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Chrysohoou C, Konstantinou K, Tsioufis K. The Role of NT-proBNP Levels in the Diagnosis and Treatment of Heart Failure with Preserved Ejection Fraction-It Is Not Always a Hide-and-Seek Game. J Cardiovasc Dev Dis 2024; 11:225. [PMID: 39057645 PMCID: PMC11277408 DOI: 10.3390/jcdd11070225] [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: 06/03/2024] [Revised: 06/12/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
Although heart failure with preserved ejection fraction (HFpEF) has become the predominant heart failure subtype, it remains clinically under-recognized. This has been attributed to the complex pathophysiological mechanisms that accompany individuals with several co-morbidities and symptoms and signs of HFpEF. Natriuretic peptides have been recognized as playing an important role in the diagnosis and monitoring of patients with heart failure with reduced ejection fraction (HFrEF), but their role in HFpEF remains controversial, driven by the different pathophysiological characteristics of these patients. The type of diet consumed has shown various modifying effects on plasma levels of NPs, irrespective of pharmacological treatment.
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Affiliation(s)
- Christina Chrysohoou
- 1st Cardiology Clinic, Hippokration Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (K.K.)
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Mănescu IB, Pál K, Lupu S, Dobreanu M. Conventional Biomarkers for Predicting Clinical Outcomes in Patients with Heart Disease. LIFE (BASEL, SWITZERLAND) 2022; 12:life12122112. [PMID: 36556477 PMCID: PMC9781565 DOI: 10.3390/life12122112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/16/2022]
Abstract
Atherosclerosis is the main cause of cardiovascular disease worldwide. The progression of coronary atherosclerosis leads to coronary artery disease, with impaired blood flow to the myocardium and subsequent development of myocardial ischemia. Acute coronary syndromes and post-myocardial infarction heart failure are two of the most common complications of coronary artery disease and are associated with worse outcomes. In order to improve the management of patients with coronary artery disease and avoid major cardiovascular events, several risk assessment tools have been developed. Blood and imaging biomarkers, as well as clinical risk scores, are now available and validated for clinical practice, but research continues. The purpose of the current paper is to provide a review of recent findings regarding the use of humoral biomarkers for risk assessment in patients with heart disease.
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Affiliation(s)
- Ion-Bogdan Mănescu
- Clinical Laboratory, County Emergency Clinical Hospital of Targu Mures, 540136 Targu Mures, Romania
- Department of Laboratory Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Krisztina Pál
- Clinical Laboratory, County Emergency Clinical Hospital of Targu Mures, 540136 Targu Mures, Romania
- Department of Laboratory Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Silvia Lupu
- Internal Medicine V, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
- 1st Department of Cardiology, Emergency Institute for Cardiovascular Disease and Heart Transplant of Targu Mures, 540136 Targu Mures, Romania
- Correspondence:
| | - Minodora Dobreanu
- Clinical Laboratory, County Emergency Clinical Hospital of Targu Mures, 540136 Targu Mures, Romania
- Department of Laboratory Medicine, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Targu Mures, Romania
- Center for Advanced Medical and Pharmaceutical Research, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
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Sakalaki M, Hansson PO, Rosengren A, Thunström E, Pivodic A, Fu M. Multi-modality biomarkers in the early prediction of ischaemic heart disease in middle-aged men during a 21-year follow-up. BMC Cardiovasc Disord 2021; 21:65. [PMID: 33530933 PMCID: PMC7851898 DOI: 10.1186/s12872-021-01886-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 01/21/2021] [Indexed: 12/31/2022] Open
Abstract
Background Ischaemic heart disease (IHD) often develops after decades of preceding subclinical coronary atherosclerosis. Biomarkers are useful prognostic predictors of IHD, but their long-term predictive value in a general population has not been adequately studied. Purpose To investigate the early predictive value of multi-modality biomarkers in addition to clinical risk factors in incident IHD in a random male general population sample followed from 50 to 71 years of age. Method “The Study of Men Born in 1943” is a longitudinal cohort study during follow-up. All the men underwent a baseline examination in 1993, where a panel of biomarkers were analysed and incident IHD was registered during 21-year follow-ups. Results Of 739 participants, 97 men (13.1%) developed an IHD event. For time to first occurrence of IHD, univariable analyses showed that elevated levels of high sensitivity troponin T (hs-TNT), high sensitivity-C reactive protein (hs-CRP) and interleukin-6 (IL-6) were significant predictors of IHD. In addition, a high number of biomarkers with elevated levels (hs-TNT > 10 ng/L, hs-CRP > 1 mg/L, IL-6 > 8 ng/L and N-terminal pro b-type natriuretic peptide (NT-proBNP) > 100 pg/mL) increased predictive ability. In univariable and multivariable analysis high-density lipoprotein-cholesterol (HDL-C) had the highest predictive ability. Hs-TNT provided better predictive ability than smoking, body mass index and glucose, and was an independent significant predictor when adjusted for HDL-C, total cholesterol and hypertension. Addition of biomarkers on top of clinical risk factors provided significantly better prediction as tested by likelihood ratio test (p = 0.033), but did not significantly enhance the model’s discriminative ability However, it appeared contributing to higher sensitivity in the late phase of follow-up. Conclusion In this random, middle-aged male population sample, the addition of biomarker hs-TNT was an independent significant predictor of IHD and significantly improved prediction, indicating the probability of a better prediction of long-term risk of IHD in a low-risk population. Trial registration: The study is registered at Clinical Trials.gov Identifier number: NCT03138122
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Affiliation(s)
- Maria Sakalaki
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital/Östra Hospital, University of Gothenburg, Diagnosvägen 11, 41650, Gothenburg, Sweden. .,Department of Medicine, Geriatrics and Emergency Medicine, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
| | - Per-Olof Hansson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital/Östra Hospital, University of Gothenburg, Diagnosvägen 11, 41650, Gothenburg, Sweden.,Department of Medicine, Geriatrics and Emergency Medicine, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital/Östra Hospital, University of Gothenburg, Diagnosvägen 11, 41650, Gothenburg, Sweden.,Department of Medicine, Geriatrics and Emergency Medicine, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Erik Thunström
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital/Östra Hospital, University of Gothenburg, Diagnosvägen 11, 41650, Gothenburg, Sweden.,Department of Medicine, Geriatrics and Emergency Medicine, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
| | - Aldina Pivodic
- Statistiska Konsultgruppen, Gothenburg, Sweden.,Department of Ophthalmology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Michael Fu
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital/Östra Hospital, University of Gothenburg, Diagnosvägen 11, 41650, Gothenburg, Sweden.,Department of Medicine, Geriatrics and Emergency Medicine, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
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Coronary artery disease in renal transplant recipients: an angiographic study. Hellenic J Cardiol 2020; 61:199-203. [DOI: 10.1016/j.hjc.2018.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 06/30/2018] [Accepted: 07/02/2018] [Indexed: 12/31/2022] Open
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Tousoulis D. Prolong antiplatelet therapy. Where we stand? Hellenic J Cardiol 2020; 60:269-270. [PMID: 32014559 DOI: 10.1016/j.hjc.2020.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 11/27/2022] Open
Affiliation(s)
- Dimitris Tousoulis
- 1(st) Cardiology Department, National and Kapodistrian University of Athens University Medical School, Hippokration Hospital, Athens, Greece.
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Chrysohoou C, Bougatsos G, Magkas N, Skoumas J, Kapota A, Kopelias J, Bliouras N, Tsioufis K, Petras D, Tousoulis D. Peritoneal dialysis as a therapeutic solution in elderly patients with cardiorenal syndrome and heart failure: A case-series report. Hellenic J Cardiol 2019; 61:73-77. [PMID: 31055051 DOI: 10.1016/j.hjc.2019.04.010] [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: 01/20/2019] [Revised: 04/18/2019] [Accepted: 04/22/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The aim of this work was to evaluate the impact of peritoneal dialysis (PD) on venous congestion, right ventricular function, pulmonary artery systolic pressure (PASP), and clinical functional status in elderly patients with cardiorenal syndrome (CRS) and chronic heart failure (HF). METHODS A case series of 21 (17 males, age 70 ± 11 years) consecutive patients with HF along with diuretic resistance and right ventricular dysfunction (median renal failure duration 60 months, range 13-287 months, mean ejection fraction 36 ± 11%) having been engaged in PD; 76% of the patients were under automated peritoneal dialysis (APD), whereas the rest were under continuous ambulatory PD (CAPD). Patients' PASP and central venous pressure (CVP) - through compression sonography - and body weight were evaluated before initiating the PD program and at 6 and 12 months. RESULTS During the follow-up period, the mortality rate was 8 deaths out of 21 patients (38%) A significant reduction by 29.9% in PASP levels (p = 0.013) and by 42% in CVP levels (p < 0.001), and in right ventricular function assessed by tricuspid annulus tissue Doppler velocity (p = 0.04) was observed, whereas patients' weight increased by 3.7% (p = 0.001). New York Heart Association class improved in 12 patients, whereas in the remaining patients, it remained constant (p = 0.046). In 8 patients, complications were reported (mainly presence of Staphylococcus aureus). In conclusion, PD seems to confer a substantial benefit in clinical status, which is in line with improvement in venous congestion and right ventricular systolic pressure among elderly patients with HF along with CRS.
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Affiliation(s)
- Christina Chrysohoou
- First Cardiology Clinic, School of Medicine, Hippokratio Hospital, University of Athens, Athens, Greece.
| | - George Bougatsos
- Peritoneal Dialysis Unit Nephrology Clinic, Hippokration Hospital, Athens, Greece
| | - Nikos Magkas
- First Cardiology Clinic, School of Medicine, Hippokratio Hospital, University of Athens, Athens, Greece
| | - John Skoumas
- First Cardiology Clinic, School of Medicine, Hippokratio Hospital, University of Athens, Athens, Greece
| | - Athanasia Kapota
- Peritoneal Dialysis Unit Nephrology Clinic, Hippokration Hospital, Athens, Greece
| | - John Kopelias
- Peritoneal Dialysis Unit Nephrology Clinic, Hippokration Hospital, Athens, Greece
| | | | - Konstantinos Tsioufis
- First Cardiology Clinic, School of Medicine, Hippokratio Hospital, University of Athens, Athens, Greece
| | - Dimitris Petras
- Peritoneal Dialysis Unit Nephrology Clinic, Hippokration Hospital, Athens, Greece
| | - Dimitris Tousoulis
- First Cardiology Clinic, School of Medicine, Hippokratio Hospital, University of Athens, Athens, Greece
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Siasos G, Tsigkou V, Tousoulis D. Circulating microRNAs as novel biomarkers in heart failure. Hellenic J Cardiol 2018; 59:215-216. [DOI: 10.1016/j.hjc.2018.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 06/07/2018] [Indexed: 02/04/2023] Open
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Bistola V, Polyzogopoulou E, Parissis J. Natriuretic peptides in acute coronary syndromes: A new role to predict recurrent ischemic event-related mortality? Hellenic J Cardiol 2018; 59:119-121. [PMID: 29730194 DOI: 10.1016/j.hjc.2018.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 03/30/2018] [Indexed: 01/27/2023] Open
Abstract
Risk stratification in acute coronary syndromes (ACS) has been previously based on the severity of acute clinical presentation, presence of cardiovascular comorbidities, and abnormalities of ischemia-specific biomarkers, most importantly troponins. Natriuretic peptides (NPs), which become elevated upon increased myocardial wall stress, are established diagnostic and prognostic biomarkers in patients with heart failure. Recently, their prognostic potential in ACS has been reported, specifically as predictors of future new-onset heart failure or left ventricular (LV) systolic dysfunction. In the current issue of the Hellenic Journal of Cardiology, a new role of NPs is suggested in ACS as predictors of long-term mortality associated with recurrent cardiac ischemic events, specifically in patients with preserved or mid-range LV ejection fraction upon index ACS. Potential pathophysiological mechanisms that explain the association between augmented NP levels with recurrent myocardial ischemia are hypothesized including the potential of NPs to reflect augmented local and/or systemic inflammation, prothrombotic state, and vascular dysregulation.
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Affiliation(s)
- Vasiliki Bistola
- Heart Failure Unit, Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Eftihia Polyzogopoulou
- Emergency Medicine Department, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - John Parissis
- Heart Failure Unit, Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece; Emergency Medicine Department, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece.
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Tousoulis D. Vitamin D deficiency and cardiovascular disease: Fact or fiction? Hellenic J Cardiol 2018; 59:69-71. [DOI: 10.1016/j.hjc.2018.06.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Tousoulis D. Novel biomarkers in heart failure: How they change clinical decision? Hellenic J Cardiol 2017; 58:317-319. [DOI: 10.1016/j.hjc.2017.11.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 10/12/2017] [Indexed: 01/20/2023] Open
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