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Dubiel-Braszczok B, Nowak K, Owczarek A, Engelmann M, Gumkowska-Sroka O, Kotyla PJ. Differential impact of biologic therapy on heart function biomarkers in rheumatoid arthritis patients: Observational study on etanercept, adalimumab and tocilizumab. Curr Pharm Des 2022; 28:2029-2037. [PMID: 35638285 DOI: 10.2174/1381612828666220527141532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/30/2022] [Indexed: 11/22/2022]
Abstract
Background Rheumatoid arthritis (RA) represents the most frequent form of inflammatory arthritis affecting approximately 1% of the population worldwide. Introduction of novel therapeutic strategies targeting proinflammatory cytokines (TNF-α and interleukin-6) revolutionized the treatment of RA. This kind of treatment, although effective in a substantial portion of patients, may potentially cause many side effects. Among them cardiovascular safety is one of the main concerns. Objectives In the present study, we investigated what impact treatment with anti-TNF-α and anti-IL-6 agents may have on heart function and levels of heart function biomarkers Methods To measure this, we used cardiac function biomarkers such as NT-pro Brain Natriuretic Peptide, mid regional pro Atrial Natriuretic Peptide, Galectin-3 and Heart-Type Fatty Acid-Binding Protein and compared them to patients treated with methotrexate as well as healthy controls. Results Patients treated with biologics were characterized by low disease activity or were in remission. The disease activity in these groups were significantly lower in comparison to the methotrexate group. All patient recruited to the study were characterized by normal heart function measured with the use of echocardiography (EF>50%). With the exception of MR-proANP between tocilizumab and adalimumab (median: 1.01 vs 0.49 nmol/L, p < 0.05), we failed to observe any significant differences in biomarkers levels between groups treated with biologics. Contrary to this, patients on MTX showed higher NT-proBNP levels compared to adalimumab, and healthy controls (p < 0.05 for both). Striking differences have been shown in regard to H-FABP. The levels of these biomarkers were elevated in all biologics and the methotrexate group as compared to healthy controls. Conclusion As this biomarker reflects potential heart injury we suggest that heart damage proceeds in continuous manner in RA patients despite effective treatment and attainment of remission/low disease activity. This finding however should be verify in larger cohort of RA patients to ascertain if routine assessment of H-FABP may be useful for detection of patients with RA who are at risk of development of heart damage.
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Affiliation(s)
- Beata Dubiel-Braszczok
- Department of Internal Medicine, Rheumatology and Clinical Immunology Faculty of Medicine in Katowice Medical University of Silesia, Katowice, Poland
| | - Karolina Nowak
- Department of Internal Medicine, Rheumatology and Clinical Immunology Faculty of Medicine in Katowice Medical University of Silesia, Katowice, Poland
| | - Aleksander Owczarek
- Department of Pathophysiology, Health Promotion and Obesity Management Unit Faculty of Medicine in Katowice Medical University of Silesia, Katowice, Poland
| | - Małgorzata Engelmann
- Department of Physiotherapy in Internal Medicine Academy of Physical Education in Katowice, Poland
| | | | - Przemysław J Kotyla
- Department of Internal Medicine, Rheumatology and Clinical Immunology Faculty of Medicine in Katowice Medical University of Silesia, Katowice, Poland
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2
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Ishihara S, Hiramitsu S, Kanaoka K, Taki M, Nakagawa H, Ueda T, Seno A, Nishida T, Onoue K, Soeda T, Ohtani T, Watanabe M, Kawakami R, Sakata Y, Kario K, Saito Y. New Conversion Formula Between B-Type Natriuretic Peptide and N-Terminal-Pro-B-Type Natriuretic Peptide - Analysis From a Multicenter Study. Circ J 2022; 86:2010-2018. [PMID: 35613887 DOI: 10.1253/circj.cj-22-0032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although B-type natriuretic peptide (BNP) and N-terminal (NT)-proBNP are commonly used markers of heart failure, a simple conversion formula between these peptides has not yet been developed for clinical use.Methods and Results: A total of 9,394 samples were obtained from Nara Medical University, Jichi Medical University, and Osaka University. We randomly selected 70% for a derivation set to investigate a conversion formula from BNP to NT-proBNP using estimated glomerular filtration rate (eGFR) and body mass index (BMI); the remaining 30% was used as the internal validation set and we used a cohort study from Nara Medical University as an external validation set. Multivariate linear regression analysis revealed a new conversion formula: log NT-proBNP = 1.21 + 1.03 × log BNP - 0.009 × BMI - 0.007 × eGFR (r2=0.900, P<0.0001). The correlation coefficients between the actual and converted values of log NT-proBNP in the internal and external validation sets were 0.942 (P<0.0001) and 0.891 (P<0.0001), respectively. We applied this formula to samples obtained from patients administered with sacubitril/valsartan. After treatment initiation, NT-proBNP levels decreased and actual BNP levels increased. However, the calculated BNP levels decreased roughly parallel to the NT-proBNP levels. CONCLUSIONS This new and simple conversion formula of BNP and NT-proBNP with eGFR and BMI is potentially useful in clinical practice.
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Affiliation(s)
- Satomi Ishihara
- Department of Cardiovascular Medicine, Nara Medical University
| | | | - Koshiro Kanaoka
- Department of Cardiovascular Medicine, Nara Medical University
| | - Mizuri Taki
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine
| | | | - Tomoya Ueda
- Department of Cardiovascular Medicine, Nara Medical University
| | - Ayako Seno
- Department of Cardiovascular Medicine, Nara Medical University
| | - Taku Nishida
- Department of Cardiovascular Medicine, Nara Medical University
| | - Kenji Onoue
- Department of Cardiovascular Medicine, Nara Medical University
| | - Tsunenari Soeda
- Department of Cardiovascular Medicine, Nara Medical University
| | - Tomohito Ohtani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Makoto Watanabe
- Department of Cardiovascular Medicine, Nara Medical University
| | - Rika Kawakami
- Department of Cardiovascular Medicine, Nara Medical University
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University
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3
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Mizoguchi T, Sugiura T, Dohi Y, Takase H, Fujii S, Seo Y, Ohte N. Indices of left ventricular voltage on electrocardiogram are closely associated with serum cardiac troponin I levels in normotensive Japanese individuals. Medicine (Baltimore) 2020; 99:e19992. [PMID: 32384453 PMCID: PMC7220072 DOI: 10.1097/md.0000000000019992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The high-sensitivity cardiac troponin I (hs-cTnI) in serum can increase due to an increase in left ventricular (LV) overload in individuals with hypertension. Since LV voltage on an electrocardiogram (ECG) reflects LV load, it is possible that LV voltage is closely associated with hs-cTnI in individuals without hypertension. This study investigated the association between LV voltage indices and serum hs-cTnI levels in normotensive Japanese individuals.Subjects who visited the Enshu Hospital for a health check-up were screened for their eligibility. Subjects with renal dysfunction, cancer, active inflammatory disease, or a history of cardiovascular events were excluded, as were subjects with obvious ST segment or T wave abnormality, Wolff-Parkinson-White syndrome, pacemaker implantation, or frequent arrhythmia in the ECG. Exclusion of individuals with hypertension left 803 subjects (54.8 ± 11.3 years) for final inclusion. The R wave voltage in lead V5 (RV5 voltage), the Sokolow-Lyon voltage (a sum of the QRS wave (a complex wave consists of Q, R, and S wave) of the S wave voltage in lead V1 and the R wave voltage in lead V5), and the Cornell product (a product of QRS duration and QRS voltage) were evaluated by ECG as LV voltage indices. Laboratory measurements included serum hs-cTnI levels. Possible associations between indices of LV voltage on ECG and serum hs-cTnI levels were cross-sectionally investigated in the normotensive subjects.The median values [interquartile range] of hs-cTnI and BNP were and 2.1 [1.4-3.0] and 13.8 [7.7-24.9] pg/mL, respectively. Multivariate regression analysis identified that the levels of hs-cTnI, but not BNP, were significantly associated with RV5 voltage (β 0.090, P = .0087), Sokolow-Lyon voltage (β 0.112, P = .0009), and Cornell product (β 0.101, P = .039) after adjustment for possible confounding factors. Moreover, the RV5 voltage, Sokolow-Lyon voltage, and Cornell product were significantly associated with the hs-cTnI levels after adjustment for possible confounding factors including ECG findings (β 0.109, P = .0075; β 0.125, P = .0010; and β 0.096, P = .0116, respectively).Indices of LV voltage in ECG had close associations with serum hs-cTnI levels in normotensive subjects. These findings support that the ECG findings of LV voltage have significant associations with slight myocardial micro-damage even in normotensive subjects.
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Affiliation(s)
- Tatsuya Mizoguchi
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Tomonori Sugiura
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Yasuaki Dohi
- Department of Internal Medicine, Faculty of Rehabilitation Sciences, Nagoya Gakuin University, Nagoya
| | | | - Satoshi Fujii
- Department of Laboratory Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Yoshihiro Seo
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Nobuyuki Ohte
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
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Debska-Kozlowska A, Ksiazczyk M, Warchol I, Lubinski A. Clinical Usefulness of N-terminal Prohormone of Brain Natriuretic Peptide and High Sensitivity Troponin T in Patients with Heart Failure Undergoing Cardiac Resynchronization Therapy. Curr Pharm Des 2020; 25:1671-1678. [PMID: 31223080 DOI: 10.2174/1381612825666190621155718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 06/12/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) is a valuable intracardiac device--based treatment option for a subgroup of patients with advanced heart failure (HF) and QRS prolongation. However, still a significant proportion of patients do not benefit from CRT implantation, labeled as non-responders. OBJECTIVES The aim of the present study was to evaluate the N-terminal prohormone of brain natriuretic peptide (NT-pro BNP) and high sensitivity troponin T (cTnThs) value as predictors of CRT response in a 12-month observation. MATERIALS AND METHODS The study included 46 patients with HF and implanted CRT-D. Levels of NT-pro BNP and cTnThs were assessed during a 12 month follow up. RESULTS 46 consecutive patients (76% men) with a mean age of 64±8 were observed for 12 months. The CRT response criteria was met by 26 patients (56,5%). A significant decline in the NT-pro BNP concentrations was documented in responders (p=0.001). Moreover, ΔNT-pro BNP by at least 579 pg/ml had high sensitivity and specificity for identifying the CRT responders. There were no statistically significant differences in the results of cTnThs between the two study groups. CONCLUSION The relative change in the level of NT-pro BNP by at least 43,5% allows to identify the responders to CRT after 12 months of follow-up. Serial measurements of NT-pro BNP can be a valuable tool for monitoring the effectiveness of CRT.
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Affiliation(s)
- Agnieszka Debska-Kozlowska
- Department of Interventional Cardiology and Cardiac Arrhythmias, Medical University of Lodz, Lodz, Poland
| | - Marcin Ksiazczyk
- Department of Interventional Cardiology and Cardiac Arrhythmias, Medical University of Lodz, Lodz, Poland
| | - Izabela Warchol
- Department of Interventional Cardiology and Cardiac Arrhythmias, Medical University of Lodz, Lodz, Poland
| | - Andrzej Lubinski
- Department of Interventional Cardiology and Cardiac Arrhythmias, Medical University of Lodz, Lodz, Poland
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Rørth R, Jhund PS, Yilmaz MB, Kristensen SL, Welsh P, Desai AS, Køber L, Prescott MF, Rouleau JL, Solomon SD, Swedberg K, Zile MR, Packer M, McMurray JJ. Comparison of BNP and NT-proBNP in Patients With Heart Failure and Reduced Ejection Fraction. Circ Heart Fail 2020; 13:e006541. [DOI: 10.1161/circheartfailure.119.006541] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background:
Both BNP (B-type natriuretic peptide) and NT-proBNP (N-terminal pro B-type natriuretic peptide) are widely used to aid diagnosis, assess the effect of therapy, and predict outcomes in heart failure and reduced ejection fraction. However, little is known about how these 2 peptides compare in heart failure and reduced ejection fraction, especially with contemporary assays. Both peptides were measured at screening in the PARADIGM-HF trial (Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure).
Methods:
Eligibility criteria in PARADIGM-HF included New York Heart Association functional class II to IV, left ventricular ejection fraction ≤40%, and elevated natriuretic peptides: BNP ≥150 pg/mL or NT-proBNP ≥600 pg/mL (for patients with HF hospitalization within 12 months, BNP ≥100 pg/mL or NT-proBNP ≥400 pg/mL). BNP and NT-proBNP were measured simultaneously at screening and only patients who fulfilled entry criteria for both natriuretic peptides were included in the present analysis. The BNP/NT-proBNP criteria were not different for patients in atrial fibrillation. Estimated glomerular filtration rate <30 mL/min per 1.73 m
2
was a key exclusion criterion.
Results:
The median baseline concentration of NT-proBNP was 2067 (Q1, Q3: 1217–4003) and BNP 318 (Q1, Q3: 207–559), and the ratio, calculated from the raw data, was ≈6.25:1. This ratio varied considerably according to rhythm (atrial fibrillation 8.03:1; no atrial fibrillation 5.75:1) and with age, renal function, and body mass index but not with left ventricular ejection fraction. Each peptide was similarly predictive of death (all-cause, cardiovascular, sudden and pump failure) and heart failure hospitalization, for example, cardiovascular death: BNP hazard ratio, 1.41 (95% CI, 1.33–1.49) per 1 SD increase,
P
<0.0001; NT-proBNP, 1.45 (1.36–1.54);
P
<0.0001.
Conclusions:
The ratio of NT-proBNP to BNP in heart failure and reduced ejection fraction appears to be greater than generally appreciated, differs between patients with and without atrial fibrillation, and increases substantially with increasing age and decreasing renal function. These findings are important for comparison of natriuretic peptide concentrations in heart failure and reduced ejection fraction.
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Affiliation(s)
- Rasmus Rørth
- BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (R.R., P.S.J., S.L.K., P.W., J.J.V.M.)
- Rigshospitalet Copenhagen University Hospital, Copenhagen (R.R., S.L.K., L.K.)
| | - Pardeep S. Jhund
- BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (R.R., P.S.J., S.L.K., P.W., J.J.V.M.)
| | - Mehmet B. Yilmaz
- Department of Cardiology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey (M.B.Y.)
| | - Søren Lund Kristensen
- BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (R.R., P.S.J., S.L.K., P.W., J.J.V.M.)
- Rigshospitalet Copenhagen University Hospital, Copenhagen (R.R., S.L.K., L.K.)
| | - Paul Welsh
- BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (R.R., P.S.J., S.L.K., P.W., J.J.V.M.)
| | - Akshay S. Desai
- Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA (A.S.D., S.D.S.)
| | - Lars Køber
- Rigshospitalet Copenhagen University Hospital, Copenhagen (R.R., S.L.K., L.K.)
| | | | - Jean L. Rouleau
- Institut de Cardiologie de Montréal, Université de Montréal, Canada (J.L.R.)
| | - Scott D. Solomon
- Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA (A.S.D., S.D.S.)
| | - Karl Swedberg
- Department of Molecular and Clinical Medicine, University of Gothenburg, Sweden and National Heart and Lung Institute, Imperial College, London (K.S.)
| | - Michael R. Zile
- Medical University of South Carolina and Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC (M.R.Z.)
| | - Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX (M.P.)
| | - John J.V. McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, United Kingdom (R.R., P.S.J., S.L.K., P.W., J.J.V.M.)
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6
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Close association between circulating high-sensitivity cardiac troponin I and metabolic syndrome in the general population. Hypertens Res 2019; 42:1768-1775. [PMID: 31222189 DOI: 10.1038/s41440-019-0283-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/30/2019] [Accepted: 05/23/2019] [Indexed: 01/10/2023]
Abstract
Individuals with metabolic syndrome reportedly have an increased risk of cardiovascular disease, although the association between asymptomatic myocardial damage and metabolic syndrome has not been sufficiently investigated. The present study investigated possible associations between circulating cardiac troponin and metabolic syndrome or related factors. Subjects undergoing their annual health checkups were enrolled in the study (n = 1242). Laboratory measurements included serum high-sensitivity cardiac troponin I (hs-cTnI) and plasma B-type natriuretic peptide (BNP). Individual salt intake was estimated by calculating 24-h urinary sodium excretion from spot urine. Subjects whose electrocardiograms revealed ST-T segment abnormalities or who had renal insufficiency or a history of cardiovascular events were excluded. Subjects with metabolic syndrome had higher hs-cTnI levels than those without, but their BNP levels were equivalent. hs-cTnI levels were significantly associated with the presence and components of metabolic syndrome. Logistic regression analysis with the endpoint of hs-cTnI levels higher than the median value identified metabolic syndrome as an independent determinant of increased hs-cTnI levels. Additionally, urinary salt excretion levels were increased in subjects with metabolic syndrome or any of its components. Logistic regression analysis with the endpoint of metabolic syndrome revealed that hs-cTnI levels were independently associated with the presence of metabolic syndrome. A close association between hs-cTnI levels and the presence of metabolic syndrome, at least partially mediated by increased salt intake, was confirmed to exist in the general population. The findings support the idea that patients with metabolic syndrome develop asymptomatic myocardial damage without obvious ischaemic findings, which leads to increased cardiovascular risk.
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7
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Rørth R, Jhund PS, Kristensen SL, Desai AS, Køber L, Rouleau JL, Solomon SD, Swedberg K, Zile MR, Packer M, McMurray JJV. The prognostic value of troponin T and N-terminal pro B-type natriuretic peptide, alone and in combination, in heart failure patients with and without diabetes. Eur J Heart Fail 2018; 21:40-49. [PMID: 30537261 PMCID: PMC6607514 DOI: 10.1002/ejhf.1359] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/09/2018] [Accepted: 10/16/2018] [Indexed: 12/11/2022] Open
Abstract
Aims We examined the prognostic importance of N‐terminal pro B‐type natriuretic peptide (NT‐proBNP) and troponin T (TnT) in heart failure patients with and without diabetes. Methods and results We measured NT‐proBNP and TnT in the biomarker substudy of the Prospective Comparison of ARNI With ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure trial (PARADIGM‐HF). Of 1907 patients, 759 (40%) had diabetes. Median TnT in patients with diabetes was 18 (interquartile range 11–27) ng/L and 13 (9–21) ng/L in those without (P < 0.001). The TnT frequency‐distribution curve was shifted to the right in patients with diabetes, compared to those without diabetes. By contrast, NT‐proBNP did not differ between patients with and without diabetes. Diabetes and each biomarker were predictive of worse outcomes. Thus, patients with diabetes, an elevated TnT and a NT‐proBNP level in the highest tertile (9% of all patients) had an absolute risk of cardiovascular death or heart failure hospitalization of 265 per 1000 person‐years, compared to a rate of 42 per 1000 person‐years in those without diabetes, a TnT < 18 ng/L and a NT‐proBNP in the lowest tertile (16% of all patients). TnT remained an independent predictor of adverse outcomes in multivariable analyses including NT‐proBNP. Conclusion TnT is elevated to a greater extent in heart failure patients with diabetes compared to those without (whereas NT‐proBNP is not). TnT and NT‐proBNP are additive in predicting risk and when combined help identify diabetes patients at extremely high absolute risk.
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Affiliation(s)
- Rasmus Rørth
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.,Cardiovascular Medicine, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Pardeep S Jhund
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Søren L Kristensen
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.,Cardiovascular Medicine, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Lars Køber
- Cardiovascular Medicine, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Jean L Rouleau
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Canada
| | | | - Karl Swedberg
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden.,National Heart and Lung Institute, Imperial College, London, UK
| | - Michael R Zile
- Medical University of South Carolina and Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC, USA
| | - Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX, USA
| | - John J V McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
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8
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Sugiura T, Dohi Y, Takase H, Fujii S, Ohte N. Findings relevant to the QRS wave in the resting electrocardiogram are associated with circulating concentrations of high-sensitivity cardiac troponin I in the general population. ACTA ACUST UNITED AC 2018; 12:614-620. [DOI: 10.1016/j.jash.2018.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 05/09/2018] [Indexed: 11/28/2022]
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9
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Sugiura T, Dohi Y, Takase H, Ito A, Fujii S, Ohte N. Differential effects of brachial and central blood pressures on circulating levels of high-sensitivity cardiac troponin I in the general population. Atherosclerosis 2018; 269:185-191. [DOI: 10.1016/j.atherosclerosis.2018.01.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 11/21/2017] [Accepted: 01/12/2018] [Indexed: 01/17/2023]
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10
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Natali A, Nesti L, Fabiani I, Calogero E, Di Bello V. Impact of empagliflozin on subclinical left ventricular dysfunctions and on the mechanisms involved in myocardial disease progression in type 2 diabetes: rationale and design of the EMPA-HEART trial. Cardiovasc Diabetol 2017; 16:130. [PMID: 29025406 PMCID: PMC5639750 DOI: 10.1186/s12933-017-0615-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 10/05/2017] [Indexed: 02/06/2023] Open
Abstract
Background Asymptomatic left ventricular (LV) dysfunction is highly prevalent in type 2 diabetes patients. Unlike the other hypoglycemic drugs, SGLT2 inhibitors have shown potential benefits for reducing cardiovascular death and risk factors, aside from lowering plasma glucose levels. With this study we aim at determining whether the treatment with empagliflozin is associated with an improvement in LV functions in diabetic patients with asymptomatic LV dysfunction against Sitagliptin, which is presumably neutral on myocardial function. To determine changes in LV systolic and diastolic functions we will use speckle-tracking echocardiography, a novel sensitive, non-invasive, bedside method allowing the calculation of LV global longitudinal strain (GLS), an index of myocardial deformability, as well as 3D echocardiography, which allows a better evaluation of LV volumes and mass. Methods The EMPA-HEART trial will be a phase III, open label, active-controlled, parallel groups, single centre, exploratory study conducted in Pisa, Italy. A cohort of 75 diabetic patients with normal LV systolic (2D-Echo EF > 50%) and renal (eGFR sec MDRD > 60 ml/min/1.73 mq) functions and no evidence of valvular and/or ischemic heart disease will be randomized to either Empagliflozin 10 mg/die or Sitagliptin 100 mg/die. The primary outcome is to detect a change in GLS from baseline to 1 and 6 months after treatment initiation. The secondary outcomes include changes from baseline to 6 months in 3-D Echocardiography EF, left atrial volume and E/E′, VO2max as measured at cardiopulmonary test, cardiac autonomic function tests (R–R interval during Valsalva manoeuvre, deep-breathing, lying-to-standing), and the determination of a set of plasma biomarkers aimed at studying volume, inflammation, oxidative stress, matrix remodelling, myocyte strain and injury. Discussion SGLT2 inhibitors might affect myocardial functions through mechanisms acting both directly and indirectly on the myocardium. The set of instrumental and biohumoral tests of our study might actually detect the presence and entity of empagliflozin beneficial effects on the myocardium and shed light on the mechanisms involved. Further, this study might eventually provide information to design a clinical strategy, based on echocardiography and/or biomarkers, to select the patients who might benefit more from this intervention. Trial registration EUDRACT Code 2016-0022250-10
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Affiliation(s)
- Andrea Natali
- Department of Clinical and Experimental Medicine, Pisa University, Via Savi 27, 56100, Pisa, Italy
| | - Lorenzo Nesti
- Department of Clinical and Experimental Medicine, Pisa University, Via Savi 27, 56100, Pisa, Italy.
| | - Iacopo Fabiani
- Department of Surgery, Medical, Molecular, and Critical Area Pathology, Pisa University, Pisa, Italy
| | - Enrico Calogero
- Department of Surgery, Medical, Molecular, and Critical Area Pathology, Pisa University, Pisa, Italy
| | - Vitantonio Di Bello
- Department of Surgery, Medical, Molecular, and Critical Area Pathology, Pisa University, Pisa, Italy
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11
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Natriuretic Peptides as Biomarkers for Congestive States: The Cardiorenal Divergence. DISEASE MARKERS 2017; 2017:1454986. [PMID: 28701807 PMCID: PMC5494089 DOI: 10.1155/2017/1454986] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 05/31/2017] [Indexed: 12/11/2022]
Abstract
Congestion represents the primary reason for hospitalization of patients with heart failure and is associated with adverse outcomes. Fluid overload has been shown to be inadequately addressed in a significant subset of these patients in part due to lack of robust, reliable, and readily available biomarkers for objective assessment and monitoring of therapy. Natriuretic peptides have long been used in this setting, often in conjunction with other assessment tools such as imaging studies. Patients presenting with concomitant cardiac and renal dysfunction represent a unique population with regard to congestion in that the interactions between the heart and the kidney can affect the utility and performance of biomarkers of fluid overload. Herein, we provide an overview of the currently available evidence on the utility of natriuretic peptides in these patients and discuss the clinical conundrum associated with their use in the setting of renal dysfunction. We highlight the potential divergence in the role of natriuretic peptides for assessment of volume status in a subset of patients with renal dysfunction who receive renal replacement therapy and call for future research to elucidate the utility of the biomarkers in this setting.
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12
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Abstract
Although substantial improvements have been made in majority of cardiac disorders, heart failure (HF) remains a major health problem, with both increasing incidence and prevalence over the past decades. For that reason, the number of potential biomarkers that could contribute to diagnosis and treatment of HF patients is, almost exponentially, increasing over the recent years. The biomarkers that are, at the moment, more or less ready for use in everyday clinical practice, reflect different pathophysiological processes present in HF. In this review, seven groups of biomarkers associated to myocardial stretch (mid-regional proatrial natriuretic peptide, MR-proANP), myocyte injury (high-sensitive troponins, hs-cTn; heart-type fatty acid-binding protein, H-FABP; glutathione transferase P1, GSTP1), matrix remodeling (galectin-3; soluble isoform of suppression of tumorigenicity 2, sST2), inflammation (growth differentiation factor-15, GDF-15), renal dysfunction (neutrophil gelatinase-associated lipocalin, NGAL; kidney injury molecule-1, KIM-1), neurohumoral activation (adrenomedullin, MR-proADM; copeptin), and oxidative stress (ceruloplasmin; myeloperoxidase, MPO; 8-hydroxy-2'-deoxyguanosine, 8-OHdG; thioredoxin 1, Trx1) in HF will be overviewed. It is important to note that clinical value of individual biomarkers within the single time points in both diagnosis and outcome prediction in HF is limited. Hence, the future of biomarker application in HF lies in the multimarker panel strategy, which would include specific combination of biomarkers that reflect different pathophysiological processes underlying HF.
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13
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Batlle M, Campos B, Farrero M, Cardona M, González B, Castel MA, Ortiz J, Roig E, Pulgarín MJ, Ramírez J, Bedini JL, Sabaté M, García de Frutos P, Pérez-Villa F. Use of serum levels of high sensitivity troponin T, galectin-3 and C-terminal propeptide of type I procollagen at long term follow-up in heart failure patients with reduced ejection fraction: Comparison with soluble AXL and BNP. Int J Cardiol 2016; 225:113-119. [PMID: 27718443 DOI: 10.1016/j.ijcard.2016.09.079] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 09/21/2016] [Accepted: 09/23/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Prognostic biomarkers are needed to improve the management of the heart failure (HF) epidemic, being the brain natriuretic peptides the most valuable. Here we evaluate 3 biomarkers, high sensitivity troponin T (hs-TnT), galectin-3 (Gal-3) and C-terminal propeptide of type I procollagen (CICP), compare them with a recently described new candidate (sAXL), and analyze their relationship with BNP. METHODS HF patients with reduced ejection fraction (n=192) were included in this prospective observational study, with measurements of candidate biomarkers, functional, clinical and echocardiographic variables. A Cox regression model was used to determine predictors for clinical events, i.e. all-cause mortality and heart transplantation. RESULTS Hs-TnT circulating values were correlated to clinical characteristics indicative of more advanced HF. When analyzing the event-free survival at a mean follow-up of 3.6years, patients in the higher quartile of either BNP, hs-TnT, CICP and sAXL had increased risk of suffering a clinical event, but not Gal-3. Combination of high sAXL and BNP values had greater predictive value (HR 6.8) than high BNP alone (HR 4.9). In a multivariate Cox regression analysis, BNP, sAXL and NYHA class were independent risk factors for clinical events. CONCLUSIONS In this HF cohort, hs-TnT is a good HF marker and has a very significant prognostic value. The prognostic value of CICP and sAXL was of less significance. However, hs-TnT did not add predictive value to BNP, while sAXL did. This suggests that elevated troponin has a common origin with BNP, while sAXL could represent an independent pathological mechanism.
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Affiliation(s)
- M Batlle
- Institute of Biomedical Research August Pi i Sunyer (IDIBAPS) and the Cardiovascular Clinic Institute, Hospital Clínic de Barcelona, Spain.
| | - B Campos
- Department of Public Health, Universitat de Barcelona, Spain
| | - M Farrero
- Heart Failure and Transplant Unit, Cardiovascular Clinic Institute, Hospital Clínic de Barcelona and researcher at Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Spain
| | - M Cardona
- Heart Failure and Transplant Unit, Cardiovascular Clinic Institute, Hospital Clínic de Barcelona and researcher at Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Spain
| | - B González
- Core Laboratory, Hospital Clínic de Barcelona, Spain
| | - M A Castel
- Heart Failure and Transplant Unit, Cardiovascular Clinic Institute, Hospital Clínic de Barcelona and researcher at Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Spain
| | - J Ortiz
- Heart Failure and Transplant Unit, Cardiovascular Clinic Institute, Hospital Clínic de Barcelona and researcher at Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Spain
| | - E Roig
- Heart Failure Unit at the Cardiology Department, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Biomèdica (IIB Sant Pau), Universitat Autònoma de Barcelona, Spain
| | - M J Pulgarín
- Institute of Biomedical Research August Pi i Sunyer (IDIBAPS) and the Cardiovascular Clinic Institute, Hospital Clínic de Barcelona, Spain
| | - J Ramírez
- Pathological Anatomy Department, Hospital Clínic de Barcelona, Spain
| | - J L Bedini
- Core Laboratory, Hospital Clínic de Barcelona, Spain
| | - M Sabaté
- Institute of Biomedical Research August Pi i Sunyer (IDIBAPS) and the Cardiovascular Clinic Institute, Hospital Clínic de Barcelona, Spain
| | - P García de Frutos
- Department of Cell Death and Proliferation at Institut d'Investigacions Biomèdiques de Barcelona (IIBB-CSIC) and IDIBAPS, Spain
| | - F Pérez-Villa
- Heart Failure and Transplant Unit, Cardiovascular Clinic Institute, Hospital Clínic de Barcelona and researcher at Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Spain
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14
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Abstract
Calcified aortic stenosis is one of the most common causes of heart failure in the elderly. Current guidelines recommend aortic valve replacement in patients with severe disease and evidence of decompensation based on either symptoms or impaired systolic ejection fraction. However, symptoms are often subjective whilst impaired ejection fraction is not a sensitive marker of ventricular decompensation. Interest has surrounded the use of cardiac biochemical markers as objective measures of left ventricular decompensation in aortic stenosis. We will first examine mechanisms of release of biochemical markers associated with myocardial wall stress (BNP/NT-proBNP), myocardial fibrosis (markers of collagen metabolism, galectin-3, soluble ST2) and myocyte death/myocardial ischemia (high-sensitivity cardiac troponins, heart-type fatty acid binding protein, myosin-binding protein C); and discuss future directions of these markers.
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Affiliation(s)
- Calvin W L Chin
- a Department of Cardiovascular Medicine , National Heart Center Singapore , Singapore .,b Duke-NUS Graduate Medical School , Singapore
| | - Andie H Djohan
- c Barts and the London School of Medicine & Dentistry, Queen Mary, University of London , London , UK , and
| | - Chim C Lang
- d Division of Cardiovascular and Diabetes Medicine , University of Dundee , Dundee , UK
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15
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Zoair A, Mawlana W, Abo-Elenin A, Korrat M. Serum Level of Heart-Type Fatty Acid Binding Protein (H-FABP) Before and After Treatment of Congestive Heart Failure in Children. Pediatr Cardiol 2015; 36:1722-7. [PMID: 26123812 DOI: 10.1007/s00246-015-1223-4] [Citation(s) in RCA: 7] [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: 03/25/2015] [Accepted: 06/16/2015] [Indexed: 11/26/2022]
Abstract
Remodeling of the heart following injury affects the morbidity and mortality in children presented with heart failure (HF). Heart-type fatty acid binding protein (H-FABP) is a novel biomarker that could be of help to predict the prognosis and risk stratification in those children. We aimed to evaluate the diagnostic and prognostic value of H-FABP in children with heart failure before and after treatment. The study was conducted as a prospective cohort study. It included 30 children with HF as a patient group and 20 healthy children matched for age and sex as a control group. Echocardiographic assessment of the heart was done using conventional Doppler echocardiography. Serum levels of (H-FABP) were measured using enzyme-linked immunosorbent assay before and after treatment of HF. All patients were observed during follow-up period of 3 months. There was a significant difference in the serum level of H-FABP in our patients before treatment (5.278 ± 3.253 ng/ml) compared with after treatment (2.089 ± 0.160 ng/ml) with significant difference compared with the control group. There was a significant increase in the serum level of H-FABP with increase in the severity of heart failure according to Ross classification. Significant increase in the H-FABP was associated with adverse outcome. Serum levels of H-FABP strongly correlated with clinical and echocardiographic assessment of LV performance of children with HF, and its levels significantly increased in children with adverse outcome suggesting its value as a useful diagnostic and prognostic predictor (with high sensitivity and specificity).
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Affiliation(s)
- Amr Zoair
- Department of Pediatrics, Faculty of Medicine, Tanta University Hospital, Tanta University, Tanta, Egypt.
| | - Wegdan Mawlana
- Department of Pediatrics, Faculty of Medicine, Tanta University Hospital, Tanta University, Tanta, Egypt.
| | - Amany Abo-Elenin
- Department of Clinical Pathology, Tanta University Hospital, Tanta University, Tanta, Egypt
| | - Mostafa Korrat
- Department of Pediatrics, Faculty of Medicine, Tanta University Hospital, Tanta University, Tanta, Egypt
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16
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Ambrosi P, Kreitmann B, Fromonot J, Habib G, Guieu R. Plasma Ultrasensitive Cardiac Troponin During Long-Term Follow-up of Heart Transplant Recipients. J Card Fail 2015; 21:103-7. [DOI: 10.1016/j.cardfail.2014.10.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 08/18/2014] [Accepted: 10/27/2014] [Indexed: 12/30/2022]
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17
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Li X, Luo R, Jiang R, Kong H, Tang Y, Shu Y, Hua W. The prognostic use of serum concentrations of cardiac troponin-I, CK-MB and myoglobin in patients with idiopathic dilated cardiomyopathy. Heart Lung 2014; 43:219-24. [DOI: 10.1016/j.hrtlng.2014.03.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 02/28/2014] [Accepted: 03/01/2014] [Indexed: 11/28/2022]
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18
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Chen YX, Li CS. The prognostic and risk-stratified value of heart-type fatty acid-binding protein in septic patients in the emergency department. J Crit Care 2014; 29:512-6. [PMID: 24768564 DOI: 10.1016/j.jcrc.2014.03.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 02/23/2014] [Accepted: 03/25/2014] [Indexed: 12/16/2022]
Abstract
PURPOSE To evaluate the prognostic and risk-stratified ability of heart-type fatty acid-binding protein (H-FABP) in septic patients in the emergency department (ED). MATERIALS AND METHODS From August to November 2012, 295 consecutive septic patients were enrolled. Circulating H-FABP was measured. The predictive value of H-FABP for 28-day mortality, organ dysfunction on ED arrival, and requirement for mechanical ventilation or a vasopressor within 6 hours after ED arrival was assessed by the receiver operating characteristic curve and logistic regression and was compared with Acute Physiology and Chronic Health Evaluation (APACHE) II score, Mortality in Emergency Department Sepsis (MEDS) score, and Sequential Organ Failure Assessment score. RESULTS The 28-day mortality, APACHE II, MEDS, and Sequential Organ Failure Assessment scores were much higher in H-FABP-positive patients. The incidence of organ dysfunction at ED arrival and requirement for mechanical ventilation or a vasopressor within 6 hours after ED arrival was higher in H-FABP-positive patients. Heart-type fatty acid-binding protein was an independent predictor of 28-day mortality and organ dysfunction. The area under the receiver operating characteristic curve for H-FABP predicting 28-day mortality and organ dysfunction was 0.784 and 0.755, respectively. Combination of H-FABP and MEDS improved the performance of MEDS in predicting organ dysfunction, and the difference of AUC was statistically significant (P<.05). The combinations of H-FABP and MEDS or H-FABP and APACHE II also improved the prognostic value of MEDS and APACHE II, but the areas under the curve were not statistically different. CONCLUSIONS Heart-type fatty acid-binding protein was helpful for prognosis and risk stratification of septic patients in the ED.
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Affiliation(s)
- Yun-Xia Chen
- Emergency Department of Beijing Chao-Yang Hospital, Affiliated to Capital Medical University, Chaoyang District, Beijing 100020, China
| | - Chun-Sheng Li
- Emergency Department of Beijing Chao-Yang Hospital, Affiliated to Capital Medical University, Chaoyang District, Beijing 100020, China.
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19
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Abstract
With the astounding morbidity and mortality associated with heart failure (HF), preventive approaches have been explored. Controlling hypertension to prevent HF is well-established, especially with sodium restriction and thiazide-based antihypertensive therapies showing potential advantages. Control of dyslipidemia with aggressive statin therapy is particularly beneficial in preventing HF in the setting of acute coronary syndrome. The HOPE study also established the benefit of ACE inhibitors in the prevention of HF in high-risk subjects. Meanwhile old data supporting tight glycemic control in preventing HF have not been confirmed, suggesting the complexity of diabetic cardiomyopathy. Avoiding tobacco use and other known cardiotoxins are likely helpful. While there has been substantial development in identifying biomarkers predicting future development of HF, therapeutic interdiction guided by biomarker levels have yet to be established, even though it offers hope in modulating the natural history of the development of HF in at-risk individuals.
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Affiliation(s)
- Justin L Grodin
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk J3-4, Cleveland, OH, 44195, USA
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20
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Akbal A, Kurtaran A, Selçuk B, Akyüz M. H-FABP, cardiovascular risk factors, and functional status in asymptomatic spinal cord injury patients. Herz 2013; 38:629-35. [PMID: 23483223 DOI: 10.1007/s00059-013-3779-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Revised: 01/19/2013] [Accepted: 02/08/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND This was a cross-sectional study in the setting of a rehabilitation hospital. OBJECTIVE The aim of the study was to determine the serum levels of heart-type fatty acid-binding protein (H-FABP) in patients with spinal cord injury (SCI). A further goal was to examine whether there is a relationship between H-FABP levels and Functional Ambulation Classification (FAC) scale, Functional Independence Measure (FIM) score, American Spinal Injury Association (ASIA) status, and metabolic syndrome (MetS). METHODS The study included 56 SCI patients and 37 age- and sex-matched healthy control subjects who had not been diagnosed with coronary artery disease in the past. RESULTS Serum H-FABP levels were significantly higher in patients with SCI than in control subjects: paraplegia group, 18.5 ± 11.4; tetraplegia group, 16.3 ± 9.1; control group, 6.7 ± 5.1 ng/ml (p < 0.001). There was no difference between the other cardiac enzymes (troponin I, AST, ALT, CK, CK-MB, and LDH) among the groups. The relationship between the serum H-FABP levels and FAC status was examined. There was a negative correlation between FAC status and H-FABP levels (p < 0.001, r = - 0.581). Patients with complete SCI were divided into two groups according to the level of the lesion: (lesion levels in C6-T6, n = 25; lesion levels in T7-L2, n = 11). In patients with complete motor injury, H-FABP levels were higher in subjects with injuries above T6 than in those with injuries below T6 (24.21 ± 10.1 and 14.1 ± 10.4, respectively; p = 0.011). Serum levels of H-FABP were higher in SCI patients with MetS (n = 10) than in those without MetS (n = 46; 25.8 ± 11.6 ng/ml vs. 16.42 ± 10.3 ng/ml, respectively; p = 0.014). Patients were then divided into two groups according to SCI duration: < 12 months (n = 27) and > 12 months (n = 29). H-FABP levels showed statistically significant differences between the two groups (14.8 ± 11.7 ng/dl and 20.9 ± 9.9 ng/dl, respectively; p = 0.036). CONCLUSION H-FABP is related to MetS and FAC status in asymptomatic SCI patients.
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Affiliation(s)
- A Akbal
- Department of Physical Medicine and Rehabilitation, Çanakkale Onsekiz Mart UniversityEducation and Research Hospital, 17100 , Kepez, Çanakkale, Turkey,
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21
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Increased H-FABP concentrations in nonalcoholic fatty liver disease. Possible marker for subclinical myocardial damage and subclinical atherosclerosis. Herz 2013; 38:417-22. [PMID: 23324907 DOI: 10.1007/s00059-012-3714-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 08/30/2012] [Accepted: 10/07/2012] [Indexed: 01/12/2023]
Abstract
AIM Nonalcoholic fatty liver disease (NAFLD) is the most common liver disorder which is reported as the hepatic manifestation of metabolic syndrome with an increased risk of cardiovascular events. Patients with NAFLD are also at risk of future cardiac events independently of metabolic syndrome. The aim of this study was to examine serum concentrations of heart type fatty acid binding protein (H-FABP) in NAFLD and to investigate its correlations with metabolic parameters and subclinical atherosclerosis. PATIENTS AND METHODS A total of 34 patients with NAFLD and 35 healthy subjects were enrolled in the study. NAFLD patients had elevated liver enzymes and steatosis graded on ultrasonography. Healthy subjects had normal liver enzymes and no steatosis on ultrasonography. H-FABP levels were measured using an enzyme linked immunosorbent assay (ELISA) method and correlations with metabolic parameters and subclinical atherosclerosis were examined. Subclinical atherosclerosis was determined with carotid artery intima-media thickness (CIMT) which was measured by high resolution B mode ultrasonography. RESULTS H-FABP levels were elevated in patients with NAFLD (16.3 ± 4.0 ng/ml) when compared with healthy controls (13.8 ± 2.1 ng/ml; p < 0.001). NAFLD patients had significantly higher CIMT than the controls had (0.64 ± 0.17 mm vs. 0.43 ± 0.14 mm, p = 0.009). The H-FABP concentrations were significantly positively correlated with body mass index (r = 0.255, p = 0.042), fasting blood glucose level (r = 0.300, p = 0.013), CIMT (r = 0.335, p = 0.043), and homeostasis model assessment-estimated insulin resistance (HOMA-IR; r = 0.156, p = 0.306). In multiple linear regression analysis, H-FABP levels were only independently associated with CIMT (p = 0.04) CONCLUSION Serum H-FABP concentrations increase in patients with NAFLD. Our results may not only suggest that H-FABP is a marker of subclinical myocardial damage in patients with NAFLD but also of subclinical atherosclerosis, independent of metabolic syndrome and cardiac risk factors.
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22
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Wessler BS, Kramer DG, Kelly JL, Trikalinos TA, Kent DM, Konstam MA, Udelson JE. Drug and Device Effects on Peak Oxygen Consumption, 6-Minute Walk Distance, and Natriuretic Peptides as Predictors of Therapeutic Effects on Mortality in Patients With Heart Failure and Reduced Ejection Fraction. Circ Heart Fail 2011; 4:578-88. [DOI: 10.1161/circheartfailure.111.961573] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Although peak oxygen consumption (peak V
o
2
), 6-minute walk distance (6MW), and natriuretic peptides (BNP and NT-proBNP) are predictors of mortality in heart failure (HF) patients, it is not known whether therapy-induced changes in these measures can predict therapeutic effect on mortality. The objective of this analysis is to quantitatively assess the relationship between therapeutic effects on commonly proposed short-term markers in HF trials and therapeutic effects on long-term outcome in patients with HF and left ventricular dysfunction.
Methods and Results—
We identified drug or device therapies for which there exists at least 1 randomized, controlled trial (RCT) assessing mortality over at least 6 months in at least 500 patients. For each of these therapies, we identified RCTs assessing the short-term changes in V
o
2
, 6MW, BNP, and NT-proBNP (few of the mortality RCTs assessed the short-term changes in markers). For each intervention, we calculated the odds ratio for mortality (using random effect meta-analysis when necessary), as well as the trial level average drug- or device-induced change in the markers. We assessed the correlation between the odds ratio for death with the placebo-corrected change in the functional parameter or biomarker across the interventions. We identified mortality RCTs of 27 distinct therapies (n=73 267 patients) with a median follow-up of 19 months, that directed the search for RCTs of the effect of those interventions on the functional markers and biomarkers. There were 54 peak V
o
2
trials (n=4646 patients), 34 6MW trials (n=6995 patients), 15 BNP trials (n=7233), and 6 NT-proBNP trials (n=1946) included in this analysis. There was no significant correlation between the average therapy-induced placebo-corrected change in peak V
o
2
and the odds ratio for mortality (
r
=0.158,
P
=0.26). Increased drug or device-induced average change in 6MW was correlated with increased odds ratio for mortality (
r
=0.373,
P
=0.036). There was no significant correlation between the average therapy-induced, placebo-corrected change in the natriuretic peptides and the odds ratio for mortality (BNP:
r
=−0.065,
P
=0.82, NT-proBNP:
r
=−0.667,
P
=0.15). There was no apparent relation between change in the functional parameter or biomarker and categorical effect on mortality.
Conclusions—
This analysis, limited to trial level data from different therapeutic eras, suggests that drug- or device-induced effects on peak V
o
2
, 6MW, and natriuretic peptides found in short-term trials do not predict the corresponding average long-term therapeutic effects on mortality for patients with HF and left ventricular dysfunction.
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Affiliation(s)
- Benjamin S. Wessler
- From the Division of Cardiology, CardioVascular Center and the Center for Clinical Evidence Synthesis, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston MA
| | - Daniel G. Kramer
- From the Division of Cardiology, CardioVascular Center and the Center for Clinical Evidence Synthesis, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston MA
| | - Jessica L. Kelly
- From the Division of Cardiology, CardioVascular Center and the Center for Clinical Evidence Synthesis, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston MA
| | - Thomas A. Trikalinos
- From the Division of Cardiology, CardioVascular Center and the Center for Clinical Evidence Synthesis, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston MA
| | - David M. Kent
- From the Division of Cardiology, CardioVascular Center and the Center for Clinical Evidence Synthesis, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston MA
| | - Marvin A. Konstam
- From the Division of Cardiology, CardioVascular Center and the Center for Clinical Evidence Synthesis, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston MA
| | - James E. Udelson
- From the Division of Cardiology, CardioVascular Center and the Center for Clinical Evidence Synthesis, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston MA
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Kamouh A, Francis GS. Contemporary management and research directions in advanced heart failure: where are we going? ACTA ACUST UNITED AC 2011; 17:241-7. [PMID: 21906249 DOI: 10.1111/j.1751-7133.2011.00243.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Advanced heart failure (AHF) is not a uniform disorder, but is rather a heterogeneous group of patients with varying clinical presentations and definitions. It is growing in magnitude and represents a major public health problem. Herein we describe contemporary care of the patient with AHF, novel medical therapies, and mechanical circulatory assist devices. We speculate where progress has been made and where the major gaps in knowledge remain. Clearly, there is ample opportunity for research and discovery to further advance the care of these very sick patients.
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Affiliation(s)
- Abdallah Kamouh
- Heart Failure and Transplantation Section, Department of Cardiology, University of Minnesota Medical Center, Minneapolis, MN, USA
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24
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High sensitive troponin T and heart fatty acid binding protein: novel biomarker in heart failure with normal ejection fraction? A cross-sectional study. BMC Cardiovasc Disord 2011; 11:41. [PMID: 21729325 PMCID: PMC3146933 DOI: 10.1186/1471-2261-11-41] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Accepted: 07/05/2011] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND High sensitive troponin T (hsTnT) and heart fatty acid binding protein (hFABP) are both markers of myocardial injury and predict adverse outcome in patients with systolic heart failure (SHF). We tested whether hsTnT and hFABP plasma levels are elevated in patients with heart failure with normal ejection fraction (HFnEF). METHODS We analyzed hsTnT, hFABP and N-terminal brain natriuretic peptide in 130 patients comprising 49 HFnEF patients, 51 patients with asymptomatic left ventricular diastolic dysfunction (LVDD), and 30 controls with normal diastolic function. Patients were classified to have HFnEF when the diagnostic criteria as recommended by the European Society of Cardiology were met. RESULTS Levels of hs TnT and hFABP were significantly higher in patients with asymptomatic LVDD and HFnEF (both p < 0.001) compared to controls. The hsTnT levels were 5.6 [0.0-9.8] pg/ml in LVDD vs. 8.5 [3.9-17.5] pg/ml in HFnEF vs. <0.03 [< 0.03-6.4] pg/ml in controls; hFABP levels were 3029 [2533-3761] pg/ml in LVDD vs. 3669 [2918-4839] pg/ml in HFnEF vs. 2361 [1860-3081] pg/ml in controls. Furthermore, hsTnT and hFABP levels were higher in subjects with HFnEF compared to LVDD (p = 0.015 and p = 0.022). CONCLUSION In HFnEF patients, hsTnT and hFABP are elevated independent of coronary artery disease, suggesting that ongoing myocardial damage plays a critical role in the pathophysiology. A combination of biomarkers and echocardiographic parameters might improve diagnostic accuracy and risk stratification of patients with HFnEF.
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25
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Giannessi D. Multimarker approach for heart failure management: Perspectives and limitations. Pharmacol Res 2011; 64:11-24. [DOI: 10.1016/j.phrs.2011.03.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Revised: 03/10/2011] [Accepted: 03/20/2011] [Indexed: 12/29/2022]
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Ma LP, Haugen E, Ikemoto M, Fujita M, Terasaki F, Fu M. S100A8/A9 complex as a new biomarker in prediction of mortality in elderly patients with severe heart failure. Int J Cardiol 2011; 155:26-32. [PMID: 21334078 DOI: 10.1016/j.ijcard.2011.01.082] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Accepted: 01/01/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND S100A8/A9 complex is a new inflammation-related protein and has a positive correlation with C-reaction protein level. However its role in chronic heart failure (CHF) remains unclear. METHODS AND RESULTS Circulating levels of S100A8/A9 complex and other biomarkers (IL-6, IL-8, TNF-α, and BNP) were measured in CHF (n = 54) and hypertensive without CHF (n = 31) as well as healthy subjects (n = 23), with follow up to 1480 days. During follow-up, cumulative mortality rate for CHF patients was 63%. Plasma levels of S100A8/A9 complex, IL-6, IL-8 and TNF-α were significantly higher in CHF than the hypertensive patients and healthy subjects. A significant positive correlation was found between S100A8/A9 complex and IL-6 and IL-8 respectively. Cox regression analysis showed that IL-6 and IL-8 were predictors for mortality for 6 months, and S100A8/A9 complex, IL-6, IL-8 and age were predictors for mortality for one year whereas BNP, TNF-α, IL-6 and IL-8 remained predictors for mortality for two years. A combination of S100A8/A9 complex and IL-6 provided powerful predictive value in mortality for both 6 and 12 months. CONCLUSIONS S100A8/A9 complex is a useful biomarker as a predictor for one year mortality and its combination with IL-6 is able to provide additive prognostic information in this vulnerable heart failure population in the elderly.
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Affiliation(s)
- Li-Ping Ma
- Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
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Dalzell JR, Jackson CE, McDonagh TA, Gardner RS. Novel biomarkers in heart failure: an overview. Biomark Med 2010; 3:453-63. [PMID: 20477516 DOI: 10.2217/bmm.09.42] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Heart failure is a complex systemic syndrome resulting from significant impairment of cardiac function. A vast array of biological pathways is now known to be involved in heart failure, including deleterious pathways promoting its development and progression, as well as compensatory cardioprotective pathways. Some of the components of these pathways are now recognized as biomarkers of this condition, and can aid diagnosis, prognostication and guide management. As the understanding of the pathophysiology of heart failure progresses, further candidate biomarkers are being identified. This article reviews the literature regarding the more recently identified biomarkers and outlines areas requiring further study.
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Affiliation(s)
- Jonathan R Dalzell
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, G12 8TA, UK.
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Abstract
Dilated cardiomyopathy is characterised by left ventricular dilation that is associated with systolic dysfunction. Diastolic dysfunction and impaired right ventricular function can develop. Affected individuals are at risk of left or right ventricular failure, or both. Heart failure symptoms can be exercise-induced or persistent at rest. Many patients are asymptomatic. Chronically treated patients sometimes present acutely with decompensated heart failure. Other life-threatening risks are ventricular arrhythmias and atrioventricular block, syncope, and sudden death. Genetic inheritance arises in 30-48% of patients, and inflammatory disorders such as myocarditis or toxic effects from medications, alcohol, or illicit drugs also result in dilated cardiomyopathy. Genes that cause dilated cardiomyopathy generally encode cytoskeletal and sarcomeric (contractile apparatus) proteins, although disturbance of calcium homeostasis also seems to be important. In children, disrupted mitochondrial function and metabolic abnormalities have a causal role. Treatments focus on improvement of cardiac efficiency and reduction of mechanical stress. Arrhythmia therapy and prevention of sudden death continue to be mainstays of treatment. Despite progress over the past 10 years, outcomes need to be improved.
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Affiliation(s)
- John Lynn Jefferies
- Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
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Kanoupakis EM, Manios EG, Vardas PE. Predicting future shocks in implantable cardioverter defibrillator recipients: the role of biomarkers. Europace 2009; 11:1434-9. [DOI: 10.1093/europace/eup235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Tsutamoto T, Kawahara C, Yamaji M, Nishiyama K, Fujii M, Yamamoto T, Horie M. Relationship between renal function and serum cardiac troponin T in patients with chronic heart failure. Eur J Heart Fail 2009; 11:653-8. [DOI: 10.1093/eurjhf/hfp072] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Takayoshi Tsutamoto
- Department of Cardiovascular and Respiratory Medicine; Shiga University of Medical Science; Tsukinowa, Seta Otsu 520-2192 Japan
| | - Chiho Kawahara
- Department of Cardiovascular and Respiratory Medicine; Shiga University of Medical Science; Tsukinowa, Seta Otsu 520-2192 Japan
| | - Masayuki Yamaji
- Department of Cardiovascular and Respiratory Medicine; Shiga University of Medical Science; Tsukinowa, Seta Otsu 520-2192 Japan
| | - Keizo Nishiyama
- Department of Cardiovascular and Respiratory Medicine; Shiga University of Medical Science; Tsukinowa, Seta Otsu 520-2192 Japan
| | - Masanori Fujii
- Department of Cardiovascular and Respiratory Medicine; Shiga University of Medical Science; Tsukinowa, Seta Otsu 520-2192 Japan
| | - Takashi Yamamoto
- Department of Cardiovascular and Respiratory Medicine; Shiga University of Medical Science; Tsukinowa, Seta Otsu 520-2192 Japan
| | - Minoru Horie
- Department of Cardiovascular and Respiratory Medicine; Shiga University of Medical Science; Tsukinowa, Seta Otsu 520-2192 Japan
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Clerico A, Vittorini S, Passino C, Emdin M. New and emerging biomarkers of heart failure. Crit Rev Clin Lab Sci 2009; 46:107-28. [DOI: 10.1080/10408360902722342] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Sbarouni E, Georgiadou P, Koutelou M, Sklavainas I, Panagiotakos D, Voudris V. Ischaemia-modified albumin in dilated cardiomyopathy. Ann Clin Biochem 2009; 46:241-3. [DOI: 10.1258/acb.2009.009022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Biomarkers of myocardial necrosis may be increased in patients with chronic heart failure. We investigated whether ischaemia-modified albumin (IMA), a marker of ischaemia, is also elevated in patients with compensated heart failure, due to dilated cardiomyopathy (DCM). Methods We studied 42 patients with DCM and an equal number of age-matched normal volunteers. We assessed IMA serum levels with the albumin cobalt binding test. Results IMA was 89.9 ± 13.1 (71–117) KU/L in the patient group and 93.9 ± 9.9 (76–122) KU/L in the control group, with no significant difference between the two ( P = 0.11). However, IMA differed significantly according to the New York Heart Association classification ( P = 0.003) and was negatively correlated with the left ventricular ejection fraction ( r = −0.40, P = 0.014). Conclusions We conclude that IMA, a marker of ischaemia, does not differ in patients with clinically stable DCM compared with normal subjects, but varies significantly in relation to the severity of the disease.
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Affiliation(s)
- Eftihia Sbarouni
- 2nd Department of Cardiology, Onassis Cardiac Surgery Center, Athens 176 74, Greece
| | - Panagiota Georgiadou
- 2nd Department of Cardiology, Onassis Cardiac Surgery Center, Athens 176 74, Greece
| | - Maria Koutelou
- 2nd Department of Cardiology, Onassis Cardiac Surgery Center, Athens 176 74, Greece
| | - Ioannis Sklavainas
- 2nd Department of Cardiology, Onassis Cardiac Surgery Center, Athens 176 74, Greece
| | | | - Vassilis Voudris
- 2nd Department of Cardiology, Onassis Cardiac Surgery Center, Athens 176 74, Greece
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Abstract
This review presents five cases that highlight the complexity of taking care of patients with ventricular arrhythmias. Three of the cases discuss management of patients with nonsustained ventricular tachycardia in the setting of structural heart disease: dilated cardiomyopathy, hypertrophic cardiomyopathy, and after myocardial infarction. A fourth case asks whether data from implantable cardioverter defibrillator (ICD) trials can be extrapolated to older patients, and the fifth case discusses management of recurrent ventricular arrhythmias in a patient with an ICD.
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Affiliation(s)
- Fred Kusumoto
- Department of Medicine, Mayo Clinic School of Medicine, Jacksonville, FL 32224, USA.
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Affiliation(s)
- Eugene Braunwald
- Thrombolysis in Myocardial Infarction (TIMI) Study Group, Cardiovascular Division, Brigham and Women's Hospital, and the Department of Medicine, Harvard Medical School, Boston, USA.
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Cotter G, Felker GM, Adams KF, Milo-Cotter O, O'Connor CM. The pathophysiology of acute heart failure--is it all about fluid accumulation? Am Heart J 2008; 155:9-18. [PMID: 18082483 DOI: 10.1016/j.ahj.2006.02.038] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2005] [Accepted: 02/12/2006] [Indexed: 12/21/2022]
Abstract
Despite significant advancement in chronic heart failure (HF), no breakthroughs have occurred in the last 2 decades in our understanding of the pathophysiology, classification, and treatment of acute HF (AHF). Traditional thinking, which has been that this disorder is a result of gradual fluid accumulation on a background of chronic HF, has been called into question by recent large registries enrolling less selected patient populations. It is increasingly recognized that many patients with this syndrome are elderly, have relatively preserved ejection fraction, and have mild or no preexisting chronic HF. In this review, we propose 2 primary subtypes of AHF: (1) acute decompensated cardiac failure, characterized by deterioration of cardiac performance over days to weeks leading to decompensation; and (2) acute vascular failure, characterized by acute hypertension and increased vascular stiffness. Registry data suggest that the latter is the more common form of AHF in the general population, although the former is often overrepresented in studies focused in academic tertiary care centers. Regardless of the clinical subtype, a variety of pathophysiologic mechanisms may play a role in this disorder, many of which remain poorly understood. In this review, we describe current understanding of the pathophysiology of AHF, including a critical evaluation of the data supporting both traditional and novel mechanisms, and suggest a framework for integrating these mechanisms into an overall model of AHF.
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Affiliation(s)
- Gad Cotter
- Duke University Medical Center, the Duke Clinical Research Institute, Durham, NC 27715, USA.
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Linklater AKJ, Lichtenberger MK, Thamm DH, Tilley L, Kirby R. Serum concentrations of cardiac troponin I and cardiac troponin T in dogs with class IV congestive heart failure due to mitral valve disease. J Vet Emerg Crit Care (San Antonio) 2007. [DOI: 10.1111/j.1476-4431.2007.00241.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Boyle A, Maurer MS, Sobotka PA. Myocellular and interstitial edema and circulating volume expansion as a cause of morbidity and mortality in heart failure. J Card Fail 2007; 13:133-6. [PMID: 17395054 DOI: 10.1016/j.cardfail.2006.10.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2006] [Revised: 09/06/2006] [Accepted: 10/24/2006] [Indexed: 11/18/2022]
Abstract
BACKGROUND Total body sodium and volume overload are the hallmarks of the congested state in the heart failure patient and result in a variety of deleterious pathophysiologic outcomes including ventricular chamber dilation, passive congestion of both encapsulated and nonencapsulated vital organs and myocardial edema and ischemia. METHODS AND RESULTS We propose that congestion is itself a disease state irrespective of the underlying cardiac or renal dysfunction and that sodium and volume overload are directly related to poor clinical outcomes in such patients. In this model, the target of decongestion therapy should be normalization of total body sodium and volume in an expeditious manner and with a durable result. CONCLUSIONS Additionally, novel tools to continuously measure the effectiveness and adequacy of decongestion therapy in all compartments are required if improved clinical outcomes are to be attained.
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Affiliation(s)
- Andrew Boyle
- Division of Cardiology, University of Minnesota, Minneapolis, Minnesota 55455, USA
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Berna MJ, Zhen Y, Watson DE, Hale JE, Ackermann BL. Strategic use of immunoprecipitation and LC/MS/MS for trace-level protein quantification: myosin light chain 1, a biomarker of cardiac necrosis. Anal Chem 2007; 79:4199-205. [PMID: 17447729 DOI: 10.1021/ac070051f] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Myosin light chain 1 (Myl3) is a 23-kDa isoform of one of the subunits of myosin, a protein involved in muscle contraction. Myl3 is presently being studied as a biomarker of cardiac necrosis to predict drug-induced cardiotoxicity, and in the work presented here, an LC/MS/MS assay was developed and validated to measure Myl3 in rat serum. The key steps in this approach involved immunoaffinity purification of Myl3 from serum followed by on-bead digestion with trypsin to release a surrogate peptide. This tryptic peptide was quantified using a synthetic peptide standard and a corresponding stable isotope-labeled internal standard, and the results were stoichiometrically converted to Myl3 serum concentrations. Myl3 concentrations were corrected for peptide recovery following immunoprecipitation and digestion (85%) and showed excellent agreement with synthetic peptide standards. Both the synthetic peptide and His-Myl3 protein were used to evaluate assay accuracy (% RE) and precision (% CV), which were measured on each of 3 days. The synthetic peptide was evaluated over the range of 0.073-7.16 nM, while Myl3 protein QC samples prepared in rat serum were evaluated over the range of 0.13-6.62 nM. To prepare control matrix, endogenous Myl3 was immunodepleted from pooled rat serum. Peptide interday accuracy and precision did not exceed 7.6 and 11.1%, and Myl3 interday accuracy and precision did not exceed 12.9 and 13.2%, respectively. Data are presented from the application of this assay to establish a time course in which rats demonstrated a marked increase in Myl3 serum concentrations following administration of isoproterenol, a beta-adrenergic receptor agonist known to induce cardiac injury. This assay is an example of a larger effort in our laboratory to use LC/MS/MS in conjunction with immunoaffinity techniques to evaluate candidate biomarkers of target organ toxicity and to expedite the development of biomarker assays for drug development.
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Affiliation(s)
- Michael J Berna
- Lilly Research Laboratories, Eli Lilly and Company, Greenfield, Indiana 46140, USA.
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de Virginy DRB. Novel and potential future biomarkers for assessment of the severity and prognosis of chronic heart failure. Heart Fail Rev 2006; 11:333-4. [PMID: 17131079 DOI: 10.1007/s10741-006-0234-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Over the last two decades, the pathophysiology and biomolecular basis of heart failure syndrome has reached sound and more comprehensive understanding. This knowledge has allowed expert researchers and clinicians to explore an entirely new spectrum of potential biochemical markers derived from different cellular and signaling pathways that lead to myocardial hypertrophy, chronic damage of the myocyte, apoptosis, and, ultimately, myocardial remodeling. Indeed, the link between myocardial remodeling and adverse outcomes, as well as the recognition of the myocardial interstitium as a multifunctional dynamic entity strongly influenced by systemic neurohormonal and inflammatory activation, has provided a solid ground for research of biomarkers that might correlate with severity and prognostication in chronic heart failure. This paper reviews and summarize recent literature on some of the most interesting circulating biomarkers with potential use for the stratification of patients with chronic heart failure.
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Affiliation(s)
- David R Buvat de Virginy
- Department of Internal Medicine, St. John's Clinic, 1100 West 10th Street, Suite 270, Rolla, Missouri 65401, USA.
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Wang AYM, Lam CWK, Yu CM, Wang M, Chan IHS, Lui SF, Sanderson JE. Troponin T, left ventricular mass, and function are excellent predictors of cardiovascular congestion in peritoneal dialysis. Kidney Int 2006; 70:444-52. [PMID: 16871255 DOI: 10.1038/sj.ki.5001605] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patients on maintenance peritoneal dialysis (PD) are frequently complicated with volume overload. In this study, we sought to evaluate troponin T testing alone or in combination with echocardiographic measures in predicting cardiovascular congestion in PD patients. This was a prospective study of 222 chronic PD patients with echocardiography and measurement of serum troponin T carried out at baseline. Patients were followed for 3 years or until death. The end point was first episode of cardiovascular congestion. Troponin T emerged as an independent predictor of cardiovascular congestion (hazard ratio, 2.98, 95% confidence intervals (CI), 1.19-7.42) in a multivariable Cox regression model, including also left ventricular mass index (LVMi) and ejection fraction (EF). Patients with troponin T>median (0.06 microg/l) and EF<or=50% and patients with troponin T>median but EF>50% had a 3.10-fold (95% CI, 1.71-5.63) and 1.88-fold (95% CI, 1.05-3.38) adjusted risk of cardiovascular congestion, respectively, than those with troponin T<or=median and EF>50%. Patients with troponin T>median and LVMi>or=median (96.23 g/m2.7) had a 2.68-fold (95% CI, 1.39-5.19) adjusted risk of cardiovascular congestion than those with troponin T<or=median and LVMi <median. In conclusion, troponin T predicts cardiovascular congestion in chronic PD patients without acute myocardial ischemia and provides incremental prognostic value for cardiovascular congestion when used in combination with LVM and EF. This easily available parameter adds significant value to echocardiography in identifying PD patients at risk of cardiovascular congestion.
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MESH Headings
- Adult
- Aged
- Biomarkers/blood
- Echocardiography
- Female
- Follow-Up Studies
- Heart Diseases/blood
- Heart Diseases/diagnostic imaging
- Heart Diseases/epidemiology
- Heart Failure/blood
- Heart Failure/diagnostic imaging
- Heart Failure/epidemiology
- Humans
- Hypertrophy, Left Ventricular/blood
- Hypertrophy, Left Ventricular/diagnostic imaging
- Hypertrophy, Left Ventricular/epidemiology
- Kidney Failure, Chronic/epidemiology
- Kidney Failure, Chronic/therapy
- Male
- Middle Aged
- Peritoneal Dialysis, Continuous Ambulatory/adverse effects
- Predictive Value of Tests
- Prognosis
- Proportional Hazards Models
- Prospective Studies
- Risk Factors
- Troponin T/blood
- Ventricular Dysfunction, Left/blood
- Ventricular Dysfunction, Left/diagnostic imaging
- Ventricular Dysfunction, Left/epidemiology
- Ventricular Function, Left
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Affiliation(s)
- A Y-M Wang
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
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