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Zach DK, Schwegel N, Santner V, Winkelbauer L, Hoeller V, Kolesnik E, Gollmer J, Seggewiss H, Batzner A, Perl S, Wallner M, Reiter U, Rainer PP, Zirlik A, Ablasser K, Verheyen N. Low-grade systemic inflammation and left ventricular dysfunction in hypertensive compared to non-hypertensive hypertrophic cardiomyopathy. Int J Cardiol 2024; 399:131661. [PMID: 38158132 DOI: 10.1016/j.ijcard.2023.131661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/13/2023] [Accepted: 12/18/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Arterial hypertension (HTN) is associated with excess mortality in hypertrophic cardiomyopathy (HCM), but underlying mechanisms are largely elusive. The objective of this study was to investigate the association between HTN and markers of left ventricular (LV) dysfunction and low-grade systemic inflammation in a HCM cohort. METHODS This was a single-center cross-sectional case-control study comparing echocardiographic and plasma-derived indices of LV dysfunction and low-grade systemic inflammation between 30 adult patients with HCM and HTN (HTN+) and 30 sex- and age-matched HCM patients without HTN (HTN-). Echocardiographic measures were assessed using post-processing analyses by blinded investigators. RESULTS Mean age of the study population was 55.1 ± 10.4 years, 30% were women. Echocardiographic measures of systolic and diastolic dysfunction, including speckle-tracking derived parameters, did not differ between HTN+ and HTN-. Moreover, levels of N-terminal pro B-type natriuretic peptide were balanced between cases and controls. Compared with HTN-, HTN+ patients exhibited a higher white blood cell count [8.1 ± 1.8 109/l vs. 6.4 ± 1.6 109/l; p < 0.001] as well as higher plasma levels of interleukin-6 [2.8 pg/ml (2.0, 5.4) vs. 2.1 pg/ml (1.5, 3.4); p = 0.008] and high-sensitivity C-reactive protein [2.6 mg/l (1.4, 6.5) vs. 1.1 mg/l (0.9, 2.4); p = 0.004]. CONCLUSION This study demonstrates that HTN is associated with indices of low-grade systemic inflammation among HCM patients. Moreover, this analysis indicates that the adverse impact of HTN in HCM patients is a consequence of systemic effects rather than alterations of cardiac function, as measures of LV systolic and diastolic dysfunction did not differ between HTN+ and HTN-.
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Affiliation(s)
- David K Zach
- University Heart Center, Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
| | - Nora Schwegel
- University Heart Center, Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Viktoria Santner
- University Heart Center, Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Larissa Winkelbauer
- University Heart Center, Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Viktoria Hoeller
- University Heart Center, Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Ewald Kolesnik
- University Heart Center, Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Johannes Gollmer
- University Heart Center, Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Hubert Seggewiss
- Comprehensive Heart Failure Center and Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Angelika Batzner
- Comprehensive Heart Failure Center and Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Sabine Perl
- University Heart Center, Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Markus Wallner
- University Heart Center, Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Ursula Reiter
- Division of General Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Peter P Rainer
- University Heart Center, Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria; BioTechMed Graz, Graz, Austria
| | - Andreas Zirlik
- University Heart Center, Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Klemens Ablasser
- University Heart Center, Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Nicolas Verheyen
- University Heart Center, Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Großmann S, Geisreiter F, Schroll S. [Natriuretic peptides in intensive care medicine]. Med Klin Intensivmed Notfmed 2023; 118:527-533. [PMID: 37099150 DOI: 10.1007/s00063-023-01002-1] [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: 09/29/2022] [Revised: 01/18/2023] [Accepted: 03/06/2023] [Indexed: 04/27/2023]
Abstract
Natriuretic peptides must be interpreted in their clinical context, especially in intensive care medicine. This overview presents the diagnostic, prognostic, and therapeutic significance of B‑type natriuretic peptide (BNP) and N‑terminal pro B‑type natriuretic peptide (NT-proBNP) in patients with cardiac dysfunction, kidney failure, sepsis, pulmonary embolism, acute respiratory distress syndrome (ARDS), acute exacerbations of chronic obstructive pulmonary disease (AECOPD), and weaning from a respirator.
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Affiliation(s)
- Stefan Großmann
- Klinik für Pneumologie und konservative Intensivmedizin, Krankenhaus Barmherzige Brüder Regensburg, Prüfeninger Str. 86, 93049, Regensburg, Deutschland.
| | - Florian Geisreiter
- Klinik für Pneumologie und konservative Intensivmedizin, Krankenhaus Barmherzige Brüder Regensburg, Prüfeninger Str. 86, 93049, Regensburg, Deutschland
| | - Stephan Schroll
- Klinik für Pneumologie und konservative Intensivmedizin, Krankenhaus Barmherzige Brüder Regensburg, Prüfeninger Str. 86, 93049, Regensburg, Deutschland
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Hua LJ, Kong LX, Hu JN, Liu Q, Bao C, Liu C, Li ZL, Chen J, Xu SY. Perioperative Risk Factors for Post-operative Pneumonia after Type A Acute Aortic Dissection Surgery. Curr Med Sci 2023; 43:69-79. [PMID: 36334171 DOI: 10.1007/s11596-022-2659-4] [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: 03/16/2022] [Accepted: 04/18/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Type A acute aortic dissection (TAAAD) is a dangerous and complicated condition with a high death rate before hospital treatment. Patients who are fortunate to receive prompt surgical treatment still face high in-hospital mortality. A series of post-operative complications further affects the prognosis. Post-operative pneumonia (POP) also leads to great morbidity and mortality. This study aimed to identify the prevalence as well as the risk factors for POP in TAAAD patients and offer references for clinical decisions to further improve the prognosis of patients who survived the surgical procedure. METHODS The study enrolled 89 TAAAD patients who underwent surgical treatment in Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei province, China from December 2020 to July 2021 and analyzed the perioperative data and outcomes of these patients. Logistic regression analyses were used to identify the risk factors for POP. RESULTS In the study, 31.5% of patients developed POP. Patients with POP had higher proportions of severe oxygenation damage, pneumothorax, reintubation, tracheotomy, renal replacement therapy, arrhythmia, gastrointestinal bleeding, and longer duration of mechanical ventilation, fever, ICU stay, and length of stay (all with P<0.05). The in-hospital mortality was 2.3%. Smoking, preoperative white blood cells, and intraoperative transfusion were the independent risk factors for POP in TAAAD. CONCLUSION Patients who underwent TAAAD surgery suffered poorer outcomes when they developed POP. Furthermore, patients with risk factors should be treated with caution.
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Affiliation(s)
- Li-Juan Hua
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Pulmonary Diseases of Health Ministry, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Lu-Xia Kong
- Department of Respiratory and Critical Care Medicine, Taikang Tongji (Wuhan) Hospital, Wuhan, 430050, China
| | - Jian-Nan Hu
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Pulmonary Diseases of Health Ministry, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Qian Liu
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Pulmonary Diseases of Health Ministry, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Chen Bao
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Pulmonary Diseases of Health Ministry, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Chao Liu
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Pulmonary Diseases of Health Ministry, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Zi-Ling Li
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Pulmonary Diseases of Health Ministry, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jun Chen
- Department of Cardiovascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Shu-Yun Xu
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Pulmonary Diseases of Health Ministry, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Lindblad YT, Vavilis G, Chromek M, Quershi AR, Löwbeer C, Bárány P. Cardiac biomarkers in pediatric CKD-a prospective follow-up study. Pediatr Nephrol 2022; 37:3165-3175. [PMID: 35294668 PMCID: PMC9587089 DOI: 10.1007/s00467-022-05481-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 01/22/2022] [Accepted: 01/24/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND The N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitive cardiac-specific troponin T (hs-cTnT) are associated with abnormal cardiac structure and function and an increased risk of cardiovascular death in chronic kidney disease (CKD) patients. There is limited knowledge about these cardiac markers in pediatric CKD patients. METHODS Longitudinal levels of NT-proBNP and hs-cTnT were analyzed in 48 pediatric patients, 22 with CKD (GFR range 8.8-68 mL/min/1.73 m2) and 26 transplanted patients (CKD-T; GFR range 30-99 mL/min/1.73 m2). Follow-up was scheduled after 1 and 3 years. Longitudinal patterns and associations to kidney function, cardiovascular risk markers, and echocardiographic parameters were assessed. RESULTS High NT-proBNP was present in 27% of CKD and 11% of CKD-T patients. Similarly 32% of CKD and 8% of CKD-T patients had elevated hs-cTnT levels. In longitudinal multivariate analyses, high log NT-proBNP was associated with low GFR (β = - 0.01, p = 0.01) and elevated left ventricular mass index (LVMI; β = 0.02, p = 0.05). The strong association to LVMI remained when using GFR-adjusted NT-proBNP in similar analysis. Patients with left ventricular hypertrophy (LVH) also had higher NT-proBNP (235 [146-301] ng/L) than patients without LVH (86 [11-477] ng/L), p = 0.02. High hs-cTnT over-time was also associated with low GFR (β = - 0.007, p = 0.01) and a low cc-TDI e´/a´, indicating a worse LV diastolic function (β = - 0.09, p = 0.05). This association did not persist for GFR-adjusted hs-cTnT. CONCLUSIONS NT-proBNP and hs-cTnT are elevated in pediatric CKD and CKD-T patients. GFR-adjusted NT-proBNP was associated with longitudinal levels of elevated LVMI suggesting this might be a marker for early subclinical myocardial damage. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Ylva Tranæus Lindblad
- Divisions of Pediatrics, CLINTEC, Karolinska Institutet, Stockholm, Sweden. .,Department of Pediatrics, Karolinska University Hospital, Stockholm, Sweden. .,Huddinge BUMM, Paradistorget 4, 5tr, S-141 47, Huddinge, Sweden.
| | - Georgios Vavilis
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden ,Division of Coronary and Valvular Heart Disease, Karolinska University Hospital, Stockholm, Sweden
| | - Milan Chromek
- Divisions of Pediatrics, CLINTEC, Karolinska Institutet, Stockholm, Sweden ,Department of Pediatrics, Karolinska University Hospital, Stockholm, Sweden
| | | | - Christian Löwbeer
- Division of Clinical Chemistry, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden ,Department of Clinical Chemistry at SYNLAB Medilab, Täby, Sweden
| | - Peter Bárány
- Department of Pediatrics, Karolinska University Hospital, Stockholm, Sweden ,Renal Medicine, CLINTEC, Karolinska Institutet, Stockholm, Sweden
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Hein S, Furkel J, Knoll M, Aus dem Siepen F, Schönland S, Hegenbart U, Katus HA, Kristen AV, Konstandin MH. Impaired in vitro growth response of plasma-treated cardiomyocytes predicts poor outcome in patients with transthyretin amyloidosis. Clin Res Cardiol 2021; 110:579-590. [PMID: 33481097 PMCID: PMC8055573 DOI: 10.1007/s00392-020-01801-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/23/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Direct toxic effects of transthyretin amyloid in patient plasma upon cardiomyocytes are discussed. However, no data regarding the relevance of this putative effect for clinical outcome are available. In this monocentric prospective study, we analyzed cellular hypertrophy after phenylephrine stimulation in vitro in the presence of patient plasma and correlated the cellular growth response with phenotype and prognosis. METHODS AND RESULTS Progress in automated microscopy and image analysis allows high-throughput analysis of cell morphology. Using the InCell microscopy system, changes in cardiomyocyte's size after treatment with patient plasma from 89 patients suffering from transthyretin amyloidosis and 16 controls were quantified. For this purpose, we propose a novel metric that we named Hypertrophic Index, defined as difference in cell size after phenylephrine stimulation normalized to the unstimulated cell size. Its prognostic value was assessed for multiple endpoints (HTX: death/heart transplantation; DMP: cardiac decompensation; MACE: combined) using Cox proportional hazard models. Cells treated with plasma from healthy controls and hereditary transthyretin amyloidosis with polyneuropathy showed an increase in Hypertrophic Index after phenylephrine stimulation, whereas stimulation after treatment with hereditary cardiac amyloidosis or wild-type transthyretin patient plasma showed a significantly attenuated response. Hypertrophic Index was associated in univariate analyses with HTX (hazard ratio (HR) high vs low: 0.12 [0.02-0.58], p = 0.004), DMP: (HR 0.26 [0.11-0.62], p = 0.003) and MACE (HR 0.24 [0.11-0.55], p < 0.001). Its prognostic value was independent of established risk factors, cardiac TroponinT or N-terminal prohormone brain natriuretic peptide (NTproBNP). CONCLUSIONS Attenuated cardiomyocyte growth response after stimulation with patient plasma in vitro is an independent risk factor for adverse cardiac events in ATTR patients.
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Affiliation(s)
- Selina Hein
- Department of Cardiology, Angiology and Pulmonology, University Hospital Heidelberg, INF 410, 69120, Heidelberg, Germany.
| | - Jennifer Furkel
- Department of Cardiology, Angiology and Pulmonology, University Hospital Heidelberg, INF 410, 69120, Heidelberg, Germany
| | - Maximilian Knoll
- Department of Radiation Oncology, Heidelberg Ion-Beam Therapy Center (HIT), German Cancer Research Center, Heidelberg University Hospital (UKHD), Heidelberg, Germany
| | - Fabian Aus dem Siepen
- Department of Cardiology, Angiology and Pulmonology, University Hospital Heidelberg, INF 410, 69120, Heidelberg, Germany
| | - Stefan Schönland
- Department of Hematology, Oncology and Rheumatology, Heidelberg University, Heidelberg, Germany
| | - Ute Hegenbart
- Department of Hematology, Oncology and Rheumatology, Heidelberg University, Heidelberg, Germany
| | - Hugo A Katus
- Department of Cardiology, Angiology and Pulmonology, University Hospital Heidelberg, INF 410, 69120, Heidelberg, Germany
- DZHK (German Center for Cardiovascular Research), Site Heidelberg/Mannheim, Heidelberg, Germany
| | - Arnt V Kristen
- Department of Cardiology, Angiology and Pulmonology, University Hospital Heidelberg, INF 410, 69120, Heidelberg, Germany
| | - Mathias H Konstandin
- Department of Cardiology, Angiology and Pulmonology, University Hospital Heidelberg, INF 410, 69120, Heidelberg, Germany.
- DZHK (German Center for Cardiovascular Research), Site Heidelberg/Mannheim, Heidelberg, Germany.
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Hein SJ, Knoll M, Aus dem Siepen F, Furkel J, Schoenland S, Hegenbart U, Katus HA, Kristen AV, Konstandin M. Elevated interleukin-6 levels are associated with impaired outcome in cardiac transthyretin amyloidosis. World J Cardiol 2021; 13:55-67. [PMID: 33791079 PMCID: PMC7988596 DOI: 10.4330/wjc.v13.i3.55] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/19/2021] [Accepted: 02/12/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Elevated interleukin (IL)-6-levels have been described in familial variant transthyretin amyloidosis (ATTRv) associated polyneuropathy and heart failure. However, IL-6 in cardiac ATTR amyloidosis (ATTR-CM) and its prognostic value have not been investigated yet.
AIM We aim to study the correlation between IL-6 levels with clinical presentation (Gillmore-class) and outcome [heart transplantation or death (htx/death)], or the combined endpoint of cardiac decompensation or htx/death in ATTR-CM.
METHODS IL-6 levels of 106 ATTR-CM patients [54 wild-type ATTRwt, 52 ATTRv-CM], 15 asymptomatic carriers of ATTR mutations (aATTRv-CM) and 27 healthy donors were quantified using Luminex technology. Statistical analysis was performed using parametric survival regression models.
RESULTS We found that IL-6 levels from wild-type ATTR patients were significantly elevated compared to healthy controls, while aATTRv-CM carriers and ATTRv-CM patients did not show a significant difference. IL-6 levels showed significantly higher values in increasing Gillmore classes. Univariate analyses revealed association of low IL-6 levels with cardiac decompensation and htx/death [odds ratio: 0.26 (0.09-0.72), P = 0.01] and htx/death [odds ratio: 0.15 (0.04-0.58), P = 0.006]. However, in the multivariate model, no significant improvement of risk prediction was seen for IL-6, while established prognostic factors were significantly associated with outcome.
CONCLUSION Raised IL-6 levels correlate with clinical presentation and are associated with worse outcome in ATTR-CM but do not improve stratification in addition to established risk factors.
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Affiliation(s)
- Selina J Hein
- Department of Cardiology, Pneumology and Angiology, University Hospital Heidelberg, Heidelberg, BW 69120, Germany
| | - Maximilian Knoll
- Department of Radiation Oncology, Heidelberg Ion-Beam Therapy Center, German Cancer Research Center, University Hospital Heidelberg, Heidelberg, BW 69120, Germany
| | - Fabian Aus dem Siepen
- Department of Cardiology, Pneumology and Angiology, University Hospital Heidelberg, Heidelberg, BW 69120, Germany
| | - Jennifer Furkel
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, BW 69120, Germany
| | - Stefan Schoenland
- Department of Hematology, Oncology and Rheumatology, Amyloidosis Center, Heidelberg University Hospital, Heidelberg, BW 69120, Germany
| | - Ute Hegenbart
- Department of Hematology, Amyloidosis Center, Heidelberg University Hospital, Heidelberg, BW 69120, Germany
| | - Hugo A Katus
- Department of Cardiology, Medical University Hospital Heidelberg, Heidelberg, BW 69120, Germany
| | - Arnt V Kristen
- Department of Cardiology, Amyloidosis Center, University of Heidelberg, Heidelberg, BW 69120, Germany
| | - Mathias Konstandin
- Department of Cardiology, Medical University Hospital Heidelberg, Heidelberg, BW 69120, Germany
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Elevated interleukin-6 levels are associated with impaired outcome in cardiac transthyretin amyloidosis. World J Cardiol 2021. [DOI: 10.4330/wjcc.v13.i3.55] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Gergei I, Krämer BK, Scharnagl H, Stojakovic T, März W. Renal function, N-terminal Pro-B-Type natriuretic peptide, propeptide big-endothelin and patients with heart failure and preserved ejection fraction. Peptides 2019; 111:112-117. [PMID: 29684593 DOI: 10.1016/j.peptides.2018.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 04/04/2018] [Accepted: 04/09/2018] [Indexed: 12/28/2022]
Abstract
Renal dysfunction may limit the clinical application of NT-proBNP in the diagnosis of heart failure. In general practice, where echocardiography is not readily available, a biomarker for the diagnosis of a heart failure with preserved ejection fraction (HFpEF) would be useful. Since cardiac diseases frequently coincide with renal disease, there is a high need of valid risk stratification methods in patients affected with both. We therefore examined NT-proBNP and another biomarker, Big-Endothelin-1, as a marker of HFpEF in patients with CKD. NT-proBNP and Big-ET-1 were determined in 439 patients with HFpEF in the Ludwigshafen Risk and Cardiovascular Health (LURIC) study. NT-proBNP plasma level has shown an exponential increase with declining GFR, while Big-ET-1 plasma level increased only in a moderate and linear fashion. In patients without CKD, a NT-proBNP cut-off point at 250 pg/mL was suitable for the discrimination between HFpEF and patients without HF. When the GFR was less than 60 mL/min/1.73m2, the NT-proBNP cut-off point should be raised to 750 pg/mL. At a cutoff point at 0.85 fmol/L, Big-ET-1 allowed to distinguish patients with HFpEF from persons without HF, independently of GFR. In general, NT-proBNP is a good indicator of suspected heart failure. While for NT-proBNP different cut-off points have to be considered in the diagnosis of HFpEF, a single cut-off point of Big-ET-1 was appropriate in the diagnosis of HFpEF, regardless of the presence or absence of CKD. An additional measurement of Big-ET-1 improves the diagnosis of HFpEF in patients with chronic kidney disease.
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Affiliation(s)
- Ingrid Gergei
- Vth Department of Medicine, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
| | - Bernhard K Krämer
- Vth Department of Medicine, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Hubert Scharnagl
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Tatjana Stojakovic
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria.
| | - Winfried März
- Vth Department of Medicine, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria; Synlab Holding Deutschland GmbH, Augsburg and Mannheim, Germany
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Kaneko H, Neuss M, Schau T, Weissenborn J, Butter C. Interaction between renal function and percutaneous edge-to-edge mitral valve repair using MitraClip. J Cardiol 2017; 69:476-482. [DOI: 10.1016/j.jjcc.2016.03.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 02/16/2016] [Accepted: 03/04/2016] [Indexed: 11/26/2022]
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Schork A, Woern M, Kalbacher H, Voelter W, Nacken R, Bertog M, Haerteis S, Korbmacher C, Heyne N, Peter A, Häring HU, Artunc F. Association of Plasminuria with Overhydration in Patients with CKD. Clin J Am Soc Nephrol 2016; 11:761-769. [PMID: 26933188 PMCID: PMC4858495 DOI: 10.2215/cjn.12261115] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 01/27/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND OBJECTIVES Hypervolemia is a common feature of patients with CKD and associated with hypertension. Recent work has shown stimulation of sodium retention by urinary plasmin during nephrotic syndrome. However, it is unclear whether plasminuria plays a role in patients with stable CKD and non-nephrotic proteinuria. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS In this cross-sectional study, we analyzed the fluid status of 171 patients with CKD consecutively presenting to our outpatient clinic from 2012 to 2013 using bioimpedance spectroscopy (Body Composition Monitor [BCM]; Fresenius Medical Care, Germany) and its associations to the urinary excretion of plasminogen and plasmin from a spot urine sample. Two-electrode voltage clamp measurements were performed in Xenopus laevis oocytes expressing human epithelial sodium channel to investigate whether plasmin in concentrations found in urine can activate the channel. RESULTS Overhydration >5% and overhydration >10% of the extracellular volume were found in 29% and 17% of the patients, respectively, and overhydration was associated with edema, hypertension, higher stages of CKD, and proteinuria. Proteinuria was the strongest independent predictor for overhydration (+0.58 L/1.73 m(2) per 10-fold increase; P<0.001). Urinary excretion of plasmin(ogen) quantified by ELISA correlated strongly with proteinuria (r=0.87) and overhydration (r=0.47). Using a chromogenic substrate, active plasmin was found in 44% of patients and correlated with proteinuria and overhydration. Estimated urinary plasmin concentrations were in a range sufficient to activate epithelial sodium channel currents in vitro. In multivariable analysis, urinary excretion of plasmin(ogen) was associated with overhydration similar to proteinuria. CONCLUSIONS Hypervolemia in patients with CKD is strongly associated with proteinuria, even in the non-nephrotic range. Protein-rich urine contains high amounts of plasminogen and active plasmin, rendering plasminuria as a possible link between proteinuria and hypervolemia.
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Affiliation(s)
- Anja Schork
- Department of Internal Medicine, Division of Endocrinology, Diabetology, Vascular Disease, Nephrology and Clinical Chemistry, University Hospital of Tuebingen, Tuebingen, Germany
| | - Matthias Woern
- Department of Internal Medicine, Division of Endocrinology, Diabetology, Vascular Disease, Nephrology and Clinical Chemistry, University Hospital of Tuebingen, Tuebingen, Germany
| | - Hubert Kalbacher
- Interfacultary Institute of Biochemistry, University Tuebingen, Tuebingen, Germany; and
| | - Wolfgang Voelter
- Interfacultary Institute of Biochemistry, University Tuebingen, Tuebingen, Germany; and
| | - Regina Nacken
- Institute of Cellular and Molecular Physiology, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Marko Bertog
- Institute of Cellular and Molecular Physiology, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Silke Haerteis
- Institute of Cellular and Molecular Physiology, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Christoph Korbmacher
- Institute of Cellular and Molecular Physiology, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Nils Heyne
- Department of Internal Medicine, Division of Endocrinology, Diabetology, Vascular Disease, Nephrology and Clinical Chemistry, University Hospital of Tuebingen, Tuebingen, Germany
| | - Andreas Peter
- Department of Internal Medicine, Division of Endocrinology, Diabetology, Vascular Disease, Nephrology and Clinical Chemistry, University Hospital of Tuebingen, Tuebingen, Germany
| | - Hans-Ulrich Häring
- Department of Internal Medicine, Division of Endocrinology, Diabetology, Vascular Disease, Nephrology and Clinical Chemistry, University Hospital of Tuebingen, Tuebingen, Germany
| | - Ferruh Artunc
- Department of Internal Medicine, Division of Endocrinology, Diabetology, Vascular Disease, Nephrology and Clinical Chemistry, University Hospital of Tuebingen, Tuebingen, Germany
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Seven E, Husemoen LLN, Ibsen H, Friedrich N, Nauck M, Wachtell K, Linneberg A, Jeppesen JL. Higher serum concentrations of N-terminal pro-B-type natriuretic peptide associate with prevalent hypertension whereas lower associate with incident hypertension. PLoS One 2015; 10:e0117864. [PMID: 25658326 PMCID: PMC4320109 DOI: 10.1371/journal.pone.0117864] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 01/02/2015] [Indexed: 12/16/2022] Open
Abstract
Background The role of the natriuretic peptides (NPs) in hypertension is complex. Thus, a higher blood NP concentration is a robust marker of pressure-induced cardiac damage in patients with hypertension, whereas genetically elevated NP concentrations are associated with a reduced risk of hypertension and overweight individuals presumably at high risk of hypertension have lower NP concentrations. Objective To investigate the associations between serum N-terminal pro-B-type natriuretic peptide (NT-proBNP), used as a surrogate marker for active BNP, and prevalent as well as 5-year incident hypertension in a Danish general population sample. Methods Cross-sectional and prospective population-based study. Results At baseline, among 5,307 participants (51.3% women, mean age 46.0±7.9 years) with a complete set of data, we recorded 1,979 cases with prevalent hypertension (PHT). Among 2,389 normotensive participants at baseline with a complete set of data, we recorded 324 cases with incident hypertension (IHT) on follow-up 5 years later. In models adjusted for age, sex, lifestyle, social, dietary, anthropometric, pulmonic, lipid, metabolic and renal risk factors, as well as heart rate and baseline blood pressure (only incident model), one standard deviation increase in baseline log-transformed NT-proBNP concentrations was on one side associated with a 21% higher risk of PHT (odds ratio [OR]: 1.21 [95% confidence interval (CI): 1.13-1.30], P<0.001), and on the other side with a 14% lower risk of IHT (OR: 0.86 [95%CI:0.76-0.98], P = 0.020). Conclusions Higher serum concentrations of NT-proBNP associate with PHT whereas lower concentrations associate with IHT. This suggests that a lower amount of circulating BNP, resulting in diminished vasodilation and natriuresis, could be involved in the pathogenesis of hypertension in its early stages.
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Affiliation(s)
- Ekim Seven
- Department of Internal Medicine, Glostrup Hospital, University of Copenhagen, Glostrup, Denmark
- Research Centre for Prevention and Health, the Capital Region of Denmark, Glostrup, Denmark
- * E-mail:
| | - Lise L. N. Husemoen
- Research Centre for Prevention and Health, the Capital Region of Denmark, Glostrup, Denmark
| | - Hans Ibsen
- Department of Internal Medicine, Holbæk Hospital, University of Copenhagen, Holbæk, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Nele Friedrich
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Kristian Wachtell
- Department of Internal Medicine, Glostrup Hospital, University of Copenhagen, Glostrup, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Allan Linneberg
- Research Centre for Prevention and Health, the Capital Region of Denmark, Glostrup, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Experimental Research, Glostrup Hospital, Glostrup, Denmark
| | - Jørgen L. Jeppesen
- Department of Internal Medicine, Glostrup Hospital, University of Copenhagen, Glostrup, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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OUANES ISLEM, JALLOUL FATEN, AYED SAMIA, DACHRAOUI FAHMI, OUANES-BESBES LAMIA, FEKIH HASSEN MOHAMED, ELATROUS SOUHEIL, ABROUG FEKRI. N-terminal proB-type natriuretic peptide levels aid the diagnosis of left ventricular dysfunction in patients with severe acute exacerbations of chronic obstructive pulmonary disease and renal dysfunction. Respirology 2012; 17:660-6. [DOI: 10.1111/j.1440-1843.2012.02153.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
PURPOSE OF REVIEW This article reviews the genetics, biochemistry, and physiology of the natriuretic polypeptide family and their receptors; their roles in cardiac, bone, and lipid metabolism in children; and pharmacological agents that utilize the natriuretic polypeptide system. RECENT FINDINGS Clinically, measurements of circulating levels of the natriuretic polypeptides are useful diagnostic and prognostic markers of cardiovascular disease in children. The natriuretic polypeptides also play an important role in growth and body composition. Therapeutic application of the natriuretic polypeptide system may provide new treatments for cardiac, renal, bone, and metabolic disease in children. SUMMARY The natriuretic polypeptide system has promising clinical utility in the care of pediatric patients with cardiac, renal, bone, and metabolic disease.
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