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Marinescu M, Oprea VD, Nechita A, Tutunaru D, Nechita LC, Romila A. The Use of Brain Natriuretic Peptide in the Evaluation of Heart Failure in Geriatric Patients. Diagnostics (Basel) 2023; 13:diagnostics13091512. [PMID: 37174904 PMCID: PMC10177186 DOI: 10.3390/diagnostics13091512] [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: 02/23/2023] [Revised: 04/11/2023] [Accepted: 04/14/2023] [Indexed: 05/15/2023] Open
Abstract
Heart failure is one of the main morbidity and mortality factors in the general population and especially in elderly patients. Thus, at the European level, the prevalence of heart failure is 1% in people under 55 years of age but increases to over 10% in people over 70 years of age. The particularities of the elderly patient, which make the management of heart failure difficult, are the presence of comorbidities, frailty, cognitive impairment and polypharmacy. However, elderly patients are under-represented in clinical trials on the diagnosis and treatment of heart failure. The need for complementary methods (biomarkers) for differential and early diagnosis of heart failure is becoming more and more evident, even in its subclinical stages. These methods need to have increased specificity and sensitivity and be widely available. Natriuretic peptides, in particular B-type natriuretic peptide (BNP) and its fraction NTproBNP, have gained an increasingly important role in the screening, diagnosis and treatment of heart failure in recent years.
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Affiliation(s)
- Mihai Marinescu
- Faculty of Medicine and Pharmacy, "Dunărea de Jos" University in Galați, 800216 Galați, Romania
- "St. Apostle Andrei" Clinical Emergency County Hospital, 800578 Galați, Romania
| | - Violeta Diana Oprea
- Faculty of Medicine and Pharmacy, "Dunărea de Jos" University in Galați, 800216 Galați, Romania
- "St. Apostle Andrei" Clinical Emergency County Hospital, 800578 Galați, Romania
| | - Aurel Nechita
- Faculty of Medicine and Pharmacy, "Dunărea de Jos" University in Galați, 800216 Galați, Romania
- "St. Ioan" Emergency Clinical Hospital for Children, 800487 Galați, Romania
| | - Dana Tutunaru
- Faculty of Medicine and Pharmacy, "Dunărea de Jos" University in Galați, 800216 Galați, Romania
- "St. Apostle Andrei" Clinical Emergency County Hospital, 800578 Galați, Romania
| | - Luiza-Camelia Nechita
- Faculty of Medicine and Pharmacy, "Dunărea de Jos" University in Galați, 800216 Galați, Romania
- "St. Apostle Andrei" Clinical Emergency County Hospital, 800578 Galați, Romania
| | - Aurelia Romila
- Faculty of Medicine and Pharmacy, "Dunărea de Jos" University in Galați, 800216 Galați, Romania
- "St. Apostle Andrei" Clinical Emergency County Hospital, 800578 Galați, Romania
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Muacevic A, Adler JR. The Role of Prognostic Nutrition Index in Predicting Hospitalization of Patients With Heart Failure With Mildly Reduced Ejection Fraction. Cureus 2022; 14:e33102. [PMID: 36721568 PMCID: PMC9884145 DOI: 10.7759/cureus.33102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2022] [Indexed: 12/30/2022] Open
Abstract
Background The prognostic nutritional index (PNI), consisting of albumin and lymphocyte counts, has been associated with satisfactory predictive values for in-hospital mortality or clinical follow-up outcomes in acute situations. In this study, we aimed to evaluate the use of PNI for the prediction of hospital admission in individuals with mildly reduced ejection fraction heart failure (HFmrEF). Methodology This retrospective study was conducted between January 2019 and May 2022 and included 200 patients with HFmrEF detected by transthoracic echocardiography. Data from hospitalized patients (group 1) and outpatients (group 2) were compared. Results In the multivariable regression analysis, brain natriuretic peptide (odds ratio (OR) = 1.001; 95% confidence interval (CI) = 1.000-1.001, p = 0.001) and PNI (OR = 0.783; 95% CI = 0.720-0.853; p < 0.001) were independent predictors of hospital admission in patients with HFmrEF. The PNI value was statistically significantly higher in group 2 (52.36 ± 5.36) than in group 1 (38.3 ± 8.63, p < 0.001). The PNI value <46.75 is a predictor of hospitalization in patients with HFmrEF, with 86% sensitivity and 88% specificity. Conclusions Lower PNI levels predict hospital admission in HFmrEF patients. This measure, which can be easily evaluated in daily cardiological practice, allows for quick and precise decisions for hospitalization.
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Abstract
Since its discovery in 1988, B-type natriuretic peptide (BNP) has been recognized as a powerful cardiovascular biomarker for a number of disease states, specifically heart failure. Concurrent with such a discovery, much effort has been allocated to the precise monitoring of physiological BNP levels. Thus, it can be used to guide the therapy of heart failure and determine the patient's stage of disease. Thus, we discuss in this article BNP as a potent biomarker. Subsequently, we will review the progress of biosensing devices as they could be applied to monitor BNP levels as assays, benchtop biosensors and implantable biosensors. The analytical characteristics of commercially available BNP assays are presented. Still emerging as a field, we define four obstacles that present opportunity for the future development of implantable biosensor: foreign body response, sensor renewability, sensitivity and selectivity.
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Emdin M, Aimo A, Passino C, Vergaro G. Breathing Not Properly in the oldest old. Is brain natriuretic peptide a poor test for the diagnosis of heart failure in the elderly ?. Eur J Heart Fail 2017; 19:549-551. [DOI: 10.1002/ejhf.774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 12/21/2016] [Accepted: 12/21/2016] [Indexed: 11/11/2022] Open
Affiliation(s)
- Michele Emdin
- Institute of Life Sciences; Scuola Superiore Sant'Anna; Pisa Italy
- Cardiology and Cardiovascular Medicine Division; Fondazione Toscana Gabriele Monasterio; Via Moruzzi 1 56124 Pisa Italy
| | - Alberto Aimo
- Cardiology and Cardiovascular Medicine Division; Fondazione Toscana Gabriele Monasterio; Via Moruzzi 1 56124 Pisa Italy
| | - Claudio Passino
- Institute of Life Sciences; Scuola Superiore Sant'Anna; Pisa Italy
- Cardiology and Cardiovascular Medicine Division; Fondazione Toscana Gabriele Monasterio; Via Moruzzi 1 56124 Pisa Italy
| | - Giuseppe Vergaro
- Institute of Life Sciences; Scuola Superiore Sant'Anna; Pisa Italy
- Cardiology and Cardiovascular Medicine Division; Fondazione Toscana Gabriele Monasterio; Via Moruzzi 1 56124 Pisa Italy
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Hypermethylation of brain natriuretic peptide gene is associated with the risk of rheumatic heart disease. Biosci Rep 2017; 37:BSR20160408. [PMID: 27920275 PMCID: PMC5240589 DOI: 10.1042/bsr20160408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 11/15/2016] [Accepted: 12/05/2016] [Indexed: 01/09/2023] Open
Abstract
To investigate the contribution of brain natriuretic peptide (BNP) promoter DNA methylation to the risk of rheumatic heart disease (RHD) and the influence of warfarin anticoagulant therapy on BNP methylation levels for RHD patients after surgery. BNP methylation levels were determined by bisulfite pyrosequencing from plasma samples of RHD patients compared with healthy controls. Several factors influencing the RHD patients were included like age, smoking and cholesterol levels. A fragment of five CG sites (CpG1–5) in the promoter region of BNP gene was measured. BNP gene hypermethylation was found in CpG4 and CpG5 in RHD patients compared with non-RHD controls. A significant difference was also observed between RHD patients with long-term administration of warfarin and RHD patients who had recently undergone an operation. Moreover, single CpG4 and CpG5 analysis revealed a significant increase in methylation levels in men. BNP gene body hypermethylation is associated with the risk of RHD, and also influenced by the warfarin anticoagulant therapy of RHD patients after surgery, which could represent novel and promising targets for therapeutic development.
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Prognostic value of simple frailty and malnutrition screening tools in patients with acute heart failure due to left ventricular systolic dysfunction. Clin Res Cardiol 2017; 106:533-541. [PMID: 28204965 DOI: 10.1007/s00392-017-1082-5] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 01/13/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Frailty and malnutrition are common in patients with heart failure (HF), and are associated with adverse outcomes. We studied the prognostic value of three malnutrition and three frailty indices in patients admitted acutely to hospital with HF. METHODS 265 consecutive patients [62% males, median age 80 (interquartile range (IQR): 72-86) years, median NTproBNP 3633 (IQR: 2025-6407) ng/l] admitted with HF between 2013 and 2014 were enrolled. Patients were screened for frailty using the Derby frailty index (DFI), acute frailty network (AFN) frailty criteria, and clinical frailty scale (CFS) and for malnutrition using the geriatric nutritional risk index (GNRI), controlling nutritional status (CONUT) score and prognostic nutritional index (PNI). RESULTS According to the CFS (> 4), DFI, and AFN, 53, 50, and 53% were frail, respectively. According to the GNRI (≤ 98), CONUT score (> 4), and PNI (≤ 38), 46, 46, and 42% patients were malnourished, respectively. During a median follow-up of 598 days (IQR 319-807 days), 113 patients died. One year mortality was 1% for those who were neither frail nor malnourished; 15% for those who were either malnourished or frail; and 65% for those who were both malnourished and frail. Amongst the malnutrition scores, PNI, and amongst the frailty scores, CFS increased model performance most compared with base model. A final model, including CFS and PNI, increased c-statistic for mortality prediction from 0.68 to 0.84. CONCLUSION Worsening frailty and malnutrition indices are strongly related to worse outcome in patients hospitalised with HF.
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 order by 1-- #] [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: 02/10/2023] Open
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 order by 8029-- awyx] [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: 02/10/2023] Open
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2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 order by 1-- -] [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: 02/10/2023] Open
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 2016; 37:2129-2200. [PMID: 27206819 DOI: 10.1093/eurheartj/ehw128] [Citation(s) in RCA: 8876] [Impact Index Per Article: 1109.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 and 1880=1880] [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: 02/10/2023] Open
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 order by 8029-- #] [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: 02/10/2023] Open
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 order by 8029-- -] [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: 02/10/2023] Open
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 order by 1-- gadu] [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: 02/10/2023] Open
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur J Heart Fail 2016; 18:891-975. [DOI: 10.1002/ejhf.592] [Citation(s) in RCA: 4631] [Impact Index Per Article: 578.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Sarzani R, Spannella F, Giulietti F, Fedecostante M, Giordano P, Gattafoni P, Espinosa E, Busco F, Piccinini G, Dessì-Fulgheri P. NT-proBNP and Its Correlation with In-Hospital Mortality in the Very Elderly without an Admission Diagnosis of Heart Failure. PLoS One 2016; 11:e0153759. [PMID: 27077910 PMCID: PMC4831737 DOI: 10.1371/journal.pone.0153759] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 04/04/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The diagnosis of heart failure (HF) is often difficult and underestimated in very elderly comorbid patients, especially when an echocardiographic evaluation is not available or feasible. AIM to evaluate NT-proBNP values and their correlation with in-hospital mortality in a population of very elderly hospitalized for medical conditions other than HF. METHODS We performed a prospective observational study on 403 very elderly admitted to an Internal Medicine and Geriatrics Department. Exclusion criterion was an admission diagnosis of HF. Patients with at least one symptom or sign compatible with HF were tested for NT-proBNP. NT-proBNP values < 300 pg/ml were considered as an age-independent exclusion criterion for HF (high negative predictive value), while NT-proBNP values ≥ 1800 pg/ml were considered as a diagnostic criterion. Main comorbidities and laboratory parameters were considered to adjust regression analyses between NT-proBNP and in-hospital mortality. RESULTS NT-proBNP values ≥ 1800 pg/ml were present in 61.0% of patients and 32.8% of patients laid between 300 ≤ NT-proBNP < 1800 pg/ml values. NT-proBNP values were associated with the main indices of disease severity/organ failure considered such as reduced eGFR, reduced albumin and elevated CRP. NT-proBNP values ≥ 1800 pg/ml and ln(NT-proBNP) values were significantly associated with in-hospital mortality independently from the main comorbidities and lab parameters considered. The patients, who were already taking ACE inhibitors/Angiotensin Receptor Blockers before admission, showed lower in-hospital mortality. CONCLUSIONS Testing for NT-proBNP should be strongly recommended in the hospitalized very elderly, because of the very high prevalence of underlying HF and its impact on in-hospital mortality, to identify an underlying cardiac involvement that requires appropriate treatment.
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Affiliation(s)
- Riccardo Sarzani
- Italian National Research Centre on Aging “U.Sestilli”, IRCCS-INRCA, Ancona, Italy
- Internal Medicine and Geriatrics, Department of Clinical and Molecular Sciences, University “Politecnica delle Marche”, Ancona, Italy
| | - Francesco Spannella
- Italian National Research Centre on Aging “U.Sestilli”, IRCCS-INRCA, Ancona, Italy
- Internal Medicine and Geriatrics, Department of Clinical and Molecular Sciences, University “Politecnica delle Marche”, Ancona, Italy
| | - Federico Giulietti
- Italian National Research Centre on Aging “U.Sestilli”, IRCCS-INRCA, Ancona, Italy
- Internal Medicine and Geriatrics, Department of Clinical and Molecular Sciences, University “Politecnica delle Marche”, Ancona, Italy
| | | | - Piero Giordano
- Italian National Research Centre on Aging “U.Sestilli”, IRCCS-INRCA, Ancona, Italy
- Internal Medicine and Geriatrics, Department of Clinical and Molecular Sciences, University “Politecnica delle Marche”, Ancona, Italy
| | - Pisana Gattafoni
- Italian National Research Centre on Aging “U.Sestilli”, IRCCS-INRCA, Ancona, Italy
- Internal Medicine and Geriatrics, Department of Clinical and Molecular Sciences, University “Politecnica delle Marche”, Ancona, Italy
| | - Emma Espinosa
- Italian National Research Centre on Aging “U.Sestilli”, IRCCS-INRCA, Ancona, Italy
- Internal Medicine and Geriatrics, Department of Clinical and Molecular Sciences, University “Politecnica delle Marche”, Ancona, Italy
| | - Franco Busco
- Italian National Research Centre on Aging “U.Sestilli”, IRCCS-INRCA, Ancona, Italy
- Clinical Analysis Laboratory, Italian National Research Centre on Aging “U.Sestilli”, IRCCS-INRCA, Ancona, Italy
| | - Gina Piccinini
- Clinical Analysis Laboratory, Italian National Research Centre on Aging “U.Sestilli”, IRCCS-INRCA, Ancona, Italy
| | - Paolo Dessì-Fulgheri
- Italian National Research Centre on Aging “U.Sestilli”, IRCCS-INRCA, Ancona, Italy
- Internal Medicine and Geriatrics, Department of Clinical and Molecular Sciences, University “Politecnica delle Marche”, Ancona, Italy
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Roberts E, Ludman AJ, Dworzynski K, Al-Mohammad A, Cowie MR, McMurray JJV, Mant J. The diagnostic accuracy of the natriuretic peptides in heart failure: systematic review and diagnostic meta-analysis in the acute care setting. BMJ 2015; 350:h910. [PMID: 25740799 PMCID: PMC4353288 DOI: 10.1136/bmj.h910] [Citation(s) in RCA: 253] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To determine and compare the diagnostic accuracy of serum natriuretic peptide levels (B type natriuretic peptide, N terminal probrain natriuretic peptide (NTproBNP), and mid-regional proatrial natriuretic peptide (MRproANP)) in people presenting with acute heart failure to acute care settings using thresholds recommended in the 2012 European Society of Cardiology guidelines for heart failure. DESIGN Systematic review and diagnostic meta-analysis. DATA SOURCES Medline, Embase, Cochrane central register of controlled trials, Cochrane database of systematic reviews, database of abstracts of reviews of effects, NHS economic evaluation database, and Health Technology Assessment up to 28 January 2014, using combinations of subject headings and terms relating to heart failure and natriuretic peptides. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Eligible studies evaluated one or more natriuretic peptides (B type natriuretic peptide, NTproBNP, or MRproANP) in the diagnosis of acute heart failure against an acceptable reference standard in consecutive or randomly selected adults in an acute care setting. Studies were excluded if they did not present sufficient data to extract or calculate true positives, false positives, false negatives, and true negatives, or report age independent natriuretic peptide thresholds. Studies not available in English were also excluded. RESULTS 37 unique study cohorts described in 42 study reports were included, with a total of 48 test evaluations reporting 15 263 test results. At the lower recommended thresholds of 100 ng/L for B type natriuretic peptide and 300 ng/L for NTproBNP, the natriuretic peptides have sensitivities of 0.95 (95% confidence interval 0.93 to 0.96) and 0.99 (0.97 to 1.00) and negative predictive values of 0.94 (0.90 to 0.96) and 0.98 (0.89 to 1.0), respectively, for a diagnosis of acute heart failure. At the lower recommended threshold of 120 pmol/L, MRproANP has a sensitivity ranging from 0.95 (range 0.90-0.98) to 0.97 (0.95-0.98) and a negative predictive value ranging from 0.90 (0.80-0.96) to 0.97 (0.96-0.98). At higher thresholds the sensitivity declined progressively and specificity remained variable across the range of values. There was no statistically significant difference in diagnostic accuracy between plasma B type natriuretic peptide and NTproBNP. CONCLUSIONS At the rule-out thresholds recommended in the 2012 European Society of Cardiology guidelines for heart failure, plasma B type natriuretic peptide, NTproBNP, and MRproANP have excellent ability to exclude acute heart failure. Specificity is variable, and so imaging to confirm a diagnosis of heart failure is required. There is no statistical difference between the diagnostic accuracy of plasma B type natriuretic peptide and NTproBNP. Introduction of natriuretic peptide measurement in the investigation of patients with suspected acute heart failure has the potential to allow rapid and accurate exclusion of the diagnosis.
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Affiliation(s)
- Emmert Roberts
- Maudsley Hospital, South London and the Maudsley Mental Health Trust, London, UK
| | - Andrew J Ludman
- Royal Devon & Exeter NHS Foundation Trust, Wonford, Exeter EX2 5DW, UK
| | | | - Abdallah Al-Mohammad
- South Yorkshire Cardiothoracic Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Martin R Cowie
- National Heart and Lung Institute, Imperial College London (Royal Brompton Hospital), London, UK
| | - John J V McMurray
- British Heart Foundation (BHF) Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Jonathan Mant
- Primary Care Unit, Department of Public Health & Primary Care, Strangeways Research Laboratory, University of Cambridge, Cambridge, UK
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Oudejans I, Mosterd A, Bloemen JA, Valk MJ, van Velzen E, Wielders JP, Zuithoff NP, Rutten FH, Hoes AW. Clinical evaluation of geriatric outpatients with suspected heart failure: value of symptoms, signs, and additional tests. Eur J Heart Fail 2014; 13:518-27. [DOI: 10.1093/eurjhf/hfr021] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Irène Oudejans
- Department of Geriatric Medicine; Elkerliek Hospital; Wesselmanlaan 25, 5705 HA Helmond, PO Box 98, 5700 AB Helmond The Netherlands
- Julius Center for Health Sciences and Primary Care; University Medical Center; Utrecht The Netherlands
| | - Arend Mosterd
- Julius Center for Health Sciences and Primary Care; University Medical Center; Utrecht The Netherlands
- Departments of Cardiology; Pulmonary Disease and Clinical Laboratory, Meander Medical Center; Amersfoort The Netherlands
- Department of Cardiology; Heart Lung Institute, University Medical Center; Utrecht The Netherlands
| | - Johanna A. Bloemen
- Department of Geriatric Medicine; Elkerliek Hospital; Wesselmanlaan 25, 5705 HA Helmond, PO Box 98, 5700 AB Helmond The Netherlands
| | - Mark J. Valk
- Julius Center for Health Sciences and Primary Care; University Medical Center; Utrecht The Netherlands
| | - Edwin van Velzen
- Departments of Cardiology; Pulmonary Disease and Clinical Laboratory, Meander Medical Center; Amersfoort The Netherlands
| | - Jos P. Wielders
- Departments of Cardiology; Pulmonary Disease and Clinical Laboratory, Meander Medical Center; Amersfoort The Netherlands
| | - Nicolaas P. Zuithoff
- Julius Center for Health Sciences and Primary Care; University Medical Center; Utrecht The Netherlands
| | - Frans H. Rutten
- Julius Center for Health Sciences and Primary Care; University Medical Center; Utrecht The Netherlands
| | - Arno W. Hoes
- Julius Center for Health Sciences and Primary Care; University Medical Center; Utrecht The Netherlands
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Atrial fibrillation and prognosis in patients 80+ years old with chronic heart failure. Aging Clin Exp Res 2014; 26:53-60. [PMID: 24022323 DOI: 10.1007/s40520-013-0134-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 08/26/2013] [Indexed: 12/16/2022]
Abstract
INTRODUCTION It is well known that the prevalence of atrial fibrillation (AF) increases with age. The purpose was to evaluate the impact of AF at the 1-year outcome of patients aged 80? who suffered from chronic heart failure (CHF). MATERIALS AND METHODS The study included 220 consecutive patients at age 80–92 (mean 82.8 years, 45.5 % men) hospitalized for heart failure. The prospective analysis contains demographic and clinical data, basic laboratory tests with hsTnT and NT-proBNP, 12-lead resting electrocardiogram, echocardiography and coronary angiography results and the number of deaths at the 1-year followup. Patients were analyzed depending on AF in the resting electrocardiogram at hospital entry. RESULTS AF was recorded in 52 patients (24 %). The relationship with AF was found for more advanced NYHA class III and IV (p\0.001), higher concentrations of hsCRP (p = 0.0005), hsTnT (p = 0.007) and NT-proBNP (p = 0.0098), higher heart rate in the electrocardiogram (p = 0.000) and longer hospitalization (p = 0.025), older age (p = 0.003) and lower left ventricular ejection fraction (p = 0.006). Annual mortality was 13 % and was higher if AF occurred (17 %). However, there was no association between deaths and AF (p = 0.3297). From the multivariate stepwise analysis, independent risk factors for annual mortality were male gender (OR = 3.432; p = 0.043), left ventricular systolic dimension (OR = 1.871; p = 0.004) and dyslipidemia (OR = 0.252; p = 0.043). CONCLUSIONS In the oldest patients aged 80? who suffered from CHF, the incidence of atrial fibrillation and annual mortality was high. The independent variables, which enhanced the risk of death at the 1-year follow-up, were male sex and left ventricular systolic dimension, but not atrial fibrillation.
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Martín Sánchez FJ, Covarrubias M, Terán C, Llorens P, Herrero P, Jacob J, Gil V, Fernández C, Miró O. [Prognostic role of NT-proBNP in emergency department in the elderly with acute heart failure]. Rev Esp Geriatr Gerontol 2013; 48:155-160. [PMID: 23528263 DOI: 10.1016/j.regg.2012.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Revised: 11/24/2012] [Accepted: 11/28/2012] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To determine prognostic role of NT-proBNP as predictor of 30 day-mortality and readmission in the elderly with acute heart failure (AHF) treated in Spanish Emergency Departments (EDs), and to analyse the confounding factors when the NT-proBNP value is interpreted. MATERIAL AND METHODS A multicentre and multi-purpose cohort study with prospective follow-up was conducted on all patients aged 65 years or older with AHF treated in Spanish EDs. The variables recorded include demographic characteristics, comorbidity, details of episode, and NT-proBNP value. The outcome variables were 30 day-mortality and readmission. An NT-proBNP ≥ 5,180 pg/ml was adopted as the cut-off limit. The statistical package SPSS 18.0 was used to analyse the data. RESULTS A total of 585 patients were included, with a mean age of 80.4 (SD: 6.9) years old. The cut-off NT-proBNP ≥ 5,180 pg/ml was independently associated with a severely impaired glomerular filtration (<30 ml/h) (P < .001) and severe episode (NYHA II-IV) (P = .012). The NT-proBNP area under curve (AUC) for 30 day-mortality was 0.71 (CI 95%: 0.63-0.77; P < .001) and for 30 day-readmission, was 0.50 (CI 95%: 0.45-0.56; P = .846). A multivariable analysis showed that the cut-off NT-proBNP ≥ 5,180 pg/ml was an independent factor associated with 30 day-mortality in the elderly with AHF attended in Spanish EDs. CONCLUSIONS The NT-proBNP value is associated with short-term mortality in the elderly with AHF attended in the EDs independently of the presence of confounding factors, such as the severity of the episode and glomerular filtration reduction, but not with 30 day-readmission.
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Narumi T, Arimoto T, Funayama A, Kadowaki S, Otaki Y, Nishiyama S, Takahashi H, Shishido T, Miyashita T, Miyamoto T, Watanabe T, Kubota I. Prognostic importance of objective nutritional indexes in patients with chronic heart failure. J Cardiol 2013; 62:307-13. [PMID: 23806549 DOI: 10.1016/j.jjcc.2013.05.007] [Citation(s) in RCA: 166] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 04/23/2013] [Accepted: 05/08/2013] [Indexed: 01/27/2023]
Abstract
BACKGROUND Although malnutrition indicates an unfavorable prognosis in some clinical settings, the association between nutritional indexes and outcomes for patients with chronic heart failure (CHF) is unclear. METHODS AND RESULTS All the previously established objective nutritional indexes were evaluated. The controlling nutritional status score (CONUT), prognostic nutritional index (PNI), and geriatric nutritional risk index (GNRI) were determined for 388 consecutive patients with CHF (mean age 69.6±12.3 years). The prevalence of malnutrition in this cohort was 60-69%. Patients were followed prospectively, with the endpoints being death due to a cardiovascular event or re-hospitalization. There were 130 events, including 33 deaths and 97 re-hospitalizations, during a mean follow-up period of 28.4 months. Patients experiencing cardiovascular events showed impaired nutritional status, higher CONUT scores, lower PNI scores, and lower GNRI scores, compared with those who did not experience cardiovascular events. CONUT score [hazard ratio 40.9, 95% confidence interval (CI) 10.8-154.8], PNI score (hazard ratio 6.4, 95% CI 5.4-25.1), and GNRI score (hazard ratio 11.6, 95% CI 3.7-10.0) were independently associated with cardiovascular events. Kaplan-Meier analysis showed that there was a significantly higher incidence of cardiovascular events in patients who were malnourished than in those who were not. CONCLUSION Malnutrition was common in patients with CHF. Evaluation of nutritional status may provide additional prognostic information in patients with CHF.
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Affiliation(s)
- Taro Narumi
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, 2-2-2 Iida-nishi, Yamagata 990-9585, Japan
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Lazzarini V, Mentz RJ, Fiuzat M, Metra M, O'Connor CM. Heart failure in elderly patients: distinctive features and unresolved issues. Eur J Heart Fail 2013; 15:717-23. [PMID: 23429975 DOI: 10.1093/eurjhf/hft028] [Citation(s) in RCA: 113] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The prevalence of heart failure (HF) increases with age. While clinical trials suggest that contemporary evidence-based HF therapies have reduced morbidity and mortality, these trials largely excluded the elderly. Questions remain regarding the clinical characteristics of elderly HF patients and the impact of contemporary therapies on their outcomes. This review presents the epidemiology of HF in the elderly and summarizes the data on the pathophysiology of the ageing heart. The clinical characteristics, treatment patterns, and outcomes of elderly HF patients are explored. Finally, the main gaps regarding HF therapies in the elderly and the opportunities for future trials are highlighted.
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Affiliation(s)
- Valentina Lazzarini
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
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NT-pro-BNP: not the prognostic all-rounder in elderly patients undergoing allogeneic stem cell transplantation. Ann Hematol 2012; 91:1929-35. [DOI: 10.1007/s00277-012-1529-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 07/16/2012] [Indexed: 11/25/2022]
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Oudejans I, Mosterd A, Zuithoff NPA, Hoes AW. Applicability of current diagnostic algorithms in geriatric patients suspected of new, slow onset heart failure. Age Ageing 2012; 41:309-16. [PMID: 22258114 DOI: 10.1093/ageing/afr181] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND referral for echocardiography for all geriatric outpatients suspected of heart failure (HF) is not feasible. Diagnostic algorithms could be helpful. OBJECTIVE to investigate whether available diagnostic algorithms accurately identify (older) patients (aged 70 years or over) eligible for echocardiography, with acceptable numbers of false-negatives. METHODS algorithms (European Society of Cardiology (ESC)) guideline, National Institute for Health and Clinical Excellence (NICE) guideline, multidisciplinary guideline the Netherlands (NL) and algorithm by Mant et al. were validated in 203 geriatric patients (mean age 82 ± 6 years, 30% men) suspected of new, slow onset HF. HF was adjudicated by an outcome panel. Applicability of algorithms was evaluated by calculating proportion of patients (i) referred for echocardiography, (ii) with HF among referred patients and (iii) without HF in the non-referred. RESULTS ninety-two (45%) patients had HF. Applying algorithms resulted in referral for echocardiography in 52% (normal NT-proBNP; ESC), 72% (normal ECG; ESC), 56% (NICE), 93% (NL) and 70% (Mant) of all patients, diagnosing HF in 78, 56, 76, 49 and 62% of those referred, respectively. In patients not referred for echocardiography HF was absent in 90, 82, 93, 100 and 95%, respectively. CONCLUSION the ESC NT-proBNP (<400 pg/ml)-based algorithm combines the lowest number of referrals for echocardiography (of whom 78% has HF) with a limited number (10%) of false negatives in the non-referred.
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Affiliation(s)
- Irène Oudejans
- Department of Geriatric Medicine, Elkerliek Hospital, Helmond, Noord-Brabant, Netherlands.
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Abstract
Either B-type natriuretic peptide (BNP) or NT-proBNP may be used as a diagnostic, screening, prognostic and therapeutic tool for CHF. The Food and Drug Administration (FDA) cleared the cut-off point for BNP at 100 pg/mL, and that of NT-proBNP at 125 pg/mL for patients <75 years and 450 pg/mL for those >75. A steadily rising titre even below the cut-off value should be raised as a concern as heart failure is progressive if left untreated and may result in cardiac death. Both biomarkers are also featured in lab investigations for patients with acute coronary syndrome (ACS).
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Affiliation(s)
| | - Soon Kieng Phua
- Department of Lab Medicine, Changi General Hospital, Singapore
| | - Tar Choon Aw
- Department of Lab Medicine, Changi General Hospital, Singapore
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