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Yuksek A, Acehan S, Satar S, Gulen M, Balcik M, Sevdimbas S, Ince C, Koca AN, Tas A. Predictors of 30-day mortality in patients diagnosed with hepatic encephalopathy on admission to the emergency department. Eur J Gastroenterol Hepatol 2023; 35:1402-1409. [PMID: 37695624 DOI: 10.1097/meg.0000000000002646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
BACKGROUND The aim of this study is to compare the laboratory findings and disease severity scores of patients diagnosed with hepatic encephalopathy (HE) in the emergency department (ED) to predict 30-day mortality. METHOD The patients over 18 years old and diagnosed HE in the ED of a tertiary hospital were included in the study. Demographic and clinical characteristics, laboratory parameters, predisposing causes and outcomes of the patients included in the study were recorded in the data form. Severity of liver disease was assessed by Child Pugh Score (CPS), End-stage liver disease model (MELD), MELD-Na and MELD-Lactate scores. RESULTS Two hundred fifty-four patients diagnosed with HE were included in the study. 59.1% of the patients were male. The mean age of the patients was 65.2 ± 12.6 years. The mortality rate of the patients was 47.2%. When the receiver operating characteristic (ROC) analysis, which determines the predictive properties of laboratory parameters and disease severity scores, was examined, the area under curve value of the MELD-Lactate score (0.858 95% CI 0.812-0.904, P < 0.001) was the highest. Binary logistic regression analysis for the estimation of patients' 30-day mortality showed that CPS and MELD-Lactate scores and blood ammonia and B-type natriuretic peptide levels were independent predictors of mortality. CONCLUSION According to the study data, MELD-Lactate and BNP levels in patients diagnosed with HE in the ED may help the clinician in the prediction of 30-day mortality in the early period.
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Affiliation(s)
- Ali Yuksek
- Hatay City Training and Research Hospital, Emergency Medicine Clinic, Hatay
| | - Selen Acehan
- Health Sciences University, Adana City Training and Research Hospital, Emergency Medicine Clinic, Adana
| | - Salim Satar
- Health Sciences University, Adana City Training and Research Hospital, Emergency Medicine Clinic, Adana
| | - Muge Gulen
- Health Sciences University, Adana City Training and Research Hospital, Emergency Medicine Clinic, Adana
| | - Muhammet Balcik
- Ministry of Health Kahramanmaras Necip Fazil City Hospital, Department of Emergency Medicine, Kahramanmaraş
| | - Sarper Sevdimbas
- Health Sciences University, Adana City Training and Research Hospital, Emergency Medicine Clinic, Adana
| | - Cagdas Ince
- Health Sciences University, Adana City Training and Research Hospital, Emergency Medicine Clinic, Adana
| | - Ahmet Naci Koca
- Ministry of Health Samandag Hospital, Department of Emergency Medicine, Hatay
| | - Adnan Tas
- Medipark Hospital, Department of Gastroenterology, Adana, Turkey
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Marinescu M, Oprea VD, Nechita A, Tutunaru D, Nechita LC, Romila A. The Use of Brain Natriuretic Peptide in the Evaluation of Heart Failure in Geriatric Patients. Diagnostics (Basel) 2023; 13:diagnostics13091512. [PMID: 37174904 PMCID: PMC10177186 DOI: 10.3390/diagnostics13091512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/11/2023] [Accepted: 04/14/2023] [Indexed: 05/15/2023] Open
Abstract
Heart failure is one of the main morbidity and mortality factors in the general population and especially in elderly patients. Thus, at the European level, the prevalence of heart failure is 1% in people under 55 years of age but increases to over 10% in people over 70 years of age. The particularities of the elderly patient, which make the management of heart failure difficult, are the presence of comorbidities, frailty, cognitive impairment and polypharmacy. However, elderly patients are under-represented in clinical trials on the diagnosis and treatment of heart failure. The need for complementary methods (biomarkers) for differential and early diagnosis of heart failure is becoming more and more evident, even in its subclinical stages. These methods need to have increased specificity and sensitivity and be widely available. Natriuretic peptides, in particular B-type natriuretic peptide (BNP) and its fraction NTproBNP, have gained an increasingly important role in the screening, diagnosis and treatment of heart failure in recent years.
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Affiliation(s)
- Mihai Marinescu
- Faculty of Medicine and Pharmacy, "Dunărea de Jos" University in Galați, 800216 Galați, Romania
- "St. Apostle Andrei" Clinical Emergency County Hospital, 800578 Galați, Romania
| | - Violeta Diana Oprea
- Faculty of Medicine and Pharmacy, "Dunărea de Jos" University in Galați, 800216 Galați, Romania
- "St. Apostle Andrei" Clinical Emergency County Hospital, 800578 Galați, Romania
| | - Aurel Nechita
- Faculty of Medicine and Pharmacy, "Dunărea de Jos" University in Galați, 800216 Galați, Romania
- "St. Ioan" Emergency Clinical Hospital for Children, 800487 Galați, Romania
| | - Dana Tutunaru
- Faculty of Medicine and Pharmacy, "Dunărea de Jos" University in Galați, 800216 Galați, Romania
- "St. Apostle Andrei" Clinical Emergency County Hospital, 800578 Galați, Romania
| | - Luiza-Camelia Nechita
- Faculty of Medicine and Pharmacy, "Dunărea de Jos" University in Galați, 800216 Galați, Romania
- "St. Apostle Andrei" Clinical Emergency County Hospital, 800578 Galați, Romania
| | - Aurelia Romila
- Faculty of Medicine and Pharmacy, "Dunărea de Jos" University in Galați, 800216 Galați, Romania
- "St. Apostle Andrei" Clinical Emergency County Hospital, 800578 Galați, Romania
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Skripnikova IA, Alikhanova NA, Yaralieva EK, Myagkova MA, Novikov VE, Vygodin VA, Drapkina OM. The level of N-terminal pro-brain natriuretic peptide depending on vascular wall condition and bone mass in postmenopausal women. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2020. [DOI: 10.15829/1728-8800-2020-2542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Aim. To assess the relationship of serum N-terminal pro-brain natriuretic peptide (NT-proBNP) levels with vascular wall condition and bone mineral density (BMD) in postmenopausal women.Material and methods. The cross-sectional study included 107 outpatients aged 45-82 years who signed informed consent. The inclusion criterion was a menopause during ≥1 year. The level of serum NT-proBNP was determined by electrochemiluminescence. BMD was assessed by dual energy x-ray absorptiometry. Intima-media thickness (IMT), the presence and number of atherosclerotic plaques were evaluated using carotid duplex scanning. Pulse wave velocity (PWV) and augmentation index were estimated by applanation tonometry. To assess 10-year cardiovascular risk, the SCORE high-risk charts were used. Using the Russian model of FRAX® score, 10-year fracture risk was assessed.Results. NT-proBNP level in women with postmenopause >10 years was significantly higher than in those with postmenopause <5 years — 98,7 vs 56,3 pg/ml (p<0,001), but there was no independent relationship according to the regression analysis. According to multivariate regression analysis adjusted for age, menopause duration, systolic blood pressure, hypercholesterolemia, smoking, elevated C-reactive protein and interleukin-6 levels, there were independent relationship between the following parameters: NT-proBNP and IMT (β=2,38, p<0,03), NT-proBNP and PWV (β=1,76, p<0,001). NT-proBNP level in patients with osteoporosis was significantly higher than in women with normal bone mass (p<0,01). A negative correlation was observed between NT-proBNP and BMD of the proximal femur (r=-0,26, p<0,05), while the relationship between BMD of the lumbar vertebrae (L1-L4) and NT-proBNP did not reach significance. In multivariate regression analysis, this relationship has not been confirmed. A positive correlation was obtained between cardiovascular risk (SCORE) and NT-proBNP levels (r=0,28, p<0,001). NT-proBNP levels did not differ in women with a high and low 10-year risk of both major osteoporotic fractures and femoral fractures.Conclusion. An independent relationship of NT-proBNP with vascular stiffness and preclinical atherosclerosis was demonstrated: IMT and PWV. This indicates the participation of NT-proBNP in the atherosclerosis development. The association of elevated NT-proBNP levels with osteoporosis is significant, but not independent, and is apparently related to other factors.
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Affiliation(s)
- I. A. Skripnikova
- National Medical Research Center for Therapy and Preventive Medicine
| | - N. A. Alikhanova
- National Medical Research Center for Therapy and Preventive Medicine
| | - E. K. Yaralieva
- National Medical Research Center for Therapy and Preventive Medicine
| | - M. A. Myagkova
- National Medical Research Center for Therapy and Preventive Medicine
| | - V. E. Novikov
- National Medical Research Center for Therapy and Preventive Medicine
| | - V. A. Vygodin
- National Medical Research Center for Therapy and Preventive Medicine
| | - O. M. Drapkina
- National Medical Research Center for Therapy and Preventive Medicine
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Vergaro G, Ghionzoli N, Innocenti L, Taddei C, Giannoni A, Valleggi A, Borrelli C, Senni M, Passino C, Emdin M. Noncardiac Versus Cardiac Mortality in Heart Failure With Preserved, Midrange, and Reduced Ejection Fraction. J Am Heart Assoc 2019; 8:e013441. [PMID: 31587602 PMCID: PMC6818034 DOI: 10.1161/jaha.119.013441] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background A thorough analysis of noncardiac determinants of mortality in heart failure (HF) is missing. Furthermore, evidence conflicts on the outcome of patients with HF and no or mild systolic dysfunction. We aimed to investigate the prevalence of noncardiac and cardiac causes of death in a cohort of chronic HF patients, covering the whole spectrum of systolic function. Methods and Results We enrolled 2791 stable HF patients, classified into HF with reduced ejection fraction (HFrEF; left ventricular ejection fraction [EF] <40%), HR with midrange EF (HFmrEF; left ventricular EF 41–49%), or HF with preserved EF (HFpEF; left ventricular EF ≥50%), and followed up for all‐cause, cardiac, and noncardiac mortality (adjudicated as due to cancer, sepsis, respiratory disease, renal disease, or other causes). Over follow‐up of 39 months, adjusted mortality was lower in HFpEF and HFmrEF versus HFrEF (hazard ratio: 0.75 [95% CI, 0.67–0.84], P<0.001 for HFpEF; hazard ratio: 0.78 [95% CI, 0.63–0.96], P=0.017 for HFmrEF). HFrEF had the highest rates of cardiac death, whereas noncardiac mortality was similar across left ventricular EF categories. Noncardiac causes accounted for 62% of deaths in HFpEF, 54% in HFmrEF and 35% in HFrEF; cancer was twice as frequent as a cause of death in HFpEF and HFmrEF versus HFrEF. Yearly rates of noncardiac death exceeded those of cardiac death since the beginning of follow‐up in HFpEF and HFmrEF. Conclusions Noncardiac death is a major determinant of outcome in stable HF, exceeding cardiac‐related mortality in HFpEF and HFmrHF. Comorbidities should be regarded as main therapeutic targets and objects of dedicated quality improvement initiatives, especially in patients with no or mild systolic dysfunction.
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Affiliation(s)
- Giuseppe Vergaro
- Institute of Life Sciences Scuola Superiore Sant'Anna Pisa Italy.,Division of Cardiology and Cardiovascular Medicine Fondazione Toscana Gabriele Monasterio Pisa Italy
| | - Nicolò Ghionzoli
- Division of Cardiology and Cardiovascular Medicine Fondazione Toscana Gabriele Monasterio Pisa Italy
| | - Lisa Innocenti
- Division of Cardiology and Cardiovascular Medicine Fondazione Toscana Gabriele Monasterio Pisa Italy
| | - Claudia Taddei
- Division of Cardiology and Cardiovascular Medicine Fondazione Toscana Gabriele Monasterio Pisa Italy
| | - Alberto Giannoni
- Institute of Life Sciences Scuola Superiore Sant'Anna Pisa Italy.,Division of Cardiology and Cardiovascular Medicine Fondazione Toscana Gabriele Monasterio Pisa Italy
| | - Alessandro Valleggi
- Division of Cardiology and Cardiovascular Medicine Fondazione Toscana Gabriele Monasterio Pisa Italy
| | - Chiara Borrelli
- Division of Cardiology and Cardiovascular Medicine Fondazione Toscana Gabriele Monasterio Pisa Italy
| | - Michele Senni
- Cardiology Division Cardiovascular Department Papa Giovanni XXIII Hospital Bergamo Italy
| | - Claudio Passino
- Institute of Life Sciences Scuola Superiore Sant'Anna Pisa Italy.,Division of Cardiology and Cardiovascular Medicine Fondazione Toscana Gabriele Monasterio Pisa Italy
| | - Michele Emdin
- Institute of Life Sciences Scuola Superiore Sant'Anna Pisa Italy.,Division of Cardiology and Cardiovascular Medicine Fondazione Toscana Gabriele Monasterio Pisa Italy
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Gerasimova EV, Popkova TV, Martynova AV, Markelova EI, Novikova DS, Kirillova IG. [Level of N-terminal fragment of brain natriuretic peptide progenitor and atherosclerotic damage of brachocephalic arteries in patients with rheumatoid arthritis with inefficiency and/or injurability of basic anti - inflammatory treatment]. TERAPEVT ARKH 2019; 91:34-39. [PMID: 32598674 DOI: 10.26442/00403660.2019.05.000286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Indexed: 11/22/2022]
Abstract
The high prognostic significance of the concentration of the N-terminal - pro-B-type natriuretic peptide (NT-proBNP) in the development of cardiovascular diseases (CVD) was identified for rheumatoid arthritis (RA) and general populations. AIM to investigate the significance of NT-proBNP level in patients (pts) with RA with the ineffectiveness and/or intolerance of basic anti - inflammatory therapy; compare the level of NT-proBNP with atherosclerotic lesion of the brachiocephalic arteries (BCA), traditional risk factors and inflammatory markers. MATERIALS AND METHODS The investigation enrolled 28 pts (24women/4men) with the lack of efficacy/resistance and/or intolerance of basic anti - inflammatory drugs (DMARDs); median age was 55 [46; 61] years, median disease duration 114 [60; 168] month; DAS28 6,2 [5.1; 7.0]; SDAI 35.0[23.9; 51.0], CDAI 30.0[21.0; 42.0], serum positivity for rheumatoid factor (RF) (100%)/anti - cyclic citrullinated peptide antibodies (ACCP) (86%). The study did not include RA pts with congestive heart failure. High incidence of traditional risk factors was found in RA pts: arterial hypertension - in 75%, dyslipidemia - 61%, smoking - 17%, overweight - 61%, family history of cardiovascular diseases - 36%, hypodynamia - 68%. Coronary artery disease was diagnosed in 11% RA pts. Lack of efficacy of 3 or more DMARDs was found in 46% of pts, intolerance to previous therapy with DMARDs - in 54% pts. 47% were receiving methotrexate (20 [18; 25] mg/week), 11% - leflunomide, 7% - sulfasalazine, 46% - glucocorticoids, 75% - non - steroidal anti - inflammatory drugs. The control group consisted of 20 healthy donors, comparable to pts by age and sex. Serum levels of of NT-proBNP were measured using electrochemiluminescence method Elecsys proBNP II (Roche Diagnostics, Switzerland). The determination of the intima - media thickness (IMT) BCA were assessed from duplex scanning. Atherosclerotic lesion of BCA was assessed by the presence of atherosclerotic plaque (IMT ≥1.2 mm). RESULTS NT-proBNP concentrations in RA pts proved to be higher (78.7 [41.4; 101.3] pg/ml) than those in the control group (55.3 [36.6; 67.3] pg/ml, p100 pg/ml - 1 group (n=6) and ≤100 pg/ml - 2 group (n=22). Groups of RA pts did not differ in gender, age, activity of RA, frequency of detection of traditional risk factors. Atherosclerotic lesion of the BCA was detected in 3 (50%) pts of the 1 group and in 8 (36%) pts of the 2 group (p>0.05). In RA pts the level of NT-proBNP correlated with age (r=0.39; p.
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Affiliation(s)
- E V Gerasimova
- V.A. Nasonova Scientific and Research Institute of Rheumatology
| | - T V Popkova
- V.A. Nasonova Scientific and Research Institute of Rheumatology
| | - A V Martynova
- V.A. Nasonova Scientific and Research Institute of Rheumatology
| | - E I Markelova
- V.A. Nasonova Scientific and Research Institute of Rheumatology
| | - D S Novikova
- V.A. Nasonova Scientific and Research Institute of Rheumatology
| | - I G Kirillova
- V.A. Nasonova Scientific and Research Institute of Rheumatology
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Vergaro G, Januzzi JL, Cohen Solal A, Aimo A, Arzilli C, Zyw L, Valleggi A, Giannoni A, Prontera C, Barison A, Poletti R, Gabutti A, Mammini C, Passino C, Emdin M. NT-proBNP prognostic value is maintained in elderly and very elderly patients with chronic systolic heart failure. Int J Cardiol 2019; 271:324-330. [PMID: 30223365 DOI: 10.1016/j.ijcard.2018.04.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 03/19/2018] [Accepted: 04/04/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Circulating concentrations of N-terminal fragment of the prohormone of brain natriuretic peptide (NT-proBNP) are influenced by age and common age-related comorbidities, such as renal dysfunction. Therefore, utility of NT-proBNP for prediction of prognosis in the aged has been questioned. We aimed to investigate the prognostic value of NT-proBNP across age classes in a cohort of patients with chronic systolic HF. METHODS AND RESULTS We enrolled 2364 consecutive outpatients with HF and left ventricular ejection fraction ≤50%. Patients were classified according to age quartiles, and a very elderly subgroup was identified, aged ≥85 years. After baseline assessment (including NT-proBNP testing), patients were followed-up for the composite of cardiovascular death, heart transplantation or ventricular assistance device implantation (primary outcome) and for all-cause death (secondary outcome). Patients in the fourth quartile (Q4, age ≥ 77 years, n = 638) and in the very elderly subgroup (age ≥ 85 years, n = 153), had higher NT-proBNP (p < .001 vs Q1). NT-proBNP was independently associated with primary and secondary outcome at 1- and 5-years follow-up in the whole population, as well as in Q4 and in the very elderly subgroup (all p < .05). Compared to the whole population, Q4 and very elderly had higher NT-proBNP cut-off for prediction of 1-year primary (4188 and 9729 ng/l, respectively vs 3710 ng/l) and secondary outcome (4296 and 7634 ng/l, respectively vs 3056 ng/l). CONCLUSIONS NT-proBNP predicts mortality in elderly and very elderly patients with chronic systolic HF, both at mid- and long-term follow-up. Higher NT-proBNP prognostic cut-off should be considered in the aged HF population.
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Affiliation(s)
- Giuseppe Vergaro
- Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy.
| | - James L Januzzi
- Massachusetts General Hospital and Harvard Clinical Research Institute, Boston, MA, USA
| | | | - Alberto Aimo
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Chiara Arzilli
- Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Luc Zyw
- Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Alessandro Valleggi
- Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | | | | | - Andrea Barison
- Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | | | | | - Chiara Mammini
- Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Claudio Passino
- Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Michele Emdin
- Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
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Liu H, Jayakumar S, Traboulsi M, Lee SS. Cirrhotic cardiomyopathy: Implications for liver transplantation. Liver Transpl 2017; 23:826-835. [PMID: 28407402 DOI: 10.1002/lt.24768] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 03/23/2017] [Indexed: 12/12/2022]
Abstract
The majority of patients on a waiting list for liver transplantation have end-stage liver disease. Because of the marked peripheral vasodilatation of end-stage cirrhosis that masks a latent myocardial dysfunction, cardiac abnormalities in the resting state are usually subclinical and escape the attention of physicians. However, when challenged, the systolic and diastolic contractile responses are attenuated. In addition to these contractile abnormalities, morphological changes, such as enlargement or hypertrophy of cardiac chambers, and electrophysiological repolarization changes, including a prolonged QT interval, can be observed. The constellation of these cardiac abnormalities is termed cirrhotic cardiomyopathy. Liver transplantation induces significant cardiovascular stress. Clamping of the inferior vena cava and portal vein, hemorrhage and blood/volume infusion, and ischemia/reperfusion all cause hemodynamic fluctuation. The changing cardiac preload and afterload status increases the cardiac workload, and thus, the previously subclinical ventricular dysfunction may manifest as overt heart failure during the operative and perioperative periods. Cardiac dysfunction contributes to morbidity and mortality associated with liver transplantation. Cardiovascular events are the third leading cause of death in liver recipients. However, because liver transplantation is the only definitive treatment for end-stage liver failure and also appears to reverse cardiac abnormalities, it is important to understand the challenges of the heart in liver transplantation. This review focuses on cardiac status before, during, and after liver transplantation. Liver Transplantation 23 826-835 2017 AASLD.
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Affiliation(s)
- Hongqun Liu
- Liver Unit, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Saumya Jayakumar
- Liver Unit, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Mouhieddin Traboulsi
- Division of Cardiology and Libin Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Samuel S Lee
- Liver Unit, Cumming School of Medicine, University of Calgary, Calgary, Canada
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Emdin M, Aimo A, Passino C, Vergaro G. Breathing Not Properly in the oldest old. Is brain natriuretic peptide a poor test for the diagnosis of heart failure in the elderly ?. Eur J Heart Fail 2017; 19:549-551. [DOI: 10.1002/ejhf.774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 12/21/2016] [Accepted: 12/21/2016] [Indexed: 11/11/2022] Open
Affiliation(s)
- Michele Emdin
- Institute of Life Sciences; Scuola Superiore Sant'Anna; Pisa Italy
- Cardiology and Cardiovascular Medicine Division; Fondazione Toscana Gabriele Monasterio; Via Moruzzi 1 56124 Pisa Italy
| | - Alberto Aimo
- Cardiology and Cardiovascular Medicine Division; Fondazione Toscana Gabriele Monasterio; Via Moruzzi 1 56124 Pisa Italy
| | - Claudio Passino
- Institute of Life Sciences; Scuola Superiore Sant'Anna; Pisa Italy
- Cardiology and Cardiovascular Medicine Division; Fondazione Toscana Gabriele Monasterio; Via Moruzzi 1 56124 Pisa Italy
| | - Giuseppe Vergaro
- Institute of Life Sciences; Scuola Superiore Sant'Anna; Pisa Italy
- Cardiology and Cardiovascular Medicine Division; Fondazione Toscana Gabriele Monasterio; Via Moruzzi 1 56124 Pisa Italy
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Senni M, D'Elia E, Emdin M, Vergaro G. Biomarkers of Heart Failure with Preserved and Reduced Ejection Fraction. Handb Exp Pharmacol 2016; 243:79-108. [PMID: 28181009 DOI: 10.1007/164_2016_86] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Biomarkers are increaingly being used in the management of heart failure not only for the purpose of screening, diagnosis, and risk stratification, but also as a guide to evaluate the response to treatment in the individual patient and as an entry criterion and/or a surrogate marker of efficacy in clinical trials testing novel drugs. In this chapter, we review the role of established biomarkers for heart failure management, according to the main classification of HF phenotypes, based on the measurement of left ventricular ejection fraction, including heart failure with reduced (<40%), preserved (≥50%), and, as recently proposed, mid-range (40-49%) ejection fraction.
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Affiliation(s)
- Michele Senni
- Department of Cardiology, Heart Failure and Heart Transplant Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy.
- CardioVascular Department, Ospedale Papa Giovanni XXIII Hospital, Bergamo, Italy.
| | - Emilia D'Elia
- CardioVascular Department, Ospedale Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Michele Emdin
- Life Science Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Giuseppe Vergaro
- Life Science Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Fondazione Toscana G. Monasterio, Pisa, Italy
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van der Vekens N, Decloedt A, de Clercq D, Ven S, Sys S, van Loon G. Atrial natriuretic peptide vs. N-terminal-pro-atrial natriuretic peptide for the detection of left atrial dilatation in horses. Equine Vet J 2014; 48:15-20. [DOI: 10.1111/evj.12362] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 09/18/2014] [Indexed: 11/26/2022]
Affiliation(s)
- N. van der Vekens
- Department of Large Animal Internal Medicine; Faculty of Veterinary Medicine; Ghent University; Belgium
| | - A. Decloedt
- Department of Large Animal Internal Medicine; Faculty of Veterinary Medicine; Ghent University; Belgium
| | - D. de Clercq
- Department of Large Animal Internal Medicine; Faculty of Veterinary Medicine; Ghent University; Belgium
| | - S. Ven
- Department of Large Animal Internal Medicine; Faculty of Veterinary Medicine; Ghent University; Belgium
| | - S. Sys
- Department of Large Animal Internal Medicine; Faculty of Veterinary Medicine; Ghent University; Belgium
| | - G. van Loon
- Department of Large Animal Internal Medicine; Faculty of Veterinary Medicine; Ghent University; Belgium
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Atrial natriuretic peptide suppresses Th17 development through regulation of cGMP-dependent protein kinase and PI3K–Akt signaling pathways. ACTA ACUST UNITED AC 2013; 181:9-16. [DOI: 10.1016/j.regpep.2012.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Revised: 09/29/2012] [Accepted: 12/17/2012] [Indexed: 11/18/2022]
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12
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Goldenberg D, Miller E, Perna M, Sattar N, Welsh P, Roman MJ, Salmon JE. Association of N-terminal pro-brain natriuretic peptide with cardiac disease, but not with vascular disease, in systemic lupus erythematosus. ACTA ACUST UNITED AC 2012; 64:316-7. [PMID: 21953476 DOI: 10.1002/art.33374] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Fabbian F, De Giorgi A, Portaluppi F, Zuliani G. Relationship between N-terminal pro-B-type natriuretic peptide plasma levels and renal function evaluated with different formulae in older adult subjects admitted because of dyspnea. Gerontology 2011; 58:50-5. [PMID: 21540563 DOI: 10.1159/000326243] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Accepted: 02/21/2011] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND N-terminal pro-B-type natriuretic peptide (NT-proBNP) plasma levels are associated with congestive heart failure severity, and are an important diagnostic tool for assessing patients with acute dyspnea. Reduced renal function increases NT-proBNP concentrations, and therefore it might be a confounding factor in chronic kidney disease (CKD) patients. OBJECTIVE The aim of the present study was to relate NT-proBNP plasma levels to different stages of renal function assessed with different methods in older adult subjects admitted because of dyspnea. METHODS NT-proBNP plasma levels (Roche Diagnostic, Mannheim, Germany) were measured in 134 older adult patients (age: 80 ± 6 years) admitted to hospital because of dyspnea. Anthropometrics, anamnesis, and biochemical data were collected. Glomerular filtration rate (GFR) was evaluated with different equations, the 4 variables MDRD equations (GFR(MDRD186), GFR(MDRD175)), Mayo Clinic Quadratic formula (GFR(MAYO)), and the new CKD-EPI formula (GFR(CKD-EPI)). Patients were classified into the five K/DOQI stages of CKD and median NT-proBNP values were calculated evaluating their relationship with GFR. RESULTS Median NT-proBNP values were better stratified into the five K/DOQI stages by GFR(MAYO) (stage 1 (n = 10) 1,640 pg/ml vs. stage 2 (n = 61) 2,371 pg/ml vs. stage 3 (n = 42) 3,815 pg/ml vs. stage 4 (n = 18) 6,320 pg/ml vs. stage 5 (n = 3) 7,256 pg/ml, p = 0.017). However, similar results were obtained with the other formulae. NT-proBNP was negatively correlated with GFR as evaluated with all the different formulae (r -0.25 to -0.29; all p < 0.01). Multiple regression analysis confirmed the independent association between LnNT-proBNP and GFR. CONCLUSION NT-proBNP plasma levels progressively increase with worsening of renal function, and appear to be related to the five K/DOQI stages of CKD. For this purpose, GFR assessed with the GFR(MAYO) formula appears to better stratify NT-proBNP in older adult subjects. Renal function should be considered when interpreting NT-proBNP levels in older adult patients admitted for dyspnoea.
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Affiliation(s)
- Fabio Fabbian
- Department of Clinical and Experimental Medicine, Section of Clinical Medicine, University Hospital St. Anna, Ferrara, Italy.
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Zhang W, Cao X, Chen D, Wang JW, Yang H, Wang W, Mohapatra S, Hellermann G, Kong X, Lockey RF, Mohapatra SS. Plasmid-encoded NP73-102 modulates atrial natriuretic peptide receptor signaling and plays a critical role in inducing tolerogenic dendritic cells. GENETIC VACCINES AND THERAPY 2011; 9:3. [PMID: 21219617 PMCID: PMC3025824 DOI: 10.1186/1479-0556-9-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Accepted: 01/10/2011] [Indexed: 11/10/2022]
Abstract
Background Atrial natriuretic peptide (ANP) is an important endogenous hormone that controls inflammation and immunity by acting on dendritic cells (DCs); however, the mechanism remains unclear. Objective We analyzed the downstream signaling events resulting from the binding of ANP to its receptor, NPRA, and sought to determine what aspects of this signaling modulate DC function. Methods We utilized the inhibitory peptide, NP73-102, to block NPRA signaling in human monocyte-derived DCs (hmDCs) and examined the effect on DC maturation and induced immune responses. The potential downstream molecules and interactions among these molecules involved in NPRA signaling were identified by immunoprecipitation and immunoblotting. Changes in T cell phenotype and function were determined by flow cytometry and BrdU proliferation ELISA. To determine if adoptively transferred DCs could alter the in vivo immune response, bone marrow-derived DCs from wild-type C57BL/6 mice were incubated with ovalbumin (OVA) and injected i.v. into C57BL/6 NPRA-/- knockout mice sensitized and challenged with OVA. Lung sections were stained and examined for inflammation and cytokines were measured in bronchoalveolar lavage fluid collected from parallel groups of mice. Results Inhibition of NPRA signaling in DCs primes them to induce regulatory T cells. Adoptive transfer of wild type DCs into NPRA-/- mice reverses the attenuation of lung inflammation seen in the NPRA-knockout model. NPRA is associated with TLR-2, SOCS3 and STAT3, and inhibiting NPRA alters expression of IL-6, IL-10 and TGF-β, but not IL-12. Conclusions Modulation of NPRA signaling in DCs leads to immune tolerance and TLR2 and SOCS3 are involved in this induction.
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Affiliation(s)
- Weidong Zhang
- Department of Internal Medicine, Division of Allergy and Immunology, University of South Florida College of Medicine, Tampa, FL 33612, USA
| | - Xueqin Cao
- Department of Molecular Medicine, University of South Florida College of Medicine, Tampa, FL 33612, USA
| | - Dongqing Chen
- Department of Internal Medicine, Division of Allergy and Immunology, University of South Florida College of Medicine, Tampa, FL 33612, USA
| | - Jia-Wang Wang
- James A. Haley Veterans Hospital Medical Center, Tampa, FL 33612, USA
| | - Hong Yang
- Department of Internal Medicine, Division of Endocrinology, University of South Florida College of Medicine, Tampa, FL 33612, USA
| | - Wenshi Wang
- Donald A. Adam Comprehensive Melanoma Research Center, Moffitt Cancer Center, 12902 Magnolia Drive, SRB-24324, Tampa, FL 33612, USA
| | - Subhra Mohapatra
- Department of Molecular Medicine, University of South Florida College of Medicine, Tampa, FL 33612, USA.,Department of Internal Medicine, Division of Translational Medicine, University of South Florida College of Medicine, Tampa, FL 33612, USA
| | - Gary Hellermann
- Department of Internal Medicine, Division of Allergy and Immunology, University of South Florida College of Medicine, Tampa, FL 33612, USA
| | - Xiaoyuan Kong
- Department of Internal Medicine, Division of Allergy and Immunology, University of South Florida College of Medicine, Tampa, FL 33612, USA
| | - Richard F Lockey
- Department of Internal Medicine, Division of Allergy and Immunology, University of South Florida College of Medicine, Tampa, FL 33612, USA.,James A. Haley Veterans Hospital Medical Center, Tampa, FL 33612, USA
| | - Shyam S Mohapatra
- Department of Internal Medicine, Division of Allergy and Immunology, University of South Florida College of Medicine, Tampa, FL 33612, USA.,James A. Haley Veterans Hospital Medical Center, Tampa, FL 33612, USA.,Department of Internal Medicine, Division of Translational Medicine, University of South Florida College of Medicine, Tampa, FL 33612, USA
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Fuchs H, Gailus-Durner V, Adler T, Aguilar-Pimentel JA, Becker L, Calzada-Wack J, Da Silva-Buttkus P, Neff F, Götz A, Hans W, Hölter SM, Horsch M, Kastenmüller G, Kemter E, Lengger C, Maier H, Matloka M, Möller G, Naton B, Prehn C, Puk O, Rácz I, Rathkolb B, Römisch-Margl W, Rozman J, Wang-Sattler R, Schrewe A, Stöger C, Tost M, Adamski J, Aigner B, Beckers J, Behrendt H, Busch DH, Esposito I, Graw J, Illig T, Ivandic B, Klingenspor M, Klopstock T, Kremmer E, Mempel M, Neschen S, Ollert M, Schulz H, Suhre K, Wolf E, Wurst W, Zimmer A, Hrabě de Angelis M. Mouse phenotyping. Methods 2010; 53:120-35. [PMID: 20708688 DOI: 10.1016/j.ymeth.2010.08.006] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Revised: 08/06/2010] [Accepted: 08/06/2010] [Indexed: 12/13/2022] Open
Abstract
Model organisms like the mouse are important tools to learn more about gene function in man. Within the last 20 years many mutant mouse lines have been generated by different methods such as ENU mutagenesis, constitutive and conditional knock-out approaches, knock-down, introduction of human genes, and knock-in techniques, thus creating models which mimic human conditions. Due to pleiotropic effects, one gene may have different functions in different organ systems or time points during development. Therefore mutant mouse lines have to be phenotyped comprehensively in a highly standardized manner to enable the detection of phenotypes which might otherwise remain hidden. The German Mouse Clinic (GMC) has been established at the Helmholtz Zentrum München as a phenotyping platform with open access to the scientific community (www.mousclinic.de; [1]). The GMC is a member of the EUMODIC consortium which created the European standard workflow EMPReSSslim for the systemic phenotyping of mouse models (http://www.eumodic.org/[2]).
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Affiliation(s)
- Helmut Fuchs
- Institute of Experimental Genetics, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764 München/Neuherberg, Germany
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Pimenta J, Paulo C, Gomes A, Silva S, Rocha-Gonçalves F, Bettencourt P. B-type natriuretic peptide is related to cardiac function and prognosis in hospitalized patients with decompensated cirrhosis. Liver Int 2010; 30:1059-66. [PMID: 20492497 DOI: 10.1111/j.1478-3231.2010.02266.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
BACKGROUND B-type natriuretic peptide (BNP) concentrations are high in cirrhosis, possibly related to volume status and cirrhotic cardiomyopathy. The prognostic significance of BNP in cirrhosis is unknown. AIMS We aimed to evaluate (i) the influence of haemodynamic parameters and volaemia, assessed by impedance cardiography (ICG), in BNP levels, (ii) the performance of BNP as a prognostic marker, in a cohort of cirrhotic patients. METHODS Patients consecutively hospitalized with decompensated cirrhosis during 1 year were evaluated. At admission, ICG and BNP measurements were performed in 83 patients (median age 56 years; median Child-Pugh score=10). The 70 patients discharged were followed for the occurrence of death within 6 months. RESULTS Median BNP levels were 130.3 (65.2-363.3) pg/ml. Independent BNP predictors in multivariate linear regression analysis were cardiac output, age and haemoglobin (R(2)=36.7%). The 24 patients with cardiac systolic dysfunction, defined by low cardiac output, had higher BNP concentrations than the other patients (230.8 vs 98.5 pg/ml, P=0.003). BNP levels above median were associated with an increased occurrence of death within 6 months of discharge (log rank P=0.023). Cardiac output and BNP were predictors of survival in univariate Cox regression analysis. Only BNP remained independently related to the outcome in multivariate analysis [hazard ratio=2.86 (1.11-7.38), P=0.03]. CONCLUSIONS BNP levels in cirrhosis reflect cardiac systolic function and non-cardiac variables that should be considered in their interpretation. BNP is an independent predictor of medium-term survival in advanced cirrhosis, suggesting its utility in risk stratification of decompensated cirrhotic patients.
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Affiliation(s)
- Joana Pimenta
- Department of Internal Medicine, Hospital S. João, Porto, Portugal.
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Santos-Araújo C, Roncon-Albuquerque R, Moreira-Rodrigues M, Henriques-Coelho T, Quelhas-Santos J, Faria B, Sampaio-Maia B, Leite-Moreira AF, Pestana M. Local modulation of the natriuretic peptide system in the rat remnant kidney. Nephrol Dial Transplant 2009; 24:1774-82. [PMID: 19145001 DOI: 10.1093/ndt/gfn719] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The natriuretic peptide (NP) system plays a central role in the renal adaptations to acute volume expansion. However, the modulation of the NP system in chronic renal insufficiency (CRI) remains to be elucidated. In the present study, we evaluated cardiac haemodynamics, plasma type-B natriuretic peptide (BNP) levels and the expression of natriuretic peptide receptor A (NPR-A) and NPR-C in the renal cortex (RC) and medulla (RM) of Sham and (3/4) nephrectomized ((3/4)nx) rats, up to 26 weeks after surgery. METHODS Male Wistar-Han rats (190-220 g; n = 49) were randomly assigned to (3/4)nx or Sham surgery. Two, 10 and 26 weeks after surgery, non-invasive blood pressure (BP) and left ventricular (LV) haemodynamics were performed, and urine and blood were collected for metabolic studies and plasma BNP determination. In addition, tissue samples from RC and RM were obtained for NPR-A and NPR-C quantification (RT-PCR and western blotting) as well as NPR-A immunodetection. RESULTS In (3/4)nx rats, the progressive interstitial fibrosis and tubular atrophy were accompanied by a time-dependent increase of BP and impaired natriuretic response to volume expansion (VE). This was accompanied in (3/4)nx rats by an early and time-dependent elevation of BNP circulating levels that was not associated with cardiac dysfunction or increased myocardial BNP gene expression. In (3/4)nx rats, NPR-A expression in the remnant RM was consistently reduced at 2, 10 and 26 weeks, and this was accompanied by an increase in NPR-C expression in the remnant RC from (3/4)nx rats. CONCLUSIONS BP elevation and compromised natriuretic response to VE in (3/4)nx rats is associated with increased circulating BNP levels in the absence of cardiac dysfunction. This is accompanied in (3/4)nx rats by both impaired NPR-A expression in the RM and upregulation of NPR-C in the RC suggesting a novel mechanism for NP resistance in CRI.
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Affiliation(s)
- Carla Santos-Araújo
- Unit of Research and Development of Nephrology, Department of Physiology, Faculty of Medicine, Porto, Portugal
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