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Hennings E, Blum S, Aeschbacher S, Coslovsky M, Knecht S, Eken C, Lischer M, Paladini RE, Krisai P, Reichlin T, Rodondi N, Beer JH, Ammann P, Conte G, De Perna ML, Kobza R, Blum MR, Bossard M, Kastner P, Ziegler A, Müller C, Bonati LH, Pfister O, Zuern CS, Conen D, Kühne M, Osswald S. Bone Morphogenetic Protein 10-A Novel Biomarker to Predict Adverse Outcomes in Patients With Atrial Fibrillation. J Am Heart Assoc 2023; 12:e028255. [PMID: 36926939 PMCID: PMC10111531 DOI: 10.1161/jaha.122.028255] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 02/01/2023] [Indexed: 03/18/2023]
Abstract
Background Patients with atrial fibrillation (AF) face an increased risk of death and major adverse cardiovascular events (MACE). We aimed to assess the predictive value of the novel atrial-specific biomarker BMP10 (bone morphogenetic protein 10) for death and MACE in patients with AF in comparison with NT-proBNP (N-terminal prohormone of B-type natriuretic peptide). Methods and Results BMP10 and NT-proBNP were measured in patients with AF enrolled in Swiss-AF (Swiss Atrial Fibrillation Study), a prospective multicenter cohort study. A total of 2219 patients were included (median follow-up 4.3 years [interquartile range 3.9, 5.1], mean age 73±9 years, 73% male). In multivariable Cox proportional hazard models, the adjusted hazard ratio (aHR) associated with 1 ng/mL increase of BMP10 was 1.60 (95% CI, 1.37-1.87) for all-cause death, and 1.54 (95% CI, 1.35-1.76) for MACE. For all-cause death, the concordance index was 0.783 (95% CI, 0.763-0.809) for BMP10, 0.784 (95% CI, 0.765-0.810) for NT-proBNP, and 0.789 (95% CI, 0.771-0.815) for both biomarkers combined. For MACE, the concordance index was 0.732 (95% CI, 0.715-0.754) for BMP10, 0.747 (95% CI, 0.731-0.768) for NT-proBNP, and 0.750 (95% CI, 0.734-0.771) for both biomarkers combined. When grouping patients according to NT-proBNP categories (<300, 300-900, >900 ng/L), higher aHRs were observed in patients with high BMP10 in the categories of low NT-proBNP (all-cause death aHR, 2.28 [95% CI, 1.15-4.52], MACE aHR, 1.88 [95% CI, 1.07-3.28]) and high NT-proBNP (all-cause death aHR, 1.61 [95% CI, 1.14-2.26], MACE aHR, 1.38 [95% CI, 1.07-1.80]). Conclusions BMP10 strongly predicted all-cause death and MACE in patients with AF. BMP10 provided additional prognostic information in low- and high-risk patients according to NT-proBNP stratification. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02105844.
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Affiliation(s)
- Elisa Hennings
- Cardiovascular Research Institute BaselUniversity Hospital Basel, University of BaselBaselSwitzerland
- CardiologyUniversity Hospital Basel, University of BaselBaselSwitzerland
| | - Steffen Blum
- Cardiovascular Research Institute BaselUniversity Hospital Basel, University of BaselBaselSwitzerland
- CardiologyUniversity Hospital Basel, University of BaselBaselSwitzerland
| | - Stefanie Aeschbacher
- Cardiovascular Research Institute BaselUniversity Hospital Basel, University of BaselBaselSwitzerland
- CardiologyUniversity Hospital Basel, University of BaselBaselSwitzerland
| | - Michael Coslovsky
- Department of Clinical ResearchUniversity Hospital Basel, University of BaselBaselSwitzerland
| | - Sven Knecht
- Cardiovascular Research Institute BaselUniversity Hospital Basel, University of BaselBaselSwitzerland
- CardiologyUniversity Hospital Basel, University of BaselBaselSwitzerland
| | - Ceylan Eken
- Cardiovascular Research Institute BaselUniversity Hospital Basel, University of BaselBaselSwitzerland
- CardiologyUniversity Hospital Basel, University of BaselBaselSwitzerland
| | - Mirko Lischer
- Cardiovascular Research Institute BaselUniversity Hospital Basel, University of BaselBaselSwitzerland
- CardiologyUniversity Hospital Basel, University of BaselBaselSwitzerland
| | - Rebecca E. Paladini
- Cardiovascular Research Institute BaselUniversity Hospital Basel, University of BaselBaselSwitzerland
- CardiologyUniversity Hospital Basel, University of BaselBaselSwitzerland
| | - Philipp Krisai
- Cardiovascular Research Institute BaselUniversity Hospital Basel, University of BaselBaselSwitzerland
- CardiologyUniversity Hospital Basel, University of BaselBaselSwitzerland
| | - Tobias Reichlin
- Department of CardiologyInselspital, Bern University Hospital, University of BernBernSwitzerland
| | - Nicolas Rodondi
- Department of General Internal MedicineInselspital, Bern University Hospital, University of BernBernSwitzerland
- Institute of Primary Health Care (BIHAM)University of BernBernSwitzerland
| | - Jürg H. Beer
- Department of Internal MedicineCantonal Hospital BadenBadenSwitzerland
| | - Peter Ammann
- Department of CardiologyKantonsspital St. GallenSt. GallenSwitzerland
| | - Giulio Conte
- Cardiocentro Ticino InstituteEnte Ospedaliero CantonaleLuganoSwitzerland
| | | | - Richard Kobza
- Cardiology DivisionHeart Center, Luzerner KantonsspitalLuzernSwitzerland
| | - Manuel R. Blum
- Department of General Internal MedicineInselspital, Bern University Hospital, University of BernBernSwitzerland
- Institute of Primary Health Care (BIHAM)University of BernBernSwitzerland
| | - Matthias Bossard
- Cardiology DivisionHeart Center, Luzerner KantonsspitalLuzernSwitzerland
| | | | - André Ziegler
- Roche Diagnostics International AGRotkreuzSwitzerland
| | - Christian Müller
- Cardiovascular Research Institute BaselUniversity Hospital Basel, University of BaselBaselSwitzerland
- CardiologyUniversity Hospital Basel, University of BaselBaselSwitzerland
| | - Leo H. Bonati
- Cardiovascular Research Institute BaselUniversity Hospital Basel, University of BaselBaselSwitzerland
- Department of Neurology and Stroke CenterUniversity Hospital Basel, University of BaselBaselSwitzerland
| | - Otmar Pfister
- Cardiovascular Research Institute BaselUniversity Hospital Basel, University of BaselBaselSwitzerland
- CardiologyUniversity Hospital Basel, University of BaselBaselSwitzerland
| | - Christine S. Zuern
- Cardiovascular Research Institute BaselUniversity Hospital Basel, University of BaselBaselSwitzerland
- CardiologyUniversity Hospital Basel, University of BaselBaselSwitzerland
| | - David Conen
- Population Health Research InstituteMcMaster UniversityHamiltonCanada
| | - Michael Kühne
- Cardiovascular Research Institute BaselUniversity Hospital Basel, University of BaselBaselSwitzerland
- CardiologyUniversity Hospital Basel, University of BaselBaselSwitzerland
| | - Stefan Osswald
- Cardiovascular Research Institute BaselUniversity Hospital Basel, University of BaselBaselSwitzerland
- CardiologyUniversity Hospital Basel, University of BaselBaselSwitzerland
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Okazaki O, Higashino Y, Yokoya K, An Y, Tanizawa K, Imamura Y, Hayashi T, Akao M, Okumura K, Yamashita T. Prognosis of elderly non-valvular atrial fibrillation patients stratified by B-type natriuretic peptide: ELDERCARE-AF subanalysis. Am Heart J 2022; 250:66-75. [PMID: 35568194 DOI: 10.1016/j.ahj.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 04/27/2022] [Accepted: 05/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND B-type natriuretic peptide (BNP) is a risk factor for stroke and cardiac death in patients with atrial fibrillation. We hypothesized the prognostic outcomes of very elderly non-valvular atrial fibrillation patients ineligible for standard anticoagulation treatment would vary according to BNP stratification. METHODS In this subanalysis of the ELDERCARE-AF trial, patients were stratified by BNP levels at enrollment, and clinical outcomes compared among BNP subgroups. Hazard ratios were adjusted for age, atrial fibrillation type, body mass index, creatine clearance, congestive heart failure, and D-dimer. BNP levels were measured using chemiluminescence enzyme immunoassays. RESULTS In total, 984 patients (average age: 86.6 years) not considered eligible for oral anticoagulant therapy at approved doses for stroke prevention were included. The BNP levels at enrollment were <200 (low), 200 to <400 (moderate), and ≥400 (high) pg/mL in 428, 300, and 256 patients, respectively. The number (%) of patients with stroke or systemic embolism (SSE) was 7 (1.2%), 24 (5.9%), and 28 (8.6%) in the low, moderate, and high BNP subgroups, respectively (adjusted hazard ratio 3.82, P = .0025 for low vs moderate BNP and 4.76, P = .0007 for low vs high BNP). There was no significant difference in major bleeding incidence between the BNP subgroups. Edoxaban 15 mg was associated with a consistent reduction in SSE vs placebo in all BNP subgroups. CONCLUSIONS Stratification by BNP level was associated with the incidence of SSE for very elderly non-valvular atrial fibrillation patients ineligible for standard anticoagulation treatment, and the effect of edoxaban 15 mg was consistent across BNP levels.
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Affiliation(s)
- Osamu Okazaki
- Department of Cardiology, National Center for Global Health and Medicine, Tokyo, Japan.
| | - Yorihiko Higashino
- Department of Cardiology, Medical Corporation Aishinkai, Higashi Takarazuka Satoh Hospital, Hyogo, Japan
| | - Koichi Yokoya
- Department of Cardiology, National Hospital Organization Toyohashi Medical Center, Aichi, Japan
| | - Yoshimori An
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Kimihiko Tanizawa
- Clinical Development Department III, Development Function, Research and Development Division, Daiichi Sankyo Co., Ltd., Tokyo, Japan
| | - Yuki Imamura
- Clinical Development Department III, Development Function, Research and Development Division, Daiichi Sankyo Co., Ltd., Tokyo, Japan
| | - Takuya Hayashi
- Data Governance & Data Engineering Group, Data Intelligence Department, Digital Transformation Management Division, Daiichi Sankyo Co., Ltd., Tokyo, Japan
| | - Masaharu Akao
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Takeshi Yamashita
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
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Castro-Portillo E, López-Izquierdo R, Sanz-García A, Ortega GJ, Delgado-Benito JF, Castro Villamor MA, Sánchez-Soberón I, Del Pozo Vegas C, Martín-Rodríguez F. Role of prehospital point-of-care N-terminal pro-brain natriuretic peptide in acute life-threatening cardiovascular disease. Int J Cardiol 2022; 364:126-132. [PMID: 35716940 DOI: 10.1016/j.ijcard.2022.06.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/18/2022] [Accepted: 06/10/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The evidence about the use of natriuretic peptides (NP) to predict mortality in the pre-hospital setting is limited. The main objective of this study is to assess the ability of point-of-care testing (POCT) N-terminal portion of B-type natriuretic peptide (NT-proBNP) to predict 2-day in-hospital mortality of acute cardiovascular diseases (ACVD). METHODS We conducted a multicentric, prospective, observational study in adults with ACVD transferred by ambulance to emergency departments (ED). The primary outcome was 2-day in-hospital mortality. The discrimination capacity of the NT-proBNP was performed through a prediction model trained using a derivation cohort and evaluated by the area under the curve (AUC) of the receiver operating characteristic on a validation cohort. RESULTS A total of 1006 patients were recruited. The median age was 75 (IQR 63-84) years and 421 (41.85%) were females. The 2-day in-hospital mortality was 5.8% (58 cases). The predictive validity of NT-proBNP, for 2-day mortality reached the following AUC: 0.823 (95%CI: 0.758-0.889, p < 0.001), and the optimal specificity and sensitivity were 73.1 and 82.7. Predictive power of NT-proBNP obtained an AUC 0.549 (95%CI: 0.432-0.865, p 0.215) for acute heart failure, AUC 0.893 (95%CI: 0.617-0.97, p < 0.001) for ischemic heart disease, AUC 0.714 (95%CI: 0.55-0.87, p = 0.0069) for arrhythmia and AUC 0.927 (95%CI: 0.877-0.978, p < 0,001) for syncope. CONCLUSION POCT NT-proBNP has proven to be a strong predictor of early mortality in ACVD, showing an excellent predictive capacity in cases of syncope. However, this biomarker does not appear to be useful for predicting outcome in patients with acute heart failure.
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Affiliation(s)
| | - Raúl López-Izquierdo
- Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain; Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain; Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain
| | - Ancor Sanz-García
- Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain; Data Analysis Unit, Health Research Institute, Hospital de la Princesa, Madrid (IIS-IP), Spain.
| | - Guillermo J Ortega
- Data Analysis Unit, Health Research Institute, Hospital de la Princesa, Madrid (IIS-IP), Spain; CONICET, Argentina; Science and Technology department, National University of Quilmes, Argentina
| | - Juan F Delgado-Benito
- Advanced Life Support, Emergency Medical Services (SACYL), Valladolid, Spain; Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain
| | - Miguel A Castro Villamor
- Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain; Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain
| | | | - Carlos Del Pozo Vegas
- Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain; Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain; Emergency Department, Hospital Clínico Universitario, Valladolid, Spain
| | - Francisco Martín-Rodríguez
- Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain; Advanced Life Support, Emergency Medical Services (SACYL), Valladolid, Spain; Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain
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Wang J, Wang J, Tang Z, Zhang P. Association of Natriuretic Peptide With Adverse Outcomes and Disease Severity After Intracerebral Hemorrhage: A Systematic Review. Front Neurol 2021; 12:775085. [PMID: 34867764 PMCID: PMC8634096 DOI: 10.3389/fneur.2021.775085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 10/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Over the past decade, many studies have reported the association of brain natriuretic peptide (BNP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) with clinical outcome of intracerebral hemorrhage (ICH). However, a broad consensus has not been reached. Objective: To evaluate the role of BNP/NT-proBNP levels in prognosis and disease severity assessment in patients with ICH. Methods: A systematic literature search was conducted utilizing PubMed, Embase, Web of Science and the Cochrane Library databases up to July 23, 2021. Studies that explored the association between BNP/NT-proBNP level and clinical outcome or disease severity in ICH patients were eligible. Outcome measures were all-cause mortality, poor functional outcome, adverse cardiac events and markers of disease severity. Results: Ten studies, involving 1,373 patients with ICH, met the inclusion criteria. Nine studies focused on clinical outcomes (five all-cause mortality, five functional outcomes, and one adverse cardiac event) and seven on disease severity. In terms of prognosis, all five studies showed an association between elevated BNP/NT-proBNP level and increased risk of all-cause mortality in ICH patients. Four of the five studies reported poor functional outcomes in patients with higher BNP/NT-proBNP levels and one study associated higher BNP/NT-proBNP levels with increased risk of adverse cardiac events. Moreover, two studies identified an additional predictive ability of BNP/NT-proBNP level beyond that of pre-existing prognostic variables. In terms of disease severity, five studies (71%) reported that BNP/NT-proBNP level correlated positively with hematoma volume in addition to ICH and GCS scores. Conclusion: Elevated BNP/NT-proBNP level is associated with increased risk of all-cause mortality, poor functional outcome, adverse cardiac events and disease severity in patients with ICH. Thus, BNP/NT-proBNP level is a promising prognostic indicator for ICH and also an effective marker of disease severity. Current evidence remains limited by the small number and high heterogeneity of included studies. Further appropriately designed, large-scale studies are required to confirm the current findings.
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Affiliation(s)
- Jiahui Wang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jingxuan Wang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhouping Tang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ping Zhang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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