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Siddiqui MH, Dixit R, Agarwal S, Jha SC, Khanna H, Agrawal SK. Determining the role of NT-proBNP levels in diabetic patients with heart failure: A study from North India. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2024; 13:20. [PMID: 38532921 PMCID: PMC10965036 DOI: 10.4103/jehp.jehp_701_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 07/11/2023] [Indexed: 03/28/2024]
Abstract
BACKGROUND Diabetic patients are at higher risk of cardiovascular morbidity and mortality. NT-proBNP levels measurements are useful for the assessment of risk in heart failure patients in emergency condition and give the faster result. Further, it also offers lower cost and unnecessary hospitalization and follow-up cost. The studies have shown that NT-proBNP levels are a direct predictor of outcome risk in diabetic patients with heart failure. The objective of this research was to study the role of NT-proBNP levels to determine the severity of heart failure in diabetic patients. MATERIALS AND METHODS In this study 150 patients diagnosed with symptomatic heart failure admitted to the emergency department of a tertiary care center from January 2021 to January 2022 have been included in Saraswati Institute Of Medical Sciences, Hapur, India. N-terminal pro-B-type natriuretic peptide (NT-Pro-BNP) levels were measured using an automated analyzer ranging between 60 and 3000 pg/ml. According to the European society of cardiology (ESC) guidelines, it has been defined as NT-Pro-BNP level above 125 pg/ml indicates a high possibility of heart failure and NT-Pro-BNP level below 125 pg/ml excludes the high possibility of heart failure. All the patients underwent an echocardiographic study and ejection fraction was calculated and recorded. RESULTS In diabetic patients ejection fraction was significantly lower in diabetic patients: 47.15 ± 8.75% vs. 43.24 ± 9.54%, P = 0.002). We have observed statistically significant lower HDL values (40.10 ± vs. 35.94 mg/dL, P = 0.0004), however, significant higher triglycerides values were found (101.43 ± 41.7 mg/dL vs. 151.37 ± 78.85, P = 0.001). No significant difference was observed in LDL level (97.8 ± 31.23 vs. 92.35 ± 314.2, P ≥ 0.05) and total cholesterol level (161.49 ± 41.38 vs. 159.97 ± 41.12, P ≥ 0.05). CONCLUSION We concluded that the measurement of NT-proBNP in heart failure and diabetic patients could be an economic marker for the evaluation of morbidity and mortality, facilitating better management and follow-up.
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Affiliation(s)
- Merajul H. Siddiqui
- Department of Biochemistry, Saraswathi Medical Institute, Hapur, Uttar Pradesh, India
| | - Ritvija Dixit
- Department of Biochemistry, Saraswathi Medical Institute, Hapur, Uttar Pradesh, India
| | - Shikha Agarwal
- Department of Biochemistry, Saraswathi Medical Institute, Hapur, Uttar Pradesh, India
| | | | - Harshita Khanna
- Department of Biochemistry, Saraswathi Medical Institute, Hapur, Uttar Pradesh, India
| | - Sonu Kumari Agrawal
- Department of Biochemistry, Saraswathi Medical Institute, Hapur, Uttar Pradesh, India
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Tanaka T, Kavsur R, Spieker M, Iliadis C, Metze C, Horn P, Sugiura A, Kelm M, Baldus S, Nickenig G, Westenfeld R, Pfister R, Becher MU. Periprocedural changes in natriuretic peptide levels and clinical outcome after transcatheter mitral valve repair. ESC Heart Fail 2021; 8:5237-5247. [PMID: 34519444 PMCID: PMC8712850 DOI: 10.1002/ehf2.13603] [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: 06/23/2021] [Revised: 08/16/2021] [Accepted: 08/23/2021] [Indexed: 11/06/2022] Open
Abstract
Aims This multicentre study investigated the association of periprocedural changes in the levels of N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) with clinical outcomes after transcatheter edge‐to‐edge mitral valve repair (TMVR). Methods and results Patients were retrospectively analysed who underwent TMVR with the MitraClip system (Abbott Vascular, Santa Clara, CA, USA) and had available sequential NT‐proBNP testing at baseline and 2 months after TMVR. Periprocedural changes in NT‐proBNP following TMVR were assessed as the percent change in NT‐proBNP between baseline and the 2 month follow‐up, and the significant reduction in NT‐proBNP was defined as a decrease of >30% in the follow‐up NT‐proBNP compared with the pre‐procedural NT‐proBNP level. Primary outcome was defined as a composite outcome consisting of all‐cause mortality and hospitalization due to heart failure from 2 months to 2 years after TMVR. Additionally, we identified the cut‐off value of pre‐procedural NT‐proBNP to predict the composite outcome using a receiver operating characteristic analysis (cut‐off: 2485 pg/mL). Of 485 patients undergoing TMVR (age: 76.2 ± 9.2 years, female: 42.1%, secondary mitral regurgitation: 67.2%), 150 patients (30.9%) had the significant reduction in NT‐proBNP (>30%) following the procedure. Patients with the NT‐proBNP reduction had a lower incidence of the composite outcome, compared with those without the reduction in NT‐proBNP (31.4% vs. 40.2%; log‐rank P = 0.03). The significant reduction in NT‐proBNP was also associated with a lower risk of the composite outcome [adjusted hazard ratio (HR): 0.67; 95% confidence interval (CI): 0.45–0.97; P = 0.04], independently of pre‐procedural NT‐proBNP levels and other clinical parameters. The percent change in NT‐proBNP was associated with a linear trend of the incidence of the composite outcome (adjusted HR per 10% decrease: 0.96; 95% CI: 0.94–0.98; P < 0.001). A stratified analysis revealed that the prognostic impact of the significant reduction in NT‐proBNP was consistent among clinical subgroups, including aetiology of mitral regurgitation (P for interaction = 0.99). Higher pre‐procedural NT‐proBNP level (>2485 pg/mL) was associated with the increased risk of the composite outcome (adjusted HR: 1.50; 95% CI: 1.03–2.17; P = 0.03); however, patients with a higher pre‐procedural NT‐proBNP who achieved the significant reduction in NT‐proBNP had a similar risk of the composite outcome to those with a lower pre‐procedural NT‐proBNP. Conclusions Changes in sequential NT‐proBNP measurements were associated with clinical outcomes within 2 years after TMVR. The assessment of NT‐proBNP dynamics may be valuable to assess the residual risk for patients undergoing TMVR and could assist with post‐procedural management after TMVR.
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Affiliation(s)
- Tetsu Tanaka
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg Campus 1, Bonn, 53127, Germany
| | - Refik Kavsur
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg Campus 1, Bonn, 53127, Germany
| | - Maximilian Spieker
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Christos Iliadis
- Heart Center, Department of Cardiology, University Hospital Cologne, Cologne, Germany
| | - Clemens Metze
- Heart Center, Department of Cardiology, University Hospital Cologne, Cologne, Germany
| | - Patrick Horn
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Atsushi Sugiura
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg Campus 1, Bonn, 53127, Germany
| | - Malte Kelm
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Stephan Baldus
- Heart Center, Department of Cardiology, University Hospital Cologne, Cologne, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg Campus 1, Bonn, 53127, Germany
| | - Ralf Westenfeld
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Roman Pfister
- Heart Center, Department of Cardiology, University Hospital Cologne, Cologne, Germany
| | - Marc Ulrich Becher
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Venusberg Campus 1, Bonn, 53127, Germany
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Spannella F, Giulietti F, Bordicchia M, Burnett JC, Sarzani R. Association Between Cardiac Natriuretic Peptides and Lipid Profile: a Systematic Review and Meta-Analysis. Sci Rep 2019; 9:19178. [PMID: 31844088 PMCID: PMC6915780 DOI: 10.1038/s41598-019-55680-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 11/20/2019] [Indexed: 02/08/2023] Open
Abstract
Cardiac natriuretic peptides (NPs) play a fundamental role in maintaining cardiovascular (CV) and renal homeostasis. Moreover, they also affect glucose and lipid metabolism. We performed a systematic review and meta-analysis of studies investigating the association of NPs with serum lipid profile. A PubMed and Scopus search (2005–2018) revealed 48 studies reporting the association between NPs and components of lipid profile [total cholesterol (TC), low-density lipoprotein cholesterol (LDLc), high-density lipoprotein cholesterol (HDLc) and triglycerides (TG)]. Despite high inconsistency across studies, NPs levels were inversely associated with TC [k = 32; pooled r = −0.09; I2 = 90.26%], LDLc [k = 31; pooled r = −0.09; I2 = 82.38%] and TG [k = 46; pooled r = −0.11; I2 = 94.14%], while they were directly associated with HDLc [k = 41; pooled r = 0.06; I2 = 87.94%]. The relationship with LDLc, HDLc and TG lost significance if only studies on special populations (works including subjects with relevant acute or chronic conditions that could have significantly affected the circulating levels of NPs or lipid profile) or low-quality studies were taken into account. The present study highlights an association between higher NP levels and a favorable lipid profile. This confirms and extends our understanding of the metabolic properties of cardiac NPs and their potential in CV prevention.
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Affiliation(s)
- Francesco Spannella
- Internal Medicine and Geriatrics, IRCCS INRCA, Via della Montagnola 81, Ancona, Italy.,Department of Clinical and Molecular Sciences, University "Politecnica delle Marche", Via Tronto 10/a, Ancona, Italy
| | - Federico Giulietti
- Internal Medicine and Geriatrics, IRCCS INRCA, Via della Montagnola 81, Ancona, Italy.,Department of Clinical and Molecular Sciences, University "Politecnica delle Marche", Via Tronto 10/a, Ancona, Italy
| | - Marica Bordicchia
- Department of Clinical and Molecular Sciences, University "Politecnica delle Marche", Via Tronto 10/a, Ancona, Italy
| | - John C Burnett
- Cardiorenal Research Laboratory, Division of Cardiovascular Diseases, Mayo Clinic and Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Riccardo Sarzani
- Internal Medicine and Geriatrics, IRCCS INRCA, Via della Montagnola 81, Ancona, Italy. .,Department of Clinical and Molecular Sciences, University "Politecnica delle Marche", Via Tronto 10/a, Ancona, Italy.
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Impact of N-terminal pro-B-type natriuretic peptide response on long-term prognosis after transcatheter aortic valve implantation for severe aortic stenosis and heart failure. Heart Vessels 2018; 34:777-783. [DOI: 10.1007/s00380-018-1297-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 11/02/2018] [Indexed: 10/27/2022]
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Kaneko H, Neuss M, Okamoto M, Weissenborn J, Butter C. Impact of Preprocedural Anemia on Outcomes ofPatients With Mitral Regurgitation Who UnderwentMitraClip Implantation. Am J Cardiol 2018; 122:859-865. [PMID: 30064861 DOI: 10.1016/j.amjcard.2018.05.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/18/2018] [Accepted: 05/18/2018] [Indexed: 01/08/2023]
Abstract
MitraClip is a novel therapeutic option for mitral regurgitation (MR). Anemia is associated with unfavorable outcomes of patients with cardiovascular diseases. In this study, we aimed to clarify the effect of preprocedural anemia on outcomes of patients who underwent MitraClip implantation. Anemia was defined as a serum hemoglobin level of <13 g/dl in men and <12 g/dl in women according to the World Health Organization criteria. Among the 392 patients receiving MitraClip implantation, anemia was prevalent in 56% (n = 220). Men tended to be more common in patients with anemia (71% vs 62%, p = 0.069). Patients with anemia were older than those without anemia (76 ± 8 vs 74 ± 10years, p = 0.008). Baseline New York Heart Association class IV (35 vs 22%, p = 0.006) and chronic kidney disease (79 vs 67%, p = 0.011) were more common in patients with anemia. Severity of MR was similar at baseline in the two groups, and it equally improved after MitraClip implantation. Despite similar improvement in MR, N-terminal pro b-type natriuretic peptide did not decrease in patients with anemia, and Kaplan-Meier curves showed that patients with anemia had lower survival (log-rank p = 0.013). After adjustment for covariates, preprocedural anemia was still associated with higher mortality after MitraClip implantation (p = 0.027, hazard ratio 1.802). The negative prognostic impact of preprocedural anemia was prominent in patients with higher baseline N-terminal of pro-Brain Natriuretic Peptide. These results suggest that preprocedural anemia was common and negatively affected patient survival. Establishing optimal management of anemia before MitraClip implantation is necessary, particularly for patients with severe heart failure.
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Affiliation(s)
- Hidehiro Kaneko
- Department of Cardiology, Heart Center Brandenburg, Bernau, Germany; Department of Cardiology, Medical School Brandenburg, Bernau, Germany
| | - Michael Neuss
- Department of Cardiology, Heart Center Brandenburg, Bernau, Germany; Department of Cardiology, Medical School Brandenburg, Bernau, Germany
| | - Maki Okamoto
- Department of Cardiology, Heart Center Brandenburg, Bernau, Germany; Department of Cardiology, Medical School Brandenburg, Bernau, Germany
| | - Jens Weissenborn
- Department of Cardiology, Heart Center Brandenburg, Bernau, Germany; Department of Cardiology, Medical School Brandenburg, Bernau, Germany
| | - Christian Butter
- Department of Cardiology, Heart Center Brandenburg, Bernau, Germany; Department of Cardiology, Medical School Brandenburg, Bernau, Germany.
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Di Marca S, Rando A, Cataudella E, Pulvirenti A, Alaimo S, Terranova V, Corriere T, Pisano M, Di Quattro R, Ronsisvalle ML, Giraffa CM, Giordano M, Stancanelli B, Malatino L. B-type natriuretic peptide may predict prognosis in older adults admitted with a diagnosis other than heart failure. Nutr Metab Cardiovasc Dis 2018; 28:636-642. [PMID: 29625779 DOI: 10.1016/j.numecd.2018.02.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 02/16/2018] [Accepted: 02/23/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND AIMS The diagnosis of heart failure (HF) in elderly patients is often difficult, due to overlap of typical signs and symptoms with those of comorbidities. B-type Natriuretic Peptide (BNP) predicts diagnosis and prognosis of HF, but little is known on its predictive role of short-term prognosis when admission diagnosis is other than HF. METHODS AND RESULTS We prospectively recruited 404 consecutive patients (aged≥65 years) hospitalized in the Unit of Internal Medicine, University of Catania, Catania, Italy, with an admission diagnosis other than HF. Clinical examination, laboratory data and BNP were evaluated at the admission. The predictive value of BNP and other variables for in-hospital mortality, thirty-day mortality and three month re-hospitalization was assessed. During hospitalization 48 (12%) patients died; by logistic regression analysis, in-hospital mortality was not predicted by BNP>600 pg/ml (OR = 1.36; CI 95% = 0.60-2.80; p = 0.4), while it was by chronic kidney disease (CKD, p < 0.001), WBC count (p < 0.001), immobilization syndrome (p < 0.008) and age (p = 0.012). After discharge, 54 patients (15%) died within 30 days; in these patients thirty-day mortality was significantly predicted by BNP>600 pg/ml (OR = 2.70; CI 95% = 1.40-5.00; p = 0.001), CKD (p < 0.001), malnutrition (p = 0.029) and age (p = 0.033). Re-hospitalized patients were 97 (32%); three month re-hospitalization was predicted by BNP>600 pg/ml (OR = 12.28; CI 95% = 6.00-24.90; p < 0.001) and anamnestic HF (p = 0.002). CONCLUSIONS Our study shows that BNP>600 pg/ml, CKD, malnutrition and age predict thirty-day mortality after discharge in elderly patients with an admission diagnosis other than HF, while CKD, WBC count, immobilization syndrome and age predict in-hospital mortality. Three-month re-hospitalization was predicted by BNP>600 pg/ml and anamnestic HF.
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Affiliation(s)
- S Di Marca
- Academic Unit of Internal Medicine, School of Emergency Medicine, Department of Clinical and Experimental Medicine, University of Catania, c/o Cannizzaro Hospital, Catania, Italy
| | - A Rando
- Academic Unit of Internal Medicine, School of Emergency Medicine, Department of Clinical and Experimental Medicine, University of Catania, c/o Cannizzaro Hospital, Catania, Italy
| | - E Cataudella
- Academic Unit of Internal Medicine, School of Emergency Medicine, Department of Clinical and Experimental Medicine, University of Catania, c/o Cannizzaro Hospital, Catania, Italy
| | - A Pulvirenti
- Unit of Bioinformatics, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - S Alaimo
- Unit of Bioinformatics, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - V Terranova
- Academic Unit of Internal Medicine, School of Emergency Medicine, Department of Clinical and Experimental Medicine, University of Catania, c/o Cannizzaro Hospital, Catania, Italy
| | - T Corriere
- Academic Unit of Internal Medicine, School of Emergency Medicine, Department of Clinical and Experimental Medicine, University of Catania, c/o Cannizzaro Hospital, Catania, Italy
| | - M Pisano
- Academic Unit of Internal Medicine, School of Emergency Medicine, Department of Clinical and Experimental Medicine, University of Catania, c/o Cannizzaro Hospital, Catania, Italy
| | - R Di Quattro
- Academic Unit of Internal Medicine, School of Emergency Medicine, Department of Clinical and Experimental Medicine, University of Catania, c/o Cannizzaro Hospital, Catania, Italy
| | - M L Ronsisvalle
- Academic Unit of Internal Medicine, School of Emergency Medicine, Department of Clinical and Experimental Medicine, University of Catania, c/o Cannizzaro Hospital, Catania, Italy
| | - C M Giraffa
- Academic Unit of Internal Medicine, School of Emergency Medicine, Department of Clinical and Experimental Medicine, University of Catania, c/o Cannizzaro Hospital, Catania, Italy
| | - M Giordano
- School of Emergency Medicine, Department of Medical, Surgical, Neurologic, Metabolic and Geriatric Sciences, Second University of Naples, Naples, Italy
| | - B Stancanelli
- Academic Unit of Internal Medicine, School of Emergency Medicine, Department of Clinical and Experimental Medicine, University of Catania, c/o Cannizzaro Hospital, Catania, Italy
| | - L Malatino
- Academic Unit of Internal Medicine, School of Emergency Medicine, Department of Clinical and Experimental Medicine, University of Catania, c/o Cannizzaro Hospital, Catania, Italy.
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Kaneko H, Neuss M, Weissenborn J, Butter C. Role of Right Ventricular Dysfunction and Diabetes Mellitus in N-terminal pro-B-type Natriuretic Peptide Response of Patients With Severe Mitral Regurgitation and Heart Failure After MitraClip. Int Heart J 2017; 58:225-231. [DOI: 10.1536/ihj.16-255] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Hidehiro Kaneko
- Department of Cardiology, Heart Center Brandenburg, Department of Cardiology, Medical School Brandenburg
| | - Michael Neuss
- Department of Cardiology, Heart Center Brandenburg, Department of Cardiology, Medical School Brandenburg
| | - Jens Weissenborn
- Department of Cardiology, Heart Center Brandenburg, Department of Cardiology, Medical School Brandenburg
| | - Christian Butter
- Department of Cardiology, Heart Center Brandenburg, Department of Cardiology, Medical School Brandenburg
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Kaneko H, Neuss M, Weissenborn J, Butter C. Prognostic Significance of Right Ventricular Dysfunction in Patients With Functional Mitral Regurgitation Undergoing MitraClip. Am J Cardiol 2016; 118:1717-1722. [PMID: 27769512 DOI: 10.1016/j.amjcard.2016.08.054] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 08/19/2016] [Accepted: 08/19/2016] [Indexed: 11/19/2022]
Abstract
Functional mitral regurgitation (MR) is common in patients with heart failure and left ventricular (LV) dysfunction. MitraClip (MC) is a novel therapeutic option for patients with high-risk MR. Similar to LV dysfunction, right ventricular dysfunction (RVD) is an important predictor of patients with heart failure. We aimed to clarify the effect of RVD on outcomes of functional MR and LV dysfunction after MC implantation. We examined 117 patients with severe functional MR and reduced LV ejection fraction (≤40%) treated with MC. RVD was defined as tricuspid annular plane systolic excursion <15 mm and was observed in 41 patients (35%). Mean age and gender were similar between patients with and without RVD. Atrial fibrillation was more common in patients with RVD. MR grades at baseline and discharge and LV ejection fraction were not different between the groups. Six months after MC implantation, responders to the N-terminal pro-B-type natriuretic peptide were less common in patients with RVD than those without (29% vs 65%, p = 0.005). Kaplan-Meier curves showed that survival rates of patients with RVD were significantly lower than those without (36.2% vs 69.6%, p = 0.008). After adjusting for covariates, RVD was still associated with all-cause mortality (hazard ratio 1.975, p = 0.042). The present study's results suggest that RVD is associated with worse survival of functional MR and LV dysfunction in patients undergoing MC in association with no response to N-terminal pro-B-type natriuretic peptide. The indication for MC should be carefully considered in functional MR patients with RVD.
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Affiliation(s)
- Hidehiro Kaneko
- Department of Cardiology, Heart Center Brandenburg, Bernau, Germany; Department of Cardiology, Medical School Brandenburg, Bernau, Germany
| | - Michael Neuss
- Department of Cardiology, Heart Center Brandenburg, Bernau, Germany; Department of Cardiology, Medical School Brandenburg, Bernau, Germany
| | - Jens Weissenborn
- Department of Cardiology, Heart Center Brandenburg, Bernau, Germany; Department of Cardiology, Medical School Brandenburg, Bernau, Germany
| | - Christian Butter
- Department of Cardiology, Heart Center Brandenburg, Bernau, Germany; Department of Cardiology, Medical School Brandenburg, Bernau, Germany.
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Stienen S, Salah K, Eurlings LW, Bettencourt P, Pimenta JM, Metra M, Bayes-Genis A, Verdiani V, Bettari L, Lazzarini V, Tijssen JP, Pinto YM, Kok WE. Targeting N-Terminal Pro-Brain Natriuretic Peptide in Older Versus Younger Acute Decompensated Heart Failure Patients. JACC-HEART FAILURE 2016; 4:736-45. [PMID: 27395353 DOI: 10.1016/j.jchf.2016.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 05/02/2016] [Accepted: 05/03/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The aim of this study was to analyze the prognostic value and attainability of N-terminal pro-brain natriuretic peptide (NT-proBNP) levels in young and elderly acute decompensated heart failure (ADHF) patients. BACKGROUND Less-effective NT-proBNP-guided therapy in chronic heart failure (HF) has been reported in elderly patients. Whether this can be attributed to differences in prognostic value of NT-proBNP or to differences in attaining a prognostic value is unclear. The authors studied this question in ADHF patients. METHODS Our study population comprised 7 ADHF cohorts. We defined absolute (<1,500 ng/l, <3,000 ng/l, <5,000 ng/l, and <15,000 ng/l) and relative NT-proBNP discharge cut-off levels (>30%, >50%, and >70%). Six-month all-cause mortality after discharge was studied for each level in Cox regression analyses, and compared between elderly (age >75 years) and young patients (age ≤75 years). Thereafter, we compared percentages of elderly and young patients attaining NT-proBNP levels (= attainability). RESULTS A total of 1,235 patients (59% male, 45% >75 years of age) was studied. Admission levels of NT-proBNP were significantly higher in elderly versus younger patients. The prognostic value of absolute and relative NT-proBNP levels was similar in elderly and young patients. Attainability was significantly lower in elderly patients for all absolute levels and a >50% relative reduction, but not for >30% and >70%. For absolute levels, attainability differences between age groups were decreased to a large extent after correction for admission NT-proBNP and anemia at discharge. For relative levels, attainability differences disappeared after correction for HF etiology and anemia at discharge. CONCLUSIONS In young and elderly ADHF patients, it is not the prognostic value of absolute and relative NT-proBNP levels that is different, but the attainability of these levels that is lower in the elderly. This can largely be attributed to factors other than age.
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Affiliation(s)
- Susan Stienen
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Khibar Salah
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Luc W Eurlings
- Department of Cardiology, VieCuri Medical Center, Venlo, the Netherlands
| | - Paulo Bettencourt
- Department of Internal Medicine, Hospital S. João, University of Porto Medical School, Porto, Portugal
| | - Joana M Pimenta
- Department of Internal Medicine, Hospital S. João, University of Porto Medical School, Porto, Portugal
| | - Marco Metra
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Antoni Bayes-Genis
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Valerio Verdiani
- Department of Internal Medicine and Emergency, Careggi University Hospital, Florence, Italy
| | - Luca Bettari
- Department of Cardiology, Azienda Istituti Ospitalieri di Cremona, Cremona, Italy
| | - Valentina Lazzarini
- Department of Cardiology, Ospedale San Pellegrino, Castiglione delle Stiviere, MN, Italy
| | - Jan P Tijssen
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Yigal M Pinto
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands
| | - Wouter E Kok
- Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands.
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10
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Stienen S, Salah K, Eurlings LW, Bettencourt P, Pimenta JM, Metra M, Bayes-Genis A, Verdiani V, Bettari L, Lazzarini V, Tijssen JP, Pinto YM, Kok WE. Challenging the two concepts in determining the appropriate pre-discharge N-terminal pro-brain natriuretic peptide treatment target in acute decompensated heart failure patients: absolute or relative discharge levels? Eur J Heart Fail 2015. [DOI: 10.1002/ejhf.320] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Susan Stienen
- Department of Cardiology; Academic Medical Center; Amsterdam The Netherlands
| | - Khibar Salah
- Department of Cardiology; Academic Medical Center; Amsterdam The Netherlands
| | - Luc W.M. Eurlings
- Department of Cardiology; Maastricht University Medical Center; The Netherlands
| | - Paulo Bettencourt
- Department of Internal Medicine, Centro Hospitalar de S. João; University of Porto Medical School; Porto Portugal
| | - Joana M. Pimenta
- Department of Internal Medicine, Centro Hospitalar de S. João; University of Porto Medical School; Porto Portugal
| | - Marco Metra
- Department of Medical and Surgical Specialties; Radiological Sciences and Public Health; University of Brescia Italy
| | - Antoni Bayes-Genis
- Department of Cardiology; Hospital Universitari Germans Trias i Pujol; Barcelona Spain
| | - Valerio Verdiani
- Department of Internal Medicine and Emergency; Careggi University Hospital; Florence Italy
| | - Luca Bettari
- Department of Cardiology; Azienda Istituti Ospitalieri di Cremona; Cremona Italy
| | - Valentina Lazzarini
- Department of Medical and Surgical Specialties; Radiological Sciences and Public Health; University of Brescia Italy
| | - Jan P. Tijssen
- Department of Cardiology; Academic Medical Center; Amsterdam The Netherlands
| | - Yigal M. Pinto
- Department of Cardiology; Academic Medical Center; Amsterdam The Netherlands
| | - Wouter E.M. Kok
- Department of Cardiology; Academic Medical Center; Amsterdam The Netherlands
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