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Piątkowski R, Kochanowski J, Budnik M, Grabowski M, Ścisło P, Opolski G. NT-proBNP increase during stress echocardiography predicts significant changes in ischemic mitral regurgitation severity in patients qualified for surgical revascularization. Cardiol J 2022; 29:927-935. [PMID: 32515485 PMCID: PMC9788748 DOI: 10.5603/cj.a2020.0078] [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: 03/08/2019] [Revised: 04/13/2020] [Accepted: 04/21/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND In many patients, significant changes in ischemic mitral regurgitation (IMR) severity during exercise can be observed independent of the degree of IMR at rest. This study aimed to investigate the correlations between N-terminal fragment B-type natriuretic peptide (NT-proBNP) and echocardiography measurements at rest and at peak exercise in patients with moderate IMR who qualified for surgical revascularization. METHODS A total of 100 patients eligible for coronary artery bypass grafting, were included in this prospective study. All patients underwent exercise echocardiography. Additionally, the levels of NT-proBNP were measured at rest and after peak exercise. RESULTS A positive correlation of absolute NT-proBNP levels with effective regurgitant orifice area (EROA) were observed and with tricuspid regurgitant peak gradient (TRPG) at peak exercise. Absolute ΔNT-proBNP during exercise and the tenting area at rest were independent predictors of severe IMR at peak exercise. The level of absolute ΔNT-proBNP during exercise and coaptation height at rest were the most important predictors of significant increases in TRPG. The best cutoff value for ΔNT-proBNP as a predictor for increases in EROA at peak exercise was 68.9 pg/mL and to predict an increase in TRPG ≥ 50 mmHg at peak exercise was 68 pg/mL. CONCLUSIONS The level of ΔNT-proBNP during exercise was the most important parameter in predicting significant changes in IMR severity and pulmonary pressure. Based on the present data, it can be speculated that integration of the assessment of NT-proBNP at rest and at exercise might improve patient selection for valve surgery.
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Yingtong M, Wei Z, Hanjun H, Tingting Z, Xiaohua G. The effects of early exercise on cardiac rehabilitation-related outcome in acute heart failure patients: a systematic review and meta-analysis. Int J Nurs Stud 2022; 130:104237. [DOI: 10.1016/j.ijnurstu.2022.104237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 03/17/2022] [Accepted: 03/19/2022] [Indexed: 10/18/2022]
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Tuttolomondo A, Maida C, Casuccio A, Di Raimondo D, Fonte R, Vassallo V, Puleo MG, Di Chiara T, Mogavero A, Del Cuore A, Daidone M, Ortello A, Pinto A. Effects of intravenous furosemide plus small-volume hypertonic saline solutions on markers of heart failure. ESC Heart Fail 2021; 8:4174-4186. [PMID: 34288546 PMCID: PMC8497323 DOI: 10.1002/ehf2.13511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/18/2021] [Accepted: 06/23/2021] [Indexed: 11/08/2022] Open
Abstract
AIMS We sought to compare the effects of furosemide + hypertonic saline solution (HSS) treatment in patients with acute decompensated heart failure in comparison with furosemide alone and the response in a compensated state after an acute saline load with regard to serum levels of heart failure biomarkers. METHODS AND RESULTS We enrolled 141 patients with acute decompensated heart failure with reduced ejection fraction admitted to our Internal Medicine ward from March 2017 to November 2019. A total of 73 patients were randomized to treatment with i.v. high-dose furosemide plus HSS, whereas 68 patients were randomized to i.v. high-dose furosemide alone. Patients treated with furosemide plus HSS compared with controls treated with furosemide alone showed a comparable degree of reduction in the serum levels of interleukin (IL)-6, soluble suppression of tumorigenicity 2 (sST2), and N-terminal pro-brain natriuretic peptide (NT-proBNP) in the 'between-group' analysis. Nevertheless, patients treated with high-dose furosemide + HSS showed significantly higher absolute delta values of IL-6 (2.3 ± 1.2 vs. 1.7 ± 0.9, P < 0.0005, and 2.0 ± 0.8 vs. 1.85 ± 1.1, P = 0.034), sST2 (41.2 ± 8.6 vs. 27.9 ± 7.6, P < 0.0005, and 37.1 ± 6.6 vs. 28.4 ± 6.7, P < 0.0005), high-sensitivity troponin T (0.03 ± 0.02 vs. 0.02 ± 0.01, P = 0.001, and 0.03 ± 0.02 vs. 0.02 ± 0.01, P = 0.009), NT-proBNP (7237 ± 7931 vs. 3244 ± 4159, P < 0.005, and 5381 ± 4829 vs. 4466 ± 4332, P = 0.004), and galectin-3 (15.7 ± 3.2 ng/mL vs. 11.68 ± 1.9 ng/mL, P < 0.0005, and 16.7 ± 3.9 ng/mL vs. 11.8 ± 2.4 ng/mL, P < 0.0005) than patients treated with furosemide alone. After acute saline load, patients treated with i.v. furosemide + HSS in comparison with subjects treated with furosemide alone showed a significantly lower increase in the serum concentrations of IL-6 (-0.26 ± 0.42 pg/mL vs. -1.43 ± 0.86 pg/mL, P < 0.0005), high-sensitivity troponin T (0 vs. -0.02 ± 0.02 ng/mL, P < 0.0005), sST2 (-8.5 ± 5.9 ng/mL vs. -14.6 ± 6.2 ng/mL, P < 0.0005), galectin-3 (-2.1 ± 1.5 ng/mL vs. -7.1 ± 3.6 ng/mL, P < 0.0005), and NT-proBNP (77 ± 1373 vs. -1706 ± 2259 pg/mL, P < 0.0005). CONCLUSIONS Our findings concerning a comparable degree of reduction in the serum levels of three cardinal biomarkers indicate that a reduction in serum heart failure markers is not linked to the higher degree of congestion relief with a more rapid achievement of a clinical compensation state. This issue may have possible benefits on clinical practice concerning its therapeutic effects over and beyond the simple amelioration of clinical congestion signs and symptoms. Nevertheless, our findings of higher delta values after treatment with i.v. furosemide plus HSS indicate a possible higher efficacy by means of modulation of the stretching and fibrosis mechanisms.
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Affiliation(s)
- Antonino Tuttolomondo
- U.O. C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno‐Infantile, di Medicina Interna e Specialistica di Eccellenza “G. D'Alessandro” (PROMISE)University of PalermoPiazza delle Cliniche n.2Palermo90127Italy
| | - Carlo Maida
- U.O. C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno‐Infantile, di Medicina Interna e Specialistica di Eccellenza “G. D'Alessandro” (PROMISE)University of PalermoPiazza delle Cliniche n.2Palermo90127Italy
| | - Alessandra Casuccio
- U.O. C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno‐Infantile, di Medicina Interna e Specialistica di Eccellenza “G. D'Alessandro” (PROMISE)University of PalermoPiazza delle Cliniche n.2Palermo90127Italy
| | - Domenico Di Raimondo
- U.O. C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno‐Infantile, di Medicina Interna e Specialistica di Eccellenza “G. D'Alessandro” (PROMISE)University of PalermoPiazza delle Cliniche n.2Palermo90127Italy
| | - Roberto Fonte
- U.O. C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno‐Infantile, di Medicina Interna e Specialistica di Eccellenza “G. D'Alessandro” (PROMISE)University of PalermoPiazza delle Cliniche n.2Palermo90127Italy
| | - Valerio Vassallo
- U.O. C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno‐Infantile, di Medicina Interna e Specialistica di Eccellenza “G. D'Alessandro” (PROMISE)University of PalermoPiazza delle Cliniche n.2Palermo90127Italy
| | - Maria Grazia Puleo
- U.O. C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno‐Infantile, di Medicina Interna e Specialistica di Eccellenza “G. D'Alessandro” (PROMISE)University of PalermoPiazza delle Cliniche n.2Palermo90127Italy
| | - Tiziana Di Chiara
- U.O. C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno‐Infantile, di Medicina Interna e Specialistica di Eccellenza “G. D'Alessandro” (PROMISE)University of PalermoPiazza delle Cliniche n.2Palermo90127Italy
| | - Alba Mogavero
- U.O. C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno‐Infantile, di Medicina Interna e Specialistica di Eccellenza “G. D'Alessandro” (PROMISE)University of PalermoPiazza delle Cliniche n.2Palermo90127Italy
| | - Alessandro Del Cuore
- U.O. C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno‐Infantile, di Medicina Interna e Specialistica di Eccellenza “G. D'Alessandro” (PROMISE)University of PalermoPiazza delle Cliniche n.2Palermo90127Italy
| | - Mario Daidone
- U.O. C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno‐Infantile, di Medicina Interna e Specialistica di Eccellenza “G. D'Alessandro” (PROMISE)University of PalermoPiazza delle Cliniche n.2Palermo90127Italy
| | - Antonella Ortello
- U.O. C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno‐Infantile, di Medicina Interna e Specialistica di Eccellenza “G. D'Alessandro” (PROMISE)University of PalermoPiazza delle Cliniche n.2Palermo90127Italy
| | - Antonio Pinto
- U.O. C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno‐Infantile, di Medicina Interna e Specialistica di Eccellenza “G. D'Alessandro” (PROMISE)University of PalermoPiazza delle Cliniche n.2Palermo90127Italy
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Djordjevic T, Arena R, Guazzi M, Popovic D. Prognostic Value of NT-Pro Brain Natriuretic Peptide During Exercise Recovery in Ischemic Heart Failure of Reduced, Midrange, and Preserved Ejection Fraction. J Cardiopulm Rehabil Prev 2021; 41:282-287. [PMID: 32947324 DOI: 10.1097/hcr.0000000000000531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Ischemic heart disease is a leading cause of heart failure (HF), which continues to carry a high mortality despite considerable improvements in diagnosis and treatment. N-terminal-pro-B-type natriuretic peptide (NT-pro-BNP) measured at rest is a recognized diagnostic and prognostic marker of HF of reduced ejection fraction (HFrEF); however, its value in patients with HF of midranged/preserved ejection fraction (HFmrEF/HFpEF) is not well established. We examined the prognostic value of NT-pro-BNP during recovery from exercise in patients with ischemic HF (IHF) of any ejection fraction. METHODS Patients (n = 213) with HF (123 HFrEF, 90 HFmrEF/HFpEF) underwent cardiopulmonary exercise testing. Doppler echocardiography was used to estimate resting pulmonary artery systolic pressure (PASP) and tricuspid annular plane systolic excursion (TAPSE). NT-pro-BNP was determined at rest, peak exercise, and after 1 min of exercise recovery. RESULTS Patients with HFrEF had higher plasma levels of NT-pro-BNP at rest, peak exercise, and recovery than those with HFmrEF/HFpEF (984 ± 865 vs 780 ± 805; 1012 ± 956 vs 845 ± 895; 990 ± 1013 vs 808 ± 884 pg/mL; P < .01, respectively), whereas ΔNT-pro-BNP peak/rest and ΔNT-pro-BNP recovery/peak were similar (60 ± 100 vs 50 ± 96; -25 ± 38 vs -20 ± 41 pg/mL, P > .05). During the tracking period (22.4 ± 20.3 mo), 34 patients died, 2 underwent cardiac transplantation, and 3 had left ventricular assist device implantation. In a multivariate regression model, only NT-pro-BNP during exercise recovery and TAPSE/PASP were retained in the regression for the prediction of adverse events (χ2 = 11.4, P <.001). CONCLUSIONS NT-pro-BNP value during exercise recovery may be a robust predictor of adverse events in patients with IHF across a wide range of ejection fraction.
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Affiliation(s)
- Tea Djordjevic
- Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia (Ms Djordjevic); Department of Physical Therapy, College of Applied Science, University at Illinois, Chicago (Dr Arena); Heart Failure Unit and Cardiopulmonary Laboratory, University Cardiology Department, IRCCS, Policlinico San Donato University Hospital, Milan, Italy (Dr Guazzi); and Clinical Center Serbia, Department of Cardiology, University of Belgrade, Belgrade, Serbia (Dr Popovic)
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Abstract
OBJECTIVE Recent studies have shown that activation of the immune system, inflammatory cell infiltration, and activation of inflammatory mediators play an important role in the development of heart failure. The purpose of this study was to investigate whether cardiac function can be improved by regulating the balance of lymphocyte subsets and cytokines. METHODS Ninety-six patients with chronic heart failure (CHF) who were older than 60 years were randomly divided into two groups: CHF testing group (CHFT) received regular therapy and thymopentin (2 mg thymopentin per day, 15th as a course, three courses in total). CHF control group (CHFC) received regular therapy. Forty-five healthy individuals older than 60 years were used as normal controls. The ejection fraction of left ventricle (LVEF), inner diameter of left ventricular end-diastole (LVEDD), inner diameter of left ventricular end-systole (LVESD), plasma high sensitive C-reactive protein (hsCRP), plasma brain natriuretic peptide (BNP), 6-min walking distance (6MWT), Minnesota Living with Heart Failure Questionnaire (MLHFQ) assessment, lymphocyte subsets, and inflammatory cytokines were tested. RESULTS The levels of LVEF, 6MWT, CD 3+, CD4+T cells, natural killer cells, CD4+/CD8+ and IL-10 in CHFT were increased (p<0.01) compared with CHFC, while BNP, hsCRP, MLHFQ, CD8+, TNF-α, IL-1ß, and TNF-α/IL-10 ratio in CHFT were decreased (p<0.01). LVEDD and LVESD were decreased, even though there was no significant difference between the two CHF groups. CONCLUSION These data suggest that immune modulation therapy improve cardiac function and regulate cytokines and lymphocyte subsets in older patients with CHF.
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Pastormerlo LE, Agazio A, Benelli E, Gabutti A, Poletti R, Prontera C, Clerico A, Emdin M, Passino C. Usefulness of High-Sensitive Troponin Elevation After Effort Stress to Unveil Vulnerable Myocardium in Patients With Heart Failure. Am J Cardiol 2015; 116:567-72. [PMID: 26089013 DOI: 10.1016/j.amjcard.2015.05.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 05/14/2015] [Accepted: 05/14/2015] [Indexed: 11/27/2022]
Abstract
Elevation of resting high-sensitivity troponin (hs-Tn) holds prognostic value in heart failure (HF), but its pathophysiological meaning is unclear. We aimed to investigate hs-Tn elevation after maximal exercise in patients with systolic HF and its neurohormonal and hemodynamic correlates: 30 patients diagnosed with systolic HF (left ventricular ejection fraction 32 ± 8%, mean ± SD), on guideline-directed medical therapy and not recognized inducible ischemia, underwent maximal cardiopulmonary stress test, with assay of plasma N-terminal proB-type natriuretic peptide (NT-proBNP), norepinephrine (NE), and hs-TnT (hs-TnT) at baseline, peak, and 1 and 4 hours after exercise. Cardiac output (CO) was measured during effort, with a rebreathing technique. The natural logarithm of the ratio between percentage (%) increase in CO and NT-proBNP (ln[CO%/NT-proBNP% increase]) was evaluated, as a noninvasive estimate of Frank-Starling adaptation to effort, with NT-proBNP variation considered as a surrogate of end-diastolic left ventricular pressure variation. Hs-TnT increased during exercise with a 4-hour peak (p = 0.001); 10 patients had hs-TnT increase >20%. Patients with Hs-TnT increase >20% were more symptomatic at rest (p = 0.039) and showed greater NE at peak exercise (p = 0.003) and less ln[CO%/NT-proBNP% increase] (p = 0.034). A lower ln[CO%/NT-proBNP% increase] correlated with greater NE at peak exercise (r = -0.430, p = 0.018). In conclusion, acute troponin elevation after maximal exercise was detected in 1/3 of this series. The association of troponin release with NE, CO, and NT-proBNP changes after effort suggests a pathophysiological link among transient hemodynamic overload, adrenergic activation, and myocardial cell damage, likely identifying a clinical subset at greater risk for HF progression.
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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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Exercise Oscillatory Breathing and NT-proBNP Levels in Stable Heart Failure Provide the Strongest Prediction of Cardiac Outcome When Combining Biomarkers With Cardiopulmonary Exercise Testing. J Card Fail 2012; 18:313-20. [DOI: 10.1016/j.cardfail.2012.01.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 01/02/2012] [Accepted: 01/09/2012] [Indexed: 11/30/2022]
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Lipshultz SE, Miller TL, Scully RE, Lipsitz SR, Rifai N, Silverman LB, Colan SD, Neuberg DS, Dahlberg SE, Henkel JM, Asselin BL, Athale UH, Clavell LA, Laverdière C, Michon B, Schorin MA, Sallan SE. Changes in cardiac biomarkers during doxorubicin treatment of pediatric patients with high-risk acute lymphoblastic leukemia: associations with long-term echocardiographic outcomes. J Clin Oncol 2012; 30:1042-9. [PMID: 22370326 DOI: 10.1200/jco.2010.30.3404] [Citation(s) in RCA: 221] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
PURPOSE Doxorubicin causes cardiac injury and cardiomyopathy in children with acute lymphoblastic leukemia (ALL). Measuring biomarkers during therapy might help individualize treatment by immediately identifying cardiac injury and cardiomyopathy. PATIENTS AND METHODS Children with high-risk ALL were randomly assigned to receive doxorubicin alone (n = 100; 75 analyzed) or doxorubicin with dexrazoxane (n = 105; 81 analyzed). Echocardiograms and serial serum measurements of cardiac troponin T (cTnT; cardiac injury biomarker), N-terminal pro-brain natriuretic peptide (NT-proBNP; cardiomyopathy biomarker), and high-sensitivity C-reactive protein (hsCRP; inflammatory biomarker) were obtained before, during, and after treatment. RESULTS cTnT levels were increased in 12% of children in the doxorubicin group and in 13% of the doxorubicin-dexrazoxane group before treatment but in 47% and 13%, respectively, after treatment (P = .005). NT-proBNP levels were increased in 89% of children in the doxorubicin group and in 92% of children in the doxorubicin-dexrazoxane group before treatment but in only 48% and 20%, respectively, after treatment (P = .07). The percentage of children with increased hsCRP levels did not differ between groups at any time. In the first 90 days of treatment, detectable increases in cTnT were associated with abnormally reduced left ventricular (LV) mass and LV end-diastolic posterior wall thickness 4 years later (P < .01); increases in NT-proBNP were related to an abnormal LV thickness-to-dimension ratio, suggesting LV remodeling, 4 years later (P = .01). Increases in hsCRP were not associated with any echocardiographic variables. CONCLUSION cTnT and NT-proBNP may hold promise as biomarkers of cardiotoxicity in children with high-risk ALL. Definitive validation studies are required to fully establish their range of clinical utility.
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Grachtrup S, Brügel M, Pankau H, Halank M, Wirtz H, Seyfarth HJ. Exercise Dependence of N-Terminal Pro-Brain Natriuretic Peptide in Patients with Precapillary Pulmonary Hypertension. Respiration 2012; 84:454-60. [DOI: 10.1159/000334950] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Accepted: 11/08/2011] [Indexed: 11/19/2022] Open
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Kallistratos MS, Pavlidis AN, Chamodraka ES, Varounis C, Dritsas A, Laoutaris ID, Manolis AJ, Cokkinos DV. Prognostic Value of NT-proBNP at Rest and Peak Exercise in Patients With Impaired Left Ventricular Function. Angiology 2011; 63:516-21. [DOI: 10.1177/0003319711429328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We aimed to identify whether N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) at peak exercise can provide incremental clinical information over resting levels. A total of 90 patients with systolic heart failure were prospectively studied. Levels of plasma NT-proBNP were assessed at rest and at peak exercise during a cardiopulmonary exercise test. Patients were followed-up for 30 ± 10 months. Levels of NT-proBNP at baseline and peak exercise were significantly correlated with left ventricular ejection fraction ([LVEF] r = −.629, P < .001 and r = −.630, P < .001, respectively) and peak oxygen uptake ([Vo2] r = −.752, P < .001 and r = −.740, P < .001, respectively). Levels of plasma NT-proBNP at peak exercise demonstrated similar predictive ability for the detection of patients with low peak Vo2 and LVEF <28%. Levels of plasma NT-proBNP can detect low-functional class patients and patients who may be the candidates for heart transplantation with high sensitivity and specificity. At baseline and peak exercise, NT–proBNP demonstrates similar prognostic and predictive ability.
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Affiliation(s)
- Manolis S. Kallistratos
- First Cardiology Department, Onassis Cardiac Surgery Centre, Athens, Greece
- Department of Cardiology, Asklepeion General Hospital, Athens, Greece
| | - Antonios N. Pavlidis
- First Cardiology Department, Onassis Cardiac Surgery Centre, Athens, Greece
- Department of Cardiology, Asklepeion General Hospital, Athens, Greece
| | | | - Christos Varounis
- Department of Cardiology, Asklepeion General Hospital, Athens, Greece
| | - Athanasios Dritsas
- First Cardiology Department, Onassis Cardiac Surgery Centre, Athens, Greece
| | | | - Athanasios J. Manolis
- Department of Cardiology, Asklepeion General Hospital, Athens, Greece
- Emory University School of Medicine, Atlanta, GA, USA
| | - Dennis V. Cokkinos
- First Cardiology Department, Onassis Cardiac Surgery Centre, Athens, Greece
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Gary RA, Cress ME, Higgins MK, Smith AL, Dunbar SB. Combined aerobic and resistance exercise program improves task performance in patients with heart failure. Arch Phys Med Rehabil 2011; 92:1371-81. [PMID: 21878207 PMCID: PMC4143394 DOI: 10.1016/j.apmr.2011.02.022] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2011] [Accepted: 02/28/2011] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To assess the effects of a home-based aerobic and resistance training program on the physical function of adults with New York Heart Association (NYHA) class II and III patients and systolic heart failure (HF). DESIGN Randomized controlled trial. SETTING Home based. PARTICIPANTS Stable patients (N=24; mean age, 60 ± 10 y; left ventricular ejection fraction, 25% ± 9%; 50% white; 50% women) with New York Heart Association (NYHA) classes II and III (NYHA class III, 58%) systolic heart failure (HF). INTERVENTION A 12-week progressive home-based program of moderate-intensity aerobic and resistance exercise. Attention control wait list participants performed light stretching and flexibility exercises. MAIN OUTCOME MEASURES A 10-item performance-based physical function measure, the Continuous Scale Physical Functional Performance test (CS-PFP10), was the major outcome variable and included specific physical activities measured in time to complete a task, weight carried during a task, and distance walked. Other measures included muscle strength, HRQOL (Minnesota Living With Heart Failure Questionnaire, Epworth Sleepiness Scale), functional capacity (Duke Activity Status Index), and disease severity (brain natriuretic peptide) levels. RESULTS After the exercise intervention, 9 of 10 specific task activities were performed more rapidly, with increased weight carried by exercise participants compared with the attention control wait list group. Exercise participants also showed significant improvements in CS-PFP10 total score (P<.025), upper and lower muscle strength, and HRQOL (P<.001) compared with the attention control wait list group. Adherence rates were 83% and 99% for the aerobic and resistance training, respectively. CONCLUSIONS Patients with stable HF who participate in a moderate-intensity combined aerobic and resistance exercise program may improve performance of routine physical activities of daily living by using a home-based exercise approach. Performance-based measures such as the CS-PFP10 may provide additional insights into physical function in patients with HF that more commonly used exercise tests may not identify. Early detection of subtle changes that may signal declining physical function that are amenable to intervention potentially may slow further loss of function in this patient population.
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Affiliation(s)
- Rebecca A Gary
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA.
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Transient elevation of NT-pro-BNP as a predictor for myocardial ischemia. Clin Res Cardiol 2010; 99:857-9. [DOI: 10.1007/s00392-010-0211-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2010] [Accepted: 08/19/2010] [Indexed: 01/08/2023]
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Perspective on the clinical application of troponin in heart failure and states of cardiac injury. Heart Fail Rev 2009; 15:305-17. [DOI: 10.1007/s10741-008-9124-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2008] [Accepted: 11/04/2008] [Indexed: 11/29/2022]
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