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Zhou R, Lei Y, Ge L, Mao Q, Yang L, Qiu X. Accuracy of brain natriuretic peptide and N-terminal brain natriuretic peptide for detecting paediatric pulmonary hypertension: a systematic review and meta-analysis. Ann Med 2024; 56:2352603. [PMID: 38753384 PMCID: PMC11100439 DOI: 10.1080/07853890.2024.2352603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 04/22/2024] [Indexed: 05/19/2024] Open
Abstract
OBJECTIVE Pulmonary hypertension (PH) is a life-threatening disease, especially in paediatric population. Symptoms of paediatric PH are non-specific. Accurate detection of paediatric PH is helpful for early treatment and mortality reduction. Therefore, we assessed the overall performance of brain natriuretic peptide (BNP) and N-terminal brain natriuretic peptide (NT-proBNP) for diagnosing PH in paediatric population. METHODS PubMed, Web of Science, Cochrane Library and Embase databases were screened since their respective inceptions until August 2023. A bivariate random model and a hierarchical summary receiver operating characteristic model were used together to evaluate and summarize the overall performance of BNP and NT-proBNP for diagnosing paediatric PH. RESULTS Eighteen studies using BNP/NT-proBNP were assessed, comprising 1127 samples. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and area under the curve (AUROC) of BNP/NT-proBNP were separately as 0.81, 0.87, 6.33, 0.21, 29.50 and 0.91, suggesting a good diagnostic performance of BNP/NT-proBNP for detecting PH in paediatric population. For BNP, the pooled sensitivity, specificity, PLR, NLR, DOR and AUROC were 0.83, 0.89, 7.76, 0.19, 40.90 and 0.93, indicating the diagnostic accuracy of BNP for paediatric PH patients was good. For NT-proBNP, the pooled sensitivity, specificity, PLR, NLR, DOR and AUROC were 0.81, 0.86, 5.59, 0.22, 24.96 and 0.90, showing that NT-proBNP could provide a good value for detecting paediatric PH. CONCLUSIONS Both BNP and NT-proBNP are good markers for differentiating paediatric PH patients from non-PH individuals.
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Affiliation(s)
- Ruixi Zhou
- Department of Pediatrics, West China Second University Hospital, Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, China
| | - Yupeng Lei
- Department of Pediatrics, West China Second University Hospital, Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, China
| | - Long Ge
- Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China
| | - Qian Mao
- Department of Pediatrics, West China Second University Hospital, Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, China
| | - Liuping Yang
- Department of Pediatrics, West China Second University Hospital, Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, China
| | - Xia Qiu
- Department of Pediatrics, West China Second University Hospital, Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, China
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Eltayeb M, Squire I, Sze S. Biomarkers in heart failure: a focus on natriuretic peptides. Heart 2024; 110:809-818. [PMID: 37673654 DOI: 10.1136/heartjnl-2020-318553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Abstract
While progress has been made in the management of most aspects of cardiovascular disease, the incidence and prevalence of heart failure (HF) remains high. HF affects around a million people in the UK and has a worse prognosis than most cancers. Patients with HF are often elderly with complex comorbidities, making accurate assessment of HF challenging. A timely diagnosis and initiation of evidence-based treatments are key to prevent hospitalisation and improve outcomes in this population. Biomarkers have dramatically impacted the way patients with HF are evaluated and managed. The most studied biomarkers in HF are natriuretic peptides (NPs). Since their discovery in the 1980s, there has been an explosion of work in the field of NPs and they have become an important clinical tool used in everyday practice to guide diagnosis and prognostic assessment of patients with HF. In this article, we will review the physiology of NPs and study their biological effects. Then, we will discuss the role of NPs in the diagnosis, management and prognostication of patients with HF. We will also explore the role of NPs as a potential therapeutic agent.
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Affiliation(s)
- Mohamed Eltayeb
- Department of Cardiovascular Sciences and NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Iain Squire
- Department of Cardiovascular Sciences and NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Shirley Sze
- Department of Cardiovascular Sciences and NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
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3
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Stubbs HD, Cannon J, Knightbridge E, Durrington C, Roddis C, Gin-Sing W, Massey F, Knight DS, Virsinskaite R, Lordan JL, Sear E, Apple-Pinguel J, Morris E, Johnson MK, Wort SJ. Sendaway capillary NT-proBNP in pulmonary hypertension. BMJ Open Respir Res 2024; 11:e002124. [PMID: 38519115 PMCID: PMC10961571 DOI: 10.1136/bmjresp-2023-002124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 03/07/2024] [Indexed: 03/24/2024] Open
Abstract
BACKGROUND N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a biomarker of cardiac ventricular wall stress that is incorporated into pulmonary hypertension (PH) risk stratification models. Sendaway sampling may enable patients to perform NT-proBNP tests remotely. This UK-wide study aimed to assess the agreement of sendaway NT-proBNP with standard venous NT-proBNP and to assess the effect of delayed processing. METHODS Reference venous NT-proBNP was collected from PH patients. Samples for capillary and venous sendaway tests were collected contemporaneously, mailed to a reference laboratory and processed at 3 and 7 days using a Roche Cobas e411 device. Differences in paired measurements were analysed with Passing-Bablok regression, percentage difference plots and the % difference in risk strata. RESULTS 113 patients were included in the study. 13% of day 3 capillary samples were insufficient. Day 3 capillary samples were not equivalent to reference samples (Passing Bablok analysis slope of 0.91 (95% CI 0.88 to 0.93) and intercept of 6.0 (95% CI 0.2 to 15.9)). The relative median difference was -7% and there were acceptable limits of agreement. Day 3 capillary NT-proBNP accurately risk stratified patients in 93.5% of cases. By comparison, day 3 venous results accurately risk stratified patients in 90.1% of cases and were equivalent by Passing-Bablok regression. Delayed sampling of sendaway tests led to an unacceptable level of agreement and systematically underestimated NT-proBNP. CONCLUSIONS Sendaway NT-proBNP sampling may provide an objective measure of right ventricular strain for virtual PH clinics. Results must be interpreted with caution in cases of delayed sampling.
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Affiliation(s)
- Harrison D Stubbs
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - John Cannon
- Pulmonary Vascular Disease Unit, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Emily Knightbridge
- Pulmonary Vascular Disease Unit, Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Charlotte Durrington
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
| | - Chloe Roddis
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
| | - Wendy Gin-Sing
- Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, London, UK
| | - Fiona Massey
- Pulmonary Hypertension Service, Imperial College Healthcare NHS Trust, London, UK
| | | | | | - James L Lordan
- Pulmonary Vascular Unit, Freeman Hospital, Newcastle upon Tyne, UK
| | - Eleanor Sear
- Pulmonary Vascular Unit, Freeman Hospital, Newcastle upon Tyne, UK
| | - Joy Apple-Pinguel
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Eleanor Morris
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Martin K Johnson
- Scottish Pulmonary Vascular Unit, Golden Jubilee National Hospital, Glasgow, UK
| | - Stephen J Wort
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
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4
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Lam CSP, Docherty KF, Ho JE, McMurray JJV, Myhre PL, Omland T. Recent successes in heart failure treatment. Nat Med 2023; 29:2424-2437. [PMID: 37814060 DOI: 10.1038/s41591-023-02567-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/25/2023] [Indexed: 10/11/2023]
Abstract
Remarkable recent advances have revolutionized the field of heart failure. Survival has improved among individuals with heart failure and a reduced ejection fraction and for the first time, new therapies have been shown to improve outcomes across the entire ejection fraction spectrum of heart failure. Great strides have been taken in the treatment of specific cardiomyopathies such as cardiac amyloidosis and hypertrophic cardiomyopathy, whereby conditions once considered incurable can now be effectively managed with novel genetic and molecular approaches. Yet there remain substantial residual unmet needs in heart failure. The translation of successful clinical trials to improved patient outcomes is limited by large gaps in implementation of care, widespread lack of disease awareness and poor understanding of the socioeconomic determinants of outcomes and how to address disparities. Ongoing clinical trials, advances in phenotype segmentation for precision medicine and the rise in technology solutions all offer hope for the future.
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Affiliation(s)
- Carolyn S P Lam
- Duke-NUS Medical School, Singapore, Singapore.
- National Heart Centre Singapore, Singapore, Singapore.
- University Medical Center Groningen, Groningen, the Netherlands.
| | - Kieran F Docherty
- University of Glasgow, School of Cardiovascular and Metabolic Health, Glasgow, UK
| | - Jennifer E Ho
- CardioVascular Institute and Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - John J V McMurray
- University of Glasgow, School of Cardiovascular and Metabolic Health, Glasgow, UK
| | - Peder L Myhre
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
- K.G. Jebsen Center for Cardiac Biomarkers, University of Oslo, Oslo, Norway
| | - Torbjørn Omland
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
- K.G. Jebsen Center for Cardiac Biomarkers, University of Oslo, Oslo, Norway
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5
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Moghaddam N, Lindsay MP, Hawkins NM, Anderson K, Ducharme A, Lee DS, McKelvie R, Poon S, Desmarais O, Desbiens M, Virani S. Access to Heart Failure Services in Canada: Findings of the Heart and Stroke National Heart Failure Resources and Services Inventory. Can J Cardiol 2023; 39:1469-1479. [PMID: 37422257 DOI: 10.1016/j.cjca.2023.06.430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 06/28/2023] [Accepted: 06/30/2023] [Indexed: 07/10/2023] Open
Abstract
BACKGROUND The rising incidence of heart failure (HF) in Canada necessitates commensurate resources dedicated to its management. Several health system partners launched an HF Action Plan to understand the current state of HF care in Canada and address inequities in access and resources. METHODS A national Heart Failure Resources and Services Inventory (HF-RaSI) was conducted from 2020 to 2021 of all 629 acute care hospitals and 20 urgent care centres in Canada. The HF-RaSI consisted of 44 questions on available resources, service,s and processes across acute care hospitals and related ambulatory settings. RESULTS HF-RaSIs were completed by 501 acute care hospitals and urgent care centres, representing 94.7% of all HF hospitalisations across Canada. Only 12.2% of HF care was provided by hospitals with HF expertise and resources, and 50.9% of HF admissions were in centres with minimal outpatient or inpatient HF capabilities. Across all Canadian hospitals, 28.7% did not have access to B-type natriuretic peptide testing, and only 48.1% had access to on-site echocardiography. Designated HF medical directors were present at 21.6% of sites (108), and 16.2% sites (81) had dedicated inpatient interdisciplinary HF teams. Among all of the sites, 28.1% (141) were HF clinics, and of those, 40.4% (57) had average wait times from referral to first appointment of more than 2 weeks. CONCLUSIONS Significant gaps and geographic variation in delivery and access to HF services exist in Canada. This study highlights the need for provincial and national health systems changes and quality improvement initiatives to ensure equitable access to the appropriate evidence-based HF care.
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Affiliation(s)
- Nima Moghaddam
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA
| | | | - Nathaniel M Hawkins
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kim Anderson
- Dalhousie, University QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Anique Ducharme
- Institut de Cardiologie, de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - Douglas S Lee
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Robert McKelvie
- St Joseph's Health Care, Western University, London, Ontario, Canada
| | - Stephanie Poon
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Sean Virani
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
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6
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Mert GÖ, Özlek B, Özlek E, Zencirkıran Ağuş H, Tekinalp M, Kahraman S, Çil C, Çelik O, Başaran Ö, Doğan V, Caner Kaya B, Rencüzoğulları İ, Ösken A, Bekar L, Ozan Çakır M, Çelik Y, Memiç Sancar K, Sevinç S, Biteker M, Uğur Mert K. Comparing the Diagnostic Performance of HFA-PEFF and H2FPEF Scoring Systems in Heart Failure with Preserved Ejection Fraction Patients: Insights from the APOLLON Registry. Anatol J Cardiol 2023; 27:539-548. [PMID: 37655737 PMCID: PMC10510413 DOI: 10.14744/anatoljcardiol.2023.3345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/28/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Heart failure with preserved ejection fraction is a complex and heterogeneous clinical syndrome, poses significant diagnostic challenges. The HFA-PEFF [Heart Failure Association of ESC diagnostic algorithm, P (Pretest Assessment), E (Echocardiographic and Natriuretic Peptide score), F1 (Functional testing in Case of Uncertainty), F2 (Final Aetiology)] and H2FPEF [Heavy (BMI>30 kg/m2), Hypertensive (use of ≥2 antihypertensive medications), atrial Fibrillation (paroxysmal or persistent), Pulmonary hypertension (Doppler Echocardiographic estimated Pulmonary Artery Systolic Pressure >35 mm Hg), Elderly (age >60 years), Filling pressure (Doppler Echocardiographic E/e' >9)] scoring systems were developed to aid in diagnosing heart failure with preserved ejection fraction. This study aimed to assess the concordance and clinical accuracy of these scoring systems in the 'A comPrehensive, ObservationaL registry of heart faiLure with mildly reduced and preserved ejection fractiON' cohort. METHODS A comPrehensive, ObservationaL registry of heart faiLure with mildly reduced and preserved ejection fractiON study was conducted as a multicenter, cross-sectional, and observational study; to evaluate a group of Heart failure with mildly reduced ejection fraction and heart failure with preserved ejection fraction patients who were seen by cardiologists in 13 participating centers across 12 cities in Türkiye. RESULTS The study enrolled 819 patients with heart failure with preserved ejection fraction, with high probability heart failure with preserved ejection fraction rates of 40% and 26% for HFA-PEFF and H2FPEF scorings, respectively. The concordance between the 2 scoring systems was found to be low (Kendall's taub correlation coefficient of 0.242, P < .001). The diagnostic performance of both scoring systems was evaluated, revealing differences in their approach and ability to accurately identify heart failure with preserved ejection fraction patients. CONCLUSION The low concordance between the HFA-PEFF and H2FPEF scoring systems underscores the ongoing challenge of accurately diagnosing and managing patients with heart failure with preserved ejection fraction. Clinicians should be aware of the strengths and limitations of each scoring system and use them in conjunction with other clinical and laboratory findings to arrive at an accurate diagnosis. Future research should focus on identifying additional diagnostic factors, developing more accurate and comprehensive diagnostic algorithms, and investigating alternative methods of diagnosis or stratification of patients based on different clinical characteristics.
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Affiliation(s)
- Gurbet Özge Mert
- Department of Cardiology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Türkiye
| | - Bülent Özlek
- Department of Cardiology, Muğla Sıtkı Koçman University Training and Research Hospital, Muğla, Türkiye
| | - Eda Özlek
- Department of Cardiology, Muğla Sıtkı Koçman University Training and Research Hospital, Muğla, Türkiye
| | - Hicaz Zencirkıran Ağuş
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Türkiye
| | - Mehmet Tekinalp
- Department of Cardiology, Kahramanmaraş Necip Fazıl City Hospital, Kahramanmaraş, Türkiye
| | - Serkan Kahraman
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Türkiye
| | - Cem Çil
- Department of Cardiology, Muğla Sıtkı Koçman University Training and Research Hospital, Muğla, Türkiye
| | - Oğuzhan Çelik
- Department of Cardiology, Muğla Sıtkı Koçman University Training and Research Hospital, Muğla, Türkiye
| | - Özcan Başaran
- Department of Cardiology, Muğla Sıtkı Koçman University Training and Research Hospital, Muğla, Türkiye
| | - Volkan Doğan
- Department of Cardiology, Muğla Sıtkı Koçman University Training and Research Hospital, Muğla, Türkiye
| | - Bedri Caner Kaya
- Department of Cardiology, Mehmet Akif İnan Training and Research Hospital, Şanlıurfa, Türkiye
| | | | - Altuğ Ösken
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Türkiye
| | - Lütfü Bekar
- Department of Cardiology, Hitit University Çorum Erol Olçok Training and Research Hospital, Çorum, Türkiye
| | - Mustafa Ozan Çakır
- Department of Cardiology, Faculty of Medicine, Bülent Ecevit Universiy, Zonguldak, Türkiye
| | - Yunus Çelik
- Department of Cardiology, Kırıkkale Yüksek İhtisas Hospital, Kırıkkale, Türkiye
| | - Kadriye Memiç Sancar
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Türkiye
| | - Samet Sevinç
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Türkiye
| | - Murat Biteker
- Department of Cardiology, Muğla Sıtkı Koçman University Training and Research Hospital, Muğla, Türkiye
| | - Kadir Uğur Mert
- Department of Cardiology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Türkiye
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Marinescu M, Oprea VD, Nechita A, Tutunaru D, Nechita LC, Romila A. The Use of Brain Natriuretic Peptide in the Evaluation of Heart Failure in Geriatric Patients. Diagnostics (Basel) 2023; 13:diagnostics13091512. [PMID: 37174904 PMCID: PMC10177186 DOI: 10.3390/diagnostics13091512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/11/2023] [Accepted: 04/14/2023] [Indexed: 05/15/2023] Open
Abstract
Heart failure is one of the main morbidity and mortality factors in the general population and especially in elderly patients. Thus, at the European level, the prevalence of heart failure is 1% in people under 55 years of age but increases to over 10% in people over 70 years of age. The particularities of the elderly patient, which make the management of heart failure difficult, are the presence of comorbidities, frailty, cognitive impairment and polypharmacy. However, elderly patients are under-represented in clinical trials on the diagnosis and treatment of heart failure. The need for complementary methods (biomarkers) for differential and early diagnosis of heart failure is becoming more and more evident, even in its subclinical stages. These methods need to have increased specificity and sensitivity and be widely available. Natriuretic peptides, in particular B-type natriuretic peptide (BNP) and its fraction NTproBNP, have gained an increasingly important role in the screening, diagnosis and treatment of heart failure in recent years.
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Affiliation(s)
- Mihai Marinescu
- Faculty of Medicine and Pharmacy, "Dunărea de Jos" University in Galați, 800216 Galați, Romania
- "St. Apostle Andrei" Clinical Emergency County Hospital, 800578 Galați, Romania
| | - Violeta Diana Oprea
- Faculty of Medicine and Pharmacy, "Dunărea de Jos" University in Galați, 800216 Galați, Romania
- "St. Apostle Andrei" Clinical Emergency County Hospital, 800578 Galați, Romania
| | - Aurel Nechita
- Faculty of Medicine and Pharmacy, "Dunărea de Jos" University in Galați, 800216 Galați, Romania
- "St. Ioan" Emergency Clinical Hospital for Children, 800487 Galați, Romania
| | - Dana Tutunaru
- Faculty of Medicine and Pharmacy, "Dunărea de Jos" University in Galați, 800216 Galați, Romania
- "St. Apostle Andrei" Clinical Emergency County Hospital, 800578 Galați, Romania
| | - Luiza-Camelia Nechita
- Faculty of Medicine and Pharmacy, "Dunărea de Jos" University in Galați, 800216 Galați, Romania
- "St. Apostle Andrei" Clinical Emergency County Hospital, 800578 Galați, Romania
| | - Aurelia Romila
- Faculty of Medicine and Pharmacy, "Dunărea de Jos" University in Galați, 800216 Galați, Romania
- "St. Apostle Andrei" Clinical Emergency County Hospital, 800578 Galați, Romania
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8
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Tsutsui H, Albert NM, Coats AJS, Anker SD, Bayes-Genis A, Butler J, Chioncel O, Defilippi CR, Drazner MH, Felker GM, Filippatos G, Fiuzat M, Ide T, Januzzi JL, Kinugawa K, Kuwahara K, Matsue Y, Mentz RJ, Metra M, Pandey A, Rosano G, Saito Y, Sakata Y, Sato N, Seferovic PM, Teerlink J, Yamamoto K, Yoshimura M. Natriuretic Peptides: Role in the Diagnosis and Management of Heart Failure: A Scientific Statement From the Heart Failure Association of the European Society of Cardiology, Heart Failure Society of America and Japanese Heart Failure Society. J Card Fail 2023; 29:787-804. [PMID: 37117140 DOI: 10.1016/j.cardfail.2023.02.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 02/16/2023] [Accepted: 02/21/2023] [Indexed: 04/30/2023]
Abstract
Natriuretic peptides, brain (B-type) natriuretic peptide (BNP) and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) are globally and most often used for the diagnosis of heart failure (HF). In addition, they can have an important complementary role in the risk stratification of its prognosis. Since the development of angiotensin receptor neprilysin inhibitors (ARNIs), the use of natriuretic peptides as therapeutic agents has grown in importance. The present document is the result of the Trilateral Cooperation Project among the Heart Failure Association of the European Society of Cardiology, the Heart Failure Society of America and the Japanese Heart Failure Society. It represents an expert consensus that aims to provide a comprehensive, up-to-date perspective on natriuretic peptides in the diagnosis and management of HF, with a focus on the following main issues: (1) history and basic research: discovery, production and cardiovascular protection; (2) diagnostic and prognostic biomarkers: acute HF, chronic HF, inclusion/endpoint in clinical trials, and natriuretic peptides-guided therapy; (3) therapeutic use: nesiritide (BNP), carperitide (ANP) and ARNIs; and (4) gaps in knowledge and future directions.
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Affiliation(s)
- Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Nancy M Albert
- Research and Innovation-Nursing Institute, Kaufman Center for Heart Failure-Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Andrew J S Coats
- University of Warwick, Warwick, UK, and Monash University, Clayton, Australia
| | - Stefan D Anker
- Department of Cardiology and Berlin Institute of Health Center for Regenerative Therapies; German Centre for Cardiovascular Research partner site Berlin, Germany; Charité Universitätsmedizin Berlin, Germany; Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Antoni Bayes-Genis
- Heart Institute, Hospital Germans Trias i Pujol, CIBERCV, Badalona, Spain; Universitat Autonoma Barcelona, Spain
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, Texas, USA; University of Mississippi, Jackson, Mississippi, USA
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases Prof. C.C. Iliescu Bucharest, University of Medicine Carol Davila, Bucharest, Romania
| | | | - Mark H Drazner
- Clinical Chief of Cardiology, University of Texas Southwestern Medical Center, Department of Internal Medicine/Division of Cardiology, Dallas, Texas, USA
| | - G Michael Felker
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Gerasimos Filippatos
- School of Medicine of National and Kapodistrian University of Athens, Athens University Hospital Attikon, Athens, Greece
| | - Mona Fiuzat
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Tomomi Ide
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - James L Januzzi
- Massachusetts General Hospital, Harvard Medical School and Baim Institute for Clinical Research, Boston, Massachusetts, USA
| | - Koichiro Kinugawa
- Second Department of Internal Medicine, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yuya Matsue
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Robert J Mentz
- Duke Clinical Research Institute, Durham, Nortth Carolina, USA; Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Marco Metra
- Cardiology. ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Ambarish Pandey
- Division of Cardiology, Department of Medicine, University of Texas Southwestern, Dallas, Texas, USA
| | - Giuseppe Rosano
- Centre for Clinical and Basic Research, Department of Medical Sciences, IRCCS San Raffaele Pisana, Rome, Italy
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan; Nara Prefecture Seiwa Medical Center, Sango, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Naoki Sato
- Department of Cardiovascular Medicine, Kawaguchi Cardiovascular and Respiratory Hospital, Kawaguchi, Japan
| | - Petar M Seferovic
- University of Belgrade Faculty of Medicine, Serbian Academy of Sciences and Arts, and Heart Failure Center, Belgrade University Medical Center, Belgrade, Serbia
| | - John Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Kazuhiro Yamamoto
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Michihiro Yoshimura
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
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Raco J, Peterson B, Muallem S. Assessment of Volume Status in Hospitalized Patients With Chronic Heart Failure. Cardiol Res 2023; 14:2-11. [PMID: 36896231 PMCID: PMC9990539 DOI: 10.14740/cr1434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 11/26/2022] [Indexed: 02/27/2023] Open
Abstract
Assessment of volume status in hospitalized patients with heart failure is a critically important diagnostic skill that clinicians utilize frequently. However, accurate assessment is challenging and there is often significant inter-provider disagreement. This review serves as an appraisal of current methods of volume assessment amongst different categories of evaluation including patient history, physical exam, laboratory analysis, imaging, and invasive procedures. Within each category, this review highlights methods that are particularly sensitive or specific, or those that carry impactful positive or negative likelihood ratios. Utilization of the information that this review provides will allow clinicians to determine volume status of hospitalized heart failure patients more accurately and more precisely in order to provide appropriate and effective therapies.
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Affiliation(s)
- Joseph Raco
- Department of Internal Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Brandon Peterson
- Department of Cardiology, Penn State Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Samer Muallem
- Department of Cardiology, Penn State Milton S. Hershey Medical Center, Hershey, PA 17033, USA
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Wan Ahmad WA, Mohd Ghazi A, Abdul Ghapar AK, Muthusamy TS, Liew HB, Zainal Abidin I, Ong ML, Ross NT, Cham YL, Ho WS, Fegade M, Chew DSP. From Primary to Tertiary Care: Expert Position Statements to Guide Heart Failure with Preserved Ejection Fraction Diagnosis. Malays J Med Sci 2023; 30:49-66. [PMID: 36875198 PMCID: PMC9984115 DOI: 10.21315/mjms2023.30.1.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/31/2022] [Indexed: 03/05/2023] Open
Abstract
Globally, heart failure with preserved ejection fraction (HFpEF) is quickly becoming the dominant form of heart failure (HF) in ageing populations. However, there are still multiple gaps and challenges in making a firm diagnosis of HFpEF in many low-to-middle income Asian countries. In response to this unmet need, the Malaysian HFpEF Working Group (MY-HPWG) gathered and reviewed evidence surrounding the use of different diagnostic modalities indicated for patients with HFpEF to identify diagnostic tools that could be conveniently accessed across different healthcare settings. As a result, five recommendation statements were proposed and an accompanying algorithm was developed, with the aim of improving the diagnostic rate of HFpEF. The MY-HPWG recommends using more easily accessible and non-invasive tools, such as natriuretic peptide (NP) biomarkers and basic echocardiogram (ECHO), to ensure timely HFpEF diagnosis in the primary and secondary care settings, and prompt referral to a tertiary care centre for more comprehensive assessments in uncertain cases.
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Affiliation(s)
- Wan Azman Wan Ahmad
- Division of Cardiology, Department of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Azmee Mohd Ghazi
- Cardiology Department, The National Heart Institute of Malaysia, Kuala Lumpur, Malaysia
| | | | | | - Houng Bang Liew
- Cardiology Department, Queen Elizabeth Hospital II, Sabah, Malaysia
| | - Imran Zainal Abidin
- Department of Medicine, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Mei Lin Ong
- Cardiology Department, Gleneagles Hospital Penang, Pulau Pinang, Malaysia
| | - Noel Thomas Ross
- Medical Department, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| | - Yee Ling Cham
- Cardiology Department, Sarawak Heart Centre, Sarawak, Malaysia
| | - Wing Sze Ho
- Novartis Corporation (Malaysia) Sdn. Bhd., Selangor, Malaysia
| | - Mayuresh Fegade
- Novartis Corporation (Malaysia) Sdn. Bhd., Selangor, Malaysia
| | - David Soon Ping Chew
- Cardiology Department, Cardiac Vascular Sentral Kuala Lumpur, Kuala Lumpur, Malaysia
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Inflammageing and Cardiovascular System: Focus on Cardiokines and Cardiac-Specific Biomarkers. Int J Mol Sci 2023; 24:ijms24010844. [PMID: 36614282 PMCID: PMC9820990 DOI: 10.3390/ijms24010844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/26/2022] [Accepted: 12/28/2022] [Indexed: 01/05/2023] Open
Abstract
The term "inflammageing" was introduced in 2000, with the aim of describing the chronic inflammatory state typical of elderly individuals, which is characterized by a combination of elevated levels of inflammatory biomarkers, a high burden of comorbidities, an elevated risk of disability, frailty, and premature death. Inflammageing is a hallmark of various cardiovascular diseases, including atherosclerosis, hypertension, and rapid progression to heart failure. The great experimental and clinical evidence accumulated in recent years has clearly demonstrated that early detection and counteraction of inflammageing is a promising strategy not only to prevent cardiovascular disease, but also to slow down the progressive decline of health that occurs with ageing. It is conceivable that beneficial effects of counteracting inflammageing should be most effective if implemented in the early stages, when the compensatory capacity of the organism is not completely exhausted. Early interventions and treatments require early diagnosis using reliable and cost-effective biomarkers. Indeed, recent clinical studies have demonstrated that cardiac-specific biomarkers (i.e., cardiac natriuretic peptides and cardiac troponins) are able to identify, even in the general population, the individuals at highest risk of progression to heart failure. However, further clinical studies are needed to better understand the usefulness and cost/benefit ratio of cardiac-specific biomarkers as potential targets in preventive and therapeutic strategies for early detection and counteraction of inflammageing mechanisms and in this way slowing the progressive decline of health that occurs with ageing.
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12
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Natriuretic peptide testing and heart failure diagnosis in primary care: diagnostic accuracy study. Br J Gen Pract 2023; 73:e1-e8. [PMID: 36543554 PMCID: PMC9799346 DOI: 10.3399/bjgp.2022.0278] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/27/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Natriuretic peptide (NP) testing is recommended for patients presenting to primary care with symptoms of chronic heart failure (HF) to prioritise referral for diagnosis. AIM To report NP test performance at European Society of Cardiology (ESC) and National Institute for Health and Care Excellence (NICE) guideline referral thresholds. DESIGN AND SETTING Diagnostic accuracy study using linked primary and secondary care data (2004 to 2018). METHOD The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of NP testing for HF diagnosis was assessed. RESULTS In total, 229 580 patients had an NP test and 21 102 (9.2%) were diagnosed with HF within 6 months. The ESC NT-proBNP threshold ≥125 pg/mL had a sensitivity of 94.6% (95% confidence interval [CI] = 94.2 to 95.0) and specificity of 50.0% (95% CI = 49.7 to 50.3), compared with sensitivity of 81.7% (95% CI = 81.0 to 82.3) and specificity of 80.3% (95% CI = 80.0 to 80.5) for the NICE NT-proBNP ≥400 pg/mL threshold. PPVs for an NT-proBNP test were 16.4% (95% CI = 16.1 to 16.6) and 30.0% (95% CI = 29.6 to 30.5) for ESC and NICE thresholds, respectively. For both guidelines, nearly all patients with an NT-proBNP level below the threshold did not have HF (NPV: ESC 98.9%, 95% CI = 98.8 to 99.0 and NICE 97.7%, 95% CI = 97.6 to 97.8). CONCLUSION At the higher NICE chronic HF guideline NP thresholds, one in five cases are initially missed in primary care but the lower ESC thresholds require more diagnostic assessments. NP is a reliable 'rule-out' test at both cut-points. The optimal NP threshold will depend on the priorities and capacity of the healthcare system.
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Amen MT, Pham TTT, Cheah E, Tran DP, Thierry B. Metal-Oxide FET Biosensor for Point-of-Care Testing: Overview and Perspective. Molecules 2022; 27:molecules27227952. [PMID: 36432052 PMCID: PMC9698540 DOI: 10.3390/molecules27227952] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/12/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022] Open
Abstract
Metal-oxide semiconducting materials are promising for building high-performance field-effect transistor (FET) based biochemical sensors. The existence of well-established top-down scalable manufacturing processes enables the reliable production of cost-effective yet high-performance sensors, two key considerations toward the translation of such devices in real-life applications. Metal-oxide semiconductor FET biochemical sensors are especially well-suited to the development of Point-of-Care testing (PoCT) devices, as illustrated by the rapidly growing body of reports in the field. Yet, metal-oxide semiconductor FET sensors remain confined to date, mainly in academia. Toward accelerating the real-life translation of this exciting technology, we review the current literature and discuss the critical features underpinning the successful development of metal-oxide semiconductor FET-based PoCT devices that meet the stringent performance, manufacturing, and regulatory requirements of PoCT.
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Rodriguez-Gonzalez M, Castellano-Martinez A. Age-adjusted NT-proBNP could help in the early identification and follow-up of children at risk for severe multisystem inflammatory syndrome associated with COVID-19 (MIS-C). World J Clin Cases 2022; 10:10435-10450. [PMID: 36312492 PMCID: PMC9602208 DOI: 10.12998/wjcc.v10.i29.10435] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/17/2022] [Accepted: 08/31/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Multisystem inflammatory syndrome in children (MIS-C) has emerged as a new disease associated with COVID-19 that presents in acute critically ill children with acute cardiovascular dysfunction.
AIM To determine whether the age-adjusted N-terminal pro-brain natriuretic peptide (NT-proBNP) value (Z-log-NT-proBNP) is associated with severe MIS-C and myocardial dysfunction.
METHODS A retrospective study was conducted which included children with MIS-C managed at our institution between April 1, 2020, and February 28, 2022. We divided the population into groups depending on severity based on pediatric intensive care unit (PICU) admission. We compared Z-log-NT-proBNP values across these groups and analyzed Z-log-NT-proBNP dynamics during the one-month follow-up.
RESULTS We included 17 participants [median age 3 (2-9) years] and seven (41%) required PICU admission. All (100%) of these cases presented very high (Z-log > 4) levels of NT-proBNP at the time of admission compared to only 5 (50%) patients with non-severe MIS-C (P = 0.025). NT-proBNP was significantly correlated with high-sensitive Troponin I levels (P = 0.045), Ross modified score (P = 0.003) and left ventricle ejection fraction (P = 0.021).
CONCLUSION Raised NT-proBNP, specifically very high values (Z-log-NT-proBNP > 4) could help in the early identification of MIS-C patients with myocardial dysfunction requiring inotropic support and PICU admission.
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15
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Dong T, Zhao Y, Jin HF, Shen L, Lin Y, Si LL, Chen L, Liu JC. SNTA1-deficient human cardiomyocytes demonstrate hypertrophic phenotype and calcium handling disorder. Stem Cell Res Ther 2022; 13:288. [PMID: 35773684 PMCID: PMC9248201 DOI: 10.1186/s13287-022-02955-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background α-1-syntrophin (SNTA1), a protein encoded by SNTA1, is highly expressed in human cardiomyocytes. Mutations in SNTA1 are associated with arrhythmia and cardiomyopathy. Previous research on SNTA1 has been based on non-human cardiomyocytes. This study was designed to identify the phenotype of SNTA1-deficiency using human cardiomyocytes. Methods SNTA1 was knocked out in the H9 embryonic stem cell line using the CRISPR-Cas9 system. H9SNTA1KO cells were then induced to differentiate into cardiomyocytes using small molecule inhibitors. The phenotypic discrepancies associated with SNTA1-deficient cardiomyocytes were investigated. Results SNTA1 was truncated at the 149th amino acid position of PH1 domain by a stop codon (TGA) using the CRISPR-Cas9 system. SNTA1-deficiency did not affect the pluripotency of H9SNTA1KO, and they retain their in vitro ability to differentiate into cardiomyocytes. However, H9SNTA1KO derived cardiomyocytes exhibited hypertrophic phenotype, lower cardiac contractility, weak calcium transient intensity, and lower level of calcium in the sarcoplasmic reticulum. Early treatment of SNTA1-deficient cardiomyocytes with ranolazine improved the calcium transient intensity and cardiac contractility. Conclusion SNTA1-deficient cardiomyocytes can be used to research the etiology, pathogenesis, and potential therapies for myocardial diseases. The SNTA1-deficient cardiomyocyte model suggests that the maintenance of cardiac calcium homeostasis is a key target in the treatment of myocardial-related diseases. Supplementary Information The online version contains supplementary material available at 10.1186/s13287-022-02955-4.
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Affiliation(s)
- Tao Dong
- Basic Medicine School, Qiqihar Medical University, 333 Bukui Street, Qiqihar, 161006, Heilongjiang, China.
| | - Yan Zhao
- College of Life Science and Agroforestry, Qiqihar University, Qiqihar, 161006, Heilongjiang, China
| | - Hai-Feng Jin
- Basic Medicine School, Qiqihar Medical University, 333 Bukui Street, Qiqihar, 161006, Heilongjiang, China
| | - Lei Shen
- Basic Medicine School, Qiqihar Medical University, 333 Bukui Street, Qiqihar, 161006, Heilongjiang, China
| | - Yan Lin
- Basic Medicine School, Qiqihar Medical University, 333 Bukui Street, Qiqihar, 161006, Heilongjiang, China
| | - Long-Long Si
- CAS Key Laboratory of Quantitative Engineering Biology, Shenzhen Institute of Synthetic Biology, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Li Chen
- CAS Key Laboratory of Quantitative Engineering Biology, Shenzhen Institute of Synthetic Biology, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Ji-Cheng Liu
- Qiqihar Institute of Medical and Pharmaceutical Sciences, Qiqihar Medical University, 333 Bukui Street, Qiqihar, 161006, Heilongjiang, China.
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Sanusi M, Momin ES, Mannan V, Kashyap T, Pervaiz MA, Akram A, Khan AA, Elshaikh AO. Using Echocardiography and Biomarkers to Determine Prognosis in Peripartum Cardiomyopathy: A Systematic Review. Cureus 2022; 14:e26130. [PMID: 35875281 PMCID: PMC9299948 DOI: 10.7759/cureus.26130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/20/2022] [Indexed: 11/05/2022] Open
Abstract
Peripartum cardiomyopathy (PPCM) is a rare but debilitating form of heart failure that affects pregnant women. Although PPCM has a high rate of complete resolution, some patients often have a progressive disease and develop significant morbidity and mortality. Making an accurate prediction of outcomes and identifying those patients at the highest risk has proven difficult over the years. This study aimed to establish if we can use echocardiographic parameters and biomarkers as reliable indicators of prognosis. A predetermined systematic search strategy was employed in four databases: PubMed, Google Scholar, Science Direct, and Cochrane Library to include articles from the last 15 years (January 2007 to January 2022). Data from 12 studies were synthesized and included in this study. Although no parameter proved consistent in all the studies, echocardiographic parameters, including strain profiles and biomarkers, proved significant in the prognostication of patients with PPCM in the various studies evaluated. Therefore, a holistic approach is still needed in the risk stratification of patients with PPCM. Future studies should evaluate these parameters as well as clinical characteristics in a larger cohort study with a long follow-up period of more than one year in order to potentially develop prognostic score criteria that can be used to accurately identify those patients at the highest risk of developing severe disease or death to allow for timely and targeted therapies to improve outcomes in these patients.
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Szabó D, Sárszegi Z, Polgár B, Sághy É, Reglődi D, Tóth T, Onódi Z, Leszek P, Varga ZV, Helyes Z, Kemény Á, Ferdinandy P, Tamás A. PACAP-38 and PAC1 Receptor Alterations in Plasma and Cardiac Tissue Samples of Heart Failure Patients. Int J Mol Sci 2022; 23:ijms23073715. [PMID: 35409075 PMCID: PMC8998504 DOI: 10.3390/ijms23073715] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 02/07/2023] Open
Abstract
Pituitary adenylate cyclase activating polypeptide-38 (PACAP-38) is a multifunctional neuropeptide, which may play a role in cardioprotection. However, little is known about the presence of PACAP-38 in heart failure (HF) patients. The aim of our study was to measure the alterations of PACAP-38 like immunoreactivity (LI) in acute (n = 13) and chronic HF (n = 33) and to examine potential correlations between PACAP-38 and HF predictors (cytokines, NT-proBNP). Tissue PACAP-38 LI and PAC1 receptor levels were also investigated in heart tissue samples of patients with HF. Significantly higher plasma PACAP-38 LI was detected in patients with acute HF, while in chronic HF patients, a lower level of immunoreactivity was observed compared to healthy controls (n = 13). Strong negative correlation was identified between plasma PACAP-38 and NT-proBNP levels in chronic HF, as opposed to the positive connection seen in the acute HF group. Plasma IL-1 β, IL-2 and IL-4 levels were significantly lower in chronic HF, and IL-10 was significantly higher in patients with acute HF. PACAP-38 levels of myocardial tissues were lower in all end-stage HF patients and lower PAC1 receptor levels were detected in the primary dilated cardiomyopathy group compared to the controls. We conclude that PACAP-38 and PAC1 expression correlates with some biomarkers of acute and chronic HF; therefore, further studies are necessary to explore whether PACAP could be a suitable prognostic biomarker in HF patients.
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Affiliation(s)
- Dóra Szabó
- Heart Institute, Clinical Centre, Medical School, University of Pecs, 7624 Pecs, Hungary; (D.S.); (Z.S.)
- Department of Anatomy, MTA-PTE PACAP Research Team, Centre for Neuroscience, Medical School, University of Pecs, 7624 Pecs, Hungary; (D.R.); (T.T.)
- Szentagothai Research Centre, University of Pecs, 7624 Pecs, Hungary; (Z.H.); (Á.K.)
| | - Zsolt Sárszegi
- Heart Institute, Clinical Centre, Medical School, University of Pecs, 7624 Pecs, Hungary; (D.S.); (Z.S.)
| | - Beáta Polgár
- Department of Medical Microbiology and Immunology, Clinical Centre, Medical School, University of Pecs, 7624 Pecs, Hungary;
| | - Éva Sághy
- Cardiometabolic Research Group, MTA-SE System Pharmacology Research Group, Department of Pharmacology and Pharmacotherapy, Semmelweis University, 1089 Budapest, Hungary; (É.S.); (Z.O.); (Z.V.V.); (P.F.)
| | - Dóra Reglődi
- Department of Anatomy, MTA-PTE PACAP Research Team, Centre for Neuroscience, Medical School, University of Pecs, 7624 Pecs, Hungary; (D.R.); (T.T.)
- Szentagothai Research Centre, University of Pecs, 7624 Pecs, Hungary; (Z.H.); (Á.K.)
| | - Tünde Tóth
- Department of Anatomy, MTA-PTE PACAP Research Team, Centre for Neuroscience, Medical School, University of Pecs, 7624 Pecs, Hungary; (D.R.); (T.T.)
- Szentagothai Research Centre, University of Pecs, 7624 Pecs, Hungary; (Z.H.); (Á.K.)
| | - Zsófia Onódi
- Cardiometabolic Research Group, MTA-SE System Pharmacology Research Group, Department of Pharmacology and Pharmacotherapy, Semmelweis University, 1089 Budapest, Hungary; (É.S.); (Z.O.); (Z.V.V.); (P.F.)
- HCEMM-SU Cardiometabolic Immunology Research Group, Semmelweis University, 1089 Budapest, Hungary
| | - Przemyslaw Leszek
- Department of Heart Failure and Transplantology, Cardinal Stefan Wyszyński National Institute of Cardiology, 04-628 Warszawa, Poland;
| | - Zoltán V. Varga
- Cardiometabolic Research Group, MTA-SE System Pharmacology Research Group, Department of Pharmacology and Pharmacotherapy, Semmelweis University, 1089 Budapest, Hungary; (É.S.); (Z.O.); (Z.V.V.); (P.F.)
- HCEMM-SU Cardiometabolic Immunology Research Group, Semmelweis University, 1089 Budapest, Hungary
| | - Zsuzsanna Helyes
- Szentagothai Research Centre, University of Pecs, 7624 Pecs, Hungary; (Z.H.); (Á.K.)
- Department of Pharmacology and Pharmacotherapy, Medical School, University of Pecs, 7624 Pecs, Hungary
| | - Ágnes Kemény
- Szentagothai Research Centre, University of Pecs, 7624 Pecs, Hungary; (Z.H.); (Á.K.)
- Department of Pharmacology and Pharmacotherapy, Medical School, University of Pecs, 7624 Pecs, Hungary
- Department of Medical Biology, Medical School, University of Pecs, 7624 Pecs, Hungary
| | - Péter Ferdinandy
- Cardiometabolic Research Group, MTA-SE System Pharmacology Research Group, Department of Pharmacology and Pharmacotherapy, Semmelweis University, 1089 Budapest, Hungary; (É.S.); (Z.O.); (Z.V.V.); (P.F.)
- Pharmahungary Group, 6720 Szeged, Hungary
| | - Andrea Tamás
- Department of Anatomy, MTA-PTE PACAP Research Team, Centre for Neuroscience, Medical School, University of Pecs, 7624 Pecs, Hungary; (D.R.); (T.T.)
- Szentagothai Research Centre, University of Pecs, 7624 Pecs, Hungary; (Z.H.); (Á.K.)
- Correspondence: or ; Tel.: +36-72-536-001 (ext. 36421)
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Nova R, Putra ST, Nurmaini S, Partan RU. The Association between NTproBNP Biomarker Levels and Clinical Symptoms of Cardiac Septal Defects in Children. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: In a cardiac septal defect, there is left-to-right shunt at the atrial, ventricle level, or both. This causes clinical symptoms of heart failure, pulmonary hypertension, or malnutrition. NTproBNP is synthesized and released into the circulation by the ventricular myocytes in response to pressure, volume overload, and increase in myocardial wall stress.
AIM: This study aims to evaluate relationship between NTproBNP levels and clinical symptoms of cardiac septal defect.
PATIENTS AND METHODS: This cross-sectional study was conducted from April to August 2021 at Moh Husin Hospital, Palembang, Indonesia. The presence of heart failure was determined using the modified Ross score. Nutritional status was defined on anthropometric measurement, and data were plot to weight to height Z-score chart. The presence of pulmonary hypertension was measured by Doppler echocardiography.
RESULTS: A total of 75 cardiac septal defect patients were included in this study. A similar plasma NTproBNP of 554 pg/ml was determined as the cut-off point for predicting heart failure and pulmonary hypertension, with a sensitivity of 57.1% and 54.5%, specificity of 85% and 80.9%, with area under receiver operating characteristic (ROC) of 0.706 and 0.716 respectively. For malnutrition, plasma NTproBNP of 429 pg/ml was found to have sensitivity, specificity, and area under ROC of 54.3%, 77.5%, and 0.640, respectively. The multivariate logistic regression showed that NTproBNP >554 pg/ml and >429 pg/ml had a 6-fold higher odds of having heart failure, an 8-fold higher odds of having pulmonary hypertension, and a 4-fold odds of having malnutrition.
CONCLUSION: NTproBNP is a biomarker that is strong enough to predict clinical symptoms of heart failure, pulmonary hypertension, and malnutrition in children with cardiac septal defect.
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NT-proBNP for heart failure diagnosis in Primary Care: Costs or savings? A budget impact study. Rev Port Cardiol 2021; 41:183-193. [DOI: 10.1016/j.repc.2021.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/16/2021] [Accepted: 03/26/2021] [Indexed: 11/22/2022] Open
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20
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Perera R, Stevens R, Aronson JK, Banerjee A, Evans J, Feakins BG, Fleming S, Glasziou P, Heneghan C, Hobbs FDR, Jones L, Kurtinecz M, Lasserson DS, Locock L, McLellan J, Mihaylova B, O’Callaghan CA, Oke JL, Pidduck N, Plüddemann A, Roberts N, Schlackow I, Shine B, Simons CL, Taylor CJ, Taylor KS, Verbakel JY, Bankhead C. Long-term monitoring in primary care for chronic kidney disease and chronic heart failure: a multi-method research programme. PROGRAMME GRANTS FOR APPLIED RESEARCH 2021. [DOI: 10.3310/pgfar09100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
Long-term monitoring is important in chronic condition management. Despite considerable costs of monitoring, there is no or poor evidence on how, what and when to monitor. The aim of this study was to improve understanding, methods, evidence base and practice of clinical monitoring in primary care, focusing on two areas: chronic kidney disease and chronic heart failure.
Objectives
The research questions were as follows: does the choice of test affect better care while being affordable to the NHS? Can the number of tests used to manage individuals with early-stage kidney disease, and hence the costs, be reduced? Is it possible to monitor heart failure using a simple blood test? Can this be done using a rapid test in a general practitioner consultation? Would changes in the management of these conditions be acceptable to patients and carers?
Design
Various study designs were employed, including cohort, feasibility study, Clinical Practice Research Datalink analysis, seven systematic reviews, two qualitative studies, one cost-effectiveness analysis and one cost recommendation.
Setting
This study was set in UK primary care.
Data sources
Data were collected from study participants and sourced from UK general practice and hospital electronic health records, and worldwide literature.
Participants
The participants were NHS patients (Clinical Practice Research Datalink: 4.5 million patients), chronic kidney disease and chronic heart failure patients managed in primary care (including 750 participants in the cohort study) and primary care health professionals.
Interventions
The interventions were monitoring with blood and urine tests (for chronic kidney disease) and monitoring with blood tests and weight measurement (for chronic heart failure).
Main outcome measures
The main outcomes were the frequency, accuracy, utility, acceptability, costs and cost-effectiveness of monitoring.
Results
Chronic kidney disease: serum creatinine testing has increased steadily since 1997, with most results being normal (83% in 2013). Increases in tests of creatinine and proteinuria correspond to their introduction as indicators in the Quality and Outcomes Framework. The Chronic Kidney Disease Epidemiology Collaboration equation had 2.7% greater accuracy (95% confidence interval 1.6% to 3.8%) than the Modification of Diet in Renal Disease equation for estimating glomerular filtration rate. Estimated annual transition rates to the next chronic kidney disease stage are ≈ 2% for people with normal urine albumin, 3–5% for people with microalbuminuria (3–30 mg/mmol) and 3–12% for people with macroalbuminuria (> 30 mg/mmol). Variability in estimated glomerular filtration rate-creatinine leads to misclassification of chronic kidney disease stage in 12–15% of tests in primary care. Glycaemic-control and lipid-modifying drugs are associated with a 6% (95% confidence interval 2% to 10%) and 4% (95% confidence interval 0% to 8%) improvement in renal function, respectively. Neither estimated glomerular filtration rate-creatinine nor estimated glomerular filtration rate-Cystatin C have utility in predicting rate of kidney function change. Patients viewed phrases such as ‘kidney damage’ or ‘kidney failure’ as frightening, and the term ‘chronic’ was misinterpreted as serious. Diagnosis of asymptomatic conditions (chronic kidney disease) was difficult to understand, and primary care professionals often did not use ‘chronic kidney disease’ when managing patients at early stages. General practitioners relied on Clinical Commissioning Group or Quality and Outcomes Framework alerts rather than National Institute for Health and Care Excellence guidance for information. Cost-effectiveness modelling did not demonstrate a tangible benefit of monitoring kidney function to guide preventative treatments, except for individuals with an estimated glomerular filtration rate of 60–90 ml/minute/1.73 m2, aged < 70 years and without cardiovascular disease, where monitoring every 3–4 years to guide cardiovascular prevention may be cost-effective. Chronic heart failure: natriuretic peptide-guided treatment could reduce all-cause mortality by 13% and heart failure admission by 20%. Implementing natriuretic peptide-guided treatment is likely to require predefined protocols, stringent natriuretic peptide targets, relative targets and being located in a specialist heart failure setting. Remote monitoring can reduce all-cause mortality and heart failure hospitalisation, and could improve quality of life. Diagnostic accuracy of point-of-care N-terminal prohormone of B-type natriuretic peptide (sensitivity, 0.99; specificity, 0.60) was better than point-of-care B-type natriuretic peptide (sensitivity, 0.95; specificity, 0.57). Within-person variation estimates for B-type natriuretic peptide and weight were as follows: coefficient of variation, 46% and coefficient of variation, 1.2%, respectively. Point-of-care N-terminal prohormone of B-type natriuretic peptide within-person variability over 12 months was 881 pg/ml (95% confidence interval 380 to 1382 pg/ml), whereas between-person variability was 1972 pg/ml (95% confidence interval 1525 to 2791 pg/ml). For individuals, monitoring provided reassurance; future changes, such as increased testing, would be acceptable. Point-of-care testing in general practice surgeries was perceived positively, reducing waiting time and anxiety. Community heart failure nurses had greater knowledge of National Institute for Health and Care Excellence guidance than general practitioners and practice nurses. Health-care professionals believed that the cost of natriuretic peptide tests in routine monitoring would outweigh potential benefits. The review of cost-effectiveness studies suggests that natriuretic peptide-guided treatment is cost-effective in specialist settings, but with no evidence for its value in primary care settings.
Limitations
No randomised controlled trial evidence was generated. The pathways to the benefit of monitoring chronic kidney disease were unclear.
Conclusions
It is difficult to ascribe quantifiable benefits to monitoring chronic kidney disease, because monitoring is unlikely to change treatment, especially in chronic kidney disease stages G3 and G4. New approaches to monitoring chronic heart failure, such as point-of-care natriuretic peptide tests in general practice, show promise if high within-test variability can be overcome.
Future work
The following future work is recommended: improve general practitioner–patient communication of early-stage renal function decline, and identify strategies to reduce the variability of natriuretic peptide.
Study registration
This study is registered as PROSPERO CRD42015017501, CRD42019134922 and CRD42016046902.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 10. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Rafael Perera
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Richard Stevens
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jeffrey K Aronson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, UK
| | - Julie Evans
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Benjamin G Feakins
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Susannah Fleming
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Paul Glasziou
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences & Medicine, Bond University, Gold Coast, QLD, Australia
| | - Carl Heneghan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - FD Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Louise Jones
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Milena Kurtinecz
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Daniel S Lasserson
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Louise Locock
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Julie McLellan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Borislava Mihaylova
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Institute of Population Health Sciences, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Jason L Oke
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nicola Pidduck
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Annette Plüddemann
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nia Roberts
- Bodleian Health Care Libraries, Knowledge Centre, University of Oxford, Oxford, UK
| | - Iryna Schlackow
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Brian Shine
- Department of Clinical Biochemistry, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Claire L Simons
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Clare J Taylor
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Kathryn S Taylor
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jan Y Verbakel
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- National Institute for Health Research (NIHR) Community Healthcare MedTech and In Vitro Diagnostics Co-operative (MIC), Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Clare Bankhead
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Use of B-Type Natriuretic Peptide (BNP) and N-Terminal proBNP (NT-proBNP) as Diagnostic Tests in Adults With Suspected Heart Failure: A Health Technology Assessment. ONTARIO HEALTH TECHNOLOGY ASSESSMENT SERIES 2021; 21:1-125. [PMID: 34055110 PMCID: PMC8129637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Heart failure is a complex clinical syndrome that usually presents with breathlessness, leg edema, and fatigue. Clinically measurable natriuretic neurohormones such as B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) are elevated in people with heart failure. We conducted a health technology assessment of BNP and NT-proBNP tests for people with suspected heart failure, which included an evaluation of diagnostic accuracy, clinical impact, cost-effectiveness, the budget impact of publicly funding BNP and NT-proBNP tests, and patient preferences and values. METHODS We performed a literature search of previously published systematic reviews of the clinical evidence. We conducted an overview of reviews and included only reviews with a low risk of bias as assessed using the Risk of Bias in Systematic Reviews tool (ROBIS). We excluded any reviews where we found 100% overlap of included primary studies and selected systematic reviews or health technology assessments published after 2006 for inclusion.We performed an economic literature review of BNP and NT-proBNP testing in people with suspected heart failure. Medical and health economic databases were searched from database inception until July 25, 2019. Next, we assessed the cost-effectiveness of BNP and NT-proBNP based on the published economic literature. We transferred the cost-effectiveness results of two applicable, recent economic evaluations from the National Institute for Health and Care Excellence (NICE) to the Ontario setting in lieu of conducting de novo primary economic evaluations. We also estimated the budget impact of publicly funding BNP and NT-proBNP tests in people with suspected heart failure in Ontario over the next 5 years.To contextualize the potential value of BNP and NT-proBNP testing, we spoke with people with suspected heart failure. RESULTS We included eight systematic reviews in the clinical evidence review. B-type natriuretic peptides and NT-proBNP had a high pooled sensitivity (80% to 94% and 86% to 96%, respectively; strength of evidence: high) and a low pooled negative likelihood ratio (0.08-0.30 and 0.09-0.23, respectively; strength of evidence: not reported) within varying thresholds or cut points and settings, as reported in seven systematic reviews. In one systematic review, when BNP or NT-proBNP was used in the diagnosis of heart failure in the emergency department (ED), there was a decrease in the mean length of hospital stay (-1.22 days; confidence interval [CI] -2.31 to -0.14; Grading of Recommendations Assessment, Development, and Evaluation [GRADE] Working Group criteria: Moderate). B-type natriuretic peptide testing did not reduce hospital admission rates (odds ratio [OR]: 0.82; CI: 0.67-1.01; GRADE: Moderate), 30-day hospital readmission rates (OR: 0.88; CI: 0.64-1,20; GRADE: Moderate), or hospital mortality rates (OR: 0.96; CI: 0.65-1.41; GRADE: Moderate). No systematic review was identified that addressed the impact on clinical outcomes of BNP use in the community setting.Our economic literature review found a total of 12 studies evaluating the cost-effectiveness of BNP or NT-proBNP testing in patients with suspected heart failure. The studies suggested that BNP or NT-proBNP tests, when used in addition to standard clinical investigations, were either dominant (less costly and more effective) or cost-effective across different countries (including Canada) and settings.Two economic evaluations conducted by NICE were considered applicable to our research question and of high methodological quality. Based on the transferred results from the two NICE economic evaluations, we concluded that BNP and NT-proBNP were highly likely to be cost-effective in Ontario in the ED setting, and NT-proBNP was highly likely to be cost-effective in the community care setting.Our budget impact analysis estimated that over the next 5 years, publicly funding BNP and NT-proBNP tests would result in an additional cost of $38 million in the ED (at a cost of $75 per test) and a cost savings of $20 million in community care (at a cost of $28 per test).We received strong support from interview participants about BNP or NT-proBNP diagnostic testing. The main reason was the perceived potential benefit of receiving a speedier diagnosis. The overall process, from diagnosis to treatment, is a substantial emotional burden for patients and caregivers, and for those living further away from secondary or tertiary care settings. An earlier diagnosis could allow patients to receive treatment at a hospital better equipped to manage their potentially fatal symptoms and conditions. CONCLUSIONS B-type natriuretic peptide and NT-proBNP tests have high sensitivity and low negative likelihood ratio, suggesting that concentrations of either natriuretic peptides within the appropriate cut points can rule out the presence of heart failure with a high degree of confidence. Additionally, BNP or NT-proBNP testing along with usual care in an ED setting likely can reduce the length of hospital stay by at least 1 day but likely results in little to no difference in hospital mortality, 30-day readmission, or admission rates to hospital.Based on the published economic literature, we expected BNP or NT-proBNP tests used in addition to standard clinical investigations to be cost-effective as a rule-out test in patients with suspected heart failure in Ontario. If BNP and NT-proBNP tests are publicly funded in Ontario, we estimated that there would be additional costs in the ED setting (due to increased detection of heart failure) and savings in community care (due to reduced referrals to echocardiography and cardiologists).People we interviewed gave BNP and NT-proBNP testing strong support, citing the perceived benefits of quicker, more accurate diagnoses that could reduce misdiagnoses, stress, and the burden on patients and caregivers.
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22
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Rammos A, Bechlioulis A, Kalogeras P, Tripoliti EE, Goletsis Y, Kalivi A, Blathra E, Salvo P, Trivella MG, Lomonaco T, Fuoco R, Bellagambi F, Watson CJ, Errachid A, Fotiadis DI, Michalis LK, Naka KK. Salivary Biomarkers for Diagnosis and Therapy Monitoring in Patients with Heart Failure. A Systematic Review. Diagnostics (Basel) 2021; 11:824. [PMID: 34063278 PMCID: PMC8147430 DOI: 10.3390/diagnostics11050824] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/26/2021] [Accepted: 04/30/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to perform a systematic review on the potential value of saliva biomarkers in the diagnosis, management and prognosis of heart failure (HF). The correlation between saliva and plasma values of these biomarkers was also studied. PubMed was searched to collect relevant literature, i.e., case-control, cross-sectional studies that either compared the values of salivary biomarkers among healthy subjects and HF patients, or investigated their role in risk stratification and prognosis in HF patients. No randomized control trials were included. The search ended on 31st of December 2020. A total of 15 studies met the inclusion criteria. 18 salivary biomarkers were analyzed and the levels of all biomarkers studied were found to be higher in HF patients compared to controls, except for amylase, sodium, and chloride that had smaller saliva concentrations in HF patients. Natriuretic peptides are the most commonly used plasma biomarkers in the management of HF. Their saliva levels show promising results, although the correlation of saliva to plasma values is weakened in higher plasma values. In most of the publications, differences in biomarker levels between HF patients and controls were found to be statistically significant. Due to the small number of patients included, larger studies need to be conducted in order to facilitate the use of saliva biomarkers in clinical practice.
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Affiliation(s)
- Aidonis Rammos
- Second Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina and University Hospital of Ioannina, GR 45500 Ioannina, Greece; (A.R.); (A.B.); (P.K.); (A.K.); (E.B.); (L.K.M.)
| | - Aris Bechlioulis
- Second Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina and University Hospital of Ioannina, GR 45500 Ioannina, Greece; (A.R.); (A.B.); (P.K.); (A.K.); (E.B.); (L.K.M.)
| | - Petros Kalogeras
- Second Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina and University Hospital of Ioannina, GR 45500 Ioannina, Greece; (A.R.); (A.B.); (P.K.); (A.K.); (E.B.); (L.K.M.)
| | - Evanthia E. Tripoliti
- Department of Biomedical Research, Institute of Molecular Biology and Biotechnology, FORTH, GR 45110 Ioannina, Greece; (E.E.T.); (Y.G.); (D.I.F.)
| | - Yorgos Goletsis
- Department of Biomedical Research, Institute of Molecular Biology and Biotechnology, FORTH, GR 45110 Ioannina, Greece; (E.E.T.); (Y.G.); (D.I.F.)
- Department of Economics, University of Ioannina, GR 45110 Ioannina, Greece
| | - Anna Kalivi
- Second Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina and University Hospital of Ioannina, GR 45500 Ioannina, Greece; (A.R.); (A.B.); (P.K.); (A.K.); (E.B.); (L.K.M.)
| | - Effrosyni Blathra
- Second Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina and University Hospital of Ioannina, GR 45500 Ioannina, Greece; (A.R.); (A.B.); (P.K.); (A.K.); (E.B.); (L.K.M.)
| | - Pietro Salvo
- Institute of Clinical Physiology, Italian National Research Council, Via G. Moruzzi 1, PI 56124 Pisa, Italy; (P.S.); (M.G.T.)
| | - M. Giovanna Trivella
- Institute of Clinical Physiology, Italian National Research Council, Via G. Moruzzi 1, PI 56124 Pisa, Italy; (P.S.); (M.G.T.)
| | - Tommaso Lomonaco
- Department of Chemistry and Industrial Chemistry, University of Pisa, PI 56124 Pisa, Italy; (T.L.); (R.F.); (F.B.)
| | - Roger Fuoco
- Department of Chemistry and Industrial Chemistry, University of Pisa, PI 56124 Pisa, Italy; (T.L.); (R.F.); (F.B.)
| | - Francesca Bellagambi
- Department of Chemistry and Industrial Chemistry, University of Pisa, PI 56124 Pisa, Italy; (T.L.); (R.F.); (F.B.)
- Institute of Analytical Sciences (ISA)—UMR 5280, University Claude Bernard Lyon 1, 69100 Lyon, France;
| | - Chris J. Watson
- UCD Conway Institute, School of Medicine, University College Dublin, DUBLIN 4, Dublin, Ireland;
- Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast BT97BL, UK
| | - Abdelhamid Errachid
- Institute of Analytical Sciences (ISA)—UMR 5280, University Claude Bernard Lyon 1, 69100 Lyon, France;
| | - Dimitrios I. Fotiadis
- Department of Biomedical Research, Institute of Molecular Biology and Biotechnology, FORTH, GR 45110 Ioannina, Greece; (E.E.T.); (Y.G.); (D.I.F.)
- Department of Economics, University of Ioannina, GR 45110 Ioannina, Greece
- Unit of Medical Technology and Intelligent Information Systems, University of Ioannina, GR 45110 Ioannina, Greece
| | - Lampros K. Michalis
- Second Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina and University Hospital of Ioannina, GR 45500 Ioannina, Greece; (A.R.); (A.B.); (P.K.); (A.K.); (E.B.); (L.K.M.)
| | - Katerina K. Naka
- Second Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina and University Hospital of Ioannina, GR 45500 Ioannina, Greece; (A.R.); (A.B.); (P.K.); (A.K.); (E.B.); (L.K.M.)
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23
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Roalfe AK, Taylor CJ, Kelder JC, Hoes AW, Hobbs FDR. Diagnosing heart failure in primary care: individual patient data meta-analysis of two European prospective studies. ESC Heart Fail 2021; 8:2193-2201. [PMID: 33755352 PMCID: PMC8120419 DOI: 10.1002/ehf2.13311] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/27/2021] [Accepted: 03/02/2021] [Indexed: 12/28/2022] Open
Abstract
Aims Natriuretic peptides are helpful in detecting chronic heart failure (HF) in primary care; however, there are a lack of data evaluating thresholds recommended by clinical guidelines. This study assesses the diagnostic accuracy of N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) using combined individual patient data from two studies in the UK and the Netherlands. Methods and results Random effects methods were used to estimate the performance characteristics of NT‐proBNP thresholds recommended by the European Society of Cardiology (ESC) and the UK National Institute for Health and Care Excellence (NICE) guidelines. New onset HF was diagnosed in 313 of 1073 (29.2%) participants. Age, sex, and atrial fibrillation‐adjusted NT‐proBNP was a better predictor of HF with reduced ejection fraction (HFrEF) than HF preserved ejection fraction (HFpEF), with area under receiver operating characteristic curve of 0.82 95% CI (0.78 to 0.86) vs. 0.71 (0.66 to 0.75). In persons aged 70 years and over, the ESC threshold at 125 ng/L for detection of all‐cause HF had summary negative predictive value (NPV) of 84.9% (81.6 to 88.2), positive predictive value (PPV) 68.1% (63.1 to 73.3), sensitivity 74.9% (69.5 to 80.3), and specificity 80.1% (76.9 to 83.4); the NICE threshold at 400 ng/L had summary NPV of 74.7% (72.1 to 77.2), PPV 81.8% (73.3 to 89.5), sensitivity 43.5% (37.2 to 49.8), and specificity 94.5% (92.3 to 96.7). Conclusions N‐terminal pro‐B‐type natriuretic peptide is better at detecting HFrEF than HFpEF in a primary care setting. In persons aged 70 and over, the ESC threshold of 125 ng/L is more accurate at detecting and excluding HF than the higher level suggested in NICE guidelines. More prospective data are required to establish the optimal NP threshold for detecting chronic HF in general practice.
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Affiliation(s)
- Andrea K Roalfe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | - Clare J Taylor
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
| | | | - Arno W Hoes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht/Utrecht University, Utrecht, The Netherlands
| | - F D Richard Hobbs
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
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24
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Hoevelmann J, Muller E, Azibani F, Kraus S, Cirota J, Briton O, Ntsekhe M, Ntusi NAB, Sliwa K, Viljoen CA. Prognostic value of NT-proBNP for myocardial recovery in peripartum cardiomyopathy (PPCM). Clin Res Cardiol 2021; 110:1259-1269. [PMID: 33555408 PMCID: PMC8318939 DOI: 10.1007/s00392-021-01808-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 01/16/2021] [Indexed: 11/25/2022]
Abstract
Introduction Peripartum cardiomyopathy (PPCM) is an important cause of pregnancy-associated heart failure worldwide. Although a significant number of women recover their left ventricular (LV) function within 12 months, some remain with persistently reduced systolic function. Methods Knowledge gaps exist on predictors of myocardial recovery in PPCM. N-terminal pro-brain natriuretic peptide (NT-proBNP) is the only clinically established biomarker with diagnostic value in PPCM. We aimed to establish whether NT-proBNP could serve as a predictor of LV recovery in PPCM, as measured by LV end-diastolic volume (LVEDD) and LV ejection fraction (LVEF). Results This study of 35 women with PPCM (mean age 30.0 ± 5.9 years) had a median NT-proBNP of 834.7 pg/ml (IQR 571.2–1840.5) at baseline. Within the first year of follow-up, 51.4% of the cohort recovered their LV dimensions (LVEDD < 55 mm) and systolic function (LVEF > 50%). Women without LV recovery presented with higher NT-proBNP at baseline. Multivariable regression analyses demonstrated that NT-proBNP of ≥ 900 pg/ml at the time of diagnosis was predictive of failure to recover LVEDD (OR 0.22, 95% CI 0.05–0.95, P = 0.043) or LVEF (OR 0.20 [95% CI 0.04–0.89], p = 0.035) at follow-up. Conclusions We have demonstrated that NT-proBNP has a prognostic value in predicting LV recovery of patients with PPCM. Patients with NT-proBNP of ≥ 900 pg/ml were less likely to show any improvement in LVEF or LVEDD. Our findings have implications for clinical practice as patients with higher NT-proBNP might require more aggressive therapy and more intensive follow-up. Point-of-care NT-proBNP for diagnosis and risk stratification warrants further investigation.
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Affiliation(s)
- J Hoevelmann
- Hatter Institute for Cardiovascular Research in Africa and Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Saarland University Hospital, Homburg (Saar), Deutschland
| | - E Muller
- Hatter Institute for Cardiovascular Research in Africa and Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - F Azibani
- Hatter Institute for Cardiovascular Research in Africa and Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - S Kraus
- Hatter Institute for Cardiovascular Research in Africa and Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Division of Cardiology, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - J Cirota
- Division of Cardiology, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - O Briton
- Hatter Institute for Cardiovascular Research in Africa and Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - M Ntsekhe
- Hatter Institute for Cardiovascular Research in Africa and Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Division of Cardiology, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - N A B Ntusi
- Hatter Institute for Cardiovascular Research in Africa and Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Division of Cardiology, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Cape Universities Body Imaging Centre, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - K Sliwa
- Hatter Institute for Cardiovascular Research in Africa and Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
- Division of Cardiology, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - C A Viljoen
- Hatter Institute for Cardiovascular Research in Africa and Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Division of Cardiology, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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25
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Taylor KS, Mahtani KR, Aronson JK. Extracting data from diagnostic test accuracy studies for meta-analysis. BMJ Evid Based Med 2021; 26:19-21. [PMID: 33402330 DOI: 10.1136/bmjebm-2020-111650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/29/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Kathryn S Taylor
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Kamal R Mahtani
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jeffrey K Aronson
- Centre for Evidence Based Medicine, University of Oxford, Oxford, UK
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26
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Noma H. Discussion on “Testing small study effects in multivariate meta‐analysis” by Chuan Hong, Georgia Salanti, Sally Morton, Richard Riley, Haitao Chu, Stephen E. Kimmel, and Yong Chen. Biometrics 2020; 76:1255-1259. [DOI: 10.1111/biom.13343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/02/2020] [Accepted: 01/06/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Hisashi Noma
- Department of Data Science The Institute of Statistical Mathematics Tokyo Japan
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27
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Li Y, Chang Y, Li X, Li X, Gao J, Zhou Y, Wu F, Bai R, Dong T, Ma S, Zhang S, Lu WJ, Tan X, Wang Y, Lan F. RAD-Deficient Human Cardiomyocytes Develop Hypertrophic Cardiomyopathy Phenotypes Due to Calcium Dysregulation. Front Cell Dev Biol 2020; 8:585879. [PMID: 33195237 PMCID: PMC7642210 DOI: 10.3389/fcell.2020.585879] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/25/2020] [Indexed: 11/30/2022] Open
Abstract
Ras associated with diabetes (RAD) is a membrane protein that acts as a calcium channel regulator by interacting with cardiac L-type Ca2 + channels (LTCC). RAD defects can disrupt intracellular calcium dynamics and lead to cardiac hypertrophy. However, due to the lack of reliable human disease models, the pathological mechanism of RAD deficiency leading to cardiac hypertrophy is not well understood. In this study, we created a RRAD–/– H9 cell line using CRISPR/Cas9 technology. RAD disruption did not affect the ability and efficiency of cardiomyocytes differentiation. However, RAD deficient hESC-CMs recapitulate hypertrophic phenotype in vitro. Further studies have shown that elevated intracellular calcium level and abnormal calcium regulation are the core mechanisms by which RAD deficiency leads to cardiac hypertrophy. More importantly, management of calcium dysregulation has been found to be an effective way to prevent the development of cardiac hypertrophy in vitro.
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Affiliation(s)
- Ya'nan Li
- Beijing Laboratory for Cardiovascular Precision Medicine, MOE Key Laboratory of Medical Engineering for Cardiovascular Diseases, MOE Key Laboratory of Remodeling-Related Cardiovascular Disease, Beijing Collaborative Innovation Center for Cardiovascular Disorders, Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Yun Chang
- Beijing Laboratory for Cardiovascular Precision Medicine, MOE Key Laboratory of Medical Engineering for Cardiovascular Diseases, MOE Key Laboratory of Remodeling-Related Cardiovascular Disease, Beijing Collaborative Innovation Center for Cardiovascular Disorders, Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Xiaolei Li
- Department of Cardiology, Heart Center, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Xiaowei Li
- Beijing Laboratory for Cardiovascular Precision Medicine, MOE Key Laboratory of Medical Engineering for Cardiovascular Diseases, MOE Key Laboratory of Remodeling-Related Cardiovascular Disease, Beijing Collaborative Innovation Center for Cardiovascular Disorders, Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Jian Gao
- Experimental Medicine, Faculty of Medicine, Vancouver, BC, Canada
| | - Yafei Zhou
- Key Laboratory of Medical Electrophysiology of the Ministry of Education, Institute of Cardiovascular Research, Southwest Medical University, Luzhou, China
| | - Fujian Wu
- Beijing Laboratory for Cardiovascular Precision Medicine, MOE Key Laboratory of Medical Engineering for Cardiovascular Diseases, MOE Key Laboratory of Remodeling-Related Cardiovascular Disease, Beijing Collaborative Innovation Center for Cardiovascular Disorders, Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Rui Bai
- Beijing Laboratory for Cardiovascular Precision Medicine, MOE Key Laboratory of Medical Engineering for Cardiovascular Diseases, MOE Key Laboratory of Remodeling-Related Cardiovascular Disease, Beijing Collaborative Innovation Center for Cardiovascular Disorders, Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Tao Dong
- Beijing Laboratory for Cardiovascular Precision Medicine, MOE Key Laboratory of Medical Engineering for Cardiovascular Diseases, MOE Key Laboratory of Remodeling-Related Cardiovascular Disease, Beijing Collaborative Innovation Center for Cardiovascular Disorders, Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Shuhong Ma
- Beijing Laboratory for Cardiovascular Precision Medicine, MOE Key Laboratory of Medical Engineering for Cardiovascular Diseases, MOE Key Laboratory of Remodeling-Related Cardiovascular Disease, Beijing Collaborative Innovation Center for Cardiovascular Disorders, Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Siyao Zhang
- Beijing Laboratory for Cardiovascular Precision Medicine, MOE Key Laboratory of Medical Engineering for Cardiovascular Diseases, MOE Key Laboratory of Remodeling-Related Cardiovascular Disease, Beijing Collaborative Innovation Center for Cardiovascular Disorders, Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Wen-Jing Lu
- Beijing Laboratory for Cardiovascular Precision Medicine, MOE Key Laboratory of Medical Engineering for Cardiovascular Diseases, MOE Key Laboratory of Remodeling-Related Cardiovascular Disease, Beijing Collaborative Innovation Center for Cardiovascular Disorders, Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Xiaoqiu Tan
- Key Laboratory of Medical Electrophysiology of the Ministry of Education, Institute of Cardiovascular Research, Southwest Medical University, Luzhou, China
| | - Yongming Wang
- The State Key Laboratory of Genetic Engineering and MOE Key Laboratory of Contemporary Anthropology, School of Life Sciences, Fudan University, Shanghai, China
| | - Feng Lan
- Beijing Laboratory for Cardiovascular Precision Medicine, MOE Key Laboratory of Medical Engineering for Cardiovascular Diseases, MOE Key Laboratory of Remodeling-Related Cardiovascular Disease, Beijing Collaborative Innovation Center for Cardiovascular Disorders, Anzhen Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.,State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Shimizu N, Kotani K. Point-of-care testing of (N-terminal pro) B-type natriuretic peptide for heart disease patients in home care and ambulatory care settings. Pract Lab Med 2020; 22:e00183. [PMID: 33134469 PMCID: PMC7585141 DOI: 10.1016/j.plabm.2020.e00183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 10/16/2020] [Indexed: 12/28/2022] Open
Abstract
Objectives The role of point-of-care testing (POCT) out of hospital, especially in home care and ambulatory care settings, is an issue meriting further research. We reviewed studies reporting cardiovascular events as a result of the implementation of B-type natriuretic peptide or N-terminal pro B-type natriuretic peptide POCT (BNP/NT-proBNP POCT) for heart disease patients in the settings. Design Articles were searched via a PubMed engine until May 30, 2020. Results In total, six studies were selected. Three studies involving ambulatory care used the POCT to refer patients with suspected heart diseases to a specialist. The other three used the tests in home care to monitor patients with heart failure. In ambulatory care, the randomized controlled trials, in which referrals were made to a specialist, showed that the group using POCT had significantly fewer cardiovascular outcomes, such as hospitalizations and deaths, than the non-use group. In home care, adverse outcomes were predicted from changes in BNP levels. Conclusions In most studies, the use of BNP/NT-proBNP POCT in home care and ambulatory care settings demonstrated favorable results regarding the cardiovascular outcomes. The utility of POCT in the settings is suggested, while more investigations are required. Point-of-care testing of BNP can be useful for referral of patients to specialists as demonstrated in two randomized control trials. Point-of-care testing of BNP couldpredict acute heart failure as demonstrated in three observational studies. The findings should be generalized with care because of the limitation of available data.
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Key Words
- ADHF, acute clinical HF decompensation
- AUC, area under the curve
- BNP
- BNP, B-type natriuretic peptide
- HF, heart failure
- HFpEF, HF with preserved ejection fraction
- HFrEF, HF with reduced ejection fraction
- HR, hazard ratio
- Heart failure
- Home care
- IRR, incidence rate ratio
- MACE, major adverse cardiac events
- NT-proBNP
- NT-proBNP, N-terminal pro B-type natriuretic peptide
- OR, odds ratio
- POCT, point-of-care testing
- Point-of-care testing
- Primary care
- RCT, randomized controlled trials
- Sn, sensitivity
- Sp, specificity
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Affiliation(s)
- Nayuta Shimizu
- Division of Community and Family Medicine, Center of Community Medicine, Jichi Medical University, Tochigi, Japan
| | - Kazuhiko Kotani
- Division of Community and Family Medicine, Center of Community Medicine, Jichi Medical University, Tochigi, Japan
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In-vitro diagnostic point-of-care tests in paediatric ambulatory care: A systematic review and meta-analysis. PLoS One 2020; 15:e0235605. [PMID: 32628707 PMCID: PMC7337322 DOI: 10.1371/journal.pone.0235605] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 06/19/2020] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Paediatric consultations form a significant proportion of all consultations in ambulatory care. Point-of-care tests (POCTs) may offer a potential solution to improve clinical outcomes for children by reducing diagnostic uncertainty in acute illness, and streamlining management of chronic diseases. However, their clinical impact in paediatric ambulatory care is unknown. We aimed to describe the clinical impact of all in-vitro diagnostic POCTs on patient outcomes and healthcare processes in paediatric ambulatory care. METHODS We searched MEDLINE, EMBASE, Pubmed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Web of Science from inception to 29 January 2020 without language restrictions. We included studies of children presenting to ambulatory care settings (general practice, hospital outpatient clinics, or emergency departments, walk-in centres, registered drug shops delivering healthcare) where in-vitro diagnostic POCTs were compared to usual care. We included all quantitative clinical outcome data across all conditions or infection syndromes reporting on the impact of POCTs on clinical care and healthcare processes. Where feasible, we calculated risk ratios (RR) with 95% confidence intervals (CI) by performing meta-analysis using random effects models. RESULTS We included 35 studies. Data relating to at least one outcome were available for 89,439 children of whom 45,283 had a POCT across six conditions or infection syndromes: malaria (n = 14); non-specific acute fever 'illness' (n = 7); sore throat (n = 5); acute respiratory tract infections (n = 5); HIV (n = 3); and diabetes (n = 1). Outcomes centred around decision-making such as prescription of medications or hospital referral. Pooled estimates showed that malarial-POCTs (Plasmodium falciparum) better targeted antimalarial treatment by reducing over-treatment by a third compared to usual care (RR 0.67; 95% CI [0.58 to 0.77], n = 36,949). HIV-POCTs improved initiating earlier antiretroviral therapy compared to usual care (RR, 3.11; 95% CI [1.55 to 6.25], n = 912). Across the other four conditions, there was limited evidence for the benefit of POCTs in paediatric ambulatory care except for acute respiratory tract infections (RTI) in low-and-middle-income countries (LMICs), where POCT C-Reactive Protein (CRP) may reduce immediate antibiotic prescribing by a third (risk difference, -0.29 [-0.47, -0.11], n = 2,747). This difference was shown in randomised controlled trials in LMICs which included guidance on interpretation of POCT-CRP, specific training or employed a diagnostic algorithm prior to POC testing. CONCLUSION Overall, there is a paucity of evidence for the use of POCTs in paediatric ambulatory care. POCTs help to target prescribing for children with malaria and HIV. There is emerging evidence that POCT-CRP may better target antibiotic prescribing for children with acute RTIs in LMIC, but not in high-income countries. Research is urgently needed to understand where POCTs are likely to improve clinical outcomes in paediatric settings worldwide.
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30
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Lewis RA, Durrington C, Condliffe R, Kiely DG. BNP/NT-proBNP in pulmonary arterial hypertension: time for point-of-care testing? Eur Respir Rev 2020; 29:29/156/200009. [PMID: 32414745 DOI: 10.1183/16000617.0009-2020] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 04/06/2020] [Indexed: 12/14/2022] Open
Abstract
Despite the advent of new therapies and improved outcomes in patients with pulmonary arterial hypertension (PAH), it remains a life-shortening disease and the time to diagnosis remains unchanged. Strategies to improve outcomes are therefore currently focused on earlier diagnosis and a treatment approach aimed at moving patients with PAH into a category of low-risk of 1-year mortality. B-type natriuretic peptide (BNP; or brain natriuretic peptide) and N-terminal prohormone of BNP (NT-proBNP) are released from cardiac myocytes in response to mechanical load and wall stress. Elevated levels of BNP and NT-proBNP are incorporated into several PAH risk stratification tools and screening algorithms to aid diagnosis of systemic sclerosis. We have undertaken a systematic review of the literature with respect to the use of BNP and NT-proBNP in PAH and the use of these biomarkers in the diagnosis and risk stratification of PAH, their relation to pulmonary haemodynamics and the potential for point-of-care testing to improve diagnosis and prognosis.
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Affiliation(s)
- Robert A Lewis
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK.,Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Charlotte Durrington
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
| | - Robin Condliffe
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
| | - David G Kiely
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK .,Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.,Insigneo Institute for in silico medicine, University of Sheffield, Sheffield, UK
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31
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Schreinlechner M, Mrakovic A, Laschober G, Mayerl C, Griesmacher A, van Lippen L, Semjonow V, Nieuwenhuis J, van Reenen A, Mair J. Clinical evaluation of capillary B-type natriuretic peptide testing. Clin Chem Lab Med 2020; 58:618-624. [PMID: 31804953 DOI: 10.1515/cclm-2019-0672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 10/31/2019] [Indexed: 11/15/2022]
Abstract
Background Capillary B-type natriuretic peptide (BNP) testing is attractive in outpatient and emergency settings. The aim of this study was to perform an evaluation of the clinical performances of capillary BNP testing as compared with venous whole blood and plasma point-of-care (POC) BNP as well as plasma N-terminal (NT) proBNP central laboratory testing. Methods BNP was measured with a novel single epitope POC assay (Minicare® BV, Eindhoven, The Netherlands) and NT-proBNP with a central laboratory assay (Roche Diagnostics®, Vienna, Austria). Results BNP and NT-proBNP were measured in 269 patients of a Department of Cardiology (mean age 67.9 ± 13 years, 26.4% females). Capillary BNP very closely correlated with whole blood venous BNP (r = 0.99, p < 0.001). There was also a close correlation of plasma BNP and NT-proBNP concentrations (r = 0.79, p < 0.001). The diagnostic performances of capillary BNP, whole blood venous BNP, plasma BNP and plasma NT-proBNP for acute heart failure (areas under receiver operating characteristic curves [AUC ROC]: 0.73-0.77) or systolic left ventricular dysfunction in the whole study population (AUC ROC: 0.72-0.76) did not differ significantly. All were significant independent predictors of cardiovascular death during follow-up of the whole study population. Conclusions Our study for the first time demonstrated a very close correlation of capillary and venous whole blood or plasma BNP concentrations using the same BNP assay in a large patient cohort. The diagnostic performances of different BNP specimens did not differ significantly, and no significant differences between BNP and NT-proBNP were found either.
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Affiliation(s)
- Michael Schreinlechner
- Department of Internal Medicine III - Cardiology and Angiology, Medical University Innsbruck, Innsbruck, Austria
| | - Anita Mrakovic
- Department of Internal Medicine III - Cardiology and Angiology, Medical University Innsbruck, Innsbruck, Austria
| | - Gerhard Laschober
- Department of Internal Medicine III - Cardiology and Angiology, Medical University Innsbruck, Innsbruck, Austria
| | - Christina Mayerl
- Department of Internal Medicine III - Cardiology and Angiology, Medical University Innsbruck, Innsbruck, Austria
| | - Andrea Griesmacher
- Central Hospital Laboratory, University Hospital Innsbruck, Innsbruck, Austria
| | | | - Veronique Semjonow
- Philips BG Emerging Businesses, Eindhoven, The Netherlands
- Magnisense SE, Paris, France
| | - Jeroen Nieuwenhuis
- Philips BG Emerging Businesses, Eindhoven, The Netherlands
- Minicare BV, Eindhoven, The Netherlands
| | - Alexander van Reenen
- Philips BG Emerging Businesses, Eindhoven, The Netherlands
- Minicare BV, Eindhoven, The Netherlands
| | - Johannes Mair
- Department of Internal Medicine III - Cardiology and Angiology, Medical University Innsbruck, Innsbruck, Austria
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32
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Homar V, Mirosevic S, Svab I, Lainscak M. Natriuretic peptides for heart failure screening in nursing homes: a systematic review. Heart Fail Rev 2020; 26:1131-1140. [PMID: 32200491 DOI: 10.1007/s10741-020-09944-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The high burden of heart failure in nursing-home populations is due to advanced age and comorbidities. Heart failure is often undiagnosed or misdiagnosed in this population and therefore remains untreated. We review the use of natriuretic peptide biomarkers for screening heart failure in nursing-home residents. The study was performed in accordance with recommendations from the Cochrane Collaboration using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA) and is registered in PROSPERO Register of Systematic Reviews. Databases PubMed, Embase, and Trip were searched from 2000 to March 2019, supplemented by hand-searching of references. Studies investigating the nursing-home population were included. The prevalence of heart failure among nursing-home residents was higher than in the general population of comparable age (23% vs 10%, respectively). The rate of misdiagnosis in nursing homes ranged from 25 to 76%. NT-proBNP was the most commonly used natriuretic peptide biomarker for heart failure screening. The mean value of NT-proBNP was significantly higher in residents with heart failure than in residents overall (pooled means of 2409 pg/mL vs 1074 pg/mL, respectively). In comparison with current guidelines, the proposed cut-off values for ruling out heart failure were higher in the analyzed studies, with ranges of 230-760 pg/mL for NT-proBNP and 50-115 pg/mL for BNP. NT-proBNP and BNP are used for screening heart failure in the nursing-home population. The current screening cut-off values are probably too low for use in nursing homes. Our most conservative estimation for ruling out heart failure is an NT-proBNP cut-off value of 230 pg/mL.
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Affiliation(s)
- Vesna Homar
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, 56 Poljanski nasip, 1000, Ljubljana, Slovenia. .,Community Health Centre Vrhnika, Vrhnika, Slovenia.
| | - Spela Mirosevic
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, 56 Poljanski nasip, 1000, Ljubljana, Slovenia
| | - Igor Svab
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, 56 Poljanski nasip, 1000, Ljubljana, Slovenia
| | - Mitja Lainscak
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, 56 Poljanski nasip, 1000, Ljubljana, Slovenia.,Division of Cardiology, General Hospital Murska Sobota, Murska Sobota, Slovenia
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33
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The varying specificity of urine cultures in different populations. Infect Control Hosp Epidemiol 2020; 41:489-491. [PMID: 32036807 DOI: 10.1017/ice.2020.16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Gkiouras K, Grammatikopoulou MG, Theodoridis X, Pagkalidou E, Chatzikyriakou E, Apostolidou AG, Rigopoulou EI, Sakkas LI, Bogdanos DP. Diagnostic and clinical significance of antigen-specific pancreatic antibodies in inflammatory bowel diseases: A meta-analysis. World J Gastroenterol 2020; 26:246-265. [PMID: 31988587 PMCID: PMC6962435 DOI: 10.3748/wjg.v26.i2.246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/19/2019] [Accepted: 01/01/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Non-invasive criteria are needed for Crohn’s disease (CD) diagnosis, with several biomarkers being tested. Results of individual diagnostic test accuracy studies assessing the diagnostic value of pancreatic autoantibodies-to-glycoprotein-2 (anti-GP2) tests for the diagnosis of CD appear promising.
AIM To systematically review and meta-analyze evidence on the diagnostic accuracy of anti-GP2 tests in patients with suspected/confirmed CD.
METHODS An electronic search was conducted on PubMed, Cochrane-CENTRAL and grey literature (CRD42019125947). The structured research question in PICPTR format was “Population” including patients with symptoms akin to CD, the “Index test” being anti-GP2 testing, the “Comparator” involved standard CD diagnosis, the “Purpose of test” being diagnostic, “Target disorder” was CD, and the “Reference standard” included standard clinical, radiological, endoscopical, and histological CD diagnostic criteria. Quality was assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 tool and hierarchical models were employed to synthesize the data.
RESULTS Out of 722 studies retrieved, 15 were meta-analyzed. Thirteen studies had industry-related conflicts-of-interest, and most included healthy donors as controls (spectrum bias). For the combination of IgA and/or IgG anti-GP2 test, the summary sensitivity was 20% (95% confidence interval: 10%-29%) at a median specificity of 97%. If the test was applied in 10000 suspected patients, 9669 would be true negatives and in 26, the diagnosis would be missed. In this hypothetical cohort, the anti-GP2 would fail to produce a diagnosis for 81.3% of the positive cases. Low summary points of sensitivity and high specificity were estimated for the IgG or IgA anti-GP2 test. Analogous results were observed when the analyses were restricted using specific cut-offs, or when ulcerative colitis patients were used as comparators.
CONCLUSION Anti-GP2 tests demonstrate low sensitivity and high specificity. These results indicate that caution is required before relying on its diagnostic value. Additionally, the need for improving the methodology of diagnostic test accuracy studies is evident.
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Affiliation(s)
- Konstantinos Gkiouras
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa GR41110, Greece
- Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, University Campus, Thessaloniki GR54124, Greece
| | - Maria G Grammatikopoulou
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa GR41110, Greece
- Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, University Campus, Thessaloniki GR54124, Greece
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, Sindos Campus, Thessaloniki GR57400, Greece
| | - Xenophon Theodoridis
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa GR41110, Greece
- Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, University Campus, Thessaloniki GR54124, Greece
| | - Eirini Pagkalidou
- Laboratory of Hygiene, Social and Preventive Medicine and Medical Statistics, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, University Campus, Thessaloniki GR54124, Greece
| | - Evangelia Chatzikyriakou
- Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, University Campus, Thessaloniki GR54124, Greece
- Laboratory of Clinical Neurophysiology, AHEPA University Hospital, Faculty of Medicine, Aristotle University of Thessaloniki, University Campus, Thessaloniki GR54124, Greece
| | - Anna G Apostolidou
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, Sindos Campus, Thessaloniki GR57400, Greece
| | - Eirini I Rigopoulou
- Department of Medicine and Research Laboratory of Internal Medicine, University Hospital of Larissa, Biopolis, Larissa GR41110, Greece
| | - Lazaros I Sakkas
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa GR41110, Greece
| | - Dimitrios Petrou Bogdanos
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, Larissa GR41110, Greece
- Division of Transplantation, Immunology and Mucosal Biology, MRC Centre for Transplantation, King's College London Medical School, London GR41110, United Kingdom
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He L, Wang T, Chen BW, Lu FM, Xu J. Puerarin inhibits apoptosis and inflammation in myocardial cells via PPARα expression in rats with chronic heart failure. Exp Ther Med 2019; 18:3347-3356. [PMID: 31602208 PMCID: PMC6777288 DOI: 10.3892/etm.2019.7984] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 07/12/2019] [Indexed: 12/15/2022] Open
Abstract
Chronic heart failure affects myocardial energy metabolism and cardiac function. Puerarin has been reported to improve cardiac function through regulation of energy metabolism in mice with myocardial infarction. The aim of the current study was to determine whether puerarin can improve body weight and reduce inflammation and apoptosis in rats with chronic heart failure. Rats were divided into three groups: Puerarin, PBS and sham group. Transverse aortic constriction was performed to induce chronic heart failure in the puerarin an PBS groups. Cardiac function, apoptosis and inflammation were evaluated following a 4-week treatment in rats with chronic heart failure. The results demonstrated that puerarin significantly increased the survival rate of rats and improved cardiac function compared with the PBS group. In addition, puerarin decreased lactate dehydrogenase and succinate dehydrogenase activity compared with the PBS group. Puerarin treatment increased the expression levels of glucose transporter type 4 and decreased the expression levels of CD36. Additionally, puerarin decreased the levels inflammatory factors, including tumor necrosis factor α, interleukin (IL)-1β and IL-6 in serum and myocardial tissue compared with the PBS group. Puerarin upregulated peroxisome proliferator-activated receptor α (PPARα) and its downstream target genes nuclear respiratory factor 1, FOS proto-oncogene, YY1 transcription factor, acetyl-coenzyme A carboxylase a, Fas cell surface death receptor, L-type pyruvate kinase and acetyl-coenzyme A dehydrogenase medium chain in myocardial cells from rats with chronic heart failure. These results demonstrated that puerarin inhibited apoptosis and inflammation in myocardial cells via the PPARα pathway. In conclusion, the present study indicated that puerarin may exhibit antiapoptotic and anti-inflammatory activity through the PPARα pathway in rats with chronic heart failure.
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Affiliation(s)
- Le He
- Department of Cardiology, Tianjin Chest Hospital, Tianjin 300222, P.R. China
| | - Tong Wang
- Department of Endocrinology, Tianjin Yellow River Hospital, Tianjin 300110, P.R. China
| | - Bing-Wei Chen
- Department of Cardiology, Tianjin Chest Hospital, Tianjin 300222, P.R. China
| | - Feng-Min Lu
- Department of Cardiology, Tianjin Chest Hospital, Tianjin 300222, P.R. China
| | - Jing Xu
- Department of Cardiology, Tianjin Chest Hospital, Tianjin 300222, P.R. China
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Ding EY, Ensom E, Hafer N, Buchholz B, Picard MA, Dunlap D, Rogers E, Lawton C, Koren A, Lilly C, Fitzgibbons TP, McManus DD. Point-of-care technologies in heart, lung, blood and sleep disorders from the Center for Advancing Point-of-Care Technologies. CURRENT OPINION IN BIOMEDICAL ENGINEERING 2019; 11:58-67. [PMID: 32582870 PMCID: PMC7314358 DOI: 10.1016/j.cobme.2019.08.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Recent advancements in point-of-care technologies have transformed care for patients with heart, lung, blood, and sleep disorders by providing rapid, cost-effective, and accessible solutions to challenges in the detection and management of many health conditions. However, major barriers exist throughout the technology development process that inhibit the actualization of many promising and potentially successful ideas. The Center for Advancing Point of Care Technologies has established a system for supporting further innovation in this field and bridging the gap between initial idea conception and implementation. We highlight current and emerging point-of-care technologies throughout the development spectrum and emphasize the need for a needs-driven model of health technology development that involve appropriate stakeholders in the process.
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Affiliation(s)
- Eric Y Ding
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
- Cardiology Division, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Emily Ensom
- Cardiology Division, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Nathaniel Hafer
- UMass Center for Clinical and Translational Science, University of Massachusetts Medical School, Worcester, MA, USA
- Program in Molecular Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Bryan Buchholz
- Department of Biomedical Engineering, University of Massachusetts Lowell, Lowell, MA, USA
- Department of Work Environment, University of Massachusetts Lowell, Lowell, MA, USA
| | - Mary Ann Picard
- Massachusetts Medical Device Development Center, University of Massachusetts, Worcester/Lowell, MA, USA
| | - Denise Dunlap
- The Manning School of Business, University of Massachusetts Lowell, Lowell, MA, USA
| | - Eugene Rogers
- Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, Lowell, MA, USA
| | - Carl Lawton
- Department of Chemical Engineering, University of Massachusetts Lowell, Lowell, M A, USA
| | - Ainat Koren
- Susan and Alan Solomont School of Nursing, University of Massachusetts Lowell, Lowell, MA, USA
| | - Craig Lilly
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Timothy P Fitzgibbons
- Cardiology Division, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
- UMass Center for Clinical and Translational Science, University of Massachusetts Medical School, Worcester, MA, USA
| | - David D McManus
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
- Cardiology Division, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
- UMass Center for Clinical and Translational Science, University of Massachusetts Medical School, Worcester, MA, USA
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Lainscak M, Omersa D, Sedlar N, Anker SD, Farkas J. Heart failure prevalence in the general population: SOBOTA-HF study rationale and design. ESC Heart Fail 2019; 6:1077-1084. [PMID: 31347289 PMCID: PMC6816073 DOI: 10.1002/ehf2.12496] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 06/02/2019] [Accepted: 06/25/2019] [Indexed: 12/28/2022] Open
Abstract
Aims Epidemiological heart failure (HF) data in the era of natriuretic peptides and echocardiography are scarce. The primary aim of this study is to evaluate the HF prevalence in the general population. We will also investigate natriuretic peptide cut‐off for diagnosis of HF. Finally, we will be able to identify left ventricular function phenotypes and study relations between cardiac function, clinical presentation, and health‐related quality of life. Methods and results Screening Of adult urBan pOpulation To diAgnose Heart Failure (SOBOTA‐HF) is a cross‐sectional prevalence study in a representative sample of Murska Sobota residents aged 55 years or more. Individuals will be invited to attend screening visit with point‐of‐care N‐terminal pro‐b‐type natriuretic peptide (NT‐proBNP) testing. All subjects with NT‐proBNP ≥ 125 pg/mL will be invited for a diagnostic visit that will include history and physical examination, electrocardiogram, echocardiography, blood and urine sampling, ankle brachial index, pulmonary function tests, body composition measurement, physical performance tests, and questionnaires. To validate the screening procedure, a control group (NT‐proBNP < 125 pg/mL) will undergo the same diagnostic evaluation. An external centre will validate echocardiography results, and the HF diagnosis will be adjudicated within an international HF expert panel. Overall and age‐specific HF prevalence will be calculated in individuals ≥ 55 years and extrapolated to the whole population. Conclusions The SOBOTA‐HF study will test the latest HF guideline diagnostic criteria in the general population sample. Next to HF prevalence, it will provide insight into left ventricular function and general patient phenotype; we will also extend current understanding of natriuretic peptides for HF screening.
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Affiliation(s)
- Mitja Lainscak
- General Hospital Murska Sobota, Ulica dr. Vrbnjaka 6, Rakican, SI-9000, Murska Sobota, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Daniel Omersa
- General Hospital Murska Sobota, Ulica dr. Vrbnjaka 6, Rakican, SI-9000, Murska Sobota, Slovenia.,General Hospital Jesenice, Jesenice, Slovenia
| | - Natasa Sedlar
- National Institute of Public Health, Ljubljana, Slovenia
| | - Stefan D Anker
- Department of Cardiology (CVK), Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jerneja Farkas
- General Hospital Murska Sobota, Ulica dr. Vrbnjaka 6, Rakican, SI-9000, Murska Sobota, Slovenia.,National Institute of Public Health, Ljubljana, Slovenia
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38
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Cleland JGF, van Veldhuisen DJ, Ponikowski P. The year in cardiology 2018: heart failure. Eur Heart J 2019; 40:651-661. [DOI: 10.1093/eurheartj/ehz010] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/02/2019] [Accepted: 01/08/2019] [Indexed: 12/19/2022] Open
Affiliation(s)
- John G F Cleland
- Robertson Centre for Biostatistics & Clinical Trials, University of Glasgow, Glasgow, UK
- National Heart & Lung Institute, Royal Brompton & Harefield Hospitals, Imperial College, London, UK
| | - Dirk J van Veldhuisen
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Piotr Ponikowski
- Department of Heart Diseases, Wroclaw Medical University, Centre for Heart Diseases, Military Hospital, ul.Weigla 5, 50-981 Wroclaw, Poland
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39
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Abstract
Normal brain natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) levels are helpful in excluding chronic heart failure in the ambulatory setting, although they have been studied less well and possibly less accurately than in acute care. They may also be of help in screening patients at risk to intervene and reduce the development of heart failure. Natriuretic peptides are also excellent prognostic markers of chronic heart failure, but the clinical value of such prognostic information is less clear. One possible application for this information is guiding medical therapy in chronic heart failure. Many studies have investigated this approach, but results are mixed and do not clearly show improvement in outcome. Still, it may be that in patients with reduced ejection fraction and few comorbidities, measuring NT-proBNP to uptitrate medication improves prognosis.
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