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Zhang X, Wan Y, Karunathilaka N, Chan W, Kostner K, Hartel G, Coats AJS, Atherton JJ, Punyadeera C. Prognostic utility of serum NT-proBNP (fragments 1-76aa and 13-71aa) and galectin-3 in predicting death and re-hospitalisation due to cardiovascular events in patients with heart failure. Heart Vessels 2024; 39:86-94. [PMID: 37537380 PMCID: PMC10764512 DOI: 10.1007/s00380-023-02296-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/20/2023] [Indexed: 08/05/2023]
Abstract
Patients with heart failure (HF) are at a higher risk of rehospitalisation. In this study, we investigated the prognostic utility of galectin-3 (Gal-3) and NT-proBNP fragments (1-76aa and 13-71aa) as biomarkers to predict outcomes for patients with HF. We collected blood samples from patients with HF (n = 101). Gal-3 and NT-proBNP fragments (1-76aa and 13-71aa) concentrations were measured by immunoassay. Survival analysis and Cox proportional regression models were used to determine the prognostic utility of Gal-3 and NT-proBNP fragments. In patients with increased baseline levels of NT-proBNP1-76 the time to primary endpoint (cardiovascular death or re-hospitalisation) was significantly shorter (p = 0.0058), but not in patient with increased baseline levels of Gal-3 or NTproBNP13-71. Patients with increased levels of NT-proBNP13-71aa at 1 month showed reduced time to the primary endpoint (p = 0.0123). Our findings demonstrated that Gal-3 and NT-proBNP can be used as prognostic biomarkers to stratify patients with HF.
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Affiliation(s)
- Xi Zhang
- Saliva and Liquid Biopsy Translational Laboratory, Griffith Institute for Drug Discovery, Griffith University, 46, Don Young Rd, Nathan, QLD, 4111, Australia
- Menzies Health Institute Queensland (MHIQ), Griffith University, Gold Coast, QLD, Australia
| | - Yunxia Wan
- Saliva and Liquid Biopsy Translational Laboratory, The School of Biomedical Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Nuwan Karunathilaka
- Saliva and Liquid Biopsy Translational Laboratory, Griffith Institute for Drug Discovery, Griffith University, 46, Don Young Rd, Nathan, QLD, 4111, Australia
- Menzies Health Institute Queensland (MHIQ), Griffith University, Gold Coast, QLD, Australia
| | - Wandy Chan
- The Prince Charles Hospital, Brisbane, QLD, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Karam Kostner
- Department of Cardiology, Mater Adult Hospital, Brisbane, QLD, Australia
| | - Gunter Hartel
- Statistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Andrew J S Coats
- Faculty of Medicine, Monash University, Melbourne, VIC, Australia
- University of Warwick, Coventry, UK
- Monash University, Clayton, Australia
| | - John J Atherton
- Cardiology Department, Faculty of Medicine, Royal Brisbane and Women's Hospital and University of Queensland, Brisbane, QLD, Australia
| | - Chamindie Punyadeera
- Saliva and Liquid Biopsy Translational Laboratory, Griffith Institute for Drug Discovery, Griffith University, 46, Don Young Rd, Nathan, QLD, 4111, Australia.
- Saliva and Liquid Biopsy Translational Laboratory, The School of Biomedical Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia.
- Translational Research Institute, Woolloongabba, Australia.
- Menzies Health Institute Queensland (MHIQ), Griffith University, Gold Coast, QLD, Australia.
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2
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Maeda D, Kanzaki Y, Sakane K, Tsuda K, Akamatsu K, Hourai R, Okuno T, Tokura D, Hasegawa HT, Morita H, Ito T, Hoshiga M. Prognostic impact of a reduction in the fibrosis-4 index among patients hospitalized with acute heart failure. Heart Vessels 2023; 38:1235-1243. [PMID: 37277568 DOI: 10.1007/s00380-023-02273-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/19/2023] [Indexed: 06/07/2023]
Abstract
Although the fibrosis-4 index (FIB-4) is associated with right atrial pressure or prognosis in acute heart failure (AHF), the prognostic impact of its reduction during hospitalization remains uncertain. We included 877 patients (age, 74.9 ± 12.0 years; 58% male) hospitalized with AHF. The reduction in FIB-4 was defined as: (FIB-4 on admission-FIB-4 at discharge)/FIB-4 on admission × 100. Patients were divided into low (< 1.0%, n = 293), middle (1.0-27.4%, n = 292), and high (> 27.4%, n = 292) FIB-4 reduction groups. The primary outcome was a composite of all-cause death or heart failure rehospitalization within 180 days. The median FIB-4 reduction was 14.7% (interquartile range - 7.8-34.9%). The primary outcome was observed in 79 (27.0%), 63 (21.6%), and 41 (14.0%) patients in the low, middle, and high FIB-4 reduction groups, respectively (P = 0.001). Adjusted Cox proportional-hazards analysis revealed that the middle and low FIB-4 reduction groups were associated with the primary outcome, independent of the pre-existing risk model including baseline FIB-4 ([high vs. middle] hazard ratio [HR]: 1.70, 95% confidence interval [CI]: 1.10-2,63, P = 0.017; [high vs. low] HR: 2.16, 95% CI 1.41-3.32, P < 0.001). FIB-4 reduction provided additional prognostic value to the baseline model, including well-known prognostic factors ([continuous net reclassification improvement] 0.304; 95% CI 0.139-0.464; P < 0.001; [integrated discrimination improvement] 0.011; 95% CI 0.004-0.017; P = 0.001). Additionally, the combination of the reduction in FIB-4 and brain natriuretic peptide was useful for risk stratification. In conclusion, among patients hospitalized with AHF, a greater FIB-4 reduction during hospitalization was associated with better prognoses.
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Affiliation(s)
- Daichi Maeda
- Department of Cardiology, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 5698686, Japan.
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - Yumiko Kanzaki
- Department of Cardiology, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 5698686, Japan
| | - Kazushi Sakane
- Department of Cardiology, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 5698686, Japan
| | - Kosuke Tsuda
- Department of Cardiology, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 5698686, Japan
- Department of Cardiology, Hokusetsu General Hospital, Osaka, Japan
| | - Kanako Akamatsu
- Department of Cardiology, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 5698686, Japan
| | - Ryoto Hourai
- Department of Cardiology, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 5698686, Japan
| | - Takahiro Okuno
- Department of Cardiology, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 5698686, Japan
| | - Daisuke Tokura
- Department of Cardiology, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 5698686, Japan
| | - Hitomi T Hasegawa
- Department of Cardiology, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 5698686, Japan
| | - Hideaki Morita
- Department of Cardiology, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 5698686, Japan
| | - Takahide Ito
- Department of Cardiology, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 5698686, Japan
| | - Masaaki Hoshiga
- Department of Cardiology, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka, 5698686, Japan
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3
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Fujisawa R, Okada K, Kaga S, Murayama M, Nakabachi M, Yokoyama S, Nishino H, Tanemura A, Masauzi N, Motoi K, Ishizaka S, Chiba Y, Tsujinaga S, Iwano H, Anzai T. Prognostic value of an echocardiographic index reflecting right ventricular operating stiffness in patients with heart failure. Heart Vessels 2021; 37:583-592. [PMID: 34655317 DOI: 10.1007/s00380-021-01960-6] [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] [Received: 07/18/2021] [Accepted: 10/01/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE We recently reported a noninvasive method for the assessment of right ventricular (RV) operating stiffness that is obtained by dividing the atrial-systolic descent of the pulmonary artery-RV pressure gradient (PRPGDAC) derived from the pulmonary regurgitant velocity by the tricuspid annular plane movement during atrial contraction (TAPMAC). Here, we investigated whether this parameter of RV operating stiffness, PRPGDAC/TAPMAC, is useful for predicting the prognosis of patients with heart failure (HF). METHODS We retrospectively included 127 hospitalized patients with HF who underwent an echocardiographic examination immediately pre-discharge. The PRPGDAC/TAPMAC was measured in addition to standard echocardiographic parameters. Patients were followed until 2 years post-discharge. The endpoint was the composite of cardiac death, readmission for acute decompensation, and increased diuretic dose due to worsening HF. RESULTS 58 patients (46%) experienced the endpoint during follow-up. Univariable and multivariable Cox regression analyses demonstrated that the PRPGDAC/TAPMAC was associated with the endpoint. In a Kaplan-Meier analysis, the event rate of the greater PRPGDAC/TAPMAC group was significantly higher than that of the lesser PRPGDAC/TAPMAC group. In a sequential Cox analysis for predicting the endpoint's occurrence, the addition of PRPGDAC/TAPMAC to the model including age, sex, NYHA functional classification, brain natriuretic peptide level, and several echocardiographic parameters including tricuspid annular plane systolic excursion significantly improved the predictive power for prognosis. CONCLUSION A completely noninvasive index of RV operating stiffness, PRPGDAC/TAPMAC, was useful for predicting prognoses in patients with HF, and it showed an incremental prognostic value over RV systolic function.
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Affiliation(s)
- Ryosuke Fujisawa
- Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Kazunori Okada
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan.
| | - Sanae Kaga
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Michito Murayama
- Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan.,Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan
| | - Masahiro Nakabachi
- Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan
| | - Shinobu Yokoyama
- Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan
| | - Hisao Nishino
- Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan
| | - Asuka Tanemura
- Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan
| | - Nobuo Masauzi
- Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Ko Motoi
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Suguru Ishizaka
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yasuyuki Chiba
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shingo Tsujinaga
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroyuki Iwano
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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4
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Siciliano RF, Gualandro DM, Bittencourt MS, Paixão M, Marcondes-Braga F, Soeiro ADM, Strunz C, Pacanaro AP, Puelacher C, Tarasoutchi F, Di Somma S, Caramelli B, de Oliveira Junior MT, Mansur AJ, Mueller C, Barretto ACP, Strabelli TMV. Biomarkers for prediction of mortality in left-sided infective endocarditis. Int J Infect Dis 2020; 96:25-30. [PMID: 32169690 DOI: 10.1016/j.ijid.2020.03.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Evidence regarding biomarkers for risk prediction in patients with infective endocarditis (IE) is limited. We aimed to investigate the value of a panel of biomarkers for the prediction of in-hospital mortality in patients with IE. METHODS Between 2016 and 2018, consecutive IE patients admitted to the emergency department were prospectively included. Blood concentrations of nine biomarkers were measured at admission (D0) and on the seventh day (D7) of antibiotic therapy: C-reactive protein (CRP), sensitive troponin I (s-cTnI), procalcitonin, B-type natriuretic peptide (BNP), neutrophil gelatinase-associated lipocalin (NGAL), interleukin 6 (IL6), tumor necrosis factor α (TNF-α), proadrenomedullin, alpha-1-acid glycoprotein, and galectin 3. The primary endpoint was in-hospital mortality. RESULTS Among 97 patients, 56% underwent cardiac surgery, and in-hospital mortality was 27%. At admission, six biomarkers were independent predictors of in-hospital mortality: s-cTnI (OR 3.4; 95%CI 1.8-6.4; P<0.001), BNP (OR 2.7; 95%CI 1.4-5.1; P=0.002), IL-6 (OR 2.06; 95%CI 1.3-3.7; P=0.019), procalcitonin (OR 1.9; 95%CI 1.1-3.2; P=0.018), TNF-α (OR 1.8; 95%CI 1.1-2.9; P=0.019), and CRP (OR 1.8; 95%CI 1.0-3.3; P=0.037). At admission, S-cTnI provided the highest accuracy for predicting mortality (area under the ROC curve: s-cTnI 0.812, BNP 0.727, IL-6 0.734, procalcitonin 0.684, TNF-α 0.675, CRP 0.670). After 7 days of antibiotic therapy, BNP and inflammatory biomarkers improved their performance (s-cTnI 0.814, BNP 0.823, IL-6 0.695, procalcitonin 0.802, TNF-α 0.554, CRP 0.759). CONCLUSION S-cTnI concentration measured at admission had the highest accuracy for mortality prediction in patients with IE.
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Affiliation(s)
- Rinaldo F Siciliano
- Heart Institute (InCor), University of São Paulo Medical School, Brazil; GREAT (Global Research on Acute Conditions Team) Network.
| | - Danielle M Gualandro
- Heart Institute (InCor), University of São Paulo Medical School, Brazil; GREAT (Global Research on Acute Conditions Team) Network; Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Marcio Sommer Bittencourt
- Center for Clinical and Epidemiological Research, University Hospital, University of Sao Paulo, Sao Paulo, Brazil; Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Milena Paixão
- Heart Institute (InCor), University of São Paulo Medical School, Brazil
| | | | | | - Célia Strunz
- Heart Institute (InCor), University of São Paulo Medical School, Brazil
| | | | - Christian Puelacher
- GREAT (Global Research on Acute Conditions Team) Network; Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | | | - Salvatore Di Somma
- Department of Medical-Surgery Sciences and Translational Medicine University of Rome Sapienza, Italy; GREAT (Global Research on Acute Conditions Team) Network
| | - Bruno Caramelli
- Heart Institute (InCor), University of São Paulo Medical School, Brazil
| | - Mucio Tavares de Oliveira Junior
- Heart Institute (InCor), University of São Paulo Medical School, Brazil; Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | | | - Christian Mueller
- Heart Institute (InCor), University of São Paulo Medical School, Brazil; Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
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5
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Pourafkari L, Tajlil A, Nader ND. Biomarkers in diagnosing and treatment of acute heart failure. Biomark Med 2019; 13:1235-1249. [PMID: 31580155 DOI: 10.2217/bmm-2019-0134] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Acute heart failure (AHF) is a complex disorder involving different pathophysiological pathways. In recent years, there is an increased focus on biomarkers that help with diagnosis, risk stratification and disease monitoring of AHF. Finding a reliable set of biomarkers not only improves morbidity and mortality but it can also potentially reveal the new targets of therapy. In this paper, we have reviewed the biomarkers found useful for the diagnosis as well as for risk stratification and prognostication in patients with AHF. We have discussed the established biomarkers for AHF including cardiac troponins and natriuretic peptides and emerging biomarkers including adiponectin, mi-RNA, sST2, Gal-3, MR-proADM, OPG, CT-proAVP and H-FABP for the purposes of making diagnosis, their use as a guide of therapy or for determination of prognosis.
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Affiliation(s)
- Leili Pourafkari
- Department of Anesthesiology, University at Buffalo, Buffalo, NY 14203, USA
| | - Arezou Tajlil
- Cardiovascular Research Center, Tabriz University of Medical Science, Tabriz, Iran
| | - Nader D Nader
- Department of Anesthesiology, University at Buffalo, Buffalo, NY 14203, USA
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6
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Prognostic Value of BNP Reduction During Hospitalization in Patients With Acute Heart Failure. J Card Fail 2019; 25:712-721. [DOI: 10.1016/j.cardfail.2019.04.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 03/23/2019] [Accepted: 04/04/2019] [Indexed: 01/04/2023]
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7
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Sawano M, Shiraishi Y, Kohsaka S, Nagai T, Goda A, Mizuno A, Sujino Y, Nagatomo Y, Kohno T, Anzai T, Fukuda K, Yoshikawa T. Performance of the MAGGIC heart failure risk score and its modification with the addition of discharge natriuretic peptides. ESC Heart Fail 2018. [PMID: 29520978 PMCID: PMC6073038 DOI: 10.1002/ehf2.12278] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Aims Predictive models for heart failure patients are widely used in the clinical practice to stratify patients' mortality and enable clinicians to tailor and intensify their approach. However, such models have not been validated internationally. In addition, biomarkers are now frequently measured to obtain prognostic information, and the implications of this practice are not known. In this study, we aimed to validate the model performance of the Meta‐analysis Global Group in Chronic Heart Failure (MAGGIC) score in a Japanese acute heart failure registry and further explore the incremental prognostic value of discharge B‐type natriuretic peptide (BNP) level. Methods and Results In this study, we evaluated the registered data of 2215 consecutive acute HF patients (with 694 119 person‐years follow‐up) from a prospective multicentre registry (the West Tokyo Heart Failure) conducted in Japan from April 2006 to August 2016. The mean age was 73.0 ± 13.0, and 61.2% were male. The MAGGIC score demonstrated modest discrimination (c‐index = 0.71, 95% confidence interval 0.67–0.74) and good calibration (R2 value = 0.97); there was constant overestimation for 1 year mortality. However, when the BNP level was added to the original MAGGIC variables, the model demonstrated good discrimination (c‐index = 0.74, 95% confidence interval 0.70–0.78) with adequate calibration (R2 value = 0.91). The modified MAGGIC BNP score was externally validated in a separate Japanese registry (NaDEF) and demonstrated moderate discrimination (c‐index = 0.69, 95% confidence interval 0.65–0.73) and calibration (R2 value = 0.85). Conclusion The original MAGGIC score performed modestly in Japanese patients, but the addition of discharge BNP level enhanced model performance. The addition of objective biomarkers may result in effective modification of preexisting internationally recognized risk models and aid in multinational comparisons of heart failure patients' outcomes.
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Affiliation(s)
- Mitsuaki Sawano
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Yasuyuki Shiraishi
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Toshiyuki Nagai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.,National Heart and Lung Institute, Imperial College London, London, UK.,Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Ayumi Goda
- Division of Cardiology, Kyorin University School of Medicine, Tokyo, Japan
| | - Atsushi Mizuno
- Department of Cardiology, St Luke's International Hospital, Tokyo, Japan
| | - Yasumori Sujino
- Department of Cardiology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Yuji Nagatomo
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan.,Department of Cardiology, National Defense Medical College
| | - Takashi Kohno
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.,Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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8
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Tromp J, Richards AM, Tay WT, Teng THK, Yeo PSD, Sim D, Jaufeerally F, Leong G, Ong HY, Ling LH, van Veldhuisen DJ, Jaarsma T, Voors AA, van der Meer P, de Boer RA, Lam CSP. N-terminal pro-B-type natriuretic peptide and prognosis in Caucasian vs. Asian patients with heart failure. ESC Heart Fail 2018; 5:279-287. [PMID: 29380931 PMCID: PMC5880675 DOI: 10.1002/ehf2.12252] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 11/19/2017] [Accepted: 11/27/2017] [Indexed: 01/09/2023] Open
Abstract
Aims N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) is the most frequently used biomarker in heart failure (HF), but its prognostic utility across ethnicities is unclear. Methods and results This study included 546 Caucasians with HF from the Coordinating Study Evaluating Outcomes of Advising and Counseling in Heart Failure and 578 Asians with HF from the Singapore Heart Failure Outcomes and Phenotypes study. NT‐proBNP was measured at discharge after HF hospitalization. The studied outcome was a composite of all‐cause mortality and HF hospitalization at 18 months. Compared with Caucasian patients, Asian patients were younger (63 ± 12 vs. 71 ± 11 years); less often female (26% vs. 39%); and had lower body mass index (26 vs. 27 kg/m2), better renal function (61 ± 37 vs. 54 ± 20 mL/min/1.73 m2), lower rates of atrial fibrillation (25% vs. 46%), strikingly higher rates of diabetes (59% vs. 30%), and higher rates of hypertension (76% vs. 44%). Despite these clear inter‐group differences in individual drivers of NT‐proBNP, average levels were similar in Asians [2709 (1350, 6302) pg/mL] and Caucasians [2545 (1308, 5484) pg/mL] (P = 0.514). NT‐proBNP was strongly associated with outcome [hazard ratio 1.28 (per doubling), 95% confidence interval 1.18–1.39, P < 0.001], regardless of ethnicity (Pinteraction = 0.719). NT‐proBNP was similarly associated with outcome in HF with reduced and preserved ejection fraction in Asian (Pinteraction = 0.776) and Caucasian patients (Pinteraction = 0.558). Conclusions NT‐proBNP has similar prognostic performance in Asians and Caucasians with HF despite ethnic differences in known clinical determinants of plasma NT‐proBNP.
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Affiliation(s)
- Jasper Tromp
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.,National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - Arthur Mark Richards
- Cardiovascular Research Institute, National University Heart Centre, Singapore, Singapore.,Christchurch Heart Institute, University of Otago, Dunedin, New Zealand
| | - Wan Ting Tay
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | - Tiew-Hwa K Teng
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.,School of Population Health, University of Western Australia, Nedlands, WA, Australia
| | | | - David Sim
- National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore
| | | | | | | | - Lieng Hsi Ling
- Cardiovascular Research Institute, National University Heart Centre, Singapore, Singapore
| | - Dirk J van Veldhuisen
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Tiny Jaarsma
- Department of Social and Welfare Studies, Faculty of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Adriaan A Voors
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Peter van der Meer
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Rudolf A de Boer
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Carolyn S P Lam
- Cardiovascular Research Institute, National University Heart Centre, Singapore, Singapore.,National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore.,Duke-National University of Singapore, Singapore, Singapore
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9
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Cyrille NB, Patel SR. Late In-Hospital Management of Patients Hospitalized with Acute Heart Failure. Prog Cardiovasc Dis 2017; 60:198-204. [PMID: 28501337 DOI: 10.1016/j.pcad.2017.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 05/08/2017] [Indexed: 12/01/2022]
Abstract
Acute Heart Failure (AHF) hospitalization presents a significant financial burden and portends a poor prognosis following discharge. As such, there has been significant emphasis on the late inpatient management of patients hospitalized with AHF to ensure successful transition to the outpatient setting and to reduce overall readmission and mortality rates. Thorough discharge planning and a multidisciplinary team approach are essential and as outlined in this review should focus on four key elements: the assessment of patients' readiness for discharge, optimization of goal directed medical therapy and appropriate device therapy, patient education and transition to the outpatient care.
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Affiliation(s)
- Nicole B Cyrille
- Department of Medicine, Division of Cardiology, Montefiore Medical Center-Albert Einstein College of Medicine, Bronx, NY
| | - Snehal R Patel
- Department of Medicine, Division of Cardiology, Montefiore Medical Center-Albert Einstein College of Medicine, Bronx, NY.
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10
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Marcondes-Braga FG, Batista GL, Gutz IGR, Saldiva PHN, Mangini S, Issa VS, Ayub-Ferreira SM, Bocchi EA, Pereira AC, Bacal F. Impact of Exhaled Breath Acetone in the Prognosis of Patients with Heart Failure with Reduced Ejection Fraction (HFrEF). One Year of Clinical Follow-up. PLoS One 2016; 11:e0168790. [PMID: 28030609 PMCID: PMC5193433 DOI: 10.1371/journal.pone.0168790] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 12/06/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The identification of new biomarkers of heart failure (HF) could help in its treatment. Previously, our group studied 89 patients with HF and showed that exhaled breath acetone (EBA) is a new noninvasive biomarker of HF diagnosis. However, there is no data about the relevance of EBA as a biomarker of prognosis. OBJECTIVES To evaluate whether EBA could give prognostic information in patients with heart failure with reduced ejection fraction (HFrEF). METHODS After breath collection and analysis by gas chromatography-mass spectrometry and by spectrophotometry, the 89 patients referred before were followed by one year. Study physicians, blind to the results of cardiac biomarker testing, ascertained vital status of each study participant at 12 months. RESULTS The composite endpoint death and heart transplantation (HT) were observed in 35 patients (39.3%): 29 patients (32.6%) died and 6 (6.7%) were submitted to HT within 12 months after study enrollment. High levels of EBA (≥3.7μg/L, 50th percentile) were associated with a progressively worse prognosis in 12-month follow-up (log-rank = 11.06, p = 0.001). Concentrations of EBA above 3.7μg/L increased the risk of death or HT in 3.26 times (HR = 3.26, 95%CI = 1.56-6.80, p = 0.002) within 12 months. In a multivariable cox regression model, the independent predictors of all-cause mortality were systolic blood pressure, respiratory rate and EBA levels. CONCLUSIONS High EBA levels could be associated to poor prognosis in HFrEF patients.
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Affiliation(s)
- Fabiana G. Marcondes-Braga
- Department of Heart Transplant, Heart Institute (InCor), do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil Av. Dr Eneas de Carvalho Aguiar, 44 – 2°. andar
- * E-mail:
| | - Guilherme L. Batista
- Chemistry Institute, University of São Paulo, Sao Paulo, Brazil Av.Prof. Lineu Prestes, 748, bloco 12, sala 1270—Cidade Universitária
| | - Ivano G. R. Gutz
- Chemistry Institute, University of São Paulo, Sao Paulo, Brazil Av.Prof. Lineu Prestes, 748, bloco 12, sala 1270—Cidade Universitária
| | - Paulo H. N. Saldiva
- Department of Pathology, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil Av. Dr. Arnaldo, 455, 1° andar
| | - Sandrigo Mangini
- Department of Heart Transplant, Heart Institute (InCor), do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil Av. Dr Eneas de Carvalho Aguiar, 44 – 2°. andar
| | - Victor S. Issa
- Department of Heart Failure, Heart Institute (InCor), do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Silvia M. Ayub-Ferreira
- Department of Heart Failure, Heart Institute (InCor), do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Edimar A. Bocchi
- Department of Heart Failure, Heart Institute (InCor), do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil
| | - Alexandre Costa Pereira
- Laboratory of Genetics and Molecular Cardiology, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil Av.Dr. Eneas de Carvalho Aguiar, 44–10°. andar
| | - Fernando Bacal
- Department of Heart Transplant, Heart Institute (InCor), do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil Av. Dr Eneas de Carvalho Aguiar, 44 – 2°. andar
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Abstract
Contributions from the Asian biomedical community to knowledge of biomarkers in heart failure have grown rapidly since 2000. Japan has made world-leading contributions in the discovery and application of cardiac natriuretic peptides as biomarkers in heart failure, but there has been rapid growth in reports from China. Contributions also come from Taiwan, South Korea, Singapore, and Hong Kong. Centers in Asia have established clinical cohorts providing powerful platforms for the discovery and validation of biomarkers in heart failure. This century, Asian enquiry into biomarkers in heart failure will include peptides, cytokines, metabolites, nucleic acids, and other analytes.
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Affiliation(s)
- Arthur Mark Richards
- Cardiac Department, Cardiovascular Research Institute, National University Heart Centre Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore 119228, Singapore; Department of Medicine, Christchurch Hospital, Christchurch Heart Institute, University of Otago, PO Box 4345, Riccarton Avenue, Christchurch 8014, New Zealand.
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12
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Serial soluble ST2 for the monitoring of pharmacologically optimised chronic stable heart failure. Int J Cardiol 2014; 178:284-91. [PMID: 25465308 DOI: 10.1016/j.ijcard.2014.11.097] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 09/14/2014] [Accepted: 11/10/2014] [Indexed: 01/30/2023]
Abstract
BACKGROUND Soluble ST2 (sST2) is an emerging biomarker of cardiac remodelling and fibrosis. Studies indicate that it is predictive of mortality in acutely decompensated heart failure. The role of sST2 in chronic heart failure (CHF) is less well defined. No studies have examined serial measurements in optimised patients as a potential monitoring tool. This study aimed to prospectively determine the prognostic utility of serial sST2 in patients with pharmacologically optimised stable CHF. METHODS 41 patients with pharmacologically optimised CHF and left ventricular ejection fraction ≤40% were recruited. Clinical review and blood sampling took place at baseline, and one, three and six months. N-terminal pro-brain natriuretic peptide (NTproBNP), sST2 and renal profile were measured on all samples. 12 lead electrocardiogram (ECG) was performed at baseline. Decompensation was defined as a composite endpoint of cardiovascular admission or worsening renal function (≥25% increase in serum creatinine from baseline). RESULTS Receiver operator curve analysis of percentage change in sST2 from baseline to six months was strongly reflective of decompensation with area under the curve (AUC) of 0.778. This was significantly better than NTproBNP (AUC 0.425; p=0.013). Correlation of baseline concentrations to surface ECG showed that both sST2 and NTproBNP were positively correlated with duration of the QRS wave, with higher level of significance demonstrated by sST2 (0.415 (p=0.007) and 0.362 (p=0.020) respectively). CONCLUSIONS Percentage changes in sST2 are better able to predict cardiovascular admission or worsening renal function in patients with pharmacologically optimised CHF than NTproBNP. Compared with NTproBNP, sST2 appears to be a promising candidate for monitoring these patients.
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Giannoni A, Baruah R, Leong T, Rehman MB, Pastormerlo LE, Harrell FE, Coats AJS, Francis DP. Do optimal prognostic thresholds in continuous physiological variables really exist? Analysis of origin of apparent thresholds, with systematic review for peak oxygen consumption, ejection fraction and BNP. PLoS One 2014; 9:e81699. [PMID: 24475020 PMCID: PMC3903471 DOI: 10.1371/journal.pone.0081699] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 10/15/2013] [Indexed: 11/22/2022] Open
Abstract
Background Clinicians are sometimes advised to make decisions using thresholds in measured variables, derived from prognostic studies. Objectives We studied why there are conflicting apparently-optimal prognostic thresholds, for example in exercise peak oxygen uptake (pVO2), ejection fraction (EF), and Brain Natriuretic Peptide (BNP) in heart failure (HF). Data Sources and Eligibility Criteria Studies testing pVO2, EF or BNP prognostic thresholds in heart failure, published between 1990 and 2010, listed on Pubmed. Methods First, we examined studies testing pVO2, EF or BNP prognostic thresholds. Second, we created repeated simulations of 1500 patients to identify whether an apparently-optimal prognostic threshold indicates step change in risk. Results 33 studies (8946 patients) tested a pVO2 threshold. 18 found it prognostically significant: the actual reported threshold ranged widely (10–18 ml/kg/min) but was overwhelmingly controlled by the individual study population's mean pVO2 (r = 0.86, p<0.00001). In contrast, the 15 negative publications were testing thresholds 199% further from their means (p = 0.0001). Likewise, of 35 EF studies (10220 patients), the thresholds in the 22 positive reports were strongly determined by study means (r = 0.90, p<0.0001). Similarly, in the 19 positives of 20 BNP studies (9725 patients): r = 0.86 (p<0.0001). Second, survival simulations always discovered a “most significant” threshold, even when there was definitely no step change in mortality. With linear increase in risk, the apparently-optimal threshold was always near the sample mean (r = 0.99, p<0.001). Limitations This study cannot report the best threshold for any of these variables; instead it explains how common clinical research procedures routinely produce false thresholds. Key Findings First, shifting (and/or disappearance) of an apparently-optimal prognostic threshold is strongly determined by studies' average pVO2, EF or BNP. Second, apparently-optimal thresholds always appear, even with no step in prognosis. Conclusions Emphatic therapeutic guidance based on thresholds from observational studies may be ill-founded. We should not assume that optimal thresholds, or any thresholds, exist.
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Affiliation(s)
- Alberto Giannoni
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College, London, United Kingdom
- Department of Cardiovascular Medicine, Fondazione Toscana G. Monasterio, Pisa, Italy
- * E-mail:
| | - Resham Baruah
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Tora Leong
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College, London, United Kingdom
| | | | | | - Frank E. Harrell
- Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Andrew J. S. Coats
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College, London, United Kingdom
- Norfolk and Norwich Hospital, University of East Anglia, Norwich, United Kingdom
| | - Darrel P. Francis
- International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College, London, United Kingdom
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Miettinen KH, Lassus J, Harjola VP, Siirilä-Waris K, Melin J, Punnonen KR, Nieminen MS, Laakso M, Peuhkurinen KJ. Prognostic role of pro- and anti-inflammatory cytokines and their polymorphisms in acute decompensated heart failure. Eur J Heart Fail 2014; 10:396-403. [DOI: 10.1016/j.ejheart.2008.02.008] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2007] [Revised: 11/13/2007] [Accepted: 02/07/2008] [Indexed: 10/22/2022] Open
Affiliation(s)
| | - Johan Lassus
- Department of Medicine; Helsinki University Hospital; Helsinki Finland
| | | | | | - John Melin
- Department of Medicine; Jyväskylä Central Hospital; Jyväskylä Finland
| | - Kari R. Punnonen
- Department of Clinical Chemistry; Kuopio University Hospital; Kuopio Finland
| | | | - Markku Laakso
- Department of Medicine; Kuopio University Hospital; Kuopio Finland
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15
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16
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Tolonen J, Lassus JPE, Siirila-Waris K, Tarvasmäki T, Pulkki K, Sund R, Peuhkurinen K, Nieminen MS, Harjola VP. The role of cardiorenal biomarkers for risk stratification in the early follow-up after hospitalisation for acute heart failure. Biomarkers 2013; 18:525-31. [DOI: 10.3109/1354750x.2013.821522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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17
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Abstract
Over the past 5 years, researchers have examined the utility of many experimental heart failure biomarkers that are not yet widely adopted clinically, to complement the role of B-type natriuretic peptide and its precursor. Candidate biomarkers have been identified from several different pathophysiologic categories, including markers of inflammation, myocyte necrosis, renal dysfunction, neurohumoral activation, oxidative stress and raised intracardiac pressure. Indeed, some biomarkers provide prognostic information that is independent of information obtained from conventional clinical and biomarker assessment. Moreover, some biomarkers studied help to identify dominant pathology that may predict responsiveness to specific therapies. Preliminary data also suggest a potential role for the development of comprehensive biomarker profiling models, integrating biomarkers from several categories to refine risk assessment.
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Affiliation(s)
- Jeremy Kobulnik
- Toronto General Hospital/University of Toronto, Toronto, ON, Canada
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18
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Malfatto G, Corticelli A, Villani A, Giglio A, Della Rosa F, Branzi G, Facchini M, Parati G. Transthoracic bioimpedance and brain natriuretic peptide assessment for prognostic stratification of outpatients with chronic systolic heart failure. Clin Cardiol 2013; 36:103-9. [PMID: 23377871 DOI: 10.1002/clc.22086] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 11/13/2012] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In patients with chronic heart failure, physical evaluation and clinical judgment may be inadequate for prognostic stratification. HYPOTHESIS Information obtained with simple bedside tests would be helpful in patient management. METHODS We report on 142 outpatients with systolic heart failure seen at our heart failure unit from 2007 to 2010 (ages 69.4 ± 8.9 years; ejection fraction [EF] 30.6 ± 6.1%; 43% with implanted defibrillators and/or resynchronization devices). At their first visit, we assessed levels of brain natriuretic peptide (BNP) (pg/mL), evaluated transthoracic conductance (TFC) (1/kΩ) by transthoracic bioimpedance, and performed echocardiography. RESULTS Four-year mortality was 21.2%. At multivariate analysis, surviving and deceased subjects did not differ regarding New York Heart Association, age, gender, heart failure etiology, or EF at index visit. Patients who died had higher BNP and TFC (BNP = 884 ± 119 pg/mL vs 334 ± 110 pg/mL; TFC = 50 ± 8/kΩ vs 37 ± 7/kΩ, both P < 0.001]. Patients with BNP < 450 pg/mL and TFC < 40/kΩ had a 2.1% 4-year mortality, compared to 46.5% mortality of patients having BNP ≥ 450 pg/mL and TFC ≥ 40/kΩ. BNP ≥ 450 pg/mL and TFC ≥ 40/kΩ showed high sensitivity (91%) and specificity (88%)in identifying patients who died at follow-up. CONCLUSIONS The combined use of BNP and impedance cardiography during the first assessment of a patient in a heart failure unit identified those carrying a worse medium-term prognosis. This approach could help the subsequent management of patients, allowing better clinical and therapeutic strategies.
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Affiliation(s)
- Gabriella Malfatto
- Cardiology Division, Saint Luke Hospital, Italian Auxologic Institute IRCCS, Milan, Italy.
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19
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Wei S, Loyo-Berríos NI, Haigney MC, Cheng H, Pinnow EE, Mitchell KR, Beachy JH, Woodward AM, Wang Y, Curtis JP, Marinac-Dabic D. Elevated B-Type Natriuretic Peptide Is Associated With Increased In-Hospital Mortality or Cardiac Arrest in Patients Undergoing Implantable Cardioverter-Defibrillator Implantation. Circ Cardiovasc Qual Outcomes 2011; 4:346-54. [DOI: 10.1161/circoutcomes.110.943621] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Shaokui Wei
- From the Division of Epidemiology (S.W., N.I.L.-B., H.C., E.E.P., D.M.D.), Office of Surveillance and Biometrics, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD; the Division of Cardiology (M.C.P.H.), Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD; the American College of Cardiology (K.R.M., J.H.B., A.M.W.), Washington, DC; and the Section of Cardiovascular Medicine (Y.W., J.P.C.), Department of Internal
| | - Nilsa I. Loyo-Berríos
- From the Division of Epidemiology (S.W., N.I.L.-B., H.C., E.E.P., D.M.D.), Office of Surveillance and Biometrics, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD; the Division of Cardiology (M.C.P.H.), Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD; the American College of Cardiology (K.R.M., J.H.B., A.M.W.), Washington, DC; and the Section of Cardiovascular Medicine (Y.W., J.P.C.), Department of Internal
| | - Mark C.P. Haigney
- From the Division of Epidemiology (S.W., N.I.L.-B., H.C., E.E.P., D.M.D.), Office of Surveillance and Biometrics, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD; the Division of Cardiology (M.C.P.H.), Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD; the American College of Cardiology (K.R.M., J.H.B., A.M.W.), Washington, DC; and the Section of Cardiovascular Medicine (Y.W., J.P.C.), Department of Internal
| | - Hong Cheng
- From the Division of Epidemiology (S.W., N.I.L.-B., H.C., E.E.P., D.M.D.), Office of Surveillance and Biometrics, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD; the Division of Cardiology (M.C.P.H.), Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD; the American College of Cardiology (K.R.M., J.H.B., A.M.W.), Washington, DC; and the Section of Cardiovascular Medicine (Y.W., J.P.C.), Department of Internal
| | - Ellen E. Pinnow
- From the Division of Epidemiology (S.W., N.I.L.-B., H.C., E.E.P., D.M.D.), Office of Surveillance and Biometrics, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD; the Division of Cardiology (M.C.P.H.), Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD; the American College of Cardiology (K.R.M., J.H.B., A.M.W.), Washington, DC; and the Section of Cardiovascular Medicine (Y.W., J.P.C.), Department of Internal
| | - Kristi R. Mitchell
- From the Division of Epidemiology (S.W., N.I.L.-B., H.C., E.E.P., D.M.D.), Office of Surveillance and Biometrics, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD; the Division of Cardiology (M.C.P.H.), Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD; the American College of Cardiology (K.R.M., J.H.B., A.M.W.), Washington, DC; and the Section of Cardiovascular Medicine (Y.W., J.P.C.), Department of Internal
| | - James H. Beachy
- From the Division of Epidemiology (S.W., N.I.L.-B., H.C., E.E.P., D.M.D.), Office of Surveillance and Biometrics, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD; the Division of Cardiology (M.C.P.H.), Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD; the American College of Cardiology (K.R.M., J.H.B., A.M.W.), Washington, DC; and the Section of Cardiovascular Medicine (Y.W., J.P.C.), Department of Internal
| | - Albert M. Woodward
- From the Division of Epidemiology (S.W., N.I.L.-B., H.C., E.E.P., D.M.D.), Office of Surveillance and Biometrics, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD; the Division of Cardiology (M.C.P.H.), Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD; the American College of Cardiology (K.R.M., J.H.B., A.M.W.), Washington, DC; and the Section of Cardiovascular Medicine (Y.W., J.P.C.), Department of Internal
| | - Yongfei Wang
- From the Division of Epidemiology (S.W., N.I.L.-B., H.C., E.E.P., D.M.D.), Office of Surveillance and Biometrics, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD; the Division of Cardiology (M.C.P.H.), Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD; the American College of Cardiology (K.R.M., J.H.B., A.M.W.), Washington, DC; and the Section of Cardiovascular Medicine (Y.W., J.P.C.), Department of Internal
| | - Jeptha P. Curtis
- From the Division of Epidemiology (S.W., N.I.L.-B., H.C., E.E.P., D.M.D.), Office of Surveillance and Biometrics, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD; the Division of Cardiology (M.C.P.H.), Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD; the American College of Cardiology (K.R.M., J.H.B., A.M.W.), Washington, DC; and the Section of Cardiovascular Medicine (Y.W., J.P.C.), Department of Internal
| | - Danica Marinac-Dabic
- From the Division of Epidemiology (S.W., N.I.L.-B., H.C., E.E.P., D.M.D.), Office of Surveillance and Biometrics, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD; the Division of Cardiology (M.C.P.H.), Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD; the American College of Cardiology (K.R.M., J.H.B., A.M.W.), Washington, DC; and the Section of Cardiovascular Medicine (Y.W., J.P.C.), Department of Internal
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Jan A, Murphy NF, O'Loughlin C, Ledwidge M, McDonald K. Profiling B-type natriuretic peptide in a stable heart failure population: a valuable adjunct to care. Ir J Med Sci 2011; 180:355-62. [PMID: 21369749 DOI: 10.1007/s11845-011-0689-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Accepted: 01/17/2011] [Indexed: 01/08/2023]
Abstract
AIM To examine the prognostic importance of absolute values and change in values of BNP in patients with stable heart failure (HF). METHODS Five-hundred and fifty-nine patients attending a disease management programme were categorized into tertiles of BNP (group 1; ≤ 95 pg/ml, group 2; 96-249 pg/ml and group 3; ≥ 250 pg/ml). A change in BNP between two stable visits was recorded. Patients were followed up for 1 year for death and a composite morbidity measure of HF hospitalization, all-cause hospitalization, unscheduled visits for clinical deterioration(UC) of HF using survival analysis. RESULTS The risk of the combined morbidity outcome increased with increasing tertiles of BNP (Log rank = 17.8 (2), p < 0.001). Furthermore, a 50 and 25% increase in BNP predicted morbidity in stable HF patients with an initial BNP > 200 pg/ml (p = 0.02) and > 450 pg/ml (p = 0.03), respectively. CONCLUSION In a stable community HF population, an elevated BNP or an increase in BNP predicts an adverse prognosis thereby potentially identifying a population in need of closer clinical follow-up.
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Affiliation(s)
- A Jan
- Department of Cardiology, Heart Failure Unit, St. Vincent's University Hospital and University College Dublin, Elm Park, Dublin 4, Ireland
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21
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Vander Werf BD, Watt J, Joseph B, Wynne J, Kulvatunyou N, O'Keeffe T, Friese RS. Can plasma B-type natriuretic peptide levels predict need for mechanical ventilation after injury? Am J Surg 2011; 200:845-50; discussion 850. [PMID: 21146031 DOI: 10.1016/j.amjsurg.2010.07.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Revised: 07/13/2010] [Accepted: 07/13/2010] [Indexed: 12/01/2022]
Abstract
BACKGROUND B-type natriuretic peptide (BNP) is a neurohormone released from cardiomyocytes in response to volume expansion and increased ventricular wall distension. Increased plasma BNP levels are associated with mortality in critically ill patients cared for in medical intensive care units (ICUs). Additionally, plasma BNP levels may serve as a biomarker for excessive fluid resuscitation after injury. The utility of plasma BNP levels as a prognosticator of outcomes after injury has not been previously described. The purpose of this study was to describe the change in plasma BNP levels over the first 48 hours after injury and determine if there was a correlation between plasma BNP levels and clinical outcomes. METHODS In this prospective observational cohort trial, plasma BNP levels were followed in injured patients admitted to a surgical ICU. Levels were obtained at admission to the emergency room (baseline) and at 12, 24, and 48 hours. Change in plasma BNP levels from baseline were calculated for each time point (ΔBNP). Demographic information was collected, including age, gender, injury severity score, ventilator days, ICU length of stay (LOS), hospital LOS, net fluid balance at 24 hours, and in-hospital mortality. Spearman's rank-order correlation coefficients were determined for plasma ΔBNP levels and outcome measures (days ventilated, ICU LOS, hospital LOS, and mortality). RESULTS Forty-four ICU patients were prospectively enrolled. Thirty-six patients (82%) were male, and 30 patients (68%) required mechanical ventilation. The mean age was 40.3 years. The median injury severity score was 19.5 (range, 9-29), and overall mortality was 14%. The mean baseline BNP level was 48 ± 66 pg/mL (range, 10-274 pg/mL). Mean ΔBNP at 24 hours was 74 ± 147 pg/mL. Net fluid balance at 48 hours after admission ranged from -1.6 to 15.6 L. Plasma ΔBNP levels at 24 and 48 hours did not correlate with net resuscitation volume at their respective time points of 24 and 48 hours. ΔBNP at 24 hours correlated with the number of days on mechanical ventilation (Spearman's ρ = .428, P = .007). ΔBNP at 24 hours also correlated with Acute Physiology and Chronic Health Evaluation II scores (Spearman's ρ = .430, P = .046). Patients with increases in plasma BNP of ≥ 75 pg/mL at 24 hours were nearly 3 times more likely to be ventilated for > 3 days (relative risk, 2.9; 95% confidence interval, 1.1-7.7). CONCLUSIONS Changes in plasma BNP levels over the first 24 hours after ICU admission may have prognostic value in determining the need for mechanical ventilation in patients admitted to ICUs after injury. Additionally, the correlation between plasma BNP levels at 24 hours and mechanical ventilation requirements is not due solely to resuscitation volume. Further studies examining the prognostic value of plasma BNP levels after injury are warranted.
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Affiliation(s)
- Brian D Vander Werf
- Division of Trauma, Critical Care & Emergency Surgery, University of Arizona College of Medicine, Tucson, AZ, USA
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Garg R, Singh A, Khaja A, Martin A, Aggarwal K. How does volume status affect BNP and troponin levels as markers of cardiovascular status in peritoneal dialysis? ACTA ACUST UNITED AC 2010; 15:240-4. [PMID: 19751426 DOI: 10.1111/j.1751-7133.2009.00094.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Cardiac biomarkers such as brain natriuretic peptide, amino-terminal pro-B-type natriuretic peptide (NT-proBNP), and cardiac troponin provide information on cardiovascular morbidity and mortality in patients with normal renal function. In a considerable number of chronic hemodialysis patients, both biomarkers-NT-proBNP and troponin-are elevated despite the absence of cardiac ischemia. The elevation of cardiac biomarkers in chronic hemodialysis patients is of prognostic value with respect to cardiovascular morbidity and mortality. Furthermore, they can serve as tools for volume assessment for optimization of the fluid management aspect of dialysis. However, the association of both these markers in peritoneal dialysis is not clear. Therefore, the authors reviewed the literature to examine the role of these markers in peritoneal dialysis patients both as prognostic indicators as well as tools for volume assessment.
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Affiliation(s)
- Rajeev Garg
- University of Missouri-Columbia, 65202, USA.
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Malfatto G, Branzi G, Giglio A, Villani A, Facchini C, Ciambellotti F, Facchini M, Parati G. Transthoracic bioimpedance and brain natriuretic peptide levels accurately indicate additional diastolic dysfunction in patients with chronic advanced systolic heart failure. Eur J Heart Fail 2010; 12:928-35. [PMID: 20562427 DOI: 10.1093/eurjhf/hfq089] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Diastolic dysfunction in patients with heart failure has prognostic relevance, possibly because of its relationship with worsening haemodynamic status. In the quest for simpler indexes of haemodynamic status in patients, brain natriuretic peptide (BNP) levels have been proposed as a surrogate of diastolic function. To date, the value of combining BNP levels with non-invasive haemodynamic monitoring by transthoracic electric bioimpedance (TEB) for the prediction of diastolic function has not been evaluated. METHODS AND RESULTS We compared left ventricular diastolic function measured by tissue Doppler imaging (TDI) with TEB results and BNP levels in 120 patients with chronic advanced systolic heart failure on optimal treatment (70 +/- 9 years, NYHA 2.4 +/- 0.8, ejection fraction 31 +/- 5%). Of the TEB variables measured, we only considered thoracic fluid content (TFC). To describe diastolic function, we used the TDI of the velocity of displacement of the mitral annulus (E') and the ratio E/E'. In all patients, E/E' was significantly related to TFC and to BNP levels (P < 0.001). Moreover, the combination of BNP > or = 350 pg/mL and TFC > or = 35/kOmega identified patients with diastolic dysfunction (defined as E/E' > or = 15) with high sensitivity and specificity (95 and 94%, respectively). CONCLUSION The combination of transthoracic bioimpedance monitoring and BNP measurement accurately indicated the presence of diastolic dysfunction in most patients. These user-friendly and operator-independent tools may be useful as a screening assessment for diastolic dysfunction, and consequently abnormal central haemodynamic status, either in ambulatory patients or when an adequate echocardiographic evaluation is not readily available.
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Affiliation(s)
- Gabriella Malfatto
- Divisione di Cardiologia, Istituto Scientifico Ospedale San Luca, Istituto Auxologico Italiano IRCCS via Spagnoletto, 3, 20149 Milano, Italy.
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SAV TANSU, INANC MEHMETTUGRUL, DOGAN ALI, OYMAK OKTAY, UTAS CENGIZ. Two daytime icodextrin exchanges decrease brain natriuretic peptide levels and improve cardiac functions in continuous ambulatory peritoneal dialysis patients. Nephrology (Carlton) 2010; 15:307-12. [DOI: 10.1111/j.1440-1797.2009.01186.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Clinical utility of NT-proBNP levels in late heart transplantation patients. Clin Chim Acta 2010; 411:161-6. [DOI: 10.1016/j.cca.2009.10.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Revised: 10/28/2009] [Accepted: 10/28/2009] [Indexed: 11/19/2022]
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Buchner S, Jungbauer C, Birner C, Debl K, Riegger GA, Luchner A. Comparison of the cardiac markers B-type natriuretic peptide and N-terminal pro B-type natriuretic peptide. Biomark Med 2009; 3:465-81. [DOI: 10.2217/bmm.09.47] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
B-type natriuretic peptide and N-terminal pro B-type natriuretic peptide have emerged as powerful biomarkers for heart failure and other cardiovascular conditions. B-type natriuretic peptide and N-terminal pro B-type natriuretic peptide are synthesized on the basis of myocardial stress and hypertrophy and are detectable in serum by several commercially available assays. Although both markers display wide similarities in their predictive values for acute and chronic heart failure, important differences exist regarding cutoff values and influence of noncardiac variables. The similarities and differences between B-type natriuretic peptide and N-terminal pro B-type natriuretic peptide will be reviewed and illustrated in detail regarding preanalytics and analytics, predictive properties for acute and chronic heart failure and prognosis as well as the influence of noncardiac parameters.
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Affiliation(s)
- Stefan Buchner
- Klinik und Poliklinik für Innere Medizin II, Kardiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauss Allee 11, 93042 Regensburg, Germany
| | - Carsten Jungbauer
- Klinik und Poliklinik für Innere Medizin II, Kardiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauss Allee 11, 93042 Regensburg, Germany
| | - Christoph Birner
- Klinik und Poliklinik für Innere Medizin II, Kardiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauss Allee 11, 93042 Regensburg, Germany
| | - Kurt Debl
- Klinik und Poliklinik für Innere Medizin II, Kardiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauss Allee 11, 93042 Regensburg, Germany
| | - Günter A Riegger
- Klinik und Poliklinik für Innere Medizin II, Kardiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauss Allee 11, 93042 Regensburg, Germany
| | - Andreas Luchner
- Klinik und Poliklinik für Innere Medizin II, Kardiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauss Allee 11, 93042 Regensburg, Germany
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Peacock WF, Fonarow GC, Ander DS, Collins SP, Gheorghiade M, Kirk JD, Filippatos G, Diercks DB, Trupp RJ, Hiestand B, Amsterdam EA, Abraham WT, Amsterdam EA, Dodge G, Gaieski DF, Gurney D, Hayes CO, Hollander JE, Holmes K, Januzzi JL, Levy P, Maisel A, Miller CD, Pang PS, Selby E, Storrow AB, Weintraub NL, Yancy CW, Bahr RD, Blomkalns AL, McCord J, Nowak RM, Stomel RJ. Society of Chest Pain Centers recommendations for the evaluation and management of the observation stay acute heart failure patient—part 1. ACTA ACUST UNITED AC 2009; 11:3-42. [DOI: 10.1080/02652040802688690] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Faggiano P, Valle R, Aspromonte N, D'Aloia A, Di Tano G, Barro S, Giovinazzo P, Milani L, Lorusso R, Dei Cas L. How often we need to measure brain natriuretic peptide (BNP) blood levels in patients admitted to the hospital for acute severe heart failure? Role of serial measurements to improve short-term prognostic stratification. Int J Cardiol 2009; 140:88-94. [PMID: 19321212 DOI: 10.1016/j.ijcard.2008.11.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Revised: 08/18/2008] [Accepted: 11/01/2008] [Indexed: 11/28/2022]
Abstract
BACKGROUND Brain natriuretic peptide (BNP) is increasingly used in the management of patients with heart failure (HF). It is still unclear how to use serial BNP measurement in HF. AIM To evaluate the usefulness of three consecutive measurements of BNP in patients (pts) hospitalized for acute HF. METHODS Clinical evaluation, BNP levels and echocardiography were assessed in 150 pts (67% males, age: 69+/-12 years; left ventricular ejection fraction: 34+/-14%) admitted for severe HF (NYHA class III-IV: 146/150). BNP measurements were obtained: at admission (basal, T0), at discharge (T1) and at first ambulatory control (T2), after optimization of medical therapy in those with discharge BNP level >250 pg/mL. End-points were death and hospital readmission during 6-month follow-up. RESULTS According to BNP levels 3 groups of patients were identified: Group 1 (62 pts, 41%), in whom discharge (T1) BNP was high and persisted elevated at T2 despite aggressive medical therapy; at 6-month follow-up 72% died or were hospitalized for HF. Group 2 (36 pts, 24%), in whom discharge (T1) BNP was high but decreased after medical therapy (T2); death and HF-readmission were observed in 8 pts (26%). Group 3 (52 pts, 35%), in whom discharge (T1) BNP levels were <250 pg/mL and persisted below this value at T2; death and HF-hospital readmission were observed in 6 pts (12%). Event rate differences among groups were statistically significant (p<0.001). At Cox-analysis discharge BNP cutoff of 250 pg/mL was the only parameter predictive of a worse outcome. CONCLUSION These data suggest that 3 BNP measurements, at admission, at discharge and few weeks later can allow to identify HF pts whom, despite a further potentiation of medical therapy, will present a worsening or even will die during short-term follow-up.
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Affiliation(s)
- Pompilio Faggiano
- Dept. of Cardiology, Spedali Civili and University of Brescia, Brescia, Italy.
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Woo JJ, Koh YY, Kim HJ, Chung JW, Chang KS, Hong SP. N-terminal pro B-type natriuretic peptide and the evaluation of cardiac dysfunction and severity of disease in cirrhotic patients. Yonsei Med J 2008; 49:625-31. [PMID: 18729306 PMCID: PMC2615290 DOI: 10.3349/ymj.2008.49.4.625] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Cardiac dysfunction and hyperdynamic systemic circulation may be present in patients with cirrhosis. The purpose of this study was to identify relations between plasma levels of N-terminal-proBNP (NT-proBNP), reflecting early ventricular dysfunction, and the severity of liver disease and cardiac dysfunction in cirrhotic patients. MATERIALS AND METHODS Sixty-three cirrhotic patients and 15 controls (group 1) were enrolled in this study. Plasma levels of NT-proBNP were determined in echocardiographically examined patients, which were allocated to 1 of 3 groups according to Child-Pugh classification or into 2 groups, i.e., a compensated group without ascites (group 2) and decompensated group with ascites (group 3). RESULTS Plasma NT-proBNP levels were significantly higher in cirrhotic patients (groups 2 and 3) than in age-matched controls (155.9 and 198.3 vs. 40.3 pg/mL, respectively, p < 0.05). NT-proBNP levels were significantly increased in Child class C patients than in classes B and A (250.0 vs. 168.6 and 119.6 pg/mL, respectively, p < 0.05). Left atrial dimension, wall thickness of left ventricle, and EF or E/E' were significantly increased, and EDT was prolonged in cirrhotic patients than in controls. Increased LVMI and decreased E/A ratio were noted in the group of patients with ascites as compared with the other groups. CONCLUSION Plasma NT-proBNP levels were high in cirrhotic patients and are likely to be related to the severity of disease. Advanced cirrhosis is associated with advanced cardiac dysfunction, and NT-proBNP levels has predictive value for concomitant cardiac dysfunction and cirrhosis progression.
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Affiliation(s)
- Jeong Joo Woo
- Department of Radiology, Eulji Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Young Youp Koh
- Division of Cardiology, Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Korea
| | - Hee Joong Kim
- Department of Internal Medicine, Hwasun Korea Hospital, Hwasun, Korea
| | - Joong Wha Chung
- Division of Cardiology, Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Korea
| | - Kyoung Sig Chang
- Division of Cardiology, Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Korea
| | - Soon Pyo Hong
- Division of Cardiology, Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Korea
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Peacock WF, Fonarow GC, Ander DS, Maisel A, Hollander JE, Januzzi JL, Yancy CW, Collins SP, Gheorghiade M, Weintraub NL, Storrow AB, Pang PS, Abraham WT, Hiestand B, Kirk JD, Filippatos G, Gheorghiade M, Pang PS, Levy P, Amsterdam EA. Society of Chest Pain Centers Recommendations for the evaluation and management of the observation stay acute heart failure patient: a report from the Society of Chest Pain Centers Acute Heart Failure Committee. Crit Pathw Cardiol 2008; 7:83-86. [PMID: 18520521 DOI: 10.1097/01.hpc.0000317706.54479.a4] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Petretta M, Scopacasa F, Fontanella L, Carlomagno A, Baldissara M, de Simone A, Petretta MP, Bonaduce D. Prognostic value of reduced kidney function and anemia in patients with chronic heart failure. J Cardiovasc Med (Hagerstown) 2007; 8:909-16. [PMID: 17906476 DOI: 10.2459/jcm.0b013e32801464b6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The present study aimed to evaluate the prognostic value of B-type natriuretic peptide (N-proBNP), renal dysfunction and anemia in chronic heart failure (CHF) patients. METHODS We analyzed data from a prospective cohort of 153 patients (mean age 64 years) with CHF referred to our hospital center. Clinical, echocardiographic and laboratory data were drawn during hospital recovery in all patients. Kidney dysfunction was defined as a glomerular filtration rate (GFR) < 60 ml/min and anemia as a hematocrit < 35%. After discharge, patients attended the outpatient clinic of our institution. RESULTS Kidney dysfunction was diagnosed in 37% of cases, whereas anemia was present in 25% of patients. During follow-up (median time 456 days), 32 patients died. Multivariate Cox proportional hazard model revealed that N-proBNP [hazard ratio (HR) = 1.002; P < 0.001] and GFR (HR = 0.972; P < 0.005) were significant predictors for mortality after adjustment for confounding variables. Kaplan-Maier analysis demonstrated a progressive decrease in survival from lowest to highest tertiles of N-proBNP values (log rank = 28.7; P < 0.001) and from higher to lower GFR values (log rank = 5.63; P < 0.01). Moreover, parametric survival analysis by the Weibull model demonstrated that the estimated probability of survival adjusted for N-proBNP values was higher in patients with GFR > or = 60 ml/min than in those with GFR < 60 ml/min (P < 0.001). CONCLUSION Increased N-proBNP and decreased kidney function, but not anemia, are independent risk factors for mortality in patients with CHF.
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Affiliation(s)
- Mario Petretta
- Department of Internal Medicine, Cardiology, Heart Surgery and Immunological Sciences, University of Naples Federico II, Via S Pansini no. 5, Naples, Italy
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Bayes-Genis A, Pascual-Figal D, Fabregat J, Domingo M, Planas F, Casas T, Ordoñez-Llanos J, Valdes M, Cinca J. Serial NT-proBNP monitoring and outcomes in outpatients with decompensation of heart failure. Int J Cardiol 2007; 120:338-43. [PMID: 17174423 DOI: 10.1016/j.ijcard.2006.10.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2006] [Revised: 09/26/2006] [Accepted: 10/14/2006] [Indexed: 11/16/2022]
Abstract
BACKGROUND NT-proBNP is useful for heart failure (HF) diagnosis and prognosis. We examined the value of serial NT-proBNP monitoring to predict outcomes in decompensated HF patients attending a structured HF clinic. METHODS Patients with decompensation of established optimally treated HF, not requiring emergency hospital admission, were enrolled in the study. Patients received intensive follow-up weekly during 4 weeks and at 3 months in specialist HF clinics. Serial NT-proBNP concentrations were measured at each visit. Primary endpoint was cardiovascular death and hospital admission for HF at 3 months. RESULTS Fifty-nine patients were enrolled (60+/-14 years, LVEF 27+/-9%) and 39% had a primary endpoint during follow-up. Baseline NT-proBNP concentration (in ng/L) was 7050+/-6620, and did not differ significantly in patients with and without events (p=0.22). Patients without events showed marked NT-proBNP reduction at week-1 (30% reduction), week-2 (36% reduction), week-3 (34% reduction) and week-4 (37% reduction). By contrast, patients with events showed no significant NT-proBNP reduction during follow-up. Using a general linear model, the relative NT-proBNP reductions (%) at weeks 1-4 were predictors of adverse events (p=0.004, p<0.001, p=0.001 and p=0.03, respectively). In a stepwise multiple Cox regression analysis, NT-proBNP relative reduction (in %) at week 2 was a strong predictor of no events during follow-up (OR 0.79, 95% CI 0.70-0.88, p<0.001). CONCLUSIONS Serial NT-proBNP monitoring in decompensated HF patients seen in a structured in-hospital HF clinic predicts cardiovascular events during follow-up. NT-proBNP may be useful in an outpatient basis to identify patients at high risk needing more aggressive therapy.
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Di Napoli P, Di Giovanni P, Gaeta MA, D'Apolito G, Barsotti A. Beneficial effects of trimetazidine treatment on exercise tolerance and B-type natriuretic peptide and troponin T plasma levels in patients with stable ischemic cardiomyopathy. Am Heart J 2007; 154:602.e1-5. [PMID: 17719313 DOI: 10.1016/j.ahj.2007.06.033] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2007] [Accepted: 06/22/2007] [Indexed: 11/28/2022]
Abstract
BACKGROUND In patients with ischemic cardiomyopathy, mortality rate and quality of life are unsatisfactory. We investigated the effects of the metabolic agent trimetazidine (TMZ) on exercise tolerance and prognostic markers B-type natriuretic peptide (BNP) and cardiac troponin T (cTnT) plasma levels. METHODS Fifty patients with ischemic cardiomyopathy were randomized either to receive TMZ (20 mg, TID) in addition to their conventional treatment (TMZ group, n = 25) or to continue their usual drug therapy (control group, n = 25) for 6 months. Patients were evaluated at baseline, at 1 month, and at 6 months (echocardiography and 6-minute walking test). At enrollment and at the end of follow-up, blood testing was performed for determination of BNP and cTnT plasma levels. RESULTS After 6 months, no significant New York Heart Association class changes occurred in all patients (P = NS). In the TMZ group, a significant increase of exercise tolerance (P < .01) was detected, whereas left ventricular ejection fraction was unchanged (28% +/- 4%, 29% +/- 5%, and 32% +/- 5% at baseline, at 1 month, and at 6 months, respectively; P = NS). In the TMZ group, BNP was significantly reduced (6 months, 135 +/- 22 vs 252 +/- 44 pg/mL; P < .001), whereas it was significantly increased in controls (6 months, 288 +/- 46 vs 239 +/- 59 pg/mL; P < .02); cTnT significantly (P < .001) reduced during TMZ treatment, whereas it was unchanged in the control group. CONCLUSIONS Six-month TMZ treatment improves exercise tolerance and reduces plasma levels of BNP and cTnT in patients with compensated ischemic cardiomyopathy.
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Affiliation(s)
- Pericle Di Napoli
- Department of Cardiology, Centre for Study and Treatment of Congestive Heart Failure, Villa Pini d'Abruzzo Clinic, Chieti, Italy.
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Abstract
There is increasing interest in the B-type natriuretic peptides in many clinical settings, with most research centered on patients with heart failure. These peptides have a strong negative predictive value in patients suspected of having this diagnosis, but are also known to be powerfully predictive of an adverse outcome. This latter property is particularly important in patients with advanced heart failure, allowing the selection of at-risk individuals for therapies that are in scarce resource. There is also ongoing research into B-type natriuretic peptide as a treatment for decompensated heart failure, as well as in other clinical contexts. This review aims to summarize the contemporary and established data on the B-type natriuretic peptides, with particular emphasis in the context of advanced heart failure.
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Affiliation(s)
- Roy S Gardner
- Royal Infirmary, Scottish National Advanced Heart Failure Service, Department of Cardiology, Glasgow, UK
| | - Kwok S Chong
- Western Infirmary, Department of Cardiology, Glasgow, UK
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Petretta M, Colao A, Sardu C, Scopacasa F, Marzullo P, Pivonello R, Fontanella L, de Caterina M, de Simone A, Bonaduce D. NT-proBNP, IGF-I and survival in patients with chronic heart failure. Growth Horm IGF Res 2007; 17:288-296. [PMID: 17383209 DOI: 10.1016/j.ghir.2007.01.020] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2006] [Revised: 01/31/2007] [Accepted: 01/31/2007] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Growth hormone (GH) resistance with a reduction of insulin-like growth factor-I (IGF-I) serum concentrations seems to be implicated in the catabolic process associated with chronic heart failure (CHF). However, data concerning the prognostic value of these alterations in CHF patients without cachexia are scant. In this study, we aimed to determine in CHF patients the prognostic value of IGF-I/GH ratio and its relationships with N-terminal brain natriuretic peptide (NT-proBNP), a known marker of prognosis in these patients. DESIGN We enrolled 82 non-cachectic patients, mean age 61+/-13 years, with ejection fraction <40% and predischarge New York Heart Association (NYHA) functional classes II-IV. All patients underwent clinical examination, two-dimensional echocardiography and NT-proBNP, GH and IGF-I measurement with log IGF-I/GH ratio calculation. Mortality and clinical status was documented at follow-up (18.4+/-8.1 months). RESULTS During follow-up 17 patients died of cardiac causes. Non-survivors were at baseline in higher NYHA class (P<0.05) and showed higher values of NT-proBNP (P<0.001) than survivors; differently IGF-I, and log IGF-I/GH ratio were lower (P<0.05). At Cox multivariate analysis, NT-proBNP (P<0.001) and IGF-I/GH ratio (P<0.05) were independent predictors of death. CONCLUSIONS High NT-proBNP levels and low IGH-I/GH ratio may be useful to stratify CHF patients at higher risk of cardiac death.
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Affiliation(s)
- Mario Petretta
- Department of Internal Medicine, Cardiology, Heart and Immunological Sciences, Section of Internal Medicine, University of Naples Federico II, Italy
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Wang AYM, Lam CWK, Yu CM, Wang M, Chan IHS, Zhang Y, Lui SF, Sanderson JE. N-Terminal Pro-Brain Natriuretic Peptide: An Independent Risk Predictor of Cardiovascular Congestion, Mortality, and Adverse Cardiovascular Outcomes in Chronic Peritoneal Dialysis Patients. J Am Soc Nephrol 2006; 18:321-30. [PMID: 17167121 DOI: 10.1681/asn.2005121299] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
This study was performed to determine whether the N-terminal pro-brain natriuretic peptide (NT-pro-BNP) is a useful biomarker in predicting cardiovascular congestion, mortality, and cardiovascular death and event in chronic peritoneal dialysis (PD) patients. A prospective cohort study was conducted in 230 chronic PD patients in a dialysis unit of a university teaching hospital. Serum NT-pro-BNP was measured at baseline together with echocardiography and dialysis indices. Each patient was followed for 3 yr from the day of enrollment or until death. Time to develop first episode of cardiovascular congestion and other cardiovascular event and time to mortality and cardiovascular death were studied in relation to NT-pro-BNP. NT-pro-BNP showed the strongest correlation with residual GFR, followed by left ventricular ejection fraction and left ventricular mass index. In the univariate Cox regression model, NT-pro-BNP was a significant predictor of cardiovascular congestion, mortality, and cardiovascular death and event. In the fully adjusted multivariable Cox regression analysis that included residual GFR, left ventricular ejection fraction, and left ventricular mass index, the hazard ratios for cardiovascular congestion, mortality, composite end point of mortality and cardiovascular congestion, and cardiovascular death and event for patients of the fourth quartile were 4.25 (95% confidence interval [CI] 1.56 to 11.62; P = 0.005), 4.97 (95% CI 1.35 to 18.28; P = 0.016), 5.03 (95% CI 2.07 to 12.26; P < 0.001), 7.50 (95% CI 1.36 to 41.39; P = 0.021), and 9.10 (95% CI 2.46 to 33.67; P = 0.001), respectively, compared with the first quartile. These data showed that NT-pro-BNP is an important risk predictor of cardiovascular congestion, mortality, and adverse cardiovascular outcomes in chronic PD patients and adds important prognostic information beyond that contributed by left ventricular hypertrophy, systolic dysfunction, and other conventional risk factors.
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Djoussé L, Hunt SC, Eckfeldt JH, Arnett DK, Province MA, Ellison RC. Alcohol consumption and plasma atrial natriuretic peptide (from the HyperGEN study). Am J Cardiol 2006; 98:628-32. [PMID: 16923450 DOI: 10.1016/j.amjcard.2006.03.041] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2005] [Revised: 03/07/2006] [Accepted: 03/09/2006] [Indexed: 10/24/2022]
Abstract
Although moderate alcohol consumption has been associated with a lower risk of cardiovascular disease, underlying physiologic mechanisms are not fully understood. Data relating alcohol intake to atrial natriuretic peptide (ANP) have been inconsistent. We evaluated whether alcohol consumption was associated with plasma ANP in 1,345 participants from the Hypertension Genetic Epidemiology Network (HyperGEN) study. We used random effect models to estimate the adjusted means of logarithmic transformed ANP. The mean age was 35.8 +/- 8.6 years, 91% were normotensive, 46% were men, and 40% and 60% were African-Americans and whites, respectively. In a model adjusting for age, body mass index, field center, education, gender, race, and serum albumin, alcohol consumption was positively associated with ANP in men (p < 0.0001 for trend) and women (p = 0.0014) and in African-Americans (p = 0.006) and whites (p < 0.0001). The adjusted mean of log-transformed ANP was 3.68, 3.67, 3.77, 3.76, 3.86, and 3.91 pg/ml in lifetime abstainers, former drinkers, and current drinkers of 1 to 6, 7 to 12, 13 to 24, and > 24 g/d, respectively. Controlling for additional factors, including left atrial size, ejection fraction, left ventricular mass, end-diastolic volume, systolic blood pressure, smoking, lipids, and serum creatinine did not change the results. Restriction to normotensive subjects yielded similar results. Alcohol intake was associated positively with systolic and diastolic blood pressure (p < 0.0001 each for trend). In conclusion, our data have shown a positive and linear association between alcohol consumption and ANP in men and women, irrespective of race.
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Affiliation(s)
- Luc Djoussé
- Division of Aging, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
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Abstract
Acute decompensated heart failure (ADHF) is a complex disease of epidemic proportions. In the United States, it accounts for more than 1 million hospitalizations annually,and heart failure represents the single greatest cost to the Centers for Medicaid and Medicare Studies. Half of the annual costs are estimated to be the result of hospitalization. Compared with other pathology, heart failure has a very high hospitalization rate, with 80% of emergency department ADHF patients being admitted. This high rate has resulted from the lack of successful management predictors available to the emergency physician and the lack of any disposition option other than hospitalization for the ADHF patient. The emergency department observation unit offers an alternative to hospitalization for patients with ADHF. Validated protocols have demonstrated that in ADHF, intensive short-term therapeutic, diagnostic, and educational protocols result in a marked improvement in hospitalization rates, while at the same time decreasing costs. New risk stratification data can aid in the identification of the appropriate candidate. The observation unit now represents a nonhospitalization disposition option for patients presenting to the emergency department with ADHF.viii CO
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Affiliation(s)
- W Frank Peacock
- Department of Emergency Medicine, The Cleveland Clinic, OH 44195, USA.
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Abstract
The recent guidelines of the European Society of Cardiology, recommends laboratory testing as an essential part of the evaluation of the patient presenting with acute or chronic heart failure. The decrease in BNP has been included as a treatment goal for the management of acute heart failure. As for other properties it is important to define what difference can be considered as a real change of the marker in serial measurements. Therefore, knowledge of pathophysiological influences and pre-analytical issues as well as the intraindividual variability of BNP and N-terminal proBNP (NT-proBNP) due to analytical imprecision and biological variation is crucial. Erroneous test results with BNP or NT-proBNP assays are rare but may occasionally occur analytical interferences and should be suspected if the results do not suit the clinical picture or the serial kinetics. Although BNP assays correlate closely, due to lack of standardization no two BNP assays are analytically equivalent, and the same assay must be used for serial measurement. The in-vitro stabilities of BNP and NT-proBNP are sufficient for routine use, and blood sampling for BNP or NT-proBNP directly after arrival without a standardized period of rest is feasible, however, heavy physical exercise should be avoided before blood sampling. To be on the safe side a period of 10 minutes rest before blood sampling is recommended. BNP and NT-proBNP are suitable for heart failure monitoring, and BNP and NT-proBNP changes >50% from baseline correlated well with clinical course and a reduction of mortality in heart failure patients.
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Affiliation(s)
- Johannes Mair
- Clinical Division of Cardiology, Department of Internal Medicine, Innsbruck Medical University, Innsbruck, Austria.
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41
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Verdiani V, Nozzoli C, Bacci F, Cecchin A, Rutili MS, Paladini S, Olivotto I. Pre-discharge B-type natriuretic peptide predicts early recurrence of decompensated heart failure in patients admitted to a general medical unit. Eur J Heart Fail 2005; 7:566-71. [PMID: 15921796 DOI: 10.1016/j.ejheart.2004.12.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2004] [Revised: 10/29/2004] [Accepted: 12/20/2004] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND B-type natriuretic peptide (BNP) represents a promising predictor of early (30 days) re-admission in patients with heart failure (HF) admitted to cardiology units. Whether BNP retains its predictive value in unselected patients admitted to general medical wards is unknown. METHODS We determined BNP levels on admission and pre-discharge in 100 consecutive patients (71 male, mean age 78+/-10 years) admitted to a general medical unit due to decompensated HF. Follow-up after discharge was 30 days. RESULTS Of the 100 patients, 86 had >/=1 comorbid conditions. Median BNP was 739 pg/ml on admission (25th-75th percentile 355-1333 pg/ml, respectively), and 414 pg/ml pre-discharge (25th-75th percentile 220-696 pg/ml). Seventeen patients were re-admitted or died within 30 days. Patients with pre-discharge BNP values >75th percentile (696 pg/ml) had greater risk of re-hospitalisation, as compared to values </=696 pg/ml (56% vs. 4%, respectively; p<0.001). Negative predictive value for this cut-off was 96%. BNP values >75th percentile were associated with a 15.0 independent relative hazard (RH) of early re-admission or death (95% CI 4.2-53.8; p<0.0001). The other independent predictor was a NYHA class >/=III at discharge (RH 2.9; 95% CI 1.1-9.3; p<0.05). CONCLUSION In a general medical unit, pre-discharge BNP levels were a strong independent predictor of early re-admission or death due to HF, irrespective of substantial comorbidity and advanced age.
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Affiliation(s)
- Valerio Verdiani
- II Unit of Internal Medicine, Azienda Ospedaliera Universitaria Careggi, Florence, Italy.
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42
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Luther SA, McCullough PA, Havranek EP, Rumsfeld JS, Jones PG, Heidenreich PA, Peterson ED, Rathore SS, Krumholz HM, Weintraub WS, Spertus JA, Masoudi FA. The Relationship Between B-type Natriuretic Peptide and Health Status in Patients With Heart Failure. J Card Fail 2005; 11:414-21. [PMID: 16105631 DOI: 10.1016/j.cardfail.2005.02.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2004] [Revised: 02/10/2005] [Accepted: 02/16/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Although B-type natriuretic peptide (BNP) levels have been proposed as a means of assessing disease severity in patients with heart failure, it is not known if BNP levels are correlated with health status (symptom burden, functional limitation, and quality of life). METHODS AND RESULTS We studied 342 outpatients with systolic heart failure from 14 centers at baseline and 6 +/- 2 weeks with BNP levels and the Kansas City Cardiomyopathy Questionnaire (KCCQ), a heart-failure-specific health status instrument. We assessed the correlation between KCCQ scores and BNP at baseline and changes in KCCQ according to changes in BNP levels between baseline and follow-up. Mean baseline BNP levels were 379 +/- 387 pg/mL and mean KCCQ summary scores were 62 +/- 23 points. Although baseline BNP and KCCQ were both associated with New York Heart Association classification (P < .001 for both), BNP and KCCQ were not correlated (r(2) = 0.008, P = .15). There was no significant relationship between changes in BNP and KCCQ regardless of the threshold used to define a clinically meaningful BNP change. For example, using >50% BNP change threshold, KCCQ improved by 3.7 +/- 14.2 in patients with decreasing BNP, improved by 1.7 +/- 13.6 in patients with no BNP change, and improved by 1.0 +/- 13.4 in patients with increasing BNP (P = .6). CONCLUSION BNP and health status are not correlated in outpatients with heart failure in the short term. This suggests that these measures may assess different aspects of heart failure severity, and that physiologic measures do not reflect patients' perceptions of the impact of heart failure on their health status.
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Affiliation(s)
- Stacie A Luther
- Department of Medicine, University of Colorado Health Sciences Center, Denver, USA
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43
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Luchner A, Hengstenberg C, Löwel H, Riegger GAJ, Schunkert H, Holmer S. Effect of Compensated Renal Dysfunction on Approved Heart Failure Markers. Hypertension 2005; 46:118-23. [PMID: 15939804 DOI: 10.1161/01.hyp.0000170140.36633.8f] [Citation(s) in RCA: 130] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Brain natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) are markers of heart failure. Although renal dysfunction may increase plasma concentrations, the magnitude of this effect has not been assessed in a head-to-head comparison between the clinically approved tests. We assessed the effect of compensated renal dysfunction on BNP (Triage BNP; Biosite) and NT-proBNP (elecsys proBNP; Roche) in 469 randomly selected stable outpatients after myocardial infarction (MI; Monitoring Trends and Determinants in Cardiovascular Diseases [MONICA] register Augsburg) who were characterized with respect to renal function (glomerular filtration rate [GFR]; Cockroft method) and left ventricular (LV) ejection fraction (EF) and mass (2D echocardiography). BNP and NT-proBNP were elevated in MI patients with LV dysfunction (LVD; EF <35%) compared with MI patients with preserved EF (>45%; BNP 139±27 pg/mL versus 75±6; NT-proBNP 816±237 pg/mL versus 243±20; both
P
<0.03). Among all MI patients, the prevalence of renal dysfunction (GFR <85 mL/min) was 24%. BNP and NT-proBNP were significantly elevated in MI patients with renal dysfunction (BNP 132±17 pg/mL versus 68±4 without renal dysfunction; NT-proBNP 535±80 pg/mL versus 232±19; both
P
<0.05), and both markers were correlated with GFR in univariate and multivariate analyses (all
P
<0.01). When binary cut-off values were stratified according to the absence or presence of renal dysfunction (BNP 75 pg/mL and 125 pg/mL, respectively; NT-proBNP 100 pg/mL and 350pg/mL, respectively), the predictive power of both markers for the detection of LVD increased substantially. BNP and NT-proBNP are almost similarly influenced by mild-to-moderate renal dysfunction. Renal dysfunction is a potential cause of elevated marker concentrations in the absence of LVD, and cut-off concentrations should be stratified according to renal function.
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Affiliation(s)
- Andreas Luchner
- Klinik und Poliklinik für Innere Medizin II, University of Regensburg, Germany.
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44
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Bayés-Genís A, Lopez L, Zapico E, Cotes C, Santaló M, Ordonez-Llanos J, Cinca J. NT-ProBNP reduction percentage during admission for acutely decompensated heart failure predicts long-term cardiovascular mortality. J Card Fail 2005; 11:S3-8. [PMID: 15948093 DOI: 10.1016/j.cardfail.2005.04.006] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND N-terminal brain natriuretic peptide (NT-proBNP) improves emergency room diagnosis of acutely decompensated heart failure. Less evidence is available on the usefulness of NT-proBNP as a prognostic marker after hospitalization for acute heart failure. The percentage of NT-proBNP reduction during admission and its prognostic significance were studied. METHODS AND RESULTS This was a prospective study of 74 patients in the emergency department who were diagnosed with acute heart failure and who had follow-up evaluation for 6 and 12 months after admission. Plasma NT-proBNP concentrations were measured on admission, at 24 hours, at day 7, and at 6 and 12 months. Eighteen patients died during the 12-month follow-up; 12 deaths were from cardiovascular causes. NT-proBNP concentrations were significantly higher in the emergency department and at 24 hours than those concentrations that were found at day 7 and beyond (P < .001). During admission, the NT-proBNP concentration fell a mean of 15% in patients who died of cardiovascular causes during the 1-year follow-up evaluation, in 75% in those patients who died of non-cardiovascular causes, and in 50% in survivors (P = .004). The area under the receiver operator characteristic curve for NT-proBNP reduction percentage to predict cardiovascular death was 0.78 (95% CI, 0.66-0.90; P = .002). A 30% NT-proBNP reduction percentage cutoff value had 75% accuracy for the identification of high-risk patients and was the only variable that was associated with cardiovascular death in multivariate analysis (odds ratio, 4.4; 95% CI, 1.12-17.4; P = .03). CONCLUSION NT-proBNP reduction percentage during admission for acutely decompensated heart failure appeared to be the best predictor of cardiovascular death during the follow-up period. A <30% NT-proBNP reduction percentage identified a subgroup of high-risk patients.
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Affiliation(s)
- Antoni Bayés-Genís
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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45
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Verma A, Kilicaslan F, Martin DO, Minor S, Starling R, Marrouche NF, Almahammed S, Wazni OM, Duggal S, Zuzek R, Yamaji H, Cummings J, Chung MK, Tchou PJ, Natale A. Preimplantation B-type natriuretic peptide concentration is an independent predictor of future appropriate implantable defibrillator therapies. Heart 2005; 92:190-5. [PMID: 15923278 PMCID: PMC1860790 DOI: 10.1136/hrt.2004.058198] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To assess prospectively whether preimplantation B-type natriuretic peptide (BNP) and C reactive protein (CRP) concentrations predict future appropriate therapies from an implantable cardioverter-defibrillator (ICD). DESIGN AND SETTING Prospective cohort study conducted in a tertiary cardiac care centre. METHODS 345 consecutive patients undergoing first time ICD implantation were prospectively studied. Serum BNP and CRP concentrations were obtained the day before ICD implantation. Patients were followed up with device interrogation to assess for appropriate shocks or antitachycardia pacing. Inappropriate therapies were excluded. Mean (SD) follow up was 13 (5) months. RESULTS Patients had ischaemic (71%), primary dilated (17%), and valvar or other cardiomyopathies (12%). About half (52%) had ICDs implanted for primary prevention. Sixty three (18%) received appropriate ICD therapies. Serum creatinine, beta blocker, statin, and angiotensin converting enzyme inhibitor usage did not differ between therapy and no therapy groups. By univariate comparison, ejection fraction (p = 0.048), not taking amiodarone (p = 0.033), and BNP concentration (p = 0.0003) were risk factors for ICD therapy. However, by Cox regression multivariate analysis, only BNP above the 50th centile was a significant predictor (hazard ratio 2.19, 95% confidence interval 1.07 to 4.71, p = 0.040). Median BNP was 573 ng/l versus 243 ng/l in therapy and no therapy patients, respectively (p = 0.0003). More patients with BNP above the 50th centile (27% v 10%, p = 0.006) received ICD therapies. CONCLUSIONS A single preimplantation BNP concentration determination is independently predictive of ICD therapies in patients with cardiomyopathies undergoing first time ICD implantation. CRP was not independently predictive of ICD therapies when compared with BNP.
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Affiliation(s)
- A Verma
- Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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46
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Doust JA, Pietrzak E, Dobson A, Glasziou P. How well does B-type natriuretic peptide predict death and cardiac events in patients with heart failure: systematic review. BMJ 2005; 330:625. [PMID: 15774989 PMCID: PMC554905 DOI: 10.1136/bmj.330.7492.625] [Citation(s) in RCA: 506] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To assess how well B-type natriuretic peptide (BNP) predicts prognosis in patients with heart failure. DESIGN Systematic review of studies assessing BNP for prognosis in patients with heart failure or asymptomatic patients. DATA SOURCES Electronic searches of Medline and Embase from January 1994 to March 2004 and reference lists of included studies. STUDY SELECTION AND DATA EXTRACTION We included all studies that estimated the relation between BNP measurement and the risk of death, cardiac death, sudden death, or cardiovascular event in patients with heart failure or asymptomatic patients, including initial values and changes in values in response to treatment. Multivariable models that included both BNP and left ventricular ejection fraction as predictors were used to compare the prognostic value of each variable. Two reviewers independently selected studies and extracted data. DATA SYNTHESIS 19 studies used BNP to estimate the relative risk of death or cardiovascular events in heart failure patients and five studies in asymptomatic patients. In heart failure patients, each 100 pg/ml increase was associated with a 35% increase in the relative risk of death. BNP was used in 35 multivariable models of prognosis. In nine of the models, it was the only variable to reach significance-that is, other variables contained no prognostic information beyond that of BNP. Even allowing for the scale of the variables, it seems to be a strong indicator of risk. CONCLUSION Although systematic reviews of prognostic studies have inherent difficulties, including the possibility of publication bias, the results of the studies in this review show that BNP is a strong prognostic indicator for both asymptomatic patients and for patients with heart failure at all stages of disease.
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Affiliation(s)
- Jenny A Doust
- Centre for General Practice, School of Medicine, University of Queensland, Herston Road, Herston, Qld 4006, Australia.
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47
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Jourdain P, Funck F, Bellorini M. [Brain natriuretic peptide and heart failure, from bench to bedside]. Ann Cardiol Angeiol (Paris) 2005; 53:193-9. [PMID: 15369315 DOI: 10.1016/j.ancard.2004.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Diagnosing or managing heart failure may still remain difficult. BNP and NT proBNP are neurohormones specifically secreted by myocytes. They have proved their effectiveness to improve clinician's diagnostic accuracy for diagnosing heart failure. BNP use is now recommended by European Society of Cardiology guidelines but multiplication of publications about BNP and NTProBNP show new possible applications for natriuretic peptides.
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Affiliation(s)
- P Jourdain
- Unité thérapeutique d'insuffisance cardiaque et service de cardiologie, centre hospitalier R.-Dubos, 95300 Pontoise, France.
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49
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Abstract
The United States is currently in the midst of a heart failure epidemic. This has a tremendous impact on morbidity, mortality, and associated costs to our health care system. With demographic trends expected to double the at-risk cohort over the next 30 years, there is a serious need to develop more efficacious strategies addressing early diagnosis, treatment options, and outcomes in patients stricken with heart failure. This article reviews the newest diagnostics, therapeutics, and strategies for the management of heart failure and suggests appropriate implementation of these approaches in the emergency department observation unit.
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Affiliation(s)
- W Frank Peacock
- Department of Emergency Medicine, The Cleveland Clinic, OH 44195, USA.
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50
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Huelmos A, Batlle E, España E, López-bescos L. Aplicaciones clínicas de la determinación plasmática del péptido natriurético auricular. Med Intensiva 2004. [DOI: 10.1016/s0210-5691(04)70083-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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