N-terminal pro-brain natriuretic peptide and associated factors in the general working population: a baseline survey of the Uranosaki cohort study

Comparing the Effects of Canagliflozin vs. Glimepiride by Body Mass Index in Patients with Type 2 Diabetes and Chronic Heart Failure: A Subanalysis of the CANDLE Trial

Background: We present results of a 24-week comparative study of the effects of the sodium−glucose cotransporter 2 (SGLT2) inhibitor canagliflozin vs. the sulfonylurea glimepiride, by baseline body mass index (BMI), in patients with type 2 diabetes and chronic heart failure. Methods: We conducted a post hoc analysis of the CANDLE trial. This subanalysis evaluated NT-proBNP, BMI, and other laboratory parameters, according to the subgroups stratified by BMI ≥ 25 kg/m2 vs. BMI < 25 kg/m2. Results: A group ratio of proportional changes in the geometric means of NT-proBNP was 0.99 (p = 0.940) for the subgroup with BMI ≥ 25 kg/m2 and 0.85 (p = 0.075) for the subgroup with BMI < 25 kg/m2, respectively. When baseline BMI was modeled as a continuous variable, results for patients with BMI < 30 kg/m2 showed a slightly smaller increase in NT-proBNP in the canagliflozin group vs. the glimepiride group (p = 0.295); that difference was not seen among patients with BMI ≥30 kg/m2 (p = 0.948). Irrespective of obesity, the canagliflozin group was associated with significant reduction in BMI compared to the glimepiride group. Conclusion: There was no significant difference in the effects of canagliflozin, relative to glimepiride, on NT-proBNP concentrations irrespective of baseline obesity. UMIN clinical trial registration number: UMIN000017669.

Cardiac magnetic resonance predicts ventricular arrhythmias in scleroderma: the Scleroderma Arrhythmia Clinical Utility Study (SAnCtUS)

OBJECTIVES

Cardiac rhythm disturbances constitute the most frequent cardiovascular cause of death in SSc. However, electrocardiographic findings are not a part of risk stratification in SSc. We aimed to translate 24 h Holter findings into a tangible risk prediction score using cardiovascular magnetic resonance.

METHODS

The Scleroderma Arrhythmia Clinical Utility Study (SAnCtUS) was a prospective multicentre study including 150 consecutive SSc patients from eight European centres, assessed with 24 h Holter and cardiovascular magnetic resonance, including ventricular function, oedema (T2 ratio) and late gadolinium enhancement (%LGE). Laboratory/clinical parameters were included in multivariable corrections. A combined endpoint of sustained ventricular tachycardia requiring hospitalization and sudden cardiac death at a median (interquartile range) follow-up of 1 (1.0-1.4) year was generated.

RESULTS

Only T2 ratio and %LGE were significant predictors of ventricular rhythm disturbances, but not of supraventricular rhythm disturbances, after multivariable correction and adjustment for multiple comparisons. Using decision-tree analysis, we created the SAnCtUS score, a four-category scoring system based on T2 ratio and %LGE, for identifying SSc patients at high risk of experiencing ventricular rhythm disturbance at baseline. Increasing SAnCtUS scores were associated with a greater disease and arrhythmic burden. All cases of non-sustained ventricular tachycardia (n = 7) occurred in patients with the highest SAnCtUS score (=4). Having a score of 4 conveyed a higher risk of reaching the combined endpoint in multivariable Cox regression compared with scores 1/2/3 [hazard ratio (95% CI): 3.86 (1.14, 13.04), P = 0.029] independently of left ventricular ejection fraction and baseline ventricular tachycardia occurrence.

CONCLUSION

T2 ratio and %LGE had the greatest utility as independent predictors of rhythm disturbances in SSc patients.

Factors Associated With Elevated N-Terminal Pro B-Type Natriuretic Peptide Concentrations at the Convalescent Stage and 1-Year Outcomes in Patients With Heart Failure With Preserved Ejection Fraction

Background: Little is known about factors associated with elevated N-terminal pro B-type natriuretic peptide (NT-proBNP) at the convalescent stage and their effects on 1-year outcomes in patients with heart failure with preserved ejection fraction (HFpEF). Methods and Results: This study included 469 patients with HFpEF. Elevated NT-proBNP was defined as the highest quartile. The first 3 quartiles (Q1-Q3) were combined together for comparison with the fourth quartile (Q4). Median NT-proBNP concentrations in Q1-Q3 and Q4 were 669 and 3,504 pg/mL, respectively. Multivariate logistic regression analysis revealed that low albumin (odds ratio [OR] 2.44; 95% confidence interval [CI] 1.35-4.39; P=0.003), low estimated glomerular filtration rate (OR 5.83; 95% CI 3.46-9.83; P<0.001), high C-reactive protein (OR 2.09; 95% CI 1.21-3.63; P=0.009), and atrial fibrillation at discharge (OR 2.33; 95% CI 1.40-3.89; P=0.001) were associated with elevated NT-proBNP. Cumulative rates of all-cause mortality and heart failure rehospitalization were significantly higher in Q4 than in Q1-Q3 (P=0.001 and P<0.001, respectively). Incidence and hazard ratios of these adverse events increased when the number of associated factors for elevated NT-proBNP clustered together (P<0.001 and P=0.002, respectively). Conclusions: In addition to atrial fibrillation, extracardiac factors (malnutrition, renal impairment and inflammation) were associated with elevated NT-proBNP at the convalescent stage, and led to poor prognosis in patients with HFpEF.

Association of Common Carotid Artery Measurements with N-terminal Pro B-type Natriuretic Peptide in Elderly Participants

Objective Numerous studies have reported an association between common carotid artery (CCA) parameters and atherosclerotic cardiovascular disease (CVD). However, the association between CCA parameters and hemodynamic stress on the left ventricle in elderly patients remains unclear. Methods We assessed CCA parameters, including the height-adjusted CCA interadventitial diameter (diameter/height), mean intima-media thickness (IMT), number of plaques, plaque score, resistance index (RI), and pulsatility index (PI) with ultrasonography, using serum N-terminal pro-brain natriuretic peptide (NT-proBNP) levels as a marker for hemodynamic stress on the left ventricle in 1,315 participants ≥70 years old without CVD. Of these participants, 706 had hypertension, defined as taking antihypertensive medications, having a systolic blood pressure ≥140 mmHg, and/or having a diastolic blood pressure ≥90 mmHg. Results After adjusting for the confounding factors, the CCA interadventitial diameter/height was significantly associated with the log NT-proBNP in both the normotensive group (β=0.125, p=0.002) and hypertensive group (β=0.080, p=0.029). The RI was significantly associated with the log NT-proBNP in the hypertensive group (β=0.176, p<0.001) but not in the normotensive group. In addition, the PI was significantly associated with the log NT-proBNP in the hypertensive group (β=0.156, p<0.001) but not in the normotensive group. However, no significant association was observed between the mean IMT, number of plaques, and plaque score and log NT-proBNP. Conclusion CCA measurements may be useful markers for hemodynamic stress on the left ventricle in elderly patients.

Screening for asymptomatic heart failure with preserved ejection fraction in mongolian population at high risk

Objective The goals of the present study were to assess the prevalence of asymptomatic heart failure with preserved ejection fraction (HFpEF) in subjects at high risk of developing HF and to define the diagnostic accuracy of NT-pro BNP assay compared with echocardiography in this setting.Material and methods This cross-sectional study included subjects aged from 35 to 64 years, with high risk of HF, who had no clinical symptoms of HF. Risk factors of HF were detected by clinical examinations. NT-pro BNP determination was performed using immunoassay analyzer (FIA8000, Getein Bio Medical Inc, China),. The cut-off point for NT-pro BNP was 125 pg/ml. Diagnosis of HFpEF was based on criteria recommended by 2016 ESC heart failure guidelines. Diastolic dysfunction was assessed according to the algorithm proposed in the joint recommendations of the ASE/EACVI.Results 602 patients with risk factors of HF were included in the study, of which 256 (42.5 %) were males and 346 (57.5 %) females. The mean age was 51.71±8.07 years. 83 patients (13.8 %) showed elevated NT-pro BNP levels of ≥125 pg / ml. Our study has shown that NT-pro BNP concentration was positively correlating with age, both systolic and diastolic blood pressure, left ventricular mass and E / e' ratio and negatively correlating with waist circumference, body mass index, left ventricular EF and E / A ratio in asymptomatic population. The likelihood of positive NT-pro BNP test was independently (p&lt;0.05) associated with age, hypertension and diabetes. The diagnosis of asymptomatic HFpEF was confirmed in 12.3 % of studied population. A cutoff value of 125 pg / ml for NT-proBNP concentration showed the following diagnostic re-abilities in identifying asymptomatic HFpEF: sensitivity 85.0 %, specificity 88.6 % and area under curve 0.92 (95 % CI 0.86-0.98).Conclusion Subjects with raised NT-pro BNP level (≥125 pg/ml) were more likely to have a confirmed diagnosis of asymptomatic HFpEF after screening. In summary, in at-risk population, natriuretic peptide based screening combined with echocardiography identifies high prevalence of asymptomatic HFpEF.

Association of Estimated Insulin Resistance with N-Terminal B-Type Natriuretic Peptide Concentration in Men with Metabolic Syndrome

BACKGROUND

The diagnostic and prognostic role of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in heart failure is well established. However, additional factors may influence its concentration. One of them is obesity, which in general is accompanied by reduced NT-proBNP levels. However, specific data concerning metabolic syndrome (MS) are equivocal. The aim of the present study was to evaluate the association of NT-proBNP with estimated insulin resistance (eIR) in men with MS.

METHODS

In 86 male patients with MS (78 of them hypertensive), blood pressure, anthropometric measures, NT-proBNP, creatinine, glucose, and insulin were assessed and eIR was calculated using homeostatic model assessment (HOMA-IR).

RESULTS

Both eIR and age were independently associated with NT-proBNP concentrations (b = 0.2248, p=0.019; b = 0.0102, p=0.049, respectively). Blood pressure, anthropometric measures, and eGFR were not correlated with NT-proBNP. Patients without eIR had higher NT-proBNP than those with eIR (32.2 ± 26.4 vs 21.4 ± 25.4 pg/mL, p=0.014). The difference was even higher in the younger subgroup of patients reaching nearly 50%.

CONCLUSIONS

Insulin resistance and, to a lesser degree, age were associated with NT-proBNP levels in men with MS. In younger subjects with eIR, mean NT-proBNP level was lower than in corresponding healthy age males.

Association Between Cardiac Natriuretic Peptides and Lipid Profile: a Systematic Review and Meta-Analysis

Cardiac natriuretic peptides (NPs) play a fundamental role in maintaining cardiovascular (CV) and renal homeostasis. Moreover, they also affect glucose and lipid metabolism. We performed a systematic review and meta-analysis of studies investigating the association of NPs with serum lipid profile. A PubMed and Scopus search (2005–2018) revealed 48 studies reporting the association between NPs and components of lipid profile [total cholesterol (TC), low-density lipoprotein cholesterol (LDLc), high-density lipoprotein cholesterol (HDLc) and triglycerides (TG)]. Despite high inconsistency across studies, NPs levels were inversely associated with TC [k = 32; pooled r = −0.09; I² = 90.26%], LDLc [k = 31; pooled r = −0.09; I² = 82.38%] and TG [k = 46; pooled r = −0.11; I² = 94.14%], while they were directly associated with HDLc [k = 41; pooled r = 0.06; I² = 87.94%]. The relationship with LDLc, HDLc and TG lost significance if only studies on special populations (works including subjects with relevant acute or chronic conditions that could have significantly affected the circulating levels of NPs or lipid profile) or low-quality studies were taken into account. The present study highlights an association between higher NP levels and a favorable lipid profile. This confirms and extends our understanding of the metabolic properties of cardiac NPs and their potential in CV prevention.

The relationship between Plasma Markers and Essential Hypertension in Middle-aged and Elderly Chinese Population: A Community Based Cross-sectional Study

Plasma markers have been continuously advocated as pointers to estimate the long-term risk of cardiovascular disease in the general population. We examined the relationship between plasma high-sensitivity C-reactive protein (hs-CRP), homocysteine (Hcy), high-sensitivity cardiac troponin T (hs-cTnT), N-terminal prohormone of brain natriuretic peptide (NT-proBNP), 25-Hydroxyvitamin D (25OHD), glycosylated hemoglobin A1c (HbA1c), and serum uric acid (SUA) levels and hypertension in middle and old aged population. A total of 2624 Chinese (62.02 ± 5.73 years old) were recruited into a population-based, cross-sectional study. Plasma hs-CRP, Hcy, HbA1c, and SUA levels were significantly higher in the hypertension group compared with control in the entire population and men (P = 0.05 for all). We observed a positive association between the highest quartiles of Hcy, NT-proBNP, HBA1c concentrations, and the prevalence of hypertension, OR (95% CI) = 1.48 (1.16–1.90), 1.62 (1.27–2.07) and 1.94 (1.49–2.52), respectively. The multivariable-adjusted OR of hypertension for the fourth versus the first quartile of homocysteine were 2.00 and 1.39 in men and women, respectively. In conclusion, our study found an independent and robust association between elevated Hcy, NT-ProBNP, and HBA1c levels and prevalence of hypertension in the middle-aged and elderly Chinese population. A follow-up study is necessary to endorse the observed association.

Metabolomic profiling implicates adiponectin as mediator of a favorable lipoprotein profile associated with NT-proBNP

Background

The N-terminal prohormone of brain natriuretic peptide (NT-proBNP) is an important biomarker for the diagnosis of heart failure. Apart from this and only recently recognized, NT-proBNP levels associate with higher HDL- and lower LDL-cholesterol levels comprising a favorable blood lipid profile. To further examine this observation, the lipoprotein profile in relation to NT-proBNP was examined in-depth by proton nuclear magnetic resonance spectroscopy (¹H-NMR). We complemented this investigation with a state-of-the-art untargeted metabolomics approach.

Methods

Lipoprotein particles were determined by ¹H-NMR spectroscopy in 872 subjects without self-reported diabetes from the population-based Study of Health in Pomerania (SHIP)-TREND with available NT-proBNP measurements. Comprehensive metabolomics data for plasma and urine samples were obtained. Linear regression models were performed to assess the associations between serum concentrations of NT-proBNP and the metabolites/lipoprotein particles measured in plasma or urine.

Results

An increase in serum NT-proBNP was associated with a benefical lipoprotein profile, including a decrease in VLDL, IDL and LDL-particles along with an increase in large HDL particles. These findings were replicated in a second independent cohort. Serum concentrations of NT-proBNP showed significant inverse associations with seven plasma metabolites while associations with 39 urinary metabolites, mostly comprising amino acids and related intermediates, were identified. Mediation analyses revealed adiponection as mediating factor for the associations observed with lipoproteins particles.

Conclusions

Most of the metabolic changes associated with NT-proBNP implicate significant influence on the blood lipid profile besides vasodilatory and the diuretic action of BNP signaling. Our data suggest that the more favorable lipoprotein profile as associated with elevated NT-proBNP concentrations in mainly cardiac healthy individuals might relate to adiponectin signaling indicating even indirect cardio-protective effects for NT-proBNP.

Electronic supplementary material

The online version of this article (10.1186/s12933-018-0765-1) contains supplementary material, which is available to authorized users.

N-terminal pro B-Type natriuretic peptide is inversely correlated with low density lipoprotein cholesterol in the very elderly

BACKGROUND AND AIMS

Laboratory studies on human adipose tissue and differentiated adipocytes indicate that natriuretic peptides (NPs) affect lipid metabolism and plasma cholesterol. Few previous clinical studies in non-elderly populations found associations between NPs in the physiological range and cholesterol.

AIM

evaluate the association between NT-proBNP and lipid profile in very elderly hospitalized patients characterized by a wide range of NT-proBNP levels.

METHODS AND RESULTS

Cross-sectional study on 288 very elderly patients hospitalized for medical conditions, in which increased NT-proBNP levels are very common. NT-proBNP, total cholesterol (TC), HDL cholesterol (HDLc) and triglycerides were collected just few days before discharge. Patients taking lipid-lowering drugs and patients with an admission diagnosis of acute heart failure were excluded. Calculated LDL-cholesterol (LDLc) was used for the analyses. Mean age: 87.7 ± 6.2 years; female prevalence (57.3%). Median NT-proBNP: 2949 (1005-7335) pg/ml; mean TC: 145.1 ± 40.3 mg/dl; mean HDLc: 38.4 ± 18.6 mg/dl; median triglycerides: 100 (75-129) mg/dl; mean LDLc: 84.0 ± 29.5 mg/dl. We found negative correlations between NT-proBNP and both TC and LDLc (Rho = -0.157; p = 0.008 and Rho = -0.166; p = 0.005, respectively), while no correlations emerged between NT-proBNP and HDLc (Rho = -0.065; p = 0.275) or triglycerides (Rho = -0.009; p = 0.874). These associations were confirmed considering NT-proBNP tertiles. The inverse association between NT-proBNP and LDLc was maintained even after adjusting for confounding factors.

CONCLUSION

Our real-life clinical study supports the hypothesis that NPs play a role on cholesterol metabolism, given the association found between LDLc and NT-proBNP even in very elderly patients where NT-proBNP values are often in the pathological range.

Inverse Association of N-terminal Pro‒B-type Natriuretic Peptide Level With Metabolic Syndrome in Kidney Transplant Patients

BACKGROUND

Low levels of natriuretic peptide may activate the renin-angiotensin-aldosterone system, which may contribute to the development of obesity. Therefore, in study we aim to evaluate the relationship between metabolic syndrome (MetS) and serum N-terminal pro‒B-type natriuretic peptide (NT-proBNP) concentration in kidney transplant recipients.

METHODS

Fasting blood samples were obtained from 66 kidney transplant recipients. MetS and its components were defined using the diagnostic criteria of the International Diabetes Federation.

RESULTS

A total of 20 patients (30.3%) had MetS. Hypertension, prevalence of diabetes, use of statin or fibrate, body weight, body mass index, waist circumference, body fat mass, and levels of systolic blood pressure, total cholesterol, triglyceride, blood urea nitrogen, insulin, and HOMA-IR were higher, whereas the levels of high-density lipoprotein cholesterol and NT-proBNP were lower in patients with MetS. Logarithmically transformed creatinine and log-HOMA-IR were associated with NT-proBNP levels in a multivariable linear regression analysis. Multivariate logistic regression analysis revealed that NT-proBNP was an independent predictor of MetS in kidney transplant recipients.

CONCLUSION

Our study has revealed that fasting level of NT-proBNP was negatively associated with MetS and that serum creatinine and HOMA-IR were independent predictors of serum NT-proBNP level in kidney transplant recipients.