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Schmidt C, Magalhães S, Gois Basilio P, Gouveia M, Teixeira M, Santos C, Tavares AI, Ferreira JP, Ribeiro F, Santos M. Home- versus centre-based EXercise InTervention in patients with Heart Failure (EXIT-HF trial): A pragmatic randomized controlled trial. Rev Port Cardiol 2024; 43:149-158. [PMID: 37716466 DOI: 10.1016/j.repc.2023.05.013] [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: 05/05/2023] [Accepted: 05/06/2023] [Indexed: 09/18/2023] Open
Abstract
INTRODUCTION The limited accessibility and the lack of adherence explain, in part, the low proportion of heart failure (HF) patients undergoing exercise-based cardiac rehabilitation (CR) programs. Home-based programs showed to be as effective and less costly than centre-based ones and might address those obstacles. Whether the evidence from international studies can be applied to our population is still unclear. OBJECTIVES To compare the clinical and economic impact of a home-based versus centre-based CR intervention in HF patients. METHODS This is a single-center, single-blind, parallel groups, non-inferiority pragmatic randomized control trial. Adult HF patients (n=120) will be randomized to either a centre-based or home-based CR program. In both groups' patients will participate in a 12-week combined CR program with 2 sessions per week. Exercise training (ExT) protocol consists of a combination of endurance [(at 60%-80% of peak oxygen uptake (VO2peak)] and resistance training (elastic bands). Those allocated to the home-based program will start with 4-5 supervised ExT sessions to familiarize themselves with the training protocol and then will continue the remaining sessions at home. The primary endpoint is the change in VO2peak at the end of the 12-week program. Secondary outcomes include alterations in circulating biomarkers, physical fitness, physical activity, quality of life, diet, psychological wellbeing, dyspnea, and cost-effectiveness analyses. RESULTS Patients are currently being recruited for the study. The study started in November 2019 and data collection is anticipated to be completed by December 2022. This is the first study in Portugal comparing the traditional CR program with a home-based program in HF patients. Our study results will better inform healthcare professionals who care for HF patients regarding CR.
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Affiliation(s)
- Cristine Schmidt
- Surgery and Physiology Department, Faculty of Medicine, University of Porto, Portugal; Research Center in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Portugal; Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
| | - Sandra Magalhães
- Department of Physical and Rehabilitation Medicine, Centro Hospitalar Universitário de Santo António (CHUdSA), Porto, Portugal
| | - Priscilla Gois Basilio
- Research Center in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Portugal
| | - Marisol Gouveia
- iBiMED - Institute of Biomedicine, Department of Medical Sciences, University of Aveiro, Portugal
| | - Manuel Teixeira
- iBiMED - Institute of Biomedicine, Department of Medical Sciences, University of Aveiro, Portugal
| | - Cláudio Santos
- Research Center in Physical Activity, Health and Leisure, Faculty of Sport, University of Porto, Portugal
| | - Aida Isabel Tavares
- CEISUC - Centre for Health Studies and Research, University of Coimbra, Coimbra, Portugal; ISEG, UL - Lisbon School of Economics and Management, University of Lisbon, Portugal
| | - João Pedro Ferreira
- Cardiovascular R&D Centre - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Portugal; Université de Lorraine, Inserm, Centre d'Investigations Cliniques, Plurithématique 14-33, and Inserm U1116, CHRU Nancy, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| | - Fernando Ribeiro
- iBiMED - Institute of Biomedicine, School of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - Mário Santos
- Cardiology Service, Centro Hospitalar Universitário de Santo António (CHUdSA), Porto, Portugal; UMIB, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Portugal; Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal.
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Yuen T, Gouda P, Margaryan R, Ezekowitz J. Do Heart Failure Biomarkers Influence Heart Failure Treatment Response? Curr Heart Fail Rep 2023; 20:358-373. [PMID: 37676613 DOI: 10.1007/s11897-023-00625-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 09/08/2023]
Abstract
PURPOSE OF REVIEW Heart failure (HF) is one of the leading causes of cardiac morbidity and mortality around the world. Our evolving understanding of the cellular and molecular pathways of HF has led to the identification and evaluation of a growing number of HF biomarkers. Natriuretic peptides remain the best studied and understood HF biomarkers, with demonstrated clinical utility in the diagnosis and prognostication of HF. Less commonly understood is the utility of HF biomarkers for guiding and monitoring treatment response. In this review, we outline the current HF biomarker landscape and identify novel biomarkers that have potential to influence HF treatment response. RECENT FINDINGS An increasing number of biomarkers have been identified through the study of HF mechanisms. While these biomarkers hold promise, they have not yet been proven to be effective in guiding HF therapy. A more developed understanding of HF mechanisms has resulted in an increased number of available pharmacologic HF therapies. In the past, biomarkers have been useful for the diagnosis and prognostication of HF. Future evaluation on their use to guide pharmacologic therapy is ongoing, and there is promise that biomarker-guided therapy will allow clinicians to begin personalizing treatment for their HF patients.
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Affiliation(s)
- Tiffany Yuen
- Division of Cardiology, University of Alberta, Edmonton, Canada
| | - Pishoy Gouda
- Division of Cardiology, University of Alberta, Edmonton, Canada
| | - Robert Margaryan
- Canadian VIGOUR Centre, 4-120 Katz Group Centre for Pharmacy and Health Research, University of Alberta, Edmonton, AB, T6G 2E1, Canada
| | - Justin Ezekowitz
- Division of Cardiology, University of Alberta, Edmonton, Canada.
- Canadian VIGOUR Centre, 4-120 Katz Group Centre for Pharmacy and Health Research, University of Alberta, Edmonton, AB, T6G 2E1, Canada.
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Hu H, Li J, Wei X, Zhang J, Wang J. Elevated level of high-sensitivity cardiac troponin I as a predictor of adverse cardiovascular events in patients with heart failure with preserved ejection fraction. Chin Med J (Engl) 2023; 136:2195-2202. [PMID: 37279378 PMCID: PMC10508375 DOI: 10.1097/cm9.0000000000002639] [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: 12/15/2022] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND The relationship between the elevation of cardiac troponin and the increase of mortality and hospitalization rate in patients with heart failure with reduced ejection fraction is clear. This study investigated the association between the extent of elevated levels of high-sensitivity cardiac troponin I (hs-cTnI) and the prognosis in heart failure with preserved ejection fraction patients. METHODS A retrospective cohort study consecutively enrolled 470 patients with heart failure with preserved ejection fraction from September 2014 to August 2017. According to the level of hs-cTnI, the patients were divided into the elevated level group (hs-cTnI >0.034 ng/mL in male and hs-cTnI >0.016 ng/mL in female) and the normal level group. All of the patients were followed up once every 6 months. Adverse cardiovascular events were cardiogenic death and heart failure hospitalization. RESULTS The mean follow-up period was 36.2 ± 7.9 months. Cardiogenic mortality (18.6% [26/140] vs. 1.5% [5/330], P <0.001) and heart failure (HF) hospitalization rate (74.3% [104/140] vs. 43.6% [144/330], P <0.001) were significantly higher in the elevated level group. The Cox regression analysis showed that the elevated level of hs-cTnI was a predictor of cardiogenic death (hazard ratio [HR]: 5.578, 95% confidence interval [CI]: 2.995-10.386, P <0.001) and HF hospitalization (HR: 3.254, 95% CI: 2.698-3.923, P <0.001). The receiver operating characteristic curve demonstrated that a sensitivity of 72.6% and specificity of 88.8% for correct prediction of adverse cardiovascular events when a level of hs-cTnI of 0.1305 ng/mL in male and a sensitivity of 70.6% and specificity of 90.2% when a level of hs-cTnI of 0.0755 ng/mL in female were used as the cut-off value. CONCLUSION Significant elevation of hs-cTnI (≥0.1305 ng/mL in male and ≥0.0755 ng/mL in female) is an effective indicator of the increased risk of cardiogenic death and HF hospitalization in heart failure with preserved ejection fraction patients.
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Affiliation(s)
- Hongyu Hu
- Department of Cardiovascular, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Jingjin Li
- Department of Cardiovascular, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Xin Wei
- Department of Cardiovascular, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Jia Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Jiayu Wang
- Department of Neurocardiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
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Zhang AB, Wang CC, Zhao P, Tong KT, He Y, Zhu XL, Fu HX, Wang FR, Mo XD, Wang Y, Zhao XY, Zhang YY, Han W, Chen H, Chen Y, Yan CH, Wang JZ, Han TT, Sun YQ, Chen YH, Chang YJ, Xu LP, Liu KY, Huang XJ, Zhang XH. A Prognostic Model Based on Clinical Biomarkers for Heart Failure in Adult Patients Following Allogeneic Hematopoietic Stem Cell Transplantation. Transplant Cell Ther 2023; 29:240.e1-240.e10. [PMID: 36634739 DOI: 10.1016/j.jtct.2022.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/05/2022] [Accepted: 12/13/2022] [Indexed: 01/11/2023]
Abstract
Heart failure (HF) is an uncommon but serious cardiovascular complication after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Unfortunately, knowledge about early mortality prognostic factors in patients with HF after allo-HSCT is limited, and an easy-to-use prognostic model is not available. This study aimed to develop and validate a clinical-biomarker prognostic model capable of predicting HF mortality following allo-HSCT that uses a combination of variables readily available in clinical practice. To investigate this issue, we conducted a retrospective analysis at our center with 154 HF patients who underwent allo-HSCT between 2008 and 2021. The patients were separated according to the time of transplantation, with 100 patients composing the derivation cohort and the other 54 patients composing the external validation cohort. We first calculated the univariable association for each variable with 2-month mortality in the derivation cohort. We then included the variables with a P value <.1 in univariate analysis as candidate predictors in the multivariate analysis using a backward stepwise logistic regression model. Variables remaining in the final model were identified as independent prognostic factors. To predict the prognosis of HF, a scoring system was established, and scores were assigned to the prognostic factors based on the regression coefficient. Finally, 4 strongly significant independent prognostic factors for 2-month mortality from HF were identified using multivariable logistic regression methods with stepwise variable selection: pulmonary infection (P = .005), grade III to IV acute graft-versus-host disease (severe aGVHD; P = .033), lactate dehydrogenase (LDH) >426 U/L (P = .049), and brain natriuretic peptide (BNP) >1799 pg/mL (P = .026). A risk grading model termed the BLIPS score (for BNP, LDH, cardiac troponin I, pulmonary infection, and severe aGVHD) was constructed according to the regression coefficients. The validated internal C-statistic was .870 (95% confidence interval [CI], .798 to .942), and the external C-statistic was .882 (95% CI, .791-.973). According to the calibration plots, the model-predicted probability correlated well with the actual observed frequencies. The clinical use of the prognostic model, according to decision curve analysis, could benefit HF patients. The BLIPS model in our study can serve to identify HF patients at higher risk for mortality early, which might aid designing timely targeted therapies and eventually improving patients' survival and prognosis.
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Affiliation(s)
- Ao-Bei Zhang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Chen-Cong Wang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Peng Zhao
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Ke-Ting Tong
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Yun He
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Xiao-Lu Zhu
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Hai-Xia Fu
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Feng-Rong Wang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Xiao-Dong Mo
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Yu Wang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Xiang-Yu Zhao
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Yuan-Yuan Zhang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Wei Han
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Huan Chen
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Yao Chen
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Chen-Hua Yan
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Jing-Zhi Wang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Ting-Ting Han
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Yu-Qian Sun
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Yu-Hong Chen
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Ying-Jun Chang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Lan-Ping Xu
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Kai-Yan Liu
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Xiao-Jun Huang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China
| | - Xiao-Hui Zhang
- Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China.
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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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Chesnaye NC, Al-Sodany E, Szummer K, Barany P, Heimbürger O, Almquist T, Melander S, Uhlin F, Dekker F, Wanner C, Jager KJ, Evans M. Association of Longitudinal High-Sensitivity Troponin T With Mortality in Patients With Chronic Kidney Disease. J Am Coll Cardiol 2022; 79:327-336. [DOI: 10.1016/j.jacc.2021.11.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/01/2021] [Accepted: 11/03/2021] [Indexed: 11/28/2022]
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Abdin A, Anker SD, Butler J, Coats AJS, Kindermann I, Lainscak M, Lund LH, Metra M, Mullens W, Rosano G, Slawik J, Wintrich J, Böhm M. 'Time is prognosis' in heart failure: time-to-treatment initiation as a modifiable risk factor. ESC Heart Fail 2021; 8:4444-4453. [PMID: 34655282 PMCID: PMC8712849 DOI: 10.1002/ehf2.13646] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 08/30/2021] [Accepted: 09/19/2021] [Indexed: 01/14/2023] Open
Abstract
In heart failure (HF), acute decompensation can occur quickly and unexpectedly because of worsening of chronic HF or to new-onset HF diagnosed for the first time ('de novo'). Patients presenting with acute HF (AHF) have a poor prognosis comparable with those with acute myocardial infarction, and any delay of treatment initiation is associated with worse outcomes. Recent HF guidelines and recommendations have highlighted the importance of a timely diagnosis and immediate treatment for patients presenting with AHF to decrease disease progression and improve prognosis. However, based on the available data, there is still uncertainty regarding the optimal 'time-to-treatment' effect in AHF. Furthermore, the immediate post-worsening HF period plays an important role in clinical outcomes in HF patients after hospitalization and is known as the 'vulnerable phase' characterized by high risk of readmission and early death. Early and intensive treatment for HF patients in the 'vulnerable phase' might be associated with lower rates of early readmission and mortality. Additionally, in the chronic stable HF outpatient, treatments are often delayed or not initiated when symptoms are stable, ignoring the risk for adverse outcomes such as sudden death. Consequently, there is a dire need to better identify HF patients during hospitalization and after discharge and treating them adequately to improve their prognosis. HF is an urgent clinical scenario along all its stages and disease conditions. Therefore, time plays a significant role throughout the entire patient's journey. Therapy should be optimized as soon as possible, because this is beneficial regardless of severity or duration of HF. Time lavished before treatment initiation is recognized as important modifiable risk factor in HF.
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Affiliation(s)
- Amr Abdin
- Klinik für Innere Medizin III‐Kardiologie, Angiologie und Internistische IntensivmedizinUniversitätsklinikum des SaarlandesKirrberger Strasse 100Homburg66421Germany
| | - Stefan D. Anker
- Department of Cardiology & Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK), partner site BerlinCharité—Universitätsmedizin Berlin (Campus CVK)BerlinGermany
| | - Javed Butler
- Department of MedicineUniversity of Mississippi Medical CenterJacksonMSUSA
| | | | - Ingrid Kindermann
- Klinik für Innere Medizin III‐Kardiologie, Angiologie und Internistische IntensivmedizinUniversitätsklinikum des SaarlandesKirrberger Strasse 100Homburg66421Germany
| | - Mitja Lainscak
- Division of CardiologyGeneral Hospital Murska SobotaMurska SobotaSlovenia
- Faculty of MedicineUniversity of LjubljanaLjubljanaSlovenia
- Faculty of Natural Sciences and MathematicsUniversity of MariborMariborSlovenia
| | - Lars H. Lund
- Division of Cardiology, Department of MedicineKarolinska InstitutetStockholmSweden
| | - Marco Metra
- Department of CardiologyUniversity and Civil Hospitals of BresciaBresciaItaly
| | - Wilfried Mullens
- Department of CardiologyZiekenhuis Oost‐Limburg (ZOL)GenkBelgium
| | - Giuseppe Rosano
- Department of Medical SciencesIRCCS San Raffaele PisanaRomeItaly
| | - Jonathan Slawik
- Klinik für Innere Medizin III‐Kardiologie, Angiologie und Internistische IntensivmedizinUniversitätsklinikum des SaarlandesKirrberger Strasse 100Homburg66421Germany
| | - Jan Wintrich
- Klinik für Innere Medizin III‐Kardiologie, Angiologie und Internistische IntensivmedizinUniversitätsklinikum des SaarlandesKirrberger Strasse 100Homburg66421Germany
| | - Michael Böhm
- Klinik für Innere Medizin III‐Kardiologie, Angiologie und Internistische IntensivmedizinUniversitätsklinikum des SaarlandesKirrberger Strasse 100Homburg66421Germany
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Schoechlin S, Schulz U, Ruile P, Hein M, Eichenlaub M, Jander N, Neumann FJ, Valina C. Impact of high-sensitivity cardiac troponin T on survival and rehospitalization after transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2021; 98:E881-E888. [PMID: 34076331 DOI: 10.1002/ccd.29781] [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] [Received: 01/28/2021] [Revised: 04/20/2021] [Accepted: 05/09/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Constant elevations of the serum concentration of cardiac troponin T (TnT) indicate a myocardial injury that may affect the long-term outcome of transcatheter aortic valve replacement (TAVR). OBJECTIVES We sought to investigate the impact of pre-TAVR TnT on outcomes after TAVR during long-term follow-up. METHODS In a retrospective, observational study we compared long term outcomes after TAVR between tertiles of preinterventional high-sensitivity TnT. Systematic follow-up was performed annually for 5 years. The primary endpoint was a composite of all-cause death and any rehospitalization. RESULTS Between 2010 and 2018, 2,129 patients with severe aortic valve stenosis underwent TAVR at our institution (mean age 82.6 years, 57.2% female, logistic EuroSCORE 20.5 ± 15.8). Boundaries for TnT tertiles were <21 ng/L and >42 ng/L. The median follow-up was 895 days. Three-year incidences for the primary endpoint were 70.9%, 76.6%, and 81.7% in the low, middle, and high tertile (log rank p < .001). Compared with the first tertile, the corresponding adjusted hazard ratios were 1.23 (95%-CI 1.08-1.40, p < .001) and 1.50 (95%-CI 1.32-1.70, p < .001) for the second and third tertile. We found consistent differences between TnT strata for all-cause death (3-year incidences 23.3%, 33.3%, and 47.1%; adjusted p < .001) and rehospitalization (3-year incidences 64.7%, 68.7% and 72.0%; adjusted p < .001), including significant differences in deaths (p < .001). The association between TnT and outcome was independent of coronary artery disease or low aortic valve gradient. CONCLUSIONS TnT before TAVR is strongly associated with all-cause death and rehospitalization during 3-year follow-up.
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Affiliation(s)
- Simon Schoechlin
- Division of Cardiology and Angiology II, University Heart Centre Freiburg · Bad Krozingen, Bad Krozingen, Germany
| | - Undine Schulz
- Division of Cardiology and Angiology II, University Heart Centre Freiburg · Bad Krozingen, Bad Krozingen, Germany
| | - Philip Ruile
- Division of Cardiology and Angiology II, University Heart Centre Freiburg · Bad Krozingen, Bad Krozingen, Germany
| | - Manuel Hein
- Division of Cardiology and Angiology II, University Heart Centre Freiburg · Bad Krozingen, Bad Krozingen, Germany
| | - Martin Eichenlaub
- Division of Cardiology and Angiology II, University Heart Centre Freiburg · Bad Krozingen, Bad Krozingen, Germany
| | - Nikolaus Jander
- Division of Cardiology and Angiology II, University Heart Centre Freiburg · Bad Krozingen, Bad Krozingen, Germany
| | - Franz-Josef Neumann
- Division of Cardiology and Angiology II, University Heart Centre Freiburg · Bad Krozingen, Bad Krozingen, Germany
| | - Christian Valina
- Division of Cardiology and Angiology II, University Heart Centre Freiburg · Bad Krozingen, Bad Krozingen, Germany
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9
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Packer M, Januzzi JL, Ferreira JP, Anker SD, Butler J, Filippatos G, Pocock SJ, Brueckmann M, Jamal W, Cotton D, Iwata T, Zannad F. Concentration-dependent clinical and prognostic importance of high-sensitivity cardiac troponin T in heart failure and a reduced ejection fraction and the influence of empagliflozin: the EMPEROR-Reduced trial. Eur J Heart Fail 2021; 23:1529-1538. [PMID: 34053177 PMCID: PMC9291909 DOI: 10.1002/ejhf.2256] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/25/2021] [Accepted: 05/26/2021] [Indexed: 11/18/2022] Open
Abstract
Aims Circulating troponin is an important measure of risk in patients with heart failure, but it has not been used to determine if disease severity influences the responses to drug treatments in randomized controlled trials. Methods and results In the EMPEROR‐Reduced trial, patients with class II–IV heart failure and a reduced ejection fraction were randomly assigned to placebo or empagliflozin 10 mg daily and followed for the occurrence of serious heart failure and renal events. High‐sensitivity cardiac troponin T (hs‐cTnT) was measured in 3636 patients (>97%) at baseline, and patients were divided into four groups based on the degree of troponin elevation. With increasing concentrations of hs‐cTnT, patients were progressively more likely to have diabetes and atrial fibrillation, to have New York Heart Association class III–IV symptoms and been hospitalized for heart failure within the prior year, and to have elevated levels of natriuretic peptides and worse renal function (P‐trend < 0.0001 for all comparisons), but importantly, the troponin groups did not differ with respect to ejection fraction. A linear relationship was observed between the logarithm of hs‐cTnT and the combined risk of cardiovascular death or hospitalization for heart failure (P = 0.0015). When treated with placebo, patients with the highest levels of hs‐cTnT had risks of cardiovascular death and hospitalization for heart failure that were 3–5 fold greater than those with values in the normal range. Patients with higher levels of hs‐cTnT were also more likely to experience worsening of renal function and serious adverse renal events and showed the least improvement in health status (as measured by the Kansas City Cardiomyopathy Questionnaire). When compared with placebo, empagliflozin reduced the combined risk of cardiovascular death or hospitalization for heart failure, regardless of the baseline level of hs‐cTnT, whether the effects of treatment were analysed as hazard ratios or absolute risk reductions. Conclusions Elevations in hs‐cTnT reflect the clinical severity, stability and prognosis of patients with heart failure and a reduced ejection fraction, with biomarkers, comorbidities, clinical course and risks that are proportional to the magnitude of hs‐cTnT elevation. Empagliflozin exerted favourable effects on heart failure and renal outcomes, regardless of the baseline concentration of hs‐cTnT.
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Affiliation(s)
- Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX, USA.,Imperial College, London, UK
| | - James L Januzzi
- Division of Cardiology, Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
| | | | - Stefan D Anker
- Department of Cardiology (CVK), and Berlin Institute of Health Center for Regenerative Therapies, German Centre for Cardiovascular Research Partner Site Berlin, Charité Universitätsmedizin, Berlin, Germany
| | - Javed Butler
- Department of Medicine, University of Mississippi School of Medicine, Jackson, MS, USA
| | - Gerasimos Filippatos
- National and Kapodistrian University of Athens School of Medicine, Athens University Hospital Attikon, Athens, Greece
| | - Stuart J Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Martina Brueckmann
- Boehringer Ingelheim International GmbH and Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Waheed Jamal
- Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - Daniel Cotton
- Boehringer Ingelheim Pharmaceuticals, Inc, Ridgefield, CT, USA
| | - Tomoko Iwata
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | - Faiez Zannad
- Université de Lorraine, Inserm INI-CRCT, CHRU, Nancy, France
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10
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Clinical Significance of Circulating Cardiomyocyte-Specific Cell-Free DNA in Patients With Heart Failure: A Proof-of-Concept Study. Can J Cardiol 2019; 36:931-935. [PMID: 32001048 DOI: 10.1016/j.cjca.2019.10.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/11/2019] [Accepted: 10/14/2019] [Indexed: 12/14/2022] Open
Abstract
We investigated clinical significance of cell-free DNA (cfDNA) in heart failure. This study enrolled 32 heart failure patients and 28 control subjects. Total cfDNA levels were not different between groups (P = 0.343). Bisulfite-digital polymerase chain reaction using the unmethylated FAM101A locus demonstrated that cardiomyocyte-specific cfDNA was significantly elevated in heart failure patients compared with control subjects (median 0.99 [interquartile range 0.77-1.98] vs 0 [0-0.91] copies/mL; P = 0.003). Cardiomyocyte-specific cfDNA significantly discriminated heart failure patients from control subjects (area under the receiver operating characteristic curve, 0.716; P = 0.003) and was positively correlated with troponin I (r = 0.438; P = 0.003) but not with B-type natriuretic peptide (r = 0.275; P = 0.058). cfDNA may be a novel biomarker to measure cardiomyocyte death in heart failure.
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11
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Klimczak-Tomaniak D, van den Berg VJ, Strachinaru M, Akkerhuis KM, Baart S, Caliskan K, Manintveld OC, Umans V, Geleijnse M, Boersma E, van Dalen BM, Kardys I. Longitudinal patterns of N-terminal pro B-type natriuretic peptide, troponin T, and C-reactive protein in relation to the dynamics of echocardiographic parameters in heart failure patients. Eur Heart J Cardiovasc Imaging 2019; 21:1005-1012. [DOI: 10.1093/ehjci/jez242] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/11/2019] [Accepted: 09/10/2019] [Indexed: 12/14/2022] Open
Abstract
Abstract
Aims
To further elucidate the nature of the association between N-terminal pro-B type natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T (hs-TnT), C-reactive protein (CRP), and clinical outcome, we examined the relationship between serial simultaneous measurements of echocardiographic parameters and these biomarkers in chronic heart failure (CHF) patients.
Methods and results
In 117 CHF patients with ejection fraction ≤50%, NT-proBNP, hs-TnT, and CRP were measured simultaneously with echocardiographic evaluation at 6-month intervals until the end of 30 months follow-up or until an adverse clinical event occurred. Linear mixed effects models were used for data-analysis. Median follow-up was 2.2 years (interquartile range 1.5–2.6). We performed up to six follow-up evaluations with 55% of patients having at least three evaluations performed. A model containing all three biomarkers revealed that doubling of NT-proBNP was associated with a decrease in left ventricular ejection fraction by 1.83 (95% confidence interval −2.63 to −1.03)%, P < 0.0001; relative increase in mitral E/e′ ratio by 12 (6–18)%, P < 0.0001; relative increase in mitral E/A ratio by 16 (9–23)%, P < 0.0001; decrease in tricuspid annular plane systolic excursion by 0.66 (−1.27 to −0.05) mm, P = 0.03; rise in tricuspid regurgitation peak systolic gradient by 2.74 (1.43–4.05) mmHg, P = 0.001; and increase in left ventricular and atrial dimensions, P < 0.05. Hs-TnT and CRP showed significant associations with some echocardiographic parameters after adjustment for clinical covariates, but after adjustment for the other biomarkers the associations were not significant.
Conclusion
Serum NT-proBNP independently reflects changes in echocardiographic parameters of systolic function, left ventricular filling pressures, estimated pulmonary pressure, and chamber dimensions. Our results support further studies on NT-proBNP as a surrogate marker for haemodynamic congestion and herewith support its potential value for therapy guidance.
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Affiliation(s)
- Dominika Klimczak-Tomaniak
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, room Na-316, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
- Department of Immunology, Transplantation and Internal Medicine, Transplantation Institute, Medical University of Warsaw, Nowogrodzka 59, 02-006 Warsaw, Poland
- Division of Heart Failure and Cardiac Rehabilitation, Medical University of Warsaw, Kondratowicza 8, 03-242 Warsaw, Poland
| | - Victor J van den Berg
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, room Na-316, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Mihai Strachinaru
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, room Na-316, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - K Martijn Akkerhuis
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, room Na-316, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Sara Baart
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, room Na-316, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Kadir Caliskan
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, room Na-316, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Olivier C Manintveld
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, room Na-316, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Victor Umans
- Department of Cardiology, Northwest Clinics, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands
| | - Marcel Geleijnse
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, room Na-316, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Eric Boersma
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, room Na-316, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Bas M van Dalen
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, room Na-316, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
- Department of Cardiology, Franciscus Gasthuis & Vlietland, Kleiweg 500, 3045 PM Rotterdam, The Netherlands
| | - Isabella Kardys
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, room Na-316, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
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12
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Sun M, Jin L, Bai Y, Wang L, Zhao S, Ma C, Ma D. Fibroblast growth factor 21 protects against pathological cardiac remodeling by modulating galectin-3 expression. J Cell Biochem 2019; 120:19529-19540. [PMID: 31286550 DOI: 10.1002/jcb.29260] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 06/11/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND/AIMS Fibroblast growth factor 21 (FGF21) plays a protective role in ischemia/reperfusion induced cardiac injury. However, the exact molecular mechanism of FGF21 action remains unclear. This study was designed the protective effect of FGF21 on the heart and its mechanism. METHOD Adenovirus vector expressing FGF21 or control β-galactosidase was injected into the myocardium of mice. Myocardial injury was observed by tissue staining and immunohistochemical staining. The expression level of caspases-3 and galectin-3 in myocardial cells were observed by immunoblotting. Then, hypoxia-induced cell model was established. Small interfering RNA (SiRNA) and plasmid were transfected into H9c2 using Lipofectamine 2000 reagent (Invitrogen). The expression levels of galectin-3, ECM and cystatin-3 in cells were observed by immunoblotting, and the relationship between fibroblast growth factor 21 and galectin-3 was analyzed. RESULT Cell test in vitro showed that FGF21 could inhibit apoptosis and decrease the expression of ECM (ColIaI, fibronectin, and alpha-SMA) under hypoxia. Western blot data showed that hypoxia-induced cell damage increased galectin-3 levels, while FGF21 decreased galactose lectin-3 levels. In addition, inhibition of galactose agglutinin-3 expression by siRNA enhanced the cardioprotective effect of FGF21, while overexpression of galectin-3 reduced the cardioprotective effect of fibroblast growth factor 21. CONCLUSION FGF21 may be a novel therapy for hypoxia-induced cardiac injury by regulating the expression of galectin-3.
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Affiliation(s)
- Mengyao Sun
- Department of Cardiac Surgery, first Hospital of Jilin University, Changchun, Jilin, P. R. China
| | - Liying Jin
- Department of Cardiac Surgery, first Hospital of Jilin University, Changchun, Jilin, P. R. China
| | - Yang Bai
- Department of Cardiac Surgery, first Hospital of Jilin University, Changchun, Jilin, P. R. China
| | - Lei Wang
- Department of Cardiac Surgery, first Hospital of Jilin University, Changchun, Jilin, P. R. China
| | - Song Zhao
- Department of Spine Surgery, first Hospital of Jilin University, Changchun, Jilin, P. R. China
| | - Chunye Ma
- Department of Cardiac Surgery, first Hospital of Jilin University, Changchun, Jilin, P. R. China
| | - Dashi Ma
- Department of Cardiac Surgery, first Hospital of Jilin University, Changchun, Jilin, P. R. China
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13
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Crespo-Leiro MG, Metra M, Lund LH, Milicic D, Costanzo MR, Filippatos G, Gustafsson F, Tsui S, Barge-Caballero E, De Jonge N, Frigerio M, Hamdan R, Hasin T, Hülsmann M, Nalbantgil S, Potena L, Bauersachs J, Gkouziouta A, Ruhparwar A, Ristic AD, Straburzynska-Migaj E, McDonagh T, Seferovic P, Ruschitzka F. Advanced heart failure: a position statement of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2018; 20:1505-1535. [DOI: 10.1002/ejhf.1236] [Citation(s) in RCA: 373] [Impact Index Per Article: 62.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 05/17/2018] [Accepted: 05/21/2018] [Indexed: 12/28/2022] Open
Affiliation(s)
- Maria G. Crespo-Leiro
- Complexo Hospitalario Universitario A Coruña (CHUAC); Instituto de Investigación Biomédica de A Coruña (INIBIC), CIBERCV, UDC; La Coruña Spain
| | - Marco Metra
- Cardiology; University of Brescia; Brescia Italy
| | - Lars H. Lund
- Department of Medicine, Unit of Cardiology; Karolinska Institute; Stockholm Sweden
| | - Davor Milicic
- Department for Cardiovascular Diseases; University Hospital Center Zagreb, University of Zagreb; Zagreb Croatia
| | | | | | - Finn Gustafsson
- Department of Cardiology; Rigshospitalet; Copenhagen Denmark
| | - Steven Tsui
- Transplant Unit; Royal Papworth Hospital; Cambridge UK
| | - Eduardo Barge-Caballero
- Complexo Hospitalario Universitario A Coruña (CHUAC); Instituto de Investigación Biomédica de A Coruña (INIBIC), CIBERCV, UDC; La Coruña Spain
| | - Nicolaas De Jonge
- Department of Cardiology; University Medical Center Utrecht; Utrecht The Netherlands
| | - Maria Frigerio
- Transplant Center and De Gasperis Cardio Center; Niguarda Hospital; Milan Italy
| | - Righab Hamdan
- Department of Cardiology; Beirut Cardiac Institute; Beirut Lebanon
| | - Tal Hasin
- Jesselson Integrated Heart Center; Shaare Zedek Medical Center; Jerusalem Israel
| | - Martin Hülsmann
- Department of Internal Medicine II; Medical University of Vienna; Vienna Austria
| | | | - Luciano Potena
- Heart and Lung Transplant Program; Bologna University Hospital; Bologna Italy
| | - Johann Bauersachs
- Department of Cardiology and Angiology; Medical School Hannover; Hannover Germany
| | - Aggeliki Gkouziouta
- Heart Failure and Transplant Unit; Onassis Cardiac Surgery Centre; Athens Greece
| | - Arjang Ruhparwar
- Department of Cardiac Surgery; University of Heidelberg; Heidelberg Germany
| | - Arsen D. Ristic
- Department of Cardiology of the Clinical Center of Serbia; Belgrade University School of Medicine; Belgrade Serbia
| | | | | | - Petar Seferovic
- Department of Internal Medicine; Belgrade University School of Medicine and Heart Failure Center, Belgrade University Medical Center; Belgrade Serbia
| | - Frank Ruschitzka
- University Heart Center; University Hospital Zurich; Zurich Switzerland
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14
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van Boven N, Battes LC, Akkerhuis KM, Rizopoulos D, Caliskan K, Anroedh SS, Yassi W, Manintveld OC, Cornel JH, Constantinescu AA, Boersma E, Umans VA, Kardys I. Toward personalized risk assessment in patients with chronic heart failure: Detailed temporal patterns of NT-proBNP, troponin T, and CRP in the Bio-SHiFT study. Am Heart J 2018; 196:36-48. [PMID: 29421013 DOI: 10.1016/j.ahj.2017.10.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 10/16/2017] [Indexed: 12/26/2022]
Affiliation(s)
- Nick van Boven
- Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands; Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Linda C Battes
- Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | | | - Kadir Caliskan
- Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Wisam Yassi
- Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands
| | | | - Jan-Hein Cornel
- Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands
| | | | - Eric Boersma
- Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Victor A Umans
- Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands
| | - Isabella Kardys
- Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands.
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17
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Otaki Y, Watanabe T, Kubota I. Heart-type fatty acid-binding protein in cardiovascular disease: A systemic review. Clin Chim Acta 2017; 474:44-53. [PMID: 28911997 DOI: 10.1016/j.cca.2017.09.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 09/09/2017] [Accepted: 09/09/2017] [Indexed: 12/12/2022]
Abstract
Fatty acid-binding proteins, whose clinical applications have been studied, are a family of proteins that reflect tissue injury. Heart-type fatty acid-binding protein (H-FABP) is a marker of ongoing myocardial damage and useful for early diagnosis of acute myocardial infarction (AMI). In the past decade, compared to other cardiac enzymes, H-FABP has shown more promise as an early detection marker for AMI. However, the role of H-FABP is being re-examined due to recent refinement in the search for newer biomarkers, and greater understanding of the role of high-sensitivity troponin. We discuss the current role of H-FABP as an early marker for AMI in the era of high sensitive troponin. H-FABP is highlighted as a prognostic marker for a broad spectrum of fatal diseases, viz., AMI, heart failure, arrhythmia, and pulmonary embolism that could be associated with poor clinical outcomes. Because the cut-off value of what constitutes an abnormal H-FABP potentially differs for each cardiovascular event and depends on the clinical setting, an optimal cut-off value has not been clearly established. Of note, several factors such as age, gender, and cardiovascular risk factors, which affect H-FABP levels need to be considered in this context. In this review, we discuss the clinical applications of H-FABP as a prognostic marker in various clinical settings.
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Affiliation(s)
- Yoichiro Otaki
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Tetsu Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan.
| | - Isao Kubota
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
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18
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Aboulhoda BE. Age-related remodeling of the JAK/STAT/SOCS signaling pathway and associated myocardial changes: From histological to molecular level. Ann Anat 2017; 214:21-30. [PMID: 28782583 DOI: 10.1016/j.aanat.2017.07.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 07/06/2017] [Accepted: 07/17/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND The cellular and molecular mechanisms implicated in age-associated changes in myocardial structure are of paramount importance since they cause profound alterations in the functional response and represent targets for alleviating age-related pathologies. One of these mechanisms is the JAK/STAT/SOCS signaling pathway. AIM OF THE STUDY The present study is designed to elucidate age-dependent changes of the myocardium to provide morphological basis displaying the pathogenesis of myocardial hypertrophy, fibrosis and inflammation with aging. MATERIAL AND METHODS Thirty male Sprague Dawley rats aged; 6, 30 and 36 months were used in this study. The animals were divided into three age groups, young adult, senile and very senile rats, respectively. The heart weight/body weight ratio was determined. The heart was subjected to gross morphologic examination, microscopic examination using H&E and Masson's trichrome stains and immunohistochemical examination for detection of JAK, pSTAT3, α-SMA, β-MHC and CD45. Western blotting was also carried out to detect SOCS genes. Real-time PCR was used to detect the inflammatory markers TNFα and IL1β and the hypertrophy marker α-SKA. Biochemical analysis of cardiac troponin I and creatine kinase-MB was done. Quantitative histomorphometric estimations included estimation of cardiac myocyte cross sectional area, estimation of the area percent of collagen fibers in Masson's trichrome stained sections and determination of optical density in immunostained sections. Electron microscopic examination was done to determine capillary density. RESULTS Jak and pSTAT3 were predominantly localized to the nuclei and exhibited progressive decline with aging, while SOCS3 activity displayed an age-related increase. The aged myocardium displayed profound age associated structural changes as well as myocardial hypertrophy, fibrosis and inflammation in senile and very senile rats. CONCLUSION The age-related modifications in the JAK/STAT/SOCS signaling as well as the age-associated pathological changes in myocardial structure are of particular interest as they provide further insight in age-associated heart pathologies and represent potential targets for cardioprotective and therapeutic approaches.
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Affiliation(s)
- Basma Emad Aboulhoda
- Department of Anatomy and Embryology, Faculty of Medicine, Cairo University, Egypt.
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19
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Luu B, Leistner DM, Herrmann E, Seeger FH, Honold J, Fichtlscherer S, Zeiher AM, Assmus B. Minute Myocardial Injury as Measured by High-Sensitive Troponin T Serum Levels Predicts the Response to Intracoronary Infusion of Bone Marrow-Derived Mononuclear Cells in Patients With Stable Chronic Post-Infarction Heart Failure: Insights From the TOPCARE-CHD Registry. Circ Res 2017; 120:1938-1946. [PMID: 28351842 DOI: 10.1161/circresaha.116.309938] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 03/16/2017] [Accepted: 03/27/2017] [Indexed: 12/13/2022]
Abstract
RATIONALE Cell-based therapies are a promising option in patients with chronic postinfarction heart failure (ischemic cardiomyopathy [ICM]). However, the responses after intracoronary infusion of autologous bone marrow-derived mononuclear cells (BMCs) are heterogeneous, which may be related to impaired cell retention in patients with ICM. Ischemic injury is associated with upregulation of prototypical chemoattractant cytokines mediating retention and homing of circulating cells. The development of ultrasensitive tests to measure high-sensitive troponin T (hs-TnT) serum levels revealed the presence of ongoing minute myocardial injury even in patients with stable ICM. OBJECTIVE To test the hypothesis that serum levels of hs-TnT correlate with cell retention and determine the response to intracoronary BMC application in patients with ICM. METHODS AND RESULTS About 157 patients with stable ICM and no substantial impairment of kidney function received intracoronary BMC administration. Immediately prior to cell application, hs-TnT levels to measure myocardial injury and NT-proBNP levels as marker of left ventricular wall stress were determined. Patients with elevated hs-TnT were older and had more severe heart failure. Importantly, only patients with elevated baseline hs-TnT≥15.19 pg/mL (upper tertile) demonstrated a significant (P=0.04) reduction in NT-proBNP serum levels (-250 [-1465; 33] pg/mL; relative reduction -24%) 4 months after BMC administration, whereas NT-proBNP levels remained unchanged in patients in the 2 lower hs-TnT tertiles. The absolute decrease in NT-proBNP at 4 months was inversely correlated with baseline hs-TnT (r=-0.27, P=0.001). Finally, retention of intracoronarily infused, 111Indium-labeled cells within the heart was closely associated with hs-TnT levels in patients with chronic ischemic heart failure (P=0.0008, n=10, triple measurements). CONCLUSIONS The extent of ongoing myocardial injury as measured by serum levels of hs-TnT predicts the reduction of NT-proBNP serum levels at 4 months after intracoronary BMC administration in patients with ICM, suggesting that the beneficial effects of BMC application on LV remodeling and wall stress are confined to patients with ongoing minute myocardial injury. CLINICAL TRIAL REGISTRATION URL: www.clinicaltrials.gov. Unique identifier: NCT00962364.
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Affiliation(s)
- Brigitte Luu
- From the Division of Cardiology, Department of Medicine III (B.L., D.M.L., F.H.S., J.H., S.F., A.M.Z., B.A.) and Institute of Biostatistics and Mathematical Modeling, Department of Medicine (E.H.), Goethe University Frankfurt, Germany; and German Center for Cardiovascular Research, DZHK, Partner Site Frankfurt Rhine-Main, Berlin, Germany (B.L., D.M.L., B.A., A.M.Z., B.A.)
| | - David M Leistner
- From the Division of Cardiology, Department of Medicine III (B.L., D.M.L., F.H.S., J.H., S.F., A.M.Z., B.A.) and Institute of Biostatistics and Mathematical Modeling, Department of Medicine (E.H.), Goethe University Frankfurt, Germany; and German Center for Cardiovascular Research, DZHK, Partner Site Frankfurt Rhine-Main, Berlin, Germany (B.L., D.M.L., B.A., A.M.Z., B.A.)
| | - Eva Herrmann
- From the Division of Cardiology, Department of Medicine III (B.L., D.M.L., F.H.S., J.H., S.F., A.M.Z., B.A.) and Institute of Biostatistics and Mathematical Modeling, Department of Medicine (E.H.), Goethe University Frankfurt, Germany; and German Center for Cardiovascular Research, DZHK, Partner Site Frankfurt Rhine-Main, Berlin, Germany (B.L., D.M.L., B.A., A.M.Z., B.A.)
| | - Florian H Seeger
- From the Division of Cardiology, Department of Medicine III (B.L., D.M.L., F.H.S., J.H., S.F., A.M.Z., B.A.) and Institute of Biostatistics and Mathematical Modeling, Department of Medicine (E.H.), Goethe University Frankfurt, Germany; and German Center for Cardiovascular Research, DZHK, Partner Site Frankfurt Rhine-Main, Berlin, Germany (B.L., D.M.L., B.A., A.M.Z., B.A.)
| | - Joerg Honold
- From the Division of Cardiology, Department of Medicine III (B.L., D.M.L., F.H.S., J.H., S.F., A.M.Z., B.A.) and Institute of Biostatistics and Mathematical Modeling, Department of Medicine (E.H.), Goethe University Frankfurt, Germany; and German Center for Cardiovascular Research, DZHK, Partner Site Frankfurt Rhine-Main, Berlin, Germany (B.L., D.M.L., B.A., A.M.Z., B.A.)
| | - Stephan Fichtlscherer
- From the Division of Cardiology, Department of Medicine III (B.L., D.M.L., F.H.S., J.H., S.F., A.M.Z., B.A.) and Institute of Biostatistics and Mathematical Modeling, Department of Medicine (E.H.), Goethe University Frankfurt, Germany; and German Center for Cardiovascular Research, DZHK, Partner Site Frankfurt Rhine-Main, Berlin, Germany (B.L., D.M.L., B.A., A.M.Z., B.A.)
| | - Andreas M Zeiher
- From the Division of Cardiology, Department of Medicine III (B.L., D.M.L., F.H.S., J.H., S.F., A.M.Z., B.A.) and Institute of Biostatistics and Mathematical Modeling, Department of Medicine (E.H.), Goethe University Frankfurt, Germany; and German Center for Cardiovascular Research, DZHK, Partner Site Frankfurt Rhine-Main, Berlin, Germany (B.L., D.M.L., B.A., A.M.Z., B.A.)
| | - Birgit Assmus
- From the Division of Cardiology, Department of Medicine III (B.L., D.M.L., F.H.S., J.H., S.F., A.M.Z., B.A.) and Institute of Biostatistics and Mathematical Modeling, Department of Medicine (E.H.), Goethe University Frankfurt, Germany; and German Center for Cardiovascular Research, DZHK, Partner Site Frankfurt Rhine-Main, Berlin, Germany (B.L., D.M.L., B.A., A.M.Z., B.A.).
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Troponin-Guided Heart Failure Therapy: Are We There Yet? CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2016. [DOI: 10.1007/s40138-016-0115-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Plasma levels of growth differentiation factor-15 are associated with myocardial injury in patients undergoing off-pump coronary artery bypass grafting. Sci Rep 2016; 6:28221. [PMID: 27311391 PMCID: PMC4911561 DOI: 10.1038/srep28221] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 06/01/2016] [Indexed: 12/20/2022] Open
Abstract
Growth differentiation factor-15 (GDF-15) has recently emerged as a risk predictor in patients with cardiovascular diseases. We therefore aimed to investigate the role of GDF-15 in the occurrence of cardiac injury during off-pump coronary artery bypass grafting (OPCAB). 55 consecutive patients with coronary artery diseases were recruited in this prospective, observational study. All patients were operated for OPCAB surgery. Serial blood samples were collected preoperatively, 12 hours and 36 hours after surgery. GDF-15, together with C-reactive protein, cardiac troponin I, creatine kinase MB and N-terminal pro B-type natriuretic peptide levels in plasma were measured at each time-point. GDF-15 levels increased significantly at 12 hours after surgery, attaining nearly 2.5 times the baseline levels (p < 0.001). Postoperative GDF-15 levels correlated positively with cTnI (p = 0.003) and EuroSCORE II (p = 0.013). According to the ROC curves, postoperative plasma GDF-15 was found to be the best biomarker to predict perioperative cardiac injury, compared with cTnI, CK-MB and EuroSCORE II. Circulating GDF-15 is a promising novel biomarker for identifying perioperative myocardial injury in patients undergoing OPCAB.
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Yousufuddin M, Abdalrhim AD, Wang Z, Murad MH. Cardiac troponin in patients hospitalized with acute decompensated heart failure: A systematic review and meta-analysis. J Hosp Med 2016; 11:446-54. [PMID: 26889916 DOI: 10.1002/jhm.2558] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 01/07/2016] [Accepted: 01/17/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND Elevated cardiac troponin (cTn) is often observed in patients with acute decompensated heart failure (ADHF). We assessed the magnitude of association and quality of supporting evidence between cTn and clinically important outcomes in persons hospitalized for ADHF. METHODS We searched MEDLINE In-Process & Other Non-Indexed Citations, MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus from inception through February 28, 2015. The outcomes analyzed included hospital length of stay (LOS), readmissions, and mortality. Random effects meta-analysis was used to combine outcomes across studies. RESULTS We included 26 clinical studies. A detectable or elevated cTn was associated with increased LOS (odds ratio [OR]: 1.05; 95% confidence interval [CI]: 1.01-1.10), increased in-hospital mortality (OR: 2.57; 95% CI: 2.27-2.91), and a composite of mortality and major adverse events (OR: 1.33; 95% CI: 1.03-1.71) during hospitalization. ADHF patients with a detectable or elevated cTn were at increased risk for mortality and composite of mortality and readmission over the short term (mortality OR: 2.11; 95% CI: 1.43-3.12; composite OR: 2.81; 95% CI: 1.60-4.92), intermediate term (mortality OR: 2.21; 95% CI: 1.46-3.35; composite OR: 2.30; 95% CI: 1.78-2.99), and long term (mortality OR: 3.69; 95% CI: 2.64-5.18; composite OR: 3.49; 95% CI: 2.08-5.84). The overall confidence in estimates was moderate. CONCLUSIONS Among ADHF patients, a detectable or elevated cTn identifies subjects at increased risk for adverse clinical outcomes during acute hospitalization and those at higher risk for postdischarge mortality and composite of readmission and mortality. Journal of Hospital Medicine 2016;11:446-454. 2016 Society of Hospital Medicine.
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Affiliation(s)
| | - Ahmed D Abdalrhim
- Department of Hospital Medicine, Mayo Clinic Health System, Austin, Minnesota
| | - Zhen Wang
- Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, Minnesota
| | - M Hassan Murad
- Division of Preventive Medicine, Mayo Clinic, Rochester, Minnesota
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Abstract
Breast cancer treatments have evolved over the past decades, although several widely used treatments have adverse cardiac effects. Radiotherapy generally improves the survival of women with breast cancer, although its deleterious cardiovascular effects pose competing risks of morbidity and/or mortality. In the past, radiation-associated cardiovascular disease was a phenomenon considered to take more than a decade to manifest, but newer research suggests that this latency is much shorter. Knowledge of coronary anatomy relative to the distribution of the delivered radiation dose has improved over time, and as a result, techniques have enabled this risk to be decreased. Studies continue to be performed to better understand, prevent and mitigate against radiation-associated cardiovascular disease. Treatments such as anthracyclines, which are a mainstay of chemotherapy for breast cancer, and newer targeted agents such as trastuzumab both have established risks of cardiotoxicity, which can limit their effectiveness and result in increased morbidity and/or mortality. Interest in whether β-blockers, statins and/or angiotensin-converting enzyme (ACE)-inhibitors might have therapeutic and/or preventative effects in these patients is currently increasing. This Review summarizes the incidence, risks and effects of treatment-induced cardiovascular disease in patients with breast cancer and describes strategies that might be used to minimize this risk.
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French B, Wang L, Ky B, Brandimarto J, Basuray A, Fang JC, Sweitzer NK, Cappola TP. Prognostic Value of Galectin-3 for Adverse Outcomes in Chronic Heart Failure. J Card Fail 2015; 22:256-62. [PMID: 26571149 DOI: 10.1016/j.cardfail.2015.10.022] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 10/27/2015] [Accepted: 10/29/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Clinical studies have suggested the prognostic value of galectin-3, a marker of fibrosis, in chronic heart failure. However, the specific role of galectin-3, compared with established biomarkers, remains uncertain. METHODS AND RESULTS The Penn Heart Failure Study was an ambulatory heart failure cohort that included 1385 participants with reduced (1141), preserved (106), and recovered (138) left ventricular ejection fraction (LVEF). Cox regression models determined the association between galectin-3 and risk of all-cause mortality, cardiac transplantation, or placement of a ventricular assist device. Receiver operating characteristic curves compared the prognostic accuracy of galectin-3, high-sensitivity soluble Toll-like receptor 2 (ST2), troponin I, and B-type natriuretic peptide (BNP) at 1 and 5 years. Higher galectin-3 levels were associated with an increased risk of adverse events (adjusted hazard ratio of 1.96 for each doubling in galectin-3; P < .001). This association was most pronounced among participants with preserved LVEF (adjusted hazard ratio 3.30; P < .001). At 5 years, galectin-3 was the most accurate discriminator of risk among participants with preserved LVEF (area under the curve 0.782; P = .81 vs high-sensitivity ST2; P = .029 vs troponin I; P = .35 vs BNP). BNP was most accurate among participants with reduced and recovered LVEF (areas under the curves 0.716 and 0.728, respectively). CONCLUSIONS Galectin-3 could have prognostic value for long-term events among patients with heart failure and preserved ejection fraction.
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Affiliation(s)
- Benjamin French
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania; Penn Cardiovascular Institute, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Le Wang
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Bonnie Ky
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania; Penn Cardiovascular Institute, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeffrey Brandimarto
- Penn Cardiovascular Institute, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anupam Basuray
- Ohio Health: Riverside Methodist Hospital, Columbus, Ohio
| | - James C Fang
- Division of Cardiovascular Medicine, University Hospital, Salt Lake City, Utah
| | | | - Thomas P Cappola
- Penn Cardiovascular Institute, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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D'Elia E, Vaduganathan M, Gori M, Gavazzi A, Butler J, Senni M. Role of biomarkers in cardiac structure phenotyping in heart failure with preserved ejection fraction: critical appraisal and practical use. Eur J Heart Fail 2015; 17:1231-9. [PMID: 26493383 DOI: 10.1002/ejhf.430] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 09/28/2015] [Accepted: 09/28/2015] [Indexed: 12/28/2022] Open
Abstract
Heart failure (HF) with preserved ejection fraction (HFpEF) is a heterogeneous clinical syndrome characterized by cardiovascular, metabolic, and pro-inflammatory diseases associated with advanced age and extracardiac comorbidities. All of these conditions finally lead to impairment of myocardial structure and function. The large phenotypic heterogeneity of HFpEF from pathophysiological underpinnings presents a major hurdle to HFpEF therapy. The new therapeutic approach in HFpEF should be targeted to each HF phenotype, instead of the 'one-size-fits-all' approach, which has not been successful in clinical trials. Unless the structural and biological determinants of the failing heart are deeply understood, it will be impossible to appropriately differentiate HFpEF patients, identify subtle myocardial abnormalities, and finally reverse abnormal cardiac function. Based on evidence from endomyocardial biopsies, some of the specific cardiac structural phenotypes to be targeted in HFpEF may be represented by myocyte hypertrophy, interstitial fibrosis, myocardial inflammation associated with oxidative stress, and coronary disease. Once the diagnosis of HFpEF has been established, a potential approach could be to use a panel of biomarkers to identify the main cardiac structural HFpEF phenotypes, guiding towards more appropriate therapeutic strategies. Accordingly, the purpose of this review is to investigate the potential role of biomarkers in identifying different cardiac structural HFpEF phenotypes and to discuss the merits of a biomarker-guided strategy in HFpEF.
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Affiliation(s)
- Emilia D'Elia
- Dipartimento Cardiovascolare, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Muthiah Vaduganathan
- Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA, USA
| | - Mauro Gori
- Dipartimento Cardiovascolare, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Antonello Gavazzi
- FROM Fondazione per la Ricerca, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - Javed Butler
- Cardiology Division, Stony Brook University, Stony Brook, NY, USA
| | - Michele Senni
- Dipartimento Cardiovascolare, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
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Kasama S, Toyama T, Funada R, Takama N, Koitabashi N, Ichikawa S, Suzuki Y, Matsumoto N, Sato Y, Kurabayashi M. Effects of adding intravenous nicorandil to standard therapy on cardiac sympathetic nerve activity and myocyte dysfunction in patients with acute decompensated heart failure. Eur J Nucl Med Mol Imaging 2015; 42:761-70. [DOI: 10.1007/s00259-015-2990-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 01/07/2015] [Indexed: 02/07/2023]
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Collins SP, Pang PS, Butler J, Fonarow G, Metra M, Gheorghiade M. Revisiting cardiac injury during acute heart failure: further characterization and a possible target for therapy. Am J Cardiol 2015; 115:141-6. [PMID: 25456864 DOI: 10.1016/j.amjcard.2014.09.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 09/25/2014] [Accepted: 09/26/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Sean P Collins
- Vanderbilt University College of Medicine, Nashville, TN
| | - Peter S Pang
- Indiana University School of Medicine, Indianapolis, IN
| | - Javed Butler
- Emory University School of Medicine, Atlanta, GA
| | - Gregg Fonarow
- University of California Los Angeles Medical Center, Los Angeles, CA
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Torre M, Jarolim P. Cardiac troponin assays in the management of heart failure. Clin Chim Acta 2014; 441:92-8. [PMID: 25545229 DOI: 10.1016/j.cca.2014.12.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 12/18/2014] [Accepted: 12/22/2014] [Indexed: 01/18/2023]
Abstract
Cardiac troponins I and T are established biomarkers of cardiac injury. Testing for either of these two cardiac troponins has long been an essential component of the diagnosis of acute myocardial infarction. In addition, cardiac troponin concentrations after acute myocardial infarction predict future adverse events including development of ischemic heart failure and chronic elevations of cardiac troponin correlate with heart failure severity. These predictions and correlations are particularly obvious when cardiac troponin concentrations are measured using the new high sensitivity cardiac troponin assays. Thus, a growing body of literature suggests that cardiac troponin testing may have important clinical implications for heart failure patients with reduced or preserved ejection fraction. In this review, we explore the prognostic utility of measuring cardiac troponin concentrations in patients with acute or chronic heart failure and in populations at risk of developing heart failure and the relationship between cardiac troponin levels and disease severity. We also summarize the ongoing debates and research on whether serial monitoring of cardiac troponin levels may become a useful tool for guiding therapeutic interventions in patients with heart failure.
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Affiliation(s)
| | - Petr Jarolim
- Harvard Medical School, Boston, MA, USA; Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA.
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29
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Jhund PS, Claggett BL, Voors AA, Zile MR, Packer M, Pieske BM, Kraigher-Krainer E, Shah AM, Prescott MF, Shi V, Lefkowitz M, McMurray JJV, Solomon SD. Elevation in high-sensitivity troponin T in heart failure and preserved ejection fraction and influence of treatment with the angiotensin receptor neprilysin inhibitor LCZ696. Circ Heart Fail 2014; 7:953-9. [PMID: 25277997 DOI: 10.1161/circheartfailure.114.001427] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Elevated high-sensitivity troponin is associated with increasing disease severity in patients with stable heart failure with reduced ejection fraction, but less is known about the association in heart failure with preserved ejection fraction. METHODS AND RESULTS We examined the prevalence of elevated high-sensitivity troponin T (hs-TnT) in 298 patients with heart failure with preserved ejection fraction enrolled in the Prospective comparison of angiotensin receptor neprilysin inhibitor with angiotensin receptor blocker on Management Of heart failUre with preserved ejectioN fracTion (PARAMOUNT) trial, in which the angiotensin receptor neprilysin inhibitor LCZ696 reduced markers of heart failure severity compared with valsartan. We assessed the association between hs-TnT and cardiac structure and function, and the effect of LCZ696, compared with valsartan, on hs-TnT over 36 weeks. Elevated hs-TnT in the myocardial injury range (>0.014 μg/L) was found in 55% of patients and was associated with older age, history of diabetes mellitus, higher N-terminal pro-brain natriuretic peptide, lower estimated glomerular filtration rate, and larger left atrial size, left ventricular volume, and mass. LCZ696 treatment reduced hs-TnT to a greater extent at 12 weeks (12% reduction; P=0.05) and at 36 weeks (14% reduction; P=0.03) compared with valsartan. CONCLUSIONS Troponin T was elevated in a substantial number of patients enrolled in a heart failure with preserved ejection fraction clinical trial and was associated with abnormalities of cardiac structure, function, and elevated baseline N-terminal pro-brain natriuretic peptide. Decreases in hs-TnT with LCZ696 in parallel with improvement in N-terminal pro-brain natriuretic peptide and left atrial size suggest that the angiotensin receptor neprilysin inhibitor LCZ696 may reduce this measure of myocardial injury in heart failure with preserved ejection fraction. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT00887588.
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Affiliation(s)
- Pardeep S Jhund
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.S.J., B.L.C., A.M.S., S.D.S.); BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (P.S.J., J.J.V.M.); Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (A.A.V.); Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC (M.R.Z.); Medical University of South Carolina, Charleston (M.R.Z.); Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas (M.P.); Department of Cardiology, Medical University Graz, Graz, Austria (B.M.P., E.K.-K.); and Novartis Pharmaceuticals, East Hanover, NJ (M.F.P., V.S., M.L.)
| | - Brian L Claggett
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.S.J., B.L.C., A.M.S., S.D.S.); BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (P.S.J., J.J.V.M.); Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (A.A.V.); Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC (M.R.Z.); Medical University of South Carolina, Charleston (M.R.Z.); Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas (M.P.); Department of Cardiology, Medical University Graz, Graz, Austria (B.M.P., E.K.-K.); and Novartis Pharmaceuticals, East Hanover, NJ (M.F.P., V.S., M.L.)
| | - Adriaan A Voors
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.S.J., B.L.C., A.M.S., S.D.S.); BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (P.S.J., J.J.V.M.); Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (A.A.V.); Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC (M.R.Z.); Medical University of South Carolina, Charleston (M.R.Z.); Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas (M.P.); Department of Cardiology, Medical University Graz, Graz, Austria (B.M.P., E.K.-K.); and Novartis Pharmaceuticals, East Hanover, NJ (M.F.P., V.S., M.L.)
| | - Michael R Zile
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.S.J., B.L.C., A.M.S., S.D.S.); BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (P.S.J., J.J.V.M.); Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (A.A.V.); Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC (M.R.Z.); Medical University of South Carolina, Charleston (M.R.Z.); Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas (M.P.); Department of Cardiology, Medical University Graz, Graz, Austria (B.M.P., E.K.-K.); and Novartis Pharmaceuticals, East Hanover, NJ (M.F.P., V.S., M.L.)
| | - Milton Packer
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.S.J., B.L.C., A.M.S., S.D.S.); BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (P.S.J., J.J.V.M.); Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (A.A.V.); Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC (M.R.Z.); Medical University of South Carolina, Charleston (M.R.Z.); Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas (M.P.); Department of Cardiology, Medical University Graz, Graz, Austria (B.M.P., E.K.-K.); and Novartis Pharmaceuticals, East Hanover, NJ (M.F.P., V.S., M.L.)
| | - Burkert M Pieske
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.S.J., B.L.C., A.M.S., S.D.S.); BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (P.S.J., J.J.V.M.); Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (A.A.V.); Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC (M.R.Z.); Medical University of South Carolina, Charleston (M.R.Z.); Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas (M.P.); Department of Cardiology, Medical University Graz, Graz, Austria (B.M.P., E.K.-K.); and Novartis Pharmaceuticals, East Hanover, NJ (M.F.P., V.S., M.L.)
| | - Elisabeth Kraigher-Krainer
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.S.J., B.L.C., A.M.S., S.D.S.); BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (P.S.J., J.J.V.M.); Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (A.A.V.); Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC (M.R.Z.); Medical University of South Carolina, Charleston (M.R.Z.); Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas (M.P.); Department of Cardiology, Medical University Graz, Graz, Austria (B.M.P., E.K.-K.); and Novartis Pharmaceuticals, East Hanover, NJ (M.F.P., V.S., M.L.)
| | - Amil M Shah
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.S.J., B.L.C., A.M.S., S.D.S.); BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (P.S.J., J.J.V.M.); Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (A.A.V.); Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC (M.R.Z.); Medical University of South Carolina, Charleston (M.R.Z.); Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas (M.P.); Department of Cardiology, Medical University Graz, Graz, Austria (B.M.P., E.K.-K.); and Novartis Pharmaceuticals, East Hanover, NJ (M.F.P., V.S., M.L.)
| | - Margaret F Prescott
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.S.J., B.L.C., A.M.S., S.D.S.); BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (P.S.J., J.J.V.M.); Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (A.A.V.); Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC (M.R.Z.); Medical University of South Carolina, Charleston (M.R.Z.); Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas (M.P.); Department of Cardiology, Medical University Graz, Graz, Austria (B.M.P., E.K.-K.); and Novartis Pharmaceuticals, East Hanover, NJ (M.F.P., V.S., M.L.)
| | - Victor Shi
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.S.J., B.L.C., A.M.S., S.D.S.); BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (P.S.J., J.J.V.M.); Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (A.A.V.); Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC (M.R.Z.); Medical University of South Carolina, Charleston (M.R.Z.); Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas (M.P.); Department of Cardiology, Medical University Graz, Graz, Austria (B.M.P., E.K.-K.); and Novartis Pharmaceuticals, East Hanover, NJ (M.F.P., V.S., M.L.)
| | - Marty Lefkowitz
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.S.J., B.L.C., A.M.S., S.D.S.); BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (P.S.J., J.J.V.M.); Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (A.A.V.); Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC (M.R.Z.); Medical University of South Carolina, Charleston (M.R.Z.); Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas (M.P.); Department of Cardiology, Medical University Graz, Graz, Austria (B.M.P., E.K.-K.); and Novartis Pharmaceuticals, East Hanover, NJ (M.F.P., V.S., M.L.)
| | - John J V McMurray
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.S.J., B.L.C., A.M.S., S.D.S.); BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (P.S.J., J.J.V.M.); Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (A.A.V.); Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC (M.R.Z.); Medical University of South Carolina, Charleston (M.R.Z.); Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas (M.P.); Department of Cardiology, Medical University Graz, Graz, Austria (B.M.P., E.K.-K.); and Novartis Pharmaceuticals, East Hanover, NJ (M.F.P., V.S., M.L.)
| | - Scott D Solomon
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (P.S.J., B.L.C., A.M.S., S.D.S.); BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (P.S.J., J.J.V.M.); Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (A.A.V.); Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC (M.R.Z.); Medical University of South Carolina, Charleston (M.R.Z.); Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas (M.P.); Department of Cardiology, Medical University Graz, Graz, Austria (B.M.P., E.K.-K.); and Novartis Pharmaceuticals, East Hanover, NJ (M.F.P., V.S., M.L.).
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Vorovich E, French B, Ky B, Goldberg L, Fang JC, Sweitzer NK, Cappola TP. Biomarker predictors of cardiac hospitalization in chronic heart failure: a recurrent event analysis. J Card Fail 2014; 20:569-76. [PMID: 24929121 DOI: 10.1016/j.cardfail.2014.05.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 05/01/2014] [Accepted: 05/05/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Identification of heart failure (HF) patients at risk for hospitalization may improve care and reduce costs. We evaluated 9 biomarkers as predictors of cardiac hospitalization in chronic HF. METHODS AND RESULTS In a multicenter cohort of 1,512 chronic HF outpatients, we assessed the association between 9 biomarkers and cardiac hospitalization with the use of a recurrent events approach. Over a median follow-up of 4 years, 843 participants experienced ≥ 1 hospitalizations (total 2,178 hospitalizations). B-type natriuretic peptide (BNP) and troponin I (TnI) exhibited the strongest associations with risk of hospitalization (hazard ratio [HR] 3.8 [95% confidence interval (CI) 2.9-4.9] and HR 3.3 [95% CI 2.8-3.9]; 3rd vs 1st tertiles). Soluble Fms-like tyrosine kinase receptor 1 (sFlt-1) exhibited the next strongest association (HR 2.8 [95% CI 2.4-3.4]), followed by soluble Toll-like receptor 2 (HR 2.3 [95% CI 2.0-2.8]) and creatinine (HR 1.9 [95% CI 1.6-2.4]). Within ischemic/nonischemic subgroups, BNP and TnI remained most strongly associated. Except for creatinine, HRs for all biomarkers studied were smaller within the ischemic subgroup, suggesting greater importance of cardiorenal interactions in decompensation of ischemic HF. CONCLUSION Although BNP and TnI exhibited the strongest associations with hospitalization, etiology-dependent associations for the remaining biomarkers suggest etiology-specific mechanisms for HF exacerbation. sFlt-1 exhibited a strong association with cardiac hospitalization, highlighting its potential role as a biomarker of HF morbidity.
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Affiliation(s)
- Esther Vorovich
- Penn Cardiovascular Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Benjamin French
- Penn Cardiovascular Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Bonnie Ky
- Penn Cardiovascular Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Lee Goldberg
- Penn Cardiovascular Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - James C Fang
- Cardiovascular Medicine, University of Utah, Salt Lake City, Utah
| | - Nancy K Sweitzer
- Cardiovascular Medicine, University of Wisconsin, Madison, Wisconsin
| | - Thomas P Cappola
- Penn Cardiovascular Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
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Jacroux T, Bottenus D, Rieck B, Ivory CF, Dong WJ. Cationic isotachophoresis separation of the biomarker cardiac troponin I from a high-abundance contaminant, serum albumin. Electrophoresis 2014; 35:2029-38. [PMID: 24723384 DOI: 10.1002/elps.201400009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 02/27/2014] [Accepted: 03/16/2014] [Indexed: 11/11/2022]
Abstract
Cationic ITP was used to separate and concentrate fluorescently tagged cardiac troponin I (cTnI) from two proteins with similar isoelectric properties in a PMMA straight-channel microfluidic chip. In an initial set of experiments, cTnI was effectively separated from R-Phycoerythrin using cationic ITP in a pH 8 buffer system. Then, a second set of experiments was conducted in which cTnI was separated from a serum contaminant, albumin. Each experiment took ∼10 min or less at low electric field strengths (34 V/cm) and demonstrated that cationic ITP could be used as an on-chip removal technique to isolate cTnI from albumin. In addition to the experimental work, a 1D numerical simulation of our cationic ITP experiments has been included to qualitatively validate experimental observations.
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Affiliation(s)
- Thomas Jacroux
- Gene and Linda Voiland School of Chemical Engineering and Bioengineering, Washington State University, Pullman, WA, USA
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32
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Negi S, Sawano M, Kohsaka S, Inohara T, Shiraishi Y, Kohno T, Maekawa Y, Sano M, Yoshikawa T, Fukuda K. Prognostic implication of physical signs of congestion in acute heart failure patients and its association with steady-state biomarker levels. PLoS One 2014; 9:e96325. [PMID: 24802880 PMCID: PMC4011709 DOI: 10.1371/journal.pone.0096325] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 04/05/2014] [Indexed: 11/30/2022] Open
Abstract
Background Congestive physical findings such as pulmonary rales and third heart sound (S3) are hallmarks of acute heart failure (AHF). However, their role in outcome prediction remains unclear. We sought to investigate the association between congestive physical findings upon admission, steady-state biomarkers at the time of discharge, and long-term outcomes in AHF patients. Methods We analyzed the data of 133 consecutive AHF patients with an established diagnosis of ischemic or non-ischemic (dilated or hypertrophic) cardiomyopathy, admitted to a single-center university hospital between 2006 and 2010. The treating physician prospectively recorded major symptoms and congestive physical findings of AHF: paroxysmal nocturnal dyspnea, orthopnea, pulmonary rales, jugular venous distension (JVD), S3, and edema. The primary endpoint was defined as rehospitalization for HF. Results Majority (63.9%) of the patients had non-ischemic etiology and, at the time of admission, S3 was seen in 69.9% of the patients, JVD in 54.1%, and pulmonary rales in 43.6%. The mean follow-up period was 726 ± 31days. Patients with pulmonary rales (p < 0.001) and S3 (p = 0.011) had worse readmission rates than those without these findings; the presence of these findings was also associated with elevated troponin T (TnT) levels at the time of discharge (odds ratio [OR] 2.8; p = 0.02 and OR 2.6; p = 0.05, respectively). Conclusion Pulmonary rales and S3 were associated with inferior readmission rates and elevated TnT levels on discharge. The worsening of the readmission rate owing to congestive physical findings may be a consequence of on-going myocardial injury.
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Affiliation(s)
- Sayoko Negi
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Mitsuaki Sawano
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
- * E-mail:
| | - Taku Inohara
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Yasuyuki Shiraishi
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Takashi Kohno
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Yuichiro Maekawa
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Motoaki Sano
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | | | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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Clinical significance of cardiac troponins I and T in acute heart failure. Eur J Heart Fail 2014; 10:772-9. [DOI: 10.1016/j.ejheart.2008.06.009] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2007] [Revised: 04/27/2008] [Accepted: 06/09/2008] [Indexed: 11/21/2022] Open
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Fillet M, Deroyer C, Cobraiville G, Le Goff C, Cavalier E, Chapelle JP, Marée R, Legrand V, Pierard L, Kolh P, Merville MP. Identification of protein biomarkers associated with cardiac ischemia by a proteomic approach. Biomarkers 2013; 18:614-24. [PMID: 24044526 DOI: 10.3109/1354750x.2013.838306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Angina is chest pain induced by ischemia of the heart muscle, generally due to obstruction or spasm of the coronary arteries. People that suffer from average to severe cases of angina have an increased percentage of death before the age of 55, usually around 60%. Therefore, prevention of major complications, optimizing diagnosis, prognosis and therapeutics are of primary importance. The main objective of this study was to uncover biomarkers by comparing serum protein profiles of patients suffering from stable or unstable angina and controls. We identified by non-targeted proteomic approach and confirmed by the means of independent techniques, the differential expression of several proteins indicating significantly increased vascular inflammation response, disturbance in the lipid metabolism and in atherogenic plaques stability.
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Affiliation(s)
- M Fillet
- GIGA Proteomic Unit, Department of Clinical Chemistry, Clinical Chemistry Laboratory
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Pascual-Figal DA. Troponinas, una señal de SOS en el corazón insuficiente. Med Clin (Barc) 2013; 140:161-3. [DOI: 10.1016/j.medcli.2012.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Accepted: 09/06/2012] [Indexed: 10/27/2022]
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ACCF 2012 expert consensus document on practical clinical considerations in the interpretation of troponin elevations: a report of the American College of Cardiology Foundation task force on Clinical Expert Consensus Documents. J Am Coll Cardiol 2012; 60:2427-63. [PMID: 23154053 DOI: 10.1016/j.jacc.2012.08.969] [Citation(s) in RCA: 263] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Perna ER, Aspromonte N, Cimbaro Canella JP, Di Tano G, Macin SM, Feola M, Coronel ML, Milani L, Parras JI, Milli M, García EH, Valle R. Minor Myocardial Damage is a Prevalent Condition in Patients With Acute Heart Failure Syndromes and Preserved Systolic Function With Long-Term Prognostic Implications. A Report From the CIAST-HF (Collaborative Italo-Argentinean Study on Cardiac Troponin T in Heart Failure) Study. J Card Fail 2012; 18:822-30. [DOI: 10.1016/j.cardfail.2012.10.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 09/30/2012] [Accepted: 10/02/2012] [Indexed: 11/26/2022]
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Mentz RJ, Allen BD, Kwasny MJ, Konstam MA, Udelson JE, Ambrosy AP, Fought AJ, Vaduganathan M, O'Connor CM, Zannad F, Maggioni AP, Swedberg K, Bonow RO, Gheorghiade M. Influence of documented history of coronary artery disease on outcomes in patients admitted for worsening heart failure with reduced ejection fraction in the EVEREST trial. Eur J Heart Fail 2012; 15:61-8. [PMID: 22968743 DOI: 10.1093/eurjhf/hfs139] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
AIMS Data on the prognosis of heart failure (HF) patients with coronary artery disease (CAD) have been conflicting. We describe the clinical characteristics and mode-specific outcomes of HF patients with reduced ejection fraction (EF) and documented CAD in a large randomized trial. METHODS AND RESULTS EVEREST was a prospective, randomized trial of vasopressin-2 receptor blockade, in addition to standard therapy, in 4133 patients hospitalized with worsening HF and reduced EF. Patients were classified as having CAD based on patient-reported myocardial infarction (MI) or coronary revascularization. We analysed the characteristics and outcomes [all-cause mortality and cardiovascular (CV) mortality/HF hospitalization] of patients with and without documented CAD. All events were centrally adjudicated. Documented CAD was present in 2353 patients (57%). Patients with CAD were older and had more co-morbidities compared with those without CAD. Patients with CAD were more likely to receive a beta-blocker, but less likely to receive an angiotensin-converting enzyme (ACE) inhibitor or aldosterone antagonist (P < 0.01). After risk adjustment, patients with documented CAD had similar mortality [hazard ratio (HR) 1.12, 95% confidence interval (CI) 0.97-1.30], but were at an increased risk for CV mortality/HF hospitalization (HR 1.25, 95% CI 1.12-1.41) due to an increased risk for HF hospitalization (HR 1.26, 95% CI 1.10-1.44). Patients with CAD had increased HF- and MI-related events, but similar rates of sudden cardiac death. CONCLUSION Documented CAD in patients hospitalized for worsening HF with reduced EF was associated with a higher burden of co-morbidities, lower use of HF therapies (except beta-blockers), and increased HF hospitalization, while all-cause mortality was similar.
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Sato Y, Fujiwara H, Takatsu Y. Cardiac troponin and heart failure in the era of high-sensitivity assays. J Cardiol 2012; 60:160-7. [PMID: 22867801 DOI: 10.1016/j.jjcc.2012.06.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 06/06/2012] [Accepted: 06/06/2012] [Indexed: 10/28/2022]
Abstract
The Joint European Society of Cardiology-American College of Cardiology Foundation-American Heart Association-World Heart Federation Task Force for the Redefinition of Myocardial Infarction recommends cardiac troponin (cTn)-T as a first-line biomarker, and suggests the use of the 99th percentile of a reference population with acceptable precision (i.e. a coefficient of variance≤10%) as a cut-off for the diagnosis of acute myocardial infarction. Recently developed troponin assays fulfill this analytical precision. While conventional cTnT assays have often been used as a positive or negative categorical variable, stepwise rises in high sensitivity (Hs)-cTnT in patients presenting with chronic heart failure (HF) have been associated with a progressive increase in the incidence of cardiovascular events. Similar observations have been made in the general population. Hs-cTnT at baseline and during follow-up is a powerful predictor of cardiac events in patients with HF and in the general population. Whether it is the ideal biomarker remains to be confirmed, however. We review the potential contributions of TnT assays in the assessment of risk of HF, in HF, and in myocardial diseases that cause HF.
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Affiliation(s)
- Yukihito Sato
- Department of Cardiovascular Medicine, Hyogo Prefecture Amagasaki Hospital, Hyogo, Japan.
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Affiliation(s)
- Viorel G. Florea
- From the Section of Cardiology, VA Medical Center (V.G.F., I.S.A.); and Department of Medicine, University of Minnesota, Minneapolis, MN (V.G.F., I.S.A.)
| | - Inder S. Anand
- From the Section of Cardiology, VA Medical Center (V.G.F., I.S.A.); and Department of Medicine, University of Minnesota, Minneapolis, MN (V.G.F., I.S.A.)
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Januzzi JL, Filippatos G, Nieminen M, Gheorghiade M. Troponin elevation in patients with heart failure: on behalf of the third Universal Definition of Myocardial Infarction Global Task Force: Heart Failure Section. Eur Heart J 2012; 33:2265-71. [PMID: 22745356 DOI: 10.1093/eurheartj/ehs191] [Citation(s) in RCA: 272] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Cardiac troponin testing is commonly performed in patients with heart failure (HF). Despite being strongly linked to spontaneous (Type I) acute myocardial infarction (MI)--a common cause of acute HF syndromes--it is well recognized that concentrations of circulating troponins above the 99 th percentile of a normal population in the context of both acute and chronic HF are highly prevalent, and frequently unrelated to Type I MI. Other mechanism(s) leading to troponin elevation in HF syndromes remain elusive in many cases but prominently includes supply-demand inequity (Type II MI), which may be associated with coronary artery obstruction and endothelial dysfunction, or may occur in the absence of coronary obstruction due to increased oxygen demand related to increased wall tension, anaemia, or other factors provoking subendocardial injury. Non-coronary triggers, such as cellular necrosis, apoptosis, or autophagy in the context of wall stress may explain the troponin release in HF, as can toxic effects of circulating neurohormones, toxins, inflammation, and infiltrative processes, among others. Nonetheless, across a wide spectrum of HF syndromes, when troponin elevation occurs, independent of mechanism, it is strongly predictive of an adverse outcome. Clinicians should be aware of the high frequency of troponin elevation when measuring the marker in patients with HF, should keep in mind the possible causes of this phenomenon, and, independent of a diagnosis of 'acute MI', should recognize the considerable ramifications of troponin elevation in this setting.
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Affiliation(s)
- James L Januzzi
- Cardiology Division, Massachusetts General Hospital, Yawkey 5984, 32 Fruit Street, Boston, MA 02114, USA.
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Troponin T levels in patients with acute heart failure: clinical and prognostic significance of their detection and release during hospitalisation. Clin Res Cardiol 2012; 101:663-72. [DOI: 10.1007/s00392-012-0441-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Accepted: 03/01/2012] [Indexed: 10/28/2022]
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van Wijk S, Jacobs L, Eurlings LW, van Kimmenade R, Lemmers R, Broos P, Bekers O, Prins MH, Crijns HJ, Pinto YM, van Dieijen-Visser MP, Brunner-La Rocca HP. Troponin T Measurements by High-Sensitivity vs Conventional Assays for Risk Stratification in Acute Dyspnea. Clin Chem 2012; 58:284-92. [DOI: 10.1373/clinchem.2011.175976] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
BACKGROUND
Cardiac troponin T measured by a high-sensitivity assay (hs-cTnT) recently proved to be of prognostic value in several populations. The hs-cTnT assay may also improve risk stratification in acute dyspnea.
METHODS
We prospectively studied the prognostic value of hs-cTnT in 678 consecutive patients presenting to the emergency department with acute dyspnea. On the basis of conventional cardiac troponin T assay (cTnT) and hs-cTnT assay measurements, patients were divided into 3 categories: (1) neither assay increased (cTnT <0.03 μg/L, hs-cTnT <0.016 μg/L), (2) only hs-cTnT increased ≥0.016 μg/L (cTnT <0.03 μg/L), and (3) both assays increased (cTnT ≥0.03 μg/L, hs-cTnT ≥0.016 μg/L). Moreover, the prognostic value of hs-cTnT was investigated if cTnT was not detectable (<0.01).
RESULTS
One hundred seventy-two patients were in the lowest, 282 patients in the middle, and 223 patients in the highest troponin category. Patients in the second and third categories had significantly higher mortality compared to those in the first category (90-day mortality rate 2%, 10%, and 26% in groups 1, 2, and 3, respectively, P < 0.001; 1-year mortality rate 9%, 21%, and 39%, P < 0.001). Importantly, in patients with undetectable cTnT (n = 347, 51%), increased hs-cTnT indicated worse outcome [90-day mortality, odds ratio 4.26 (95% CI 1.19–15.21); 1-year mortality, hazard ratio 2.27 (1.19–4.36), P = 0.013], whereas N-terminal pro–brain-type natriuretic peptide (NT-proBNP) was not predictive of short-term outcome.
CONCLUSIONS
hs-cTnT is associated with mortality in patients presenting with acute dyspnea. hs-cTnT concentrations provide additional prognostic information to cTnT and NT-proBNP testing in patients with cTnT concentrations below the detection limit. In particular, the hs-cTnT cutoff of 0.016 μg/L enables identification of low-risk patients.
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Affiliation(s)
| | | | | | | | | | | | | | - Martin H Prins
- Department of Epidemiology, Maastricht University Medical Center, CARIM, Maastricht, the Netherlands
| | | | - Yigal M Pinto
- Heart Failure Research Center, Academic Medical Center, Amsterdam, the Netherlands
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Miller WL, Hartman KA, Grill DE, Struck J, Bergmann A, Jaffe AS. Serial measurements of midregion proANP and copeptin in ambulatory patients with heart failure: incremental prognostic value of novel biomarkers in heart failure. Heart 2011; 98:389-94. [PMID: 22194151 PMCID: PMC3276775 DOI: 10.1136/heartjnl-2011-300823] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Disease progression in heart failure (HF) reflects derangements in neurohormonal systems, and biomarkers of these systems can help to establish the diagnosis and assess the prognosis. Serial measurements of the precursor peptides of the natriuretic and vasopressin systems (midregional proatrial natriuretic peptide (MR-proANP) and C-terminal provasopressin (copeptin), respectively) should add incremental value to risk stratification in ambulatory patients with HF. Methods and results A cohort of 187 patients with class III–IV HF was prospectively enrolled, with biomarkers collected every 3 months over 2 years and analysed in relation to death/transplantation. Time-dependent analyses (dichotomous and continuous variables) showed that increases in MR-proANP (HR 7.6, 95% CI 1.85 to 31.15, p<0.01) and copeptin (HR 2.7, 95% CI 1.27 to 5.61, p=0.01) were associated with increased risk, but, in multivariate analysis adjusted for troponin T (cTnT) ≥0.01 ng/ml, only raised MR-proANP remained an independent predictor (HR 5.49, 95% CI 1.31 to 23.01, p=0.02). Combined increases in MR-proANP and copeptin (HR 9.01, 95% CI 1.24 to 65.26, p=0.03) with cTnT (HR 11.1, 95% CI 1.52 to 80.85, p=0.02), and increases ≥30% above already raised values identified the patients at greatest risk (MR-proANP: HR 10.1, 95% CI 2.34 to 43.38, p=0.002; copeptin: HR 11.5, 95% CI 2.74 to 48.08, p<0.001). Conclusions A strategy of serial monitoring of MR-proANP and, of lesser impact, copeptin, combined with cTnT, may be advantageous in detecting and managing the highest-risk outpatients with HF.
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Affiliation(s)
- Wayne L Miller
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA.
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Ather S, Hira RS, Shenoy M, Fatemi O, Deswal A, Aguilar D, Ramasubbu K, Bolos M, Chan W, Bozkurt B. Recurrent low-level troponin I elevation is a worse prognostic indicator than occasional injury pattern in patients hospitalized with heart failure. Int J Cardiol 2011; 166:394-8. [PMID: 22119115 DOI: 10.1016/j.ijcard.2011.10.113] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Revised: 07/18/2011] [Accepted: 10/22/2011] [Indexed: 10/15/2022]
Abstract
BACKGROUND Elevated troponin at baseline is associated with higher mortality in heart failure (HF) patients, but the prognostic role of recurrently elevated troponin is not well described. METHODS AND RESULTS We performed chart reviews of 196 HF patients without acute coronary syndrome, with at least three Troponin I (TnI) measurements on different admissions. For the analyses, three sets of TnI values closest to baseline, one year and two years were selected for each patient. Based on the three sets of TnI, the lowest value of TnI (minimum), the highest value of TnI (maximum), median value of TnI and delta TnI (3rd TnI-baseline TnI) were derived for each patient. The study population of 196 patients had 632 person-year follow-up, consisted predominantly of elderly (68 ± 10 years) male patients (99%) with mean ejection fraction of 26 ± 13%. Using multivariate Cox proportional hazards model only minimum TnI, but not the maximum, median or delta of TnI values, was significantly associated with mortality (HR: 13.7, 95% CI: 3.7 to 50.8, p<0.001). As a categorical variable, minimum TnI value of >0.04ng/ml was also independently associated with mortality (p=0.01, HR=1.6, 95% CI: 1.1 to 2.3). CONCLUSIONS In HF patients without acute coronary syndrome, the persistence of TnI elevation, even at low levels, is associated with a worse survival than sporadic TnI elevations of higher magnitude or any single elevation in TnI; and a recurrent elevation of TnI >0.04ng/ml portends a poor prognosis.
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O'Connor CM, Fiuzat M, Lombardi C, Fujita K, Jia G, Davison BA, Cleland J, Bloomfield D, Dittrich HC, DeLucca P, Givertz MM, Mansoor G, Ponikowski P, Teerlink JR, Voors AA, Massie BM, Cotter G, Metra M. Impact of Serial Troponin Release on Outcomes in Patients With Acute Heart Failure. Circ Heart Fail 2011; 4:724-32. [DOI: 10.1161/circheartfailure.111.961581] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Christopher M. O'Connor
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (C.M.O., M.F.); the Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy (C.L., M.M.); Merck Research Laboratories, Rahway, NJ (K.F., G.J., D.B., H.D., P.D., G.M.); Momentum Research (B.D., G.C.), Durham, NC; University of Hull, United Kingdom (J.C.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.G.); Medical University, Clinical Military Hospital, Wroclaw,
| | - Mona Fiuzat
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (C.M.O., M.F.); the Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy (C.L., M.M.); Merck Research Laboratories, Rahway, NJ (K.F., G.J., D.B., H.D., P.D., G.M.); Momentum Research (B.D., G.C.), Durham, NC; University of Hull, United Kingdom (J.C.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.G.); Medical University, Clinical Military Hospital, Wroclaw,
| | - Carlo Lombardi
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (C.M.O., M.F.); the Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy (C.L., M.M.); Merck Research Laboratories, Rahway, NJ (K.F., G.J., D.B., H.D., P.D., G.M.); Momentum Research (B.D., G.C.), Durham, NC; University of Hull, United Kingdom (J.C.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.G.); Medical University, Clinical Military Hospital, Wroclaw,
| | - Kenji Fujita
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (C.M.O., M.F.); the Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy (C.L., M.M.); Merck Research Laboratories, Rahway, NJ (K.F., G.J., D.B., H.D., P.D., G.M.); Momentum Research (B.D., G.C.), Durham, NC; University of Hull, United Kingdom (J.C.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.G.); Medical University, Clinical Military Hospital, Wroclaw,
| | - Gang Jia
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (C.M.O., M.F.); the Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy (C.L., M.M.); Merck Research Laboratories, Rahway, NJ (K.F., G.J., D.B., H.D., P.D., G.M.); Momentum Research (B.D., G.C.), Durham, NC; University of Hull, United Kingdom (J.C.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.G.); Medical University, Clinical Military Hospital, Wroclaw,
| | - Beth A. Davison
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (C.M.O., M.F.); the Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy (C.L., M.M.); Merck Research Laboratories, Rahway, NJ (K.F., G.J., D.B., H.D., P.D., G.M.); Momentum Research (B.D., G.C.), Durham, NC; University of Hull, United Kingdom (J.C.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.G.); Medical University, Clinical Military Hospital, Wroclaw,
| | - John Cleland
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (C.M.O., M.F.); the Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy (C.L., M.M.); Merck Research Laboratories, Rahway, NJ (K.F., G.J., D.B., H.D., P.D., G.M.); Momentum Research (B.D., G.C.), Durham, NC; University of Hull, United Kingdom (J.C.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.G.); Medical University, Clinical Military Hospital, Wroclaw,
| | - Daniel Bloomfield
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (C.M.O., M.F.); the Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy (C.L., M.M.); Merck Research Laboratories, Rahway, NJ (K.F., G.J., D.B., H.D., P.D., G.M.); Momentum Research (B.D., G.C.), Durham, NC; University of Hull, United Kingdom (J.C.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.G.); Medical University, Clinical Military Hospital, Wroclaw,
| | - Howard C. Dittrich
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (C.M.O., M.F.); the Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy (C.L., M.M.); Merck Research Laboratories, Rahway, NJ (K.F., G.J., D.B., H.D., P.D., G.M.); Momentum Research (B.D., G.C.), Durham, NC; University of Hull, United Kingdom (J.C.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.G.); Medical University, Clinical Military Hospital, Wroclaw,
| | - Paul DeLucca
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (C.M.O., M.F.); the Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy (C.L., M.M.); Merck Research Laboratories, Rahway, NJ (K.F., G.J., D.B., H.D., P.D., G.M.); Momentum Research (B.D., G.C.), Durham, NC; University of Hull, United Kingdom (J.C.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.G.); Medical University, Clinical Military Hospital, Wroclaw,
| | - Michael M. Givertz
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (C.M.O., M.F.); the Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy (C.L., M.M.); Merck Research Laboratories, Rahway, NJ (K.F., G.J., D.B., H.D., P.D., G.M.); Momentum Research (B.D., G.C.), Durham, NC; University of Hull, United Kingdom (J.C.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.G.); Medical University, Clinical Military Hospital, Wroclaw,
| | - George Mansoor
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (C.M.O., M.F.); the Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy (C.L., M.M.); Merck Research Laboratories, Rahway, NJ (K.F., G.J., D.B., H.D., P.D., G.M.); Momentum Research (B.D., G.C.), Durham, NC; University of Hull, United Kingdom (J.C.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.G.); Medical University, Clinical Military Hospital, Wroclaw,
| | - Piotr Ponikowski
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (C.M.O., M.F.); the Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy (C.L., M.M.); Merck Research Laboratories, Rahway, NJ (K.F., G.J., D.B., H.D., P.D., G.M.); Momentum Research (B.D., G.C.), Durham, NC; University of Hull, United Kingdom (J.C.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.G.); Medical University, Clinical Military Hospital, Wroclaw,
| | - John R. Teerlink
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (C.M.O., M.F.); the Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy (C.L., M.M.); Merck Research Laboratories, Rahway, NJ (K.F., G.J., D.B., H.D., P.D., G.M.); Momentum Research (B.D., G.C.), Durham, NC; University of Hull, United Kingdom (J.C.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.G.); Medical University, Clinical Military Hospital, Wroclaw,
| | - Adriaan A. Voors
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (C.M.O., M.F.); the Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy (C.L., M.M.); Merck Research Laboratories, Rahway, NJ (K.F., G.J., D.B., H.D., P.D., G.M.); Momentum Research (B.D., G.C.), Durham, NC; University of Hull, United Kingdom (J.C.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.G.); Medical University, Clinical Military Hospital, Wroclaw,
| | - Barry M. Massie
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (C.M.O., M.F.); the Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy (C.L., M.M.); Merck Research Laboratories, Rahway, NJ (K.F., G.J., D.B., H.D., P.D., G.M.); Momentum Research (B.D., G.C.), Durham, NC; University of Hull, United Kingdom (J.C.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.G.); Medical University, Clinical Military Hospital, Wroclaw,
| | - Gad Cotter
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (C.M.O., M.F.); the Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy (C.L., M.M.); Merck Research Laboratories, Rahway, NJ (K.F., G.J., D.B., H.D., P.D., G.M.); Momentum Research (B.D., G.C.), Durham, NC; University of Hull, United Kingdom (J.C.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.G.); Medical University, Clinical Military Hospital, Wroclaw,
| | - Marco Metra
- From the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (C.M.O., M.F.); the Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy (C.L., M.M.); Merck Research Laboratories, Rahway, NJ (K.F., G.J., D.B., H.D., P.D., G.M.); Momentum Research (B.D., G.C.), Durham, NC; University of Hull, United Kingdom (J.C.); Brigham and Women's Hospital, Harvard Medical School, Boston, MA (M.G.); Medical University, Clinical Military Hospital, Wroclaw,
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High sensitive troponin T and heart fatty acid binding protein: novel biomarker in heart failure with normal ejection fraction? A cross-sectional study. BMC Cardiovasc Disord 2011; 11:41. [PMID: 21729325 PMCID: PMC3146933 DOI: 10.1186/1471-2261-11-41] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Accepted: 07/05/2011] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND High sensitive troponin T (hsTnT) and heart fatty acid binding protein (hFABP) are both markers of myocardial injury and predict adverse outcome in patients with systolic heart failure (SHF). We tested whether hsTnT and hFABP plasma levels are elevated in patients with heart failure with normal ejection fraction (HFnEF). METHODS We analyzed hsTnT, hFABP and N-terminal brain natriuretic peptide in 130 patients comprising 49 HFnEF patients, 51 patients with asymptomatic left ventricular diastolic dysfunction (LVDD), and 30 controls with normal diastolic function. Patients were classified to have HFnEF when the diagnostic criteria as recommended by the European Society of Cardiology were met. RESULTS Levels of hs TnT and hFABP were significantly higher in patients with asymptomatic LVDD and HFnEF (both p < 0.001) compared to controls. The hsTnT levels were 5.6 [0.0-9.8] pg/ml in LVDD vs. 8.5 [3.9-17.5] pg/ml in HFnEF vs. <0.03 [< 0.03-6.4] pg/ml in controls; hFABP levels were 3029 [2533-3761] pg/ml in LVDD vs. 3669 [2918-4839] pg/ml in HFnEF vs. 2361 [1860-3081] pg/ml in controls. Furthermore, hsTnT and hFABP levels were higher in subjects with HFnEF compared to LVDD (p = 0.015 and p = 0.022). CONCLUSION In HFnEF patients, hsTnT and hFABP are elevated independent of coronary artery disease, suggesting that ongoing myocardial damage plays a critical role in the pathophysiology. A combination of biomarkers and echocardiographic parameters might improve diagnostic accuracy and risk stratification of patients with HFnEF.
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Everett BM, Cook NR, Magnone MC, Bobadilla M, Kim E, Rifai N, Ridker PM, Pradhan AD. Sensitive cardiac troponin T assay and the risk of incident cardiovascular disease in women with and without diabetes mellitus: the Women's Health Study. Circulation 2011; 123:2811-8. [PMID: 21632491 PMCID: PMC3144564 DOI: 10.1161/circulationaha.110.009928] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Very low levels of cardiac troponin T are associated with an increased risk of cardiovascular death in patients with stable chronic coronary disease. Whether high-sensitivity cardiac troponin T levels are associated with adverse cardiovascular outcomes in individuals without cardiovascular disease (CVD) has not been well studied. METHODS AND RESULTS Using 2 complementary study designs, we evaluated the relationship between baseline cardiac troponin and incident CVD events among diabetic and nondiabetic participants in the Women's Health Study (median follow-up, 12.3 years). All diabetic women with blood specimens were included in a cohort study (n=512 diabetic women, n=65 events), and nondiabetic women were sampled for inclusion in a case-cohort analysis (n=564 comprising the subcohort, n=479 events). High-sensitivity cardiac troponin T was detectable (≥ 0.003 μg/L) in 45.5% of diabetic women and 30.3% of nondiabetic women (P<0.0001). In models adjusted for traditional risk factors and hemoglobin A(1c), detectable high-sensitivity cardiac troponin T was associated with subsequent CVD (myocardial infarction, stroke, cardiovascular death) in diabetic women (adjusted hazard ratio, 1.79; 95% confidence interval, 1.04 to 3.07, P=0.036) but not nondiabetic women (adjusted hazard ratio, 1.13; 95% confidence interval, 0.82 to 1.55; P=0.46). Further adjustment for amino-terminal pro-B-type natriuretic peptide and estimated renal function did not substantially alter this relationship among diabetic women (hazard ratio, 1.76; 95% confidence interval, 1.00 to 3.08; P=0.0499), which appeared to be driven by a 3-fold increase in CVD death that was not observed in nondiabetic women. CONCLUSIONS Very low but detectable levels of cardiac troponin T are associated with total CVD and CVD death in women with diabetes mellitus. Among healthy nondiabetic women, detectable compared with undetectable troponin was not associated with CVD events.
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Affiliation(s)
- Brendan M Everett
- Center for Cardiovascular Disease Prevention, Brigham and Women's Hospital, 900 Commonwealth Ave E, Boston, MA 02215, USA.
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Frankenstein L, Remppis A, Giannitis E, Frankenstein J, Hess G, Zdunek D, Doesch A, Zugck C, Katus HA. Biological variation of high sensitive Troponin T in stable heart failure patients with ischemic or dilated cardiomyopathy. Clin Res Cardiol 2011; 100:633-40. [PMID: 21327843 DOI: 10.1007/s00392-011-0285-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2010] [Accepted: 01/26/2011] [Indexed: 12/30/2022]
Abstract
INTRODUCTION High sensitive Troponin (hsTn) assays enable detection of minimal marker elevation in heart failure patients previously deemed Troponin negative. Biovariability, reference change values (RCV), and index of individuality (II) have not been previously described for hsTnT although serial testing is important in interpreting low concentrations. For these values, a difference between ischemic heart disease (IHD) and dilated cardiomyopathy (dCMP) appears conceivable. METHODS Change in hsTnT was determined alongside with clinical variables in 41 patients with stable chronic systolic dysfunction at 2-week-, 1-month-, 2-month-, and 3-month-intervals (IHD n = 17; dCMP n = 24). RESULTS HsTnT was detectable in all patients. Individual hsTnT-variations at 2-week, 1-month, 2-month, and 3-month follow-up were 7.2, 22.6, 28.9, and 15.7%, respectively, corresponding to RCVs of 20.1, 62.5, 80.0, and 43.3%, respectively, for crude values. For log-normalised values, individual variations were 3.2, 2.8, 2.7, and 3.5%, respectively, corresponding to RCVs of 8.8, 7.9, 7.6, and 9.7%, respectively. The II was 0.03 to 0.33 according to interval. Aetiology of heart failure was not a consistent determinant of variation (p = 0.28; p = 0.07; p = 0.98; p = 0.03 for 2-week, 1-month, 2-month, and 3-month follow-up, respectively). CONCLUSION While short-term biological variation of hsTnT is low, it becomes relatively more important for intermediate follow-up. It is not related to aetiology of heart failure. The corresponding indices of individuality indicate high individuality of values.
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Affiliation(s)
- Lutz Frankenstein
- Department of Cardiology, Angiology, Pulmonology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
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