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Horiuchi Y, Maisel AS, van Veldhuisen DJ, Mueller C, Hogan C, Kontos MC, Cannon CM, Müller GA, Taub P, Vilke GM, Duff S, McDonald K, Mahon N, Nuñez J, Briguori C, Passino C, Murray PT, Wettersten N. Significance of an Early Repeat Troponin Measurement Upon Presentation to the Hospital for Acute Heart Failure. J Am Heart Assoc 2024:e034850. [PMID: 39248254 DOI: 10.1161/jaha.124.034850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 08/08/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND Higher cardiac troponin is associated with worse outcomes in patients with acute heart failure. The significance of repeat measurements over hours remains unclear. We assessed whether a repeat measurement and the Δ between measurements of high-sensitivity cardiac troponin I (hs-cTnI) were associated with outcomes in hypervolemic patients with acute heart failure without acute coronary syndrome. METHODS AND RESULTS We analyzed 582 individuals from AKINESIS (Acute Kidney Injury Neutrophil Gelatinase-Associated Lipocalin Evaluation of Symptomatic Heart Failure Study) with hs-cTnI measured ≤12 hours from admission and repeated ≤6 hours thereafter. Associations between hs-cTnI levels and their Δ with short-term (death, intensive care unit admission, receipt of inotropes, or positive pressure ventilation during hospitalization) and long-term (death or heart failure readmission within 1 year) outcomes were assessed. The average age was 69±13 years, 62% were men, 65% were White, 46% had coronary artery disease, and 22% had chest pain. Median hs-cTnI levels were 27 (interquartile range [IQR], 13-62) ng/L initially and 28 (IQR, 14-68) ng/L subsequently, with a Δ of 0 [IQR, -2 to 4] ng/L over 3.4±1 hours. Only the second measurement was associated with short-term outcomes (odds ratio, 1.14 per 2-fold higher [95% CI, 1.02-1.28]). Both individual measurements and the Δ were associated with long-term outcomes (hazard ratios, 1.09, 1.12, and 1.16 for first, second, and Δ, respectively). Associated risk for the first and second measurements were not constant over the year but highest early after being measured and decreased over 1 year. CONCLUSIONS Repeat measurements of hs-cTnI over hours can identify individuals with acute heart failure without acute coronary syndrome at risk for short- and long-term outcomes.
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Affiliation(s)
- Yu Horiuchi
- Division of Cardiology Mitsui Memorial Hospital Tokyo Japan
| | - Alan S Maisel
- Division of Cardiovascular Medicine University of California, San Diego La Jolla CA
| | - Dirk J van Veldhuisen
- Department of Cardiology, University Medical Center Groningen University of Groningen Groningen the Netherlands
| | - Christian Mueller
- Department of Cardiology, University Hospital Basel University of Basel Basel Switzerland
| | - Christopher Hogan
- Division of Emergency Medicine and Acute Care Surgical Services, VCU Medical Center Virginia Commonwealth University Richmond VA
| | - Michael C Kontos
- Division of Cardiology, VCU Medical Center Virginia Commonwealth University Richmond VA
| | - Chad M Cannon
- Department of Emergency Medicine University of Kansas Medical Center Kansas City KS
| | - Gerhard A Müller
- Division of Nephrology and Rheumatology, UMG, University of Göttingen Göttingen Germany
| | - Pam Taub
- Division of Cardiovascular Medicine University of California, San Diego La Jolla CA
| | - Gary M Vilke
- Department of Emergency Medicine University of California, San Diego La Jolla CA
| | - Stephen Duff
- School of Medicine University College Dublin Dublin Ireland
| | - Kenneth McDonald
- Department of Cardiology, Mater Misericordiae University Hospital University College Dublin Dublin Ireland
- Department of Cardiology St. Vincent's University Hospital Dublin Ireland
| | - Niall Mahon
- Department of Cardiology, Mater Misericordiae University Hospital University College Dublin Dublin Ireland
| | - Julio Nuñez
- Department of Cardiology, Hospital Clínico Universitario Valencia, INCLIVA University of Valencia Valencia Spain
- CIBER in Cardiovascular Diseases Madrid Spain
| | - Carlo Briguori
- Department of Cardiology, Interventional Cardiology Mediterranea Cardiocentro Naples Italy
| | - Claudio Passino
- Department of Cardiology and Cardiovascular Medicine Fondazione Gabriele Monasterio Pisa Italy
| | | | - Nicholas Wettersten
- Division of Cardiovascular Medicine University of California, San Diego La Jolla CA
- Division of Cardiovascular Medicine San Diego Veterans Affairs Medical Center San Diego CA
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Magnusson NE, Frydman S, Freund O, Zornizki L, Banai S, Shacham Y. Early neutrophil gelatinase-associated lipocalin (NGAL) measurement could rule out future acute kidney injury in patients with acute coronary syndrome-Prospective observational study. Health Sci Rep 2024; 7:e2229. [PMID: 39035681 PMCID: PMC11258435 DOI: 10.1002/hsr2.2229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 06/17/2024] [Accepted: 06/25/2024] [Indexed: 07/23/2024] Open
Abstract
Background and Aims The diagnosis of acute kidney injury (AKI) is of importance among patients with ST segment elevation (STEMI) undergoing primary coronary intervention (PCI). It is often delayed given the need in serial measurements of creatinine or other serum markers. Neutrophil gelatinase-associated lipocalin (NGAL) is a proven marker for AKI, although its role as an early predictor in this setting was scarcely addressed before and was the aim of our study. Methods Prospective observational study including 133 patients with STEMI treated with PCI. Plasma NGAL was drawn immediately before PCI (NGAL-0) and 24 h after (NGAL-24). Similar analysis of C-reactive protein (CRP) was performed for additional comparison. Results Mean age was 62 ± 13 years, 78% were men, and 20 (15%) developed AKI after admission. Patients with AKI after admission demonstrated higher levels of NGAL-0 (164 vs. 95 ng/mL; p < 0.001) and NGAL-24 (142 vs. 93 ng/mL; p < 0.001). Levels of NGAL-0 and NGAL-24 were similar within the AKI and non-AKI groups. Using ROC curve analysis, NGAL-0 had best predictive ability for AKI development (AUC 0.841, 95% CI 0.80-0.96), compared with NGAL-24 (0.783, 95% CI 0.74-0.85), CRP-0 (0.701, 95% CI 0.58-0.83), and CRP-24 (0.781, 95% CI 0.66-0.90). The optimal NGAL-0 cutoff for AKI prediction was 125 ng/mL, with 70% sensitivity, 84% specificity, and 94% negative predictive value. Conclusions Among STEMI patients, NGAL measurement upon admission are associated with AKI and may serve as a reliable marker for early AKI detection. Future studies may direct risk stratification using this single test can direct personalized evaluations during the admission, and focused interventions to prevent AKI.
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Affiliation(s)
- Nils Erik Magnusson
- Medical Research Laboratory, Department of Clinical MedicineAarhus University HospitalAarhusDenmark
| | - Shir Frydman
- Department of Cardiology, Tel‐Aviv Sourasky Medical Center affiliated to the Sackler Faculty of MedicineTel‐Aviv UniversityTel‐AvivIsrael
| | - Ophir Freund
- Department of Cardiology, Tel‐Aviv Sourasky Medical Center affiliated to the Sackler Faculty of MedicineTel‐Aviv UniversityTel‐AvivIsrael
| | - Lior Zornizki
- Department of Cardiology, Tel‐Aviv Sourasky Medical Center affiliated to the Sackler Faculty of MedicineTel‐Aviv UniversityTel‐AvivIsrael
| | - Shmuel Banai
- Department of Cardiology, Tel‐Aviv Sourasky Medical Center affiliated to the Sackler Faculty of MedicineTel‐Aviv UniversityTel‐AvivIsrael
| | - Yacov Shacham
- Department of Cardiology, Tel‐Aviv Sourasky Medical Center affiliated to the Sackler Faculty of MedicineTel‐Aviv UniversityTel‐AvivIsrael
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Kim MJ, Jeon DS, Ahn Y, Byeon J, Lee D, Choi IJ. Systemic reserve dysfunction and contrast-associated acute kidney injury following percutaneous coronary intervention. PLoS One 2024; 19:e0299899. [PMID: 38442122 PMCID: PMC10914285 DOI: 10.1371/journal.pone.0299899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 02/17/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Developing contrast-associated acute kidney injury (CA-AKI) following percutaneous coronary intervention (PCI) is closely related to patient-related risk factors as well as contrast administration. The diagnostic and prognostic roles of neutrophil gelatinase-associated lipocalin (NGAL) in CA-AKI following PCI are not well established. METHODS Consecutive patients undergoing PCI were enrolled prospectively. CA-AKI was defined as an increase in the serum creatinine level ≥0.3 mg/dL within 48 hours or ≥1.5 times the baseline within 7 days after PCI. Serum NGAL concentrations were determined immediately before and 6 hours after PCI. The participants were classified into four NGAL groups according to the pre- and post-PCI NGAL values at 75th percentile. RESULTS CA-AKI occurred in 38 (6.4%) of 590 patients. With chronic kidney disease status (hazard ratio [HR] 1.63, 95% confidence interval [CI]: 1.06-2.52), NGAL groups defined by the combination of pre- and 6 h post-PCI values were independently associated with the occurrence of CA-AKI (HR 1.69, 95% CI: 1.16-2.45). All-cause mortality for 29-month follow-ups was different among NGAL groups (log-rank p<0.001). Pre-PCI NGAL levels significantly correlated with baseline cardiac, inflammatory, and renal markers. Although post-PCI NGAL levels increased in patients with larger contrast administration, contrast media made a relatively limited contribution to the development of CA-AKI. CONCLUSION In patients undergoing PCI, the combination of pre- and post-PCI NGAL values may be a useful adjunct to current risk-stratification of CA-AKI and long-term mortality. CA-AKI is likely caused by systemic reserve deficiency rather than contrast administration itself.
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Affiliation(s)
- Mi-Jeong Kim
- Department of Cardiology, Incheon St. Mary’s Hospital, The Catholic University of Korea, Incheon, Republic of Korea
- Department of Cardiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Doo Soo Jeon
- Department of Cardiology, Incheon St. Mary’s Hospital, The Catholic University of Korea, Incheon, Republic of Korea
- Department of Cardiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Youngchul Ahn
- Department of Cardiology, Incheon St. Mary’s Hospital, The Catholic University of Korea, Incheon, Republic of Korea
| | - Jaeho Byeon
- Department of Cardiology, Incheon St. Mary’s Hospital, The Catholic University of Korea, Incheon, Republic of Korea
| | - Dongjae Lee
- Department of Cardiology, Incheon St. Mary’s Hospital, The Catholic University of Korea, Incheon, Republic of Korea
| | - Ik Jun Choi
- Department of Cardiology, Incheon St. Mary’s Hospital, The Catholic University of Korea, Incheon, Republic of Korea
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Rao VS, Ivey-Miranda JB, Cox ZL, Moreno-Villagomez J, Testani JM. Association of Urine Galectin-3 With Cardiorenal Outcomes in Patients With Heart Failure. J Card Fail 2024; 30:340-346. [PMID: 37301248 PMCID: PMC10947725 DOI: 10.1016/j.cardfail.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND OBJECTIVES Approaches to distinguishing pathological cardiorenal dysfunction in heart failure (HF) from functional/hemodynamically mediated changes in serum creatinine are needed. We investigated urine galectin-3 as a candidate biomarker of renal fibrosis and a prognostic indicator of cardiorenal dysfunction phenotypes. METHODS We measured urine galectin-3 in 2 contemporary HF cohorts: the Yale Transitional Care Clinic (YTCC) cohort (n = 132) and the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial (n = 434). We assessed the association of urine galectin-3 with all-cause mortality in both cohorts and the association with an established marker of renal tissue fibrosis, urinary amino-terminal propeptide of type III procollagen (PIIINP) in TOPCAT. RESULTS In the YTCC cohort, there was significant effect modification between higher urine galectin-3 and lower estimated glomerular filtration rates (eGFRs) (Pinteraction = 0.046), such that low eGFR levels had minimal prognostic importance if urine galectin-3 levels were low, but they were important and indicated high risk if urine galectin-3 levels were high. Similar observations were noted in the TOPCAT study (Pinteraction = 0.002). In TOPCAT, urine galectin-3 also positively correlated with urine PIIINP at both baseline (r = 0.43; P < 0.001) and at 12 months (r = 0.42; P < 0.001). CONCLUSIONS Urine galectin-3 levels correlated with an established biomarker of renal fibrosis in 2 cohorts and was able to differentiate high- vs low-risk phenotypes of chronic kidney disease in HF. These proof-of-concept results indicate that additional biomarker research to differentiate cardiorenal phenotypes is warranted.
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Affiliation(s)
- Veena S Rao
- Division of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Juan B Ivey-Miranda
- Division of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA; Heart Failure and Heart Transplant Clinic, Hospital de Cardiologia, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Zachary L Cox
- Department of Pharmacy Practice, Lipscomb University College of Pharmacy, Nashville, TN, USA; Department of Pharmacy, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Julieta Moreno-Villagomez
- Division of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Jeffrey M Testani
- Division of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA.
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Delalić Đ, Brežni T, Prkačin I. Diagnostic value and utility of commonly used biomarkers of cardiac and renal function in cardiorenal syndromes: a narrative review. Biochem Med (Zagreb) 2023; 33:030502. [PMID: 37545695 PMCID: PMC10373058 DOI: 10.11613/bm.2023.030502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 06/15/2023] [Indexed: 08/08/2023] Open
Abstract
Cardiorenal syndrome (CRS), first defined in 2004 as a consequence of the interactions between the kidneys and other circulatory departments leading to acute heart failure, has since been recognized as a complex clinical entity that is hard to define, diagnose and classify. The framework for the classification of CRS according to pathophysiologic background was laid out in 2008, dividing CRS into five distinct phenotypes. However, determining the timing of individual organ injuries and making a diagnosis of either renal or cardiac failure remains an elusive task. In clinical practice, the diagnosis and phenotyping of CRS is mostly based on using laboratory biomarkers in order to directly or indirectly estimate the degree of end-organ functional decline. Therefore, a well-educated clinician should be aware of the effects that the reduction of renal and cardiac function has on the diagnostic and predictive value and properties of the most commonly used biomarkers (e.g. troponins, N-terminal pro-brain natriuretic peptide, serum creatinine etc). They should also be acquainted, on a basic level, with emerging biomarkers that are specific to either the degree of glomerular integrity (cystatin C) or tubular injury (neutrophil gelatinase-associated lipocalin). This narrative review aims to provide a scoping overview of the different roles that biomarkers play in both the diagnosis of CRS and the prognosis of the disease in patients who have been diagnosed with it, along with highlighting the most important pitfalls in their interpretation in the context of impaired renal and/or cardiac function.
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Affiliation(s)
- Điđi Delalić
- University of Zagreb School of Medicine, Zagreb, Croatia
| | - Tanja Brežni
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Ingrid Prkačin
- University of Zagreb School of Medicine, Zagreb, Croatia
- Emergency Internal Medicine Clinic, Clinical Hospital Merkur, Zagreb, Croatia
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Kenneally LF, Lorenzo M, Romero-González G, Cobo M, Núñez G, Górriz JL, Barrios AG, Fudim M, de la Espriella R, Núñez J. Kidney function changes in acute heart failure: a practical approach to interpretation and management. Clin Kidney J 2023; 16:1587-1599. [PMID: 37779845 PMCID: PMC10539207 DOI: 10.1093/ckj/sfad031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Indexed: 10/03/2023] Open
Abstract
Worsening kidney function (WKF) is common in patients with acute heart failure (AHF) syndromes. Although WKF has traditionally been associated with worse outcomes on a population level, serum creatinine concentrations vary greatly during episodes of worsening heart failure, with substantial individual heterogeneity in terms of their clinical meaning. Consequently, interpreting such changes within the appropriate clinical context is essential to unravel the pathophysiology of kidney function changes and appropriately interpret their clinical meaning. This article aims to provide a critical overview of WKF in AHF, aiming to provide physicians with some tips and tricks to appropriately interpret kidney function changes in the context of AHF.
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Affiliation(s)
- Laura Fuertes Kenneally
- Cardiology Department, General Hospital of Alicante, Dr Balmis. Alicante, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL). Alicante, Spain
| | - Miguel Lorenzo
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain
| | - Gregorio Romero-González
- Nephrology Department, University Hospital Germans Trias I Pujol, Badalona, Spain, International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
| | - Marta Cobo
- CIBER Cardiovascular
- Cardiology Department, Hospital Universitario Puerta de Hierro Majadahonda (IDIPHISA), Madrid, Spain
| | - Gonzalo Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain
| | - Jose Luis Górriz
- Nephrology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, Valencia, Spain
| | - Ana Garcia Barrios
- Cardiology Department, General Hospital of Alicante, Dr Balmis. Alicante, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL). Alicante, Spain
| | - Marat Fudim
- Cardiology Department, Duke University Medical Center. Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Rafael de la Espriella
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, Valencia, Spain
- CIBER Cardiovascular
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7
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Bhardwaj A, Baran DA. Biomarkers in HF: How Does the "Weight" Weigh in? J Card Fail 2023; 29:1132-1134. [PMID: 37315835 DOI: 10.1016/j.cardfail.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 06/05/2023] [Indexed: 06/16/2023]
Affiliation(s)
- Anju Bhardwaj
- Center for Advanced Cardiopulmonary Therapies and Transplantation, University of Texas, Houston, TX
| | - David A Baran
- Department of Cardiology, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL 33331, 954-659-5290.
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8
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Horiuchi YU, Wettersten N, Vanveldhuisen DJ, Mueller C, Nowak R, Hogan C, Kontos MC, Cannon CM, Birkhahn R, Vilke GM, Mahon N, Nuñez J, Briguori C, Duff S, Murray PT, Maisel A. The Influence of Body Mass Index on Clinical Interpretation of Established and Novel Biomarkers in Acute Heart Failure. J Card Fail 2023; 29:1121-1131. [PMID: 37127240 DOI: 10.1016/j.cardfail.2023.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 03/12/2023] [Accepted: 03/23/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Body mass index (BMI) is a known confounder for natriuretic peptides, but its influence on other biomarkers is less well described. We investigated whether BMI interacts with biomarkers' association with prognosis in patients with acute heart failure (AHF). METHODS AND RESULTS B-type natriuretic peptide (BNP), high-sensitivity cardiac troponin I (hs-cTnI), galectin-3, serum neutrophil gelatinase-associated lipocalin (sNGAL), and urine NGAL were measured serially in patients with AHF during hospitalization in the AKINESIS (Acute Kidney Injury Neutrophil gelatinase-associated lipocalin Evaluation of Symptomatic Heart Failure) study. Cox regression analysis was used to determine the association of biomarkers and their interaction with BMI for 30-day, 90-day and 1-year composite outcomes of death or HF readmission. Among 866 patients, 21.2%, 29.7% and 46.8% had normal (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2) or obese (≥ 30 kg/m2) BMIs on admission, respectively. Admission values of BNP and hs-cTnI were negatively associated with BMI, whereas galectin-3 and sNGAL were positively associated with BMI. Admission BNP and hs-cTnI levels were associated with the composite outcome within 30 days, 90 days and 1 year. Only BNP had a significant interaction with BMI. When BNP was analyzed by BMI category, its association with the composite outcome attenuated at higher BMIs and was no longer significant in obese individuals. Findings were similar when evaluated by the last-measured biomarkers and BMIs. CONCLUSIONS In patients with AHF, only BNP had a significant interaction with BMI for the outcomes, with its association attenuating as BMI increased; hs-cTnI was prognostic, regardless of BMI.
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Affiliation(s)
- Y U Horiuchi
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Nicholas Wettersten
- Division of Cardiovascular Medicine, San Diego Veterans Affairs Medical Center, San Diego, CA, USA; Division of Cardiovascular Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Dirk J Vanveldhuisen
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Christian Mueller
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Richard Nowak
- Department of Emergency Medicine, Henry Ford Hospital System, Detroit, MI; USA
| | - Christopher Hogan
- Division of Emergency Medicine and Acute Care Surgical Services, VCU Medical Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Michael C Kontos
- Division of Cardiology, VCU Medical Center, Virginia Commonwealth University, Richmond, VA
| | - Chad M Cannon
- Department of Emergency Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Robert Birkhahn
- Department of Emergency Medicine, New York Methodist Hospital, Brooklyn, NY, USA
| | - Gary M Vilke
- Department of Emergency Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Niall Mahon
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Julio Nuñez
- Department of Cardiology, Hospital Clínico Universitario Valencia, INCLIVA, University of Valencia, Valencia, Spain and CIBER in Cardiovascular Diseases, Madrid, Spain
| | - Carlo Briguori
- Department of Cardiology, Interventional Cardiology, Mediterranea Cardiocentro, Naples, Italy
| | - Stephen Duff
- School of Medicine, University College Dublin, Dublin, Ireland
| | | | - Alan Maisel
- Division of Cardiovascular Medicine, University of California, San Diego, La Jolla, CA, USA.
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Peters AE, Nguyen M, Green JB, Pearson ER, Buse J, Sourij H, Hernandez AF, Sattar N, Holman RR, Mentz RJ, Shah SH. Proteomic Pathways across Ejection Fraction Spectrum in Heart Failure: an EXSCEL Substudy. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.05.16.23288273. [PMID: 37293003 PMCID: PMC10246051 DOI: 10.1101/2023.05.16.23288273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background Ejection fraction (EF) is a key component of heart failure (HF) classification, including the increasingly codified HF with mildly reduced EF (HFmrEF) category. However, the biologic basis of HFmrEF as an entity distinct from HF with preserved EF (HFpEF) and reduced EF (HFrEF) has not been well characterized. Methods The EXSCEL trial randomized participants with type 2 diabetes (T2DM) to once-weekly exenatide (EQW) vs. placebo. For this study, profiling of ∼5000 proteins using the SomaLogic SomaScan platform was performed in baseline and 12-month serum samples from N=1199 participants with prevalent HF at baseline. Principal component analysis (PCA) and ANOVA (FDR p<0.1) were used to determine differences in proteins between three EF groups, as previously curated in EXSCEL (EF>55% [HFpEF], EF 40-55% [HFmrEF], EF<40% [HFrEF]). Cox proportional hazards was used to assess association between baseline levels of significant proteins, and changes in protein level between baseline and 12-month, with time-to-HF hospitalization. Mixed models were used to assess whether significant proteins changed differentially with exenatide vs. placebo therapy. Results Of N=1199 EXSCEL participants with prevalent HF, 284 (24%), 704 (59%) and 211 (18%) had HFpEF, HFmrEF and HFrEF, respectively. Eight PCA protein factors and 221 individual proteins within these factors differed significantly across the three EF groups. Levels of the majority of proteins (83%) demonstrated concordance between HFmrEF and HFpEF, but higher levels in HFrEF, predominated by the domain of extracellular matrix regulation, e.g. COL28A1 and tenascin C [TNC]; p<0.0001. Concordance between HFmrEF and HFrEF was observed in a minority of proteins (1%) including MMP-9 (p<0.0001). Biologic pathways of epithelial mesenchymal transition, ECM receptor interaction, complement and coagulation cascades, and cytokine receptor interaction demonstrated enrichment among proteins with the dominant pattern, i.e. HFmrEF-HFpEF concordance. Baseline levels of 208 (94%) of the 221 proteins were associated with time-to-incident HF hospitalization including domains of extracellular matrix (COL28A1, TNC), angiogenesis (ANG2, VEGFa, VEGFd), myocyte stretch (NT-proBNP), and renal function (cystatin-C). Change in levels of 10 of the 221 proteins from baseline to 12 months (including increase in TNC) predicted incident HF hospitalization (p<0.05). Levels of 30 of the 221 significant proteins (including TNC, NT-proBNP, ANG2) were reduced differentially by EQW compared with placebo (interaction p<0.0001). Conclusions In this HF substudy of a large clinical trial of people with T2DM, we found that serum levels of most proteins across multiple biologic domains were similar between HFmrEF and HFpEF. HFmrEF may be more biologically similar to HFpEF than HFrEF, and specific related biomarkers may offer unique data on prognosis and pharmacotherapy modification with variability by EF.
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10
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Matsuura R, Doi K, Rabb H. Acute kidney injury and distant organ dysfunction-network system analysis. Kidney Int 2023; 103:1041-1055. [PMID: 37030663 DOI: 10.1016/j.kint.2023.03.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/24/2023] [Accepted: 03/24/2023] [Indexed: 04/10/2023]
Abstract
Acute kidney injury (AKI) occurs in about half of critically ill patients and associates with high in-hospital mortality, increased long-term mortality post-discharge and subsequent progression to chronic kidney disease. Numerous clinical studies have shown that AKI is often complicated by dysfunction of distant organs, which is a cause of the high mortality associated with AKI. Experimental studies have elucidated many mechanisms of AKI-induced distant organ injury, which include inflammatory cytokines, oxidative stress and immune responses. This review will provide an update on evidence of organ crosstalk and potential therapeutics for AKI-induced organ injuries, and present the new concept of a systemic organ network to balance homeostasis and inflammation that goes beyond kidney-crosstalk with a single distant organ.
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Affiliation(s)
- Ryo Matsuura
- Department of Nephrology and Endocrinology, the University of Tokyo Hospital
| | - Kent Doi
- Department of Emergency and Critical Care Medicine, the University of Tokyo Hospital.
| | - Hamid Rabb
- Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine
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Horiuchi YU, Wettersten N, VAN Veldhuisen DJ, Mueller C, Filippatos G, Nowak R, Hogan C, Kontos MC, Cannon CM, Müeller GA, Birkhahn R, Taub P, Vilke GM, McDonald K, Mahon N, Nuñez J, Briguori C, Passino C, Duff S, Maisel A, Murray PT. Galectin-3, Acute Kidney Injury and Myocardial Damage in Patients With Acute Heart Failure. J Card Fail 2023; 29:269-277. [PMID: 36332898 DOI: 10.1016/j.cardfail.2022.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 09/28/2022] [Accepted: 09/28/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Galectin-3, a biomarker of inflammation and fibrosis, can be associated with renal and myocardial damage and dysfunction in patients with acute heart failure (AHF). METHODS AND RESULTS We retrospectively analyzed 790 patients with AHF who were enrolled in the AKINESIS study. During hospitalization, patients with galectin-3 elevation (> 25.9 ng/mL) on admission more commonly had acute kidney injury (assessed by KDIGO criteria), renal tubular damage (peak urine neutrophil gelatinase-associated lipocalin [uNGAL] > 150 ng/dL) and myocardial injury (≥ 20% increase in the peak high-sensitivity cardiac troponin I [hs-cTnI] values compared to admission). They less commonly had ≥ 30% reduction in B-type natriuretic peptide from admission to last measured value. In multivariable linear regression analysis, galectin-3 was negatively associated with estimated glomerular filtration rate and positively associated with uNGAL and hs-cTnI. Higher galectin-3 was associated with renal replacement therapy, inotrope use and mortality during hospitalization. In univariable Cox regression analysis, higher galectin-3 was associated with increased risk for the composite of death or rehospitalization due to HF and death alone at 1 year. After multivariable adjustment, higher galectin-3 levels were associated only with death. CONCLUSIONS In patients with AHF, higher galectin-3 values were associated with renal dysfunction, renal tubular damage and myocardial injury, and they predicted worse outcomes.
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Affiliation(s)
- Y U Horiuchi
- Division of Cardiovascular Medicine, University of California San Diego, La Jolla, CA, USA; Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Nicholas Wettersten
- Division of Cardiovascular Medicine, University of California San Diego, La Jolla, CA, USA; Division of Cardiovascular Medicine, San Diego Veterans Affairs Medical Center, San Diego, CA
| | - Dirk J VAN Veldhuisen
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Christian Mueller
- Cardiovascular Research Institute Basel, Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Gerasimos Filippatos
- Department of Cardiology, Athens University Hospital Attikon, University of Athens, Athens, Greece
| | - Richard Nowak
- Department of Emergency Medicine, Henry Ford Hospital System, Detroit, MI, USA
| | - Christopher Hogan
- Division of Emergency Medicine and Acute Care Surgical Services, VCU Medical Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Michael C Kontos
- Division of Cardiology, VCU Medical Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Chad M Cannon
- Department of Emergency Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Gerhard A Müeller
- Department of Nephrology and Rheumatology, University Medical Centre Göttingen, University of Göttingen, Göttingen, Germany
| | - Robert Birkhahn
- Department of Emergency Medicine, New York Methodist Hospital, New York, NY, USA
| | - Pam Taub
- Division of Cardiovascular Medicine, University of California San Diego, La Jolla, CA, USA
| | - Gary M Vilke
- Department of Emergency Medicine, University of California San Diego, La Jolla, CA, USA
| | - Kenneth McDonald
- Department of Cardiology, School of Medicine, University College Dublin, Dublin, Ireland; Department of Cardiology, St Vincent's University Hospital, Dublin, Ireland
| | - Niall Mahon
- Department of Cardiology, School of Medicine, University College Dublin, Dublin, Ireland; Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Julio Nuñez
- Department of Cardiology, Hospital Clínico Universitario, INCLIVA, Valencia, Spain; Centro de Investigación Biomédica en Red (CIBER) in Cardiovascular Diseases, Madrid, Spain
| | - Carlo Briguori
- Department of Cardiology, Mediterranea Cardiocentro, Naples, Italy
| | - Claudio Passino
- Department of Cardiology and Cardiovascular Medicine, Fondazione Gabriele Monasterio, Pisa, Italy
| | - Stephen Duff
- Department of Medicine, School of Medicine, University College Dublin, Dublin, Ireland
| | - Alan Maisel
- Division of Cardiovascular Medicine, University of California San Diego, La Jolla, CA, USA
| | - Patrick T Murray
- Department of Medicine, School of Medicine, University College Dublin, Dublin, Ireland.
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12
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Wettersten N, Duff S, Horiuchi Y, van Veldhuisen DJ, Mueller C, Filippatos G, Nowak R, Hogan C, Kontos MC, Cannon CM, Müeller GA, Birkhahn R, Taub P, Vilke GM, McDonald K, Mahon N, Nuñez J, Briguori C, Passino C, Maisel A, Murray PT, Ix JH. Implications of worsening renal function before hospitalization for acute heart failure. ESC Heart Fail 2023; 10:532-541. [PMID: 36325747 PMCID: PMC9871662 DOI: 10.1002/ehf2.14221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/13/2022] [Accepted: 10/09/2022] [Indexed: 11/06/2022] Open
Abstract
AIMS Kidney function changes dynamically during AHF treatment, but risk factors for and consequences of worsening renal function (WRF) at hospital admission are uncertain. We aimed to determine the significance of WRF at admission for acute heart failure (AHF). METHODS AND RESULTS We evaluated a subgroup of 406 patients from The Acute Kidney Injury Neutrophil gelatinase-associated lipocalin Evaluation of Symptomatic heart failure Study (AKINESIS) who had serum creatinine measurements available within 3 months before and at the time of admission. Admission WRF was primarily defined as a 0.3 mg/dL or 50% creatinine increase from preadmission. Alternative definitions evaluated were a ≥0.5 mg/dL creatinine increase, ≥25% glomerular filtration rate decrease, and an overall change in creatinine. Predictors of admission WRF were evaluated. Outcomes evaluated were length of hospitalization, a composite of adverse in-hospital events, and the composite of death or HF readmission at 30, 90, and 365 days. Biomarkers' prognostic ability for these outcomes were evaluated in patients with admission WRF. One-hundred six patients (26%) had admission WRF. These patients had features of more severe AHF with lower blood pressure, higher BUN, and lower serum sodium concentrations at admission. Higher BNP (odds ratio [OR] per doubling 1.16-1.28, 95% confidence interval [CI] 1.00-1.55) and lower diastolic blood pressure (OR 0.97-0.98, 95% CI 0.96-0.99) were associated with a higher odds for the three definitions of admission WRF. The primary WRF definition was not associated with a longer hospitalization, but alternative WRF definitions were (1.3 to 1.6 days longer, 95% CI 1.0-2.2). WRF across definitions was not associated with a higher odds of adverse in-hospital events or a higher risk of death or HF readmission. In the subset of patients with WRF, biomarkers were not prognostic for any outcome. CONCLUSIONS Admission WRF is common in AHF patients and is associated with an increased length of hospitalization, but not adverse in-hospital events, death, or HF readmission. Among those with admission WRF, biomarkers did not risk stratify for adverse events.
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Affiliation(s)
- Nicholas Wettersten
- Division of Cardiovascular MedicineSan Diego Veterans Affairs Medical CenterSan DiegoCaliforniaUSA
- Division of Cardiovascular MedicineUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Stephen Duff
- School of MedicineUniversity College DublinDublinIreland
| | - Yu Horiuchi
- Division of CardiologyMitsui Memorial HospitalTokyoJapan
| | - Dirk J. van Veldhuisen
- Department of Cardiology, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Christian Mueller
- Department of Cardiology, University Hospital BaselUniversity of BaselBaselSwitzerland
| | - Gerasimos Filippatos
- Department of Cardiology, Athens University Hospital AttikonUniversity of AthensAthensGreece
| | - Richard Nowak
- Department of Emergency MedicineHenry Ford Hospital SystemDetroitMichiganUSA
| | - Christopher Hogan
- Division of Emergency Medicine and Acute Care Surgical Services, VCU Medical CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Michael C. Kontos
- Division of Cardiology, VCU Medical CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Chad M. Cannon
- Department of Emergency MedicineUniversity of Kansas Medical CenterKansas CityKansasUSA
| | - Gerhard A. Müeller
- Department of Nephrology and Rheumatology, University Medical Center GöttingenUniversity of GöttingenGöttingenGermany
| | - Robert Birkhahn
- Department of Emergency MedicineNew York MethodistBrooklynNew YorkUSA
| | - Pam Taub
- Division of Cardiovascular MedicineUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Gary M. Vilke
- Department of Emergency MedicineUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Kenneth McDonald
- Department of Cardiology, Mater Misericordiae University HospitalUniversity College DublinDublinIreland
- Department of CardiologySt. Vincent's University HospitalDublinIreland
| | - Niall Mahon
- Department of CardiologySt. Vincent's University HospitalDublinIreland
| | - Julio Nuñez
- Department of Cardiology, Hospital Clínico Universitario Valencia, INCLIVAUniversity of ValenciaValenciaSpain
- CIBER in Cardiovascular DiseasesMadridSpain
| | - Carlo Briguori
- Department of Cardiology, Interventional CardiologyMediterranea CardiocentroNaplesItaly
| | - Claudio Passino
- Department of Cardiology and Cardiovascular MedicineFondazione Gabriele MonasterioPisaItaly
| | - Alan Maisel
- Division of Cardiovascular MedicineUniversity of California, San DiegoLa JollaCaliforniaUSA
| | | | - Joachim H. Ix
- Division of Nephrology‐Hypertension, Department of MedicineUniversity of California San DiegoLa JollaCaliforniaUSA
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13
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Łagosz P, Biegus J, Urban S, Zymliński R. Renal Assessment in Acute Cardiorenal Syndrome. Biomolecules 2023; 13:biom13020239. [PMID: 36830608 PMCID: PMC9953721 DOI: 10.3390/biom13020239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/20/2023] [Accepted: 01/25/2023] [Indexed: 01/28/2023] Open
Abstract
Cardiorenal syndrome (CRS) is a complex, heterogeneous spectrum of symptoms that has kept cardiologists awake for decades. The heart failure (HF) population being burdened with multimorbidity poses diagnostic and therapeutic challenges even for experienced clinicians. Adding deteriorated renal function to the equation, which is one of the strongest predictors of adverse outcome, we measure ourselves against possibly the biggest problem in modern cardiology. With the rapid development of new renal assessment methods, we can treat CRS more effectively than ever. The presented review focuses on explaining the pathophysiology, recent advances and current practices of monitoring renal function in patients with acute CRS. Understanding the dynamic interaction between the heart and the kidney may improve patient care and support the selection of an effective and nephroprotective treatment strategy.
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Affiliation(s)
- Piotr Łagosz
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland
- Institute of Heart Diseases, University Clinical Hospital, 50-556 Wroclaw, Poland
- Correspondence:
| | - Jan Biegus
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland
- Institute of Heart Diseases, University Clinical Hospital, 50-556 Wroclaw, Poland
| | - Szymon Urban
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Robert Zymliński
- Institute of Heart Diseases, Wroclaw Medical University, 50-556 Wroclaw, Poland
- Institute of Heart Diseases, University Clinical Hospital, 50-556 Wroclaw, Poland
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14
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Zhao HL, Hu HJ, Zhao XJ, Chi WW, Liu DM, Wang Q, Cui W. Urine N-terminal pro-B-type natriuretic peptide and plasma proenkephalin are promising biomarkers for early diagnosis of cardiorenal syndrome type 1 in acute decompensated heart failure: a prospective, double-center, observational study in real-world. Ren Fail 2022; 44:1486-1497. [PMID: 36000917 PMCID: PMC9423828 DOI: 10.1080/0886022x.2022.2114367] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Patients with acute decompensated heart failure (ADHF) show cardiorenal syndrome type 1 (CRS-1) are more likely to have a poor outcome. However, the current criteria often lead to delayed CRS-1 diagnosis. Therefore, we evaluated the predictive value of plasma proenkephalin (pPENK) and urine NT-proBNP (uNT-proBNP) for early diagnosis of CRS-1 and vulnerable-phase prognosis in ADHF patients. Methods The plasma NT-proBNP (pNT-proBNP), pPENK, and uNT-proBNP were measured in 121 ADHF patients on admission. The plasma neutrophil gelatinase-associated lipocalin (pNGAL) was chosen as the reference. Logistic regression was used to determine the predictors of CRS-1. The area under the receiver operating curves (ROCs) was calculated to assess the early diagnostic value of pNGAL, pPENK, and uNT-proBNP/uCr for CRS-1. To evaluate the prognostic risk of factors for the 90-d outcomes of all ADHF patients, the Cox regression was performed and the cumulative risk curve was plotted. Results We found that pPENK [OR 1.093 (95% CI 1.022–1.169), p = 0.010; AUROC = 0.899 (95% CI 0.831–0.946)] and uNT-proBNP/uCr ratio [OR 1.015 (95% CI 1.003–1.028), p = 0.012; AUROC = 0.934 (95% CI 0.874–0.971)] could independently predict the occurrence of CRS-1 in hospitalized patients with ADHF. The pPENK [HR 1.014 (95% CI 1.000–1.042), p = 0.044] and uNT-proBNP/uCr ration [HR 0.998 (95% CI 0.997–1.000), p = 0.045] were also independent predictors of the risk of HF readmission or all-cause death 90 d after discharge in ADHF patients. Conclusions The newly found pPENK and noninvasive test of uNT-proBNP/uCr ratio (pg/nmol) on admission may be two promising novel predictive biomarkers for early diagnosis of CRS-1 occurrence and vulnerable-phase outcomes in ADHF patients.
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Affiliation(s)
- Hong-Liang Zhao
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, PR China.,Department of Cardiology, The First Hospital of Hebei Medical University, Shijiazhuang, PR China
| | - Hai-Juan Hu
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, PR China
| | - Xiu-Jie Zhao
- Department of Cardiology, The First Hospital of Hebei Medical University, Shijiazhuang, PR China
| | - Wei-Wei Chi
- Biobank, The First Hospital of Hebei Medical University, Shijiazhuang, PR China
| | - De-Min Liu
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, PR China
| | - Qian Wang
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, PR China
| | - Wei Cui
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, PR China
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15
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Heart Failure and Cardiorenal Syndrome: A Narrative Review on Pathophysiology, Diagnostic and Therapeutic Regimens-From a Cardiologist's View. J Clin Med 2022; 11:jcm11237041. [PMID: 36498617 PMCID: PMC9741317 DOI: 10.3390/jcm11237041] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/22/2022] [Accepted: 11/25/2022] [Indexed: 12/04/2022] Open
Abstract
In cardiorenal syndrome (CRS), heart failure and renal failure are pathophysiologically closely intertwined by the reciprocal relationship between cardiac and renal injury. Type 1 CRS is most common and associated with acute heart failure. A preexistent chronic kidney disease (CKD) is common and contributes to acute kidney injury (AKI) in CRS type 1 patients (acute cardiorenal syndrome). The remaining CRS types are found in patients with chronic heart failure (type 2), acute and chronic kidney diseases (types 3 and 4), and systemic diseases that affect both the heart and the kidney (type 5). Establishing the diagnosis of CRS requires various tools based on the type of CRS, including non-invasive imaging modalities such as TTE, CT, and MRI, adjuvant volume measurement techniques, invasive hemodynamic monitoring, and biomarkers. Albuminuria and Cystatin C (CysC) are biomarkers of glomerular filtration and integrity in CRS and have a prognostic impact. Comprehensive "all-in-one" magnetic resonance imaging (MRI) approaches, including cardiac magnetic resonance imaging (CMR) combined with functional MRI of the kidneys and with brain MRI are proposed for CRS. Hospitalizations due to CRS and mortality are high. Timely diagnosis and initiation of effective adequate therapy, as well as multidisciplinary care, are pertinent for the improvement of quality of life and survival. In addition to the standard pharmacological heart failure medication, including SGLT2 inhibitors (SGLT2i), renal aspects must be strongly considered in the context of CRS, including control of the volume overload (diuretics) with special caution on diuretic resistance. Devices involved in the improvement of myocardial function (e.g., cardiac resynchronization treatment in left bundle branch block, mechanical circulatory support in advanced heart failure) have also shown beneficial effects on renal function.
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16
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Pan HC, Yang SY, Chiou TTY, Shiao CC, Wu CH, Huang CT, Wang TJ, Chen JY, Liao HW, Chen SY, Huang TM, Yang YF, Lin HYH, Chan MJ, Sun CY, Chen YT, Chen YC, Wu VC. Comparative accuracy of biomarkers for the prediction of hospital-acquired acute kidney injury: a systematic review and meta-analysis. Crit Care 2022; 26:349. [PMID: 36371256 PMCID: PMC9652605 DOI: 10.1186/s13054-022-04223-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background Several biomarkers have been proposed to predict the occurrence of acute kidney injury (AKI); however, their efficacy varies between different trials. The aim of this study was to compare the predictive performance of different candidate biomarkers for AKI. Methods In this systematic review, we searched PubMed, Medline, Embase, and the Cochrane Library for papers published up to August 15, 2022. We selected all studies of adults (> 18 years) that reported the predictive performance of damage biomarkers (neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), liver-type fatty acid-binding protein (L-FABP)), inflammatory biomarker (interleukin-18 (IL-18)), and stress biomarker (tissue inhibitor of metalloproteinases-2 × insulin-like growth factor-binding protein-7 (TIMP-2 × IGFBP-7)) for the occurrence of AKI. We performed pairwise meta-analyses to calculate odds ratios (ORs) and 95% confidence intervals (CIs) individually. Hierarchical summary receiver operating characteristic curves (HSROCs) were used to summarize the pooled test performance, and the Grading of Recommendations, Assessment, Development and Evaluations criteria were used to appraise the quality of evidence. Results We identified 242 published relevant studies from 1,803 screened abstracts, of which 110 studies with 38,725 patients were included in this meta-analysis. Urinary NGAL/creatinine (diagnostic odds ratio [DOR] 16.2, 95% CI 10.1–25.9), urinary NGAL (DOR 13.8, 95% CI 10.2–18.8), and serum NGAL (DOR 12.6, 95% CI 9.3–17.3) had the best diagnostic accuracy for the risk of AKI. In subgroup analyses, urinary NGAL, urinary NGAL/creatinine, and serum NGAL had better diagnostic accuracy for AKI than urinary IL-18 in non-critically ill patients. However, all of the biomarkers had similar diagnostic accuracy in critically ill patients. In the setting of medical and non-sepsis patients, urinary NGAL had better predictive performance than urinary IL-18, urinary L-FABP, and urinary TIMP-2 × IGFBP-7: 0.3. In the surgical patients, urinary NGAL/creatinine and urinary KIM-1 had the best diagnostic accuracy. The HSROC values of urinary NGAL/creatinine, urinary NGAL, and serum NGAL were 91.4%, 85.2%, and 84.7%, respectively. Conclusions Biomarkers containing NGAL had the best predictive accuracy for the occurrence of AKI, regardless of whether or not the values were adjusted by urinary creatinine, and especially in medically treated patients. However, the predictive performance of urinary NGAL was limited in surgical patients, and urinary NGAL/creatinine seemed to be the most accurate biomarkers in these patients. All of the biomarkers had similar predictive performance in critically ill patients. Trial registrationCRD42020207883, October 06, 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-04223-6.
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17
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Núñez J, de la Espriella R, Rossignol P, Voors AA, Mullens W, Metra M, Chioncel O, Januzzi JL, Mueller C, Richards AM, de Boer RA, Thum T, Arfsten H, González A, Abdelhamid M, Adamopoulos S, Anker SD, Gal TB, Biegus J, Cohen-Solal A, Böhm M, Emdin M, Jankowska EA, Gustafsson F, Hill L, Jaarsma T, Jhund PS, Lopatin Y, Lund LH, Milicic D, Moura B, Piepoli MF, Ponikowski P, Rakisheva A, Ristic A, Savarese G, Tocchetti CG, Van Linthout S, Volterrani M, Seferovic P, Rosano G, Coats AJS, Bayes-Genis A. Congestion in heart failure: a circulating biomarker-based perspective. A review from the Biomarkers Working Group of the Heart Failure Association, European Society of Cardiology. Eur J Heart Fail 2022; 24:1751-1766. [PMID: 36039656 DOI: 10.1002/ejhf.2664] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/22/2022] [Accepted: 08/22/2022] [Indexed: 11/07/2022] Open
Abstract
Congestion is a cardinal sign of heart failure (HF). In the past, it was seen as a homogeneous epiphenomenon that identified patients with advanced HF. However, current evidence shows that congestion in HF varies in quantity and distribution. This updated view advocates for a congestive-driven classification of HF according to onset (acute vs. chronic), regional distribution (systemic vs. pulmonary), compartment of distribution (intravascular vs. extravascular), and clinical vs. subclinical. Thus, this review will focus on the utility of circulating biomarkers for assessing and managing the different fluid overload phenotypes. This discussion focused on the clinical utility of the natriuretic peptides, carbohydrate antigen 125 (also called mucin 16), bio-adrenomedullin and mid-regional pro-adrenomedullin, ST2 (also known as interleukin-1 receptor-like 1), cluster of differentiation 146, troponin, C-terminal pro-endothelin-1, and parameters of haemoconcentration. The utility of circulation biomarkers on top of clinical evaluation, haemodynamics, and imaging needs to be better determined by dedicated studies. Some multiparametric frameworks in which these tools contribute to management are proposed.
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Affiliation(s)
- Julio Núñez
- Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, Valencia, Spain
- CIBER Cardiovascular, Madrid, Spain
| | - Rafael de la Espriella
- Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, Valencia, Spain
- CIBER Cardiovascular, Madrid, Spain
| | - Patrick Rossignol
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques-Plurithématique 14-33, INSERM U1116, CHRU Nancy, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| | - Adriaan A Voors
- Department of Cardiology University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Marco Metra
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Cardiology. ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', University of Medicine Carol Davila, Bucharest, Romania
| | - James L Januzzi
- Massachusetts General Hospital and Baim Institute for Clinical Research, Boston, MA, USA
| | | | - A Mark Richards
- Cardiovascular Research Institute, National University of Singapore, Singapore, Singapore
- Christchurch Heart Institute, University of Otago, Dunedin, New Zealand
| | - Rudolf A de Boer
- Department of Cardiology University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS) and Rebirth Center for Translational Regenerative Therapies, Hannover Medical School, Hannover, Germany
- Fraunhofer Institute of Toxicology and Experimental Medicine, Hannover, Germany
| | - Henrike Arfsten
- Clinical Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
- German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
| | - Arantxa González
- CIBER Cardiovascular, Madrid, Spain
- Program of Cardiovascular Diseases, CIMA Universidad de Navarra, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | | | - Stamatis Adamopoulos
- 2nd Department of Cardiovascular Medicine, Onassis Cardiac Surgery Center, Athens, Greece
| | - Stefan D Anker
- Department of Cardiology (CVK); and Berlin Institute of Health Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Tuvia Ben Gal
- Cardiology Department, Rabin Medical Center, Petah Tikva, Israel
| | - Jan Biegus
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Alain Cohen-Solal
- Inserm 942 MASCOT, Université de Paris, AP-HP, Hopital Lariboisière, Paris, France
| | - Michael Böhm
- Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin Homburg/Saar, Saarland University, Saarbrücken, Germany
| | - Michele Emdin
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Ewa A Jankowska
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Finn Gustafsson
- Rigshospitalet-Copenhagen University Hospital, Heart Centre, Department of Cardiology, Copenhagen, Denmark
| | | | | | - Pardeep S Jhund
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Yuri Lopatin
- Volgograd State Medical University, Volgograd, Russia
| | - Lars H Lund
- Department of Medicine, Karolinska Institutet, and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Davor Milicic
- University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Brenda Moura
- Faculty of Medicine, University of Porto, Porto, Portugal
- Cardiology Department, Porto Armed Forces Hospital, Porto, Portugal
| | - Massimo F Piepoli
- Cardiology Division, Castel San Giovanni Hospital, Castel San Giovanni, Italy
| | - Piotr Ponikowski
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Amina Rakisheva
- Scientific Research Institute of Cardiology and Internal Medicine, Almaty, Kazakhstan
| | - Arsen Ristic
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Gianluigi Savarese
- Department of Medicine, Karolinska Institutet, and Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Carlo G Tocchetti
- Cardio-Oncology Unit, Department of Translational Medical Sciences, Center for Basic and Clinical Immunology Research (CISI), Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Interdepartmental Hypertension Research Center (CIRIAPA), Federico II University, Naples, Italy
| | - Sophie Van Linthout
- German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
- Berlin Institute of Health (BIH) at Charité-Universitätmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Berlin, Germany
| | | | - Petar Seferovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | - Giuseppe Rosano
- St. George's Hospitals NHS Trust University of London, London, UK
| | | | - Antoni Bayes-Genis
- CIBER Cardiovascular, Madrid, Spain
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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18
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Xu C, Lin S, Mao L, Li Z. Neutrophil gelatinase-associated lipocalin as predictor of acute kidney injury requiring renal replacement therapy: A systematic review and meta-analysis. Front Med (Lausanne) 2022; 9:859318. [PMID: 36213627 PMCID: PMC9533127 DOI: 10.3389/fmed.2022.859318] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 08/30/2022] [Indexed: 11/23/2022] Open
Abstract
Background Patients with severe acute kidney injury (AKI) may require renal replacement therapy (RRT), such as hemodialysis and peritoneal dialysis. Neutrophil gelatinase-associated lipocalin (NGAL) is a sensitive indicator for early diagnosis and recognition of AKI; however, its predictive value of AKI-associated need for RRT needs further evaluation. Methods Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, relevant articles were systematically searched and selected from seven databases. The random effects model was applied to evaluate the predictive performance of NGAL for AKI requiring RRT. The Newcastle–Ottawa Scale (NOS) was used to assess the quality of each included study. Results A total of 18 studies including 1,787 patients with AKI and having an average NOS score of 7.67 were included in the meta-analysis. For plasma/serum NGAL, the pooled sensitivity and specificity with corresponding 95% confidence interval (CI) were 0.75 (95% CI: 0.68–0.81) and 0.76 (95% CI: 0.70–0.81), respectively. The pooled positive likelihood ratio (PLR) was 2.9 (95% CI: 2.1–4.1), and the pooled negative likelihood ratio (NLR) was 0.34 (95% CI: 0.25–0.46). Subsequently, the pooled diagnostic odds ratio (DOR) was 9 (95% CI: 5–16) using a random effects model, and the area under the curve (AUC) of summary receiver operating characteristic to summarize predictive accuracy was 0.82 (95% CI: 0.79–0.85). For urine NGAL, the pooled sensitivity, specificity, PLR, NLR, DOR, and AUC values were 0.78 (95% CI: 0.61–0.90), 0.77 (95% CI: 0.65–0.85), 3.4 (95% CI: 2.4–4.8), 0.28 (95% CI: 0.15–0.52), 12 (95% CI: 6–24), and 0.84 (95% CI: 0.80–0.87), respectively. Conclusion Plasma/serum and urine NGAL levels performed comparably well in predicting AKI requiring RRT. Our findings suggested that NGAL is an effective predictive biomarker for the AKI-associated need for RRT. Nevertheless, more pieces of high-quality evidence and future trials with larger sample sizes are needed for further improvement of patient outcomes. Systematic review registration [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022346595], identifier [CRD42022346595].
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Affiliation(s)
- Chunhua Xu
- Guangdong Provincial Key Laboratory of Systems Biology and Synthetic Biology for Urogenital Tumors, Shenzhen Key Laboratory of Genitourinary Tumor, Department of Urology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital (Shenzhen Institute of Translational Medicine), Shenzhen, Guangdong, China
- Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, Shenzhen University Health Science Center, School of Biomedical Engineering, Shenzhen, Guangdong, China
- Shulan International Medical College, Zhejiang Shuren University, Hangzhou, China
| | - Shan Lin
- Guangdong Provincial Key Laboratory of Systems Biology and Synthetic Biology for Urogenital Tumors, Shenzhen Key Laboratory of Genitourinary Tumor, Department of Urology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital (Shenzhen Institute of Translational Medicine), Shenzhen, Guangdong, China
- Department of Central Laboratory, Shenzhen Hospital, Beijing University of Chinese Medicine, Shenzhen, Guangdong, China
| | - Longyi Mao
- Guangdong Provincial Key Laboratory of Systems Biology and Synthetic Biology for Urogenital Tumors, Shenzhen Key Laboratory of Genitourinary Tumor, Department of Urology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital (Shenzhen Institute of Translational Medicine), Shenzhen, Guangdong, China
| | - Zesong Li
- Guangdong Provincial Key Laboratory of Systems Biology and Synthetic Biology for Urogenital Tumors, Shenzhen Key Laboratory of Genitourinary Tumor, Department of Urology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital (Shenzhen Institute of Translational Medicine), Shenzhen, Guangdong, China
- *Correspondence: Zesong Li,
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19
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Juncos LA, Wieruszewski PM, Kashani K. Pathophysiology of Acute Kidney Injury in Critical Illness: A Narrative Review. Compr Physiol 2022; 12:3767-3780. [PMID: 36073750 DOI: 10.1002/cphy.c210028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Acute kidney injury (AKI) is a syndrome that entails a rapid decline in kidney function with or without injury. The consequences of AKI among acutely ill patients are dire and lead to higher mortality, morbidity, and healthcare cost. To prevent AKI and its short and long-term repercussions, understanding its pathophysiology is essential. Depending on the baseline kidney histology and function reserves, the number of kidney insults, and the intensity of each insult, the clinical presentation of AKI may differ. While many factors are capable of inducing renal injury, they can be categorized into a few processes. The three primary processes reported in the literature are hemodynamic changes, inflammatory reactions, and nephrotoxicity. The majority of patients with AKI will suffer from more than one during their development and/or progression of AKI. Moreover, the development of one usually leads to the instigation of another. Thus, the interactions and progression between these mechanisms may determine the severity and duration of the AKI. Other factors such as organ crosstalk and how our concurrent therapies interact with these mechanisms complicate the pathophysiology of the progression of the AKI even further. In this narrative review article, we describe these three main pathophysiological processes that lead to the development and progression of AKI. © 2022 American Physiological Society. Compr Physiol 12: 1-14, 2022.
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Affiliation(s)
- Luis A Juncos
- Division of Nephrology, Central Arkansas Veterans' Healthcare System, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Patrick M Wieruszewski
- Division of Hospital Pharmacy, Department of Pharmacy, Mayo Clinic, Rochester, Minnesota, USA
| | - Kianoush Kashani
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
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20
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Zdanowicz A, Urban S, Ponikowska B, Iwanek G, Zymliński R, Ponikowski P, Biegus J. Novel Biomarkers of Renal Dysfunction and Congestion in Heart Failure. J Pers Med 2022; 12:jpm12060898. [PMID: 35743683 PMCID: PMC9224642 DOI: 10.3390/jpm12060898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/15/2022] [Accepted: 05/26/2022] [Indexed: 02/04/2023] Open
Abstract
Heart failure is a major public health problem and, despite the constantly emerging, new, effective treatments, it remains a leading cause of morbidity and mortality. Reliable tools for early diagnosis and risk stratification are crucial in the management of HF. This explains a growing interest in the development of new biomarkers related to various pathophysiological mechanisms of HF. In the course of this review, we focused on the markers of congestion and renal dysfunction in terms of their interference with cardiovascular homeostasis. Congestion is a hallmark feature of heart failure, contributing to symptoms, morbidity, and hospitalizations of patients with HF and has, therefore, become a therapeutic target in AHF. On the other hand, impaired renal function by altering the volume status contributes to the development and progression of HF and serves as a marker of an adverse clinical outcome. Early detection of congestion and an adequate assessment of renal status are essential for the prompt administration of patient-tailored therapy. This review provides an insight into recent advances in the field of HF biomarkers that could be potentially implemented in diagnosis and risk stratification of patients with HF.
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Affiliation(s)
- Agata Zdanowicz
- Institute of Heart Diseases, Medical University, 50-556 Wroclaw, Poland; (A.Z.); (G.I.); (R.Z.); (P.P.); (J.B.)
| | - Szymon Urban
- Institute of Heart Diseases, Medical University, 50-556 Wroclaw, Poland; (A.Z.); (G.I.); (R.Z.); (P.P.); (J.B.)
- Correspondence: ; Tel.: +48-71-733-11-12
| | - Barbara Ponikowska
- Student Scientific Organization, Institute of Heart Diseases, Medical University, 50-556 Wroclaw, Poland;
| | - Gracjan Iwanek
- Institute of Heart Diseases, Medical University, 50-556 Wroclaw, Poland; (A.Z.); (G.I.); (R.Z.); (P.P.); (J.B.)
| | - Robert Zymliński
- Institute of Heart Diseases, Medical University, 50-556 Wroclaw, Poland; (A.Z.); (G.I.); (R.Z.); (P.P.); (J.B.)
| | - Piotr Ponikowski
- Institute of Heart Diseases, Medical University, 50-556 Wroclaw, Poland; (A.Z.); (G.I.); (R.Z.); (P.P.); (J.B.)
| | - Jan Biegus
- Institute of Heart Diseases, Medical University, 50-556 Wroclaw, Poland; (A.Z.); (G.I.); (R.Z.); (P.P.); (J.B.)
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21
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Mandurino-Mirizzi A, Munafò A, Crimi G. Contrast-Associated Acute Kidney Injury. J Clin Med 2022; 11:2167. [PMID: 35456260 PMCID: PMC9027950 DOI: 10.3390/jcm11082167] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 03/28/2022] [Accepted: 04/06/2022] [Indexed: 01/25/2023] Open
Abstract
Contrast-associated acute kidney injury (CA-AKI) is an impairment of renal function, which occurs within days of intravascular administration of iodinated contrast media. Taking into account that minimally invasive cardiac interventions are becoming increasingly popular, compared to traditional surgery, given their impact on prognosis and costs, CA-AKI remains a subject of increasing interest for patients and physicians. This review summarizes the epidemiology and risk stratification, diagnostic criteria, pathophysiology and clinical implications of CA-AKI, providing evidence for the most studied preventive strategies.
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Affiliation(s)
| | - Andrea Munafò
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (A.M.-M.); (A.M.)
| | - Gabriele Crimi
- Interventional Cardiology Unit, Cardio-Thoraco Vascular Department (DICATOV), IRCCS Ospedale Policlinico San Martino, 16100 Genova, Italy
- IRCCS Italian Cardiovascular Network & Department of Internal Medicine, University of Genova, 16100 Genova, Italy
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22
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Aimo A, Lupón J, Bayes-Genis A, Emdin M. Urinary NGAL in acute heart failure revisited: the game is not over yet. Int J Cardiol 2022; 357:113-114. [PMID: 35301078 DOI: 10.1016/j.ijcard.2022.03.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 03/10/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Alberto Aimo
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy.
| | - Josep Lupón
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; CIBERCV, Carlos III Institute of Health, Madrid, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antoni Bayes-Genis
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; CIBERCV, Carlos III Institute of Health, Madrid, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Michele Emdin
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
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23
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Decongestion, kidney injury and prognosis in patients with acute heart failure. Int J Cardiol 2022; 354:29-37. [PMID: 35202737 DOI: 10.1016/j.ijcard.2022.02.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 02/11/2022] [Accepted: 02/16/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND In patients with acute heart failure (AHF), the development of worsening renal function with appropriate decongestion is thought to be a benign functional change and not associated with poor prognosis. We investigated whether the benefit of decongestion outweighs the risk of concurrent kidney tubular damage and leads to better outcomes. METHODS We retrospectively analyzed data from the AKINESIS study, which enrolled AHF patients requiring intravenous diuretic therapy. Urine neutrophil gelatinase-associated lipocalin (uNGAL) and B-type natriuretic peptide (BNP) were serially measured during the hospitalization. Decongestion was defined as ≥30% BNP decrease at discharge compared to admission. Univariable and multivariable Cox models were assessed for one-year mortality. RESULTS Among 736 patients, 53% had ≥30% BNP decrease at discharge. Levels of uNGAL and BNP at each collection time point had positive but weak correlations (r ≤ 0.133). Patients without decongestion and with higher discharge uNGAL values had worse one-year mortality, while those with decongestion had better outcomes regardless of uNGAL values (p for interaction 0.018). This interaction was also significant when the change in BNP was analyzed as a continuous variable (p < 0.001). Although higher peak and discharge uNGAL were associated with mortality in univariable analysis, only ≥30% BNP decrease was a significant predictor after multivariable adjustment. CONCLUSIONS Among AHF patients treated with diuretic therapy, decongestion was generally not associated with kidney tubular damage assessed by uNGAL. Kidney tubular damage with adequate decongestion does not impact outcomes; however, kidney injury without adequate decongestion is associated with a worse prognosis.
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24
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Kremer D, Post A, Gomes-Neto AW, Groothof D, Kunutsor SK, Nilsen T, Hidden C, Sundrehagen E, Eisenga MF, Navis G, Bakker SJL. Plasma neutrophil gelatinase-associated lipocalin and kidney graft outcome. Clin Kidney J 2022; 15:235-243. [PMID: 35145638 PMCID: PMC8824800 DOI: 10.1093/ckj/sfab219] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Plasma neutrophil gelatinase-associated lipocalin (pNGAL) has been investigated extensively in acute kidney injury. This study investigated its pathophysiological significance and utility as marker for graft failure and mortality in stable kidney transplant recipients (KTR). METHODS Baseline pNGAL was measured in 698 KTR (58% male, age 53 ± 13 years, estimated glomerular filtration rate 52.4 ± 20.4 mL/min/1.73 m2) at median 5.4 (interquartile range 1.8-12.0) years after transplantation, enrolled in the prospective TransplantLines Food and Nutrition Biobank and Cohort Study. RESULTS pNGAL concentrations were higher in males, younger patients, patients with a deceased-donor kidney and higher serum creatinine. Independent of these, pNGAL was positively associated with urinary protein excretion, systemic inflammation parameters and calcineurin inhibitor use. During median follow-up of 5.3 (4.5-6.0) years, death-censored graft failure rates were 3.9%, 7.3% and 25.0% across increasing tertiles of pNGAL (Plog-rank < 0.001). Cox-regression analyses showed no independent associations of pNGAL with mortality, but strong associations with graft failure (hazard ratio, per doubling 4.16; 95% confidence interval 3.03-5.71; P < 0.001), which remained independent of adjustment for confounders. These associations were present only in patients with pre-existent proteinuria and poor kidney function. CONCLUSIONS pNGAL is associated with parameters of kidney graft damage and with graft failure. The latter association is particularly present in KTR with pre-existent poor kidney function and proteinuria. Trial Registration: ClinicalTrials.gov NCT02811835.
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Affiliation(s)
- Daan Kremer
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Adrian Post
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - António W Gomes-Neto
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Dion Groothof
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Setor K Kunutsor
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
- Translational Health Sciences, Bristol Medical School, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Bristol, UK
| | | | | | | | - Michele F Eisenga
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gerjan Navis
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Stephan J L Bakker
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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25
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Templeton EM, Lassé M, Kleffmann T, Ellmers LJ, Palmer SC, Davidson T, Scott NJA, Pickering JW, Charles CJ, Endre ZH, Cameron VA, Richards AM, Rademaker MT, Pilbrow AP. Identifying Candidate Protein Markers of Acute Kidney Injury in Acute Decompensated Heart Failure. Int J Mol Sci 2022; 23:ijms23021009. [PMID: 35055195 PMCID: PMC8778509 DOI: 10.3390/ijms23021009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/15/2021] [Accepted: 01/13/2022] [Indexed: 11/16/2022] Open
Abstract
One-quarter of patients with acute decompensated heart failure (ADHF) experience acute kidney injury (AKI)—an abrupt reduction or loss of kidney function associated with increased long-term mortality. There is a critical need to identify early and real-time markers of AKI in ADHF; however, to date, no protein biomarkers have exhibited sufficient diagnostic or prognostic performance for widespread clinical uptake. We aimed to identify novel protein biomarkers of AKI associated with ADHF by quantifying changes in protein abundance in the kidneys that occur during ADHF development and recovery in an ovine model. Relative quantitative protein profiling was performed using sequential window acquisition of all theoretical fragment ion spectra–mass spectrometry (SWATH–MS) in kidney cortices from control sheep (n = 5), sheep with established rapid-pacing-induced ADHF (n = 8), and sheep after ~4 weeks recovery from ADHF (n = 7). Of the 790 proteins quantified, we identified 17 candidate kidney injury markers in ADHF, 1 potential kidney marker of ADHF recovery, and 2 potential markers of long-term renal impairment (differential abundance between groups of 1.2–2.6-fold, adjusted p < 0.05). Among these 20 candidate protein markers of kidney injury were 6 candidates supported by existing evidence and 14 novel candidates not previously implicated in AKI. Proteins of differential abundance were enriched in pro-inflammatory signalling pathways: glycoprotein VI (activated during ADHF development; adjusted p < 0.01) and acute phase response (repressed during recovery from ADHF; adjusted p < 0.01). New biomarkers for the early detection of AKI in ADHF may help us to evaluate effective treatment strategies to prevent mortality and improve outcomes for patients.
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Affiliation(s)
- Evelyn M. Templeton
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch 8014, New Zealand; (M.L.); (L.J.E.); (N.J.A.S.); (J.W.P.); (C.J.C.); (V.A.C.); (A.M.R.); (M.T.R.); (A.P.P.)
- Correspondence: ; Tel.: +64-03-364-12-53
| | - Moritz Lassé
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch 8014, New Zealand; (M.L.); (L.J.E.); (N.J.A.S.); (J.W.P.); (C.J.C.); (V.A.C.); (A.M.R.); (M.T.R.); (A.P.P.)
| | - Torsten Kleffmann
- Research Infrastructure Centre, Division of Health Sciences, University of Otago, Dunedin 9016, New Zealand;
| | - Leigh J. Ellmers
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch 8014, New Zealand; (M.L.); (L.J.E.); (N.J.A.S.); (J.W.P.); (C.J.C.); (V.A.C.); (A.M.R.); (M.T.R.); (A.P.P.)
| | - Suetonia C. Palmer
- Department of Medicine, University of Otago, Christchurch 8014, New Zealand;
| | - Trent Davidson
- Department of Anatomical Pathology, Prince of Wales Hospital, Sydney, NSW 2031, Australia;
| | - Nicola J. A. Scott
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch 8014, New Zealand; (M.L.); (L.J.E.); (N.J.A.S.); (J.W.P.); (C.J.C.); (V.A.C.); (A.M.R.); (M.T.R.); (A.P.P.)
| | - John W. Pickering
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch 8014, New Zealand; (M.L.); (L.J.E.); (N.J.A.S.); (J.W.P.); (C.J.C.); (V.A.C.); (A.M.R.); (M.T.R.); (A.P.P.)
| | - Christopher J. Charles
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch 8014, New Zealand; (M.L.); (L.J.E.); (N.J.A.S.); (J.W.P.); (C.J.C.); (V.A.C.); (A.M.R.); (M.T.R.); (A.P.P.)
| | - Zoltan H. Endre
- Department of Nephrology, Prince of Wales Hospital, Sydney, NSW 2031, Australia;
| | - Vicky A. Cameron
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch 8014, New Zealand; (M.L.); (L.J.E.); (N.J.A.S.); (J.W.P.); (C.J.C.); (V.A.C.); (A.M.R.); (M.T.R.); (A.P.P.)
| | - A. Mark Richards
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch 8014, New Zealand; (M.L.); (L.J.E.); (N.J.A.S.); (J.W.P.); (C.J.C.); (V.A.C.); (A.M.R.); (M.T.R.); (A.P.P.)
- Cardiovascular Research Institute, Department of Cardiology, National University of Singapore, Singapore 119077, Singapore
| | - Miriam T. Rademaker
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch 8014, New Zealand; (M.L.); (L.J.E.); (N.J.A.S.); (J.W.P.); (C.J.C.); (V.A.C.); (A.M.R.); (M.T.R.); (A.P.P.)
| | - Anna P. Pilbrow
- Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch 8014, New Zealand; (M.L.); (L.J.E.); (N.J.A.S.); (J.W.P.); (C.J.C.); (V.A.C.); (A.M.R.); (M.T.R.); (A.P.P.)
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Dotare T, Ishiwata S, Matsue Y, Nakamura Y, Sunayama T, Maeda D, Yatsu S, Suda S, Kato T, Hiki M, Kasai T, Minamino T. Prevalence and Prognostic Relevance of Isolated Tubular Dysfunction in Patients With Acute Heart Failure. Circ J 2021; 86:709-714. [PMID: 34955476 DOI: 10.1253/circj.cj-21-0759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Renal dysfunction includes glomerular dysfunction (GD) and tubular dysfunction (TD); however, there is limited information regarding the prevalence, coexistence, and prognostic relevance of TD and GD among patients with acute heart failure (AHF).Methods and Results:This study reviewed 489 patients with AHF who had undergone testing at the time of their admission to identify GD (estimated glomerular filtration rate <60 mL/min/1.73 m2) and TD (urinary β-2-microglobulin ≥300 µg/gCr). Patients were grouped according to the presence/absence of GD and TD as having neither condition (n=116), isolated TD (n=101), isolated GD (n=83), or coexisting GD plus TD (n=189). During a median follow up of 466 days (interquartile range: 170-871 days), 107 deaths were observed. Kaplan-Meier curve analysis revealed that, relative to the absence of a GD and TD group, higher mortality rates were observed in the groups with isolated TD, isolated GD, and coexisting GD plus TD (log-rank P<0.001). Similarly, the adjusted Cox regression analyses revealed that significantly higher risks of mortality were associated with isolated TD, isolated GD, and coexisting GD plus TD. Moreover, isolated GD and isolated TD were both independently associated with increased risks of all-cause mortality. CONCLUSIONS As a significant proportion of patients with AHF had isolated TD and an increased risk of mortality, patients with AHF should be screened for TD even if they do not have GD.
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Affiliation(s)
- Taishi Dotare
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | - Sayaki Ishiwata
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine.,Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine
| | - Yuya Matsue
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine.,Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine
| | - Yutaka Nakamura
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | - Tsutomu Sunayama
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | - Daichi Maeda
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine.,Department of Cardiology, Osaka Medical and Pharmaceutical University
| | - Shoichiro Yatsu
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | - Shoko Suda
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | - Takao Kato
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | - Masaru Hiki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | - Takatoshi Kasai
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine.,Sleep and Sleep-Disordered Breathing Center, Juntendo University Hospital
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine.,Japan Agency for Medical Research and Development-Core Research for Evolutionary Medical Science and Technology (AMED-CREST), Japan Agency for Medical Research and Development
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27
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Sunayama T, Yatsu S, Matsue Y, Dotare T, Maeda D, Ishiwata S, Nakamura Y, Suda S, Kato T, Hiki M, Kasai T, Minamino T. Urinary liver-type fatty acid-binding protein as a prognostic marker in patients with acute heart failure. ESC Heart Fail 2021; 9:442-449. [PMID: 34921522 PMCID: PMC8787958 DOI: 10.1002/ehf2.13730] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 10/20/2021] [Accepted: 11/10/2021] [Indexed: 11/30/2022] Open
Abstract
Aims Urinary liver‐type fatty acid‐binding protein (L‐FABP) is expressed in proximal tubular epithelial cells and excreted into the urine during tubular injury. We hypothesized that high urinary L‐FABP is associated with poor prognosis in patients with acute heart failure (AHF). Methods and results We analysed 623 patients (74 ± 13 years old; 60.0% male patients) with AHF. Urinary L‐FABP levels were measured at the time of admission and adjusted for the urinary creatinine concentration. The primary endpoint was all‐cause mortality. The median value and interquartile range of urinary L‐FABP levels were 6.66 and 3.37–21.1 μg/gCr, respectively. Urinary L‐FABP levels were significantly correlated with both beta‐2 microglobulin and cystatin C levels; the correlation with the former was higher than that with the latter. During the follow‐up of 631 (interquartile range: 387–875) days, 142 deaths occurred. A high tertile of urinary L‐FABP level was associated with high mortality; this association was retained after adjusting for other covariates (second tertile hazard ratio 1.40, P = 0.152 vs. first tertile; third tertile hazard ratio 1.94, P = 0.005 vs. first tertile). Conclusions Urinary L‐FABP is more closely associated with tubular dysfunction than with glomerular dysfunction. Tubular dysfunction, which was evaluated based on urinary L‐FABP levels, in patients with AHF is associated with all‐cause mortality and is independent of pre‐existing risk factors. L‐FABP should be considered for use in the prognosis of AHF.
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Affiliation(s)
- Tsutomu Sunayama
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shoichiro Yatsu
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuya Matsue
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Taishi Dotare
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Daichi Maeda
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Cardiology, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Sayaki Ishiwata
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yutaka Nakamura
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shoko Suda
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takao Kato
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Masaru Hiki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takatoshi Kasai
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Japan Agency for Medical Research and Development-Core Research for Evolutionary Medical Science and Technology (AMED-CREST), Japan Agency for Medical Research and Development, Tokyo, Japan
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28
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Wang L, Zhao YT. Development and Validation of a Prediction Model for Acute Kidney Injury Among Patients With Acute Decompensated Heart Failure. Front Cardiovasc Med 2021; 8:719307. [PMID: 34869626 PMCID: PMC8634389 DOI: 10.3389/fcvm.2021.719307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 10/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Acute kidney injury is an adverse event that carries significant morbidity among patients with acute decompensated heart failure (ADHF). We planned to develop a parsimonious model that is simple enough to use in clinical practice to predict the risk of acute kidney injury (AKI) occurrence. Methods: Six hundred and fifty patients with ADHF were enrolled in this study. Data for each patient were collected from medical records. We took three different approaches of variable selection to derive four multivariable logistic regression model. We selected six candidate predictors that led to a relatively stable outcome in different models to derive the final prediction model. The prediction model was verified through the use of the C-Statistics and calibration curve. Results: Acute kidney injury occurred in 42.8% of the patients. Advanced age, diabetes, previous renal dysfunction, high baseline creatinine, high B-type natriuretic peptide, and hypoalbuminemia were the strongest predictors for AKI. The prediction model showed moderate discrimination C-Statistics: 0.766 (95% CI, 0.729-0.803) and good identical calibration. Conclusion: In this study, we developed a prediction model and nomogram to estimate the risk of AKI among patients with ADHF. It may help clinical physicians detect AKI and manage it promptly.
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Affiliation(s)
- Lei Wang
- Department of Cardiology, Aerospace Center Hospital, Beijing, China
| | - Yun-Tao Zhao
- Department of Cardiology, Aerospace Center Hospital, Beijing, China
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29
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Liu H, Wan X, Shi Y, Huang F, Shu H, Huang R, Gu L. Neutrophil Gelatinase-Associated Lipocalin Contributes to Increased Risk of Cardiovascular Death After Acute Coronary Syndrome. Int J Gen Med 2021; 14:4887-4895. [PMID: 34475780 PMCID: PMC8407785 DOI: 10.2147/ijgm.s328022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 08/05/2021] [Indexed: 11/23/2022] Open
Abstract
Background Neutrophil gelatinase-associated lipocalin (NGAL) has been suggested to reflect early renal dysfunction. We investigated the predictive significance of serum NGAL in predicting cardiovascular (CV) death in an old-age population with coronary heart disease (CHD). Methods In total, 633 CHD patients with a stable clinical condition were enrolled. The measurements of serum NGAL and other laboratory indices were performed within 24 hours after admission. Adjusted analysis was used to assess relationships between serum NGAL and CV death during the 10-year follow-up period. Results Multivariate logistic regression analysis demonstrated that elevated NGAL levels were related to a higher prevalence of CV disease history [quartile 4, 2.41 (1.60–4.59), P-trend <0.001]. The Kaplan–Meier curve indicated that patients with high NGAL levels tended to have a higher rate of CV death than patients with low NGAL levels. A multivariate Cox model suggested that increased levels of NGAL were independently linked with elevated risk of CV death (HR=2.62, 95% CI 1.51–4.96, P<0.001) during the 10-year follow-up period, after adjusting for related confounding factors using sensitivity analysis. Furthermore, the receiver operating characteristics (ROC) curve demonstrated that serum NGAL (AUC=0.917, 95% CI 0.895–0.940, P<0.001) had an ideal predictive value in predicting CV death. Conclusion Serum levels of NGAL were elevated in patients with CHD and may be a new parameter that could independently predict CV death in these patients, which may strengthen its potential application in clinical practice.
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Affiliation(s)
- Huogen Liu
- Department of Critical Care Medicine, Mindong Hospital Affiliated to Fujian Medical University, Fu'an City, Fujian Province, 355000, People's Republic of China
| | - Xin Wan
- Department of Critical Care Medicine, Mindong Hospital Affiliated to Fujian Medical University, Fu'an City, Fujian Province, 355000, People's Republic of China
| | - Yundi Shi
- Department of Critical Care Medicine, Mindong Hospital Affiliated to Fujian Medical University, Fu'an City, Fujian Province, 355000, People's Republic of China
| | - Fengming Huang
- Department of Critical Care Medicine, Mindong Hospital Affiliated to Fujian Medical University, Fu'an City, Fujian Province, 355000, People's Republic of China
| | - Hailin Shu
- Department of Critical Care Medicine, Mindong Hospital Affiliated to Fujian Medical University, Fu'an City, Fujian Province, 355000, People's Republic of China
| | - Rijin Huang
- Department of Critical Care Medicine, Mindong Hospital Affiliated to Fujian Medical University, Fu'an City, Fujian Province, 355000, People's Republic of China
| | - Ling Gu
- Department of Critical Care Medicine, Mindong Hospital Affiliated to Fujian Medical University, Fu'an City, Fujian Province, 355000, People's Republic of China
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30
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Goffredo G, Barone R, Di Terlizzi V, Correale M, Brunetti ND, Iacoviello M. Biomarkers in Cardiorenal Syndrome. J Clin Med 2021; 10:jcm10153433. [PMID: 34362216 PMCID: PMC8348334 DOI: 10.3390/jcm10153433] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 07/29/2021] [Indexed: 01/16/2023] Open
Abstract
Cardiorenal syndrome is a clinical manifestation of the bidirectional interaction between the heart and kidney diseases. Over the last years, in patients with cardiovascular diseases, several biomarkers have been studied in order to better assess renal function as well as to identify patients prone to experiencing chronic or acute worsening of renal function. The aim of this review is to focus on the possible clinical usefulness of the most recent biomarkers in the setting of cardiorenal syndrome.
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Affiliation(s)
- Giovanni Goffredo
- Department of Medical and Surgical Sciences, University of Foggia, Viale Luigi Pinto 1, 71122 Foggia, Italy; (G.G.); (R.B.); (V.D.T.); (M.C.); (N.D.B.)
- Cardiology Unit, University Policlinic Hospital Riuniti, Viale Luigi Pinto 1, 71122 Foggia, Italy
| | - Roberta Barone
- Department of Medical and Surgical Sciences, University of Foggia, Viale Luigi Pinto 1, 71122 Foggia, Italy; (G.G.); (R.B.); (V.D.T.); (M.C.); (N.D.B.)
- Cardiology Unit, University Policlinic Hospital Riuniti, Viale Luigi Pinto 1, 71122 Foggia, Italy
| | - Vito Di Terlizzi
- Department of Medical and Surgical Sciences, University of Foggia, Viale Luigi Pinto 1, 71122 Foggia, Italy; (G.G.); (R.B.); (V.D.T.); (M.C.); (N.D.B.)
- Cardiology Unit, University Policlinic Hospital Riuniti, Viale Luigi Pinto 1, 71122 Foggia, Italy
| | - Michele Correale
- Department of Medical and Surgical Sciences, University of Foggia, Viale Luigi Pinto 1, 71122 Foggia, Italy; (G.G.); (R.B.); (V.D.T.); (M.C.); (N.D.B.)
- Cardiology Unit, University Policlinic Hospital Riuniti, Viale Luigi Pinto 1, 71122 Foggia, Italy
| | - Natale Daniele Brunetti
- Department of Medical and Surgical Sciences, University of Foggia, Viale Luigi Pinto 1, 71122 Foggia, Italy; (G.G.); (R.B.); (V.D.T.); (M.C.); (N.D.B.)
- Cardiology Unit, University Policlinic Hospital Riuniti, Viale Luigi Pinto 1, 71122 Foggia, Italy
| | - Massimo Iacoviello
- Department of Medical and Surgical Sciences, University of Foggia, Viale Luigi Pinto 1, 71122 Foggia, Italy; (G.G.); (R.B.); (V.D.T.); (M.C.); (N.D.B.)
- Cardiology Unit, University Policlinic Hospital Riuniti, Viale Luigi Pinto 1, 71122 Foggia, Italy
- Correspondence:
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31
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Horiuchi Y, Wettersten N, van Veldhuisen DJ, Mueller C, Filippatos G, Nowak R, Hogan C, Kontos MC, Cannon CM, Müeller GA, Birkhahn R, Taub P, Vilke GM, Barnett O, McDonald K, Mahon N, Nuñez J, Briguori C, Passino C, Maisel A, Murray PT. Relation of Decongestion and Time to Diuretics to Biomarker Changes and Outcomes in Acute Heart Failure. Am J Cardiol 2021; 147:70-79. [PMID: 33617811 DOI: 10.1016/j.amjcard.2021.01.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 01/03/2023]
Abstract
Prompt treatment may mitigate the adverse effects of congestion in the early phase of heart failure (HF) hospitalization, which may lead to improved outcomes. We analyzed 814 acute HF patients for the relationships between time to first intravenous loop diuretics, changes in biomarkers of congestion and multiorgan dysfunction, and 1-year composite end point of death or HF hospitalization. B-type natriuretic peptide (BNP), high sensitivity cardiac troponin I (hscTnI), urine and serum neutrophil gelatinase-associated lipocalin, and galectin 3 were measured at hospital admission, hospital day 1, 2, 3 and discharge. Time to diuretics was not correlated with the timing of decongestion defined as BNP decrease ≥ 30% compared with admission. Earlier BNP decreases but not time to diuretics were associated with earlier and greater decreases in hscTnI and urine neutrophil gelatinase-associated lipocalin, and lower incidence of the composite end point. After adjustment for confounders, only no BNP decrease at discharge was significantly associated with mortality but not the composite end point (p = 0.006 and p = 0.062, respectively). In conclusion, earlier time to decongestion but not the time to diuretics was associated with better biomarker trajectories. Residual congestion at discharge rather than the timing of decongestion predicted a worse prognosis.
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Affiliation(s)
- Yu Horiuchi
- Division of Cardiovascular Medicine, University of California San Diego, La Jolla, California; Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Nicholas Wettersten
- Division of Cardiovascular Medicine, University of California San Diego, La Jolla, California
| | - Dirk J van Veldhuisen
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Christian Mueller
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Gerasimos Filippatos
- Department of Cardiology, Athens University Hospital Attikon, University of Athens, Athens, Greece
| | - Richard Nowak
- Department of Emergency Medicine, Henry Ford Hospital System, Detroit, Michigan
| | - Christopher Hogan
- Division of Emergency Medicine and Acute Care Surgical Services, VCU Medical Center, Virginia Commonwealth University, Richmond, Virginia
| | - Michael C Kontos
- Division of Cardiology, VCU Medical Center, Virginia Commonwealth University, Richmond, Virginia
| | - Chad M Cannon
- Department of Emergency Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Gerhard A Müeller
- Department of Nephrology and Rheumatology, University Medical Centre Göttingen, University of Göttingen, Göttingen, Germany
| | - Robert Birkhahn
- Department of Emergency Medicine, New York Methodist Hospital, New York, New York
| | - Pam Taub
- Division of Cardiovascular Medicine, University of California San Diego, La Jolla, California
| | - Gary M Vilke
- Department of Emergency Medicine, University of California San Diego, La Jolla, California
| | - Olga Barnett
- Division of Cardiology, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Kenneth McDonald
- Department of Cardiology, School of Medicine, University College Dublin, Dublin, Ireland; Department of Cardiology, St Vincent's University Hospital, Dublin, Ireland
| | - Niall Mahon
- Department of Cardiology, School of Medicine, University College Dublin, Dublin, Ireland; Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Julio Nuñez
- Department of Cardiology, Valencia University Hospital, INCLIVA, Valencia, Spain; Centro de Investigación Biomédica en Red (CIBER) in Cardiovascular Diseases, Madrid, Spain
| | - Carlo Briguori
- Department of Cardiology, Mediterranea Cardiocentro, Naples, Italy
| | - Claudio Passino
- Department of Cardiology and Cardiovascular Medicine, Fondazione Gabriele Monasterio, Pisa, Italy
| | - Alan Maisel
- Division of Cardiovascular Medicine, University of California San Diego, La Jolla, California
| | - Patrick T Murray
- Department of Medicine, School of Medicine, University College Dublin, Dublin, Ireland.
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32
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Horiuchi YU, Wettersten N, Veldhuisen DJV, Mueller C, Filippatos G, Nowak R, Hogan C, Kontos MC, Cannon CM, Müeller GA, Birkhahn R, Taub P, Vilke GM, Barnett O, McDONALD K, Mahon N, Nuñez J, Briguori C, Passino C, Maisel A, Murray PT. Potential Utility of Cardiorenal Biomarkers for Prediction and Prognostication of Worsening Renal Function in Acute Heart Failure. J Card Fail 2021; 27:533-541. [PMID: 33296713 DOI: 10.1016/j.cardfail.2020.11.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 11/09/2020] [Accepted: 11/18/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Multiple different pathophysiologic processes can contribute to worsening renal function (WRF) in acute heart failure. METHODS AND RESULTS We retrospectively analyzed 787 patients with acute heart failure for the relationship between changes in serum creatinine and biomarkers including brain natriuretic peptide, high sensitivity cardiac troponin I, galectin 3, serum neutrophil gelatinase-associated lipocalin, and urine neutrophil gelatinase-associated lipocalin. WRF was defined as an increase of greater than or equal to 0.3 mg/dL or 50% in creatinine within first 5 days of hospitalization. WRF was observed in 25% of patients. Changes in biomarkers and creatinine were poorly correlated (r ≤ 0.21) and no biomarker predicted WRF better than creatinine. In the multivariable Cox analysis, brain natriuretic peptide and high sensitivity cardiac troponin I, but not WRF, were significantly associated with the 1-year composite of death or heart failure hospitalization. WRF with an increasing urine neutrophil gelatinase-associated lipocalin predicted an increased risk of heart failure hospitalization. CONCLUSIONS Biomarkers were not able to predict WRF better than creatinine. The 1-year outcomes were associated with biomarkers of cardiac stress and injury but not with WRF, whereas a kidney injury biomarker may prognosticate WRF for heart failure hospitalization.
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Affiliation(s)
- Y U Horiuchi
- From the Division of Cardiovascular Medicine, University of California San Diego, La Jolla, California; Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Nicholas Wettersten
- From the Division of Cardiovascular Medicine, University of California San Diego, La Jolla, California
| | - Dirk J van Veldhuisen
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Christian Mueller
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Gerasimos Filippatos
- Department of Cardiology, Athens University Hospital Attikon, University of Athens, Athens, Greece
| | - Richard Nowak
- Department of Emergency Medicine, Henry Ford Hospital System, Detroit, Michigan
| | - Christopher Hogan
- Division of Emergency Medicine and Acute Care Surgical Services, VCU Medical Center, Virginia Commonwealth University, Richmond, Virginia
| | - Michael C Kontos
- Division of Cardiology, VCU Medical Center, Virginia Commonwealth University, Richmond, Virginia
| | - Chad M Cannon
- Department of Emergency Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Gerhard A Müeller
- Department of Nephrology and Rheumatology, University Medical Centre Göttingen, University of Göttingen, Göttingen, Germany
| | - Robert Birkhahn
- Department of Emergency Medicine, New York Methodist Hospital, Brooklyn, New York
| | - Pam Taub
- From the Division of Cardiovascular Medicine, University of California San Diego, La Jolla, California
| | - Gary M Vilke
- Department of Emergency Medicine, University of California San Diego, La Jolla, California
| | - Olga Barnett
- Division of Cardiology, Danylo Halytsky Lviv National Medical University, Lviv Oblast, Ukraine
| | - Kenneth McDONALD
- Department of Cardiology, School of Medicine, University College Dublin, Belfield, Dublin, Ireland; Department of Cardiology, St Vincent's University Hospital, Dublin, Ireland
| | - Niall Mahon
- Department of Cardiology, School of Medicine, University College Dublin, Belfield, Dublin, Ireland; Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Julio Nuñez
- Department of Cardiology, Valencia University Hospital, INCLIVA, Valencia, Spain; Centro de Investigación Biomédica en Red (CIBER) in Cardiovascular Diseases, Madrid, Spain
| | - Carlo Briguori
- Department of Cardiology, Mediterranea Cardiocentro, Naples, Italy
| | - Claudio Passino
- Department of Cardiology and Cardiovascular Medicine, Fondazione Gabriele Monasterio, Pisa, Italy; and the
| | - Alan Maisel
- From the Division of Cardiovascular Medicine, University of California San Diego, La Jolla, California
| | - Patrick T Murray
- Department of Medicine, School of Medicine, University College Dublin, Health Sciences Centre, Dublin, Ireland.
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33
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Wettersten N, Horiuchi Y, van Veldhuisen DJ, Ix JH, Mueller C, Filippatos G, Nowak R, Hogan C, Kontos MC, Cannon CM, Müeller GA, Birkhahn R, Taub P, Vilke GM, Duff S, McDonald K, Mahon N, Nuñez J, Briguori C, Passino C, Maisel A, Murray PT. Decongestion discriminates risk for one-year mortality in patients with improving renal function in acute heart failure. Eur J Heart Fail 2021; 23:1122-1130. [PMID: 33788989 DOI: 10.1002/ejhf.2179] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/19/2021] [Accepted: 03/23/2021] [Indexed: 01/28/2023] Open
Abstract
AIMS Improving renal function (IRF) is paradoxically associated with worse outcomes in acute heart failure (AHF), but outcomes may differ based on response to decongestion. We explored if the relationship of IRF with mortality in hospitalized AHF patients differs based on successful decongestion. METHODS AND RESULTS We evaluated 760 AHF patients from AKINESIS for the relationship between IRF, change in B-type natriuretic peptide (BNP), and 1-year mortality. IRF was defined as a ≥20% increase in estimated glomerular filtration rate (eGFR) relative to admission. Adequate decongestion was defined as a ≥40% decrease in last measured BNP relative to admission. IRF occurred in 22% of patients who had a mean age of 69 years, 58% were men, 72% were white, and median admission eGFR was 49 mL/min/1.73 m2 . IRF patients had more severe heart failure reflected by lower admission eGFR, higher blood urea nitrogen, lower systolic blood pressure, lower sodium, and higher use of inotropes. IRF patients had higher 1-year mortality (25%) than non-IRF patients (15%) (P < 0.01). However, this relationship differed by BNP trajectory (P-interaction = 0.03). When stratified by BNP change, non-IRF patients and IRF patients with decreasing BNP had lower 1-year mortality than either non-IRF and IRF patients without decreasing BNP. However, in multivariate analysis, IRF was not associated with mortality [adjusted hazard ratio (HR) 1.0, 95% confidence interval (CI) 0.7-1.5] while BNP was (adjusted HR 0.5, 95% CI 0.3-0.7). When IRF was evaluated as transiently occurring or persisting at discharge, again only BNP change was significantly associated with mortality. CONCLUSION Improving renal function is associated with mortality in AHF but not independent of other variables and congestion status. Achieving adequate decongestion, as reflected by lower BNP, in AHF is more strongly associated with mortality than IRF.
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Affiliation(s)
- Nicholas Wettersten
- Division of Cardiovascular Medicine, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA.,Division of Cardiovascular Medicine, University of California San Diego, La Jolla, CA, USA
| | - Yu Horiuchi
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Dirk J van Veldhuisen
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Joachim H Ix
- Division of Nephrology-Hypertension, Department of Medicine, University of California San Diego and Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Christian Mueller
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Gerasimos Filippatos
- Department of Cardiology, Athens University Hospital Attikon, University of Athens, Athens, Greece
| | - Richard Nowak
- Department of Emergency Medicine, Henry Ford Hospital System, Detroit, MI, USA
| | - Christopher Hogan
- Division of Emergency Medicine and Acute Care Surgical Services, VCU Medical Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Michael C Kontos
- Division of Cardiology, VCU Medical Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Chad M Cannon
- Department of Emergency Medicine, University of Kansas Medical Center, Kansas City, MO, USA
| | - Gerhard A Müeller
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, University of Göttingen, Göttingen, Germany
| | - Robert Birkhahn
- Department of Emergency Medicine, New York Methodist, Brooklyn, NY, USA
| | - Pam Taub
- Division of Cardiovascular Medicine, University of California San Diego, La Jolla, CA, USA
| | - Gary M Vilke
- Department of Emergency Medicine, University of California San Diego, La Jolla, CA, USA
| | - Stephen Duff
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Kenneth McDonald
- Department of Cardiology, Mater Misericordiae University Hospital, University College Dublin, Dublin, Ireland.,Department of Cardiology, St. Vincent's University Hospital, Dublin, Ireland
| | - Niall Mahon
- Department of Cardiology, Mater Misericordiae University Hospital, University College Dublin, Dublin, Ireland
| | - Julio Nuñez
- Department of Cardiology, Hospital Clínico Universitario Valencia, INCLIVA, University of Valencia, Valencia, Spain.,CIBER in Cardiovascular Diseases, Madrid, Spain
| | - Carlo Briguori
- Department of Cardiology, Interventional Cardiology, Mediterranea Cardiocentro, Naples, Italy
| | - Claudio Passino
- Department of Cardiology and Cardiovascular Medicine, Fondazione Gabriele Monasterio, Pisa, Italy
| | - Alan Maisel
- Division of Cardiovascular Medicine, University of California San Diego, La Jolla, CA, USA
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34
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Banai A, Rozenfeld KL, Loewenstein I, Zahler D, Shtark M, Goldiner I, Banai S, Shacham Y. Neutrophil Gelatinase-Associated Lipocalin for the Assessment of Reversible versus Persistent Renal Tubular Damage in ST-Segment Myocardial Infarction Patients. Blood Purif 2021; 50:925-930. [PMID: 33756457 DOI: 10.1159/000513943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 12/16/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Most studies investigated the value of neutrophil gelatinase-associated lipocalin (NGAL) as a marker of renal tubular injury only at a single time point. We investigated the possible utilization of NGAL level dynamics for the identification of different renal injury patterns in ST-elevation myocardial infarction (STEMI) patients. METHODS Blood samples for plasma NGAL in 132 STEMI patients were drawn immediately before and 24 h following primary coronary intervention. Abnormal elevation of NGAL levels was defined using the cardiac surgery-associated NGAL score with NGAL levels ≥100 ng/mL suggesting renal tubular damage. According to NGAL levels at 0 and 24 h, patients were stratified into 3 groups: no tubular damage (NGAL <100 ng/mL in both exams), reversible tubular damage (NGAL >100 ng/mL at 0 h but <100 ng/mL at 24 h), and persistent tubular damage (NGAL >100 ng/mL at both 0 and 24 h). RESULTS Mean age was 62 ± 13 years, and 78% were men. Of these patients, 29/132 (22%) demonstrated reversible tubular damage, and 36/132 (27%) persistent tubular damage. Only 13/132 patients (10%) progressed to clinical acute kidney injury during hospitalization, all of whom had persistent tubular injury. In multivariate regression model, symptom duration was independently associated with persistent tubular damage, both as continues variable (odds ratio [OR] 1.02, 95% confidence interval [CI] 1.01-1.04; p = 0.04) and for symptom duration >360 min (OR 2.66, 95% CI 1.07-6.63; p = 0.03). CONCLUSIONS Renal tubular damage is common among STEMI patients. Dynamic NGAL measurement may differentiate between reversible and persistent tubular damage. Further trials are needed in order to assess the complex cardiorenal interactions.
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Affiliation(s)
- Ariel Banai
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Keren-Lee Rozenfeld
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Itamar Loewenstein
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Zahler
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Shtark
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilana Goldiner
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shmuel Banai
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yacov Shacham
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel,
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35
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Albert C, Haase M, Albert A, Zapf A, Braun-Dullaeus RC, Haase-Fielitz A. Biomarker-Guided Risk Assessment for Acute Kidney Injury: Time for Clinical Implementation? Ann Lab Med 2021; 41:1-15. [PMID: 32829575 PMCID: PMC7443517 DOI: 10.3343/alm.2021.41.1.1] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/23/2020] [Accepted: 08/02/2020] [Indexed: 01/01/2023] Open
Abstract
Acute kidney injury (AKI) is a common and serious complication in hospitalized patients, which continues to pose a clinical challenge for treating physicians. The most recent Kidney Disease Improving Global Outcomes practice guidelines for AKI have restated the importance of earliest possible detection of AKI and adjusting treatment accordingly. Since the emergence of initial studies examining the use of neutrophil gelatinase-associated lipocalin (NGAL) and cycle arrest biomarkers, tissue inhibitor metalloproteinase-2 (TIMP-2) and insulin-like growth factor-binding protein (IGFBP7), for early diagnosis of AKI, a vast number of studies have investigated the accuracy and additional clinical benefits of these biomarkers. As proposed by the Acute Dialysis Quality Initiative, new AKI diagnostic criteria should equally utilize glomerular function and tubular injury markers for AKI diagnosis. In addition to refining our capabilities in kidney risk prediction with kidney injury biomarkers, structural disorder phenotypes referred to as "preclinical-" and "subclinical AKI" have been described and are increasingly recognized. Additionally, positive biomarker test findings were found to provide prognostic information regardless of an acute decline in renal function (positive serum creatinine criteria). We summarize and discuss the recent findings focusing on two of the most promising and clinically available kidney injury biomarkers, NGAL and cell cycle arrest markers, in the context of AKI phenotypes. Finally, we draw conclusions regarding the clinical implications for kidney risk prediction.
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Affiliation(s)
- Christian Albert
- Medical Faculty, University Clinic for Cardiology and Angiology, Otto-von-Guericke-University Magdeburg, Magdeburg,
Germany
- Diaverum Renal Services, MVZ Potsdam, Potsdam,
Germany
| | - Michael Haase
- Diaverum Renal Services, MVZ Potsdam, Potsdam,
Germany
- Medical Faculty, Otto-von-Guericke University Magdeburg, Magdeburg,
Germany
| | - Annemarie Albert
- Diaverum Renal Services, MVZ Potsdam, Potsdam,
Germany
- Department of Nephrology and Endocrinology, Klinikum Ernst von Bergmann, Potsdam,
Germany
| | - Antonia Zapf
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf,
Germany
| | | | - Anja Haase-Fielitz
- Department of Cardiology, Immanuel Diakonie Bernau, Heart Center Brandenburg, Brandenburg Medical School Theodor Fontane (MHB),
Germany
- Institute of Social Medicine and Health Systems Research, Otto-von-Guericke University Magdeburg, Magdeburg,
Germany
- Faculty of Health Sciences Brandenburg, Potsdam,
Germany
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36
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Scurt FG, Bose K, Canbay A, Mertens PR, Chatzikyrkou C. [Acute kidney injury following acute pancreatitis (AP-AKI): Definition, Pathophysiology, Diagnosis and Therapy]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2020; 58:1241-1266. [PMID: 33291178 DOI: 10.1055/a-1255-3413] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Acute pancreatitis (AP) is the most frequent gastrointestinal cause for hospitalization and one of the leading causes of in-hospital deaths. Severe acute pancreatitis is often associated with multiorgan failure and especially with acute kidney injury (AKI). AKI can develop early or late in the course of the disease and is a strong determinator of outcome. The mortality in the case of dialysis-dependent AKI and acute pancreatitis raises exponentially in the affected patients. AP-induced AKI (AP-AKI) shows many similarities but also distinct differences to other causes of AKI occurring in the intensive care unit setting. The knowledge of the exact pathophysiology can help to adjust, control and improve therapeutic approaches to the disease. Unfortunately, there are only a few studies dealing with AP and AKI.In this review, we discuss recent data about pathogenesis, causes and management of AP-AKI in patients with severe acute pancreatitis and exploit in this regard the diagnostic and prognostic potential of respective newer serum and urine markers.
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Affiliation(s)
- Florian Gunnar Scurt
- Klinik für Nieren- und Hochdruckerkrankungen, Diabetologie und Endokrinologie, Medizinische Fakultät der Otto-von-Guericke-Universität, Magdeburg, Deutschland.,Health Campus Immunology, Infectiology and Inflammation, Otto-von-Guericke-University, Magdeburg, Germany
| | - Katrin Bose
- Health Campus Immunology, Infectiology and Inflammation, Otto-von-Guericke-University, Magdeburg, Germany.,Universitätsklinik für Gastroenterologie, Hepatologie und Infektiologie, Medizinische Fakultät der Otto-von-Guericke-Universität, Otto-von-Guericke-Universität, Magdeburg, Deutschland
| | - Ali Canbay
- Ruhr-Universität Bochum, Medizinische Klinik, Universitätsklinikum Knappschaftskrankenhaus Bochum GmbH, Bochum, Deutschland
| | - Peter R Mertens
- Klinik für Nieren- und Hochdruckerkrankungen, Diabetologie und Endokrinologie, Medizinische Fakultät der Otto-von-Guericke-Universität, Magdeburg, Deutschland.,Health Campus Immunology, Infectiology and Inflammation, Otto-von-Guericke-University, Magdeburg, Germany
| | - Christos Chatzikyrkou
- Klinik für Nieren- und Hochdruckerkrankungen, Diabetologie und Endokrinologie, Medizinische Fakultät der Otto-von-Guericke-Universität, Magdeburg, Deutschland.,Health Campus Immunology, Infectiology and Inflammation, Otto-von-Guericke-University, Magdeburg, Germany
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37
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Abstract
PURPOSE OF REVIEW To characterize and interpret recent studies of biomarkers of cardiorenal syndrome. RECENT FINDINGS Recent studies have questioned the mechanisms and significance of moderate worsening renal function (WRF) in patients with acute heart failure. In the setting of successful decongestion, WRF may not predict cardiorenal morbidity. Cardiac-specific biomarkers including cardiac troponins and natriuretic peptides are highly prognostic in acute and chronic HF patients with kidney impairment, and serial changes in these markers during hospitalization are also predictive of longer-term adverse outcomes. These markers also predict new HF in patients with established chronic kidney disease (CKD). The role of kidney tubular injury markers in acute HF remains controversial, with inconsistent associations with short- and long-term cardiorenal outcomes. Many cases of WRF in acute HF are not characterized by a clear pattern of renal tubular injury. Cardiac-specific and renal-specific biomarkers may provide mechanistic and prognostic information in cardiorenal syndromes.
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Affiliation(s)
- Stephen Seliger
- University of Maryland School of Medicine, 22 S. Greene Street N3W143, Baltimore, MD, 21201, USA.
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38
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Abstract
Background Cardiorenal syndrome (CRS), a serious condition with high morbidity and mortality, is characterized by the coexistence of cardiac abnormality and renal dysfunction. There is limited information about CRS in association thalassemia. This study aimed to investigate the prevalence of CRS in thalassemia patients and also associated risk factors. Methods Thalassemia patients who attended the out-patient clinic of a tertiary care university hospital from October 2016 to September 2017 were enrolled onto this cross-sectional study. Clinical and laboratory findings from 2 consecutive visits, 3 months apart, were assessed. The criteria for diagnosis of CRS was based on a system proposed by Ronco and McCullough. Cardiac abnormalities are assessed by clinical presentation, establishment of acute or chronic heart failure using definitions from 2016 ESC guidelines or from structural abnormalities shown in an echocardiogram. Renal dysfunction was defined as chronic kidney disease according to the 2012 KDIGO guidelines. Results Out of 90 thalassemia patients, 25 (27.8%) had CRS. The multivariable analysis showed a significant association between CRS and extramedullary hematopoiesis (EMH) (odds ratio (OR) 20.55, p = 0.016); thalassemia type [β0/βE vs β0/β0 thalassemia (OR 0.005, p = 0.002)]; pulmonary hypertension (OR 178.1, p = 0.001); elevated serum NT-proBNP (OR 1.028, p = 0.022), and elevated 24-h urine magnesium (OR 1.913, p = 0.016). There was no association found between CRS and frequency of blood transfusion, serum ferritin, liver iron concentration, cardiac T2*, type of iron chelating agents, or urine neutrophil gelatinase-associated lipocalin level. Conclusions CRS is relatively common in thalassemia patients. Its occurrence is associated with laboratory parameters which are easily measured in clinical practice.
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39
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Han X, Zhang S, Chen Z, Adhikari BK, Zhang Y, Zhang J, Sun J, Wang Y. Cardiac biomarkers of heart failure in chronic kidney disease. Clin Chim Acta 2020; 510:298-310. [PMID: 32710942 DOI: 10.1016/j.cca.2020.07.040] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/18/2020] [Accepted: 07/20/2020] [Indexed: 12/15/2022]
Abstract
Heart failure remains a continuing threat to patients with chronic kidney disease (CKD). Although various heart failure biomarkers have been applied for early detection, diagnosis and prognosis in CKD, these are easily affected by renal insufficiency thus limiting use in these patients. In this review, the major four groups of heart failure biomarkers are explored. These include those associated with: myocardial stretch, ie, brain natriuretic peptide (BNP), N-terminal pro-BNP (NT-proBNP) and mid-regional proatrial natriuretic peptide (MR-proANP); myocyte injury, ie, high-sensitivity troponin T (hsTnT), heart-type fatty acid-binding protein (H-FABP); fibrosis, matrix remodelling and inflammation, ie, soluble growth stimulating gene 2 (sST2), galectin-3 (Gal-3), growth differentiation factor-15 (GDF-15); and renal function, ie, neutrophil gelatinase-associated lipocalin (NGAL) kidney injury molecule-1 (KIM-1), cystatin C (CysC), urinary sodium and urinary albumin. This review highlights classic heart failure biomarkers with critical values adjusted to glomerular filtration rate, summarizes research progress of new heart failure biomarkers and future research directions. Because diagnostic and prognostic usefulness of a single time point biomarker is limited, biomarkers should be combined and monitored at multiple times for optimal clinical impact.
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Affiliation(s)
- Xiaorong Han
- Department of Cardiovascular Centre, The First Hospital of Jilin University, Changchun, Jilin 130021, China
| | - Shuai Zhang
- Department of Cardiovascular Centre, The First Hospital of Jilin University, Changchun, Jilin 130021, China
| | - Zhongbo Chen
- Department of Cardiovascular Centre, The First Hospital of Jilin University, Changchun, Jilin 130021, China
| | | | - Ying Zhang
- Department of Cardiovascular Centre, The First Hospital of Jilin University, Changchun, Jilin 130021, China
| | - Jin Zhang
- Department of Cardiovascular Centre, The First Hospital of Jilin University, Changchun, Jilin 130021, China
| | - Jian Sun
- Department of Cardiovascular Centre, The First Hospital of Jilin University, Changchun, Jilin 130021, China.
| | - Yonggang Wang
- Department of Cardiovascular Centre, The First Hospital of Jilin University, Changchun, Jilin 130021, China.
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40
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Sarhene M, Wang Y, Wei J, Huang Y, Li M, Li L, Acheampong E, Zhengcan Z, Xiaoyan Q, Yunsheng X, Jingyuan M, Xiumei G, Guanwei F. Biomarkers in heart failure: the past, current and future. Heart Fail Rev 2020; 24:867-903. [PMID: 31183637 DOI: 10.1007/s10741-019-09807-z] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Despite the enhanced knowledge of the pathophysiology of heart failure (HF), it still remains a serious syndrome with substantial morbidity, mortality, and frequent hospitalizations. These are due to the current improvements in other cardiovascular diseases (like myocardial infarction), the aging population, and growing prevalence of comorbidities. Biomarker-guided management has brought a new dimension in prognostication, diagnosis, and therapy options. Following the recommendation of natriuretic peptides (B-type natriuretic peptide and N-terminal-proBNP), many other biomarkers have been thoroughly studied to reflect different pathophysiological processes (such as fibrosis, inflammation, myocardial injury, and remodeling) in HF and some of them (like cardiac troponins, soluble suppression of tumorigenesis-2, and galectin 3) have subsequently been recommended to aid in the diagnosis and prognostication in HF. Consequently, multi-marker approach has also been approved owing to the varied nature of HF syndrome. In this review, we discussed the guidelines available for HF biomarkers, procedures for evaluating novel markers, and the utilities of both emerging and established biomarkers for risk stratification, diagnosis, and management of HF in the clinics. We later looked at how the rapidly emerging field-OMICs, can help transform HF biomarkers discoveries and establishment.
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Affiliation(s)
- Michael Sarhene
- First teaching hospital of Tianjin University of Traditional Chinese Medicine, Number 314 Anshanxi Road, Nankai District, Tianjin, China.,State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China.,Tianjin Laboratory of Translational Research of TCM Prescription and Syndrome, Tianjin, 300193, China
| | - Yili Wang
- First teaching hospital of Tianjin University of Traditional Chinese Medicine, Number 314 Anshanxi Road, Nankai District, Tianjin, China.,State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China.,Tianjin Laboratory of Translational Research of TCM Prescription and Syndrome, Tianjin, 300193, China
| | - Jing Wei
- First teaching hospital of Tianjin University of Traditional Chinese Medicine, Number 314 Anshanxi Road, Nankai District, Tianjin, China.,State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China.,Tianjin Laboratory of Translational Research of TCM Prescription and Syndrome, Tianjin, 300193, China
| | - Yuting Huang
- First teaching hospital of Tianjin University of Traditional Chinese Medicine, Number 314 Anshanxi Road, Nankai District, Tianjin, China.,State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China.,Tianjin Laboratory of Translational Research of TCM Prescription and Syndrome, Tianjin, 300193, China
| | - Min Li
- First teaching hospital of Tianjin University of Traditional Chinese Medicine, Number 314 Anshanxi Road, Nankai District, Tianjin, China.,State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China.,Tianjin Laboratory of Translational Research of TCM Prescription and Syndrome, Tianjin, 300193, China
| | - Lan Li
- First teaching hospital of Tianjin University of Traditional Chinese Medicine, Number 314 Anshanxi Road, Nankai District, Tianjin, China.,State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China.,Tianjin Laboratory of Translational Research of TCM Prescription and Syndrome, Tianjin, 300193, China
| | - Enoch Acheampong
- State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Zhou Zhengcan
- First teaching hospital of Tianjin University of Traditional Chinese Medicine, Number 314 Anshanxi Road, Nankai District, Tianjin, China.,State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Qin Xiaoyan
- First teaching hospital of Tianjin University of Traditional Chinese Medicine, Number 314 Anshanxi Road, Nankai District, Tianjin, China.,State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xu Yunsheng
- First teaching hospital of Tianjin University of Traditional Chinese Medicine, Number 314 Anshanxi Road, Nankai District, Tianjin, China.,State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Mao Jingyuan
- First teaching hospital of Tianjin University of Traditional Chinese Medicine, Number 314 Anshanxi Road, Nankai District, Tianjin, China
| | - Gao Xiumei
- State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Fan Guanwei
- First teaching hospital of Tianjin University of Traditional Chinese Medicine, Number 314 Anshanxi Road, Nankai District, Tianjin, China. .,State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China.
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41
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Abstract
Acute heart failure (AHF) is a syndrome defined as the new onset (de novo heart failure (HF)) or worsening (acutely decompensated heart failure (ADHF)) of symptoms and signs of HF, mostly related to systemic congestion. In the presence of an underlying structural or functional cardiac dysfunction (whether chronic in ADHF or undiagnosed in de novo HF), one or more precipitating factors can induce AHF, although sometimes de novo HF can result directly from the onset of a new cardiac dysfunction, most frequently an acute coronary syndrome. Despite leading to similar clinical presentations, the underlying cardiac disease and precipitating factors may vary greatly and, therefore, the pathophysiology of AHF is highly heterogeneous. Left ventricular diastolic or systolic dysfunction results in increased preload and afterload, which in turn lead to pulmonary congestion. Fluid retention and redistribution result in systemic congestion, eventually causing organ dysfunction due to hypoperfusion. Current treatment of AHF is mostly symptomatic, centred on decongestive drugs, at best tailored according to the initial haemodynamic status with little regard to the underlying pathophysiological particularities. As a consequence, AHF is still associated with high mortality and hospital readmission rates. There is an unmet need for increased individualization of in-hospital management, including treatments targeting the causative factors, and continuation of treatment after hospital discharge to improve long-term outcomes.
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Affiliation(s)
- Mattia Arrigo
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Mariell Jessup
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Wilfried Mullens
- Ziekenhuis Oost Limburg, Genk, Belgium
- University of Hasselt, Hasselt, Belgium
| | - Nosheen Reza
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ajay M Shah
- School of Cardiovascular Medicine & Sciences, King's College London British Heart Foundation Centre, London, UK
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, Faculty of Health Sciences, Department of Medicine and Cardiology, University of Cape Town, Cape Town, South Africa
| | - Alexandre Mebazaa
- Université de Paris, MASCOT, Inserm, Paris, France.
- Department of Anesthesia, Burn and Critical Care Medicine, AP-HP, Hôpital Lariboisière, Paris, France.
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42
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Wettersten N, Horiuchi Y, van Veldhuisen DJ, Mueller C, Filippatos G, Nowak R, Hogan C, Kontos MC, Cannon CM, Müeller GA, Birkhahn R, Taub P, Vilke GM, Barnett O, McDonald K, Mahon N, Nuñez J, Briguori C, Passino C, Maisel A, Murray PT. Short-term prognostic implications of serum and urine neutrophil gelatinase-associated lipocalin in acute heart failure: findings from the AKINESIS study. Eur J Heart Fail 2020; 22:251-263. [PMID: 31863682 DOI: 10.1002/ejhf.1642] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/11/2019] [Accepted: 09/18/2019] [Indexed: 01/23/2023] Open
Abstract
AIMS Kidney impairment has been associated with worse outcomes in acute heart failure (AHF), although recent studies challenge this association. Neutrophil gelatinase-associated lipocalin (NGAL) is a novel biomarker of kidney tubular injury. Its prognostic role in AHF has not been evaluated in large cohorts. The present study aimed to determine if serum NGAL (sNGAL) or urine NGAL (uNGAL) is superior to creatinine for predicting short-term outcomes in AHF. METHODS AND RESULTS The study was conducted in an international, multicentre, prospective cohort consisting of 927 patients with AHF. Admission and peak values of sNGAL, uNGAL and uNGAL/urine creatinine (uCr) ratio were compared to admission and peak serum creatinine (sCr). The composite endpoints were death, initiation of renal replacement therapy, heart failure (HF) readmission and any emergent HF-related outpatient visit within 30 and 60 days, respectively. The mean age of the cohort was 69 years and 62% were male. The median length of stay was 6 days. The composite endpoint occurred in 106 patients and 154 patients within 30 and 60 days, respectively. Serum NGAL was more predictive than uNGAL and the uNGAL/uCr ratio but was not superior to sCr [area under the curve: admission sNGAL 0.61, 95% confidence interval (CI) 0.55-0.67, and 0.59, 95% CI 0.54-0.65; peak sNGAL: 0.60, 95% CI 0.54-0.66, and 0.57, 95% CI 0.52-0.63; admission sCr: 0.60, 95% CI 0.54-0.64, and 0.59, 95% CI 0.53-0.64; peak sCr: 0.61, 95% CI 0.55-0.67, and 0.59, 95% CI 0.54-0.64, at 30 and 60 days, respectively]. NGAL was not predictive of the composite endpoint in multivariate analysis. CONCLUSIONS Serum NGAL outperformed uNGAL but neither was superior to admission or peak sCr for predicting adverse events.
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Affiliation(s)
- Nicholas Wettersten
- Division of Cardiovascular Medicine, University of California San Diego, La Jolla, CA, USA
| | - Yu Horiuchi
- Division of Cardiovascular Medicine, Veterans Affairs Medical Center San Diego, La Jolla, CA, USA
| | - Dirk J van Veldhuisen
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Christian Mueller
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Gerasimos Filippatos
- Department of Cardiology, Athens University Hospital Attikon, University of Athens, Athens, Greece
| | - Richard Nowak
- Department of Emergency Medicine, Henry Ford Hospital System, Detroit, MI, USA
| | - Christopher Hogan
- Division of Emergency Medicine and Acute Care Surgical Services, VCU Medical Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Michael C Kontos
- Division of Cardiology, VCU Medical Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Chad M Cannon
- Department of Emergency Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Gerhard A Müeller
- Department of Nephrology and Rheumatology, University Medical Centre Göttingen, University of Göttingen, Göttingen, Germany
| | - Robert Birkhahn
- Department of Emergency Medicine, New York Methodist Hospital, New York, NY, USA
| | - Pam Taub
- Division of Cardiovascular Medicine, University of California San Diego, La Jolla, CA, USA
| | - Gary M Vilke
- Department of Emergency Medicine, University of California San Diego, La Jolla, CA, USA
| | - Olga Barnett
- Division of Cardiology, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Kenneth McDonald
- Department of Cardiology, School of Medicine, University College Dublin, Dublin, Ireland
- Department of Cardiology, St Vincent's University Hospital, Dublin, Ireland
| | - Niall Mahon
- Department of Cardiology, School of Medicine, University College Dublin, Dublin, Ireland
- Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Julio Nuñez
- Department of Cardiology, Valencia University Hospital, INCLIVA, Valencia, Spain
- Centro de Investigación Biomédica en Red (CIBER) in Cardiovascular Diseases, Madrid, Spain
| | - Carlo Briguori
- Department of Cardiology, Clinica Mediterranea, Naples, Italy
| | - Claudio Passino
- Department of Cardiology and Cardiovascular Medicine, Fondazione Gabriele Monasterio, Pisa, Italy
| | - Alan Maisel
- Division of Cardiovascular Medicine, University of California San Diego, La Jolla, CA, USA
| | - Patrick T Murray
- Department of Medicine, School of Medicine, University College Dublin, Dublin, Ireland
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43
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Gosmanova EO, Lyubarova R. Neutrophil gelatinase‐associated lipocalin in acute heart failure: time to move on? Eur J Heart Fail 2020; 22:264-266. [DOI: 10.1002/ejhf.1684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 10/24/2019] [Indexed: 11/10/2022] Open
Affiliation(s)
- Elvira O. Gosmanova
- Nephrology SectionStratton Veterans Affairs Medical Center Albany NY USA
- Division of Nephrology and HypertensionAlbany Medical College Albany NY USA
| | - Radmila Lyubarova
- Division of Cardiology, Department of MedicineAlbany Medical College Albany NY USA
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44
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Mullens W, Damman K, Testani JM, Martens P, Mueller C, Lassus J, Tang WW, Skouri H, Verbrugge FH, Orso F, Hill L, Ural D, Lainscak M, Rossignol P, Metra M, Mebazaa A, Seferovic P, Ruschitzka F, Coats A. Evaluation of kidney function throughout the heart failure trajectory – a position statement from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2020; 22:584-603. [DOI: 10.1002/ejhf.1697] [Citation(s) in RCA: 120] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/28/2019] [Accepted: 11/05/2019] [Indexed: 12/25/2022] Open
Affiliation(s)
| | - Kevin Damman
- University Medical Center Groningen University of Groningen Groningen The Netherlands
| | | | | | | | - Johan Lassus
- Cardiology, Heart and Lung Center Helsinki University and Helsinki University Hospital Helsinki Finland
| | | | - Hadi Skouri
- American University of Beirut Medical Center Beirut Lebanon
| | | | | | - Loreena Hill
- School of Nursing and Midwifery Queen's University Belfast UK
| | | | | | - Patrick Rossignol
- Université de Lorraine INSERM, Centre d'Investigations Clinique – 1433 and INSERM U1116; CHRU Nancy; F‐CRIN INI‐CRCT Nancy France
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45
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Griffin M, Rao VS, Fleming J, Raghavendra P, Turner J, Mahoney D, Wettersten N, Maisel A, Ivey-Miranda JB, Inker L, Tang WHW, Wilson FP, Testani JM. Effect on Survival of Concurrent Hemoconcentration and Increase in Creatinine During Treatment of Acute Decompensated Heart Failure. Am J Cardiol 2019; 124:1707-1711. [PMID: 31601358 PMCID: PMC6959849 DOI: 10.1016/j.amjcard.2019.08.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/21/2019] [Accepted: 08/26/2019] [Indexed: 01/11/2023]
Abstract
Hemoconcentration during the treatment of acute decompensated heart failure is a surrogate for plasma volume reduction and is associated with improved survival, but most definitions only allow for hemoconcentration to be determined retrospectively. An increase in serum creatinine can also be a marker of aggressive decongestion, but in isolation is not specific. Our objective was to determine if combined hemoconcentration and worsening creatinine could better identify patients that were aggressively treated and, as such, may have improved postdischarge outcomes. A total of 4,181 patients hospitalized with acute decompensated heart failure were evaluated. Those who experienced both hemoconcentration and worsening creatinine at any point had a profile consistent with aggressive in-hospital treatment and longer length of stay (p <0.01), higher loop diuretic doses (p <0.001), greater weight (p = 0.001), and net fluid loss (p <0.001) compared with the remainder of the cohort. In isolation, neither worsening creatinine (p = 0.11) nor hemoconcentration (p = 0.36) at any time were associated with improved survival. However, patients who experienced both (21%) had significantly better survival (hazard ratio 0.80, 95% confidence interval 0.69 to 0.94, pinteraction = 0.005). In conclusion, this combination of hemoconcentration and worsening creatinine, which can be determined prospectively during patient care, was associated with in-hospital parameters consistent with aggressive diuresis and improved postdischarge survival.
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Affiliation(s)
- Matthew Griffin
- Sections of Cardiovascular Medicine, Yale University, New Haven, Connecticut
| | - Veena S Rao
- Sections of Cardiovascular Medicine, Yale University, New Haven, Connecticut
| | - James Fleming
- Sections of Cardiovascular Medicine, Yale University, New Haven, Connecticut
| | | | - Jeffrey Turner
- Department of Nephrology, Yale University School of Medicine, New Haven, Connecticut
| | - Devin Mahoney
- Sections of Cardiovascular Medicine, Yale University, New Haven, Connecticut
| | - Nicholas Wettersten
- Department of Cardiovascular Medicine, Veteran Affairs Medical Center, San Diego, California
| | - Alan Maisel
- Department of Cardiovascular Medicine, Veteran Affairs Medical Center, San Diego, California
| | - Juan B Ivey-Miranda
- Hospital de Cardiologia, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Lesley Inker
- Tufts University Medical Center, Boston, Massachusetts
| | | | - Francis Perry Wilson
- Department of Nephrology, Yale University School of Medicine, New Haven, Connecticut
| | - Jeffrey M Testani
- Sections of Cardiovascular Medicine, Yale University, New Haven, Connecticut.
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Manguba AS, Vela Parada X, Coca SG, Lala A. Synthesizing Markers of Kidney Injury in Acute Decompensated Heart Failure: Should We Even Keep Looking? Curr Heart Fail Rep 2019; 16:257-273. [DOI: 10.1007/s11897-019-00448-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Wettersten N, Horiuchi Y, van Veldhuisen DJ, Mueller C, Filippatos G, Nowak R, Hogan C, Kontos MC, Cannon CM, Müeller GA, Birkhahn R, Taub P, Vilke GM, Barnett O, McDonald K, Mahon N, Nuñez J, Briguori C, Passino C, Murray PT, Maisel A. B-type natriuretic peptide trend predicts clinical significance of worsening renal function in acute heart failure. Eur J Heart Fail 2019; 21:1553-1560. [PMID: 31769140 DOI: 10.1002/ejhf.1627] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 07/27/2019] [Accepted: 09/02/2019] [Indexed: 12/24/2022] Open
Abstract
AIMS In acute heart failure (AHF), relationships between changes in B-type natriuretic peptide (BNP) and worsening renal function (WRF) and its prognostic implications have not been fully determined. We investigated the relationship between WRF and a decrease in BNP with in-hospital and 1-year mortality in AHF. METHODS AND RESULTS The Acute Kidney Injury NGAL Evaluation of Symptomatic heart faIlure Study (AKINESIS) was a prospective, international, multicentre study of AHF patients. Severe WRF (sWRF) was a sustained increase of ≥44.2 μmol/L (0.5 mg/dL) or ≥50% in creatinine, non-severe WRF (nsWRF) was a non-sustained increase of ≥26.5 μmol/L (0.3 mg/dL) or ≥50% in creatinine, and WRF with clinical deterioration was nsWRF with renal replacement therapy, inotrope use, or mechanical ventilation. Decreased BNP was defined as a ≥30% reduction in the last measured BNP compared to admission BNP. Among 814 patients, the incidence of WRF was not different between patients with or without decreased BNP (nsWRF: 33% vs. 31%, P = 0.549; sWRF: 11% vs. 9%, P = 0.551; WRF with clinical deterioration: 8% vs. 10%, P = 0.425). Decreased BNP was associated with better in-hospital and 1-year mortality regardless of WRF, while WRF was associated with worse outcomes only in patients without decreased BNP. In multivariate Cox regression analysis, decreased BNP, sWRF, and WRF with clinical deterioration were significantly associated with 1-year mortality. CONCLUSIONS Decreased BNP was associated with better in-hospital and long-term outcomes. WRF was only associated with adverse outcomes in patients without decreased BNP.
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Affiliation(s)
- Nicholas Wettersten
- Division of Cardiovascular Medicine, University of California, San Diego, CA, USA.,Division of Cardiovascular Medicine, Veterans Affairs Medical Center, San Diego, CA, USA
| | - Yu Horiuchi
- Division of Cardiovascular Medicine, University of California, San Diego, CA, USA.,Division of Cardiovascular Medicine, Veterans Affairs Medical Center, San Diego, CA, USA
| | - Dirk J van Veldhuisen
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Christian Mueller
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Gerasimos Filippatos
- Department of Cardiology, Athens University Hospital Attikon, University of Athens, Athens, Greece
| | - Richard Nowak
- Department of Emergency Medicine, Henry Ford Hospital System, Detroit, Michigan, USA
| | - Christopher Hogan
- Division of Emergency Medicine and Acute Care Surgical Services, VCU Medical Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Michael C Kontos
- Division of Cardiology, VCU Medical Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Chad M Cannon
- Department of Emergency Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Gerhard A Müeller
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, University of Göttingen, Göttingen, Germany
| | - Robert Birkhahn
- Department of Emergency Medicine, New York Methodist, Brooklyn, NY, USA
| | - Pam Taub
- Division of Cardiovascular Medicine, University of California, San Diego, CA, USA
| | - Gary M Vilke
- Department of Emergency Medicine, University of California, San Diego, CA, USA
| | - Olga Barnett
- Division of Cardiology, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Kenneth McDonald
- Department of Cardiology, Mater Misericordiae University Hospital, University College, Dublin, Ireland.,Department of Cardiology, St. Vincent's University Hospital, Dublin, Ireland
| | - Niall Mahon
- Department of Cardiology, Mater Misericordiae University Hospital, University College, Dublin, Ireland
| | - Julio Nuñez
- Department of Cardiology, Hospital Clínico Universitario de Valencia, INCLIVA, University of Valencia, Valencia, Spain & CIBER in Cardiovascular Diseases, Madrid, Spain
| | - Carlo Briguori
- Department of Cardiology, Interventional Cardiology, Mediterranea Cardiocentro, Naples, Italy
| | - Claudio Passino
- Department of Cardiology and Cardiovascular Medicine, 'Gabriele Monasterio' Foundation, Pisa, Italy
| | - Patrick T Murray
- Department of Cardiology, Mater Misericordiae University Hospital, University College, Dublin, Ireland
| | - Alan Maisel
- Division of Cardiovascular Medicine, University of California, San Diego, CA, USA
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Guo S, Jian L, Cheng D, Pan L, Liu S, Lu C. Early Renal-Protective Effects of Remote Ischemic Preconditioning in Elderly Patients with Non-ST-Elevation Myocardial Infarction (NSTEMI). Med Sci Monit 2019; 25:8602-8609. [PMID: 31762443 PMCID: PMC6873631 DOI: 10.12659/msm.917442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background With the wide clinical application of angiography, contrast-enhanced nephropathy (CIN) has become the third-leading cause of acute kidney injury (AKI). Remote ischemic preconditioning (RIPC) is a non-fatal ischemia-reperfusion injury that can provide protection against lethal ischemia-reperfusion. This study aimed to assess the effect of RIPC on CIN in elderly patients with non-ST-elevation myocardial infarction (NSTEMI). Material/Methods Patients were randomly divided into 2 groups with 119 patients in each group treated with interventional therapy. Patients in the RIPC group received distal ischemic preconditioning 2 h before contrast exposure, while patients in the control group received a sham RIPC procedure. Incidence of CIN was the primary outcome. Changes in creatinine, NGAL, and KIM-1 after contrast administration were secondary outcomes. Results CIN occurred in a total of 27 (12.3%) patients, including 12 (10.1%) in the RIPC group and 15 (15.1%) in the control group (P=0.329). RIPC treatment significantly reduced the levels of NGAL (P=0.024) and KIM-1 (P=0.007) at 12 h after contrast administration, suggesting RIPC treatment reduces sub-clinical renal damage. Subgroup analysis revealed that significant reduction of KIM-1 and NGAL by RIPC, mainly occurring in patients with a Mehran risk score of 6–10. Conclusions Although RIPC did not significantly reduce CIN incidence in elderly patients with NSTEMI, the application of more sensitive biomarkers – NGAL and KIM-1 – indicated a reduction of sub-clinical renal damage by RIPC, especially in the early stage of injury. As a simple and well-tolerated method, RIPC may be a potentially feasible option to prevent CIN.
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Affiliation(s)
- Suzhen Guo
- Department of Cardiology, Tianjin First Central Hospital, Tianjin, China (mainland)
| | - Lian Jian
- Department of Cardiology, Tianjin First Central Hospital, Tianjin, China (mainland)
| | - Degang Cheng
- Department of Cardiology, Tianjin First Central Hospital, Tianjin, China (mainland)
| | - Li Pan
- Department of Cardiology, Tianjin First Central Hospital, Tianjin, China (mainland)
| | - Shaoying Liu
- Department of Cardiology, Tianjin First Central Hospital, Tianjin, China (mainland)
| | - Chengzhi Lu
- Department of Cardiology, Tianjin First Central Hospital, Tianjin, China (mainland)
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Li D, Yan Sun W, Fu B, Xu A, Wang Y. Lipocalin-2-The myth of its expression and function. Basic Clin Pharmacol Toxicol 2019; 127:142-151. [PMID: 31597008 DOI: 10.1111/bcpt.13332] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 09/19/2019] [Indexed: 01/01/2023]
Abstract
Lipocalin-2 is a functional biomarker for acute and chronic kidney diseases, heart failure and obesity-related medical complications. It is rapidly induced in epithelial cells under stress conditions, but constitutively produced from pre-adipocytes and mature adipocytes. Measuring the lipocalin-2 levels represents an effective approach for risk prediction, patient stratification and disease management. Nevertheless, due to ligand-binding, post-translational modification and protein-protein interaction, lipocalin-2 exists as multiple variants that elicit different pathophysiological functions. To characterize the specific structure-functional relationships of lipocalin-2 variants is critical for the development of biomarker assays with sufficient precision and reliability. Moreover, identifying the pathological forms of lipocalin-2 will provide new therapeutic targets and treatment approaches for obesity-related complications.
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Affiliation(s)
- Dahui Li
- The State Key Laboratory of Pharmaceutical Biotechnology and Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong SAR, China
| | - Wai Yan Sun
- The State Key Laboratory of Pharmaceutical Biotechnology and Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong SAR, China
| | - Bowen Fu
- The State Key Laboratory of Pharmaceutical Biotechnology and Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong SAR, China
| | - Aimin Xu
- The State Key Laboratory of Pharmaceutical Biotechnology and Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong SAR, China
| | - Yu Wang
- The State Key Laboratory of Pharmaceutical Biotechnology and Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong SAR, China
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