Interlaboratory variation for NT-proBNP among Swedish laboratories in an external quality program 2011-2021

OBJECTIVES

NT-proBNP is frequently used for ruling out heart failure. Different cut-offs are used depending on the clinical context, e.g. an acute or chronic condition. Medical decision limits have been suggested at 125 and 300 ng/L or 400 ng/L in international guidelines. However, there is limited standardization between NT-proBNP methods and using the same blood sample might cause different treatment of patients.

METHODS

Data from the external quality assessment program for NT-proBNP from Equalis, Sweden, were extracted for the period 2011-2021, and categorized according to manufacturer. Manufacturer median NT-proBNP values were compared to total median values. CV% was calculated for each manufacturer and in comparison to different levels of NT-proBNP.

RESULTS

Roche was the most common method, and its median results were closest to the median consensus results. When looking at the total CV at NT-proBNP levels in the range of 0-500 ng/L, the total CV varied from 4 to 27%. During 2019-2021, Siemens (Immulite, Centaur, Atellica) yielded results 16-20% above the consensus median depending on sample level. Similarly, Abbott was 5-7% above, while Roche and Siemens Stratus were 1% respectively 6-10% below the consensus median.

CONCLUSIONS

The introduction of new manufacturers and methods in 2017 have caused the agreement between manufacturers to decline. This highlights the need for a common calibrator and reference materials, particularly since medical decision limits in guidelines, e.g. European Society of Cardiology 2021, which are mostly based on Roche methods, do not take these method differences into account.

His bundle pacing therapy for patients with chronic heart failure: A protocol for meta-analysis based on prospective studies

INTRODUCTION

A considerable amount of studies have been published with the results of clinical benefit from his bundle pacing (HBP) for chronic heart failure (CHF) patients and these researches led a uncertain conclusion for clinics. Thus, we will conduct a meta-analysis to evaluate the effect of his bundle pacing therapy for chronic heart failure.

METHODS

Pubmed, EMBASE, the Cochrane Library, Web of Science and Chinese online databases including Chinese National Knowledge Infrastructure, China Biology Medicine disc, Chinese Scientifific Journals Database (VIP), and Wanfang Database will be searched from these databases construction to the end of November, 2020. The STATA 13.0 will be used for data synthesis and meta-analysis.

RESULTS

The outcome measures included QRS duration, left ventricular ejection fraction, pacing threshold, New York Heart Association (NYHA), left ventricular end-diastolic diameter, left ventricular end-systolic diameter, mitral regurgitation, tricuspid regurgitation, and BNP will be analyzed and synthesized.

CONCLUSION

This meta-analysis will evaluate the effect of his bundle pacing therapy for chronic heart failure.

REGISTRATION NUMBER

INPLASY202110109.

Association of age and symptoms with frequency of Premature Ventricular Contractions on 24 hours Holter monitoring

Objectives:

This study was done with the objective to identify the determinants of mild, moderate and frequent burdens of premature ventricular contractions (PVCs) which may guide the health care professionals to stratify the high risk patients on basis of their symptoms.

Methods:

It was a cross sectional descriptive study conducted in Islamic International Medical College (IIMC) in collaboration with Armed Forces Institute of Cardiology (AFIC) from 18^th April 2016 to 20^th March 2018. It comprised 60 diagnosed patients of PVCs, divided into three groups on the basis of their PVCs burden determined by Holter monitoring report. Each group of mild (Group-A), moderate (Group-B) and frequent burden (Group-C) constituted 20 patients having PVC burden<10%, 10-20% and >20% respectively. All patients were evaluated for their symptoms by a cardiologist. Statistical analysis was done to determine the association of patient’s symptom and age with mild, moderate and frequent PVCs burden.

Results:

PVCs were significantly associated with presence of symptoms as compared to asymptomatic patients. While no significant correlation of age or any specific symptom (palpitations, chest pain, dizziness, shortness of breath) was found with mild, moderate and frequent PVCs burden with p-value of 0.466.

Conclusions:

Mild, moderate or frequent PVCs burden are not associated with any specific symptom predominantly or old age. So, it is equally important for all the patients presenting with any symptom of palpitations, chest pain, dizziness or shortness of breath to undergo the work up of PVCs, irrespective of their age.