Ansari U, Weidner K, Kuche P, Rusnak J, Kim SH, Natale M, Reckord N, Lang S, Hoffmann U, Bertsch T, Fatar M, Borggrefe M, Akin I. The association of high-sensitivity cardiac troponin I and T with echocardiographic stages of heart failure with preserved ejection fraction. Ann Clin Biochem 2019; 56:431-441. [PMID: 31112389 DOI: 10.1177/0004563219841644] [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: 11/16/2022]
Abstract
Background This study evaluates the associations between high-sensitivity troponin I and T (hs-TnI/hs-TnT) and the stages of heart failure with preserved ejection fraction (HFpEF)/diastolic dysfunction. Methods Blood samples for biomarker measurements (hs-TnI/hs-TnT/NT-proBNP) were collected within 24 h of routine echocardiographic examination. Patients with left ventricular ejection fraction <50%, right ventricular dysfunction and moderate-to-severe valvular heart disease were excluded. Graduation of diastolic dysfunction was determined according to current guidelines. Results A total of 70 patients were included. Hs-TnT concentrations increased significantly according to the progression of diastolic dysfunction ( P = 0.024). Hs-TnT was able to discriminate patients with diastolic dysfunction grade III (AUC = 0.737; P = 0.013), while NT-proBNP revealed a greater AUC (AUC 0.798; P = 0.002). Concentrations of hs-TnI increased only numerically according to the increasing stages of diastolic dysfunction ( P = 0.353). In multivariable logistic regression models, hs-TnT concentrations > 28 ng/L were associated with diastolic dysfunction grade III (OR = 4.7, P = 0.024), even after adjusting for NT-proBNP. Conclusion Increasing concentrations of hs-TnT may reflect the stages of diastolic dysfunction being assessed by echocardiography, whereas hs-TnI does not show any association with diastolic dysfunction.
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Affiliation(s)
- Julia Hoffmann
- 1 First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Michael Behnes
- 1 First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Uzair Ansari
- 1 First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Kathrin Weidner
- 1 First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Philip Kuche
- 1 First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Jonas Rusnak
- 1 First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Seung-Hyun Kim
- 1 First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Michele Natale
- 1 First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Nadine Reckord
- 1 First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Siegfried Lang
- 1 First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Ursula Hoffmann
- 1 First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Thomas Bertsch
- 2 Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, General Hospital Nuremberg, Paracelsus Medical University, Germany
| | - Marc Fatar
- 3 Department of Neurology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Martin Borggrefe
- 1 First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- 1 First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, European Center for AngioScience (ECAS) and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany
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Change in N-terminal pro B-type natriuretic peptide levels and clinical outcomes in children undergoing congenital heart surgery. Int J Cardiol 2019; 283:96-100. [DOI: 10.1016/j.ijcard.2019.02.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 01/31/2019] [Accepted: 02/13/2019] [Indexed: 11/20/2022]
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Tripoliti EE, Ioannidou P, Toumpaniaris P, Rammos A, Pacitto D, Lourme JC, Goletsis Y, Naka KK, Errachid A, Fotiadis DI. Point-of-Care Testing Devices for Heart Failure Analyzing Blood and Saliva Samples. IEEE Rev Biomed Eng 2019; 13:17-31. [PMID: 30892234 DOI: 10.1109/rbme.2019.2905730] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Heart failure (HF) is the most rapidly growing cardiovascular condition with an estimated prevalence of >37.7 million individuals globally. HF is associated with increased mortality and morbidity and confers a substantial burden, in terms of cost and quality of life, for the individuals and the healthcare systems, highlighting thus the need for early and accurate diagnosis of HF. The accuracy of HF diagnosis, severity estimation, and prediction of adverse events has improved by the utilization of blood tests measuring biomarkers. The contribution of biomarkers for HF management is intensified by the fact that they can be measured in short time at the point-of-care. This is allowed by the development of portable analytical devices, commonly known as point-of-care testing (POCT) devices, which exploit the advancements in the area of microfluidics and nanotechnology. The aim of this review paper is to present a review of POCT devices used for the measurement of biomarkers facilitating decision making when managing HF patients. The devices are either commercially available or in the form of prototypes under development. Both blood and saliva samples are considered. The challenges concerning the implementation of POCT devices and the barriers for their adoption in clinical practice are discussed.
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Voors AA, Shah SJ, Bax JJ, Butler J, Gheorghiade M, Hernandez AF, Kitzman DW, McMurray JJV, Wirtz AB, Lanius V, van der Laan M, Solomon SD. Rationale and design of the phase 2b clinical trials to study the effects of the partial adenosine A1-receptor agonist neladenoson bialanate in patients with chronic heart failure with reduced (PANTHEON) and preserved (PANACHE) ejection fraction. Eur J Heart Fail 2018; 20:1601-1610. [PMID: 30225882 DOI: 10.1002/ejhf.1295] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 06/12/2018] [Accepted: 07/07/2018] [Indexed: 12/28/2022] Open
Abstract
Despite major advances in the treatment of chronic heart failure (HF) with reduced ejection fraction (HFrEF), morbidity and mortality associated with the condition remain high, suggesting the need for additional treatment options, particularly haemodynamically neutral treatments that do not alter blood pressure, heart rate, or renal function. HF with preserved ejection fraction (HFpEF) is also associated with high morbidity and mortality and adequate treatment options are limited; thus there is a critical unmet need for the development of novel therapies for HFpEF. Chronic HFrEF and HFpEF are both systemic disorders that affect not only the heart but several other tissues and organs including skeletal muscle, leading to exercise intolerance and dyspnoea. Partial adenosine A1-receptor agonists represent a novel potential therapy for HF regardless of underlying ejection fraction given their minimal effect on heart rate and blood pressure, and preclinical data demonstrate several possible beneficial mechanisms, including improved mitochondrial function and sarcoplasmic reticulum Ca2+ -ATPase (SERCA2a) activity, enhanced energy substrate utilization, reverse ventricular remodelling, and anti-ischemic, cardioprotective properties. However, data on this class of drugs in humans are scarce, and the optimal dose of the partial adenosine A1 receptor, neladenoson bialanate, has not been defined. Here we describe the design and rationale of two randomized, double-blind, placebo-controlled, parallel-group, dose-finding phase 2b trials, PANTHEON (HFrEF) and PANACHE (HFpEF), that will advance our understanding of the potential benefit and optimal dose of neladenoson bialanate and provide critical information for the planning of future phase 3 trials.
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Affiliation(s)
- Adriaan A Voors
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sanjiv J Shah
- Feinberg Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jeroen J Bax
- Leiden University Medical Center, Leiden, The Netherlands
| | - Javed Butler
- Department of Medicine, University of Mississippi, Jackson, MS, USA
| | - Mihai Gheorghiade
- Feinberg Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Dalane W Kitzman
- Department of Internal Medicine, Sections on Cardiovascular Medicine and Geriatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - John J V McMurray
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | | | | | | | - Scott D Solomon
- Division of Cardiology, Brigham and Women's Hospital, Boston, MA, USA
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Jarolim P, White WB, Cannon CP, Gao Q, Morrow DA. Serial Measurement of Natriuretic Peptides and Cardiovascular Outcomes in Patients With Type 2 Diabetes in the EXAMINE Trial. Diabetes Care 2018; 41:1510-1515. [PMID: 29848776 DOI: 10.2337/dc18-0109] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 04/23/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Patients with type 2 diabetes are at increased risk of developing heart failure (HF). Enhanced recognition of patients at risk for HF would help guide therapeutic decisions. RESEARCH DESIGN AND METHODS We investigated the prognostic implications of changes in N-terminal B-type natriuretic peptide (NT-proBNP) concentration in patients with type 2 diabetes and ischemic heart disease who were enrolled in the Examination of Cardiovascular Outcomes with Alogliptin versus Standard of Care (EXAMINE) trial, a phase 3b trial of alogliptin, a dipeptidyl peptidase 4 (DPP-4) inhibitor. Patients with type 2 diabetes and a recent acute coronary syndrome event were eligible. NT-proBNP was measured at baseline and 6 months. Cardiovascular (CV) death or hospitalization for HF was the end point of principal interest for this analysis. RESULTS We observed a strong graded relationship between increasing baseline and 6-month NT-proBNP concentration and the incidence of major CV events (P < 0.001). After adjusting for potential confounders, NT-proBNP at baseline was independently associated with the development of major CV events, in particular hospitalization for HF. Patients who had persistently high NT-proBNP (P < 0.001) or developed high NT-proBNP at 6 months (P < 0.001) were at a significantly higher risk for CV death/HF than those in whom NT-proBNP remained low at both time points or who had a high NT-proBNP value at baseline that subsequently declined to the low category. Absolute changes in NT-proBNP by 6 months were also strongly associated with subsequent outcomes. Treatment with a DPP-4 inhibitor did not meaningfully alter NT-proBNP concentrations (P = 0.20). CONCLUSIONS Serial monitoring of NT-proBNP in patients with type 2 diabetes and ischemic heart disease may be useful for identifying patients at highest risk for HF.
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Affiliation(s)
- Petr Jarolim
- Department of Pathology, Brigham and Women's Hospital, Boston, MA .,Harvard Medical School, Boston, MA
| | - William B White
- Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, CT
| | - Christopher P Cannon
- Division of Cardiology and the TIMI Study Group, Brigham and Women's Hospital, Boston, MA.,Baim Institute for Clinical Research, Boston, MA
| | - Qi Gao
- Baim Institute for Clinical Research, Boston, MA
| | - David A Morrow
- Harvard Medical School, Boston, MA.,Division of Cardiology and the TIMI Study Group, Brigham and Women's Hospital, Boston, MA
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Persson H, Donal E, Lund LH, Matan D, Oger E, Hage C, Daubert JC, Linde C. Importance of structural heart disease and diastolic dysfunction in heart failure with preserved ejection fraction assessed according to the ESC guidelines - A substudy in the Ka (Karolinska) Ren (Rennes) study. Int J Cardiol 2018; 274:202-207. [PMID: 30049496 DOI: 10.1016/j.ijcard.2018.06.078] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 03/27/2018] [Accepted: 06/18/2018] [Indexed: 12/28/2022]
Abstract
AIMS To study prevalence and prognostic importance of diagnostic echocardiographic variables in patients with suspected heart failure with preserved ejection fraction (HFpEF) in the prospective KaRen register study. METHODS AND RESULTS KaRen patients were included following an acute HF-presentation, using Framingham criteria, B-type natriuretic peptide (BNP) >100 ng/L or N-terminal pro-BNP (NT-pro-BNP) >300 ng/L, and left ventricular (LV) ejection fraction ≥45%. Echocardiography was performed after 4-8 weeks and analyzed at a core laboratory. In this substudy HFpEF was diagnosed according to the ESC guidelines for heart failure 2016. A total of 539 patients were included with a follow-up after 4-8 weeks in 438 patients. Complete echocardiography and ECG were available in 356 patients. At least two abnormal echocardiographic criteria for HFpEF were found in 94% (n = 333). Echocardiographic signs of structural heart disease and diastolic dysfunction according to 4 criteria by ESC were found in 76% (n = 270). Diastolic dysfunction was graded as mild in 30% (n = 107), moderate in 27% (n = 97) or severe in 35% (n = 124). After multivariate analyses with adjustment for age, gender, EF and natriuretic peptides we found two independent predictors of worse prognosis: presence of moderate and severe diastolic dysfunction (HR 1.8, CI 1.2-2.7, p = 0.0037) and presence of a high number (≥4) of abnormal diastolic parameters (HR 2.0, CI 1.3-3.1, p = 0.0033). CONCLUSION The majority of KaRen patients with suspected HFpEF had diagnostic echocardiographic criteria for HFpEF according to ESC Guidelines. Our findings support using 2016 ESC HF guidelines for risk prediction in HFpEF.
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Affiliation(s)
- Hans Persson
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, 182 88 Stockholm, Sweden
| | - Erwan Donal
- University Hospital of Rennes, Departemente de Cardiologie & CIC-IT U 804, Rennes, France; Clinical Investigation Centre of Rennes, INSERM CIC-0203, CHU de Rennes, Rennes, France
| | - Lars H Lund
- Karolinska Institutet, Karolinska University Hospital, Heart and Vascular Theme, 171 76 Stockholm, Sweden
| | - Dmitri Matan
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, 182 88 Stockholm, Sweden.
| | - Emmanuel Oger
- Clinical Investigation Centre of Rennes, INSERM CIC-0203, CHU de Rennes, Rennes, France
| | - Camilla Hage
- Karolinska Institutet, Karolinska University Hospital, Heart and Vascular Theme, 171 76 Stockholm, Sweden
| | - Jean-Claude Daubert
- University Hospital of Rennes, Departemente de Cardiologie & CIC-IT U 804, Rennes, France
| | - Cecilia Linde
- Karolinska Institutet, Karolinska University Hospital, Heart and Vascular Theme, 171 76 Stockholm, Sweden
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Oikonomou E, Vogiatzi G, Tsalamandris S, Mourouzis K, Siasos G, Lazaros G, Skotsimara G, Marinos G, Vavuranakis M, Tousoulis D. Non-natriuretic peptide biomarkers in heart failure with preserved and reduced ejection fraction. Biomark Med 2018; 12:783-797. [PMID: 29865857 DOI: 10.2217/bmm-2017-0376] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Heart failure (HF) with reduced and preserved ejection fraction constitutes two entities with distinct pathogenetic backgrounds sharing common features. Beyond natriuretic peptides, several novel biomarkers have been proven useful in the diagnosis, prognosis and treatment of HF. Biomarkers of myocardial fibrosis have a low diagnostic yield in subjects with acute HF but may add prognostic information, especially in patients with HF and preserved ejection fraction. Biomarkers of renal impairment identify subjects with worse prognosis independently of left ventricle ejection fraction while inflammatory markers have not been proven useful in patients with systolic or diastolic impairment. In this review article, we summarize the main differences and application of non-natriuretic peptide biomarkers in HF patients with preserved and reduced ejection fraction.
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Affiliation(s)
- Evangelos Oikonomou
- Department of Cardiology, 'Hippokration' Hospital, University of Athens Medical School, Athens, 11528, Greece
| | - Georgia Vogiatzi
- Department of Cardiology, 'Hippokration' Hospital, University of Athens Medical School, Athens, 11528, Greece
| | - Sotiris Tsalamandris
- Department of Cardiology, 'Hippokration' Hospital, University of Athens Medical School, Athens, 11528, Greece
| | - Konstantinos Mourouzis
- Department of Cardiology, 'Hippokration' Hospital, University of Athens Medical School, Athens, 11528, Greece
| | - Gerasimos Siasos
- Department of Cardiology, 'Hippokration' Hospital, University of Athens Medical School, Athens, 11528, Greece
| | - George Lazaros
- Department of Cardiology, 'Hippokration' Hospital, University of Athens Medical School, Athens, 11528, Greece
| | - Georgia Skotsimara
- Department of Cardiology, 'Hippokration' Hospital, University of Athens Medical School, Athens, 11528, Greece
| | - George Marinos
- Department of Cardiology, 'Hippokration' Hospital, University of Athens Medical School, Athens, 11528, Greece
| | - Manolis Vavuranakis
- Department of Cardiology, 'Hippokration' Hospital, University of Athens Medical School, Athens, 11528, Greece
| | - Dimitris Tousoulis
- Department of Cardiology, 'Hippokration' Hospital, University of Athens Medical School, Athens, 11528, Greece
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31
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Michalska-Kasiczak M, Bielecka-Dabrowa A, von Haehling S, Anker SD, Rysz J, Banach M. Biomarkers, myocardial fibrosis and co-morbidities in heart failure with preserved ejection fraction: an overview. Arch Med Sci 2018; 14:890-909. [PMID: 30002709 PMCID: PMC6040115 DOI: 10.5114/aoms.2018.76279] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 04/24/2018] [Indexed: 02/06/2023] Open
Abstract
The prevalence of heart failure with preserved ejection fraction (HFpEF) is steadily increasing. Its diagnosis remains difficult and controversial and relies mostly on non-invasive echocardiographic detection of left ventricular diastolic dysfunction and elevated filling pressures. The large phenotypic heterogeneity of HFpEF from pathophysiologic al underpinnings to clinical manifestations presents a major obstacle to the development of new therapies targeted towards specific HF phenotypes. Recent studies suggest that natriuretic peptides have the potential to improve the diagnosis of early HFpEF, but they still have significant limitations, and the cut-off points for diagnosis and prognosis in HFpEF remain open to debate. The purpose of this review is to present potential targets of intervention in patients with HFpEF, starting with myocardial fibrosis and methods of its detection. In addition, co-morbidities are discussed as a means to treat HFpEF according to cut-points of biomarkers that are different from usual. Biomarkers and approaches to co-morbidities may be able to tailor therapies according to patients' pathophysiological needs. Recently, soluble source of tumorigenicity 2 (sST2), growth differentiation factor 15 (GDF-15), galectin-3, and other cardiac markers have emerged, but evidence from large cohorts is still lacking. Furthermore, the field of miRNA is a very promising area of research, and further exploration of miRNA may offer diagnostic and prognostic applications and insight into the pathology, pointing to new phenotype-specific therapeutic targets.
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Affiliation(s)
- Marta Michalska-Kasiczak
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland
- Department of Endocrine Disorders and Bone Metabolism, 1 Chair of Endocrinology, Medical University of Lodz, Lodz, Poland
| | - Agata Bielecka-Dabrowa
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland
- Department of Cardiology and Congenital Diseases of Adults, Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
| | - Stefan D. Anker
- Division of Cardiology and Metabolism – Heart Failure, Cachexia and Sarcopenia, Department of Cardiology, Campus Virchow-Klinikum, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jacek Rysz
- Department of Nephrology, Hypertension and Family Medicine, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland
| | - Maciej Banach
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland
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32
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Savarese G, Orsini N, Hage C, Dahlström U, Vedin O, Rosano GM, Lund LH. Associations With and Prognostic and Discriminatory Role of N-Terminal Pro–B-Type Natriuretic Peptide in Heart Failure With Preserved Versus Mid-range Versus Reduced Ejection Fraction. J Card Fail 2018; 24:365-374. [DOI: 10.1016/j.cardfail.2018.03.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 01/22/2018] [Accepted: 03/20/2018] [Indexed: 11/26/2022]
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Tousoulis D. Novel biomarkers in heart failure: How they change clinical decision? Hellenic J Cardiol 2017; 58:317-319. [DOI: 10.1016/j.hjc.2017.11.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 10/12/2017] [Indexed: 01/20/2023] Open
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Ferreira JP, Duarte K, Graves TL, Zile MR, Abraham WT, Weaver FA, Lindenfeld J, Zannad F. Natriuretic Peptides, 6-Min Walk Test, and Quality-of-Life Questionnaires as Clinically Meaningful Endpoints in HF Trials. J Am Coll Cardiol 2017; 68:2690-2707. [PMID: 27978953 DOI: 10.1016/j.jacc.2016.09.936] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 09/06/2016] [Accepted: 09/19/2016] [Indexed: 11/29/2022]
Abstract
The Expedited Access for Premarket Approval and De Novo Medical Devices Intended for Unmet Medical Need for Life Threatening or Irreversibly Debilitating Diseases or Conditions document was issued as a guidance for industry and for the Food and Drug Administration. The Expedited Access Pathway was designed as a new program for medical devices that demonstrated the potential to address unmet medical needs for life threatening or irreversibly debilitating conditions. The Food and Drug Administration would consider assessments of a device's effect on intermediate endpoints that, when improving in a congruent fashion, are reasonably likely to predict clinical benefit. The purpose of this review is to provide evidence to support the use of 3 such intermediate endpoints: natriuretic peptides, such as N-terminal pro-B-type natriuretic peptide/B-type natriuretic peptide, the 6-min walk test distance, and health-related quality of life in heart failure.
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Affiliation(s)
- João Pedro Ferreira
- INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France
| | - Kevin Duarte
- INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France
| | | | - Michael R Zile
- Medical University of South Carolina and the RHJ Department of Veterans Affairs Medical Center, Charleston, South Carolina
| | | | - Fred A Weaver
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Southern California, Los Angeles, California
| | | | - Faiez Zannad
- INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France.
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35
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Wolsk E, Claggett B, Pfeffer MA, Diaz R, Dickstein K, Gerstein HC, Lawson FC, Lewis EF, Maggioni AP, McMurray JJV, Probstfield JL, Riddle MC, Solomon SD, Tardif JC, Køber L. Role of B-Type Natriuretic Peptide and N-Terminal Prohormone BNP as Predictors of Cardiovascular Morbidity and Mortality in Patients With a Recent Coronary Event and Type 2 Diabetes Mellitus. J Am Heart Assoc 2017; 6:JAHA.116.004743. [PMID: 28554908 PMCID: PMC5669146 DOI: 10.1161/jaha.116.004743] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Natriuretic peptides are recognized as important predictors of cardiovascular events in patients with heart failure, but less is known about their prognostic importance in patients with acute coronary syndrome. We sought to determine whether B-type natriuretic peptide (BNP) and N-terminal prohormone B-type natriuretic peptide (NT-proBNP) could enhance risk prediction of a broad range of cardiovascular outcomes in patients with acute coronary syndrome and type 2 diabetes mellitus. METHODS AND RESULTS Patients with a recent acute coronary syndrome and type 2 diabetes mellitus were prospectively enrolled in the ELIXA trial (n=5525, follow-up time 26 months). Best risk models were constructed from relevant baseline variables with and without BNP/NT-proBNP. C statistics, Net Reclassification Index, and Integrated Discrimination Index were analyzed to estimate the value of adding BNP or NT-proBNP to best risk models. Overall, BNP and NT-proBNP were the most important predictors of all outcomes examined, irrespective of history of heart failure or any prior cardiovascular disease. BNP significantly improved C statistics when added to risk models for each outcome examined, the strongest increments being in death (0.77-0.82, P<0.001), cardiovascular death (0.77-0.83, P<0.001), and heart failure (0.84-0.87, P<0.001). BNP or NT-proBNP alone predicted death as well as all other variables combined (0.77 versus 0.77). CONCLUSIONS In patients with a recent acute coronary syndrome and type 2 diabetes mellitus, BNP and NT-proBNP were powerful predictors of cardiovascular outcomes beyond heart failure and death, ie, were also predictive of MI and stroke. Natriuretic peptides added as much predictive information about death as all other conventional variables combined. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01147250.
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Affiliation(s)
- Emil Wolsk
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Brian Claggett
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Marc A Pfeffer
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Rafael Diaz
- Estudios Clínicos Latinoamérica, Rosario, Argentina
| | - Kenneth Dickstein
- University of Bergen Stavanger University Hospital, Stavanger, Norway
| | - Hertzel C Gerstein
- Division of Endocrinology & Metabolism, McMaster University, Hamilton, Ontario, Canada
| | | | - Eldrin F Lewis
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Aldo P Maggioni
- Research Center of the Italian Association of Hospital Cardiologists, Florence, Italy
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, United Kingdom
| | | | - Matthew C Riddle
- Division of Endocrinology, Oregon Health and Science University, Portland, OR
| | - Scott D Solomon
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
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36
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Chow SL, Maisel AS, Anand I, Bozkurt B, de Boer RA, Felker GM, Fonarow GC, Greenberg B, Januzzi JL, Kiernan MS, Liu PP, Wang TJ, Yancy CW, Zile MR. Role of Biomarkers for the Prevention, Assessment, and Management of Heart Failure: A Scientific Statement From the American Heart Association. Circulation 2017; 135:e1054-e1091. [PMID: 28446515 DOI: 10.1161/cir.0000000000000490] [Citation(s) in RCA: 357] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND PURPOSE Natriuretic peptides have led the way as a diagnostic and prognostic tool for the diagnosis and management of heart failure (HF). More recent evidence suggests that natriuretic peptides along with the next generation of biomarkers may provide added value to medical management, which could potentially lower risk of mortality and readmissions. The purpose of this scientific statement is to summarize the existing literature and to provide guidance for the utility of currently available biomarkers. METHODS The writing group used systematic literature reviews, published translational and clinical studies, clinical practice guidelines, and expert opinion/statements to summarize existing evidence and to identify areas of inadequacy requiring future research. The panel reviewed the most relevant adult medical literature excluding routine laboratory tests using MEDLINE, EMBASE, and Web of Science through December 2016. The document is organized and classified according to the American Heart Association to provide specific suggestions, considerations, or contemporary clinical practice recommendations. RESULTS A number of biomarkers associated with HF are well recognized, and measuring their concentrations in circulation can be a convenient and noninvasive approach to provide important information about disease severity and helps in the detection, diagnosis, prognosis, and management of HF. These include natriuretic peptides, soluble suppressor of tumorgenicity 2, highly sensitive troponin, galectin-3, midregional proadrenomedullin, cystatin-C, interleukin-6, procalcitonin, and others. There is a need to further evaluate existing and novel markers for guiding therapy and to summarize their data in a standardized format to improve communication among researchers and practitioners. CONCLUSIONS HF is a complex syndrome involving diverse pathways and pathological processes that can manifest in circulation as biomarkers. A number of such biomarkers are now clinically available, and monitoring their concentrations in blood not only can provide the clinician information about the diagnosis and severity of HF but also can improve prognostication and treatment strategies.
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Karlström P, Johansson P, Dahlström U, Boman K, Alehagen U. The impact of time to heart failure diagnosis on outcomes in patients tailored for heart failure treatment by use of natriuretic peptides. Results from the UPSTEP study. Int J Cardiol 2017; 236:315-320. [PMID: 28268084 DOI: 10.1016/j.ijcard.2017.02.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 02/02/2017] [Accepted: 02/15/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Heart failure (HF) is a life-threatening condition and optimal handling is necessary to reduce risk of therapy failure. The impact of the duration of HF diagnosis on HF outcome has not previously been examined. The objectives of this study were (I) to evaluate the impact of patient age on clinical outcomes, (II) to evaluate the impact of duration of the HF disease on outcomes, and (III) to evaluate the impact of age and HF duration on B-type Natriuretic Peptide (BNP) concentration in a population of HF patients. METHODS AND RESULTS In the UPSTEP (Use of PeptideS in Tailoring hEart failure Project) study we retrospectively evaluated how age and HF duration affected HF outcome. HF duration was divided into <1year, 1-5years and >5years. A multivariate Cox proportional hazard regression analysis showed that HF duration influenced outcome more than age, even when adjusted for comorbidities(<1year versus >5years: HR 1.65; 95% CI 1.28-2.14; P<0.0002) on HF mortality and hospitalisations. The influence of age on BNP showed increased BNP as age increased. However, there was a significant effect on BNP concentration when comparing HF duration of less than one year to HF duration to more than five years, even when adjusted for age. CONCLUSIONS Patients with longer HF duration had significantly worse outcome compared to those with short HF duration, even when adjusted for patient age and comorbidities. Age did not influence outcome but had an impact on BNP concentration; however, BNP concentration increased as HF duration increased.
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Affiliation(s)
- Patric Karlström
- Department of Medicine, Division of Cardiology, County Hospital Ryhov, Jönköping, Sweden.
| | - Peter Johansson
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Ulf Dahlström
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Kurt Boman
- Research unit Skellefteå Department of Medicine, Institution of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Urban Alehagen
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Yang W, Zhou YJ, Fu Y, Qin J, Qin S, Chen XM, Guo JC, Wang DZ, Zhan H, Li J, He JY, Hua Q. Efficacy and Safety of Intravenous Urapidil for Older Hypertensive Patients with Acute Heart Failure: A Multicenter Randomized Controlled Trial. Yonsei Med J 2017; 58:105-113. [PMID: 27873502 PMCID: PMC5122625 DOI: 10.3349/ymj.2017.58.1.105] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 07/05/2016] [Accepted: 07/08/2016] [Indexed: 01/06/2023] Open
Abstract
PURPOSE Urapidil is putatively effective for patients with hypertension and acute heart failure, although randomized controlled trials thereon are lacking. We investigated the efficacy and safety of intravenous urapidil relative to that of nitroglycerin in older patients with hypertension and heart failure in a randomized controlled trial. MATERIALS AND METHODS Patients (>60 y) with hypertension and heart failure were randomly assigned to receive intravenous urapidil (n=89) or nitroglycerin (n=91) for 7 days. Hemodynamic parameters, cardiac function, and safety outcomes were compared. RESULTS Patients in the urapidil group had significantly lower mean systolic blood pressure (110.1±6.5 mm Hg) than those given nitroglycerin (126.4±8.1 mm Hg, p=0.022), without changes in heart rate. Urapidil was associated with improved cardiac function as reflected by lower N terminal-pro B type natriuretic peptide after 7 days (3311.4±546.1 ng/mL vs. 4879.1±325.7 ng/mL, p=0.027) and improved left ventricular ejection fraction (62.2±3.4% vs. 51.0±2.4%, p=0.032). Patients given urapidil had fewer associated adverse events, specifically headache (p=0.025) and tachycardia (p=0.004). The one-month rehospitalization and all-cause mortality rates were similar. CONCLUSION Intravenous administration of urapidil, compared with nitroglycerin, was associated with better control of blood pressure and preserved cardiac function, as well as fewer adverse events, for elderly patients with hypertension and acute heart failure.
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Affiliation(s)
- Wei Yang
- Department of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yu Jie Zhou
- Department of Cardiology, An Zhen Hospital affiliated with Capital Medical University, Beijing, China
| | - Yan Fu
- Fu Yan Emergency Department, Tong Ren Hospital affiliated with Capital Medical University, Beijing, China
| | - Jian Qin
- Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Shu Qin
- Department of Cardiology, First Hospital affiliated with Chongqing University, Chongqing, China
| | - Xiao Min Chen
- Department of Cardiology, Ningbo First Hospital, Ningbo, China
| | - Jin Cheng Guo
- Department of Cardiology, Luhe Hospital of Beijing Tongzhou District, Beijing, China
| | - De Zhao Wang
- Department of Cardiology, Mentougou District Hospital of Beijing City, Beijing, China
| | - Hong Zhan
- Emergency Department, First Hospital affiliated with Sun Yat-sen University, Guangzhou, China
| | - Jing Li
- Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jing Yu He
- Emergency Department, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qi Hua
- Department of Cardiology, Xuanwu Hospital, Capital Medical University, Beijing, China.
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Changes in natriuretic peptides after acute hospital presentation for heart failure with preserved ejection fraction: A feasible surrogate trial endpoint? A report from the prospective Karen study. Int J Cardiol 2017; 226:65-70. [DOI: 10.1016/j.ijcard.2016.10.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/08/2016] [Accepted: 10/14/2016] [Indexed: 12/28/2022]
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Hamo CE, Butler J, Gheorghiade M, Chioncel O. The bumpy road to drug development for acute heart failure. Eur Heart J Suppl 2016. [DOI: 10.1093/eurheartj/suw045] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Simioniuc A, Carluccio E, Ghio S, Rossi A, Biagioli P, Reboldi G, Galeotti GG, Lu F, Zara C, Whalley G, Temporelli PL, Dini FL. Echo and natriuretic peptide guided therapy improves outcome and reduces worsening renal function in systolic heart failure: An observational study of 1137 outpatients. Int J Cardiol 2016; 224:416-423. [DOI: 10.1016/j.ijcard.2016.09.034] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 08/29/2016] [Accepted: 09/15/2016] [Indexed: 11/25/2022]
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Farmakis D, Parissis J, Papingiotis G, Lekakis J, Filippatos G. Natriuretic peptides revisited. J Cardiovasc Med (Hagerstown) 2016; 17:840-2. [DOI: 10.2459/jcm.0000000000000447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Correlates of postexercise B-type natriuretic peptide levels in patients with normal left ventricular function and normal coronary arteries. Int J Cardiol 2016; 222:973-974. [DOI: 10.1016/j.ijcard.2016.08.142] [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: 06/14/2016] [Revised: 08/05/2016] [Accepted: 08/06/2016] [Indexed: 11/21/2022]
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Savarese G, Hage C, Orsini N, Dahlström U, Perrone-Filardi P, Rosano GM, Lund LH. Reductions in N-Terminal Pro-Brain Natriuretic Peptide Levels Are Associated With Lower Mortality and Heart Failure Hospitalization Rates in Patients With Heart Failure With Mid-Range and Preserved Ejection Fraction. Circ Heart Fail 2016; 9:CIRCHEARTFAILURE.116.003105. [DOI: 10.1161/circheartfailure.116.003105] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 10/13/2016] [Indexed: 01/15/2023]
Abstract
Background—
In heart failure with mid-range ejection fraction (HFmrEF) and preserved ejection fraction (HFpEF), feasible surrogate end points are needed for phase II trials. The aim was to assess whether a reduction in N-terminal pro–B-type natriuretic peptide (NT-proBNP) is associated with improved mortality/morbidity in an unselected population of HFmrEF and HFpEF patients.
Methods and Results—
In the Swedish Heart Failure Registry, HFmrEF (EF=40%–49%) and HFpEF (EF≥50%) patients reporting at least 2 consecutive outpatient NT-proBNP assessments were prospectively studied. Associations between reduction in NT-proBNP and overall mortality, HF hospitalization, and their composite were assessed by multivariable Cox regressions, with NT-proBNP changes modeled as binary (decrease/increase) or quantitative predictor by restricted cubic splines. In 650 patients, at a median of 7 months between the 2 measurements of NT-proBNP and over a median follow-up of 1.65 years, 361 patients (55%) showed a reduction and 289 patients (45%) an increase in NT-proBNP. Change in NT-proBNP was associated with risk of outcomes. Fifty-seven patients (16%) who decreased their NT-proBNP versus 78 patients (27%) who increased it died from any cause (adjusted hazard ratio=0.53; 95% confidence interval=0.36–0.77), 61 (17%) versus 86 (30%) were hospitalized for HF (hazard ratio=0.41; 95% confidence interval=0.29–0.60), and 96 (27%) versus 125 (43%) reported the composite outcome (hazard ratio=0.46; 95% confidence interval=0.34–0.62). These findings were replicated in HFmrEF and HFpEF separately.
Conclusions—
In HFmrEF and HFpEF during routine care, decreases in NT-proBNP were associated with improved mortality and morbidity. Studies to determine whether NT-proBNP changes in response to therapy predict drug efficacy are needed.
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Affiliation(s)
- Gianluigi Savarese
- From the Department of Medicine (G.S., C.H., L.H.L.) and Department of Public Health Sciences (N.O.), Karolinska Institutet, Stockholm, Sweden; Department of Cardiology (U.D.) and Department of Medical and Health Sciences (U.D.), Linkoping University, Sweden; Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy (P.P.-F.); Cardiovascular and Cell Sciences Research Institute, St George’s University, London, UK (G.M.C.R.); and IRCCS San Raffaele Pisana, Rome, Italy (G.M.C.R.)
| | - Camilla Hage
- From the Department of Medicine (G.S., C.H., L.H.L.) and Department of Public Health Sciences (N.O.), Karolinska Institutet, Stockholm, Sweden; Department of Cardiology (U.D.) and Department of Medical and Health Sciences (U.D.), Linkoping University, Sweden; Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy (P.P.-F.); Cardiovascular and Cell Sciences Research Institute, St George’s University, London, UK (G.M.C.R.); and IRCCS San Raffaele Pisana, Rome, Italy (G.M.C.R.)
| | - Nicola Orsini
- From the Department of Medicine (G.S., C.H., L.H.L.) and Department of Public Health Sciences (N.O.), Karolinska Institutet, Stockholm, Sweden; Department of Cardiology (U.D.) and Department of Medical and Health Sciences (U.D.), Linkoping University, Sweden; Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy (P.P.-F.); Cardiovascular and Cell Sciences Research Institute, St George’s University, London, UK (G.M.C.R.); and IRCCS San Raffaele Pisana, Rome, Italy (G.M.C.R.)
| | - Ulf Dahlström
- From the Department of Medicine (G.S., C.H., L.H.L.) and Department of Public Health Sciences (N.O.), Karolinska Institutet, Stockholm, Sweden; Department of Cardiology (U.D.) and Department of Medical and Health Sciences (U.D.), Linkoping University, Sweden; Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy (P.P.-F.); Cardiovascular and Cell Sciences Research Institute, St George’s University, London, UK (G.M.C.R.); and IRCCS San Raffaele Pisana, Rome, Italy (G.M.C.R.)
| | - Pasquale Perrone-Filardi
- From the Department of Medicine (G.S., C.H., L.H.L.) and Department of Public Health Sciences (N.O.), Karolinska Institutet, Stockholm, Sweden; Department of Cardiology (U.D.) and Department of Medical and Health Sciences (U.D.), Linkoping University, Sweden; Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy (P.P.-F.); Cardiovascular and Cell Sciences Research Institute, St George’s University, London, UK (G.M.C.R.); and IRCCS San Raffaele Pisana, Rome, Italy (G.M.C.R.)
| | - Giuseppe M.C. Rosano
- From the Department of Medicine (G.S., C.H., L.H.L.) and Department of Public Health Sciences (N.O.), Karolinska Institutet, Stockholm, Sweden; Department of Cardiology (U.D.) and Department of Medical and Health Sciences (U.D.), Linkoping University, Sweden; Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy (P.P.-F.); Cardiovascular and Cell Sciences Research Institute, St George’s University, London, UK (G.M.C.R.); and IRCCS San Raffaele Pisana, Rome, Italy (G.M.C.R.)
| | - Lars H. Lund
- From the Department of Medicine (G.S., C.H., L.H.L.) and Department of Public Health Sciences (N.O.), Karolinska Institutet, Stockholm, Sweden; Department of Cardiology (U.D.) and Department of Medical and Health Sciences (U.D.), Linkoping University, Sweden; Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy (P.P.-F.); Cardiovascular and Cell Sciences Research Institute, St George’s University, London, UK (G.M.C.R.); and IRCCS San Raffaele Pisana, Rome, Italy (G.M.C.R.)
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Metra M, Carubelli V, Ravera A, Stewart Coats AJ. Heart failure 2016: still more questions than answers. Int J Cardiol 2016; 227:766-777. [PMID: 27838123 DOI: 10.1016/j.ijcard.2016.10.060] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/23/2016] [Accepted: 10/23/2016] [Indexed: 12/21/2022]
Abstract
Heart failure has reached epidemic proportions given the ageing of populations and is associated with high mortality and re-hospitalization rates. This article reviews and summarizes recent advances in the diagnosis, assessment and treatment of the patients with heart failure. Data are discussed based also on the most recent guidelines indications. Open issues and unmet needs are highlighted.
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Affiliation(s)
- Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy.
| | - Valentina Carubelli
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy
| | - Alice Ravera
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy
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Factors related to outcome in heart failure with a preserved (or normal) left ventricular ejection fraction. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2016; 2:153-163. [DOI: 10.1093/ehjqcco/qcw026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Indexed: 12/15/2022]
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Abstract
Biomarkers are widely used and studied in heart failure. Most studies have described the utility and performance of biomarkers in sub-studies of randomised clinical trials, where the vast majority of the patients suffered from heart failure with reduced ejection fraction (HFrEF), and not with preserved ejection fraction (HFpEF). As a result, there is a scarcity of data describing the levels, dynamics, clinical and biochemical correlates, and biology of biomarkers in patients suffering from HFpEF, whereas HFpEF is in fact a very frequent clinical entity. This article discusses the value of different biomarkers in HFpEF. We describe various aspects of natriuretic peptide measurements in HFpEF patients, with a focus on diagnosis, prognosis and the risk prediction of developing heart failure. Further, we will discuss several emerging biomarkers such as galectin-3 and suppression of tumorigenicity 2, and recently discovered ones such as growth differentiation factor-15 and syndecan-1.
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Senni M, D'Elia E, Emdin M, Vergaro G. Biomarkers of Heart Failure with Preserved and Reduced Ejection Fraction. Handb Exp Pharmacol 2016; 243:79-108. [PMID: 28181009 DOI: 10.1007/164_2016_86] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Biomarkers are increaingly being used in the management of heart failure not only for the purpose of screening, diagnosis, and risk stratification, but also as a guide to evaluate the response to treatment in the individual patient and as an entry criterion and/or a surrogate marker of efficacy in clinical trials testing novel drugs. In this chapter, we review the role of established biomarkers for heart failure management, according to the main classification of HF phenotypes, based on the measurement of left ventricular ejection fraction, including heart failure with reduced (<40%), preserved (≥50%), and, as recently proposed, mid-range (40-49%) ejection fraction.
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Affiliation(s)
- Michele Senni
- Department of Cardiology, Heart Failure and Heart Transplant Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy.
- CardioVascular Department, Ospedale Papa Giovanni XXIII Hospital, Bergamo, Italy.
| | - Emilia D'Elia
- CardioVascular Department, Ospedale Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Michele Emdin
- Life Science Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Giuseppe Vergaro
- Life Science Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Fondazione Toscana G. Monasterio, Pisa, Italy
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Metra M. August 2015 at a glance. Eur J Heart Fail 2015. [DOI: 10.1002/ejhf.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health; University of Brescia; Brescia Italy
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