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Meo L, Savarese M, Munno C, Mirabelli P, Ragno P, Leone O, Alfieri M. Circulating Biomarkers for Monitoring Chemotherapy-Induced Cardiotoxicity in Children. Pharmaceutics 2023; 15:2712. [PMID: 38140053 PMCID: PMC10747387 DOI: 10.3390/pharmaceutics15122712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/24/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023] Open
Abstract
Most commonly diagnosed cancer pathologies in the pediatric population comprise leukemias and cancers of the nervous system. The percentage of cancer survivors increased from approximatively 50% to 80% thanks to improvements in medical treatments and the introduction of new chemotherapies. However, as a consequence, heart disease has become the main cause of death in the children due to the cardiotoxicity induced by chemotherapy treatments. The use of different cardiovascular biomarkers, complementing data obtained from electrocardiogram, echocardiography cardiac imaging, and evaluation of clinical symptoms, is considered a routine in clinical diagnosis, prognosis, risk stratification, and differential diagnosis. Cardiac troponin and natriuretic peptides are the best-validated biomarkers broadly accepted in clinical practice for the diagnosis of acute coronary syndrome and heart failure, although many other biomarkers are used and several potential markers are currently under study and possibly will play a more prominent role in the future. Several studies have shown how the measurement of cardiac troponin (cTn) can be used for the early detection of heart damage in oncological patients treated with potentially cardiotoxic chemotherapeutic drugs. The advent of high sensitive methods (hs-cTnI or hs-cTnT) further improved the effectiveness of risk stratification and monitoring during treatment cycles.
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Affiliation(s)
- Luigia Meo
- Department of Chemistry and Biology, University of Salerno, Via Giovanni Paolo II, 132, 84084 Salerno, Italy; (L.M.); (P.R.)
| | - Maria Savarese
- Clinical Pathology, Santobono-Pausilipon Children’s Hospital, 80123 Naples, Italy; (M.S.); (C.M.); (O.L.)
| | - Carmen Munno
- Clinical Pathology, Santobono-Pausilipon Children’s Hospital, 80123 Naples, Italy; (M.S.); (C.M.); (O.L.)
| | - Peppino Mirabelli
- Clinical and Translational Research Unit, Santobono-Pausilipon Children’s Hospital, 80123 Naples, Italy;
| | - Pia Ragno
- Department of Chemistry and Biology, University of Salerno, Via Giovanni Paolo II, 132, 84084 Salerno, Italy; (L.M.); (P.R.)
| | - Ornella Leone
- Clinical Pathology, Santobono-Pausilipon Children’s Hospital, 80123 Naples, Italy; (M.S.); (C.M.); (O.L.)
| | - Mariaevelina Alfieri
- Clinical Pathology, Santobono-Pausilipon Children’s Hospital, 80123 Naples, Italy; (M.S.); (C.M.); (O.L.)
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Song YK, Yuan HX, Jian YP, Chen YT, Liang KF, Liu XJ, Ou ZJ, Liu JS, Li Y, Ou JS. Pentraxin 3 in Circulating Microvesicles: a Potential Biomarker for Acute Heart Failure After Cardiac Surgery with Cardiopulmonary Bypass. J Cardiovasc Transl Res 2022; 15:1414-1423. [PMID: 35879589 DOI: 10.1007/s12265-022-10253-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/04/2022] [Indexed: 10/16/2022]
Abstract
The aim of this study was to investigate whether pentraxin 3 (PTX3) in microvesicles (MVs) can be a valuable biomarker for the prediction of acute heart failure (AHF) after cardiac surgery with cardiopulmonary bypass (CPB). One hundred and twenty-four patients undergoing cardiac surgery with CPB were included and analyzed (29 with AHF and 95 without AHF). The concentrations of PTX3 in MVs isolated from plasma were measured by ELISA kits before, 12 h, and 3 days after surgery. Patients' demographics, medical history, surgical data, and laboratory results were collected. The levels of PTX3 in MVs were significantly elevated during perioperative surgery, which was increased more in the AHF group. The concentrations of PTX3 in MVs at postoperative 12 h were independent risk factors for AHF with the area under the ROC curve of 0.920. The concentration of PTX3 in MVs may be a novel biomarker for prediction of AHF after cardiac surgery.
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Affiliation(s)
- Yuan-Kai Song
- Division of Cardiac Surgery, Heart Center, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhong Shan Er Road, Guangzhou, 510080, China
- National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), Guangzhou, China
- Guangdong Provincial Engineering and Technology Center for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
| | - Hao-Xiang Yuan
- Division of Cardiac Surgery, Heart Center, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhong Shan Er Road, Guangzhou, 510080, China
- National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), Guangzhou, China
- Guangdong Provincial Engineering and Technology Center for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
| | - Yu-Peng Jian
- Division of Cardiac Surgery, Heart Center, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhong Shan Er Road, Guangzhou, 510080, China
- National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), Guangzhou, China
- Guangdong Provincial Engineering and Technology Center for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
| | - Ya-Ting Chen
- Division of Cardiac Surgery, Heart Center, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhong Shan Er Road, Guangzhou, 510080, China
- National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), Guangzhou, China
- Guangdong Provincial Engineering and Technology Center for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
| | - Kai-Feng Liang
- Division of Cardiac Surgery, Heart Center, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhong Shan Er Road, Guangzhou, 510080, China
- National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), Guangzhou, China
- Guangdong Provincial Engineering and Technology Center for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
| | - Xiao-Jun Liu
- Division of Cardiac Surgery, Heart Center, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhong Shan Er Road, Guangzhou, 510080, China
- National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), Guangzhou, China
- Guangdong Provincial Engineering and Technology Center for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
| | - Zhi-Jun Ou
- National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), Guangzhou, China
- Guangdong Provincial Engineering and Technology Center for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
- Division of Hypertension and Vascular Diseases, Heart Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jia-Sheng Liu
- Division of Cardiac Surgery, Heart Center, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhong Shan Er Road, Guangzhou, 510080, China
- National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
- NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), Guangzhou, China
- Guangdong Provincial Engineering and Technology Center for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China
| | - Yan Li
- Division of Cardiac Surgery, Heart Center, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhong Shan Er Road, Guangzhou, 510080, China.
- National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China.
- NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), Guangzhou, China.
- Guangdong Provincial Engineering and Technology Center for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China.
| | - Jing-Song Ou
- Division of Cardiac Surgery, Heart Center, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhong Shan Er Road, Guangzhou, 510080, China.
- National-Guangdong Joint Engineering Laboratory for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China.
- NHC Key Laboratory of Assisted Circulation (Sun Yat-Sen University), Guangzhou, China.
- Guangdong Provincial Engineering and Technology Center for Diagnosis and Treatment of Vascular Diseases, Guangzhou, China.
- Guangdong Provincial Key Laboratory of Brain Function and Disease, Guangzhou, China.
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Tian P, Zhao X, Huang L, Feng J, Zhao L, Liang L, Huang B, Zhang Y, Zhang J. Prognostic value of high-sensitivity cardiac troponin I in patients with non-ischaemic heart failure: insights from China. ESC Heart Fail 2022; 9:3345-3357. [PMID: 35831235 DOI: 10.1002/ehf2.14065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/27/2022] [Accepted: 06/27/2022] [Indexed: 11/12/2022] Open
Abstract
AIMS Evidence of the prognostic value of high-sensitivity troponin in patients with non-ischaemic heart failure (NIHF) is scarce. This study aimed to assess the predictive value of high-sensitivity cardiac troponin I (hs-cTnI) in NIHF patients. METHODS Hs-cTnI was measured at baseline in 650 NIHF patients admitted to the Heart Failure Center. The prognostic value of hs-cTnI was assessed based on a well-established model (including age, sex, New York Heart Association class, left ventricular ejection fraction, haemoglobin, sodium, estimated glomerular filtration rate, diabetes mellitus, treatment with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, treatment with β-blockers, and NT-proBNP). RESULTS During a median follow-up of 1036 days, 163 patients died of various causes. In total, 46.92% of patients had high hs-cTnI (hs-cTnI >0.011 ng/ml). Over a 3-year follow-up, patients with high hs-cTnI (>0.011 ng/ml) had a 1.54 [95% confidence interval (95% CI) 1.11-2.15] fold higher all-cause mortality risk than those without. Increasing concertation of hs-cTnI was also associated with a 23.0% (95% CI 13-33%, per log2 increase) increment risk of all-cause mortality. The inclusion of hs-cTnI significantly improved the risk prediction and stratification of all-cause mortality (integrated discrimination improvement 1.58%, 95% CI 0.38-2.79%, absolute net reclassification improvement 23.41% 95% CI 4.52-44.49%, additive net reclassification improvement 27.8%, 95% CI 9.29-46.3%) of the well-established model. CONCLUSIONS Hs-cTnI provides significant prognostic value and could further remarkably improve risk stratification and prediction capabilities in NIHF patients.
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Affiliation(s)
- Pengchao Tian
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science, Peking Union Medical College, 10037, Beijing, China
| | - Xuemei Zhao
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science, Peking Union Medical College, 10037, Beijing, China
| | - Liyan Huang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science, Peking Union Medical College, 10037, Beijing, China
| | - Jiayu Feng
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science, Peking Union Medical College, 10037, Beijing, China
| | - Lang Zhao
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science, Peking Union Medical College, 10037, Beijing, China
| | - Lin Liang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science, Peking Union Medical College, 10037, Beijing, China
| | - Boping Huang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science, Peking Union Medical College, 10037, Beijing, China
| | - Yuhui Zhang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science, Peking Union Medical College, 10037, Beijing, China
| | - Jian Zhang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science, Peking Union Medical College, 10037, Beijing, China.,Key Laboratory of Clinical Research for Cardiovascular Medications, National Health Committee, 10037, Beijing, China
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4
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Vallabhajosyula S, Verghese D, Desai VK, Sundaragiri PR, Miller VM. Sex differences in acute cardiovascular care: a review and needs assessment. Cardiovasc Res 2021; 118:667-685. [PMID: 33734314 PMCID: PMC8859628 DOI: 10.1093/cvr/cvab063] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 01/16/2021] [Accepted: 03/03/2021] [Indexed: 12/17/2022] Open
Abstract
Despite significant progress in the care of patients suffering from cardiovascular disease, there remains a persistent sex disparity in the diagnosis, management, and outcomes of these patients. These sex disparities are seen across the spectrum of cardiovascular care, but, are especially pronounced in acute cardiovascular care. The spectrum of acute cardiovascular care encompasses critically ill or tenuous patients with cardiovascular conditions that require urgent or emergent decision-making and interventions. In this narrative review, the disparities in the clinical course, management, and outcomes of six commonly encountered acute cardiovascular conditions, some with a known sex-predilection will be discussed within the basis of underlying sex differences in physiology, anatomy, and pharmacology with the goal of identifying areas where improvement in clinical approaches are needed.
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Affiliation(s)
- Saraschandra Vallabhajosyula
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA.,Center for Clinical and Translational Science, Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN, USA.,Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Dhiran Verghese
- Department of Medicine, Amita Health Saint Joseph Hospital, Chicago, IL, USA
| | - Viral K Desai
- Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA
| | - Pranathi R Sundaragiri
- Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Virginia M Miller
- Department of Physiology and Biomedical Engineering, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.,Department of Surgery, Mayo Clinic, Rochester, MN, USA
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Li S, She F, Lv T, Geng Y, Xue Y, Miao G, Zhang P. The prognostic role of high-sensitivity cardiac troponin T over time in ischemic and non-ischemic heart failure. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2021; 17:54-59. [PMID: 33868418 PMCID: PMC8039922 DOI: 10.5114/aic.2021.104769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/16/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION High-sensitivity cardiac troponin T (hs-cTnT) as a prognostic biomarker can be detected in patients with heart failure (HF). AIM This study focuses on hs-cTnT to evaluate its prognostic role in ischemic heart failure (IHF) and non-ischemic heart failure (NIHF). MATERIAL AND METHODS One hundred and sixty patients with HF were divided into IHF and NIHF groups. Hs-cTnT measured at baseline, 2-5 h, 6-24 h and 24 h-7 d after admission was analyzed by generalized estimating equations. Patients were followed up for 1 year at the endpoint events of re-hospitalization for HF and all-cause death that was tested by the Kaplan-Meier method and the Cox regression method. RESULTS Hs-cTnT varied significantly over time, first increasing and then decreasing in IHF while showing a continuously elevated trend in NIHF. Patients with hs-cTnT levels > 0.014 ng/ml had a significantly higher re-hospitalization rate compared with those with hs-cTnT levels ≤ 0.014 ng/ml (23.7% vs. 7.0%, p < 0.05). Adjusted for age, New York Heart Association class, N-terminal pro-B-type natriuretic peptide, and left ventricular ejection fraction, baseline hs-cTnT was independently associated with re-hospitalization and all-cause death in HF (p < 0.05). Optimal hs-cTnT cut-off of 0.0275 ng/ml was derived to predict the re-hospitalization and death in IHF (AUC = 0.709, 95% CI: 0.561-0.856, sensitivity: 76.9%, specificity: 63.5%, p < 0.05). CONCLUSIONS Hs-cTnT varying over time is an important risk factor for the prognosis of patients with IHF and NIHF.
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Affiliation(s)
- Siyuan Li
- Department of Cardiology, Beijing Tsinghua Changgung Hospital, Tsinghua, China
| | - Fei She
- Department of Cardiology, Beijing Tsinghua Changgung Hospital, Tsinghua, China
| | - Tingting Lv
- Department of Cardiology, Beijing Tsinghua Changgung Hospital, Tsinghua, China
| | - Yu Geng
- Department of Cardiology, Beijing Tsinghua Changgung Hospital, Tsinghua, China
| | - Yajun Xue
- Department of Cardiology, Beijing Tsinghua Changgung Hospital, Tsinghua, China
| | - Guobin Miao
- Department of Cardiology, Beijing Tsinghua Changgung Hospital, Tsinghua, China
| | - Ping Zhang
- Department of Cardiology, Beijing Tsinghua Changgung Hospital, Tsinghua, China
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6
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Li X, Shan L, Lv M, Li Z, Han C, Liu B, Ge W, Zhang Y. Predictive ability of EuroSCORE II integrating cardiactroponin T in patients undergoing OPCABG. BMC Cardiovasc Disord 2020; 20:463. [PMID: 33115418 PMCID: PMC7594339 DOI: 10.1186/s12872-020-01745-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/18/2020] [Indexed: 12/14/2022] Open
Abstract
Background Preoperative risk evaluation systems are significant and important to the allocation of medical resources and the communication between doctors and patients. The European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) is widely used in clinical practice. Cardiac troponin T (cTnT) can specifically and accurately reflect myocardial injury. Whether EuroSCORE II can improve the predictive power after integrating with cTnT is still unclear. This study was a retrospective single center study designed to assess the predictive ability of EuroSCORE II integrated with cTnT for patients undergoing isolated off-pump coronary artery bypass grafting (OPCABG). Methods This retrospective and observational cohort study included 1887 patients who underwent first isolated OPCABG. cTnT was detected within 48 h before operation in each patient. According to myocardial injury, patients were divided by cTnT into 4 stages. A new risk evaluation system was created through logistic regression with EuroSCORE II and myocardial injury classification as covariates. Then the two risk evaluation systems were comparatively assessed by regression analysis, receiver operator characteristic curves, net reclassification index, Bland–Altman plots and decision curve analysis. Results There were 43 in-hospital deaths, with a mortality of 2.30% (43/1887). The logistic regression analysis showed that preoperative myocardial injury classification was a significant risk factor for in-hospital mortality in both total cohort (OR 1.491, 95%CI 1.049–2.119) and subsets (OR 1.761, 95%CI 1.102–2.814). The new risk evaluation system has higher calibration and discrimination power than EuroSCORE II, both for overall cohort and subsets. Especially, the new system has obvious advantages in discrimination power in the subset of acute myocardial infarction (AUC 0.813 vs. 0.772, 0.906 vs. 0.841, and 0.715 vs. 0.646, respectively). Conclusions Both myocardial injury classification and EuroSCORE II are independent risk factors of in-hospital mortality in OPCABG patients. The new risk evaluation system has higher predictive ability than EuroSCORE II, especially in patients with a recent history of AMI.
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Affiliation(s)
- Xiang Li
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, People's Republic of China
| | - Lingtong Shan
- Department of Thoracic Surgery, Sheyang County People's Hospital, Yancheng, Jiangsu, People's Republic of China.,Department of Thoracic Surgery, Yancheng Third People's Hospital, The Affiliated Yancheng Hospital of Southeast University Medical College, Yancheng, Jiangsu, People's Republic of China
| | - Mengwei Lv
- Shanghai East Hospital of Clinical Medical College, Nanjing Medical University, Shanghai, People's Republic of China.,Department of Cardiovascular Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai, 200120, People's Republic of China
| | - Zhi Li
- Department of Cardiovascular Surgery, Jiangsu Province Hospital, The First Affiliated Hospital With Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Chunyan Han
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No.301 Central Yanchang Road, Shanghai, 200072, People's Republic of China
| | - Ban Liu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No.301 Central Yanchang Road, Shanghai, 200072, People's Republic of China.
| | - Wen Ge
- Department of Cardiothoracic Surgery, Shuguang Hospital, Affiliated to Shanghai University of TCM, Shanghai, People's Republic of China.
| | - Yangyang Zhang
- Department of Cardiovascular Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai, 200120, People's Republic of China.
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Wang A, Lv G, Cheng X, Ma X, Wang W, Gui J, Hu J, Lu M, Chu G, Chen J, Zhang H, Jiang Y, Chen Y, Yang W, Jiang L, Geng H, Zheng R, Li Y, Feng W, Johnson B, Wang W, Zhu D, Hu Y. Guidelines on multidisciplinary approaches for the prevention and management of diabetic foot disease (2020 edition). BURNS & TRAUMA 2020; 8:tkaa017. [PMID: 32685563 PMCID: PMC7336185 DOI: 10.1093/burnst/tkaa017] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 03/21/2020] [Indexed: 02/07/2023]
Abstract
In recent years, as living standards have continued to improve, the number of diabetes patients in China, along with the incidence of complications associated with the disease, has been increasing. Among these complications, diabetic foot disease is one of the main causes of disability and death in diabetic patients. Due to the differences in economy, culture, religion and level of medical care available across different regions, preventive and treatment methods and curative results for diabetic foot vary greatly. In multidisciplinary models built around diabetic foot, the timely assessment and diagnosis of wounds and appropriate methods of prevention and treatment with internal and external surgery are key to clinical practice for this pathology. In 2019, under the leadership of the Jiangsu Medical Association and Chinese Diabetes Society, the writing group for the Guidelines on multidisciplinary approaches for the prevention and management of diabetic foot disease (2020 edition) was established with the participation of scholars from the specialist areas of endocrinology, burn injury, vascular surgery, orthopedics, foot and ankle surgery and cardiology. Drawing lessons from diabetic foot guidelines from other countries, this guide analyses clinical practices for diabetic foot, queries the theoretical basis and grades and gives recommendations based on the characteristics of the pathology in China. This paper begins with assessments and diagnoses of diabetic foot, then describes treatments for diabetic foot in detail, and ends with protections for high-risk feet and the prevention of ulcers. This manuscript covers the disciplines of internal medicine, surgical, nursing and rehabilitation and describes a total of 50 recommendations that we hope will provide procedures and protocols for clinicians dealing with diabetic foot. Registry number: IPGRP-2020cn124
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Affiliation(s)
- Aiping Wang
- Diabetic Foot Centre, The Air Force Hospital From Eastern Theater of PLA, Nanjing, 210002, China
| | - Guozhong Lv
- Department of Burn and Plastic Surgery, Affiliated Hospital of Jiangnan University, Wuxi, 214062, China
| | - Xingbo Cheng
- Department of endocrinology, the First Affiliated Hospital of Suzhou University, Suzhou, 215006, China
| | - Xianghua Ma
- Department of endocrinology, Jiangsu Province Hospital, Nanjing, 210029, China.,Department of endocrinology, Xuzhou Central Hospital, Xuzhou, 221009,China
| | - Wei Wang
- Vascular Surgery, Gulou Hospital, Nanjing, 210008, China
| | - Jianchao Gui
- Department of orthopedics, Nanjing First Hospital, Nanjing, 210006, China
| | - Ji Hu
- Department of endocrinology, The Second Affiliated Hospital of Suzhou University, Suzhou, 215004, China
| | - Meng Lu
- Diabetic Foot Centre, The Air Force Hospital From Eastern Theater of PLA, Nanjing, 210002, China
| | - Guoping Chu
- Department of Burn and Plastic Surgery, Affiliated Hospital of Jiangnan University, Wuxi, 214062, China
| | - Jin'an Chen
- Diabetic Foot Centre, The Air Force Hospital From Eastern Theater of PLA, Nanjing, 210002, China
| | - Hao Zhang
- Department of endocrinology, Jiangsu Province Hospital, Nanjing, 210029, China
| | - Yiqiu Jiang
- Department of orthopedics, Nanjing First Hospital, Nanjing, 210006, China
| | - Yuedong Chen
- Diabetic Foot Centre, The Air Force Hospital From Eastern Theater of PLA, Nanjing, 210002, China
| | - Wengbo Yang
- Department of orthopedics, Nanjing First Hospital, Nanjing, 210006, China
| | - Lin Jiang
- Department of endocrinology, Jiangsu Province Hospital, Nanjing, 210029, China
| | - Houfa Geng
- Department of endocrinology, Xuzhou Central Hospital, Xuzhou, 221009,China
| | - Rendong Zheng
- Department of endocrinology, Jiangsu Province Hospital on Traditional of Chinese and Western Medicine, 210028, China
| | - Yihui Li
- Diabetic Foot Centre, The Air Force Hospital From Eastern Theater of PLA, Nanjing, 210002, China
| | - Wei Feng
- Operating department, Jiangsu Medical Association, Nanjing, 210008, China
| | - Boey Johnson
- Diabetic Foot Centre, The National University Hospital, 119077, Singapore
| | - Wenjuan Wang
- Department of Chronic Non-Communicable Diseases, Chinese Center for Disease Control and Prevention, Beijing, 102206, China
| | - Dalong Zhu
- Vascular Surgery, Gulou Hospital, Nanjing, 210008, China
| | - Yin Hu
- Operating department, Jiangsu Medical Association, Nanjing, 210008, China
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8
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Sarak T, Karadeniz M. The relationship between serum NT-proBNP levels and severity of coronary artery disease assessed by SYNTAX score in patients with acute myocardial infarction. Turk J Med Sci 2019; 49:1366-1373. [PMID: 31648513 PMCID: PMC7018338 DOI: 10.3906/sag-1902-26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 06/14/2019] [Indexed: 12/14/2022] Open
Abstract
Background/aim In the present study, we aimed to investigate the relationship between NT-proBNP and SYNTAX score, which is a measure of the complexity of coronary artery disease. Materials and methods We enrolled 405 consecutive patients with myocardial infarction who underwent coronary angiographic examination. Patients were divided into 3 groups according to their SYNTAX scores. Those with SYNTAX score ≤22 were included in the low SYNTAX score group (LSTX), those with a score of 23–32 were included in the intermediate SYNTAX score group (ISTX), and those with a score of ≥33 were included in the high SYNTAX score group (HSTX). Results NT-proBNP levels were found to be significantly higher in the HSTX group compared to the other groups (P < 0.001) and in the ISTX group compared to the LSTX group (P < 0.001). The NT-proBNP levels demonstrated an increase from low SYNTAX score to high SYNTAX score tertiles. Conclusions NT-ProBNP levels in patients with myocardial infarction on admission were independently associated with extent, severity, and complexity of coronary atherosclerosis as assessed by SYNTAX score.
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Affiliation(s)
- Taner Sarak
- Department of Cardiology, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
| | - Muhammed Karadeniz
- Department of Cardiology, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
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Takahashi Y, Satoh M, Ohmomo H, Tanaka F, Osaki T, Tanno K, Nasu T, Sakata K, Morino Y, Sobue K, Sasaki M. Association between high-sensitivity cardiac troponin T and future cardiovascular incidence in a general Japanese population: results from the Tohoku medical megabank project. Biomarkers 2019; 24:566-573. [PMID: 30978115 DOI: 10.1080/1354750x.2019.1606278] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Purpose: Elevation of high-sensitivity cardiac troponin T (hs-cTnT) is associated with an increased risk of cardiovascular disease (CVD). This study determined whether hs-cTnT was detectable with N-terminal pro-b-type natriuretic peptide (NT-proBNP) and related to CV risk factors in a general Japanese population. Materials and methods: The Tohoku Medical Megabank Organization pooled individual participant data for a population-based cohort study in the Iwate prefecture (n = 30,193, age = 60.2 ± 11.5 year). Results: Hs-cTnT levels were higher in participants with hypertension, diabetes mellitus than in participants without these conditions (all ps < 0.001). Logistic regression analysis demonstrated that NT-proBNP was strongly associated with elevation of hs-cTnT (OR = 3.35, 95% CI = 2.90-3.89, p < 0.001). The receiver operating characteristic curve analysis showed that hs-cTnT was one of useful biomarker for the differentiation of high risk for CVD (the Suita score ≥ 56) from a general population. Logistic regression analysis demonstrated hs-cTnT levels were related to the CVD high risk group (OR = 2.67, 95% CI = 2.28-3.14, p < 0.001). Conclusions: Hs-cTnT levels are associated with elevation of NT-proBNP and high Suita score, which suggests that elevated hs-cTnT is related to subclinical myocardial damage and indicates CV risk.
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Affiliation(s)
- Yuji Takahashi
- a Division of Cardiology, Department of Internal Medicine, Iwate Medical University , Morioka , Japan
| | - Mamoru Satoh
- b Iwate Tohoku Medical Megabank Organization, Disaster Reconstruction Center, Iwate Medical University , Morioka , Japan.,c Division of Biomedical Information Analysis, Institute for Biomedical Sciences Iwate Medical University , Morioka , Japan
| | - Hideki Ohmomo
- b Iwate Tohoku Medical Megabank Organization, Disaster Reconstruction Center, Iwate Medical University , Morioka , Japan
| | - Fumitaka Tanaka
- d Division of Cardioangiology, Nephrology and Endocrinology, Department of Internal Medicine, Iwate Medical University , Morioka , Japan
| | - Takuya Osaki
- a Division of Cardiology, Department of Internal Medicine, Iwate Medical University , Morioka , Japan.,b Iwate Tohoku Medical Megabank Organization, Disaster Reconstruction Center, Iwate Medical University , Morioka , Japan
| | - Kozo Tanno
- b Iwate Tohoku Medical Megabank Organization, Disaster Reconstruction Center, Iwate Medical University , Morioka , Japan.,e Department of Hygiene and Preventive Medicine, Iwate Medical University , Morioka , Japan
| | - Takahito Nasu
- a Division of Cardiology, Department of Internal Medicine, Iwate Medical University , Morioka , Japan
| | - Kiyomi Sakata
- b Iwate Tohoku Medical Megabank Organization, Disaster Reconstruction Center, Iwate Medical University , Morioka , Japan.,e Department of Hygiene and Preventive Medicine, Iwate Medical University , Morioka , Japan
| | - Yoshihiro Morino
- a Division of Cardiology, Department of Internal Medicine, Iwate Medical University , Morioka , Japan
| | - Kenji Sobue
- b Iwate Tohoku Medical Megabank Organization, Disaster Reconstruction Center, Iwate Medical University , Morioka , Japan.,f Department of Neuroscience, Institute for Biomedical Science, Iwate Medical University , Morioka , Japan
| | - Makoto Sasaki
- b Iwate Tohoku Medical Megabank Organization, Disaster Reconstruction Center, Iwate Medical University , Morioka , Japan.,g Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University , Morioka , Japan
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Escobar-Robledo LA, Bayés-de-Luna A, Lupón J, Baranchuk A, Moliner P, Martínez-Sellés M, Zamora E, de Antonio M, Domingo M, Cediel G, Núñez J, Santiago-Vacas E, Bayés-Genís A. Advanced interatrial block predicts new-onset atrial fibrillation and ischemic stroke in patients with heart failure: The "Bayes' Syndrome-HF" study. Int J Cardiol 2018; 271:174-180. [PMID: 29801761 DOI: 10.1016/j.ijcard.2018.05.050] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/04/2018] [Accepted: 05/15/2018] [Indexed: 01/08/2023]
Abstract
AIMS Advanced interatrial block (IAB) is characterized by a prolonged (≥120 ms) and bimodal P wave in the inferior leads. The association between advanced IAB and atrial fibrillation (AF) is known as "Bayes' Syndrome", and there is scarce information about it in heart failure (HF). We examined the prevalence of IAB and whether advanced IAB could predict new-onset AF and/or stroke in HF patients. METHODS AND RESULTS The prospective observational "Bayes' Syndrome-HF" study included consecutive outpatients with chronic HF. The primary endpoints were new-onset AF, ischemic stroke, and the composite of both. A secondary endpoint included all-cause death alone or in combination with the primary endpoint. Comprehensive multivariable Cox regression analyses were performed. Among 1050 consecutive patients, 536 (51.0%) were in sinus rhythm, 464 with a measurable P wave are the focus of this study. Two-hundred and sixty patients (56.0%) had normal atrial conduction, 95 (20.5%) partial IAB, and 109 (23.5%) advanced IAB. During a mean follow-up of 4.5 ± 2.1 years, 235 patients experienced all-cause death, new-onset AF, or stroke. In multivariable comprehensive Cox regression analyses, advanced IAB was associated with new-onset AF (HR 2.71 [1.61-4.56], P < 0.001), ischemic stroke (HR 3.02 [1.07-8.53], P = 0.04), and the composite of both (HR 2.42 [1.41-4.15], P < 0.001). CONCLUSIONS In patients with HF advanced IAB predicts new-onset AF and ischemic stroke. Future studies must assess whether anticoagulant treatment in Bayes' Syndrome leads to better outcomes in HF.
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Affiliation(s)
- Luis Alberto Escobar-Robledo
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Department of Medicine, CIBERCV, Autonomous University of Barcelona, Barcelona, Spain
| | - Antoni Bayés-de-Luna
- Autonomous University of Barcelona and Institut Català Ciències Cardiovasculars (ICCC)-St. Pau Hospital, Barcelona, Spain
| | - Josep Lupón
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Department of Medicine, CIBERCV, Autonomous University of Barcelona, Barcelona, Spain
| | - Adrian Baranchuk
- Division of Cardiology, Queen's University, Kingston, Ontario, Canada
| | - Pedro Moliner
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Department of Medicine, CIBERCV, Autonomous University of Barcelona, Barcelona, Spain
| | - Manuel Martínez-Sellés
- Cardiology Department, Hospital General Universitario Gregorio Marañón, CIBERCV, Universidad Complutense, Universidad Europea, Madrid. Spain
| | - Elisabet Zamora
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Department of Medicine, CIBERCV, Autonomous University of Barcelona, Barcelona, Spain
| | - Marta de Antonio
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Department of Medicine, CIBERCV, Autonomous University of Barcelona, Barcelona, Spain
| | - Mar Domingo
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Department of Medicine, CIBERCV, Autonomous University of Barcelona, Barcelona, Spain
| | - Germán Cediel
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Department of Medicine, CIBERCV, Autonomous University of Barcelona, Barcelona, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, CIBERCV, Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Evelyn Santiago-Vacas
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Department of Medicine, CIBERCV, Autonomous University of Barcelona, Barcelona, Spain
| | - Antoni Bayés-Genís
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Department of Medicine, CIBERCV, Autonomous University of Barcelona, Barcelona, Spain.
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Man J, Barnett P, Christoffels VM. Structure and function of the Nppa-Nppb cluster locus during heart development and disease. Cell Mol Life Sci 2018; 75:1435-1444. [PMID: 29302701 PMCID: PMC5852170 DOI: 10.1007/s00018-017-2737-0] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 12/07/2017] [Accepted: 12/20/2017] [Indexed: 01/20/2023]
Abstract
Atrial natriuretic factor and brain natriuretic peptide are two important biomarkers in clinical cardiology. These two natriuretic peptide hormones are encoded by the paralogous genes Nppa and Nppb, which are evolutionary conserved. Both genes are predominantly expressed by the heart muscle during the embryonic and fetal stages, and in particular Nppa expression is strongly reduced in the ventricles after birth. Upon cardiac stress, Nppa and Nppb are strongly upregulated in the ventricular myocardium. Much is known about the molecular and physiological ques inducing Nppa and Nppb expression; however, the transcriptional regulatory mechanisms of the Nppa-Nppb cluster in vivo has proven to be quite complex and is not well understood. In this review, we will provide recent insights into the dynamic and complex regulation of Nppa and Nppb during heart development and hypertrophy, and the association of this gene cluster with the cardiomyocyte-intrinsic program of heart regeneration.
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Affiliation(s)
- Joyce Man
- Department of Medical Biology, Academic Medical Center, University of Amsterdam, Meibergdreef 15, 1105 AZ, Amsterdam, The Netherlands.
| | - Phil Barnett
- Department of Medical Biology, Academic Medical Center, University of Amsterdam, Meibergdreef 15, 1105 AZ, Amsterdam, The Netherlands
| | - Vincent M Christoffels
- Department of Medical Biology, Academic Medical Center, University of Amsterdam, Meibergdreef 15, 1105 AZ, Amsterdam, The Netherlands
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Kerekanič M, Hudák M, Mišíková S, Komanová E, Bohó A, Kyselovič J, Stančák B. The prognostic value of high sensitive cardiac troponin I in patients receiving cardiac resynchronisation therapy. Acta Cardiol 2018; 73:141-146. [PMID: 29025373 DOI: 10.1080/00015385.2017.1351248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Cardiac troponin I (cTnI) is a valuable prognostic biomarker in patients with chronic heart failure (CHF). However, the prognostic importance of cTnI in patients who received cardiac resynchronisation therapy (CRT) remains unknown. The aim of this prospective study was to determine the prognostic value of high-sensitive cTnI (hs-cTnI) in CHF patients receiving CRT. METHODS We performed measurements of baseline hs-cTnI levels in CRT patients with ischaemic as well as nonischaemic aetiology of CHF, and we investigated their possible association with response to CRT and survival of patients. RESULTS Ninety consecutive CRT patients (mean age 64 ± 9 years, 71 men) were included. According to the best cut-off value of hs-cTnI level to predict CRT response and all cause mortality, patients were divided into group 1 (hs-cTnI level ≥6.5 ng/l, n = 46) and group 2 (hs-cTnI level <6.5 ng/l, n = 44). During the follow-up period (1155 ± 406 days), 47% of patients were CRT responders (30% in group 1 and 64% in group 2, p = .002) and 31% of patients died from any cause (48% in group 1 and 14% in group 2, p = .001). Regression analysis showed that hs-cTnI level <6.5 ng/l was an independent predictor of CRT response (OR 3.49, p = .019) and that hs-cTnI level ≥6.5 ng/l was an independent predictor of all cause mortality (HR 3.01, p = .021). CONCLUSION The hs-cTnI can be an useful biomarker with prognostic value in patients receiving CRT.
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Affiliation(s)
- Michal Kerekanič
- Cardiology Clinic, Arrhythmology department, East Slovak Institute for Cardiac and Vascular Diseases, Kosice, Slovakia
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Comenius University in Bratislava, Bratislava, Slovakia
| | - Marek Hudák
- Cardiology Clinic, Arrhythmology department, East Slovak Institute for Cardiac and Vascular Diseases, Kosice, Slovakia
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Comenius University in Bratislava, Bratislava, Slovakia
| | - Silvia Mišíková
- Cardiology Clinic, Arrhythmology department, East Slovak Institute for Cardiac and Vascular Diseases, Kosice, Slovakia
| | - Erika Komanová
- Cardiology Clinic, Arrhythmology department, East Slovak Institute for Cardiac and Vascular Diseases, Kosice, Slovakia
| | - Alexander Bohó
- Cardiology Clinic, Arrhythmology department, East Slovak Institute for Cardiac and Vascular Diseases, Kosice, Slovakia
| | - Ján Kyselovič
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Comenius University in Bratislava, Bratislava, Slovakia
| | - Branislav Stančák
- Cardiology Clinic, Arrhythmology department, East Slovak Institute for Cardiac and Vascular Diseases, Kosice, Slovakia
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14
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Moliner P, Lupón J, Barallat J, de Antonio M, Domingo M, Núñez J, Zamora E, Galán A, Santesmases J, Pastor C, Bayes-Genis A. Bio-profiling and bio-prognostication of chronic heart failure with mid-range ejection fraction. Int J Cardiol 2018; 257:188-192. [DOI: 10.1016/j.ijcard.2018.01.119] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 01/24/2018] [Accepted: 01/26/2018] [Indexed: 11/24/2022]
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Moin DS, Sackheim J, Hamo CE, Butler J. Cardiac Myosin Activators in Systolic Heart Failure: More Friend than Foe? Curr Cardiol Rep 2017; 18:100. [PMID: 27568794 DOI: 10.1007/s11886-016-0778-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Despite the rising prevalence of HF, new evidence-based novel therapies for patients with worsening HF remain lacking, e.g., safe inotropic therapies. Traditional inotropes increase contractility by altering intracellular calcium flux, a pathway that may be responsible for the multitude of adverse effects associated with current options. Omecamtiv mecarbil, a direct myosin activator, increases contractility through a distinct pathway by increasing the proportion of myosin heads that are bound to actin in a high-affinity state. Phase II clinical trials in patients with chronic HF with this agent seem promising. A phase III trial investigating this therapy has not yet been pursued to date.
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Affiliation(s)
- Danyaal S Moin
- Division of Cardiology, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Julia Sackheim
- Division of Cardiology, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Carine E Hamo
- Division of Cardiology, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Javed Butler
- Division of Cardiology, Stony Brook University School of Medicine, Stony Brook, NY, USA. .,Health Sciences Center, Stony Brook University Medical Center, T16-080, Stony Brook, NY, 11794, USA.
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Tanaka A, Yoshida H, Kawaguchi A, Oyama JI, Kotooka N, Toyoda S, Inoue T, Natsuaki M, Node K. N-terminal pro-brain natriuretic peptide and associated factors in the general working population: a baseline survey of the Uranosaki cohort study. Sci Rep 2017; 7:5810. [PMID: 28724951 PMCID: PMC5517578 DOI: 10.1038/s41598-017-06090-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 06/07/2017] [Indexed: 12/16/2022] Open
Abstract
Few data on clinical characteristics associated with N-terminal pro-brain natriuretic peptide (NT-proBNP) or the clinical value of measuring NT-proBNP in the working population are available. The aim of the present study was to investigate the levels of NT-proBNP and their association with clinical variables in the Japanese general working population by using baseline data from the Uranosaki cohort study. In the study, the plasma concentration of NT-proBNP and some biomarkers were measured in addition to the standard health checkups at the workplace. Questionnaires regarding health-related quality of life (HR-QOL) were also completed. A total of 2140 participants were enrolled in the study. Plasma levels of NT-proBNP were positively associated with age, female sex, systolic blood pressure, pulse pressure, prevalent hypertension, smoking habit, high-density lipoprotein cholesterol (HDL-C), and prevalent proteinuria, and negatively associated with body mass index, lipid profiles except HDL-C, uric acid, renal function, and hemoglobin. Both the plasma concentration of high-molecular weight adiponectin and that of high-sensitivity troponin T were positively and independently associated with NT-proBNP. In addition, the HR-QOL score regarding sleep disorder was independently associated with NT-proBNP. Thus, we have obtained evidence that the plasma NT-proBNP is affected by several clinical variables in the general working population.
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Affiliation(s)
- Atsushi Tanaka
- Department of Cardiovascular Medicine, Saga University, Saga, Japan.
| | | | | | - Jun-Ichi Oyama
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Norihiko Kotooka
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Shigeru Toyoda
- Department of Cardiovascular Medicine, Dokkyo Medical University, Mibu, Japan
| | - Teruo Inoue
- Department of Cardiovascular Medicine, Dokkyo Medical University, Mibu, Japan
| | - Masafumi Natsuaki
- Department of Internal Medicine, Imari Matsuura Hospital, Imari, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, Saga, Japan.
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Barcan A, Suciu Z, Rapolti E. Monitoring Acute Myocardial Infarction Complicated with Cardiogenic Shock — from the Emergency Room to Coronary Care Units. JOURNAL OF CARDIOVASCULAR EMERGENCIES 2017. [DOI: 10.1515/jce-2017-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Cardiogenic shock remains the leading cause of death in patients hospitalized for acute myocardial infarction, despite many advances encountered in the last years in reperfusion, mechanical, and pharmacological therapies addressed to stabilization of the hemodynamic condition of these critical patients. Such patients require immediate initiation of the most effective therapy, as well as a continuous monitoring in the Coronary Care Unit. Novel biomarkers have been shown to improve diagnosis and risk stratification in patients with cardiogenic shock, and their proper use may be especially important for the identification of the critical condition, leading to prompt therapeutic interventions. The aim of this review was to evaluate the current literature data on complex biomarker assessment and monitoring of patients with acute myocardial infarction complicated with cardiogenic shock in the Coronary Care Unit.
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Affiliation(s)
| | | | - Emese Rapolti
- Cardiovascular Rehabilitation Hospital , Covasna, Romania
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18
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Mehdiani A, Akhyari P, Kamiya H, Ahlers J, Godehardt E, Albert A, Boeken U, Lichtenberg A. Prognostic value of the new high sensitive cardiac troponin T assay (hs-cTnT) after coronary artery bypass grafting. Acta Cardiol 2017. [PMID: 28636504 DOI: 10.1080/00015385.2017.1304693] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background The aim of the study was to assess the value of post-operative cardiac troponin T-levels, measured with a new highly sensitive assay (hs-cTnT), as a suitable parameter to predict patients' outcome after cardiac surgery. With the introduction of the new hs-cTnT assay the correlation between measured levels and the post-operative patient's outcome remains to be evaluated. Methods Patients undergoing coronary artery bypass grafting (n = 213) were included. Perioperative measurements of hs-cTnT and CK-MB were correlated to parameters of clinical outcome and further explored. Patients with an uneventful course were compared with those with post-operative complications, including need of repeat revascularization (RR) or death (RR/death), cardiogenic shock (CS) or death (CS/death) and a combination of all (RR/CS/death). Results Significant results were observed in patients after isolated CABG, where CS/death and RR/CS/death patients had higher post-operative hs-cTnT levels (P < 0.01). Moreover, multivariate analysis of the CABG-group revealed that acute renal failure (OR =14.7, 95% CI =2.7-79.1, P < 0.001), early post-operative hs-cTnT levels higher than the upper quintile (> 1,476.8 pg/ml) (OR =8.1, 95% CI =3.0-22.2, P < 0.001) and unstable angina pectoris (OR =2.4, 95% CI =1.1-5.7, P < 0.05) were the most powerful independent predictors of post-operative complications. Upon discriminant analysis the application of hs-cTnT almost doubled the sensitivity of the outcome prediction. Conclusions The new hs-cTnT assay is a useful diagnostic tool that may significantly enhance the prediction of adverse events after CABG. In our study a hs-cTnT-value >1,476.8 pg/ml proved to be a reliable marker for ongoing post-operative complications.
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Affiliation(s)
- Arash Mehdiani
- Dept. of Cardiovascular Surgery, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Payam Akhyari
- Dept. of Cardiovascular Surgery, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Hiroyuki Kamiya
- Dept. of Cardiovascular Surgery, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Joachim Ahlers
- Dept. of Cardiovascular Surgery, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Erhard Godehardt
- Dept. of Cardiovascular Surgery, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
- Biometric Research Group, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Alexander Albert
- Dept. of Cardiovascular Surgery, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Udo Boeken
- Dept. of Cardiovascular Surgery, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Artur Lichtenberg
- Dept. of Cardiovascular Surgery, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
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Troponin-Guided Heart Failure Therapy: Are We There Yet? CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2016. [DOI: 10.1007/s40138-016-0115-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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20
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Bayes-Genis A, Barallat J, Galán A, de Antonio M, Domingo M, Zamora E, Gastelurrutia P, Vila J, Peñafiel J, Gálvez-Montón C, Lupón J. Estrategia multimarcador para estratificar el pronóstico en insuficiencia cardiaca. Valor de los marcadores neurohumorales: neprilisina frente a NT-proBNP. Rev Esp Cardiol 2015. [DOI: 10.1016/j.recesp.2015.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Blaes AH, Rehman A, Vock DM, Luo X, Menge M, Yee D, Missov E, Duprez D. Utility of high-sensitivity cardiac troponin T in patients receiving anthracycline chemotherapy. Vasc Health Risk Manag 2015; 11:591-4. [PMID: 26648730 PMCID: PMC4664531 DOI: 10.2147/vhrm.s89842] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Anthracycline chemotherapy remains an integral part of the care for curative intent chemotherapy in breast cancer and non-Hodgkin lymphoma patients. Better tools need to be identified to predict cardiac complications of anthracycline chemotherapy. Materials and methods We investigated the utility of high-sensitivity cardiac troponin T (hscTnT), N-terminal pro-B-type natriuretic peptide, cardiac troponin T and I, and creatine kinase (CK)-MB in cancer patients receiving anthracycline-based chemotherapy, in order to determine whether baseline levels or changes in these biomarkers may help predict the onset of congestive heart failure. Results Eighteen consecutive patients with a pathologic diagnosis of breast cancer or non-Hodgkin lymphoma were enrolled. The median dose of doxorubicin exposure was 240 mg/m2 (range 240–400 mg/m2). After treatment with doxorubicin, the hscTnT increased to 19.1 pg/mL (P<0.001). CKMB and N-terminal pro-B-type natriuretic peptide levels increased to 1.1 ng/mL and 88.3 pg/mL, respectively (P=0.02). When subjects who had a decline in left ventricular ejection fraction (LVEF) by equilibrium radionuclide ventriculography were compared to those who did not have a change in LVEF, there was a suggestion that those subjects with an elevated baseline hscTnT were more likely to have a decline in LVEF (2.7 pg/mL and 0.1 pg/mL, respectively; P=0.07). Spearman correlation demonstrated that patients with higher baseline hscTnT and CKMB tended to have a greater decline in LVEF (Spearman correlation −0.54, 95% confidence interval −0.80 to −0.08 [P=0.02], and −0.49, 95% confidence interval −0.77 to −0.01 [P=0.04], respectively). Conclusion Elevations in baseline hscTnT levels are suggestive of an oncology subgroup at high risk of developing cardiac complications from their chemotherapy. Early detection by oncologists with the use of baseline biomarkers may be clinically important in designing interventions to prevent serious anthracycline-based chemotherapy complications.
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Affiliation(s)
- Anne H Blaes
- Division of Hematology/Oncology/Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Aamer Rehman
- Division of Cardiology, University of Louisville, Louisville, KY, USA
| | - David M Vock
- Masonic Cancer Center, University of Minnesota, Minneapolis, USA ; Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, USA
| | - Xianghua Luo
- Masonic Cancer Center, University of Minnesota, Minneapolis, USA ; Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, USA
| | - Mark Menge
- Park Nicollet Frauenshuh Cancer Center, St Louis Park, USA
| | - Douglas Yee
- Masonic Cancer Center, University of Minnesota, Minneapolis, USA
| | - Emil Missov
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Daniel Duprez
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
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22
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Bayes-Genis A, Barallat J, Galán A, de Antonio M, Domingo M, Zamora E, Gastelurrutia P, Vila J, Peñafiel J, Gálvez-Montón C, Lupón J. Multimarker Strategy for Heart Failure Prognostication. Value of Neurohormonal Biomarkers: Neprilysin vs NT-proBNP. ACTA ACUST UNITED AC 2015; 68:1075-84. [PMID: 26297179 DOI: 10.1016/j.rec.2015.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 07/06/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION AND OBJECTIVES Neprilysin breaks down numerous vasoactive peptides. The soluble form of neprilysin, which was recently identified in heart failure, is associated with cardiovascular outcomes. Within a multibiomarker strategy, we directly compared soluble neprilysin and N-terminal pro-B-type natriuretic peptide as risk stratifiers in a real-life cohort of heart failure patients. METHODS Soluble neprilysin, N-terminal pro-B-type natriuretic peptide, ST2, and high-sensitivity troponin T levels were measured in 797 consecutive ambulatory heart failure patients followed up for 4.7 years. Comprehensive multivariable analyses and soluble neprilysin vs N-terminal pro-B-type natriuretic peptide head-to-head assessments of performance were performed. A primary composite endpoint included cardiovascular death or heart failure hospitalization. A secondary endpoint explored cardiovascular death alone. RESULTS Median soluble neprilysin and N-terminal pro-B-type natriuretic peptide concentrations were 0.64ng/mL and 1187 ng/L, respectively. Both biomarkers significantly correlated with age (P<.001) and ST2 (P<.001), but only N-terminal pro-B-type natriuretic peptide significantly correlated with estimated glomerular filtration rate (P<.001), body mass index (P<.001), left ventricular ejection fraction (P=.02) and high-sensitivity troponin T (P<.001). In multivariable Cox regression analyses, soluble neprilysin remained independently associated with the composite endpoint (hazard ratio=1.14; 95% confidence interval, 1.02-1.27; P=.03) and cardiovascular death (hazard ratio=1.15; 95% confidence interval, 1.01-1.31; P=.04), but N-terminal pro-B-type natriuretic peptide did not. The head-to-head soluble neprilysin vs N-terminal pro-B-type natriuretic peptide comparison showed good calibration and similar discrimination and reclassification for both neurohormonal biomarkers, but only soluble neprilysin improved overall goodness-of-fit. CONCLUSIONS When added to a multimarker strategy, soluble neprilysin remained an independent prognosticator, while N-terminal pro-B-type natriuretic peptide lost significance as a risk stratifier in ambulatory patients with heart failure. Both biomarkers performed similarly in head-to-head analyses.
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Affiliation(s)
- Antoni Bayes-Genis
- Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Departamento de Medicina, Universitat Autónoma de Barcelona, Barcelona, Spain.
| | - Jaume Barallat
- Departamento de Medicina, Universitat Autónoma de Barcelona, Barcelona, Spain; Servicio de Bioquímica, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Amparo Galán
- Departamento de Medicina, Universitat Autónoma de Barcelona, Barcelona, Spain; Servicio de Bioquímica, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Marta de Antonio
- Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Departamento de Medicina, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Mar Domingo
- Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Elisabet Zamora
- Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Departamento de Medicina, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Paloma Gastelurrutia
- Fundació Institut Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Joan Vila
- IMIM (Institut de Recerca Hospital del Mar), Barcelona, Spain; CIBER Epidemiología y Salud Pública, Barcelona, Spain
| | - Judith Peñafiel
- IMIM (Institut de Recerca Hospital del Mar), Barcelona, Spain; CIBER Epidemiología y Salud Pública, Barcelona, Spain
| | - Carolina Gálvez-Montón
- Fundació Institut Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Josep Lupón
- Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Departamento de Medicina, Universitat Autónoma de Barcelona, Barcelona, Spain
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Zannad F, Greenberg B, Cleland JGF, Gheorghiade M, van Veldhuisen DJ, Mehra MR, Anker SD, Byra WM, Fu M, Mills RM. Rationale and design of a randomized, double-blind, event-driven, multicentre study comparing the efficacy and safety of oral rivaroxaban with placebo for reducing the risk of death, myocardial infarction or stroke in subjects with heart failure and significant coronary artery disease following an exacerbation of heart failure: the COMMANDER HF trial. Eur J Heart Fail 2015; 17:735-42. [PMID: 25919061 PMCID: PMC5029775 DOI: 10.1002/ejhf.266] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 03/04/2015] [Accepted: 03/11/2015] [Indexed: 01/06/2023] Open
Abstract
AIMS Thrombin is a critical element of crosstalk between pathways contributing to worsening of established heart failure (HF). The aim of this study is to explore the efficacy and safety of rivaroxaban 2.5 mg bid compared with placebo (with standard care) after an exacerbation of HF in patients with reduced ejection fraction (HF-rEF) and documented coronary artery disease. METHODS This is an international prospective, multicentre, randomized, double-blind, placebo-controlled, event-driven study of approximately 5000 patients for a targeted 984 events. Patients must have a recent symptomatic exacerbation of HF, increased plasma concentrations of natriuretic peptides (B-type natriuretic peptide ≥200 pg/mL or N-terminal pro-B-type natriuretic peptide ≥800 pg/mL), with left ventricular ejection fraction ≤40% and coronary artery disease. Patients requiring anticoagulation for atrial fibrillation or other conditions will be excluded. After an index event (overnight hospitalization, emergency department or observation unit admission, or unscheduled outpatient parenteral treatment for worsening HF), patients will be randomized 1:1 to rivaroxaban or placebo (with standard of care). The primary efficacy outcome event is a composite of all-cause mortality, myocardial infarction or stroke. The principal safety outcome events are the composite of fatal bleeding or bleeding into a critical space with potential permanent disability, bleeding events requiring hospitalization and major bleeding events according to International Society on Thrombosis and Haemostasis bleeding criteria. CONCLUSION COMMANDER HF is the first prospective study of a target-specific oral antithrombotic agent in HF. It will provide important information regarding rivaroxaban use following an HF event in an HF-rEF patient population with coronary artery disease.
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Affiliation(s)
- Faiez Zannad
- Inserm Centre d'Investigation Clinique CIC 1433, UMR 1116, CHU de Nancy, Institut Lorrain du Coeur et des Vaisseaux, Université de Lorraine, Nancy, France
| | - Barry Greenberg
- Department of Medicine, Cardiology Division, University of California, San Diego, La Jolla, CA, USA
| | - John G F Cleland
- National Heart and Lung Institute, Royal Brompton and Harefield Hospitals, Imperial College, London, England
| | - Mihai Gheorghiade
- Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Dirk J van Veldhuisen
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Mandeep R Mehra
- Brigham and Women's Hospital Heart and Vascular Center, and Harvard Medical School, Boston, MA, USA
| | - Stefan D Anker
- Division of Innovative Clinical Trials, Department of Cardiology, University Medical Centre Göttingen (UMG), Göttingen, Germany
| | - William M Byra
- Janssen Research & Development, LLC, 920 US 202, Raritan, NJ, USA
| | - Min Fu
- Janssen Research & Development, LLC, 920 US 202, Raritan, NJ, USA
| | - Roger M Mills
- Janssen Research & Development, LLC, 920 US 202, Raritan, NJ, USA
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Oremus M, Don-Wauchope A, McKelvie R, Santaguida PL, Hill S, Balion C, Booth R, Brown JA, Ali U, Bustamam A, Sohel N, Raina P. BNP and NT-proBNP as prognostic markers in persons with chronic stable heart failure. Heart Fail Rev 2015; 19:471-505. [PMID: 24986335 DOI: 10.1007/s10741-014-9439-6] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Prognosis permits clinicians to separate persons with heart failure (HF) into subgroups based on likely health outcomes. Treatment is partly guided by these likely outcomes. This systematic review explores whether brain natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) are independent predictors of prognosis in persons with chronic stable HF. We electronically searched Medline, Embase, AMED, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and CINAHL for English-language articles published between 1989 and mid-2012. We utilized trained reviewers and standardized forms to screen articles for inclusion and extracted data from included articles. All included studies were summarized in narrative and tabular form. We used the Hayden criteria to assess the risk of bias. Sixteen BNP publications and 88 NT-proBNP publications were included in the systematic review. BNP was positively associated with all-cause and HF mortality. NT-proBNP was positively associated with all-cause and cardiovascular mortality. BNP and NT-proBNP levels are useful for estimating prognosis in persons with chronic stable HF. Further research is required to establish optimal cutpoints and to assess whether prognostic effects differ by age, sex, or time period.
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Affiliation(s)
- Mark Oremus
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, MIP Suite 309A, Hamilton, ON, L8S 4K1, Canada
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Pruett AE, Lee AK, Patterson JH, Schwartz TA, Glotzer JM, Adams KF. Evolution of biomarker guided therapy for heart failure: current concepts and trial evidence. Curr Cardiol Rev 2015; 11:80-9. [PMID: 24251462 PMCID: PMC4347213 DOI: 10.2174/1573403x09666131117123525] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 07/09/2013] [Accepted: 09/27/2013] [Indexed: 12/30/2022] Open
Abstract
Optimizing management of patients with heart failure remains quite challenging despite many significant advances in drug and device therapy for this syndrome. Although a large body of evidence from robust clinical trials supports multiple thera-pies, utilization of these well-established treatments remains inconsistent and outcomes suboptimal in “real-world” patients with heart failure. Disease management programs may be effective, but are difficult to implement due to cost and logistical issues. Another approach to optimizing therapy is to utilize biomarkers to guide therapeutic choices. Natriuretic peptides pro-vide additional information of significant clinical value in the diagnosis and estimation of risk inpatients with heart failure. Ongoing research suggests a potential important added role for natriuretic peptides in heart failure. Guiding therapy based on serial changes in these biomarkers may be an effective strategy to optimize treatment and achieve better outcomes in this syn-drome. Initial, innovative, proof-of-concept studies have provided encouraging results and important insights into key as-pects of this strategy, but well designed, large-scale, multicenter, randomized, outcome trials are needed to definitively estab-lish this novel approach to management. Given the immense and growing public health burden of heart failure, identification of cost-effective ways to decrease the morbidity and mortality due to this syndrome is critical.
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Abstract
Despite important progress in recent decades, mortality remains high for patients with chronic heart failure. Risk stratification may be refined by the use of biomarkers for different pathophysiological processes that established mortality risk factors do not directly reflect. Biomarkers that are currently available can provide information about at least 7 pathobiological processes operative in HF, help to identify the specific processes involved in individual patients, and aid in constructing management plans. However, the additional prognostic information gained by any biomarker over a clinical risk model plus other biomarkers needs to be determined with adequate statistical tools. A major problem in selecting a biomarker profile is the proportional increase in economic burden; thus, the addition of any biomarker to a profile should be justified by adequate discrimination, calibration, reclassification, and likelihood analyses. Three studies that implemented such rigorous analyses have assessed a multimarker panel in chronic heart failure that incorporated the biomarker ST2: the Penn HF Study, the Barcelona Study, and the ProBNP Outpatient Tailored Chronic Heart Failure (PROTECT) biomarker substudy. In all 3 studies, a multimarker panel appeared to provide significant information over conventional risk stratification. The latter 2 reports proposed that ST2 might be superior to natriuretic peptides. The Barcelona Bio-HF calculator (www.bcnbiohfcalculator.cat) is a novel risk calculator that considers clinical variables, treatment, and biomarkers (i.e., N terminal pro-brain natriuretic peptide [NT-proBNP], ST2, and high sensitivity troponin T [hsTnT]). The optimal panel of markers, the change in these markers over time, and how these changes might help guide therapeutic interventions remain to be defined.
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Affiliation(s)
- Antoni Bayes-Genis
- Cardiology Service, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - A Mark Richards
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand; Cardiovascular Research Institute, National University of Singapore, Singapore, Singapore
| | - Alan S Maisel
- Coronary Care Unit and Heart Failure Program, VA San Diego, San Diego, California; University of California San Diego, San Diego, California
| | - Christian Mueller
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Bonnie Ky
- Cardiovascular Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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ST2 Pathogenetic Profile in Ambulatory Heart Failure Patients. J Card Fail 2015; 21:355-61. [DOI: 10.1016/j.cardfail.2014.10.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 10/17/2014] [Accepted: 10/27/2014] [Indexed: 01/19/2023]
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Campbell RT, Jackson CE, Wright A, Gardner RS, Ford I, Davidson PM, Denvir MA, Hogg KJ, Johnson MJ, Petrie MC, McMurray JJV. Palliative care needs in patients hospitalized with heart failure (PCHF) study: rationale and design. ESC Heart Fail 2015; 2:25-36. [PMID: 27347426 PMCID: PMC4864752 DOI: 10.1002/ehf2.12027] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 02/18/2015] [Accepted: 02/23/2015] [Indexed: 01/29/2023] Open
Abstract
Aims The primary aim of this study is to provide data to inform the design of a randomized controlled clinical trial (RCT) of a palliative care (PC) intervention in heart failure (HF). We will identify an appropriate study population with a high prevalence of PC needs defined using quantifiable measures. We will also identify which components a specific and targeted PC intervention in HF should include and attempt to define the most relevant trial outcomes. Methods An unselected, prospective, near‐consecutive, cohort of patients admitted to hospital with acute decompensated HF will be enrolled over a 2‐year period. All potential participants will be screened using B‐type natriuretic peptide and echocardiography, and all those enrolled will be extensively characterized in terms of their HF status, comorbidity, and PC needs. Quantitative assessment of PC needs will include evaluation of general and disease‐specific quality of life, mood, symptom burden, caregiver burden, and end of life care. Inpatient assessments will be performed and after discharge outpatient assessments will be carried out every 4 months for up to 2.5 years. Participants will be followed up for a minimum of 1 year for hospital admissions, and place and cause of death. Methods for identifying patients with HF with PC needs will be evaluated, and estimates of healthcare utilisation performed. Conclusion By assessing the prevalence of these needs, describing how these needs change over time, and evaluating how best PC needs can be identified, we will provide the foundation for designing an RCT of a PC intervention in HF.
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Affiliation(s)
- Ross T Campbell
- BHF Glasgow Cardiovascular Research Centre University of Glasgow Glasgow Scotland UK
| | | | - Ann Wright
- BHF Glasgow Cardiovascular Research Centre University of Glasgow Glasgow Scotland UK
| | | | - Ian Ford
- Robertson Centre for Biostatistics University of Glasgow UK
| | | | | | | | | | - Mark C Petrie
- Robertson Centre for Biostatistics University of Glasgow UK
| | - John J V McMurray
- BHF Glasgow Cardiovascular Research Centre University of Glasgow Glasgow Scotland UK
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Bayes-Genis A, Ordonez-Llanos J. Multiple biomarker strategies for risk stratification in heart failure. Clin Chim Acta 2015; 443:120-5. [DOI: 10.1016/j.cca.2014.10.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Revised: 08/29/2014] [Accepted: 10/15/2014] [Indexed: 10/24/2022]
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Voroneanu L, Siriopol D, Nistor I, Apetrii M, Hogas S, Onofriescu M, Covic A. Superior predictive value for NTproBNP compared with high sensitivity cTnT in dialysis patients: a pilot prospective observational study. Kidney Blood Press Res 2014; 39:636-47. [PMID: 25571877 DOI: 10.1159/000368452] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS The clinical utility of the new biomarker, high sensitivity cardiac T troponin (hs-cTnT) is still unclear in dialysis patients. Furthermore, the prognostic value of combining N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) and hs-cTnT has not been explored so far. The objective of this pilot study was to determine the utility of hs-cTnT alone versus hs-cTnT in combination with NT-proBNP for predicting death in a stable hemodialysis cohort. METHODS A prospective observational pilot study including 98 chronic asymptomatic hemodialysis patients with a follow up period of 24 months was designed. The cut-off values for NT-proBNP and hs-cTnT were calculated using receiver operating characteristic (ROC) analysis, using mortality as an end-point. Based on the cut-off values, the cohort was divided into four groups. Group 1--NT-proBNP < 14275 pg/ml and hs-cTnT < 69.48 ng/l; group 2--NT-proBNP < 14275 pg/ml and hs-cTnT > 69.48 ng/l; group 3--NT-proBNP > 14275 pg/ml and hs-cTnT < 69.48 ng/l; group 4--NT-proBNP > 14275 pg/ml and hs-cTnT > 69.48 ng/l. Survival for each group was determined using the Kaplan-Meier method and Cox regression analysis. RESULTS During the follow-up period 16 patients died. According to the ROC curves analysis, the cut-off point for hs-cTnT and for NT-proBNP were 69.43 ng/l (AUC = 0.618; p = 0.04) and 14275 pg/ml (AUC = 0.722; p = 0.003), respectively. In univariate Cox analysis, both hs-cTnT (HR = 3.34; p = 0.016) and NT-proBNP (HR = 5.94; p = 0.01) were predictors of death. In the multivariable Cox proportional hazards model, only NT-pro-BNP levels above the cut-off value remained an independent predictor of all-cause mortality. The combined elevation of both biomarkers did not improve significantly the prognostic value compared with NT-proBNP alone (HR = 6.15 versus HR =4 .78; p = 0.338). CONCLUSION NT-pro-BNP is a strong predictor of overall mortality in asymptomatic hemodialysis patients. The addition of hs-cTnT did not improve the prognostic accuracy compared with NT proBNP alone.
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Affiliation(s)
- Luminita Voroneanu
- Nephrology Clinic, Dialysis and Renal Transplant Center, C.I. Parhon University Hospital, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania
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Biomarkers in cardiology--part 1--in heart failure and specific cardiomyopathies. Arq Bras Cardiol 2014; 103:451-9. [PMID: 25590924 PMCID: PMC4290735 DOI: 10.5935/abc.20140184] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 09/30/2014] [Indexed: 02/02/2023] Open
Abstract
Cardiovascular diseases are the leading causes of mortality and morbidity in Brazil.
The primary and secondary preventions of those diseases are a priority for the health
system and require multiple approaches to increase their effectiveness. Biomarkers
are tools used to more accurately identify high-risk individuals, to speed the
diagnosis, and to aid in treatment and prognosis determination. This review aims to
highlight the importance of biomarkers in clinical cardiology practice, and to raise
relevant points of their use and the promises for the coming years. This document was
divided into two parts, and this first one discusses the use of biomarkers in
specific cardiomyopathies and heart failure.
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Ueland T, Gullestad L, Nymo SH, Yndestad A, Aukrust P, Askevold ET. Inflammatory cytokines as biomarkers in heart failure. Clin Chim Acta 2014; 443:71-7. [PMID: 25199849 DOI: 10.1016/j.cca.2014.09.001] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 08/31/2014] [Accepted: 09/01/2014] [Indexed: 12/18/2022]
Abstract
Inflammation has been implicated in the pathogenesis of heart failure (HF). In addition to their direct involvement as mediators in the pathogenesis of HF, inflammatory cytokines and related mediators could also be suitable markers for risk stratification and prognostication in HF patients. Many reports have suggested that inflammatory cytokines may predict adverse outcome in these patients. However, most studies have been limited in sample size and lacking full adjustment with the most recent and strongest biochemical predictor such as NT-proBNP and high sensitivity troponins. Furthermore, a number of pre-analytical and analytical aspects of cytokine measurements may limit their use as biomarkers. This review focuses on technical, informative and practical considerations concerning the clinical use of inflammatory cytokines as prognostic biomarkers in HF. We focus on the predictive value of tumor necrosis factor (TNF) α, the TNF family receptors sTNFR1 and osteoprotegerin, interleukin (IL)-6 and its receptor gp130, the chemokines MCP-1, IL-8, CXCL16 and CCL21 and the pentraxin PTX-3 in larger prospective fully adjusted studies. No single inflammatory cytokine provides sufficient discrimination to justify the transition to everyday clinical use as a prognosticator in HF. However, while subjecting potential new HF markers to rigorous comparisons with "gold-standard" markers, such as NT-proBNP, using receiver operating characteristics (ROCs) and HF risk models, makes sense from a clinical standpoint, it may pose a threat to a broadening of mechanistic insight if the new markers are dismissed solely on account of lower statistical power.
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Affiliation(s)
- Thor Ueland
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Norway; Faculty of Medicine, University of Oslo, Norway; K.G. Jebsen Inflammatory Research Center, University of Oslo, Norway; KG Jebsen Thrombosis Research and Expertise Center, N-9037 Tromsø, Norway.
| | - Lars Gullestad
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Norway; Faculty of Medicine, University of Oslo, Norway; KG Jebsen Cardiac Research Center and Center for Heart Failure Research, University of Oslo, Norway
| | - Ståle H Nymo
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Norway
| | - Arne Yndestad
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Norway; Faculty of Medicine, University of Oslo, Norway; K.G. Jebsen Inflammatory Research Center, University of Oslo, Norway
| | - Pål Aukrust
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Norway; Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, Norway; Faculty of Medicine, University of Oslo, Norway; K.G. Jebsen Inflammatory Research Center, University of Oslo, Norway; KG Jebsen Thrombosis Research and Expertise Center, N-9037 Tromsø, Norway
| | - Erik T Askevold
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Norway; KG Jebsen Cardiac Research Center and Center for Heart Failure Research, University of Oslo, Norway; Clinic for Internal Medicine, Lovisenberg Diakonale Hospital, N-0027 Oslo, Norway
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Don-Wauchope AC, Santaguida PL, Oremus M, McKelvie R, Ali U, Brown JA, Bustamam A, Sohel N, Hill SA, Booth RA, Balion C, Raina P. Incremental predictive value of natriuretic peptides for prognosis in the chronic stable heart failure population: a systematic review. Heart Fail Rev 2014; 19:521-40. [DOI: 10.1007/s10741-014-9443-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Bayes-Genis A, Zamora E, de Antonio M, Galán A, Vila J, Urrutia A, Díez C, Coll R, Altimir S, Lupón J. Soluble ST2 serum concentration and renal function in heart failure. J Card Fail 2014; 19:768-75. [PMID: 24263122 DOI: 10.1016/j.cardfail.2013.09.005] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 09/06/2013] [Accepted: 09/19/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Soluble ST2 (sST2) provides important prognostic information in patients with heart failure (HF). How sST2 serum concentration is related to renal function is uncertain. We evaluated the association between sST2 and renal function and compared its prognostic value in HF patients with renal insufficiency. METHODS AND RESULTS Patients (n = 879; median age 70.4 years; 71.8% men) were divided into 3 subgroups according to estimated glomerular filtration rate (eGFR): ≥60 mL/min/1.73 m(2) (n = 337); 30-59 mL/min/1.73 m(2) (n = 352); and <30 mL/min/1.73 m(2) (n = 190). sST2 (rho = -0.16; P < .001), N-terminal pro-B-type natriuretic peptide (rho = -0.40; P < .001), and high-sensitivity cardiac troponin T (rho = -0.47; P < .001) inversely correlated with eGFR. All-cause mortality was the primary end point. During a median follow-up of 3.46 years, 312 patients (35%) died, 246 of them from the subgroup of 542 patients with eGFR <60 mL/min/1.73 m(2) (45%). Biomarker combination including sST2 showed best discrimination, calibration, and reclassification metrics in renal insufficiency patients (net reclassification improvement 16.6 [95% confidence interval (CI) 8.1-25; P < .001]; integrated discrimination improvement 4.2 [95% CI 2.2-6.2; P < .001]). Improvement in reclassification was higher in these patients than in the total cohort. CONCLUSIONS The prognostic value of sST2 was not influenced by renal function. On top of other biomarkers, sST2 improved long-term prediction in patients with renal insufficiency even more than in the total cohort.
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Affiliation(s)
- Antoni Bayes-Genis
- Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain.
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Mayer O, Seidlerová J, Bruthans J, Vaněk J, Černá L, Wohlfahrt P, Filipovský J, Cífková R, Windrichová J, Topolčan O. The predictive potential of asymptomatic mild elevation of cardiac troponin I on mortality risk of stable patients with vascular disease. Clin Biochem 2014; 48:353-7. [PMID: 25091937 DOI: 10.1016/j.clinbiochem.2014.07.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 06/19/2014] [Accepted: 07/23/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Due to improved analytical performance of the newest generation of troponin assays, several patients have mild elevations of this parameter. Nevertheless, they do not show any signs of acute coronary syndrome. We speculated whether non-acute cardiac troponin I (cTnI) concentrations may improve prediction of residual mortality risk in clinically stable outpatients with chronic vascular disease. DESIGN AND METHODS We followed 830 patients (mean age 65.2years) after myocardial infarction, coronary revascularization or first ischemic stroke (pooled Czech samples of EUROASPIRE III and EUROASPIRE-stroke surveys, interviewed in 2006/2007) in a prospective cohort study. In addition to standard protocol, troponin I and brain natriuretic peptide (BNP) was estimated from frozen samples. Vital status and declared cause of death from death certificates was registered to ascertain a 5-year all-cause and cardiovascular mortality. RESULTS During a median follow up of 2050days (5.6years) 168 patients died. In the multivariate Cox proportional hazard model, cTnI≥0.03ng/mL independently predicted an all-cause 5-year mortality with HRR 1.76 (95% CI: 1.09-2.83). In the Cox model, the better predictor of mortality was BNP >150ng/L [HRR 3.47 (95% CI: 2.23-5.41)]. However, the combination of BNP with cTnI did not substantially improve its sensitivity or predictive power. CONCLUSION We cannot confirm the utility of asymptomatic mild cTnI elevation as a tool to detect residual risk of stable patients with vascular disease. On the other hand, BNP seems to be more appropriate for this purpose.
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Affiliation(s)
- Otto Mayer
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic; Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic.
| | - Jitka Seidlerová
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic; Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic
| | - Jan Bruthans
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic; Centre for Cardiovascular Prevention of the First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Jiří Vaněk
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic
| | - Lenka Černá
- Department of Neurology, University Hospital, Pilsen, Czech Republic
| | - Peter Wohlfahrt
- Centre for Cardiovascular Prevention of the First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic; International Clinical Research Centre, St. Anne's University Hospital Brno, Czech Republic
| | - Jan Filipovský
- 2nd Department of Internal Medicine, Medical Faculty of Charles University and University Hospital, Pilsen, Czech Republic; Biomedical Center, Medical Faculty of Charles University, Pilsen, Czech Republic
| | - Renata Cífková
- Centre for Cardiovascular Prevention of the First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic; International Clinical Research Centre, St. Anne's University Hospital Brno, Czech Republic
| | - Jindra Windrichová
- Department of Immunodiagnostics, University Hospital, Pilsen, Czech Republic
| | - Ondřej Topolčan
- Department of Immunodiagnostics, University Hospital, Pilsen, Czech Republic
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Otaki Y, Watanabe T, Takahashi H, Hirayama A, Narumi T, Kadowaki S, Honda Y, Arimoto T, Shishido T, Miyamoto T, Konta T, Shibata Y, Fukao A, Daimon M, Ueno Y, Kato T, Kayama T, Kubota I. Association of heart-type fatty acid-binding protein with cardiovascular risk factors and all-cause mortality in the general population: the Takahata study. PLoS One 2014; 9:e94834. [PMID: 24847804 PMCID: PMC4029574 DOI: 10.1371/journal.pone.0094834] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Accepted: 03/19/2014] [Indexed: 12/26/2022] Open
Abstract
Background Despite many recent advances in medicine, preventing the development of cardiovascular diseases remains a challenge. Heart-type fatty acid-binding protein (H-FABP) is a marker of ongoing myocardial damage and has been reported to be a useful indicator for future cardiovascular events. However, it remains to be determined whether H-FABP can predict all-cause and cardiovascular deaths in the general population. Methods and Results This longitudinal cohort study included 3,503 subjects who participated in a community-based health checkup with a 7-year follow-up. Serum H-FABP was measured in registered subjects. The results demonstrated that higher H-FABP levels were associated with increasing numbers of cardiovascular risk factors, including hypertension, diabetes mellitus, obesity, and metabolic syndrome. There were 158 deaths during the follow-up period, including 50 cardiovascular deaths. Deceased subjects had higher H-FABP levels compared to surviving subjects. Multivariate Cox proportional hazard regression analysis revealed that H-FABP is an independent predictor of all-cause and cardiovascular deaths after adjustments for confounding factors. Subjects were divided into four quartiles according to H-FABP level, and Kaplan-Meier analysis demonstrated that the highest H-FABP quartile was associated with the greatest risks for all-cause and cardiovascular deaths. Net reclassification index and integrated discrimination index were significantly increased by addition of H-FABP to cardiovascular risk factors. Conclusions H-FABP level was increased in association with greater numbers of cardiovascular risk factors and was an independent risk factor for all-cause and cardiovascular deaths. H-FABP could be a useful indicator for the early identification of high-risk subjects in the general population.
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Affiliation(s)
- Yoichiro Otaki
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Tetsu Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
- * E-mail:
| | - Hiroki Takahashi
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Atushi Hirayama
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Taro Narumi
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Shinpei Kadowaki
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Yuki Honda
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Takanori Arimoto
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Tetsuro Shishido
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Takuya Miyamoto
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Tsuneo Konta
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Yoko Shibata
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Akira Fukao
- Global Center of Excellence Program Study Group, Yamagata University School of Medicine, Yamagata, Japan
| | - Makoto Daimon
- Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Yoshiyuki Ueno
- Global Center of Excellence Program Study Group, Yamagata University School of Medicine, Yamagata, Japan
| | - Takeo Kato
- Global Center of Excellence Program Study Group, Yamagata University School of Medicine, Yamagata, Japan
| | - Takamasa Kayama
- Global Center of Excellence Program Study Group, Yamagata University School of Medicine, Yamagata, Japan
| | - Isao Kubota
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
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Abstract
Due to their tissue specificity and ease of detection, the cardiac troponins (cTn) have emerged as the most important and most utilized biomarkers for the diagnosis of acute myocardial infarction (AMI). The recent achievement of greater sensitivity by cTn assay systems, however, has resulted in the detection of cTn in a wide array of medical conditions, highlighting myocardial cellular necrosis as a feature in several, seemingly unrelated medical conditions, yet complicating the interpretation of a positive test. Since elevated cTn levels are associated with worse clinical outcomes and, thereby, influence medical decisions, careful consideration should be given to the method by which these biomarkers are measured, the patient population on which the test is being applied, and applicable thresholds based on particular clinical conditions. The objective of this review is to trace the clinical evolution of the cTn biomarker from a test for AMI to a general marker of myocardial cellular necrosis with clinically important prognostic information.
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Lv P, Zhou M, He J, Meng W, Ma X, Dong S, Meng X, Zhao X, Wang X, He F. Circulating miR-208b and miR-34a are associated with left ventricular remodeling after acute myocardial infarction. Int J Mol Sci 2014; 15:5774-88. [PMID: 24714087 PMCID: PMC4013595 DOI: 10.3390/ijms15045774] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 03/10/2014] [Accepted: 03/13/2014] [Indexed: 02/07/2023] Open
Abstract
Left ventricular remodeling after acute myocardial infarction (AMI) is associated with adverse prognosis. It is becoming increasingly clear that circulating miRNAs could be promising biomarkers for various pathological processes in the heart, including myocardial infarction, myocardial remodeling and progression to heart failure. In the present study, a total of 359 consecutive patients were recruited. Plasma samples were collected on admission. Echocardiographic studies were performed during the admission and at six months follow-up after AMI. Remodeling was defined as an at least 10% increase from baseline in the left ventricular end-diastolic volume. Plasma miRNA levels were assessed for association with six months mortality or development of heart failure. Results showed that levels of plasma miR-208b and miR-34a were significantly higher in patients with remodeling than those without. Increased miRNA levels were strongly associated with increased risk of mortality or heart failure within six months for miR-208b (OR 17.91, 95% confidence interval=2.07-98.81, p=0.003), miR-34a (OR 4.18, 95% confidence interval=1.36-12.83, p=0.012) and combination of the two miRNAs (OR 18.73, 95% confidence interval=1.96-101.23, p=0.000). The two miRNA panels reclassified a significant proportion of patients with a net reclassification improvement of 11.7% (p=0.025) and an integrated discrimination improvement of 7.7% (p=0.002). These results demonstrated that circulating miR-208b and miR-34a could be useful biomarkers for predicting left ventricular remodeling after AMI, and the miRNA levels are associated with increased risk of mortality or heart failure.
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Affiliation(s)
- Pin Lv
- Department of Medical Laboratory, the First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China.
| | - Mingxia Zhou
- Basic Medical College, Zhengzhou University, Zhengzhou 450052, China.
| | - Jing He
- Basic Medical College, Zhengzhou University, Zhengzhou 450052, China.
| | - Weiwei Meng
- Department of Medical Laboratory, the First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China.
| | - Xuehan Ma
- Department of Medical Laboratory, the First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China.
| | - Shuling Dong
- Department of Medical Laboratory, the First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China.
| | - Xianchun Meng
- Department of Medical Laboratory, the First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China.
| | - Xue Zhao
- Department of Medical Laboratory, the First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China.
| | - Xi Wang
- Department of Cardiology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China.
| | - Fucheng He
- Department of Medical Laboratory, the First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China.
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Petrie CJ, Weir RAP, Anwar MS, Ali MA, Kerr M, Abed JA. High sensitivity troponin T in acute medicine; more questions than answers? QJM 2014; 107:193-200. [PMID: 24259723 DOI: 10.1093/qjmed/hct232] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Troponin testing in acute medicine is routine. The introduction of a high sensitivity assay (hs Tn T) has created uncertainty regarding the clinical significance of 'abnormal' troponin T levels. The previous assay could not detect troponin levels <30 ng/l. AIMS AND METHODS To characterize those with a hs Tn T ≥14 ng/l. Prospective cohort study of consecutive admissions to an acute medical unit. RESULTS Troponin was measured in 564 consecutive patients (∼50% of all admissions) over 1 month; was ≥14 ng/l in 224 (40%) of which 220 patients had demographic data for this analysis. Median (inter-quartile range) peak troponin was 47.5 ng/l (24-130) and 36% had a Tn T between 14 and 30 ng/l. Mean [standard deviation (SD)] age was 72 (12) years and 57% were male. Only 44 patients (20%) had an acute myocardial infarction, reflecting the increased sensitivity but reduced specificity of the assay. Prognosis was poor with 31% mortality at 1 year. Over a mean (SD) follow-up of 648 (61) days, there were 87 deaths (40%). Those with a primary non-cardiac diagnosis (n = 126) had poorer survival than those with a primary cardiac diagnosis (n = 94). Troponin elevation related to sepsis conferred a very poor prognosis with 24 deaths (70%) over the follow-up period. CONCLUSION Elevated hs Tn T is very common in acute medicine, but myocardial infarction as an explanation is uncommon. Overall, the prognosis is poor with a tendency to worse outcomes in those with a primary 'non-cardiac' diagnosis.
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Affiliation(s)
- C J Petrie
- Department of Cardiology, Monklands Hospital, Monkscourt Avenue, Airdrie, ML6 0JS, Glasgow.
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40
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Development of a novel heart failure risk tool: the barcelona bio-heart failure risk calculator (BCN bio-HF calculator). PLoS One 2014; 9:e85466. [PMID: 24454874 PMCID: PMC3893213 DOI: 10.1371/journal.pone.0085466] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 11/28/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND A combination of clinical and routine laboratory data with biomarkers reflecting different pathophysiological pathways may help to refine risk stratification in heart failure (HF). A novel calculator (BCN Bio-HF calculator) incorporating N-terminal pro B-type natriuretic peptide (NT-proBNP, a marker of myocardial stretch), high-sensitivity cardiac troponin T (hs-cTnT, a marker of myocyte injury), and high-sensitivity soluble ST2 (ST2), (reflective of myocardial fibrosis and remodeling) was developed. METHODS Model performance was evaluated using discrimination, calibration, and reclassification tools for 1-, 2-, and 3-year mortality. Ten-fold cross-validation with 1000 bootstrapping was used. RESULTS The BCN Bio-HF calculator was derived from 864 consecutive outpatients (72% men) with mean age 68.2 ± 12 years (73%/27% New York Heart Association (NYHA) class I-II/III-IV, LVEF 36%, ischemic etiology 52.2%) and followed for a median of 3.4 years (305 deaths). After an initial evaluation of 23 variables, eight independent models were developed. The variables included in these models were age, sex, NYHA functional class, left ventricular ejection fraction, serum sodium, estimated glomerular filtration rate, hemoglobin, loop diuretic dose, β-blocker, Angiotensin converting enzyme inhibitor/Angiotensin-2 receptor blocker and statin treatments, and hs-cTnT, ST2, and NT-proBNP levels. The calculator may run with the availability of none, one, two, or the three biomarkers. The calculated risk of death was significantly changed by additive biomarker data. The average C-statistic in cross-validation analysis was 0.79. CONCLUSIONS A new HF risk-calculator that incorporates available biomarkers reflecting different pathophysiological pathways better allowed individual prediction of death at 1, 2, and 3 years.
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Nakamura Y, Yoshihisa A, Takiguchi M, Shimizu T, Yamauchi H, Iwaya S, Owada T, Miyata M, Abe S, Sato T, Suzuki S, Oikawa M, Kobayashi A, Yamaki T, Sugimoto K, Kunii H, Nakazato K, Suzuki H, Saitoh SI, Takeishi Y. High-Sensitivity Cardiac Troponin T Predicts Non-Cardiac Mortality in Heart Failure. Circ J 2014; 78:890-5. [DOI: 10.1253/circj.cj-13-1372] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yuichi Nakamura
- Department of Cardiology and Hematology, Fukushima Medical University
| | - Akiomi Yoshihisa
- Department of Cardiology and Hematology, Fukushima Medical University
| | - Mai Takiguchi
- Department of Cardiology and Hematology, Fukushima Medical University
| | - Takeshi Shimizu
- Department of Cardiology and Hematology, Fukushima Medical University
| | - Hiroyuki Yamauchi
- Department of Cardiology and Hematology, Fukushima Medical University
| | - Shoji Iwaya
- Department of Cardiology and Hematology, Fukushima Medical University
| | - Takashi Owada
- Department of Cardiology and Hematology, Fukushima Medical University
| | - Makiko Miyata
- Department of Cardiology and Hematology, Fukushima Medical University
| | - Satoshi Abe
- Department of Cardiology and Hematology, Fukushima Medical University
| | - Takamasa Sato
- Department of Cardiology and Hematology, Fukushima Medical University
| | - Satoshi Suzuki
- Department of Cardiology and Hematology, Fukushima Medical University
| | - Masayoshi Oikawa
- Department of Cardiology and Hematology, Fukushima Medical University
| | - Atsushi Kobayashi
- Department of Cardiology and Hematology, Fukushima Medical University
| | - Takayoshi Yamaki
- Department of Cardiology and Hematology, Fukushima Medical University
| | - Koichi Sugimoto
- Department of Cardiology and Hematology, Fukushima Medical University
| | - Hiroyuki Kunii
- Department of Cardiology and Hematology, Fukushima Medical University
| | - Kazuhiko Nakazato
- Department of Cardiology and Hematology, Fukushima Medical University
| | - Hitoshi Suzuki
- Department of Cardiology and Hematology, Fukushima Medical University
| | - Shu-ichi Saitoh
- Department of Cardiology and Hematology, Fukushima Medical University
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Regulation of expression of atrial and brain natriuretic peptide, biomarkers for heart development and disease. Biochim Biophys Acta Mol Basis Dis 2013; 1832:2403-13. [DOI: 10.1016/j.bbadis.2013.07.003] [Citation(s) in RCA: 125] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 07/01/2013] [Accepted: 07/03/2013] [Indexed: 11/17/2022]
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43
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An integrated multiple marker modality is superior to NT-proBNP alone in prognostic prediction in all-cause mortality in a prospective cohort of elderly heart failure patients. Eur Geriatr Med 2013. [DOI: 10.1016/j.eurger.2013.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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44
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de Antonio M, Lupón J, Galán A, Vila J, Zamora E, Urrutia A, Díez C, Coll R, Altimir S, Bayes-Genis A. Head-to-head comparison of high-sensitivity troponin T and sensitive-contemporary troponin I regarding heart failure risk stratification. Clin Chim Acta 2013; 426:18-24. [DOI: 10.1016/j.cca.2013.08.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 07/25/2013] [Accepted: 08/15/2013] [Indexed: 11/25/2022]
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Usefulness of high-sensitivity cardiac troponin T and brain natriuretic peptide as biomarkers of myocardial fibrosis in patients with hypertrophic cardiomyopathy. Am J Cardiol 2013; 112:867-72. [PMID: 23746480 DOI: 10.1016/j.amjcard.2013.04.060] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 04/25/2013] [Accepted: 04/25/2013] [Indexed: 01/20/2023]
Abstract
Myocardial fibrosis assessed by late gadolinium enhancement cardiac magnetic resonance imaging is associated with cardiovascular events in patients with hypertrophic cardiomyopathy (HC), but few data are available regarding the utility of biomarkers for detecting late gadolinium enhancement. The aim of this study was to examine serum levels of myoglobin, cardiac myosin light chain I, high-sensitivity cardiac troponin T (hs-cTnT), and creatine kinase-MB isoenzyme and plasma levels of brain natriuretic peptide (BNP) in relation to late gadolinium enhancement in 53 patients with HC. Levels of hs-cTnT and BNP were higher in 23 patients with late gadolinium enhancement than in 30 patients without it (p <0.01 for both). An hs-cTnT level ≥0.007 ng/ml or a BNP level ≥70 pg/ml had good diagnostic value for detecting late gadolinium enhancement, with sensitivity of 96% or specificity of 90% with the combination of these 2 biomarkers. The extent of late gadolinium enhancement was correlated with BNP level (p <0.01) but not with hs-cTnT level in 23 patients with HC with late gadolinium enhancement. The increase in the extent of late gadolinium enhancement was related to hs-cTnT level in 8 patients during 22 months of follow-up (p = 0.02). In conclusion, the combination of hs-cTnT and BNP is useful in detecting myocardial fibrosis in patients with HC. The findings of this study indicate that hs-cTnT is a direct marker of ongoing myocardial fibrosis and that BNP is a marker of left ventricular overload partially associated with myocardial fibrosis.
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Current World Literature. Curr Opin Cardiol 2013; 28:369-79. [DOI: 10.1097/hco.0b013e328360f5be] [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: 11/26/2022]
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47
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Lupón J, de Antonio M, Galán A, Vila J, Zamora E, Urrutia A, Bayes-Genis A. Combined use of the novel biomarkers high-sensitivity troponin T and ST2 for heart failure risk stratification vs conventional assessment. Mayo Clin Proc 2013; 88:234-43. [PMID: 23384388 DOI: 10.1016/j.mayocp.2012.09.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 09/17/2012] [Accepted: 09/21/2012] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To assess an innovative multimarker strategy for risk stratification of death in a real-life ambulatory heart failure (HF) cohort. PATIENTS AND METHODS The study included 876 consecutive outpatients (median age, 70.3 years; left ventricular ejection fraction, 34%) between May 22, 2006, and July 7, 2010, prospectively followed up in a structured HF unit. A combination of biomarkers reflecting myocardial stretch (N-terminal pro-B-type natriuretic peptide [NT-proBNP]), myocyte injury (high-sensitivity cardiac troponin T [hs-cTnT]), and ventricular fibrosis and remodeling (high-sensitivity ST2 [hs-ST2]) were added to an assessment based on established mortality risk factors (age, sex, left ventricular ejection fraction, New York Heart Association functional class, diabetes mellitus, estimated glomerular filtration rate, ischemic etiology, sodium level, hemoglobin level, and pharmacologic treatment). RESULTS During median follow-up of 41.4 months, 311 patients died. The combined addition of hs-cTnT and hs-ST2 to the model yielded good measurements of performance (C statistic, 0.789; Bayesian information criterion, 3611; integrated discrimination improvement, 4.1 [95% CI, 2.5-5.6]; and net reclassification index, 13.9% [95% CI, 6.2-21.6]). Reclassification did not significantly benefit after NT-proBNP addition into the full model; some indices even worsened with all 3 biomarkers. Separate addition of NT-proBNP provided prognostic discrimination only in the subgroup of patients with either hs-cTnT or hs-ST2 levels below the cutoff points (hazard ratio, 2.97; 95% CI, 2.24-9.39; P<.001). CONCLUSION A multimarker strategy seems useful for stratifying risk in chronic HF. However, NT-proBNP in addition to the new-generation biomarkers hs-cTnT and hs-ST2 had a limited effect on risk stratification.
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Affiliation(s)
- Josep Lupón
- Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
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Kodavanti UP, Thomas RF, Ledbetter AD, Schladweiler MC, Bass V, Krantz QT, King C, Nyska A, Richards JE, Andrews D, Gilmour MI. Diesel exhaust induced pulmonary and cardiovascular impairment: the role of hypertension intervention. Toxicol Appl Pharmacol 2013; 268:232-40. [PMID: 23415681 DOI: 10.1016/j.taap.2013.02.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Revised: 01/28/2013] [Accepted: 02/04/2013] [Indexed: 11/17/2022]
Abstract
Exposure to diesel exhaust (DE) and associated gases is linked to cardiovascular impairments; however, the susceptibility of hypertensive individuals is poorly understood. The objectives of this study were (1) to determine cardiopulmonary effects of gas-phase versus whole-DE and (2) to examine the contribution of systemic hypertension in pulmonary and cardiovascular effects. Male Wistar Kyoto (WKY) rats were treated with hydralazine to reduce blood pressure (BP) or l-NAME to increase BP. Spontaneously hypertensive (SH) rats were treated with hydralazine to reduce BP. Control and drug-pretreated rats were exposed to air, particle-filtered exhaust (gas), or whole DE (1500μg/m(3)), 4h/day for 2days or 5days/week for 4weeks. Acute and 4-week gas and DE exposures increased neutrophils and γ-glutamyl transferase (γ-GT) activity in lavage fluid of WKY and SH rats. DE (4weeks) caused pulmonary albumin leakage and inflammation in SH rats. Two-day DE increased serum fatty acid binding protein-3 (FABP-3) in WKY. Marked increases occurred in aortic mRNA after 4-week DE in SH (eNOS, TF, tPA, TNF-α, MMP-2, RAGE, and HMGB-1). Hydralazine decreased BP in SH while l-NAME tended to increase BP in WKY; however, neither changed inflammation nor BALF γ-GT. DE-induced and baseline BALF albumin leakage was reduced by hydralazine in SH rats and increased by l-NAME in WKY rats. Hydralazine pretreatment reversed DE-induced TF, tPA, TNF-α, and MMP-2 expression but not eNOS, RAGE, and HMGB-1. ET-1 was decreased by HYD. In conclusion, antihypertensive drug treatment reduces gas and DE-induced pulmonary protein leakage and expression of vascular atherogenic markers.
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Affiliation(s)
- Urmila P Kodavanti
- Environmental Public Health Division, National Health and Environmental Effects Research Laboratory (NHEERL), Office of Research and Development (ORD), U.S. Environmental Protection Agency (EPA), Research Triangle Park, NC 27711, USA.
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