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Song C, Yuan S, Cui K, Cai Z, Zhang R, He J, Qiao Z, Bian X, Wu S, Wang H, Fu R, Wang C, Liu Q, Yin D, Jia L, Dou K. Prognostic value of N-terminal Pro–B-Type natriuretic peptide in patients with intermediate coronary lesions. Front Cardiovasc Med 2022; 9:903757. [PMID: 35966554 PMCID: PMC9370998 DOI: 10.3389/fcvm.2022.903757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/01/2022] [Indexed: 11/20/2022] Open
Abstract
Background The optimal treatment strategy for patients with coronary intermediate lesions, defined as diameter stenosis of 50–70%, remains a great challenge for cardiologists. Identification of potential biomarkers predictive of major adverse cardiovascular events (MACEs) risk may assist in risk stratification and clinical decision. Methods A total of 1,187 patients with intermediate coronary lesions and available N-terminal pro-brain natriuretic peptide (NT-proBNP) levels were enrolled in the current study. A baseline NT-proBNP level was obtained. The primary endpoint was defined as MACEs, the composite endpoint of all-cause death and non-fatal myocardial infarction. A multivariate Cox regression model was used to explore the association between NT-proBNP level and MACE risk. Results The mean age of the study cohort was 59.2 years. A total of 68 patients experienced MACE during a median follow-up of 6.1 years. Restricted cubic spline analysis delineated a linear relationship between the baseline NT-proBNP level and MACE risk. Both univariate and multivariate analyses demonstrated that an increased NT-proBNP level was associated with an increased risk of MACE [adjusted hazard ratio (HR) per doubling: 1.412, 95% confidence interval (CI): 1.022–1.952, p = 0.0365]. This association remains consistent in clinical meaningful subgroups according to age, sex, body mass index (BMI), and diabetes. Conclusion An increased NT-proBNP level is associated with an increased risk of MACE in patients with intermediate coronary lesions and may serve as the potential biomarker for risk stratification and treatment decision guidance.
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Affiliation(s)
- Chenxi Song
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Cardiovascular Disease, Beijing, China
| | - Sheng Yuan
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Cardiovascular Disease, Beijing, China
| | - Kongyong Cui
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Cardiovascular Disease, Beijing, China
| | - Zhongxing Cai
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Cardiovascular Disease, Beijing, China
| | - Rui Zhang
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Cardiovascular Disease, Beijing, China
| | - Jining He
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Cardiovascular Disease, Beijing, China
| | - Zheng Qiao
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Cardiovascular Disease, Beijing, China
| | - Xiaohui Bian
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Cardiovascular Disease, Beijing, China
| | - Shaoyu Wu
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Cardiovascular Disease, Beijing, China
| | - Haoyu Wang
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Cardiovascular Disease, Beijing, China
| | - Rui Fu
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Cardiovascular Disease, Beijing, China
| | - Chunyue Wang
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Cardiovascular Disease, Beijing, China
| | - Qianqian Liu
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Cardiovascular Disease, Beijing, China
| | - Dong Yin
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Cardiovascular Disease, Beijing, China
| | - Lei Jia
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- *Correspondence: Lei Jia,
| | - Kefei Dou
- Cardiometabolic Medicine Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Cardiovascular Disease, Beijing, China
- *Correspondence: Lei Jia,
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2
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Elevated plasma levels of NT-proBNP in ambulatory patients with peripheral arterial disease. PLoS One 2021; 16:e0253792. [PMID: 34288948 PMCID: PMC8294530 DOI: 10.1371/journal.pone.0253792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 06/14/2021] [Indexed: 11/19/2022] Open
Abstract
N-terminal pro B-type natriuretic peptide (NT-proBNP), a cardiac disease biomarker, has been demonstrated to be a strong independent predictor of cardiovascular events in patients without heart failure. Patients with peripheral arterial disease (PAD) are at high risk of cardiovascular events and death. In this study, we investigated levels of NT-proBNP in patients with PAD compared to non-PAD controls. A total of 355 patients were recruited from outpatient clinics at a tertiary care hospital network. Plasma NT-proBNP levels were quantified using protein multiplex. There were 279 patients with both clinical and diagnostic features of PAD and 76 control patients without PAD (non-PAD cohort). Compared with non-PAD patients, median (IQR) NT-proBNP levels in PAD patients were significantly higher (225 ng/L (120-363) vs 285 ng/L (188-425), p- value = 0.001, respectively). Regression analysis demonstrated that NT-proBNP remained significantly higher in patients with PAD relative to non-PAD despite adjusting for age, sex, hypercholesterolemia, smoking and hypertension [odds ratio = 1.28 (1.07-1.54), p-value <0.05]. Subgroup analysis showed elevated NT-proBNP levels in patients with PAD regardless of prior history of CHF, CAD, diabetes and hypercholesteremia (p-value <0.05). Finally, spearmen's correlation analysis demonstrated a negative correlation between NT-proBNP and ABI (ρ = -0.242; p-value < 0.001). In conclusion, our data shows that patients with PAD in an ambulatory care setting have elevated levels of NT-proBNP compared to non-PAD patients in the absence of cardiac symptoms.
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3
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Ohashi N, Takase H, Aoki T, Matsuyama T, Ishigaki S, Isobe S, Fujikura T, Kato A, Yasuda H. Salt intake causes B-type natriuretic peptide elevation independently of blood pressure elevation in the general population without hypertension and heart disease. Medicine (Baltimore) 2021; 100:e25931. [PMID: 34106662 PMCID: PMC8133175 DOI: 10.1097/md.0000000000025931] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/23/2021] [Indexed: 10/31/2022] Open
Abstract
Excessive salt intake causes hypertension and cardiovascular diseases (CVDs). B-type natriuretic peptide (BNP) is synthesized and released from the ventricle, and is a surrogate marker reflecting various CVDs. Moreover, when a slight BNP elevation is shown, it leads to a poor prognosis in the general population. However, the relationship between salt intake and BNP levels in the general population remains unclear, especially in those without hypertension and heart diseases.In this study, we recruited 1404 participants without hypertension and electrocardiogram abnormalities, who received regular annual health check-ups in Japan. Plasma BNP levels were measured, and daily salt intake levels were evaluated using urinary samples. In addition, some clinical parameters were obtained, and the data were cross-sectionally analyzed.The median of plasma BNP levels was 10.50 pg/mL, and daily salt intake was 8.50 ± 1.85 g. When dividing participants into quartiles according to daily salt intake, those with the highest daily salt intake revealed the highest plasma BNP levels. Plasma BNP levels were significantly and positively associated with daily salt intake. Moreover, multiple linear regression analyses revealed that plasma BNP levels showed a significant positive association with daily salt intake levels after adjustments.Plasma BNP levels were significantly and positively associated with daily salt intake after adjustment in the general population. Plasma BNP levels may be a surrogate marker reflecting salt-induced heart diseases.
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Affiliation(s)
- Naro Ohashi
- Internal Medicine 1, Hamamatsu University School of Medicine, Higashi-ku Hamamatsu
| | - Hiroyuki Takase
- Department of Internal Medicine, Enshu Hospital, Naka-ku Hamamatsu
| | - Taro Aoki
- Internal Medicine 1, Hamamatsu University School of Medicine, Higashi-ku Hamamatsu
| | - Takashi Matsuyama
- Internal Medicine 1, Hamamatsu University School of Medicine, Higashi-ku Hamamatsu
| | - Sayaka Ishigaki
- Blood Purification Unit, Hamamatsu University School of Medicine, Higashi-ku Hamamatsu, Japan
| | - Shinsuke Isobe
- Internal Medicine 1, Hamamatsu University School of Medicine, Higashi-ku Hamamatsu
| | - Tomoyuki Fujikura
- Internal Medicine 1, Hamamatsu University School of Medicine, Higashi-ku Hamamatsu
| | - Akihiko Kato
- Blood Purification Unit, Hamamatsu University School of Medicine, Higashi-ku Hamamatsu, Japan
| | - Hideo Yasuda
- Internal Medicine 1, Hamamatsu University School of Medicine, Higashi-ku Hamamatsu
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4
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Hammerer-Lercher A, Gruson D, Stankovic S, Collinson P, Suvisaari J, Pulkki K, Duff CJ, Baum H, Stavljenic-Rukavina A, Aakre KM, Langlois MR, Laitinen P. Update on current practice in laboratory medicine in respect of natriuretic peptide testing for heart failure diagnosis and management in Europe. The CARdiac MArker guideline Uptake in Europe (CARMAGUE) study. Clin Chim Acta 2020; 511:59-66. [DOI: 10.1016/j.cca.2020.09.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 09/21/2020] [Indexed: 12/19/2022]
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5
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Ghanem SE, Abdel-Samiee M, Torky MH, Gaafar A, Mohamed SM, Salah Eldin GMM, Awad SM, Diab KA, ELsabaawy DM, Yehia SA, Abdelaziz Elbasyouni HA, Elshormilisy AA. Role of resistin, IL-6 and NH2-terminal portion proBNP in the pathogenesis of cardiac disease in type 2 diabetes mellitus. BMJ Open Diabetes Res Care 2020; 8:8/1/e001206. [PMID: 32988848 PMCID: PMC7523202 DOI: 10.1136/bmjdrc-2020-001206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 05/29/2020] [Accepted: 08/04/2020] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Epidemiological and genetic studies have recorded the association between proinflammatory cytokines and the development of insulin resistance, diabetes, and cardiovascular disease. The role of interleukin 6 (IL-6), NH2-terminal portion pro-brain natriuretic peptide (NT-proBNP) and resistin in the pathogenesis of heart disease in type 2 diabetes mellitus (T2DM) is still a matter of controversy. The current study aimed to evaluate the role of these biomarkers in the development of left ventricular systolic dysfunction and the ability to use them as non-invasive test in the prediction of left ventricular hypertrophy and systolic dysfunction in T2DM. RESEARCH DESIGN AND METHODS 150 participants were included in this case-control study. Patients were divided into two subgroups according to echocardiographic findings: group 1a included 46 patients with type 2 diabetes mellitus and echocardiographic evidence of abnormal systolic function; group 1b included 54 patients with type 2 diabetes mellitus and with normal echocardiogenic study; and group 2 included 50 apparently healthy controls. Routine laboratory investigations such as complete blood count, liver and renal function tests, and lipid profile, serum IL-6, NT-proBNP, and resistin were measured in all participants. Conventional echocardiography was done with special concern on the assessment of left ventricular systolic function (ejection fraction). RESULTS There was a significant increase in the level of resistin, NT-proBNP and IL-6 in group 1a patients compared with group 1b and in healthy controls. Echocardiographic parameters showed a significant increase in left ventricular mass index, left ventricle posterior wall thickness, interventricular septum thickness, and left ventricle mass in group 1a compared with group 1b and the control group. The increased left ventricular mass index was associated with higher levels of IL-6, NT-proBNP and resistin. CONCLUSIONS Proinflammatory cytokines had a clear relation with left ventricular systolic dysfunction and hypertrophy and can be used as early non-invasive markers for detection of left ventricular remodeling and systolic dysfunction in patients with T2DM.
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Affiliation(s)
- Samar Ebrahim Ghanem
- Department of Clinical Biochemistry and Molecular Diagnostics, National Liver Institute, Menoufia University, Menoufia, Egypt
| | - Mohamed Abdel-Samiee
- Department of Hepatology and Gastroenterology, National Liver Institute, Menoufia University, Menoufia, Egypt
| | | | - Ahmed Gaafar
- Department of Cardiology, Helwan University, Cairo, Egypt
| | - Somia Mokabel Mohamed
- Department of Physiology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | | | - Samah Mohammed Awad
- Department of Clinical Microbiology and Immunology and Molecular Microbiology in Liver and GIT, National Liver Institute, Menoufia University, Menoufia, Egypt
| | - Karema A Diab
- Department of Clinical Pathology, National Liver Institute, Menoufia University, Menoufia, Egypt
| | - Dalia M ELsabaawy
- Department of Clinical Pharmacy, Faculty of Pharmacy, Menoufia University, Menoufia, Egypt
| | - Sania Ali Yehia
- Department of Epidemiology and Preventive Medicine, National Liver Institute, Menoufia University, Menoufia, Egypt
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6
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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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7
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van Wezenbeek J, Canada JM, Ravindra K, Carbone S, Kadariya D, Trankle CR, Wohlford G, Buckley L, Del Buono MG, Billingsley H, Viscusi M, Tchoukina I, Shah KB, Arena R, Van Tassell B, Abbate A. Determinants of Cardiorespiratory Fitness in Patients with Heart Failure Across a Wide Range of Ejection Fractions. Am J Cardiol 2020; 125:76-81. [PMID: 31703805 DOI: 10.1016/j.amjcard.2019.09.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 09/26/2019] [Accepted: 09/27/2019] [Indexed: 12/23/2022]
Abstract
Impaired cardiorespiratory fitness (CRF) in heart failure (HF) is influenced by a complex array of cardiac and extracardiac factors. The study aimed to identify clinical determinants of CRF measured as peak oxygen consumption (peak VO2) in HF patients, and to determine a peak VO2 prediction model using regression equations. Retrospective analysis of 200 HF patients who completed treadmill cardiopulmonary exercise testing and underwent Doppler echocardiography and/or biomarker analysis on the same day was performed. After univariate linear regression analysis, a multivariate peak VO2 prediction model was developed using significant variables in a stepwise linear regression analysis. In subjects with repeated testing, Pearson's correlation was used to assess correlations between measured and predicted change in peak VO2 (Δpeak VO2) over time. Mean age was 57 years, with 55% being male. Stepwise linear regression was used to generate a weighted model for peak VO2: 30.895 + (-0.112•age[years]) + (0.296•hemoglobin [g/dl]) + (-0.101•E/e'[unit change]) + (-0.202• body mass index [kg/m2]) + (-0.593• N-terminal pro-brain natriuretic peptide [logN pg/ml])) + (-1.349•CRP [log mg/L]). Predicted peak VO2 correlated strongly with measured peak VO2 in HF with reduced ejection fraction and HF with preserved ejection fraction patients (r = +0.63, p <0.001; r = +0.64, p <0.001, respectively). Predicted Δpeak VO2 correlated with measured Δpeak VO2 (r = +0.23, p <0.001). In conclusion, in patients with HF across a wide range of left ventricular ejection fraction, age, systemic inflammation, oxygen carrying capacity, obesity, and elevated filling pressures are the strongest predictors of impaired CRF. The proposed CRF model allows prediction of peak VO2 in HF patients and may be used to estimate peak VO2 changes over time.
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Affiliation(s)
| | - Justin M Canada
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Krishna Ravindra
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Salvatore Carbone
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Dinesh Kadariya
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Cory R Trankle
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - George Wohlford
- Department of Pharmacotherapy and Outcome Sciences, Virginia Commonwealth University, Richmond, Virginia
| | - Leo Buckley
- School of Pharmacy, Brigham and Women's Hospital, Boston, Massachusett
| | | | - Hayley Billingsley
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Michele Viscusi
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Inna Tchoukina
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Keyur B Shah
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, Illinois
| | - Benjamin Van Tassell
- Department of Pharmacotherapy and Outcome Sciences, Virginia Commonwealth University, Richmond, Virginia
| | - Antonio Abbate
- VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia.
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8
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Nabeshima Y, Sakanishi Y, Otani K, Higa Y, Honda M, Otsuji Y, Takeuchi M. Estimation of B-type Natriuretic Peptide Values from N-Terminal proBNP Levels. J UOEH 2020; 42:1-12. [PMID: 32213738 DOI: 10.7888/juoeh.42.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Both brain natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) are established biomarkers that are necessary in the diagnosis and management of heart failure (HF). However, it is difficult to infer BNP concentration from NT-proBNP concentration for a clinician who is familiar with BNP. We investigated whether estimated BNP concentration from NT-proBNP has an equivalent prognostic strength compared with the actual BNP concentration in the prediction of future outcomes. We created a formula for estimating BNP concentration using multivariate analysis in a derivation cohort with known or suspected HF (n = 374). We determined whether the estimated BNP level had a similar prognostic power compared with the actual BNP and NT-proBNP levels in a validation cohort (n = 375). There was a strong correlation between log-transformed BNP and log-transformed NT-proBNP (r = 0.90) in the derivation cohort. We created two types of equation from the derivation cohort. During a median of 1 year of follow up, 49 major adverse cardiac events developed in the validation cohort. Cox proportional analysis revealed that the actual and estimated BNP levels represented equivalent and significant predictors of the future cardiovascular outcome. The estimated BNP levels calculated by our new formula showed a prognostic power similar to the actual BNP levels. This equation will be useful, especially for a physician who is not familiar with NT-proBNP testing.
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Affiliation(s)
- Yosuke Nabeshima
- Second Department of Internal Medicine, University of Occupational and Environmental Health, Japan
- These authors contributed equally to this work
| | - Youko Sakanishi
- Department of Laboratory and Transfusion Medicine, University of Occupational and Environmental Health, Japan
- These authors contributed equally to this work
| | - Kyoko Otani
- Department of Laboratory and Transfusion Medicine, University of Occupational and Environmental Health, Japan
| | - Yukie Higa
- Department of Laboratory and Transfusion Medicine, University of Occupational and Environmental Health, Japan
| | - Masahisa Honda
- Department of Laboratory and Transfusion Medicine, University of Occupational and Environmental Health, Japan
| | - Yutaka Otsuji
- Second Department of Internal Medicine, University of Occupational and Environmental Health, Japan
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, University of Occupational and Environmental Health, Japan
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9
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Abstract
PURPOSE OF REVIEW Cardiac biomarkers play important roles in routine evaluation of cardiac patients. But while these biomarkers can be extremely valuable, none of them should ever be used by themselves-without adding the clinical context. This paper explores the non-cardiac pathologies that can be seen with the cardiac biomarkers most commonly used. RECENT FINDINGS High-sensitivity troponin assay gained FDA approval for use in the USA, and studies demonstrated its diagnostic utility can be extended to patients with renal impairment. Gender-specific cut points may be utilized for high-sensitivity troponin assays. In the realm of the natriuretic peptides, studies demonstrated states of natriuretic peptide deficiency in obesity and in subjects of African-American race. Regardless, BNP and NT-proBNP both retained prognostic utilities across a variety of comorbid conditions. We are rapidly gaining clinical evidence with use of soluble ST2 and procalcitonin levels in management of cardiac disease states. In order to get the most utility from their measurement, one must be aware of non-cardiac pathologies that may affect the levels of biomarkers as although many of these are actually true values, they may not represent the disease we are trying to delineate. A few take-home points are as follows: 1. A biomarker value should never be used without clinical context 2. Serial sampling of biomarkers is often helpful 3. Panels of biomarkers may be valuable.
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10
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Kotecha D, Flather MD, Atar D, Collins P, Pepper J, Jenkins E, Reid CM, Eccleston D. B-type natriuretic peptide trumps other prognostic markers in patients assessed for coronary disease. BMC Med 2019; 17:72. [PMID: 30943979 PMCID: PMC6448253 DOI: 10.1186/s12916-019-1306-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 03/13/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Risk prediction for patients with suspected coronary artery disease is complex due to the common occurrence of prior cardiovascular disease and extensive risk modification in primary care. Numerous markers have the potential to predict prognosis and guide management, but we currently lack robust 'real-world' evidence for their use. METHODS Prospective, multicentre observational study of consecutive patients referred for elective coronary angiography. Clinicians were blinded to all risk assessments, consisting of conventional factors, radial artery pulse wave analysis, 5-minute heart rate variability, high-sensitivity C-reactive protein and B-type natriuretic peptide (BNP). Blinded, independent adjudication was performed for all-cause mortality and the composite of death, myocardial infarction or stroke, analysed with Cox proportional hazards regression. RESULTS Five hundred twenty-two patients were assessed with median age 66 years and 21% prior revascularization. Median baseline left ventricular ejection fraction was 64%, and 62% had ≥ 50% stenosis on angiography. During 5.0 years median follow-up, 30% underwent percutaneous and 16% surgical revascularization. In multivariate analysis, only age and BNP were independently associated with outcomes. The adjusted hazard ratio per log unit increase in BNP was 2.15 for mortality (95% CI 1.45-3.19; p = 0.0001) and 1.27 for composite events (1.04-1.54; p = 0.018). Patients with baseline BNP > 100 pg/mL had substantially higher mortality and composite events (20.9% and 32.2%) than those with BNP ≤ 100 pg/mL (5.6% and 15.5%). BNP improved both classification and discrimination of outcomes (p ≤ 0.003), regardless of left ventricular systolic function. Conversely, high-sensitivity C-reactive protein, pulse wave analysis and heart rate variability were unrelated to prognosis at 5 years after risk modification and treatment of coronary disease. CONCLUSIONS Conventional risk factors and other markers of arterial compliance, inflammation and autonomic function have limited value for prediction of outcomes in risk-modified patients assessed for coronary disease. BNP can independently identify patients with subtle impairment of cardiac function that might benefit from more intensive management. TRIAL REGISTRATION Clinicaltrials.gov, NCT00403351 Registered on 22 November 2006.
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Affiliation(s)
- Dipak Kotecha
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK. .,Monash Centre of Cardiovascular Research and Education in Therapeutics, School of Public Health and Preventive Medicine, Melbourne, Australia.
| | - Marcus D Flather
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Dan Atar
- Department of Cardiology, Oslo University Hospital Ulleval, University of Oslo, Oslo, Norway
| | - Peter Collins
- Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, UK
| | - John Pepper
- Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Christopher M Reid
- Monash Centre of Cardiovascular Research and Education in Therapeutics, School of Public Health and Preventive Medicine, Melbourne, Australia.,Faculty of Health Sciences, School of Public Health, Curtin University, Perth, Australia
| | - David Eccleston
- Monash Centre of Cardiovascular Research and Education in Therapeutics, School of Public Health and Preventive Medicine, Melbourne, Australia
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11
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Affiliation(s)
- Germán Cediel
- Department of Medicine, Heart Institute, Hospital Universitari Germans Trias i Pujol, CIBERCV, Autonomous University of Barcelona, Carretera de Canyet s/n, Barcelona, Spain
| | - Evelyn Santiago-Vacas
- Department of Medicine, Heart Institute, Hospital Universitari Germans Trias i Pujol, CIBERCV, Autonomous University of Barcelona, Carretera de Canyet s/n, Barcelona, Spain
| | - Antoni Bayes-Genis
- Department of Medicine, Heart Institute, Hospital Universitari Germans Trias i Pujol, CIBERCV, Autonomous University of Barcelona, Carretera de Canyet s/n, Barcelona, Spain
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12
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Chua AP, Koo CY, Kristanto W, Parot MVJM, Tan ESJ, Koh EHT, Abd Gani MB, Kojodjojo P, Han TO, Chan SP, Chong JPC, Frampton C, Richards AM, Lee CH. Sleep study-guided multidisciplinary therapy (SGMT) for patients with acute coronary syndrome: Trial rationale and design. Clin Cardiol 2018; 41:721-728. [PMID: 29582447 DOI: 10.1002/clc.22950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 03/20/2018] [Accepted: 03/23/2018] [Indexed: 12/12/2022] Open
Abstract
Obstructive sleep apnea (OSA) is an emerging risk marker for acute coronary syndrome (ACS). This randomized trial aims to determine the effects of sleep study-guided multidisciplinary therapy (SGMT) comprising overnight sleep study, continuous positive airway pressure, and behavioral therapy for OSA during the subacute phase of ACS. We hypothesize that SGMT will reduce (1) the plasma levels of N-terminal pro brain natriuretic peptide and suppression of tumorigenicity 2; (2) the estimated 10-year risk of cardiovascular mortality as measured by the European Systematic Coronary Risk Evaluation (SCORE) algorithm; and (3) the cardiovascular event rate during a 3-year follow-up, compared with standard therapy. In the SGMT trial, 180 patients presenting with ACS will be randomly assigned to SGMT (n = 90) and standard therapy (n = 90) groups. Both groups will receive guideline-mandated treatment for ACS. Those assigned to SGMT will additionally undergo a sleep study and, if OSA is diagnosed, attend a multidisciplinary OSA clinic where they will receive personalized treatment including continuous positive airway pressure and behavioral/lifestyle counseling. The primary endpoint is the plasma N-terminal pro brain natriuretic peptide concentration at 7-month follow-up. This report presents the baseline characteristics of 117 patients (SGMT group: n =54; standard therapy group: n =63) who had been enrolled into the study as of August 31, 2017. The results of this trial will help us to understand whether active OSA diagnosis and treatment will improve the physiologic and clinical cardiovascular outcomes of this group of patients.
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Affiliation(s)
- Ai-Ping Chua
- Division of Respiratory Medicine, Department of Medicine, Ng Teng Fong General Hospital, Singapore
| | - Chieh-Yang Koo
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - William Kristanto
- Division of Cardiology, Department of Medicine, Ng Teng Fong General Hospital, Singapore
| | | | | | | | | | - Pipin Kojodjojo
- Department of Cardiology, National University Heart Centre Singapore, Singapore.,Division of Cardiology, Department of Medicine, Ng Teng Fong General Hospital, Singapore
| | - Tun-Oo Han
- Clinical Research Unit, Ng Teng Fong General Hospital, Singapore
| | - Siew-Pang Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Cardiovascular Research Institute, National University of Singapore, Singapore
| | - Jenny Pek-Ching Chong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Cardiovascular Research Institute, National University of Singapore, Singapore
| | | | - Arthur Mark Richards
- Department of Cardiology, National University Heart Centre Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Cardiovascular Research Institute, National University of Singapore, Singapore.,Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Chi-Hang Lee
- Department of Cardiology, National University Heart Centre Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Cardiovascular Research Institute, National University of Singapore, Singapore
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13
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Abstract
Plasma amino-terminal pro-B-type natriuretic peptide (NT-proBNP) is a guideline-mandated biomarker in heart failure (HF). Used as an inclusion criterion for therapeutic trials, NT-proBNP enriches trial populations and is a valid surrogate endpoint. Its diagnostic performance is best validated in acute decompensated HF (ADHF). NT-proBNP offers prognostic information independent of standard clinical predictors and refines risk stratification. With the advent of combined angiotensin 2 type 1 receptor blockade and neprilysin inhibition (ARNI) NT-proBNP retains its relationship to cardiac status and is the marker of choice in assessment of possible ADHF and in serial monitoring of HF patients receiving ARNI treatment.
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Affiliation(s)
- Arthur Mark Richards
- Cardiovascular Research Institute, National University of Singapore, National University Heart Centre, 1E Kent Ridge Road, NUHS Tower Block 9th Floor (Cardiology), Singapore 129788, Singapore; Christchurch Heart Institute, University of Otago, Riccarton Avenue, Christchurch 8014, New Zealand.
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14
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Chen F, Li JQ, Ou YWX, Xia TL, Huang FY, Chai H, Huang BT, Li Q, Pu XB, Li GY, Peng Y, Chen M, Huang DJ. The impact of renal function on the prognostic value of N-terminal pro-B-type natriuretic peptide in patients with coronary artery disease. Cardiol J 2018; 26:696-703. [PMID: 29611168 DOI: 10.5603/cj.a2018.0031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 02/08/2018] [Accepted: 03/06/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The impact of renal function on the prognostic value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) remains unclear in coronary artery disease (CAD). This study sought to investigate the value of using NT-proBNP level to predict prognoses of CAD patients with different estimated glomerular filtration rates (eGFRs). METHODS A retrospective analysis was conducted from a single registered database. 2087 consecutive patients with CAD confirmed by coronary angiography were enrolled. The primary endpoint was allcause mortality. RESULTS The mean follow-up time was 26.4 ± 11.9 months and death events occurred in 197 cases. The NT-proBNP levels increased with the deterioration of renal function, as well as the optimal cutoff values based on eGFR stratification to predict endpoint outcome (179.4 pg/mL, 1443.0 pg/mL, 3478.0 pg/mL, for eGFR ≥ 90, 60-90 and < 60 mL/min/1.73 m2, respectively). Compared with the routine cut-off value or overall optimal one, stratified optimal ones had superior predictive ability for endpoint in each eGFR group (all with the highest Youden's J statistics). And the prognostic value became weaker as eGFR level decreased (eGFR ≥ 90 vs. 60-90 vs. < 60 mL/min/1.73 m2, odds ratio [OR] 7.7; 95% confidence interval [CI] 1.7-33.9 vs. OR 4.8; 95% CI 2.7-8.5 vs. OR 3.0; 95% CI 1.5-6.2). CONCLUSIONS This study demonstrated that NT-proBNP exhibits different predictive values for prognosis for CAD patients with different levels of renal function. Among the assessed values, the NT-proBNP cut-off value determined using renal function improve the accuracy of the prognosis prediction of CAD. Moreover, lower eGFR is associated with a higher NT-proBNP cut-off value for prognostic prediction.
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Affiliation(s)
- Fei Chen
- West China Hospital of Sichuan University, 37 Guo Xue Xiang, 610041 chengdu, China.
| | - Jia-Qi Li
- West China Hospital of Sichuan University, 37 Guo Xue Xiang, 610041 chengdu, China
| | - Yuan-Wei-Xiang Ou
- West China Hospital of Sichuan University, 37 Guo Xue Xiang, 610041 chengdu, China
| | - Tian-Li Xia
- West China Hospital of Sichuan University, 37 Guo Xue Xiang, 610041 chengdu, China
| | - Fang-Yang Huang
- West China Hospital of Sichuan University, 37 Guo Xue Xiang, 610041 chengdu, China
| | - Hua Chai
- West China Hospital of Sichuan University, 37 Guo Xue Xiang, 610041 chengdu, China
| | - Bao-Tao Huang
- West China Hospital of Sichuan University, 37 Guo Xue Xiang, 610041 chengdu, China
| | - Qiao Li
- West China Hospital of Sichuan University, 37 Guo Xue Xiang, 610041 chengdu, China
| | - Xiao-Bo Pu
- West China Hospital of Sichuan University, 37 Guo Xue Xiang, 610041 chengdu, China
| | - Guo-Yong Li
- West China Hospital of Sichuan University, 37 Guo Xue Xiang, 610041 chengdu, China
| | - Yong Peng
- West China Hospital of Sichuan University, 37 Guo Xue Xiang, 610041 chengdu, China
| | - Mao Chen
- West China Hospital of Sichuan University, 37 Guo Xue Xiang, 610041 chengdu, China
| | - De-Jia Huang
- West China Hospital of Sichuan University, 37 Guo Xue Xiang, 610041 chengdu, China
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15
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Holl MJ, van den Bos EJ, van Domburg RT, Fouraux MA, Kofflard MJ. NT-proBNP is associated with mortality and adverse cardiac events in patients with atrial fibrillation presenting to the emergency department. Clin Cardiol 2018; 41:400-405. [PMID: 29480582 DOI: 10.1002/clc.22883] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 12/22/2017] [Accepted: 12/27/2017] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common cardiac arrhythmia in the emergency department. The CHA2 DS2 -VASc score helps to predict thromboembolic risk; however, the rate of other adverse cardiac events is more difficult to predict. HYPOTHESIS The biomarker N-terminal pro-brain natriuretic peptide (NT-proBNP) has prognostic value in patients presenting to the emergency department with AF. METHODS During a 1.5-year period, a prospective study was performed in consecutive patients presenting to the emergency department with AF on the presenting electrocardiogram. At baseline, NT-proBNP was measured. The primary endpoints were all-cause death and major adverse cardiac events (MACE: all-cause mortality, myocardial infarction, or revascularization). RESULTS A total of 355 patients were included (mean age, 71 years; 55% male). The median duration of follow-up was 2 years. After adjustment for baseline variables, the logNT-proBNP was independently correlated with death (hazard ratio [HR]: 1.54, 95% confidence interval [CI]: 1.18-1.99) and MACE (HR: 1.27, 95% CI: 1.03-1.58). After adjustment for baseline variables, a high NT-proBNP value (>500 pmol/L) was independently correlated with death (HR: 2.26, 95% CI: 1.19-4.28), and for MACE a trend was seen (HR: 1.67, 95% CI: 0.96-2.91) compared with a low value (<250 pmol/L). CONCLUSIONS In patients presenting to the emergency department with AF, higher NT-proBNP values are independently associated with an increased mortality and MACE. Therefore, this biomarker may be a useful prognostic marker in the management and treatment of these patients.
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Affiliation(s)
- Marijn J Holl
- Department of Cardiology, The Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ewout J van den Bos
- Department of Cardiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Ron T van Domburg
- Department of Cardiology, The Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Michael A Fouraux
- Department of Clinical Chemistry, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Marcel J Kofflard
- Department of Cardiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
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16
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Abstract
PURPOSE OF REVIEW Recognition of subclinical myocardial dysfunction offers clinicians and patients an opportunity for early intervention and prevention of symptomatic cardiovascular disease. We review the data on novel biomarkers in subclinical heart disease in the general population with a focus on pathophysiology, recent observational or trial data, and potential applicability and pitfalls for clinical use. RECENT FINDINGS High-sensitivity cardiac troponin and natriuretic peptide assays are powerful markers of subclinical cardiac disease. Elevated levels of these biomarkers signify subclinical cardiac injury and hemodynamic stress and portend an adverse prognosis. Novel biomarkers of myocardial inflammation, fibrosis, and abnormal contraction are gaining momentum as predictors for incident heart failure, providing new insight into pathophysiologic mechanisms of cardiac disease. There has been exciting growth in both traditional and novel biomarkers of subclinical cardiac injury in recent years. Many biomarkers have demonstrated associations with relevant cardiovascular outcomes and may enhance the diagnostic and prognostic power of more conventional biomarkers. However, their use in "prime time" to identify patients with or at risk for subclinical cardiac dysfunction in the general population remains an open question. Strategic investigation into their clinical applicability in the context of clinical trials remains an area of ongoing investigation.
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Affiliation(s)
- Kamal Shemisa
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8830, USA
| | - Anish Bhatt
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8830, USA
| | - Daniel Cheeran
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8830, USA
| | - Ian J Neeland
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8830, USA.
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17
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Pre-procedural peripheral endothelial function is associated with increased serum creatinine following percutaneous coronary procedure in stable patients with a preserved estimated glomerular filtration rate. J Cardiol 2017; 70:461-469. [PMID: 28408073 DOI: 10.1016/j.jjcc.2017.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 03/11/2017] [Accepted: 03/14/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND Worsening renal function, indicated by increased serum creatinine (SCr), is a common complication of percutaneous coronary procedures. Risk factors for increased SCr overlap with coronary risk factors involved in endothelial dysfunction. We hypothesized that endothelial dysfunction, measured using the reactive hyperemia peripheral arterial tonometry index (RHI), can predict periprocedure-increased SCr. METHODS RHI was assessed before elective coronary procedures in 316 consecutive stable patients with a preserved estimated glomerular filtration rate (eGFR, >60mL/min/1.73m2). SCr was measured before and 2 days after procedures. RESULTS There was no significant correlation between natural logarithmic transformations of RHI (Ln-RHI) and basal Ln-eGFR. Periprocedure increase in SCr was observed in 148 (47%) patients. The increased SCr group had significantly lower Ln-RHI [0.48 (0.36, 0.62) vs. 0.59 (0.49, 0.76), p<0.001]. Multivariate linear regression analysis identified body mass index (BMI) (β=0.148, p=0.005) and Ln-RHI (β=-0.365, p<0.001) as significant determinants of percent changes in SCr. Multivariate logistic regression analysis identified Ln-RHI (per 0.1) [odds ratio (OR) 0.672, 95% confidence interval (95% CI) 0.586-0.722; p<0.001], Ln-B-type natriuretic peptide (OR: 1.484, 95% CI: 1.130-1.974; p=0.004), current smoking (OR: 2.563, 95% CI: 1.379-4.763, p=0.003), BMI (OR: 1.113, 95% CI: 1.031-1.203; p=0.007), coronary intervention (OR: 1.736, 95% CI: 1.036-2.909; p=0.036), and Ln-hemoglobin A1c (OR: 6.728, 95% CI: 1.093-41.392, p=0.040) as independent determinants of increased SCr. Receiver-operating characteristics curve analysis showed that Ln-RHI correlated significantly with increased SCr (area under the curve, 0.684, 95% CI: 0.626-0.742, p<0.001). The optimum cut-off point of Ln-RHI for the periprocedure increased SCr was 0.545. CONCLUSIONS Pre-procedure measurement of endothelial function by RHI is an effective strategy to assess the patient's risk conditions for worsening renal function after percutaneous coronary procedures.
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18
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Hammerer-Lercher A, Collinson PO, Suvisaari J, Christenson RH, Pulkki K, van Dieijen-Visser MP, Duff CJ, Baum H, Stavljenic-Rukavina A, Aakre KM, Langlois MR, Stankovic S, Laitinen P. Are Heart Failure Management Recommendations and Guidelines Followed in Laboratory Medicine in Europe and North America? The Cardiac Marker Guideline Uptake in Europe (CARMAGUE) Study. ACTA ACUST UNITED AC 2017; 1:483-493. [DOI: 10.1373/jalm.2016.021345] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 10/04/2016] [Indexed: 11/06/2022]
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19
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Radosavljevic-Radovanovic M, Radovanovic N, Vasiljevic Z, Marinkovic J, Mitrovic P, Mrdovic I, Stankovic S, Kružliak P, Beleslin B, Uscumlic A, Kostic J. Usefulness of NT-proBNP in the Follow-Up of Patients after Myocardial Infarction. J Med Biochem 2016; 35:158-165. [PMID: 28356876 PMCID: PMC5346793 DOI: 10.1515/jomb-2016-0003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 12/08/2015] [Indexed: 12/31/2022] Open
Abstract
Background Since serial analyses of NT-proBNP in patients with acute coronary syndromes have shown that levels measured during a chronic, later phase are a better predictor of prognosis and indicator of left ventricular function than the levels measured during an acute phase, we sought to assess the association of NT-proBNP, measured 6 months after acute myocardial infarction (AMI), with traditional risk factors, characteristics of in-hospital and early postinfarction course, as well as its prognostic value and optimal cut-points in the ensuing 1-year follow-up. Methods Fasting venous blood samples were drawn from 100 ambulatory patients and NT-proBNP concentrations in lithium-heparin plasma were determined using a one-step enzyme immunoassay based on the »sandwich« principle on a Dimension RxL clinical chemistry system (DADE Behring-Siemens). Patients were followed-up for the next 1 year, for the occurrence of new cardiac events. Results Median (IQR) level of NT-proBNP was 521 (335–1095) pg/mL. Highest values were mostly associated with cardiac events during the first 6 months after AMI. Negative association with reperfusion therapy for index infarction confirmed its long-term beneficial effect. In the next one-year follow-up of stable patients, multivariate Cox regression analysis revealed the independent prognostic value of NT-proBNP for new-onset heart failure prediction (p=0.014), as well as for new coronary events prediction (p=0.035). Calculation of the AUCs revealed the optimal NT-proBNP cut-points of 800 pg/mL and 516 pg/mL, respectively. Conclusions NT-proBNP values 6 months after AMI are mainly associated with the characteristics of early infarction and postinfarction course and can predict new cardiac events in the next one-year follow-up.
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Affiliation(s)
| | - Nebojsa Radovanovic
- Cardiology Clinic, Clinical Center of Serbia and Medical School, University of Belgrade
| | - Zorana Vasiljevic
- Cardiology Clinic, Clinical Center of Serbia and Medical School, University of Belgrade
| | - Jelena Marinkovic
- Institute of Statistics, Medical School, University of Belgrade, Belgrade, Serbia
| | - Predrag Mitrovic
- Cardiology Clinic, Clinical Center of Serbia and Medical School, University of Belgrade
| | - Igor Mrdovic
- Cardiology Clinic, Clinical Center of Serbia and Medical School, University of Belgrade
| | - Sanja Stankovic
- Centre of Medical Biochemistry, Clinical Center of Serbia, Belgrade, Serbia
| | - Peter Kružliak
- International Clinical Research Center, St Anne's University Hospital, Brno, Czech Republic
| | - Branko Beleslin
- Cardiology Clinic, Clinical Center of Serbia and Medical School, University of Belgrade
| | - Ana Uscumlic
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - Jelena Kostic
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
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Malhotra AK, Ramakrishna H. N-terminal pro B type natriuretic peptide in high cardiovascular-risk patients for noncardiac surgery: What is the current prognostic evidence? Ann Card Anaesth 2016; 19:314-20. [PMID: 27052075 PMCID: PMC4900342 DOI: 10.4103/0971-9784.179636] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
As millions of surgical procedures are performed worldwide on an aging population with multiple comorbidities, accurate and simple perioperative risk stratification is critical. The cardiac biomarker, brain natriuretic peptide (BNP), has generated considerable interest as it is easy to obtain and appears to have powerful predictive and prognostic capabilities. BNP is currently being used to guide medical therapy for heart failure and has been added to several algorithms for perioperative risk stratification. This review examines the current evidence for the use of BNP in the perioperative period in patients who are at high-cardiovascular risk for noncardiac surgery. In addition, we examined the use of BNP in patients with pulmonary embolism and left ventricular assist devices. The available data strongly suggest that the addition of BNP to perioperative risk calculators is beneficial; however, whether this determination of risk will impact outcomes, remains to be seen.
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Affiliation(s)
- Anita K Malhotra
- Department of Anesthesiology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
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21
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Plasma B-type natriuretic peptide concentration is independently associated with kidney function decline in Japanese patients with chronic kidney disease. J Hypertens 2016; 34:753-61. [DOI: 10.1097/hjh.0000000000000847] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Richards AM. Biomarkers in Acute Heart Failure - Cardiac And Kidney. Card Fail Rev 2015; 1:107-111. [PMID: 28785442 PMCID: PMC5490877 DOI: 10.15420/cfr.2015.1.2.107] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 08/11/2015] [Indexed: 01/30/2023] Open
Abstract
Natriuretic peptides (NP) are well-validated aids in the diagnosis of acute decompensated heart failure (ADHF). In acute presentations, both brain natriuretic peptide (BNP) and N-terminal of the prohormone brain natriuretic peptide (NT-proBNP) offer high sensitivity (>90 %) and negative predictive values (>95 %) for ruling out ADHF at thresholds of 100 and 300 pg/ml, respectively. Plasma NP rise with age. For added rule-in performance age-adjusted thresholds (450 pg/ml for under 50 years, 900 pg/ml for 50-75 years and 1,800 pg/ml for those >75 years) can be applied to NT-proBNP results. Test performance (specificity and accuracy but not sensitivity) is clearly reduced by renal dysfunction and atrial fibrillation. Obesity offsets the threshold downwards (to ~50 pg/ml for BNP), but overall discrimination is preserved. Reliable markers for impending acute kidney injury in ADHF constitute an unmet need, with candidates, such as kidney injury molecule-1 and neutrophil gelatinase-associated lipocalin, failing to perform sufficiently well, and new possibilities, including the cell cycle markers insulin growth factor binding protein 7 and tissue inhibitor of metalloproteinases type 2, remain the subject of research.
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Affiliation(s)
- A Mark Richards
- Christchurch Heart Institute, University of Otago,Christchurch, New Zealand
- Cardiovascular Research Institute,National University of Singapore, Singapore
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23
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Lee J, Young J, Frampton C, Aldous S, Troughton R, Than M, Richards A, Pemberton C. A novel troponin T peptide in humans: Assay, biochemistry and preliminary findings in acute coronary syndromes. Int J Cardiol 2015; 190:68-74. [DOI: 10.1016/j.ijcard.2015.04.145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 03/17/2015] [Accepted: 04/16/2015] [Indexed: 10/23/2022]
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Lee J, Than M, Aldous S, Troughton R, Richards M, Pemberton CJ. CNP Signal Peptide in Patients with Cardiovascular Disease. Front Cardiovasc Med 2015; 2:28. [PMID: 26664899 PMCID: PMC4671342 DOI: 10.3389/fcvm.2015.00028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 05/30/2015] [Indexed: 11/30/2022] Open
Abstract
We have previously reported that signal peptide fragments of C-type natriuretic peptide (CNP) are present in the human circulation. Here, we provide the first preliminary assessment of the potential utility of CNP signal peptide (CNPsp) measurement in acute cardiovascular disease. Utilizing our specific and sensitive immunoassay, we assessed the potential of CNPsp measurement to assist in the identification of acute coronary syndromes in 494 patients presenting consecutively with chest pain. The diagnostic and prognostic potential of CNPsp were assessed in conjunction with a contemporary clinical troponin I assay, an investigational highly sensitive troponin T assay and NT-proBNP measurement. Utility was assessed via receiver operator curve characteristic analysis. CNPsp did not identify patients with myocardial infarction (MI) or those with unstable angina, nor did it assist the diagnostic ability of clinical or investigational troponin measurement. CNPsp levels were significantly elevated in patients presenting with atrial fibrillation (P < 0.05) and were significantly lower in those with a history of previous MI (P < 0.05). CNPsp could identify those at risk of mortality within 1 year (P < 0.05) and also could identify those at risk of death or re-infarction within 1 year (P < 0.01). This is the first exploratory report describing the potential of CNPsp measurement in acute cardiovascular disease. While CNPsp does not have utility in acute diagnosis, it may have potential in assisting risk prognosis with respect to mortality and re-infarction.
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Affiliation(s)
- Jacqui Lee
- Department of Medicine, Christchurch Heart Institute, University of Otago , Christchurch , New Zealand
| | - Martin Than
- Department of Medicine, Christchurch Heart Institute, University of Otago , Christchurch , New Zealand
| | - Sally Aldous
- Department of Medicine, Christchurch Heart Institute, University of Otago , Christchurch , New Zealand
| | - Richard Troughton
- Department of Medicine, Christchurch Heart Institute, University of Otago , Christchurch , New Zealand
| | - Mark Richards
- Department of Medicine, Christchurch Heart Institute, University of Otago , Christchurch , New Zealand
| | - Chris J Pemberton
- Department of Medicine, Christchurch Heart Institute, University of Otago , Christchurch , New Zealand
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Gupta DK, Claggett B, Wells Q, Cheng S, Li M, Maruthur N, Selvin E, Coresh J, Konety S, Butler KR, Mosley T, Boerwinkle E, Hoogeveen R, Ballantyne CM, Solomon SD. Racial differences in circulating natriuretic peptide levels: the atherosclerosis risk in communities study. J Am Heart Assoc 2015; 4:JAHA.115.001831. [PMID: 25999400 PMCID: PMC4599412 DOI: 10.1161/jaha.115.001831] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Natriuretic peptides promote natriuresis, diuresis, and vasodilation. Experimental deficiency of natriuretic peptides leads to hypertension (HTN) and cardiac hypertrophy, conditions more common among African Americans. Hospital-based studies suggest that African Americans may have reduced circulating natriuretic peptides, as compared to Caucasians, but definitive data from community-based cohorts are lacking. Methods and Results We examined plasma N-terminal pro B-type natriuretic peptide (NTproBNP) levels according to race in 9137 Atherosclerosis Risk in Communities (ARIC) Study participants (22% African American) without prevalent cardiovascular disease at visit 4 (1996–1998). Multivariable linear and logistic regression analyses were performed adjusting for clinical covariates. Among African Americans, percent European ancestry was determined from genetic ancestry informative markers and then examined in relation to NTproBNP levels in multivariable linear regression analysis. NTproBNP levels were significantly lower in African Americans (median, 43 pg/mL; interquartile range [IQR], 18, 88) than Caucasians (median, 68 pg/mL; IQR, 36, 124; P<0.0001). In multivariable models, adjusted log NTproBNP levels were 40% lower (95% confidence interval [CI], −43, −36) in African Americans, compared to Caucasians, which was consistent across subgroups of age, gender, HTN, diabetes, insulin resistance, and obesity. African-American race was also significantly associated with having nondetectable NTproBNP (adjusted OR, 5.74; 95% CI, 4.22, 7.80). In multivariable analyses in African Americans, a 10% increase in genetic European ancestry was associated with a 7% (95% CI, 1, 13) increase in adjusted log NTproBNP. Conclusions African Americans have lower levels of plasma NTproBNP than Caucasians, which may be partially owing to genetic variation. Low natriuretic peptide levels in African Americans may contribute to the greater risk for HTN and its sequalae in this population.
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Affiliation(s)
- Deepak K Gupta
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN (D.K.G., Q.W.)
| | - Brian Claggett
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA (B.C., S.C., S.D.S.)
| | - Quinn Wells
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN (D.K.G., Q.W.)
| | - Susan Cheng
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA (B.C., S.C., S.D.S.)
| | - Man Li
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD (M.L., E.S., J.C.)
| | - Nisa Maruthur
- Department of Medicine, Johns Hopkins University, Baltimore, MD (N.M., E.S.)
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD (M.L., E.S., J.C.) Department of Medicine, Johns Hopkins University, Baltimore, MD (N.M., E.S.)
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD (M.L., E.S., J.C.)
| | - Suma Konety
- Division of General Internal Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN (S.K.)
| | - Kenneth R Butler
- Division of Geriatrics, Department of Medicine, University of Mississippi, Jackson, MS (K.R.B., T.M.)
| | - Thomas Mosley
- Division of Geriatrics, Department of Medicine, University of Mississippi, Jackson, MS (K.R.B., T.M.)
| | - Eric Boerwinkle
- Division of Epidemiology and Public Health, University of Texas-Houston, Houston, TX (E.B.)
| | - Ron Hoogeveen
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine and Houston Methodist Debakey Heart and Vascular Center, Houston, TX (R.H., C.M.B.)
| | - Christie M Ballantyne
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine and Houston Methodist Debakey Heart and Vascular Center, Houston, TX (R.H., C.M.B.)
| | - Scott D Solomon
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA (B.C., S.C., S.D.S.)
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Kim MS, Jeong TD, Han SB, Min WK, Kim JJ. Role of Soluble ST2 as a Prognostic Marker in Patients with Acute Heart Failure and Renal Insufficiency. J Korean Med Sci 2015; 30:569-75. [PMID: 25931787 PMCID: PMC4414640 DOI: 10.3346/jkms.2015.30.5.569] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 12/29/2014] [Indexed: 01/06/2023] Open
Abstract
This study sought to assess the relationship between serum concentrations of the soluble ST2 (sST2) and B-type natriuretic peptide (BNP) and investigate the role of sST2 as a prognosticator in patients hospitalized with acute heart failure (HF) and renal insufficiency. sST2 was measured at admission and discharge in 66 patients hospitalized with acute decompensated HF and renal insufficiency (estimated glomerular filtration rate [eGFR] < 90 mL/min/1.73 m(2)) using a high sensitivity immunoassay. BNP was sampled at the same time and compared to sST2. Demographical, biochemical, and echocardiographic data were also obtained during hospitalization.There were positive correlations between sST2 and BNP levels at admission (r = 0.330, P = 0.007) and at discharge (r = 0.320, P = 0.009) in overall patients. However, there was no correlation between them at each timepoint in patients with severe renal insufficiency (eGFR < 30 mL/min/1.73 m(2), n = 17). sST2 level was not changed with the degree of renal function, even though BNP level was much higher in patients with severe renal insufficiency. During 3 month follow-up, 9 (13.6%) died and 16 (24.2%) were readmitted due to HF aggravation.On multivariate analysis, sST2 at discharge was independently associated with death or HF readmission during 3 months after discharge (hazard ratio, 1.038; 95% confidence interval, 1.011-1.066, P = 0.006). In conclusion, sST2 is not affected by renal function compared with BNP in acute HF patients. The measurement of predischarge sST2 can be helpful in predicting short-term outcomes in acute decompensated HF patients with renal insufficiency.
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Affiliation(s)
- Min-Seok Kim
- Asan Medical Center Heart Institute, Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Dong Jeong
- Department of Laboratory Medicine, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Bong Han
- Department of Applied Statistics, Gachon University, Seongnam, Korea
| | - Won-Ki Min
- Department of Laboratory Medicine, Asan Medical Center and University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Joong Kim
- Asan Medical Center Heart Institute, Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea
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Dallmeier D, Pencina MJ, Rajman I, Koenig W, Rothenbacher D, Brenner H. Serial measurements of N-terminal pro-brain natriuretic peptide in patients with coronary heart disease. PLoS One 2015; 10:e0117143. [PMID: 25629613 PMCID: PMC4309398 DOI: 10.1371/journal.pone.0117143] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 11/20/2014] [Indexed: 11/27/2022] Open
Abstract
Objective To assess the prognostic value of 12-months N-Terminal Pro-Brain Natriuretic Peptide (NT-proBNP) levels on adverse cardiovascular events in patients with stable coronary heart disease. Methods NT-proBNP concentrations were measured at baseline and at 12-months follow-up in participants of cardiac rehabilitation (median follow-up 8.96 years). Cox-proportional hazards models evaluated the prognostic value of log-transformed NT-proBNP levels, and of 12-months NT-proBNP relative changes on adverse cardiovascular events adjusting for established risk factors measured at baseline. Results Among 798 participants (84.7% men, mean age 59 years) there were 114 adverse cardiovascular events. 12-months NT-proBNP levels were higher than baseline levels in 60 patients (7.5%) and numerically more strongly associated with the outcome in multivariable analysis (HR 1.65 [95% CI 1.33–2.05] vs. HR 1.41 [95% CI 1.12–1.78], with a net reclassification improvement (NRI) of 0.098 [95% CI 0.002–0.194] compared to NRI of 0.047 [95% CI −0.0004–0.133] for baseline NT-proBNP levels. A 12-month 10% increment of NT-proBNP was associated with a HR of 1.35 [95% CI 1.12–1.63] for the onset of an adverse cardiovascular event. Subjects with a 12-month increment of NT-proBNP had a HR of 2.56 [95% CI 1.10–5.95] compared to those with the highest 12-months reduction. Conclusions Twelve-months NT-proBNP levels after an acute cardiovascular event are strongly associated with a subsequent event and may provide numerically better reclassification of patients at risk for an adverse cardiovascular event compared to NT-proBNP baseline levels after adjustment for established risk factors.
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Affiliation(s)
- Dhayana Dallmeier
- University of Ulm Medical Center, Department of Internal Medicine II-Cardiology, Ulm, Germany
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States of America
- Ulm University, Institute of Epidemiology and Medical Biometry, Ulm, Germany
| | - Michael J. Pencina
- Duke Clinical Research Institute, Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, United States of America
| | - Iris Rajman
- Novartis Institute of Biomedical Research, Basel, Switzerland
| | - Wolfgang Koenig
- University of Ulm Medical Center, Department of Internal Medicine II-Cardiology, Ulm, Germany
- * E-mail:
| | | | - Hermann Brenner
- German Cancer Research Center, Division of Clinical Epidemiology & Aging Research, Heidelberg, Germany
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Mishra RK, Beatty AL, Jaganath R, Regan M, Wu AHB, Whooley MA. B-type natriuretic peptides for the prediction of cardiovascular events in patients with stable coronary heart disease: the Heart and Soul Study. J Am Heart Assoc 2014; 3:jah3626. [PMID: 25053234 PMCID: PMC4310375 DOI: 10.1161/jaha.114.000907] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Brain‐type natriuretic peptide (BNP) and the amino‐terminal fragment of its prohormone (NT‐proBNP) are known predictors of cardiovascular outcomes in patients with coronary heart disease; however, the relative prognostic value of these 2 biomarkers for secondary events remains unclear. Methods and Results In 983 participants with stable coronary heart disease, we evaluated the association of BNP and NT‐proBNP with time to hospitalization for heart failure, nonfatal myocardial infarction, stroke or transient ischemic attack, cardiovascular death, and combined major adverse cardiovascular events (MACE). During an average follow‐up of 6.5±3.3 years, both BNP and NT‐proBNP were associated with increased risk of MACE in a multivariable‐adjusted model (hazard ratio per standard deviation of log BNP: 1.58; 95% CI: 1.32 to 1.89; hazard ratio per standard deviation of log NT‐proBNP: 1.84; 95% CI: 1.52 to 2.24). When added to traditional risk factors, NT‐proBNP predicted MACE better than BNP (C statistic: 0.76 versus 0.72, P<0.001). Similarly, the addition of NT‐proBNP resulted in a greater net reclassification improvement for predicting MACE than the addition of BNP (65% for NT‐proBNP, 56% for BNP). Conclusions Both BNP and NT‐proBNP were significant predictors of MACE in stable coronary heart disease; however, NT‐proBNP was superior to BNP for net risk reclassification for MACE.
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Affiliation(s)
- Rakesh K Mishra
- Department of Medicine, University of California, San Francisco, California (R.K.M., A.L.B., R.J., M.A.W.) San Francisco Veterans Affairs Medical Center, San Francisco, California (R.K.M., M.R., M.A.W.)
| | - Alexis L Beatty
- Department of Medicine, University of California, San Francisco, California (R.K.M., A.L.B., R.J., M.A.W.)
| | - Rajesh Jaganath
- Department of Medicine, University of California, San Francisco, California (R.K.M., A.L.B., R.J., M.A.W.)
| | - Mathilda Regan
- San Francisco Veterans Affairs Medical Center, San Francisco, California (R.K.M., M.R., M.A.W.)
| | - Alan H B Wu
- Departments of Pathology & Laboratory Medicine, University of California, San Francisco, California (A.H.W.)
| | - Mary A Whooley
- Department of Medicine, University of California, San Francisco, California (R.K.M., A.L.B., R.J., M.A.W.) San Francisco Veterans Affairs Medical Center, San Francisco, California (R.K.M., M.R., M.A.W.)
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29
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Sinner MF, Stepas KA, Moser CB, Krijthe BP, Aspelund T, Sotoodehnia N, Fontes JD, Janssens ACJW, Kronmal RA, Magnani JW, Witteman JC, Chamberlain AM, Lubitz SA, Schnabel RB, Vasan RS, Wang TJ, Agarwal SK, McManus DD, Franco OH, Yin X, Larson MG, Burke GL, Launer LJ, Hofman A, Levy D, Gottdiener JS, Kääb S, Couper D, Harris TB, Astor BC, Ballantyne CM, Hoogeveen RC, Arai AE, Soliman EZ, Ellinor PT, Stricker BHC, Gudnason V, Heckbert SR, Pencina MJ, Benjamin EJ, Alonso A. B-type natriuretic peptide and C-reactive protein in the prediction of atrial fibrillation risk: the CHARGE-AF Consortium of community-based cohort studies. Europace 2014; 16:1426-33. [PMID: 25037055 DOI: 10.1093/europace/euu175] [Citation(s) in RCA: 139] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
AIMS B-type natriuretic peptide (BNP) and C-reactive protein (CRP) predict atrial fibrillation (AF) risk. However, their risk stratification abilities in the broad community remain uncertain. We sought to improve risk stratification for AF using biomarker information. METHODS AND RESULTS We ascertained AF incidence in 18 556 Whites and African Americans from the Atherosclerosis Risk in Communities Study (ARIC, n=10 675), Cardiovascular Health Study (CHS, n = 5043), and Framingham Heart Study (FHS, n = 2838), followed for 5 years (prediction horizon). We added BNP (ARIC/CHS: N-terminal pro-B-type natriuretic peptide; FHS: BNP), CRP, or both to a previously reported AF risk score, and assessed model calibration and predictive ability [C-statistic, integrated discrimination improvement (IDI), and net reclassification improvement (NRI)]. We replicated models in two independent European cohorts: Age, Gene/Environment Susceptibility Reykjavik Study (AGES), n = 4467; Rotterdam Study (RS), n = 3203. B-type natriuretic peptide and CRP were significantly associated with AF incidence (n = 1186): hazard ratio per 1-SD ln-transformed biomarker 1.66 [95% confidence interval (CI), 1.56-1.76], P < 0.0001 and 1.18 (95% CI, 1.11-1.25), P < 0.0001, respectively. Model calibration was sufficient (BNP, χ(2) = 17.0; CRP, χ(2) = 10.5; BNP and CRP, χ(2) = 13.1). B-type natriuretic peptide improved the C-statistic from 0.765 to 0.790, yielded an IDI of 0.027 (95% CI, 0.022-0.032), a relative IDI of 41.5%, and a continuous NRI of 0.389 (95% CI, 0.322-0.455). The predictive ability of CRP was limited (C-statistic increment 0.003). B-type natriuretic peptide consistently improved prediction in AGES and RS. CONCLUSION B-type natriuretic peptide, not CRP, substantially improved AF risk prediction beyond clinical factors in an independently replicated, heterogeneous population. B-type natriuretic peptide may serve as a benchmark to evaluate novel putative AF risk biomarkers.
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Affiliation(s)
- Moritz F Sinner
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University, 81377 Munich, Germany
| | - Katherine A Stepas
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA
| | - Carlee B Moser
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA
| | - Bouwe P Krijthe
- Department of Epidemiology, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands Netherlands Consortium for Healthy Aging (NCHA), 2300 RC Leiden, The Netherlands
| | - Thor Aspelund
- Icelandic Heart Association, Research Institute, IS-201 Kopavogur, Iceland The University of Iceland, IS-101 Reykjavik, Iceland
| | - Nona Sotoodehnia
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA 98195, USA Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA 98101, USA
| | - João D Fontes
- National Heart Lung and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA 01702, USA
| | - A Cecile J W Janssens
- Department of Epidemiology, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands Netherlands Consortium for Healthy Aging (NCHA), 2300 RC Leiden, The Netherlands
| | - Richard A Kronmal
- Department of Biostatistics, University of Washington, Seattle, WA 98195, USA
| | - Jared W Magnani
- National Heart Lung and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA 01702, USA Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA
| | - Jacqueline C Witteman
- Department of Epidemiology, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands Netherlands Consortium for Healthy Aging (NCHA), 2300 RC Leiden, The Netherlands
| | | | - Steven A Lubitz
- Cardiovascular Research Center, Massachusetts General Hospital, Charlestown, MA 02129, USA Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Renate B Schnabel
- Department of General and Interventional Cardiology, University Heart Center, 20246 Hamburg-Eppendorf, Germany
| | - Ramachandran S Vasan
- National Heart Lung and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA 01702, USA Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
| | - Thomas J Wang
- National Heart Lung and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA 01702, USA Cardiology Division, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Sunil K Agarwal
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA
| | - David D McManus
- National Heart Lung and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA 01702, USA Departments of Medicine and Quantitative Health Sciences, University of Massachusetts, Worcester, MA 01605, USA Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA 01609, USA
| | - Oscar H Franco
- Department of Epidemiology, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands
| | - Xiaoyan Yin
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA National Heart Lung and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA 01702, USA
| | - Martin G Larson
- National Heart Lung and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA 01702, USA
| | - Gregory L Burke
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Lenore J Launer
- Laboratory of Epidemiology, Demography, and Biometry, National Institute of Aging, National Institutes of Health, Bethesda, MD 20892, USA
| | - Albert Hofman
- Department of Epidemiology, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands Netherlands Consortium for Healthy Aging (NCHA), 2300 RC Leiden, The Netherlands
| | - Daniel Levy
- National Heart Lung and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA 01702, USA Center for Population Studies, NHLBI, Framingham, MA 01702, USA
| | - John S Gottdiener
- Division of Cardiology, University of Maryland Medical Center, Baltimore, MD 21201, USA
| | - Stefan Kääb
- Department of Medicine I, University Hospital Munich, Ludwig-Maximilians University, 81377 Munich, Germany Deutsches Zentrum für Herz-Kreislauferkrankungen (DZHK), partner site Munich Heart Alliance, 80802 Munich, Germany
| | - David Couper
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Tamara B Harris
- Laboratory of Epidemiology, Demography, and Biometry, National Institute of Aging, National Institutes of Health, Bethesda, MD 20892, USA
| | - Brad C Astor
- University of Wisconsin, School of Medicine and Public Health, Madison, WI 53705, USA
| | - Christie M Ballantyne
- Baylor College of Medicine, Houston, TX 77030, USA Methodist DeBakey Heart and Vascular Center, Houston, TX 77030, USA
| | | | - Andrew E Arai
- Cardiovascular and Pulmonary Branch, NHLBI, Bethesda, MD 20892, USA
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center (EPICARE), Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Patrick T Ellinor
- Cardiovascular Research Center, Massachusetts General Hospital, Charlestown, MA 02129, USA Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Bruno H C Stricker
- Department of Epidemiology, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands Netherlands Consortium for Healthy Aging (NCHA), 2300 RC Leiden, The Netherlands Department of Internal Medicine, Erasmus Medical Center, 3000 CA Rotterdam, The Netherlands Inspectorate for Health Care, 3500 GR The Hague, The Netherlands Department of Medical Informatics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Vilmundur Gudnason
- Icelandic Heart Association, Research Institute, IS-201 Kopavogur, Iceland The University of Iceland, IS-101 Reykjavik, Iceland
| | - Susan R Heckbert
- Department of Epidemiology, University of Washington, Seattle, WA 98195, USA
| | - Michael J Pencina
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA
| | - Emelia J Benjamin
- National Heart Lung and Blood Institute's and Boston University's Framingham Heart Study, Framingham, MA 01702, USA Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
| | - Alvaro Alonso
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55454, USA
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Pizzolo F, Zorzi F, Chiecchi L, Consoli L, Aprili I, Guarini P, Castagna A, Salvagno GL, Pavan C, Olivieri O. NT-proBNP, a useful tool in hypertensive patients undergoing a diagnostic evaluation for primary aldosteronism. Endocrine 2014; 45:479-86. [PMID: 23943252 DOI: 10.1007/s12020-013-0028-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 07/30/2013] [Indexed: 11/24/2022]
Abstract
Primary aldosteronism (PA) is the most frequent form of secondary hypertension, but diagnostic tools for this disease still lack optimal accuracy. The heart is one important target tissue for damage due to excess aldosterone, and the role of natriuretic peptides is well recognized in diagnosing heart failure. We hypothesized that measuring the NT-proBNP could improve the diagnostic evaluation of PA. We enrolled 132 hypertensive patients, who underwent aldosterone to renin ratio (ARR) screening, and 81 underwent an intravenous saline loading test (ivSLT) because of a high ARR. The NT-proBNP level positively correlated with the ARR and inversely correlated with the renin level. The NT-proBNP level was higher in patients with a high ARR than in those with a low ARR and higher in patients with a positive ivSLT than in those with a negative ivSLT. After logistic regression analysis, an NT-proBNP value above the median and male gender were predictors of a positive ivSLT. The proportion of patients with a positive ivSLT ranged from only 23 % in females with a low NT-proBNP to 93 % in males with a high NT-proBNP. NT-proBNP and gender are predictors of a positive PA confirmatory test. These findings highlight the possibility of using NT-proBNP to identify which patients with a high ARR should receive a complete PA diagnostic evaluation.
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Affiliation(s)
- Francesca Pizzolo
- Division of Internal Medicine, Department of Medicine, University of Verona, pzz.le Scuro, 37134, Verona, Italy,
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May A, Wang TJ. Evaluating the role of biomarkers for cardiovascular risk prediction: focus on CRP, BNP and urinary microalbumin. Expert Rev Mol Diagn 2014; 7:793-804. [DOI: 10.1586/14737159.7.6.793] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Omland T. B-type natriuretic peptides: prognostic markers in stable coronary artery disease. Expert Rev Mol Diagn 2014; 8:217-25. [DOI: 10.1586/14737159.8.2.217] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ahluwalia N, Blacher J, Szabo de Edelenyi F, Faure P, Julia C, Hercberg S, Galan P. Prognostic value of multiple emerging biomarkers in cardiovascular risk prediction in patients with stable cardiovascular disease. Atherosclerosis 2013; 228:478-84. [DOI: 10.1016/j.atherosclerosis.2013.03.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 02/13/2013] [Accepted: 03/11/2013] [Indexed: 11/28/2022]
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Fu S, Luo L, Ye P, Yi S, Liu Y, Zhu B, Wang L, Xiao T, Bai Y. The ability of NT-proBNP to detect chronic heart failure and predict all-cause mortality is higher in elderly Chinese coronary artery disease patients with chronic kidney disease. Clin Interv Aging 2013; 8:409-17. [PMID: 23723693 PMCID: PMC3665499 DOI: 10.2147/cia.s42700] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Objective To analyze the relationship between N-terminal pro-brain natriuretic peptide (NT-proBNP) and renal function, and compare the ability and cut-off thresholds of NT-proBNP to detect chronic heart failure (CHF) and predict mortality in elderly Chinese coronary artery disease (CAD) patients with and without chronic kidney disease (CKD). Methods The study included 999 CAD patients older than 60 years. The endpoint was all-cause mortality over a mean follow-up period of 417 days. Results The median age was 86 years (range: 60–104 years), and the median NT-proBNP level was 409.8 pg/mL. CKD was present in 358 patients. Three hundred and six patients were positive for CHF. One hundred and ten CKD patients and 105 non-CKD patients died. Not only CKD, but also estimated glomerular filtration rate independently affected NT-proBNP. NT-proBNP detected CHF with a cut-off value of 298.4 pg/mL in non-CKD patients and a cut-off value of 435.7 pg/mL in CKD patients. NT-proBNP predicted death with a cut-off value of 369.5 pg/mL in non-CKD patients and a cut-off value of 2584.1 pg/mL in CKD patients. The NT-proBNP level was significantly related to the prevalence of CHF and all-cause mortality in CAD patients with and without CKD; this effect persisted after adjustment. The crude and multiple adjusted hazard ratios of NT-proBNP to detect CHF and predict mortality were significantly higher in patients with CKD compared with the remainder of the population. The addition of NT-proBNP to the three-variable and six-variable models generated a significant increase in the C-statistic. Conclusion Amongst elderly Chinese CAD patients, there was an independently inverse association between NT-proBNP and renal function. With the higher cutoff points, NT-proBNP better detected CHF and better predicted mortality in CKD patients than in non-CKD patients.
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Affiliation(s)
- Shihui Fu
- Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, People's Republic of China
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Jiang K, Shah K, Daniels L, Maisel AS. Review on natriuretic peptides: where we are, where we are going. ACTA ACUST UNITED AC 2013; 2:1137-53. [PMID: 23496424 DOI: 10.1517/17530059.2.10.1137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Tremendous advances have been made in our understanding of the pathophysiology and treatment of congestive heart failure. However, diagnosis of the disease still remains difficult, even with a comprehensive physical examination. Symptoms such as dyspnea are nonspecific and insensitive indicators for heart failure, which can go largely undetected. Several studies have suggested the need for new diagnostic capabilities, especially with the increasing prevalence of heart failure in the US. The discovery of natriuretic peptides as diagnostic biomarkers has been one of the most critical advances for the management of heart failure. Both B-type natriuretic peptide and N-terminal pro-B-type natriuretic peptide have the potential to diagnose heart failure, assess prognostic risk of rehospitalization and mortality, and even help guide treatment. Their relative cost-effectiveness and availability have also facilitated their acceptance into many emergency departments, clinics and in-patient units as standard care when evaluating patients with suspected heart failure. Our understanding of the natriuretic peptide system is still in its infancy, but natriuretic peptides have emerged as important diagnostic and prognostic tools that have generated interest in finding broader applications for their use. OBJECTIVE The purpose of this review is to discuss the clinical approaches and future applications of natriuretic peptides in diagnosing and managing treatment of congestive heart failure. METHOD A comprehensive review of studies to assess the utility of natriuretic peptides for diagnosis and prognosis of heart failure and other conditions. CONCLUSION Natriuretic peptides are powerful tools to aid the physician in the diagnosis, prognosis and management of heart failure in both in-patient and out-patient settings. However, natriuretic peptides should be used as an adjunct test as many circumstances can also influence changes in natriuretic peptide levels.
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Affiliation(s)
- Kevin Jiang
- VA San Diego Medical Center and the University of California, Division of Cardiology, Department of Medicine, VAMC, 3350 La Jolla Village Dr, San Diego, CA 92161, USA +1 858 552 8585 ; +1 858 552 7490 ;
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Delaporta P, Kattamis A, Apostolakou F, Boiu S, Bartzeliotou A, Tsoukas E, Papassotiriou I. Correlation of NT-proBNP levels and cardiac iron concentration in patients with transfusion-dependent thalassemia major. Blood Cells Mol Dis 2013; 50:20-4. [DOI: 10.1016/j.bcmd.2012.09.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 08/30/2012] [Accepted: 08/31/2012] [Indexed: 01/12/2023]
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Waldum B, Stubnova V, Westheim AS, Omland T, Grundtvig M, Os I. Prognostic utility of B-type natriuretic peptides in patients with heart failure and renal dysfunction. Clin Kidney J 2012; 6:55-62. [PMID: 24422171 PMCID: PMC3888094 DOI: 10.1093/ckj/sfs174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 11/19/2012] [Indexed: 11/23/2022] Open
Abstract
Background Renal dysfunction is considered a confounding variable in the interpretation of B-type natriuretic peptides (BNPs) and their amino-terminal fragments (NT-ProBNP) in patients with heart failure (HF). Our aim was to investigate the prognostic utility of BNPs and NT-proBNP in HF outpatients with renal dysfunction, and compare the prognostic significance of the corresponding BNP/NT-ProBNP levels in patients with and without renal dysfunction. Methods A total of 2076 patients from 13 HF clinics in the Norwegian Heart Failure Registry were investigated. The BNP/NT-ProBNP levels were categorized centre-wise into four groups using the quartile limits found in patients with preserved renal function. Patients with renal dysfunction, i.e. glomerular filtration rate (GFR) ≤60 mL/min/1.73 m2, were then assigned to BNP groups 1–4 centre-wise according to their level of natriuretic peptides. Results Renal dysfunction was present in 37.5% of the patients, of whom the majority (59.1%) had levels of natriuretic peptide in the highest BNP group. Patients with renal dysfunction and BNP levels in the lower three BNP groups had similar 2-year survival as patients without renal dysfunction and comparable BNP levels [crude hazard ratio (HR) 1.25, 95% CI 0.82–1.89, P = 0.302, multiple adjusted HR 0.85, 95% CI 0.54–1.33, P = 0.457]. Beyond 2 years of follow-up, renal dysfunction predicted all-cause mortality irrespective of the level of natriuretic peptides at the start of follow-up. Conclusion In HF outpatients, the BNP/NT-ProBNP level predicted 2-year mortality irrespective of renal function and provided important prognostic information on patients with renal dysfunction.
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Affiliation(s)
- Bård Waldum
- Institute of Clinical Medicine, Faculty of Medicine , University of Oslo , Oslo , Norway ; Department of Nephrology , Oslo University Hospital , Ullevål, Oslo , Norway
| | - Viera Stubnova
- Department of Nephrology , Oslo University Hospital , Ullevål, Oslo , Norway
| | - Arne S Westheim
- Department of Cardiology , Oslo University Hospital , Ullevål, Oslo , Norway
| | - Torbjørn Omland
- Institute of Clinical Medicine, Faculty of Medicine , University of Oslo , Oslo , Norway ; Department of Cardiology , Akershus University Hospital , Lørenskog , Norway
| | - Morten Grundtvig
- Department of Medicine , Innlandet Hospital Trust , Lillehammer , Norway
| | - Ingrid Os
- Institute of Clinical Medicine, Faculty of Medicine , University of Oslo , Oslo , Norway ; Department of Nephrology , Oslo University Hospital , Ullevål, Oslo , Norway
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Jungbauer CG, Kaess B, Buchner S, Birner C, Lubnow M, Resch M, Debl K, Buesing M, Zerback R, Riegger G, Luchner A. Equal performance of novel N-terminal proBNP (Cardiac proBNP®) and established BNP (Triage BNP®) point-of-care tests. Biomark Med 2012; 6:789-96. [DOI: 10.2217/bmm.12.67] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Recently, a novel point-of-care test (POCT) for N-terminal proBNP (NTproBNP) has been introduced (Cardiac proBNP®, Roche). Aim: The aim was to compare the novel POCT for NTproBNP with the established POCT for BNP. Methods: NTproBNP and BNP were assessed in 222 individuals with chronic heart failure (n = 151) or controls (n = 71) with both POCTs. Results: NTproBNP and BNP were closely correlated upon regression analysis (r = 0.93; p < 0.01). NTproBNP and BNP were both correlated with ejection fraction and New York Heart Association stage. Receiver operating characteristic analysis yielded satisfying and equivalent predictive values for the detection of left ventricular dysfunction (ejection fraction <40%; NTproBNP: area under the curve 0.97; BNP: area under the curve 0.96; p > 0.05) and presence of New York Heart Association stage >2 (area under the curve 0.92 vs 0.91 for NT-proBNP and BNP, respectively; p > 0.05). Conclusion: The NTproBNP POCT allows biochemical detection of heart failure with satisfactory predictive values, is equivalent to the BNP POCT and will improve near-patient testing.
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Affiliation(s)
- Carsten G Jungbauer
- Department of Cardiology, Klinik und Poliklinik fuer Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Bernhard Kaess
- Department of Cardiology, Klinik und Poliklinik fuer Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Stefan Buchner
- Department of Cardiology, Klinik und Poliklinik fuer Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Christoph Birner
- Department of Cardiology, Klinik und Poliklinik fuer Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Matthias Lubnow
- Department of Cardiology, Klinik und Poliklinik fuer Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Markus Resch
- Department of Cardiology, Klinik und Poliklinik fuer Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Kurt Debl
- Department of Cardiology, Klinik und Poliklinik fuer Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Monika Buesing
- Department of Cardiology, Klinik und Poliklinik fuer Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Rainer Zerback
- Clinical Operations, Roche Diagnostics GmbH, Mannheim, Germany
| | - Günter Riegger
- Department of Cardiology, Klinik und Poliklinik fuer Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Andreas Luchner
- Department of Cardiology, Klinik und Poliklinik fuer Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany
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Montaner J, García-Berrocoso T, Mendioroz M, Palacios M, Perea-Gainza M, Delgado P, Rosell A, Slevin M, Ribó M, Molina CA, Alvarez-Sabín J. Brain natriuretic peptide is associated with worsening and mortality in acute stroke patients but adds no prognostic value to clinical predictors of outcome. Cerebrovasc Dis 2012; 34:240-5. [PMID: 23018289 DOI: 10.1159/000341858] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Accepted: 07/11/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND At the present time, the determination of the outcome of stroke patients is based on the analysis of clinical and neuroimaging data. The use of prognostic blood biomarkers could aid in decision-making processes, e.g. admitting patients to specialized stroke units. Although the prognostic role of natriuretic peptides has been studied in heart failure and coronary diseases, the value of brain natriuretic peptide (BNP) is less known within the field of strokes. OBJECTIVE We aimed to study the relationship between plasma levels of BNP and acute neurological worsening or mortality after stroke in a large cohort of patients (investigating both ischemic and hemorrhagic disease). METHODS Consecutive stroke patients (ischemic and hemorrhagic) admitted to the Stroke Unit of our University Hospital within 24 h of the onset of symptoms were included. Stroke severity was assessed according to the National Institutes of Health Stroke Scale (NIHSS) at admission and at discharge. Neurological worsening was defined as an increase of 4 or more points in the NIHSS score or death during the patient's stay at the Stroke Unit. Blood samples were drawn upon admission to measure plasma levels of BNP (Biosite Inc., San Diego, Calif., USA). Statistical analysis was performed using SPSS 15.0 and R software. RESULTS Altogether, 896 patients were included in the study. BNP plasma levels were higher among patients who deteriorated the most over time (n = 112; 90.5 vs. 61.2 ng/l; p = 0.006) or died (n = 83; 118.2 vs. 60.9 ng/l; p < 0.001). Multivariate logistic regression analysis indicated that plasma BNP level was an independent predictor of neurological worsening [BNP >56.7 ng/l; odds ratio (OR) = 1.64; p = 0.04] and death after stroke (BNP >65.3 ng/l; OR = 1.97; p = 0.034). Adding BNP level to other well-known clinical predictors of bad outcome did not significantly increase the predictive value. CONCLUSIONS Plasma levels of BNP measured during the acute phase of stroke are associated both with early neurological worsening and mortality. However, this biological information does not supply prognostic information which would add to clinical variables, which limits its use as a biomarker. Further investigation and systematic reviews are needed to clarify the role of natriuretic peptides in stroke outcome.
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Affiliation(s)
- J Montaner
- Neurovascular Research Laboratory, Vall d'Hebron University Hospital Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Bertoni AG, Wagenknecht LE, Kitzman DW, Marcovina SM, Rushing JT, Espeland MA. Impact of the look AHEAD intervention on NT-pro brain natriuretic peptide in overweight and obese adults with diabetes. Obesity (Silver Spring) 2012; 20:1511-8. [PMID: 21959345 PMCID: PMC3509930 DOI: 10.1038/oby.2011.296] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Look AHEAD (Action for Health in Diabetes) is a randomized trial determining whether intensive lifestyle intervention (ILI) aimed at long-term weight loss and increased physical fitness reduces cardiovascular morbidity and mortality in overweight and obese individuals with type 2 diabetes compared to control (diabetes support and education, DSE). We investigated the correlates of N-terminal pro-brain natriuretic peptide (NT-proBNP), a biomarker associated with heart failure (HF) risk, in a subsample from 15 of 16 participating centers and tested the hypothesis that ILI decreased NT-proBNP levels. Baseline and 1-year blood samples were assayed for NT-proBNP in a random sample of 1,500 without, and all 628 with, self-reported baseline CVD (cardiovascular disease) (N = 2,128). Linear models were used to assess relationships that log-transformed NT-proBNP had with CVD risk factors at baseline and that 1-year changes in NT-proBNP had with intervention assignment. At baseline, the mean (s.d.) age, BMI, and hemoglobin A(1c) (HbA(1c)) were 59.6 (6.8) years, 36.0 kg/m(2) (5.8), and 7.2% (1.1), respectively. Baseline geometric mean NT-proBNP was not different by condition (ILI 53.3 vs. DSE 51.5, P = 0.45), was not associated with BMI, and was inversely associated with HbA(1c). At 1 year, ILI participants achieved an average weight loss of 8.3% compared to 0.7% in DSE. At 1 year, NT-proBNP levels increased to a greater extent in the intervention arm (ILI +21.3% vs. DSE +14.2%, P = 0.046). The increased NT-proBNP associated with ILI was correlated with changes in HbA(1c), BMI, and body composition. In conclusion, among overweight and obese persons with diabetes, an ILI that reduced weight was associated with an increased NT-proBNP.
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Affiliation(s)
- Alain G Bertoni
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA.
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Quiroga B, Goicoechea M, García de Vinuesa S, Verde E, Verdalles U, Yuste C, Reque J, Luño J. [Cardiac markers in different degrees of chronic kidney disease: influence of inflammation and previous heart disease]. Med Clin (Barc) 2012; 139:98-102. [PMID: 21807382 DOI: 10.1016/j.medcli.2011.05.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Revised: 05/03/2011] [Accepted: 05/05/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVE Troponin T (TnT), brain natriuretic peptide (BNP) and its precursor (NT-proBNP) are useful markers of acute coronary events and heart failure. The aim of this study was to analyze the influence of chronic renal failure, inflammation and heart disease in these biomarkers. PATIENTS AND METHODS In 266 patients with different stages of chronic renal diseases, the following parameters were measured: cardiac markers (TnT, BNP and NT-proBNP), renal function, inflammatory markers (hsCRP, fibrinogen, albumin, uric acid and white blood cells). We recorded the cardiovascular history. Ventricular dysfunction and left ventricular hypertrophy were assessed by echocardiography. RESULTS A significant correlation between cardiac markers and inflammatory parameters such as fibrinogen, hsCRP and albumin was found. Age (OR 1.05, P = .021), serum albumin (OR: 0.06, P=.006), ischemic heart disease (OR: 8.17, P=.0092) and renal failure (OR: 1.67, P=.05) were predictors of higher BNP levels. Age (OR 1.05, P=.0097), serum albumin (OR: 0.12, P=.001), ischemic heart disease (OR: 3.43, P=.034), renal failure (OR: 1, 65, P=.036) and heart failure (OR: 4.33, P=.0312) were predictors of elevated NT-proBNP. Previous ischemic heart disease alone increased TnT levels (OR: 6.51, P=.0012). CONCLUSIONS Age, previous cardiac disease and inflammation increase cardiac marker levels in patients with different stages of renal disease, but the degree of renal failure is an important factor influencing NT-proBNP levels. However, ischemic heart disease alone increases the levels of TnT.
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Affiliation(s)
- Borja Quiroga
- Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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de Leeuw K, Nieuwenhuis MK, Niemeijer AS, Eshuis H, Beerthuizen GIJM, Janssen WM. Increased B-type natriuretic peptide and decreased proteinuria might reflect decreased capillary leakage and is associated with a better outcome in patients with severe burns. Crit Care 2011; 15:R161. [PMID: 21722363 PMCID: PMC3387595 DOI: 10.1186/cc10297] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Revised: 04/18/2011] [Accepted: 07/01/2011] [Indexed: 11/10/2022] Open
Abstract
Introduction It is difficult to adjust fluid balance adequately in patients with severe burns due to various physical changes. B-type natriuretic peptide (BNP) is emerging as a potential marker of hydration state. Proteinuria is used as a predictor of outcome in severe illness and might correlate to systemic capillary leakage. This study investigates whether combining BNP and proteinuria can be used as a guide for individualized resuscitation and as a predictor of outcome in patients with severe burns. Methods From 2006 to 2009, 38 consecutive patients (age 47 ± 15 years, 74% male) with severe burns were included and followed for 20 days. All had normal kidney function at admission. BNP and proteinuria were routinely measured. Ordered and actually administered fluid resuscitation volumes were recorded. The Sequential Organ Failure Assessment (SOFA) score was used as the measure of outcome. Results BNP increased during follow-up, reaching a plateau level at Day 3. Based on median BNP levels at Day 3, patients were divided into those with low BNP and those with high BNP levels. Both groups had comparable initial SOFA scores. Patients with high BNP received less fluid from Days 3 to 10. Furthermore, patients with a high BNP at Day 3 had less morbidity, reflected by lower SOFA scores on the following days. To minimize effects of biological variability, proteinuria on Days 1 and 2 was averaged. By dividing the patients based on median BNP at Day 3 and median proteinuria, patients with high BNP and low proteinuria had significantly lower SOFA scores during the entire follow-up period compared to those patients with low BNP and high proteinuria. Conclusions Patients with higher BNP levels received less fluid. This might be explained by a lower capillary leakage in these patients, resulting in more intravascular fluid and consequently an increase in BNP. In combination with low proteinuria, possibly reflecting minimal systemic capillary leakage, a high BNP level was associated with a better outcome. BNP and proteinuria have prognostic potential in severely burned patients and may be used to adjust individual resuscitation.
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Affiliation(s)
- Karina de Leeuw
- Department of Internal Medicine, Martini Hospital, van Swietenplein 1, 9700 RM Groningen, The Netherlands.
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Lurati Buse GA, Koller MT, Burkhart C, Seeberger MD, Filipovic M. The Predictive Value of Preoperative Natriuretic Peptide Concentrations in Adults Undergoing Surgery. Anesth Analg 2011; 112:1019-33. [DOI: 10.1213/ane.0b013e31820f286f] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Crowson CS, Myasoedova E, Davis JM, Roger VL, Karon BL, Borgeson D, Rodeheffer RJ, Therneau TM, Gabriel SE. Use of B-type natriuretic peptide as a screening tool for left ventricular diastolic dysfunction in rheumatoid arthritis patients without clinical cardiovascular disease. Arthritis Care Res (Hoboken) 2011; 63:729-34. [PMID: 21225672 PMCID: PMC3091972 DOI: 10.1002/acr.20425] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Patients with rheumatoid arthritis (RA) are at an increased risk for heart failure and left ventricular diastolic dysfunction (LVDD). B-type natriuretic peptide (BNP) may be useful to screen for LVDD in the general population. We compared the effectiveness of BNP as a screening tool for LVDD in RA and non-RA subjects without cardiovascular disease (CVD). METHODS Study subjects were recruited from population-based samples with and without RA, excluding subjects with CVD. LVDD was assessed by 2-dimensional and Doppler echocardiography and categorized as none, mild, moderate/severe, or indeterminate. Linear regression and proportional odds models evaluated the association between LVDD and BNP, adjusting for age, sex, and body mass index. RESULTS Among 231 RA and 1,730 non-RA subjects without CVD, BNP was significantly higher in subjects with moderate/severe LVDD compared to those with no or mild LVDD (P = 0.02 for RA and P < 0.001 for non-RA subjects). More RA subjects had elevated BNP than non-RA subjects (16% versus 9%; P < 0.001). Positive predictive value (25% in RA and 18% in non-RA subjects) and sensitivity (40% in RA and 26% in non-RA subjects) were similarly low in both cohorts, but specificity was significantly lower in RA than in non-RA subjects (89% versus 94%; P = 0.02). CONCLUSION While RA subjects were more likely to have elevated BNP, few RA patients with elevated BNP actually have LVDD. Also, normal BNP levels are less likely to rule out LVDD in RA than in non-RA subjects. Therefore, BNP may be less effective for screening in RA subjects compared to the general population.
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MESH Headings
- Aged
- Arthritis, Rheumatoid/blood
- Arthritis, Rheumatoid/complications
- Arthritis, Rheumatoid/physiopathology
- Biomarkers/blood
- Case-Control Studies
- Diastole
- Echocardiography, Doppler
- Female
- Humans
- Linear Models
- Logistic Models
- Male
- Mass Screening/methods
- Middle Aged
- Minnesota
- Natriuretic Peptide, Brain/blood
- Odds Ratio
- Predictive Value of Tests
- Risk Assessment
- Risk Factors
- Severity of Illness Index
- Up-Regulation
- Ventricular Dysfunction, Left/blood
- Ventricular Dysfunction, Left/diagnosis
- Ventricular Dysfunction, Left/etiology
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Function, Left
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Affiliation(s)
- Cynthia S. Crowson
- Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Elena Myasoedova
- Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - John M. Davis
- Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Veronique L. Roger
- Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
- Division of Cardiovascular Diseases, Mayo Clinic, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Barry L. Karon
- Division of Cardiovascular Diseases, Mayo Clinic, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Daniel Borgeson
- Division of Cardiovascular Diseases, Mayo Clinic, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Richard J. Rodeheffer
- Division of Cardiovascular Diseases, Mayo Clinic, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Terry M. Therneau
- Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Sherine E. Gabriel
- Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
- Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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Di Stasio E, Russo A, Mettimano M, Viviani D, Scagliusi A, Bruno A, Giuliani A, Isgrò MA, Romitelli F, Savi L. NT-proBNP: A marker of preclinical cardiac damage in arterial hypertension. Clin Chim Acta 2011; 412:1106-11. [DOI: 10.1016/j.cca.2011.02.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Revised: 02/25/2011] [Accepted: 02/25/2011] [Indexed: 10/18/2022]
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Abstract
Coronary artery disease affects millions of Americans and is a major cause of global morbidity and mortality. Detection and optimal treatment strategies are needed to reduce the clinical and economic burden of this disease. Chest pain history, risk factor profile, and noninvasive stress test results are used for clinical risk stratification. In high-risk patients, coronary angiography is the standard for anatomic diagnosis and additional risk stratification. All patients with coronary artery disease should be treated with optimal medical therapy. Patients with uncontrolled symptoms or high risk for adverse outcomes benefit from coronary artery revascularization with percutaneous coronary intervention or coronary artery bypass graft surgery.
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ROBERTS MATTHEWA, HEDLEY ADAMJ, IERINO FRANCESCOL. Understanding cardiac biomarkers in end-stage kidney disease: Frequently asked questions and the promise of clinical application. Nephrology (Carlton) 2011; 16:251-60. [DOI: 10.1111/j.1440-1797.2010.01413.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Harutyunyan MJ, Mathiasen AB, Winkel P, Gøtze JP, Hansen JF, Hildebrandt P, Jensen GB, Hilden J, Jespersen CM, Kjøller E, Kolmos HJ, Gluud C, Kastrup J. High-sensitivity C-reactive protein and N-terminal pro-B-type natriuretic peptide in patients with stable coronary artery disease: a prognostic study within the CLARICOR Trial. Scandinavian Journal of Clinical and Laboratory Investigation 2010; 71:52-62. [DOI: 10.3109/00365513.2010.538081] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Marina J. Harutyunyan
- Department of Medicine B, The Heart Centre
- The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital
| | - Anders B. Mathiasen
- Department of Medicine B, The Heart Centre
- The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital
| | - Per Winkel
- The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital
| | - Jens P. Gøtze
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital and Faculty of Health Sciences
| | | | - Per Hildebrandt
- Department of Cardiology, Frederiksberg Hospital, Copenhagen University Hospital
| | - Gorm Boje Jensen
- Department of Cardiology, Hvidovre Hospital, Copenhagen University Hospital
| | - Jørgen Hilden
- Department of Biostatistics, Institute of Public Health, Faculty of Health Sciences, University of Copenhagen
| | | | - Erik Kjøller
- Department of Cardiology, Herlev Hospital, Copenhagen University Hospital
| | - Hans J. Kolmos
- Department of Clinical Microbiology, Odense University Hospital, Denmark
| | - Christian Gluud
- The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital
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Radovanovic M, Vasiljevic Z, Radovanovic N, Marinkovic J, Beleslin B, Mitrovic P, Stankovic S, Stankovic G. B-type natriuretic peptide in outpatients after myocardial infarction: optimized cut-off value for incident heart failure prediction. Peptides 2010; 31:1946-8. [PMID: 20600420 DOI: 10.1016/j.peptides.2010.06.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 06/20/2010] [Accepted: 06/21/2010] [Indexed: 01/06/2023]
Abstract
Higher levels of natriuretic peptides were identified in outpatients after myocardial infarction (MI) compared to the healthy population, even in the absence of heart failure (HF). Therefore, we assessed the optimal cut-off value of B-type natriuretic peptide (BNP) in relation to new-onset HF prediction in 79 post-MI patients with preserved left ventricular systolic function (ejection fraction >40%). Plasma BNP was measured by enzyme immunoassay, 6 months after MI and patients were followed-up for the next one year. Cox proportional regression model analysis revealed the independent prognostic value of BNP for HF prediction (p=0.005). As assessed by ROC analysis the optimal cut-off value of BNP was 175 pg/mL (sensitivity 82%; specificity 77%, AUC 0.77), associated with significantly different rates of incident HF by Kaplan-Meier analysis (p=0.001). In this population of outpatients with preserved left ventricular systolic function after MI, BNP strongly correlated with new-onset HF development at the optimal cut-off value of 175 pg/mL.
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Affiliation(s)
- Mina Radovanovic
- Cardiology Clinic, Clinical Center of Serbia and Medical School of Belgrade, 8 Koste Todorovica, 11000 Belgrade, Serbia.
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