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Rammos A, Bechlioulis A, Kalogeras P, Watson CJ, Salvo P, Lomonaco T, Kardakari O, Tripoliti EE, Goletsis Y, Fotiadis DI, Katsouras CS, Michalis LK, Naka KK. The Potential Role of Salivary NT-proBNP in Heart Failure. Life (Basel) 2023; 13:1818. [PMID: 37763222 PMCID: PMC10532738 DOI: 10.3390/life13091818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 08/20/2023] [Accepted: 08/23/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Serum natriuretic peptides (NPs) have an established role in heart failure (HF) diagnosis. Saliva NT-proBNP that may be easily acquired has been studied little. METHODS Ninety-nine subjects were enrolled; thirty-six obese or hypertensive with dyspnoea but no echocardiographic HF findings or raised NPs served as controls, thirteen chronic HF (CHF) patients and fifty patients with acute decompensated HF (ADHF) requiring hospital admission. Electrocardiogram, echocardiogram, 6 min walking distance (6MWD), blood and saliva samples, were acquired in all participants. RESULTS Serum NT-proBNP ranged from 60-9000 pg/mL and saliva NT-proBNP from 0.64-93.32 pg/mL. Serum NT-proBNP was significantly higher in ADHF compared to CHF (p = 0.007) and in CHF compared to controls (p < 0.05). There was no significant difference in saliva values between ADHF and CHF, or between CHF and controls. Saliva and serum levels were positively associated only in ADHF patients (R = 0.352, p = 0.012). Serum NT-proBNP was positively associated with NYHA class (R = 0.506, p < 0.001) and inversely with 6MWD (R = -0.401, p = 0.004) in ADHF. Saliva NT-proBNP only correlated with age in ADHF patients. CONCLUSIONS In the current study, saliva NT-proBNP correlated with serum values in ADHF patients, but could not discriminate between HF and other causes of dyspnoea. Further research is needed to explore the value of saliva NT-proBNP.
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Affiliation(s)
- Aidonis Rammos
- 2nd Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina & University Hospital of Ioannina, 45110 Ioannina, Greece (P.K.); (O.K.)
| | - Aris Bechlioulis
- 2nd Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina & University Hospital of Ioannina, 45110 Ioannina, Greece (P.K.); (O.K.)
| | - Petros Kalogeras
- 2nd Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina & University Hospital of Ioannina, 45110 Ioannina, Greece (P.K.); (O.K.)
| | - Chris J. Watson
- Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast BT9 7BL, UK;
- UCD Conway Institute, School of Medicine, University College Dublin, 4 Dublin, Ireland
| | - Pietro Salvo
- Institute of Clinical Physiology, Italian National Research Council, Via G. Moruzzi 1, 56124 Pisa, Italy
| | - Tommaso Lomonaco
- Department of Chemistry and Industrial Chemistry, University of Pisa, 56124 Pisa, Italy;
| | - Olga Kardakari
- 2nd Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina & University Hospital of Ioannina, 45110 Ioannina, Greece (P.K.); (O.K.)
| | - Evanthia E. Tripoliti
- Department of Biomedical Research, Institute of Molecular Biology and Biotechnology, FORTH, 45110 Ioannina, Greece (Y.G.); (D.I.F.)
| | - Yorgos Goletsis
- Department of Biomedical Research, Institute of Molecular Biology and Biotechnology, FORTH, 45110 Ioannina, Greece (Y.G.); (D.I.F.)
- Department of Economics, University of Ioannina, 45110 Ioannina, Greece
| | - Dimitris I. Fotiadis
- Department of Biomedical Research, Institute of Molecular Biology and Biotechnology, FORTH, 45110 Ioannina, Greece (Y.G.); (D.I.F.)
- Department of Economics, University of Ioannina, 45110 Ioannina, Greece
- Unit of Medical Technology and Intelligent Information Systems, University of Ioannina, 45110 Ioannina, Greece
| | - Christos S. Katsouras
- 2nd Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina & University Hospital of Ioannina, 45110 Ioannina, Greece (P.K.); (O.K.)
| | - Lampros K. Michalis
- 2nd Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina & University Hospital of Ioannina, 45110 Ioannina, Greece (P.K.); (O.K.)
| | - Katerina K. Naka
- 2nd Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina & University Hospital of Ioannina, 45110 Ioannina, Greece (P.K.); (O.K.)
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Wyszynski DF, Hernandez-Diaz S, Gordon-Dseagu V, Ramiro N, Koenen KC. Stress levels among an international sample of pregnant and postpartum women during the COVID-19 pandemic. J Matern Fetal Neonatal Med 2021; 35:7043-7051. [PMID: 34157929 DOI: 10.1080/14767058.2021.1936489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Stress is a complex condition that can have a profound effect on an individual's sense of wellbeing and their ability to live a happy and healthy life. COVID-19 and its associated stressors have the potential to disrupt numerous facets of our everyday lives. Pregnant and postpartum women are especially vulnerable to changes in the availability of routine health and social care services and of their support networks. The current study sought to explore stress levels and their influencers among an international cohort of pregnant and postpartum women during the COVID-19 pandemic. METHODS We conducted an anonymous, online, cross-sectional survey in 64 countries between May and June 2020. The survey was hosted on the Pregistry platform and made available in 12 languages, with respondents sought through a variety of social media platforms and parenting forums. In addition to levels of stress, we collected data related to demographics, COVID-19 exposure and worries, lifestyle changes, traditional and social media use, precautionary measures related to COVID-19, and mental health. RESULTS In total, 7185 women were included in our sample. We found statistically significant (p-value <0.05) reductions in stress score among older women (≥35 years of age), those either living with a partner or married, those who had graduated from college, and those with medical coverage. Higher stress scores were found among women who resided in Africa, Asia and the Pacific, the Middle East, and North America compared with those in Europe. When race and ethnicity were included in the model, black women were found to have higher stress compared to white women. Level of family and community support was inversely associated with level of stress. CONCLUSION Our study is one of the first to explore stress levels among pregnant and postpartum women during the COVID-19 pandemic. We found statistically significant differences in stress levels by age, education, marital status, region of residence, race/ethnicity and level of support. Understanding stress during the COVID-19 pandemic, and exploring ways to address it, will be key to contributing to the mental and physical health of expectant and new mothers, as well as their children, in both the short and long term.
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Affiliation(s)
| | | | | | | | - Karestan C Koenen
- Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Massachusetts General Hospital, Boston, MA, USA
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Rammos A, Bechlioulis A, Kalogeras P, Tripoliti EE, Goletsis Y, Kalivi A, Blathra E, Salvo P, Trivella MG, Lomonaco T, Fuoco R, Bellagambi F, Watson CJ, Errachid A, Fotiadis DI, Michalis LK, Naka KK. Salivary Biomarkers for Diagnosis and Therapy Monitoring in Patients with Heart Failure. A Systematic Review. Diagnostics (Basel) 2021; 11:824. [PMID: 34063278 PMCID: PMC8147430 DOI: 10.3390/diagnostics11050824] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/26/2021] [Accepted: 04/30/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to perform a systematic review on the potential value of saliva biomarkers in the diagnosis, management and prognosis of heart failure (HF). The correlation between saliva and plasma values of these biomarkers was also studied. PubMed was searched to collect relevant literature, i.e., case-control, cross-sectional studies that either compared the values of salivary biomarkers among healthy subjects and HF patients, or investigated their role in risk stratification and prognosis in HF patients. No randomized control trials were included. The search ended on 31st of December 2020. A total of 15 studies met the inclusion criteria. 18 salivary biomarkers were analyzed and the levels of all biomarkers studied were found to be higher in HF patients compared to controls, except for amylase, sodium, and chloride that had smaller saliva concentrations in HF patients. Natriuretic peptides are the most commonly used plasma biomarkers in the management of HF. Their saliva levels show promising results, although the correlation of saliva to plasma values is weakened in higher plasma values. In most of the publications, differences in biomarker levels between HF patients and controls were found to be statistically significant. Due to the small number of patients included, larger studies need to be conducted in order to facilitate the use of saliva biomarkers in clinical practice.
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Affiliation(s)
- Aidonis Rammos
- Second Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina and University Hospital of Ioannina, GR 45500 Ioannina, Greece; (A.R.); (A.B.); (P.K.); (A.K.); (E.B.); (L.K.M.)
| | - Aris Bechlioulis
- Second Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina and University Hospital of Ioannina, GR 45500 Ioannina, Greece; (A.R.); (A.B.); (P.K.); (A.K.); (E.B.); (L.K.M.)
| | - Petros Kalogeras
- Second Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina and University Hospital of Ioannina, GR 45500 Ioannina, Greece; (A.R.); (A.B.); (P.K.); (A.K.); (E.B.); (L.K.M.)
| | - Evanthia E. Tripoliti
- Department of Biomedical Research, Institute of Molecular Biology and Biotechnology, FORTH, GR 45110 Ioannina, Greece; (E.E.T.); (Y.G.); (D.I.F.)
| | - Yorgos Goletsis
- Department of Biomedical Research, Institute of Molecular Biology and Biotechnology, FORTH, GR 45110 Ioannina, Greece; (E.E.T.); (Y.G.); (D.I.F.)
- Department of Economics, University of Ioannina, GR 45110 Ioannina, Greece
| | - Anna Kalivi
- Second Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina and University Hospital of Ioannina, GR 45500 Ioannina, Greece; (A.R.); (A.B.); (P.K.); (A.K.); (E.B.); (L.K.M.)
| | - Effrosyni Blathra
- Second Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina and University Hospital of Ioannina, GR 45500 Ioannina, Greece; (A.R.); (A.B.); (P.K.); (A.K.); (E.B.); (L.K.M.)
| | - Pietro Salvo
- Institute of Clinical Physiology, Italian National Research Council, Via G. Moruzzi 1, PI 56124 Pisa, Italy; (P.S.); (M.G.T.)
| | - M. Giovanna Trivella
- Institute of Clinical Physiology, Italian National Research Council, Via G. Moruzzi 1, PI 56124 Pisa, Italy; (P.S.); (M.G.T.)
| | - Tommaso Lomonaco
- Department of Chemistry and Industrial Chemistry, University of Pisa, PI 56124 Pisa, Italy; (T.L.); (R.F.); (F.B.)
| | - Roger Fuoco
- Department of Chemistry and Industrial Chemistry, University of Pisa, PI 56124 Pisa, Italy; (T.L.); (R.F.); (F.B.)
| | - Francesca Bellagambi
- Department of Chemistry and Industrial Chemistry, University of Pisa, PI 56124 Pisa, Italy; (T.L.); (R.F.); (F.B.)
- Institute of Analytical Sciences (ISA)—UMR 5280, University Claude Bernard Lyon 1, 69100 Lyon, France;
| | - Chris J. Watson
- UCD Conway Institute, School of Medicine, University College Dublin, DUBLIN 4, Dublin, Ireland;
- Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast BT97BL, UK
| | - Abdelhamid Errachid
- Institute of Analytical Sciences (ISA)—UMR 5280, University Claude Bernard Lyon 1, 69100 Lyon, France;
| | - Dimitrios I. Fotiadis
- Department of Biomedical Research, Institute of Molecular Biology and Biotechnology, FORTH, GR 45110 Ioannina, Greece; (E.E.T.); (Y.G.); (D.I.F.)
- Department of Economics, University of Ioannina, GR 45110 Ioannina, Greece
- Unit of Medical Technology and Intelligent Information Systems, University of Ioannina, GR 45110 Ioannina, Greece
| | - Lampros K. Michalis
- Second Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina and University Hospital of Ioannina, GR 45500 Ioannina, Greece; (A.R.); (A.B.); (P.K.); (A.K.); (E.B.); (L.K.M.)
| | - Katerina K. Naka
- Second Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina and University Hospital of Ioannina, GR 45500 Ioannina, Greece; (A.R.); (A.B.); (P.K.); (A.K.); (E.B.); (L.K.M.)
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Harris KM, Jacoby DL, Lampert R, Soucier RJ, Burg MM. Psychological stress in heart failure: a potentially actionable disease modifier. Heart Fail Rev 2020; 26:561-575. [PMID: 33215323 DOI: 10.1007/s10741-020-10056-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2020] [Indexed: 10/24/2022]
Abstract
Psychological stress is common in patients with heart failure, due in part to the complexities of effective disease self-management and progressively worsening functional limitations, including frequent symptom exacerbations and hospitalizations. Emerging evidence suggests that heart failure patients who experience higher levels of stress may have a more burdensome disease course, with diminished quality of life and increased risk for adverse events, and that multiple behavioral and pathophysiological pathways are involved. Furthermore, the reduced quality of life associated with heart failure can serve as a life stressor for many patients. The purpose of this review is to summarize the current state of the science concerning psychological stress in patients with heart failure and to discuss potential pathways responsible for the observed effects. Key knowledge gaps are also outlined, including the need to understand patterns of exposure to various heart failure-related and daily life stressors and their associated effects on heart failure symptoms and pathophysiology, to identify patient subgroups at increased risk for stress exposure and disease-related consequences, and the effect of stress specifically for patients who have heart failure with preserved ejection fraction. Stress is a potentially modifiable factor, and addressing these gaps and advancing the science of stress in heart failure is likely to yield important insights about actionable pathways for improving patient quality of life and outcomes.
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Affiliation(s)
- Kristie M Harris
- Yale School of Medicine, Department of Internal Medicine, Section of Cardiovascular Medicine, New Haven, CT, USA. .,VA Connecticut Healthcare System, Department of Cardiology, West Haven, CT, USA.
| | - Daniel L Jacoby
- Yale School of Medicine, Department of Internal Medicine, Section of Cardiovascular Medicine, New Haven, CT, USA
| | - Rachel Lampert
- Yale School of Medicine, Department of Internal Medicine, Section of Cardiovascular Medicine, New Haven, CT, USA
| | - Richard J Soucier
- Saint Francis Hospital and Medical Center, Trinity Health of New England, Hartford, CT, USA
| | - Matthew M Burg
- Yale School of Medicine, Department of Internal Medicine, Section of Cardiovascular Medicine, New Haven, CT, USA.,VA Connecticut Healthcare System, Department of Cardiology, West Haven, CT, USA.,Yale School of Medicine, Department of Anesthesiology, New Haven, CT, USA
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Alhurani AS, Dekker R, Ahmad M, Miller J, Yousef KM, Abdulqader B, Salami I, Lennie TA, Randall DC, Moser DK. Stress, cognitive appraisal, coping, and event free survival in patients with heart failure. Heart Lung 2018; 47:205-210. [PMID: 29627073 DOI: 10.1016/j.hrtlng.2018.03.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 03/16/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To describe self-reported stress level, cognitive appraisal and coping among patients with heart failure (HF), and to examine the association of cognitive appraisal and coping strategies with event-free survival. METHODS This was a prospective, longitudinal, descriptive study of patients with chronic HF. Assessment of stress, cognitive appraisal, and coping was performed using Perceived Stress Scale, Cognitive Appraisal Health Scale, and Brief COPE scale, respectively. The event-free survival was defined as cardiac rehospitalization and all-cause death. RESULTS A total of 88 HF patients (mean age 58 ± 13 years and 53.4% male) participated. Linear and cox regression showed that harm/loss cognitive appraisal was associated with avoidant emotional coping (β = -0.28; 95% CI: -0.21 - 0.02; p = 0.02) and event free survival (HR = 0.53; 95% CI: 0.28 - 1.02; p = 0.05). CONCLUSIONS The cognitive appraisal of the stressors related to HF may lead to negative coping strategies that are associated with worse event-free survival.
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Affiliation(s)
| | | | | | | | | | - Basel Abdulqader
- California School for Health Sciences, Garden Grove, United States
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Tan C, Rossiter HB, Porszasz J, Bowen TS, Witte KK, Stringer WW, Casaburi R, Hansen JE. Reliability and Physiological Interpretation of Pulmonary Gas Exchange by "Circulatory Equivalents" in Chronic Heart Failure. J Am Heart Assoc 2018; 7:e008072. [PMID: 29588313 PMCID: PMC5907590 DOI: 10.1161/jaha.117.008072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 02/26/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Peak ratios of pulmonary gas-exchange to ventilation during exercise (V˙O2/V˙E and V˙CO2/V˙E, termed "circulatory equivalents") are sensitive to heart failure (HF) severity, likely reflecting low and/or poorly distributed pulmonary perfusion. We tested whether peak V˙O2/V˙E and V˙CO2/V˙E would: (1) distinguish HF patients from controls; (2) be independent of incremental exercise protocol; and (3) correlate with lactate threshold (LT) and ventilatory compensation point (VCP), respectively. METHODS AND RESULTS Twenty-four HF patients (61±11 years) with reduced ejection fraction (31±8%) and 11 controls (63±7 years) performed ramp-incremental cycle ergometry. Eighteen HF patients also performed slow (5±1 W/min), medium (9±4 W/min), and fast (19±6 W/min) ramps. Peak V˙O2/V˙E and V˙CO2/V˙E from X-Y plot, and LT and VCP from 9-panel plot, were determined by 2 independent, blinded, assessors. Peak V˙O2/V˙E (31.2±4.4 versus 41.8±4.8 mL/L; P<0.0001) and V˙CO2/V˙E (29.3±3.0 versus 36.9±4.0 mL/L; P<0.0001) were lower in HF than controls. Within individuals, there was no difference across 3 ramp rates in peak V˙O2/V˙E (P=0.62) or V˙CO2/V˙E (P=0.97). Coefficient of variation (CV) in peak V˙O2/V˙E was lower than for LT (5.1±2.1% versus 8.2±3.7%; P=0.014), and coefficient of variation in peak V˙CO2/V˙E was lower than for VCP (3.3±1.8% versus 8.7±4.2%; P<0.001). In all participants, peak V˙O2/V˙E was correlated with, but occurred earlier than, LT (r2=0.94; mean bias, -0.11 L/min), and peak V˙CO2/V˙E was correlated with, but occurred earlier than, VCP (r2=0.98; mean bias -0.08 L/min). CONCLUSIONS Peak circulatory equivalents during exercise are strongly associated with (but not identical to) LT and VCP. Peak circulatory equivalents are reliable, objective, effort-independent indices of gas-exchange abnormality in HF.
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Affiliation(s)
- Chunting Tan
- Department of Respiratory Medicine, Beijing Friendship Hospital Capital Medical University, Beijing, China
- Division of Respiratory and Critical Care Physiology and Medicine, Rehabilitation Clinical Trials Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
| | - Harry B Rossiter
- Division of Respiratory and Critical Care Physiology and Medicine, Rehabilitation Clinical Trials Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
- Faculty of Biological Sciences, University of Leeds, United Kingdom
| | - Janos Porszasz
- Division of Respiratory and Critical Care Physiology and Medicine, Rehabilitation Clinical Trials Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
| | - T Scott Bowen
- Faculty of Biological Sciences, University of Leeds, United Kingdom
| | - Klaus K Witte
- Faculty of Medicine, University of Leeds, United Kingdom
| | - William W Stringer
- Division of Respiratory and Critical Care Physiology and Medicine, Rehabilitation Clinical Trials Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
| | - Richard Casaburi
- Division of Respiratory and Critical Care Physiology and Medicine, Rehabilitation Clinical Trials Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
| | - James E Hansen
- Division of Respiratory and Critical Care Physiology and Medicine, Rehabilitation Clinical Trials Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA
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