1
|
Paranicova I, Bodnarova S, Trojova I, Hertelyova Z, Gulasová Z, Cimbolakova I, Genzor S, Joppa P, Tkacova R, Pobeha P. Long-term myocardial effects of noninvasive ventilation in patients with obesity hypoventilation syndrome. Respir Med 2024:107735. [PMID: 38977108 DOI: 10.1016/j.rmed.2024.107735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 06/24/2024] [Accepted: 07/05/2024] [Indexed: 07/10/2024]
Abstract
INTRODUCTION Chronic effects of noninvasive ventilation on myocardial function in patients with obesity hypoventilation syndrome (OHS) are scarcely understood. The aim of the present study was to evaluate the long-term effects of volume-targeted bilevel positive airway pressure ventilation (BiPAP) on cardiac parameters and myocardial biomarkers in patients with OHS. METHODS Clinically stable patients with OHS referred to the tertiary center for the initiation of long-term BiPAP therapy were consecutively enrolled. At baseline, all participants underwent overnight cardiorespiratory polygraphy. BiPAP therapy using volume-targeted spontaneous/timed mode delivered via an oro-nasal mask was initiated. Beat-to-beat noninvasive monitoring by impedance cardiography was used to assess heart function at baseline and after 3 and 12 months of BiPAP use. Serum troponin 1, N-Terminal Pro-B-Type Natriuretic Peptide (NT-ProBNP), tumor necrosis factor-alpha (TNF-α), and interleukin-6 (IL-6) were monitored. RESULTS Thirteen patients (10 men; mean age, 55.8 ± 9.8 years; mean body mass index of 47.8 ± 5.9 kg/m2) were recruited. From baseline to 3, and to 12 months of BiPAP use, left ventricular stroke volume (SV), ejection time (LVET), and ejection time index significantly increased (P = 0.030; P < 0.001; P = 0.003, respectively), while heart rate and systolic time ratio significantly decreased (P = 0.004; P = 0.034, respectively). Reductions in serum NT-proBNP, IL-6 and TNF-α were observed (P = 0.045; P = 0.018; P = 0.003, respectively). No significant changes in serum troponin were detected throughout the study. CONCLUSIONS The present findings of increased SV, in association with lengthening of LVET, reductions of NT-proBNP and reductions in circulatory inflammatory markers in patients with stable OHS and chronic moderate-to-severe daytime hypercapnia treated with BiPAP over 1 year support the role of this therapeutic mode in such patients.
Collapse
Affiliation(s)
- I Paranicova
- Department of Respiratory Medicine and Tuberculosis, P.J. Safarik University, Faculty of Medicine, and L. Pasteur University Hospital, Kosice, Slovakia
| | - S Bodnarova
- Department of Respiratory Medicine and Tuberculosis, P.J. Safarik University, Faculty of Medicine, and L. Pasteur University Hospital, Kosice, Slovakia
| | - I Trojova
- Department of Respiratory Medicine and Tuberculosis, P.J. Safarik University, Faculty of Medicine, and L. Pasteur University Hospital, Kosice, Slovakia
| | - Z Hertelyova
- Center of Clinical and Preclinical Research MEDIPARK, P.J. Safarik University, Faculty of Medicine, Kosice, Slovakia
| | - Z Gulasová
- Center of Clinical and Preclinical Research MEDIPARK, P.J. Safarik University, Faculty of Medicine, Kosice, Slovakia
| | - I Cimbolakova
- Institute of Physical Education and Sport, P.J. Safarik University, Kosice, Slovakia
| | - S Genzor
- Department of Respiratory Medicine and Tuberculosis, University Hospital Olomouc and Faculty of Medicine and Dentistry Palacky University, Olomouc, Czech Republic
| | - P Joppa
- Department of Respiratory Medicine and Tuberculosis, P.J. Safarik University, Faculty of Medicine, and L. Pasteur University Hospital, Kosice, Slovakia
| | - R Tkacova
- Department of Respiratory Medicine and Tuberculosis, P.J. Safarik University, Faculty of Medicine, and L. Pasteur University Hospital, Kosice, Slovakia
| | - P Pobeha
- Department of Respiratory Medicine and Tuberculosis, P.J. Safarik University, Faculty of Medicine, and L. Pasteur University Hospital, Kosice, Slovakia.
| |
Collapse
|
2
|
Prokopidis K, Irlik K, Ishiguchi H, Rietsema W, Lip GYH, Sankaranarayanan R, Isanejad M, Nabrdalik K. Natriuretic peptides and C-reactive protein in in heart failure and malnutrition: a systematic review and meta-analysis. ESC Heart Fail 2024. [PMID: 38850122 DOI: 10.1002/ehf2.14851] [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: 12/07/2023] [Revised: 04/16/2024] [Accepted: 04/24/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Heart failure (HF) and malnutrition exhibit overlapping risk factors, characterized by increased levels of natriuretic peptides and an inflammatory profile. The aim of this study was to compare the differences in plasma brain natriuretic peptide (BNP), N-terminal-pro B-type natriuretic peptide (NT-proBNP), and C-reactive protein (CRP) in patients with HF and malnutrition versus normal nutrition. METHODS From inception until July 2023, the databases, PubMed, Scopus, Web of Science, and Cochrane Library were searched. To examine the association among malnutrition [controlling nutritional status (CONUT) score ≥2; Geriatric Nutritional Risk Index (GNRI) score <92] with BNP, NT-proBNP and CRP in patients with HF, a meta-analysis using a random-effects model was conducted (CRD42023445076). RESULTS A significant association of GNRI with increased levels of BNP were demonstrated [mean difference (MD): 204.99, 95% confidence interval (CI) (101.02, 308.96, I2 = 88%, P < 0.01)], albeit no statistically significant findings were shown using CONUT [MD: 158.51, 95% CI (-1.78 to 318.79, I2 = 92%, P = 0.05)]. GNRI [MD: 1885.14, 95% CI (1428.76-2341.52, I2 = 0%, P < 0.01)] and CONUT [MD: 1160.05, 95% CI (701.04-1619.07, I2 = 0%, P < 0.01)] were associated with significantly higher levels of NT-proBNP. Patients with normal GNRI scores had significantly lower levels of CRP [MD: 0.50, 95% CI (0.12-0.88, I2 = 87%, P = 0.01)] whereas significantly higher levels of CRP were observed in those with higher CONUT [MD: 0.40, 95% CI (0.08-0.72, I2 = 88%, P = 0.01)]. Employing meta-regression, age was deemed a potential moderator between CRP and GNRI. CONCLUSIONS Normal nutrition scores in patients with HF are linked to lower BNP, NT-proBNP, and CRP levels compared with malnourished counterparts. Despite the significant link between CRP and malnutrition, their relationship may be influenced in older groups considering the sensitivity of GNRI due to ageing factors.
Collapse
Affiliation(s)
- Konstantinos Prokopidis
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Krzysztof Irlik
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Students' Scientific Association by the Department of Internal Medicine, Diabetology and Nephrology in Zabrze, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Hironori Ishiguchi
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | | | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Rajiv Sankaranarayanan
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- National Institute for Health and Care Research, London, UK
| | - Masoud Isanejad
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Katarzyna Nabrdalik
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Internal Medicine, Diabetology and Nephrology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| |
Collapse
|
3
|
Tepe M, Hakkoymaz H, Kilci Aİ, Gedik MS, Öztürk C, Gökçe MK, Aykan AÇ. Evaluation of the relationship between end-tidal carbon dioxide level and heart failure classification. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e20231499. [PMID: 38775509 PMCID: PMC11110962 DOI: 10.1590/1806-9282.20231499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/05/2024] [Indexed: 05/24/2024]
Abstract
OBJECTIVE Heart failure is a disease with cardiac dysfunction, and its morbidity and mortality are associated with the degree of dysfunction. The New York Heart Association classifies the heart failure stages based on the severity of symptoms and physical activity. End-tidal carbon dioxide refers to the level of carbon dioxide that a person exhales with each breath. End-tidal carbon dioxide levels can be used in many clinical conditions such as heart failure, asthma, and chronic obstructive pulmonary disease. The aim of the study was to reveal the relationship between end-tidal carbon dioxide levels and the New York Heart Association classification of heart failure stages. METHODS This study was conducted at Kahramanmaraş Sütçü İmam University Faculty of Medicine Adult Emergency Department between 01/03/2019 and 01/09/2019. A total of 80 patients who presented to the emergency department with a history of heart failure or were diagnosed with heart failure during admission were grouped according to the New York Heart Association classification of heart failure stages. The laboratory parameters, ejection fraction values, and end-tidal carbon dioxide levels of the patients were measured and recorded in the study forms. RESULTS End-tidal carbon dioxide levels and ejection fraction values were found to be significantly lower in the stage 4 group compared to the other groups. Furthermore, pro-B-type natriuretic peptide (BNP) values were found to be significantly higher in stage 4 group compared to the other groups. CONCLUSION It was concluded that end-tidal carbon dioxide levels could be used together with pro-BNP and ejection fraction values in determining the severity of heart failure.
Collapse
Affiliation(s)
- Murat Tepe
- Necip Fazıl City Hospital, Emergency Medicine – Kahramanmaraş, Turkey
| | - Hakan Hakkoymaz
- Kahramanmaraş Sütçü İmam University, Emergency Medicine – Kahramanmaraş, Turkey
| | - Ali İhsan Kilci
- Kahramanmaraş Sütçü İmam University, Emergency Medicine – Kahramanmaraş, Turkey
| | | | - Cebrail Öztürk
- Necip Fazıl City Hospital, Emergency Medicine – Kahramanmaraş, Turkey
| | | | - Ahmet Çağrı Aykan
- Kahramanmaraş Sütçü İmam University, Cardiology – Kahramanmaraş, Turkey
| |
Collapse
|
4
|
Eltayeb M, Squire I, Sze S. Biomarkers in heart failure: a focus on natriuretic peptides. Heart 2024; 110:809-818. [PMID: 37673654 DOI: 10.1136/heartjnl-2020-318553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Abstract
While progress has been made in the management of most aspects of cardiovascular disease, the incidence and prevalence of heart failure (HF) remains high. HF affects around a million people in the UK and has a worse prognosis than most cancers. Patients with HF are often elderly with complex comorbidities, making accurate assessment of HF challenging. A timely diagnosis and initiation of evidence-based treatments are key to prevent hospitalisation and improve outcomes in this population. Biomarkers have dramatically impacted the way patients with HF are evaluated and managed. The most studied biomarkers in HF are natriuretic peptides (NPs). Since their discovery in the 1980s, there has been an explosion of work in the field of NPs and they have become an important clinical tool used in everyday practice to guide diagnosis and prognostic assessment of patients with HF. In this article, we will review the physiology of NPs and study their biological effects. Then, we will discuss the role of NPs in the diagnosis, management and prognostication of patients with HF. We will also explore the role of NPs as a potential therapeutic agent.
Collapse
Affiliation(s)
- Mohamed Eltayeb
- Department of Cardiovascular Sciences and NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Iain Squire
- Department of Cardiovascular Sciences and NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Shirley Sze
- Department of Cardiovascular Sciences and NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| |
Collapse
|
5
|
Agarwal A, Beddhu S, Boucher R, Rao V, Ramkumar N, Rodan AR, Fang J, Wynne BM, Drakos SG, Hanff T, Cheung AK, Fang JC. Evaluation of renal sodium handling in heart failure with preserved ejection fraction: A pilot study. Physiol Rep 2024; 12:e16033. [PMID: 38740564 PMCID: PMC11090885 DOI: 10.14814/phy2.16033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/19/2024] [Accepted: 04/14/2024] [Indexed: 05/16/2024] Open
Abstract
The pathophysiology behind sodium retention in heart failure with preserved ejection fraction (HFpEF) remains poorly understood. We hypothesized that patients with HFpEF have impaired natriuresis and diuresis in response to volume expansion and diuretic challenge, which is associated with renal hypo-responsiveness to endogenous natriuretic peptides. Nine HFpEF patients and five controls received saline infusion (0.25 mL/kg/min for 60 min) followed by intravenous furosemide (20 mg or home dose) 2 h after the infusion. Blood and urine samples were collected at baseline, 2 h after saline infusion, and 2 h after furosemide administration; urinary volumes were recorded. The urinary cyclic guanosine monophosphate (ucGMP)/plasma B-type NP (BNP) ratio was calculated as a measure of renal response to endogenous BNP. Wilcoxon rank-sum test was used to compare the groups. Compared to controls, HFpEF patients had reduced urine output (2480 vs.3541 mL; p = 0.028), lower urinary sodium excretion over 2 h after saline infusion (the percentage of infused sodium excreted 12% vs. 47%; p = 0.003), and a lower baseline ucGMP/plasma BNP ratio (0.7 vs. 7.3 (pmol/mL)/(mg/dL)/(pg/mL); p = 0.014). Patients with HFpEF had impaired natriuretic response to intravenous saline and furosemide administration and lower baseline ucGMP/plasma BNP ratios indicating renal hypo-responsiveness to NPs.
Collapse
Affiliation(s)
- Adhish Agarwal
- Division of Nephrology and Hypertension, Department of Internal MedicineUniversity of UtahSalt Lake CityUtahUSA
- Medical Service, Veterans Affairs Salt Lake City Health Care SystemSalt Lake CityUtahUSA
| | - Srinivasan Beddhu
- Division of Nephrology and Hypertension, Department of Internal MedicineUniversity of UtahSalt Lake CityUtahUSA
- Medical Service, Veterans Affairs Salt Lake City Health Care SystemSalt Lake CityUtahUSA
| | - Robert Boucher
- Division of Nephrology and Hypertension, Department of Internal MedicineUniversity of UtahSalt Lake CityUtahUSA
| | - Veena Rao
- Yale University School of MedicineNew HavenConnecticutUSA
| | - Nirupama Ramkumar
- Division of Nephrology and Hypertension, Department of Internal MedicineUniversity of UtahSalt Lake CityUtahUSA
| | - Aylin R. Rodan
- Division of Nephrology and Hypertension, Department of Internal MedicineUniversity of UtahSalt Lake CityUtahUSA
- Medical Service, Veterans Affairs Salt Lake City Health Care SystemSalt Lake CityUtahUSA
- Department of Human GeneticsUniversity of UtahSalt Lake CityUtahUSA
| | - Jacob Fang
- Division of Cardiovascular Medicine, Department of Internal MedicineUniversity of UtahSalt Lake CityUtahUSA
| | - Brandi M. Wynne
- Division of Nephrology and Hypertension, Department of Internal MedicineUniversity of UtahSalt Lake CityUtahUSA
| | - Stavros G. Drakos
- Medical Service, Veterans Affairs Salt Lake City Health Care SystemSalt Lake CityUtahUSA
- Division of Cardiovascular Medicine, Department of Internal MedicineUniversity of UtahSalt Lake CityUtahUSA
| | - Thomas Hanff
- Medical Service, Veterans Affairs Salt Lake City Health Care SystemSalt Lake CityUtahUSA
- Division of Cardiovascular Medicine, Department of Internal MedicineUniversity of UtahSalt Lake CityUtahUSA
| | - Alfred K. Cheung
- Division of Nephrology and Hypertension, Department of Internal MedicineUniversity of UtahSalt Lake CityUtahUSA
| | - James C. Fang
- Division of Cardiovascular Medicine, Department of Internal MedicineUniversity of UtahSalt Lake CityUtahUSA
| |
Collapse
|
6
|
Assunção AS, Vidal M, Martins MJ, Girão AV, Loyez M, Caucheteur C, Mesquita-Bastos J, Costa FM, Pereira SO, Leitão C. Detection of NT-proBNP Using Optical Fiber Back-Reflection Plasmonic Biosensors. BIOSENSORS 2024; 14:173. [PMID: 38667166 PMCID: PMC11048293 DOI: 10.3390/bios14040173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 03/30/2024] [Accepted: 04/01/2024] [Indexed: 04/28/2024]
Abstract
Heart failure (HF) is a clinical entity included in cardiovascular diseases affecting millions of people worldwide, being a leading cause of hospitalization of older adults, and therefore imposing a substantial economic burden on healthcare systems. HF is characterized by dyspnea, fatigue, and edema associated with elevated blood levels of natriuretic peptides, such as N Terminal pro-B-type Natriuretic Peptide (NT-proBNP), for which there is a high demand for point of care testing (POCT) devices. Optical fiber (OF) biosensors offer a promising solution, capable of real-time detection, quantification, and monitoring of NT-proBNP concentrations in serum, saliva, or urine. In this study, immunosensors based on plasmonic uncladded OF tips were developed using OF with different core diameters (200 and 600 µm). The tips were characterized to bulk refractive index (RI), anddetection tests were conducted with NT-proBNP concentrations varying from 0.01 to 100 ng/mL. The 200 µm sensors showed an average total variation of 3.6 ± 2.5 mRIU, an average sensitivity of 50.5 mRIU/ng·mL-1, and a limit of detection (LOD) of 0.15 ng/mL, while the 600 µm sensors had a response of 6.1 ± 4.2 mRIU, a sensitivity of 102.8 mRIU/ng·mL-1, and an LOD of 0.11 ng/mL. Control tests were performed using interferents such as uric acid, glucose, and creatinine. The results show the potential of these sensors for their use in biological fluids.
Collapse
Affiliation(s)
- Ana Sofia Assunção
- i3N, Department of Physics, University of Aveiro, 3810-193 Aveiro, Portugal; (A.S.A.); (M.V.); (M.J.M.); (F.M.C.)
| | - Miguel Vidal
- i3N, Department of Physics, University of Aveiro, 3810-193 Aveiro, Portugal; (A.S.A.); (M.V.); (M.J.M.); (F.M.C.)
| | - Maria João Martins
- i3N, Department of Physics, University of Aveiro, 3810-193 Aveiro, Portugal; (A.S.A.); (M.V.); (M.J.M.); (F.M.C.)
| | - Ana Violeta Girão
- CICECO—Aveiro Institute of Materials, Department of Materials and Ceramics Engineering, University of Aveiro, 3810-193 Aveiro, Portugal;
| | - Médéric Loyez
- Electromagnetism and Telecommunication Department, University of Mons, 31 Bld Dolez, 7000 Mons, Belgium; (M.L.); (C.C.)
| | - Christophe Caucheteur
- Electromagnetism and Telecommunication Department, University of Mons, 31 Bld Dolez, 7000 Mons, Belgium; (M.L.); (C.C.)
| | - José Mesquita-Bastos
- Institute of Biomedicine—iBiMED, School of Health Sciences, University of Aveiro, 3810-193 Aveiro, Portugal;
| | - Florinda M. Costa
- i3N, Department of Physics, University of Aveiro, 3810-193 Aveiro, Portugal; (A.S.A.); (M.V.); (M.J.M.); (F.M.C.)
| | - Sónia O. Pereira
- i3N, Department of Physics, University of Aveiro, 3810-193 Aveiro, Portugal; (A.S.A.); (M.V.); (M.J.M.); (F.M.C.)
| | - Cátia Leitão
- i3N, Department of Physics, University of Aveiro, 3810-193 Aveiro, Portugal; (A.S.A.); (M.V.); (M.J.M.); (F.M.C.)
| |
Collapse
|
7
|
Pascual-Figal DA, Hernández-Vicente A, Pastor-Pérez F, Martínez-Sellés M, Solé-González E, Alvarez-García J, García-Pavía P, Varela-Román A, Sánchez PL, Delgado JF, Noguera-Velasco JA, Bayes-Genis A. N-terminal pro-B-type natriuretic peptide post-discharge monitoring in the management of patients with heart failure and preserved ejection fraction - a randomized trial: The NICE study. Eur J Heart Fail 2024; 26:776-784. [PMID: 38606524 DOI: 10.1002/ejhf.3222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/26/2024] [Accepted: 03/17/2024] [Indexed: 04/13/2024] Open
Abstract
AIMS There is a lack of specific studies assessing the impact of natriuretic peptide monitoring in the post-discharge management of patients with heart failure (HF) and preserved ejection fraction (HFpEF), throughout the vulnerable phase following acute HF hospitalization. The NICE study aims to assess the clinical benefit of incorporating N-terminal pro-B-type natriuretic peptide (NT-proBNP) into the post-discharge management of HFpEF patients. METHODS AND RESULTS Individuals admitted with HFpEF (left ventricular ejection fraction >50%) were included in a multicentre randomized controlled study employing an open-label design with event blinding (NCT02807168). Upon discharge, 157 patients were randomly allocated to either NT-proBNP monitoring (n = 79) or no access to NT-proBNP (control group, n = 78) during pre-scheduled visits at 2, 4 and 12 weeks. Clinical endpoints were evaluated at 6 months. The primary endpoint of HF rehospitalizations occurred in 12.1% patients, without significant differences observed between the NT-proBNP monitoring group (12.8%) and the control group (11.4%) (hazard ratio [HR] 1.15, 95% confidence interval [CI] 0.47-2.81, p = 0.760). Regarding secondary endpoints, the NT-proBNP monitoring group demonstrated a significantly lower risk of death (1.3% vs. 10.1%; HR 0.12, 95% CI 0.02-0.98; p = 0.048), whereas non-HF hospitalizations (12.8% vs. 19.0%, p = 0.171) and any adverse clinical event (26.9% vs. 36.7%, p = 0.17) did not reach statistical significance [Correction added on 29 April 2024, after first online publication: In the preceding sentence, "95% CI 0.02 - 0.09" has been corrected to "95% CI 0.02 - 0.98; p = 0.048" in this version.]. Awareness of NT-proBNP levels were associated with higher doses of diuretics and renin-angiotensin system inhibitors (angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers) in the NT-proBNP monitoring group. CONCLUSIONS Post-discharge monitoring of NT-proBNP in HFpEF patients did not exhibit an association with reduced rates of HF hospitalization in this study. Nonetheless, it appears to enhance global clinical management by optimizing medical therapies and contributing to improved overall survival.
Collapse
Affiliation(s)
- Domingo A Pascual-Figal
- Hospital Virgen de la Arrixaca, Universidad de Murcia, IMIB-Pascual Parrilla, Murcia, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- CIBERCV, Madrid, Spain
| | | | - Francisco Pastor-Pérez
- Hospital Virgen de la Arrixaca, Universidad de Murcia, IMIB-Pascual Parrilla, Murcia, Spain
- CIBERCV, Madrid, Spain
| | - Manuel Martínez-Sellés
- CIBERCV, Madrid, Spain
- Hospital Gregorio Marañón, Universidad Europea, Universidad Complutense, Madrid, Spain
| | | | | | - Pablo García-Pavía
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- CIBERCV, Madrid, Spain
- Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, Madrid, Spain
| | - Alfonso Varela-Román
- CIBERCV, Madrid, Spain
- Hospital Clínico Universitario de Santiago, A Coruña, Spain
| | - Pedro Luis Sánchez
- CIBERCV, Madrid, Spain
- Hospital Clinico de Salamanca-IBSAL, Universidad de Salamanca, Salamanca, Spain
| | - Juan F Delgado
- CIBERCV, Madrid, Spain
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Jose A Noguera-Velasco
- Hospital Virgen de la Arrixaca, Universidad de Murcia, IMIB-Pascual Parrilla, Murcia, Spain
| | - Antoni Bayes-Genis
- CIBERCV, Madrid, Spain
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| |
Collapse
|
8
|
Tian L, Li X, Zhang J, Tian X, Wan X, Yao D, Luo B, Huang Q, Deng Y, Xiang W. Influence of Body Mass Index on the Prognostic Value of N-Terminal Pro-B-Type Natriuretic Peptide Level in Chinese Patients with Heart Failure. Int Heart J 2024; 65:47-54. [PMID: 38296579 DOI: 10.1536/ihj.23-461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
N-terminal pro-B-type natriuretic peptide (NT-proBNP) is an essential biomarker for the prediction of heart failure (HF), but its prognostic ability across body mass index (BMI) categories needs to be clarified. Our study aimed to explore the association between BMI and NT-proBNP and assess the effect of BMI on the prognostic ability of NT-proBNP in Chinese patients with HF. We retrospectively analyzed clinical data from the FuWai Hospital HF Center in Beijing, China. According to the Chinese adult BMI standard, 1,508 patients with HF were classified into four groups: underweight (BMI < 18.5 kg/m2), normal weight (BMI 18.5-23.9 kg/m2, as a reference category), overweight (BMI 24-27.9 kg/m2), and obesity (BMI ≥ 28 kg/m2). NT-proBNP was examined for its prognostic role in adverse events as an endpoint. BMI was independently and negatively associated with NT-proBNP (β = -0.074; P < 0.001), and NT-proBNP levels tended to decrease as BMI increased across the different BMI categories. The results of our study differ from those of other studies of European-American populations. In this study, NT-proBNP was a weak predictor of a 4-year adverse prognosis in underweight patients (BMI < 18.5 kg/m2). In other BMI categories, NT-proBNP was an independent predictor of adverse events in HF. BMI and sex significantly affected the optimal threshold for NT-proBNP to predict the risk of adverse events. There is a negative correlation between BMI and NT-proBNP, and NT-proBNP independently predicts adverse HF events in patients with a BMI of ≥ 18.5 kg/m2. The optimal risk prediction cutoffs are lower in patients who are overweight and obese.
Collapse
Affiliation(s)
- Lingfang Tian
- Key Laboratory of Electronic and Information Engineering, State Ethnic Affairs Commission, Southwest Minzu University
| | - Xiangkui Li
- School of Computer Science and Technology, Harbin University of Science and Technology
| | - Jian Zhang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University
| | - Xinhui Tian
- Key Laboratory of Electronic and Information Engineering, State Ethnic Affairs Commission, Southwest Minzu University
| | - Xiaolei Wan
- Key Laboratory of Electronic and Information Engineering, State Ethnic Affairs Commission, Southwest Minzu University
| | - Dengju Yao
- School of Computer Science and Technology, Harbin University of Science and Technology
| | - Bin Luo
- Sichuan Huhui Software CO.,LTD
| | - Qinzhen Huang
- Key Laboratory of Electronic and Information Engineering, State Ethnic Affairs Commission, Southwest Minzu University
| | - Yansong Deng
- Key Laboratory of Electronic and Information Engineering, State Ethnic Affairs Commission, Southwest Minzu University
| | - Wei Xiang
- Key Laboratory of Electronic and Information Engineering, State Ethnic Affairs Commission, Southwest Minzu University
| |
Collapse
|
9
|
Watany MM, Elhosary MM. Clinical utility of circulating TWEAK and CD163 as biomarkers of iron-induced cardiac decompensation in transfusion dependent thalassemia major. Cytokine 2024; 173:156443. [PMID: 38000169 DOI: 10.1016/j.cyto.2023.156443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 08/30/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND AND AIM Tumor necrosis factor-like weak inducer of apoptosis (TWEAK) affects most of the cells involved in cardiac fibrosis like inflammatory cells, cardiomyocytes and fibroblasts. CD163, the receptor of TWEAK on the surface of type 2 macrophages, is shed into plasma upon macrophages activation. This work aimed to evaluate serum TWEAK and its decoy receptor CD163 as probable biomarkers to monitor myocardial iron overload (MIO) in transfusion dependent thalassemia major (TDTM) patients and to predict iron-induced cardiac decompensation (IICD). METHODS A total of 140 TDTM patients were enrolled. Patients were categorized into two groups; group I (n = 70) diagnosed with IICD while group II (n = 70) had no evidence of IICD. sTWEAK and sCD163 were quantitated utilizing Enzyme-linked-immunosorbent- assay. RESULTS sTWEAK was evidently lower in group I than group II (medians, 412 and 1052 pg/mL respectively). sCD163 was higher in group I than group II (medians, 615.5 and 323.5 ng/mL respectively). sTWEAK positively correlated with cardiac MRI-T2 mapping and ventricular ejection fractions and negatively correlated with B-Natriuretic peptide and cardiac troponin. An inverse relationship between TWEAK and CD163 was documented throughout the study. sTWEAK, sCD163 and TWEAK/CD163 ratio proved to be significant predictors of IICD in TDTM patients. TWEAK/CD163 ratio < 1.04 discriminated IICD in TDTM patients with 100 % clinical sensitivity and specificity. CONCLUSION Circulating TWEAK and CD163 appears to be promising biomarkers for monitoring MIO and predicting IICD in TDTM patients.
Collapse
Affiliation(s)
- Mona M Watany
- Clinical Pathology Department, Faculty of Medicine, Tanta University, Tanta 31527, Egypt.
| | - Marwa M Elhosary
- Msc Immunology from Tanta University, Faculty of Science, Tanta 31527, Egypt
| |
Collapse
|
10
|
Wu WJ, Chen R, Guo R, Yan JJ, Zhang CK, Wang YQ, Yan HX, Zhang YQ. A novel method for assessing cardiac function in patients with coronary heart disease based on wrist pulse analysis. Ir J Med Sci 2023; 192:2697-2706. [PMID: 36961673 PMCID: PMC10692030 DOI: 10.1007/s11845-023-03341-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/08/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND The timely assessment of B-type natriuretic peptide (BNP) marking chronic heart failure risk in patients with coronary heart disease (CHD) helps to reduce patients' mortality. OBJECTIVE To evaluate the potential of wrist pulse signals for use in the cardiac monitoring of patients with CHD. METHODS A total of 419 patients with CHD were assigned to Group 1 (BNP < 95 pg/mL, n = 249), 2 (95 < BNP < 221 pg/mL, n = 85), and 3 (BNP > 221 pg/mL, n = 85) according to BNP levels. Wrist pulse signals were measured noninvasively. Both the time-domain method and multiscale entropy (MSE) method were used to extract pulse features. Decision tree (DT) and random forest (RF) algorithms were employed to construct models for classifying three groups, and the models' performance metrics were compared. RESULTS The pulse features of the three groups differed significantly, suggesting different pathological states of the cardiovascular system in patients with CHD. Moreover, the RF models outperformed the DT models in performance metrics. Furthermore, the optimal RF model was that based on a dataset comprising both time-domain and MSE features, achieving accuracy, average precision, average recall, and average F1-score of 90.900%, 91.048%, 90.900%, and 90.897%, respectively. CONCLUSIONS The wrist pulse detection technology employed in this study is useful for assessing the cardiac function of patients with CHD.
Collapse
Affiliation(s)
- Wen-Jie Wu
- Department of Basic Medical Science, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong New District, Shanghai, 201203, China
| | - Rui Chen
- Department of Basic Medical Science, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong New District, Shanghai, 201203, China
| | - Rui Guo
- Department of Basic Medical Science, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong New District, Shanghai, 201203, China.
| | - Jian-Jun Yan
- Institute of Intelligent Perception and Diagnosis, School of Mechanical and Power Engineering, East China University of Science and Technology, 130 Meilong Road, Xuhui District, Shanghai, 200237, China
| | - Chun-Ke Zhang
- Department of Basic Medical Science, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong New District, Shanghai, 201203, China
| | - Yi-Qin Wang
- Department of Basic Medical Science, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong New District, Shanghai, 201203, China
| | - Hai-Xia Yan
- Department of Basic Medical Science, Shanghai University of Traditional Chinese Medicine, 1200 Cailun Road, Pudong New District, Shanghai, 201203, China
| | - Ye-Qing Zhang
- Department of Chinese Internal Medicine, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200071, China
| |
Collapse
|
11
|
Saghir H, Andaleeb H, Azhar A, Babu S, Fatima S, Mumtaz H. Diagnostic accuracy of plasma brain natriuretic peptide for evaluation of dyspnea NYHA-III and NYHA-IV in emergency department of tertiary care hospital. Ann Med Surg (Lond) 2023; 85:4739-4744. [PMID: 37811080 PMCID: PMC10553004 DOI: 10.1097/ms9.0000000000001093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/13/2023] [Indexed: 10/10/2023] Open
Abstract
Objective To determine the diagnostic accuracy of breathing not properly (BNP) for evaluation of dyspnea NYHA III and IV due to systolic heart failure in emergency department patients keeping echocardiography as the gold standard. Study design Cross-sectional validation study. Setting: Department of Accident and Emergency Duration of Study: 25 July 2022-25 January 2023. Subjects and methods A total of 115 of both sexes presenting with acute onset of dyspnea and having NYHA Class III and IV were included. Emergency nursing staff had immediately taken a single venous blood sample for BNP and creatinine levels and a 2D echo was performed. Ejection fraction was recorded, and the diagnosis of systolic heart failure on the basis of an ejection fraction, that is less than or equal to 45% was documented. Results The age range in this study was from 18 to 65 years, with a mean age of 49.147±8.73 years. Mean BNP levels were 139.452±84.04 pg/ml. Patients with NYHA class III was 67.8 and 32.2% belongs to NYHA class IV. BNP levels greater than or equal to 100 pg/ml diagnosed 76 (66.1%) and echocardiography has diagnosed 68 (59.1%) patients with heart failure. BNP levels greater than or equal to 100 pg/ml had shown sensitivity 94.1%, specificity 74.5%, and diagnostic accuracy 86%, positive predictive value 84.21%, negative prediction value 89.74%, likelihood positive ratio 3.68 and likelihood negative ratio was 0.08 in diagnosis of heart failure. Conclusion BNP estimation is a sensible and particular procedure for diagnosing CHF in patients who present to the emergency department with acute dyspnea and may add extra advantages to the administration of patients with congestive heart failure (CHF) in our population.
Collapse
Affiliation(s)
| | | | - Amina Azhar
- Cardiologist Government City Hospital, Talagang, Pakistan
| | - Sadia Babu
- Department of Wah Medical College, Rawalpindi
| | | | - Hassan Mumtaz
- Maroof International Hospital Public Health Scholar, Health Services Academy, Islamabad
| |
Collapse
|
12
|
Shahnazaryan S, Pepoyan S, Sisakian H. Heart Failure with Reduced Ejection Fraction: The Role of Cardiovascular and Lung Ultrasound beyond Ejection Fraction. Diagnostics (Basel) 2023; 13:2553. [PMID: 37568916 PMCID: PMC10416843 DOI: 10.3390/diagnostics13152553] [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: 06/26/2023] [Revised: 07/21/2023] [Accepted: 07/22/2023] [Indexed: 08/13/2023] Open
Abstract
Heart failure with reduced ejection fraction (HFrEF) is considered a major health care problem with frequent decompensations, high hospitalization and mortality rates. In severe heart failure (HF), the symptoms are refractory to medical treatment and require advanced therapeutic strategies. Early recognition of HF sub- and decompensation is the cornerstone of the timely treatment intensification and, therefore, improvement in the prognosis. Echocardiography is the gold standard for the assessment of systolic and diastolic functions. It allows one to obtain accurate and non-invasive measurements of the ventricular function in HF. In severely compromised HF patients, advanced cardiovascular ultrasound modalities may provide a better assessment of intracardiac hemodynamic changes and subclinical congestion. Particularly, cardiovascular and lung ultrasound allow us to make a more accurate diagnosis of subclinical congestion in HFrEF. The aim of this review was to summarize the advantages and limitations of the currently available ultrasound modalities in the ambulatory monitoring of patients with HFrEF.
Collapse
Affiliation(s)
| | | | - Hamayak Sisakian
- Clinic of General and Invasive Cardiology, “Heratsi” Hospital Complex #1, Yerevan State Medical University, 2 Koryun Street, Yerevan 375025, Armenia; (S.S.); (S.P.)
| |
Collapse
|
13
|
Núñez-Marín G, Iraola D, Lorenzo M, de la Espriella R, Villar S, Santas E, Miñana G, Sanchis J, Carratalá A, Miró Ò, Bayés-Genís A, Núñez J. An update on utilising brain natriuretic peptide for risk stratification, monitoring and guiding therapy in heart failure. Expert Rev Mol Diagn 2023:1-13. [PMID: 37216616 DOI: 10.1080/14737159.2023.2216386] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/04/2023] [Accepted: 05/16/2023] [Indexed: 05/24/2023]
Abstract
INTRODUCTION Heart failure (HF) is a dominant health problem with an overall poor prognosis. Natriuretic peptides (NPs) are upregulated in HF as a compensatory mechanism. They have extensively been used for diagnosis and risk stratification. AREAS COVERED This review addresses the history and physiology of NPs in order to understand their current role in clinical practice. It further provides a detailed and updated narrative review on the utility of those biomarkers for risk stratification, monitoring, and guiding therapy in HF. EXPERT OPINION NPs show excellent predictive ability in heart failure patients, both in acute and chronic settings. Understanding their pathophysiology and their modifications in specific situations is key for an adequate interpretation in specific clinical scenarios in which their prognostic value may be weaker or less well evaluated. To better promote risk stratification in HF, NPs should be integrated with other predictive tools to develop multiparametric risk models. Both inequalities of access to NPs and evidence caveats and limitations will need to be addressed by future research in the coming years.
Collapse
Affiliation(s)
- Gonzalo Núñez-Marín
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia. Valencia, Spain. Valencia, Spain
| | - Diego Iraola
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia. Valencia, Spain. Valencia, Spain
| | - Miguel Lorenzo
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia. Valencia, Spain. Valencia, Spain
| | - Rafael de la Espriella
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia. Valencia, Spain. Valencia, Spain
| | - Sandra Villar
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia. Valencia, Spain. Valencia, Spain
| | - Enrique Santas
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia. Valencia, Spain. Valencia, Spain
| | - Gema Miñana
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia. Valencia, Spain. Valencia, Spain
| | - Juan Sanchis
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia. Valencia, Spain. Valencia, Spain
| | - Arturo Carratalá
- Clinical Chemistry Department, Hospital Clínico Universitario, INCLIVA
| | - Òscar Miró
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Antoni Bayés-Genís
- Cardiology Department, Hospital Universitari Germas Trias i Pujol. Badalona, Spain
- CIBER Cardiovascular, Madrid, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de Valencia. Valencia, Spain. Valencia, Spain
- Emergency Department, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain
| |
Collapse
|
14
|
Prameswari HS, Putra ICS, Kamarullah W, Pranata R, Iqbal M, Karwiky G, Pramudyo M, Kusumawardhani NY, Achmad C, Martha JW, Akbar MR. Role of N-terminal pro-B type natriuretic peptide as a predictor of poor outcomes in patients with HFrEF receiving primary prevention implantable cardioverter-defibrillator therapy: a systematic review and dose-response meta-analysis. Open Heart 2023; 10:openhrt-2022-002225. [PMID: 36927867 PMCID: PMC10030785 DOI: 10.1136/openhrt-2022-002225] [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: 12/02/2022] [Accepted: 02/27/2023] [Indexed: 03/18/2023] Open
Abstract
INTRODUCTION Several studies have demonstrated that combining left ventricular ejection fraction and New York Heart Association functional class is insufficient for predicting risk of appropriate implantable cardioverter-defibrillator (ICD) shock in primary prevention candidates. Hence, our aim was to assess the relationship between N-terminal pro-B type natriuretic peptide (NT-pro BNP) along with appropriate ICD shock and all-cause mortality in order to improve the stratification process of patients with heart failure with reduced ejection fraction (HFrEF) being considered for primary preventive ICD therapy. METHODS A systematic literature search from several databases was conducted up until 9 June 2022. Studies were eligible if they investigated the relationship of NT-pro BNP with all-cause mortality and appropriate ICD shock. RESULTS This meta-analysis comprised nine studies with a total of 5117 participants. Our study revealed that high levels of NT-pro BNP were associated with all-cause mortality (HR=2.12 (95% CI=1.53 to 2.93); p<0.001, I2=78.1%, p<0.001 for heterogeneity) and appropriate ICD shock (HR=1.71 (95% CI=1.18 to 2.49); p<0.001, I2=43.4%, p=0.102 for heterogeneity). The adjusted HR for all-cause mortality and appropriate ICD shock increased by approximately 3% and 5%, respectively per 100 pg/mL increment pursuant to concentration-response model (Pnon-linearity <0.001). The curves became steeper after NT-pro BNP reached its inflection point (3000 pg/mL). CONCLUSION A positive concentration-dependent association between elevated NT-pro BNP levels along with the risk of all-cause mortality and appropriate ICD shock was found in patients with HFrEF with ICD. PROSPERO REGISTRATION NUMBER CRD42022339285.
Collapse
Affiliation(s)
- Hawani Sasmaya Prameswari
- Department of Cardiology and Vascular Medicine, University of Padjadjaran Faculty of Medicine, Bandung, Jawa Barat, Indonesia
| | - Iwan Cahyo Santosa Putra
- Department of Cardiology and Vascular Medicine, University of Padjadjaran Faculty of Medicine, Bandung, Jawa Barat, Indonesia
| | - William Kamarullah
- Department of Emergency, R Syamsudin SH Regional Public Hospital, Sukabumi, West Java, Indonesia
| | - Raymond Pranata
- Department of Cardiology and Vascular Medicine, University of Padjadjaran Faculty of Medicine, Bandung, Jawa Barat, Indonesia
| | - Mohammad Iqbal
- Department of Cardiology and Vascular Medicine, University of Padjadjaran Faculty of Medicine, Bandung, Jawa Barat, Indonesia
| | - Giky Karwiky
- Department of Cardiology and Vascular Medicine, University of Padjadjaran Faculty of Medicine, Bandung, Jawa Barat, Indonesia
| | - Miftah Pramudyo
- Department of Cardiology and Vascular Medicine, University of Padjadjaran Faculty of Medicine, Bandung, Jawa Barat, Indonesia
| | - Nuraini Yasmin Kusumawardhani
- Department of Cardiology and Vascular Medicine, University of Padjadjaran Faculty of Medicine, Bandung, Jawa Barat, Indonesia
- Department of Internal Medicine, University of Padjadjaran Faculty of Medicine, Bandung, Jawa Barat, Indonesia
| | - Chaerul Achmad
- Department of Cardiology and Vascular Medicine, University of Padjadjaran Faculty of Medicine, Bandung, Jawa Barat, Indonesia
| | - Januar Wibawa Martha
- Department of Cardiology and Vascular Medicine, University of Padjadjaran Faculty of Medicine, Bandung, Jawa Barat, Indonesia
| | - Mohammad Rizki Akbar
- Department of Cardiology and Vascular Medicine, University of Padjadjaran Faculty of Medicine, Bandung, Jawa Barat, Indonesia
| |
Collapse
|
15
|
Bayes-Genis A, Cediel G, Domingo M, Codina P, Santiago E, Lupón J. Biomarkers in Heart Failure with Preserved Ejection Fraction. Card Fail Rev 2022; 8:e20. [PMID: 35815256 PMCID: PMC9253965 DOI: 10.15420/cfr.2021.37] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/02/2022] [Indexed: 12/23/2022] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous disorder developing from multiple aetiologies with overlapping pathophysiological mechanisms. HFpEF diagnosis may be challenging, as neither cardiac imaging nor physical examination are sensitive in this situation. Here, we review biomarkers of HFpEF, of which the best supported are related to myocardial stretch and injury, including natriuretic peptides and cardiac troponins. An overview of biomarkers of inflammation, extracellular matrix derangements and fibrosis, senescence, vascular dysfunction, anaemia/iron deficiency and obesity is also provided. Finally, novel biomarkers from -omics technologies, including plasma metabolites and circulating microRNAs, are outlined briefly. A cardiac-centred approach to HFpEF diagnosis using natriuretic peptides seems reasonable at present in clinical practice. A holistic approach including biomarkers that provide information on the non-cardiac components of the HFpEF syndrome may enrich our understanding of the disease and may be useful in classifying HFpEF phenotypes or endotypes that may guide patient selection in HFpEF trials.
Collapse
Affiliation(s)
- Antoni Bayes-Genis
- Heart Institute, University Hospital Germans Trias i Pujol, Badalona, Spain; Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain; CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Germán Cediel
- Heart Institute, University Hospital Germans Trias i Pujol, Badalona, Spain; CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Mar Domingo
- Heart Institute, University Hospital Germans Trias i Pujol, Badalona, Spain; CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Pau Codina
- Heart Institute, University Hospital Germans Trias i Pujol, Badalona, Spain; CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Evelyn Santiago
- Heart Institute, University Hospital Germans Trias i Pujol, Badalona, Spain; CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Josep Lupón
- Heart Institute, University Hospital Germans Trias i Pujol, Badalona, Spain; CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
16
|
Wang C, Taskinen JH, Segersvärd H, Immonen K, Kosonen R, Tolva JM, Mäyränpää MI, Kovanen PT, Olkkonen VM, Sinisalo J, Laine M, Tikkanen I, Lakkisto P. Alterations of Cardiac Protein Kinases in Cyclic Nucleotide-Dependent Signaling Pathways in Human Ischemic Heart Failure. Front Cardiovasc Med 2022; 9:919355. [PMID: 35783854 PMCID: PMC9247256 DOI: 10.3389/fcvm.2022.919355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 05/13/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives Impaired protein kinase signaling is a hallmark of ischemic heart disease (IHD). Inadequate understanding of the pathological mechanisms limits the development of therapeutic approaches. We aimed to identify the key cardiac kinases and signaling pathways in patients with IHD with an effort to discover potential therapeutic strategies. Methods Cardiac kinase activity in IHD left ventricle (LV) and the related signaling pathways were investigated by kinomics, transcriptomics, proteomics, and integrated multi-omics approach. Results Protein kinase A (PKA) and protein kinase G (PKG) ranked on top in the activity shift among the cardiac kinases. In the IHD LVs, PKA activity decreased markedly compared with that of controls (62% reduction, p = 0.0034), whereas PKG activity remained stable, although the amount of PKG protein increased remarkably (65%, p = 0.003). mRNA levels of adenylate cyclases (ADCY 1, 3, 5, 9) and cAMP-hydrolysing phosphodiesterases (PDE4A, PDE4D) decreased significantly, although no statistically significant alterations were observed in that of PKGs (PRKG1 and PRKG2) and guanylate cyclases (GUCYs). The gene expression of natriuretic peptide CNP decreased remarkably, whereas those of BNP, ANP, and neprilysin increased significantly in the IHD LVs. Proteomics analysis revealed a significant reduction in protein levels of “Energy metabolism” and “Muscle contraction” in the patients. Multi-omics integration highlighted intracellular signaling by second messengers as the top enriched Reactome pathway. Conclusion The deficiency in cAMP/PKA signaling pathway is strongly implicated in the pathogenesis of IHD. Natriuretic peptide CNP could be a potential therapeutic target for the modulation of cGMP/PKG signaling.
Collapse
Affiliation(s)
- Chunguang Wang
- Minerva Foundation Institute for Medical Research, Biomedicum Helsinki 2 U, Helsinki, Finland
- *Correspondence: Chunguang Wang
| | - Juuso H. Taskinen
- Minerva Foundation Institute for Medical Research, Biomedicum Helsinki 2 U, Helsinki, Finland
| | - Heli Segersvärd
- Minerva Foundation Institute for Medical Research, Biomedicum Helsinki 2 U, Helsinki, Finland
| | - Katariina Immonen
- Minerva Foundation Institute for Medical Research, Biomedicum Helsinki 2 U, Helsinki, Finland
| | - Riikka Kosonen
- Minerva Foundation Institute for Medical Research, Biomedicum Helsinki 2 U, Helsinki, Finland
| | - Johanna M. Tolva
- Transplantation Laboratory, Department of Pathology, University of Helsinki, Helsinki, Finland
| | - Mikko I. Mäyränpää
- Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Petri T. Kovanen
- Atherosclerosis Research Laboratory, Wihuri Research Institute, Helsinki, Finland
| | - Vesa M. Olkkonen
- Minerva Foundation Institute for Medical Research, Biomedicum Helsinki 2 U, Helsinki, Finland
- Department of Anatomy, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Juha Sinisalo
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mika Laine
- Minerva Foundation Institute for Medical Research, Biomedicum Helsinki 2 U, Helsinki, Finland
- Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ilkka Tikkanen
- Minerva Foundation Institute for Medical Research, Biomedicum Helsinki 2 U, Helsinki, Finland
- Abdominal Center, Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Päivi Lakkisto
- Minerva Foundation Institute for Medical Research, Biomedicum Helsinki 2 U, Helsinki, Finland
- Clinical Chemistry and Hematology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Päivi Lakkisto
| |
Collapse
|
17
|
Nath M, Romaine SP, Koekemoer A, Hamby S, Webb TR, Nelson CP, Castellanos‐Uribe M, Papakonstantinou M, Anker SD, Lang CC, Metra M, Zannad F, Filippatos G, van Veldhuisen DJ, Cleland JG, Ng LL, May ST, Marelli‐Berg F, Voors AA, Timmons JA, Samani NJ. Whole blood transcriptomic profiling identifies molecular pathways related to cardiovascular mortality in heart failure. Eur J Heart Fail 2022; 24:1009-1019. [PMID: 35570197 PMCID: PMC9546237 DOI: 10.1002/ejhf.2540] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 03/08/2022] [Accepted: 03/18/2022] [Indexed: 12/01/2022] Open
Abstract
AIMS Chronic heart failure (CHF) is a systemic syndrome with a poor prognosis and a need for novel therapies. We investigated whether whole blood transcriptomic profiling can provide new mechanistic insights into cardiovascular (CV) mortality in CHF. METHODS AND RESULTS Transcriptome profiles were generated at baseline from 944 CHF patients from the BIOSTAT-CHF study, of whom 626 survived and 318 died from a CV cause during a follow-up of 21 months. Multivariable analysis, including adjustment for cell count, identified 1153 genes (6.5%) that were differentially expressed between those that survived or died and strongly related to a validated clinical risk score for adverse prognosis. The differentially expressed genes mainly belonged to five non-redundant pathways: adaptive immune response, proteasome-mediated ubiquitin-dependent protein catabolic process, T-cell co-stimulation, positive regulation of T-cell proliferation, and erythrocyte development. These five pathways were selectively related (RV coefficients >0.20) with seven circulating protein biomarkers of CV mortality (fibroblast growth factor 23, soluble ST2, adrenomedullin, hepcidin, pentraxin-3, WAP 4-disulfide core domain 2, and interleukin-6) revealing an intricate relationship between immune and iron homeostasis. The pattern of survival-associated gene expression matched with 29 perturbagen-induced transcriptome signatures in the iLINCS drug-repurposing database, identifying drugs, approved for other clinical indications, that were able to reverse in vitro the molecular changes associated with adverse prognosis in CHF. CONCLUSION Systematic modelling of the whole blood protein-coding transcriptome defined molecular pathways that provide a link between clinical risk factors and adverse CV prognosis in CHF, identifying both established and new potential therapeutic targets.
Collapse
Affiliation(s)
- Mintu Nath
- Department of Cardiovascular SciencesUniversity of Leicester and NIHR Leicester Biomedical Research CentreGlenfield Hospital, LeicesterUK
- Institute of Applied Health SciencesUniversity of AberdeenAberdeenUK
| | - Simon P.R. Romaine
- Department of Cardiovascular SciencesUniversity of Leicester and NIHR Leicester Biomedical Research CentreGlenfield Hospital, LeicesterUK
| | - Andrea Koekemoer
- Department of Cardiovascular SciencesUniversity of Leicester and NIHR Leicester Biomedical Research CentreGlenfield Hospital, LeicesterUK
| | - Stephen Hamby
- Department of Cardiovascular SciencesUniversity of Leicester and NIHR Leicester Biomedical Research CentreGlenfield Hospital, LeicesterUK
| | - Thomas R. Webb
- Department of Cardiovascular SciencesUniversity of Leicester and NIHR Leicester Biomedical Research CentreGlenfield Hospital, LeicesterUK
| | - Christopher P. Nelson
- Department of Cardiovascular SciencesUniversity of Leicester and NIHR Leicester Biomedical Research CentreGlenfield Hospital, LeicesterUK
| | | | - Manolo Papakonstantinou
- Department of Cardiovascular SciencesUniversity of Leicester and NIHR Leicester Biomedical Research CentreGlenfield Hospital, LeicesterUK
| | - Stefan D. Anker
- German Centre for Cardiovascular Research (DZHK) Partner Site Berlin, Charité – Universitätsmedizin BerlinBerlinGermany
| | - Chim C. Lang
- Division of Molecular and Clinical Medicine, School of MedicineUniversity of DundeeDundeeUK
| | - Marco Metra
- Department of Medical and Surgical Specialties, Radiological Sciences and Public HealthUniversity of BresciaBresciaItaly
| | - Faiez Zannad
- Clinical Investigation Center 1433, Centre Hospitalier Regional et Universitaire de NancyVandoeuvre les NancyFrance
| | | | - Dirk J. van Veldhuisen
- Department of Cardiology, University of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - John G. Cleland
- National Heart and Lung Institute, Royal Brompton and Harefield Hospitals, Imperial College, London, UK and Robertson Centre for Biostatistics and Clinical TrialsUniversity of GlasgowGlasgowUK
| | - Leong L. Ng
- Department of Cardiovascular SciencesUniversity of Leicester and NIHR Leicester Biomedical Research CentreGlenfield Hospital, LeicesterUK
| | - Sean T. May
- School of BiosciencesUniversity of Nottingham, Sutton Bonington CampusLoughboroughUK
| | | | - Adriaan A. Voors
- Department of Cardiology, University of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - James A. Timmons
- Barts & The London School of MedicineQueen Mary University of LondonLondonUK
- Augur Precision Medicine LtdStirling University Innovation ParkUK
| | - Nilesh J. Samani
- Department of Cardiovascular SciencesUniversity of Leicester and NIHR Leicester Biomedical Research CentreGlenfield Hospital, LeicesterUK
| |
Collapse
|
18
|
Bergamasco A, Luyet-Déruaz A, Gollop ND, Moride Y, Qiao Q. Epidemiology of Asymptomatic Pre-heart Failure: a Systematic Review. Curr Heart Fail Rep 2022; 19:146-156. [PMID: 35355204 PMCID: PMC9177493 DOI: 10.1007/s11897-022-00542-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2022] [Indexed: 10/28/2022]
Abstract
PURPOSE OF REVIEW To quantify the prevalence of asymptomatic pre-heart failure (pre-HF), progression to more severe stages, and associated mortality. RECENT FINDINGS A systematic review was conducted between 01 January 2010 and 12 March 2020 (PROSPERO: CRD42020176141). Data of interest included prevalence, disease progression, and mortality rates. In total, 1030 sources were identified, of which, 12 reported on pre-HF (using the ACC/AHA definition for stage B HF) and were eligible. Prevalence estimates of pre-HF ranged from 11 to 42.7% (10 sources) with higher estimates found in the elderly, in patients with hypertension, and in men. Three studies reported on disease progression with follow-up ranging from 13 months to 7 years. The incidence of symptomatic HF (HF/advanced HF) ranged from 0.63 to 9.8%, and all-cause mortality from 1.6 to 5.4%. Further research is required to investigate whether early detection and intervention can slow or stop the progression from asymptomatic to symptomatic HF.
Collapse
Affiliation(s)
| | | | - Nicholas D Gollop
- Boehringer Ingelheim International GmbH, Ingelheim Am Rhein, Germany
| | - Yola Moride
- YolaRX Consultants, Paris, France
- YolaRX Consultants, Montreal, Canada
- Faculty of Pharmacy, Université de Montréal, Montreal, Canada
- Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Qing Qiao
- Boehringer Ingelheim International GmbH, Ingelheim Am Rhein, Germany
| |
Collapse
|
19
|
Vergaro G, Gentile F, Aimo A, Januzzi JL, Richards AM, Lam CSP, de Boer RA, Meems LMG, Latini R, Staszewsky L, Anand IS, Cohn JN, Ueland T, Gullestad L, Aukrust P, Brunner-La Rocca HP, Bayes-Genis A, Lupón J, Yoshihisa A, Takeishi Y, Egstrup M, Gustafsson I, Gaggin HK, Eggers KM, Huber K, Gamble GD, Ling LH, Leong KTG, Yeo PSD, Ong HY, Jaufeerally F, Ng TP, Troughton R, Doughty RN, Devlin G, Lund M, Giannoni A, Passino C, Emdin M. Circulating levels and prognostic cut-offs of sST2, hs-cTnT, and NT-proBNP in women vs. men with chronic heart failure. ESC Heart Fail 2022; 9:2084-2095. [PMID: 35510529 PMCID: PMC9288762 DOI: 10.1002/ehf2.13883] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/17/2022] [Accepted: 03/02/2022] [Indexed: 11/11/2022] Open
Abstract
Aims To define plasma concentrations, determinants, and optimal prognostic cut‐offs of soluble suppression of tumorigenesis‐2 (sST2), high‐sensitivity cardiac troponin T (hs‐cTnT), and N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) in women and men with chronic heart failure (HF). Methods and results Individual data of patients from the Biomarkers In Heart Failure Outpatient Study (BIOS) Consortium with sST2, hs‐cTnT, and NT‐proBNP measured were analysed. The primary endpoint was a composite of 1 year cardiovascular death and HF hospitalization. The secondary endpoints were 5 year cardiovascular and all‐cause death. The cohort included 4540 patients (age 67 ± 12 years, left ventricular ejection fraction 33 ± 13%, 1111 women, 25%). Women showed lower sST2 (24 vs. 27 ng/mL, P < 0.001) and hs‐cTnT level (15 vs. 20 ng/L, P < 0.001), and similar concentrations of NT‐proBNP (1540 vs. 1505 ng/L, P = 0.408). Although the three biomarkers were confirmed as independent predictors of outcome in both sexes, the optimal prognostic cut‐off was lower in women for sST2 (28 vs. 31 ng/mL) and hs‐cTnT (22 vs. 25 ng/L), while NT‐proBNP cut‐off was higher in women (2339 ng/L vs. 2145 ng/L). The use of sex‐specific cut‐offs improved risk prediction compared with the use of previously standardized prognostic cut‐offs and allowed to reclassify the risk of many patients, to a greater extent in women than men, and for hs‐cTnT than sST2 or NT‐proBNP. Specifically, up to 18% men and up to 57% women were reclassified, by using the sex‐specific cut‐off of hs‐cTnT for the endpoint of 5 year cardiovascular death. Conclusions In patients with chronic HF, concentrations of sST2 and hs‐cTnT, but not of NT‐proBNP, are lower in women. Lower sST2 and hs‐cTnT and higher NT‐proBNP cut‐offs for risk stratification could be used in women.
Collapse
Affiliation(s)
- Giuseppe Vergaro
- Institute of Life Sciences, Scuola Superiore Sant'Anna and Division of Cardiology and Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio, via Giuseppe Moruzzi 1, Pisa, 56124, Italy
| | | | - Alberto Aimo
- Institute of Life Sciences, Scuola Superiore Sant'Anna and Division of Cardiology and Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio, via Giuseppe Moruzzi 1, Pisa, 56124, Italy
| | - James L Januzzi
- Massachusetts General Hospital and Baim Institute for Clinical Research, Boston, MA, USA
| | - A Mark Richards
- Department of Medicine, University of Otago, New Zealand & National University Heart Centre, National University of Singapore, Singapore
| | - Carolyn S P Lam
- National Heart Centre Singapore and Duke-National University of Singapore, Singapore
| | | | - Laura M G Meems
- University Medical Centre Groningen, Groningen, The Netherlands
| | - Roberto Latini
- Istituto di Ricerche Farmacologiche - "Mario Negri" (IRCCS), Milan, Italy
| | - Lidia Staszewsky
- Istituto di Ricerche Farmacologiche - "Mario Negri" (IRCCS), Milan, Italy
| | - Inder S Anand
- University of Minnesota Medical Center, University of Minnesota, Minneapolis, MN, USA.,VA Medical Centre, Minneapolis, MN, USA
| | - Jay N Cohn
- University of Minnesota Medical Center, University of Minnesota, Minneapolis, MN, USA
| | - Thor Ueland
- Oslo University Hospital, Ullevål, Oslo, Norway.,Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,K. G. Jebsen Thrombosis Research and Expertise Center, University of Tromsø, Tromsø, Norway
| | - Lars Gullestad
- KG Jebsen Center for Cardiac Research, University of Oslo and Center for Heart Failure Research, Oslo University Hospital, Norway
| | - Pål Aukrust
- Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | | | - Antoni Bayes-Genis
- Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona) and CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Josep Lupón
- Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona) and CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Akiomi Yoshihisa
- First Department of Internal Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yasuchika Takeishi
- First Department of Internal Medicine, Fukushima Medical University, Fukushima, Japan
| | - Michael Egstrup
- Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Ida Gustafsson
- Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Hanna K Gaggin
- Heart Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Kai M Eggers
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Kurt Huber
- Wilhelminenspital and Sigmund Freud University Medical School, Vienna, Austria
| | - Greg D Gamble
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Lieng H Ling
- Department of Cardiology, National University Heart Centre and National University of Singapore, Singapore
| | | | | | | | | | - Tze P Ng
- Department of Cardiology, National University Heart Centre and National University of Singapore, Singapore
| | - Richard Troughton
- Department of Medicine, University of Otago, New Zealand & National University Heart Centre, National University of Singapore, Singapore
| | - Robert N Doughty
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | | | - Alberto Giannoni
- Institute of Life Sciences, Scuola Superiore Sant'Anna and Division of Cardiology and Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio, via Giuseppe Moruzzi 1, Pisa, 56124, Italy
| | - Claudio Passino
- Institute of Life Sciences, Scuola Superiore Sant'Anna and Division of Cardiology and Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio, via Giuseppe Moruzzi 1, Pisa, 56124, Italy
| | - Michele Emdin
- Institute of Life Sciences, Scuola Superiore Sant'Anna and Division of Cardiology and Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio, via Giuseppe Moruzzi 1, Pisa, 56124, Italy
| |
Collapse
|
20
|
Pan B, Hu D, Sun H, Lv T, Xu W, Tian J. Pediatric Diastolic Heart Failure: Clinical Features Description of 421 Cases. Front Pediatr 2022; 10:846408. [PMID: 35586825 PMCID: PMC9108191 DOI: 10.3389/fped.2022.846408] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 04/11/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND AND AIM Heart failure in children differs substantially from the adult population. Clinical characteristics of pediatric diastolic heart failure has rarely been reported. In this study, we aimed to summary the causes, clinical features, lab tests, and treatment effect of pediatric diastolic heart failure. METHODS This study was a single center, retrospective study conducted in Children's Hospital of Chongqing Medical University. Children who were diagnosed with diastolic heart failure (DHF) without systolic heart failure (SHF) between 2006 and 2014 were included. Meanwhile, SHF (without DHF) cases were also collected from 2013 to 2014. RESULTS A total of 421 DHF and 42 SHF cases were included. The average age of pediatric DHF was 1.89 ± 3.29 years old, significant younger than that of SHF (4.65 ± 4.90). The top three cardiovascular causes of DHF were complex congenital heart malformations (53.4%), simple congenital heart defect (15.7%), and cardiomyopathy (7.4%). Alternatively, number of cardiomyopathy cases (57.1%) ranked first in SHF group. Simple congenital heart diseases (CHDs) rarely caused SHF. The most common symptom and sign were tachypnea and hepatomegaly in pediatric HF. Symptoms like cyanosis, feeding difficulty, be fidgety, pale, fatigue, and edema were valuable in differential diagnosis of DHF and SHF in children. B-type natriuretic peptide (BNP) increase was found in 36.9% of DHF children, and 60% in SHF patients. Sensitivity of BNP greater than 100 pg/ml in diagnosis of DHF was 0.37, and specificity of it was 0.86. Diastolic function indicators, such as E/A (early wave/late wave) ratio, IVRT (isovolumic relaxation time) were significant recovered after treatment in DHF patients. Less therapeutic benefits were achieved in children with cardiomyopathy induced DHF, in compared with non-cardiomyopathy patients. CONCLUSION Pediatric DHF and SHF were largely different in primary causes, clinical symptoms and signs and short-term prognosis. There was a limit diagnostic value of BNP with 100 pg/ml as cut-off value in pediatric DHF. Larger, multicenter studies of pediatric DHF are required in the future.
Collapse
Affiliation(s)
- Bo Pan
- Department of Cardiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Di Hu
- Department of Otorhinolaryngology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Huichao Sun
- Department of Cardiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Tiewei Lv
- Department of Cardiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Wangguo Xu
- Department of Cardiology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Jie Tian
- Department of Cardiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| |
Collapse
|
21
|
Orso F, Herbst A, Migliorini M, Ghiara C, Virciglio S, Camartini V, Tognelli S, Lucarelli G, Fortini G, Pratesi A, Di Bari M, Marchionni N, Ungar A, Fattirolli F, Baldasseroni S. Telehealth Management and Risk Stratification of Older Patients With Chronic Heart Failure During COVID-19 Pandemic: Prognostic Evaluation of the TeleHFCovid19-Score. J Am Med Dir Assoc 2021; 23:421-427. [PMID: 35041828 PMCID: PMC8702408 DOI: 10.1016/j.jamda.2021.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 11/12/2021] [Accepted: 12/14/2021] [Indexed: 12/03/2022]
Abstract
Objectives To evaluate 6-month risk stratification capacity of the newly developed TeleHFCovid19-Score for remote management of older patients with heart failure (HF) during the coronavirus disease 2019 pandemic. Design Monocentric observational prospective study. Setting and Participants Older HF outpatients remotely managed during the first pandemic wave. Methods The TeleHFCovid19-Score (0-29) was obtained by an ad hoc developed multiparametric standardized questionnaire administered during telephone visits to older HF patients (and/or caregivers) followed at our HF clinic. Questions were weighed on the basis of clinical judgment and review of current HF literature. According to the score, patients were divided in progressively increasing risk groups: green (0-3), yellow (4-8), and red (≥9). Results A total of 146 patients composed our study population: at baseline, 112, 21, and 13 were classified as green, yellow, and red, respectively. Mean age was 81±9 years, and women were 40%. Compared to patients of red and yellow groups, those in the green group had a lower use of high-dose loop diuretics (P < .001) or thiazide-like diuretics (P = .027) and had reported less frequently dyspnea at rest or for basic activities, new or worsening extremity edema, or weight increase (all P < .001). At 6 months, compared with red (62.2%) and yellow patients (33.3%), green patients (8.9%) presented a significantly lower rate of the composite outcome of cardiovascular death and/or HF hospitalization (P < .001). Moreover, receiver operating characteristic curve analysis showed a high sensibility and specificity of our score at 6 months (area under the curve = 0.789, 95% CI 0.682-0.896, P < .001) with a score <4.5 (very close to green group cutoff) that identified lower-risk subjects. Conclusions and Implications The TeleHFCovid19-Score was able to correctly identify patients with midterm favorable outcome. Therefore, our questionnaire might be used to identify low-risk chronic HF patients who could be temporarily managed remotely, allowing to devote more efforts to the care of higher-risk patients who need closer and on-site clinical evaluations.
Collapse
Affiliation(s)
- Francesco Orso
- Heart Failure Clinic, Division of Geriatric Medicine and Intensive Care Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Andrea Herbst
- Heart Failure Clinic, Division of Geriatric Medicine and Intensive Care Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Marta Migliorini
- Heart Failure Clinic, Division of Geriatric Medicine and Intensive Care Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Camilla Ghiara
- Heart Failure Clinic, Division of Geriatric Medicine and Intensive Care Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Simona Virciglio
- Heart Failure Clinic, Division of Geriatric Medicine and Intensive Care Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Viola Camartini
- Heart Failure Clinic, Division of Geriatric Medicine and Intensive Care Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Silvia Tognelli
- Heart Failure Clinic, Division of Geriatric Medicine and Intensive Care Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Giulia Lucarelli
- Heart Failure Clinic, Division of Geriatric Medicine and Intensive Care Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Giacomo Fortini
- Heart Failure Clinic, Division of Geriatric Medicine and Intensive Care Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Alessandra Pratesi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Mauro Di Bari
- Heart Failure Clinic, Division of Geriatric Medicine and Intensive Care Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Niccolò Marchionni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Department of Cardiothoracovascular Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Andrea Ungar
- Heart Failure Clinic, Division of Geriatric Medicine and Intensive Care Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesco Fattirolli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Department of Cardiothoracovascular Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Samuele Baldasseroni
- Heart Failure Clinic, Division of Geriatric Medicine and Intensive Care Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| |
Collapse
|
22
|
Hobbs FR, Hussain RI, Vitale C, Pinto YM, Bueno H, Lequeux B, Pauschinger M, Obermeier M, Ferber PC, Gustafsson F. PRospective Evaluation of natriuretic peptide-based reFERral of patients with chronic heart failure in primary care (PREFER): a real-world study. Open Heart 2021; 8:openhrt-2021-001630. [PMID: 34670830 PMCID: PMC8529980 DOI: 10.1136/openhrt-2021-001630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 09/23/2021] [Indexed: 11/21/2022] Open
Abstract
Objective To assess current management practice of heart failure with reduced ejection fraction (HFrEF) in multinational primary care (PC) and determine whether N-terminal-pro-B-type natriuretic peptide (NT-pro-BNP)-guided referral of HFrEF patients from PC to a cardiologist could improve care, defined as adherence to European Society of Cardiology (ESC) guideline-recommended pharmacotherapy. Methods PRospective Evaluation of natriuretic peptide-based reFERral of patients with chronic HF in PC (PREFER) study enrolled HFrEF patients from PC considered clinically stable and those with NT-pro-BNP ≥600 pg/mL were referred to a cardiologist for optimisation of HF treatment. The primary outcome of adherence to ESC HF guidelines after referral to specialist was assessed at the second visit within 4 weeks of cardiologist’s referral and no later than 6 months after the baseline visit. Based on futility interim analysis, the study was terminated early. Results In total, 1415 HFrEF patients from 223 PCs from 18 countries in Europe were enrolled. Of these, 1324 (96.9%) were considered clinically stable and 920 (65.0%) had NT-pro-BNP ≥600 pg/mL (mean: 2631 pg/mL). In total, 861 (60.8%) patients fulfilled both criteria and were referred to a cardiologist. Before cardiologist consultation, 10.1% of patients were on ESC guideline-recommended HFrEF medications and 2.7% were on recommended dosages of HFrEF medication (defined as ≥50% of ESC guideline-recommended dose). Postreferral, prescribed HFrEF drugs remained largely unchanged except for an increase in diuretics (+4.6%) and mineralocorticoid receptor antagonists (+7.9%). No significant increase in patients’ adherence to guideline-defined drug combinations (11.2% post-referral vs 10.1% baseline) or drug combinations and dosages (3.3% postreferral vs 2.7% baseline) was observed after cardiologist consultation. Conclusions PREFER demonstrates substantial suboptimal treatment of HFrEF patients in the real world. Referral of patients with elevated NT-pro-BNP levels from PC to cardiologist did not result in meaningful treatment optimisation for treatments with known mortality and morbidity benefit.
Collapse
Affiliation(s)
| | | | - Cristina Vitale
- Department of Medical Sciences, IRCCS San Raffaele Pisana, Roma, Italy
| | - Yigal M Pinto
- Departments of Cardiology and Experimental Cardiology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Hector Bueno
- Department of Cardiology, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | | | | | | | | | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet University of Copenhagen, Copenhagen, Denmark
| | | |
Collapse
|
23
|
Smith AG, Perez R, Thomas A, Stewart S, Samiei A, Bangalore A, Gomer H, Darr MB, Schweitzer RC, Vasudevan S, Cohen J, Post JC, Murali S, Treado PJ. Objective determination of peripheral edema in heart failure patients using short-wave infrared molecular chemical imaging. JOURNAL OF BIOMEDICAL OPTICS 2021; 26:JBO-210090RR. [PMID: 34689443 PMCID: PMC8541742 DOI: 10.1117/1.jbo.26.10.105002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 09/16/2021] [Indexed: 05/04/2023]
Abstract
SIGNIFICANCE Peripheral pitting edema is a clinician-administered measure for grading edema. Peripheral edema is graded 0, 1 + , 2 + , 3 + , or 4 + , but subjectivity is a major limitation of this technique. A pilot clinical study for short-wave infrared (SWIR) molecular chemical imaging (MCI) effectiveness as an objective, non-contact quantitative peripheral edema measure is underway. AIM We explore if SWIR MCI can differentiate populations with and without peripheral edema. Further, we evaluate the technology for correctly stratifying subjects with peripheral edema. APPROACH SWIR MCI of shins from healthy subjects and heart failure (HF) patients was performed. Partial least squares discriminant analysis (PLS-DA) was used to discriminate the two populations. PLS regression (PLSR) was applied to assess the ability of MCI to grade edema. RESULTS Average spectra from edema exhibited higher water absorption than non-edema spectra. SWIR MCI differentiated healthy volunteers from a population representing all pitting edema grades with 97.1% accuracy (N = 103 shins). Additionally, SWIR MCI correctly classified shin pitting edema levels in patients with 81.6% accuracy. CONCLUSIONS Our study successfully achieved the two primary endpoints. Application of SWIR MCI to monitor patients while actively receiving HF treatment is necessary to validate SWIR MCI as an HF monitoring technology.
Collapse
Affiliation(s)
- Aaron G. Smith
- ChemImage Corporation, Pittsburgh, Pennsylvania, United States
| | - Reina Perez
- Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
| | - Aaron Thomas
- Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
| | - Shona Stewart
- ChemImage Corporation, Pittsburgh, Pennsylvania, United States
- Address all correspondence to Shona Stewart,
| | - Arash Samiei
- ChemImage Corporation, Pittsburgh, Pennsylvania, United States
| | - Arjun Bangalore
- ChemImage Corporation, Pittsburgh, Pennsylvania, United States
| | - Heather Gomer
- ChemImage Corporation, Pittsburgh, Pennsylvania, United States
| | - Marlena B. Darr
- ChemImage Corporation, Pittsburgh, Pennsylvania, United States
| | | | | | - Jeffrey Cohen
- ChemImage Corporation, Pittsburgh, Pennsylvania, United States
- Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
| | | | - Srinivas Murali
- Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
| | | |
Collapse
|
24
|
Diaz-Rodriguez N, Nyhan SM, Kolb TM, Steppan J. How We Would Treat Our Own Pulmonary Hypertension if We Needed to Undergo Cardiac Surgery. J Cardiothorac Vasc Anesth 2021; 36:1540-1548. [PMID: 34649806 DOI: 10.1053/j.jvca.2021.09.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/13/2021] [Accepted: 09/19/2021] [Indexed: 01/08/2023]
Abstract
Pulmonary hypertension (PH) is a disease that has many etiologies and is particularly prevalent in patients presenting for cardiac surgery, with which it is linked to poor outcomes. This manuscript is intended to provide a comprehensive review of the impact of PH on the perioperative management of patients who are undergoing cardiac surgery. The diagnosis of PH often involves a combination of noninvasive and invasive testing, whereas preoperative optimization frequently necessitates the use of specific medications that affect anesthetic management of these patients. The authors postulate that a thoughtful, multidisciplinary approach is required to deliver excellent perioperative care. Furthermore, they use an index case to illustrate the implications of managing a patient with pulmonary hypertension who presents for cardiac surgery with cardiopulmonary bypass.
Collapse
Affiliation(s)
- Natalia Diaz-Rodriguez
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
| | - Sinead M Nyhan
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
| | - Todd M Kolb
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
| | - Jochen Steppan
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD.
| |
Collapse
|
25
|
Moura B, Aimo A, Al-Mohammad A, Flammer A, Barberis V, Bayes-Genis A, Brunner-La Rocca HP, Fontes-Carvalho R, Grapsa J, Hülsmann M, Ibrahim N, Knackstedt C, Januzzi JL, Lapinskas T, Sarrias A, Matskeplishvili S, Meijers WC, Messroghli D, Mueller C, Pavo N, Simonavičius J, Teske AJ, van Kimmenade R, Seferovic P, Coats AJS, Emdin M, Richards AM. Integration of imaging and circulating biomarkers in heart failure: a consensus document by the Biomarkers and Imaging Study Groups of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2021; 23:1577-1596. [PMID: 34482622 DOI: 10.1002/ejhf.2339] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/28/2021] [Accepted: 08/29/2021] [Indexed: 12/28/2022] Open
Abstract
Circulating biomarkers and imaging techniques provide independent and complementary information to guide management of heart failure (HF). This consensus document by the Heart Failure Association (HFA) of the European Society of Cardiology (ESC) presents current evidence-based indications relevant to integration of imaging techniques and biomarkers in HF. The document first focuses on application of circulating biomarkers together with imaging findings, in the broad domains of screening, diagnosis, risk stratification, guidance of treatment and monitoring, and then discusses specific challenging settings. In each section we crystallize clinically relevant recommendations and identify directions for future research. The target readership of this document includes cardiologists, internal medicine specialists and other clinicians dealing with HF patients.
Collapse
Affiliation(s)
- Brenda Moura
- Faculty of Medicine, University of Porto, Porto, Portugal.,Cardiology Department, Porto Armed Forces Hospital, Porto, Portugal
| | - Alberto Aimo
- Scuola Superiore Sant'Anna, and Fondazione G. Monasterio, Pisa, Italy
| | - Abdallah Al-Mohammad
- Medical School, University of Sheffield and Sheffield Teaching Hospitals, Sheffield, UK
| | | | | | - Antoni Bayes-Genis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Hans-Peter Brunner-La Rocca
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ricardo Fontes-Carvalho
- Cardiovascular Research and Development Unit (UnIC), Faculty of Medicine University of Porto, Porto, Portugal.,Cardiology Department, Centro Hospitalar de Vila Nova Gaia/Espinho, Espinho, Portugal
| | - Julia Grapsa
- Department of Cardiology, Guys and St Thomas NHS Hospitals Trust, London, UK
| | - Martin Hülsmann
- Department of Internal Medicine, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Nasrien Ibrahim
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Christian Knackstedt
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - James L Januzzi
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Tomas Lapinskas
- Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Axel Sarrias
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | | | - Daniel Messroghli
- Department of Internal Medicine-Cardiology, Deutsches Herzzentrum Berlin and Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Mueller
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Noemi Pavo
- Department of Internal Medicine, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Justas Simonavičius
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands.,Vilnius University Hospital Santaros klinikos, Vilnius, Lithuania
| | - Arco J Teske
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Roland van Kimmenade
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Petar Seferovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | | | - Michele Emdin
- Scuola Superiore Sant'Anna, and Fondazione G. Monasterio, Pisa, Italy
| | - A Mark Richards
- Christchurch Heart Institute, University of Otago, Dunedin, New Zealand.,Cardiovascular Research Institute, National University of Singapore, Singapore
| |
Collapse
|
26
|
Faragli A, Abawi D, Quinn C, Cvetkovic M, Schlabs T, Tahirovic E, Düngen HD, Pieske B, Kelle S, Edelmann F, Alogna A. The role of non-invasive devices for the telemonitoring of heart failure patients. Heart Fail Rev 2021; 26:1063-1080. [PMID: 32338334 PMCID: PMC8310471 DOI: 10.1007/s10741-020-09963-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Heart failure (HF) patients represent one of the most prevalent as well as one of the most fragile population encountered in the cardiology and internal medicine departments nowadays. Estimated to account for around 26 million people worldwide, diagnosed patients present a poor prognosis and quality of life with a clinical history accompanied by repeated hospital admissions caused by an exacerbation of their chronic condition. The frequent hospitalizations and the extended hospital stays mean an extremely high economic burden for healthcare institutions. Meanwhile, the number of chronically diseased and elderly patients is continuously rising, and a lack of specialized physicians is evident. To cope with this health emergency, more efficient strategies for patient management, more accurate diagnostic tools, and more efficient preventive plans are needed. In recent years, telemonitoring has been introduced as the potential answer to solve such needs. Different methodologies and devices have been progressively investigated for effective home monitoring of cardiologic patients. Invasive hemodynamic devices, such as CardioMEMS™, have been demonstrated to be reducing hospitalizations and mortality, but their use is however restricted to limited cases. The role of external non-invasive devices for remote patient monitoring, instead, is yet to be clarified. In this review, we summarized the most relevant studies and devices that, by utilizing non-invasive telemonitoring, demonstrated whether beneficial effects in the management of HF patients were effective.
Collapse
Affiliation(s)
- A Faragli
- Department of Internal Medicine and Cardiology Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - D Abawi
- Department of Internal Medicine and Cardiology Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - C Quinn
- Department of Biological Sciences, Rensselaer Polytechnic Institute, 110 Eighth Street, Troy, NY, USA
| | - M Cvetkovic
- Department of Internal Medicine and Cardiology Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - T Schlabs
- Department of Internal Medicine and Cardiology Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - E Tahirovic
- Department of Internal Medicine and Cardiology Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - H-D Düngen
- Department of Internal Medicine and Cardiology Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - B Pieske
- Department of Internal Medicine and Cardiology Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - S Kelle
- Department of Internal Medicine and Cardiology Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - F Edelmann
- Department of Internal Medicine and Cardiology Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Alessio Alogna
- Department of Internal Medicine and Cardiology Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany.
- Berlin Institute of Health (BIH), Berlin, Germany.
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.
| |
Collapse
|
27
|
Shchendrygina AA, Zhbanov KA, Privalova EV, Yusupova AO, Danilogorskaya YA, Salakheeva EY, Sokolova IY, Tsatsurova SA, Ageeva AA, Belenkov YN. Heart Failure with Perserved Ejection Fraction Current Diagnostic and Therapeutic Approaches. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2021. [DOI: 10.20996/1819-6446-2021-05-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a syndrome associated with high morbidity and mortality rates. Little progress has been in the treatment of this condition since its introduction some 30 years ago. It's accepted that HFpEF is heterogeneous in many ways, ethologically and phenotypically. The underlying mechanisms of the syndrome are not clear. Recently, it has been shown that the diagnostic criteria for HFpEF lacks sensitivity and specificity. Novel treatment approaches, which were developed based on current HFpEF pathophysiological concepts, did not show either clinical or prognostic benefit for patients. Therefore, there is an urgent need to revise current diagnostic approaches and to further investigate the underlying mechanisms. Recently, two novel diagnostic score systems were proposed: H2PEF and HFA-PEFF. Recently, a number of phase II and III randomized control trials have been completed. Here, the authors discuss the potential novel diagnostic approaches to HFpEF and treatment perspectives.
Collapse
Affiliation(s)
| | - K. A. Zhbanov
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - E. V. Privalova
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - A. O. Yusupova
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | | | - E. Yu. Salakheeva
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - I. Ya. Sokolova
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - S. A. Tsatsurova
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - A. A. Ageeva
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - Yu. N. Belenkov
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| |
Collapse
|
28
|
Vergaro G, Gentile F, Meems LMG, Aimo A, Januzzi JL, Richards AM, Lam CSP, Latini R, Staszewsky L, Anand IS, Cohn JN, Ueland T, Gullestad L, Aukrust P, Brunner-La Rocca HP, Bayes-Genis A, Lupón J, Yoshihisa A, Takeishi Y, Egstrup M, Gustafsson I, Gaggin HK, Eggers KM, Huber K, Gamble GD, Ling LH, Leong KTG, Yeo PSD, Ong HY, Jaufeerally F, Ng TP, Troughton R, Doughty RN, Devlin G, Lund M, Giannoni A, Passino C, de Boer RA, Emdin M. NT-proBNP for Risk Prediction in Heart Failure: Identification of Optimal Cutoffs Across Body Mass Index Categories. JACC-HEART FAILURE 2021; 9:653-663. [PMID: 34246607 DOI: 10.1016/j.jchf.2021.05.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/07/2021] [Accepted: 05/17/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The goal of this study was to assess the predictive power of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and the decision cutoffs in heart failure (HF) across body mass index (BMI) categories. BACKGROUND Concentrations of NT-proBNP predict outcome in HF. Although the influence of BMI to reduce levels of NT-proBNP is known, the impact of obesity on prognostic value remains uncertain. METHODS Individual data from the BIOS (Biomarkers In Heart Failure Outpatient Study) consortium were analyzed. Patients with stable HF were classified as underweight (BMI <18.5 kg/m2), normal weight (BMI 18.5-24.9 kg/m2), overweight (BMI 25-29.9 kg/m2), and mildly (BMI 30-34.9 kg/m2), moderately (BMI 35-39.9 kg/m2), or severely (BMI ≥40 kg/m2) obese. The prognostic role of NT-proBNP was tested for the endpoints of all-cause and cardiac death. RESULTS The study population included 12,763 patients (mean age 66 ± 12 years; 25% women; mean left ventricular ejection fraction 33% ± 13%). Most patients were overweight (n = 5,176), followed by normal weight (n = 4,299), mildly obese (n = 2,157), moderately obese (n = 612), severely obese (n = 314), and underweight (n = 205). NT-proBNP inversely correlated with BMI (β = -0.174 for 1 kg/m2; P < 0.001). Adding NT-proBNP to clinical models improved risk prediction across BMI categories, with the exception of severely obese patients. The best cutoffs of NT-proBNP for 5-year all-cause death prediction were lower as BMI increased (3,785 ng/L, 2,193 ng/L, 1,554 ng/L, 1,045 ng/L, 755 ng/L, and 879 ng/L, for underweight, normal weight, overweight, and mildly, moderately, and severely obese patients, respectively) and were higher in women than in men. CONCLUSIONS NT-proBNP maintains its independent prognostic value up to 40 kg/m2 BMI, and lower optimal risk-prediction cutoffs are observed in overweight and obese patients.
Collapse
Affiliation(s)
- Giuseppe Vergaro
- Scuola Superiore Sant'Anna, Pisa, Italy; Fondazione Toscana G. Monasterio, Pisa, Italy.
| | | | - Laura M G Meems
- University Medical Centre Groningen, Groningen, the Netherlands
| | | | - James L Januzzi
- Massachusetts General Hospital and Baim Institute for Clinical Research, Boston, Massachusetts, USA
| | | | - Carolyn S P Lam
- National Heart Centre Singapore and Duke-National University of Singapore, Singapore
| | - Roberto Latini
- IRCCS-Istituto di Ricerche Farmacologiche-"Mario Negri," IRCCS Milano, Italy
| | - Lidia Staszewsky
- IRCCS-Istituto di Ricerche Farmacologiche-"Mario Negri," IRCCS Milano, Italy
| | - Inder S Anand
- University of Minnesota, Minneapolis, Minnesota, USA; VA Medical Centre, Minneapolis, Minnesota, USA
| | - Jay N Cohn
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Thor Ueland
- Oslo University Hospital, Ullevål, Oslo, Norway; Oslo University Hospital, Rikshospitalet, Oslo, Norway; University of Oslo, Oslo, Norway; University of Tromsø, Tromsø, Norway
| | - Lars Gullestad
- KG Jebsen Center for Cardiac Research, University of Oslo, and Center for Heart Failure Research, Oslo University Hospital, Oslo, Norway
| | - Pål Aukrust
- Oslo University Hospital, Rikshospitalet, Oslo, Norway; University of Oslo, Oslo, Norway
| | | | - Antoni Bayes-Genis
- Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona) and CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Josep Lupón
- Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona) and CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | | | | | - Michael Egstrup
- Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Ida Gustafsson
- Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Hanna K Gaggin
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Kurt Huber
- Wilhelminenspital and Sigmund Freud University Medical School, Vienna, Austria
| | | | - Lieng H Ling
- National University Heart Centre and National University of Singapore, Singapore
| | | | | | | | | | - Tze P Ng
- National University Heart Centre and National University of Singapore, Singapore
| | - Richard Troughton
- Massachusetts General Hospital and Baim Institute for Clinical Research, Boston, Massachusetts, USA
| | | | | | | | - Alberto Giannoni
- Scuola Superiore Sant'Anna, Pisa, Italy; Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Claudio Passino
- Scuola Superiore Sant'Anna, Pisa, Italy; Fondazione Toscana G. Monasterio, Pisa, Italy
| | | | - Michele Emdin
- Scuola Superiore Sant'Anna, Pisa, Italy; Fondazione Toscana G. Monasterio, Pisa, Italy
| |
Collapse
|
29
|
Bellagambi FG, Petersen C, Salvo P, Ghimenti S, Franzini M, Biagini D, Hangouët M, Trivella MG, Di Francesco F, Paolicchi A, Errachid A, Fuoco R, Lomonaco T. Determination and stability of N-terminal pro-brain natriuretic peptide in saliva samples for monitoring heart failure. Sci Rep 2021; 11:13088. [PMID: 34158583 PMCID: PMC8219749 DOI: 10.1038/s41598-021-92488-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 06/01/2021] [Indexed: 02/05/2023] Open
Abstract
Heart failure (HF) is the main cause of mortality worldwide, particularly in the elderly. N-terminal pro-brain natriuretic peptide (NT-proBNP) is the gold standard biomarker for HF diagnosis and therapy monitoring. It is determined in blood samples by the immunochemical methods generally adopted by most laboratories. Saliva analysis is a powerful tool for clinical applications, mainly due to its non-invasive and less risky sampling. This study describes a validated analytical procedure for NT-proBNP determination in saliva samples using a commercial Enzyme-Linked Immuno-Sorbent Assay. Linearity, matrix effect, sensitivity, recovery and assay-precision were evaluated. The analytical approach showed a linear behaviour of the signal throughout the concentrations tested, with a minimum detectable dose of 1 pg/mL, a satisfactory NT-proBNP recovery (95-110%), and acceptable precision (coefficient of variation ≤ 10%). Short-term (3 weeks) and long-term (5 months) stability of NT-proBNP in saliva samples under the storage conditions most frequently used in clinical laboratories (4, - 20, and - 80 °C) was also investigated and showed that the optimal storage conditions were at - 20 °C for up to 2.5 months. Finally, the method was tested for the determination of NT-proBNP in saliva samples collected from ten hospitalized acute HF patients. Preliminary results indicate a decrease in NT-proBNP in saliva from admission to discharge, thus suggesting that this procedure is an effective saliva-based point-of-care device for HF monitoring.
Collapse
Affiliation(s)
- Francesca G. Bellagambi
- grid.5395.a0000 0004 1757 3729Department of Chemistry and Industrial Chemistry, University of Pisa, 56124 Pisa, Italy ,grid.7849.20000 0001 2150 7757Institute of Analytical Sciences (ISA) – UMR 5280, University Claude Bernard Lyon 1, 69100 Lyon, France
| | - Christina Petersen
- grid.452599.60000 0004 1781 8976Cardiology Division, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, Italy
| | - Pietro Salvo
- grid.5326.20000 0001 1940 4177Institute of Clinical Physiology, National Research Council, 56124 Pisa, Italy
| | - Silvia Ghimenti
- grid.5395.a0000 0004 1757 3729Department of Chemistry and Industrial Chemistry, University of Pisa, 56124 Pisa, Italy
| | - Maria Franzini
- grid.5395.a0000 0004 1757 3729Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Denise Biagini
- grid.5395.a0000 0004 1757 3729Department of Chemistry and Industrial Chemistry, University of Pisa, 56124 Pisa, Italy
| | - Marie Hangouët
- grid.4444.00000 0001 2112 9282Institute of Analytical Sciences (ISA), UMR 5280, French National Center for Scientific Research (CNRS), 69100 Lyon, France
| | - Maria Giovanna Trivella
- grid.5326.20000 0001 1940 4177Institute of Clinical Physiology, National Research Council, 56124 Pisa, Italy
| | - Fabio Di Francesco
- grid.5395.a0000 0004 1757 3729Department of Chemistry and Industrial Chemistry, University of Pisa, 56124 Pisa, Italy
| | - Aldo Paolicchi
- grid.5395.a0000 0004 1757 3729Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Abdelhamid Errachid
- grid.7849.20000 0001 2150 7757Institute of Analytical Sciences (ISA) – UMR 5280, University Claude Bernard Lyon 1, 69100 Lyon, France
| | - Roger Fuoco
- grid.5395.a0000 0004 1757 3729Department of Chemistry and Industrial Chemistry, University of Pisa, 56124 Pisa, Italy
| | - Tommaso Lomonaco
- grid.5395.a0000 0004 1757 3729Department of Chemistry and Industrial Chemistry, University of Pisa, 56124 Pisa, Italy
| |
Collapse
|
30
|
Kumric M, Ticinovic Kurir T, Borovac JA, Bozic J. Role of novel biomarkers in diabetic cardiomyopathy. World J Diabetes 2021; 12:685-705. [PMID: 34168722 PMCID: PMC8192249 DOI: 10.4239/wjd.v12.i6.685] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/22/2021] [Accepted: 03/18/2021] [Indexed: 02/06/2023] Open
Abstract
Diabetic cardiomyopathy (DCM) is commonly defined as cardiomyopathy in patients with diabetes mellitus in the absence of coronary artery disease and hypertension. As DCM is now recognized as a cause of substantial morbidity and mortality among patients with diabetes mellitus and clinical diagnosis is still inappropriate, various expert groups struggled to identify a suitable biomarker that will help in the recognition and management of DCM, with little success so far. Hence, we thought it important to address the role of biomarkers that have shown potential in either human or animal studies and which could eventually result in mitigating the poor outcomes of DCM. Among the array of biomarkers we thoroughly analyzed, long noncoding ribonucleic acids, soluble form of suppression of tumorigenicity 2 and galectin-3 seem to be most beneficial for DCM detection, as their plasma/serum levels accurately correlate with the early stages of DCM. The combination of relatively inexpensive and accurate speckle tracking echocardiography with some of the highlighted biomarkers may be a promising screening method for newly diagnosed diabetes mellitus type 2 patients. The purpose of the screening test would be to direct affected patients to more specific confirmation tests. This perspective is in concordance with current guidelines that accentuate the importance of an interdisciplinary team-based approach.
Collapse
Affiliation(s)
- Marko Kumric
- Department of Pathophysiology, University of Split School of Medicine, Split 21000, Croatia
| | - Tina Ticinovic Kurir
- Department of Pathophysiology, University of Split School of Medicine, Split 21000, Croatia
- Department of Endocrinology, University Hospital of Split, Split 21000, Croatia
| | - Josip A Borovac
- Department of Pathophysiology, University of Split School of Medicine, Split 21000, Croatia
- Emergency Medicine, Institute of Emergency Medicine of Split-Dalmatia County, Split 21000, Croatia
| | - Josko Bozic
- Department of Pathophysiology, University of Split School of Medicine, Split 21000, Croatia
| |
Collapse
|
31
|
Abdel Hamid TA, Eldin ZME, Hegazy RA, Esmail RI, El-sholkamy LMA. B-natriuretic peptide serum levels in neonates with persistent pulmonary hypertension. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2021. [DOI: 10.1186/s43054-021-00058-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Better management of persistent pulmonary hypertension of neonates (PPHN) required new markers that can predict the response of patient to treatment and thus influence the medical decision to avoid short-term and long-term adverse effects. Hence, we aimed to evaluate B-natriuretic peptide (BNP) serum levels in neonates with PPHN and to correlate its levels with disease severity and response to treatment.
Patients and methods
The study included 60 neonates (30 PPHN patients and 30 healthy subjects). BNP was assessed, using the ELISA technique, at admission and after 4 days of treatment.
Results
Initial serum BNP levels were significantly higher in patients compared to controls (p < 0.001). Patients with mild severity showed lower BNP levels compared to patients with moderate severity, while patients with moderate severity showed decreased levels in comparison to severe cases (p < 0.001). The group of patients who showed remission after 4 days of treatment had lower pre-treatment and post-treatment BNP levels, compared to patients who showed incomplete remission. Initial levels of BNP showed strong positive correlations with pulmonary artery pressure (PAP) and oxygenation index (OI) before treatment (r = 0.9, p < 0.001 and r = 0.85, p = 0.001), while BNP after treatment showed moderate positive correlations with PAP before treatment (r = 0.6, p = 0.001) and OI before treatment (r = 0.6, p = 0.001). Analysis of the ROC curve revealed an AUC of 0.83with CI = 0.7–0.98 and p = 0.003.
Conclusions
BNP may play a role in the pathogenesis of PPHN, and BNP serum level can be used as a marker to detect disease severity and predict response to treatment.
Collapse
|
32
|
Gori M, Claggett B, Senni M, Shah AM, Goldenberg I, Kutyifa V, Knappe D, Pouleur AC, Solomon SD. Combining diastolic dysfunction and natriuretic peptides to risk stratify patients with heart failure with reduced ejection fraction. Int J Cardiol 2021; 335:59-65. [PMID: 33887340 DOI: 10.1016/j.ijcard.2021.04.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/21/2021] [Accepted: 04/16/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Diastolic dysfunction (DD) might help to risk stratify patients with heart failure (HF) with reduced ejection fraction (HFrEF). Nonetheless, HF guidelines/risk scores don't consider DD. We aimed to show the independent prognostic value of DD for nonfatal HF/death in patients with HFrEF on top of natriuretic peptides (NP). METHODS We analyzed 1155 baseline echocardiograms of the MADIT-CRT study (LVEF≤30%, QRS ≥ 130 ms, NYHA class I/II), classifying DD according to 2016 ASE/EACVI classification. RESULTS Patients were 64 ± 11 years-old, 24% females, LVEF was 24 ± 5%, 58% had abnormal BNP (≥100 pg/ml). While 45% had impaired relaxation, 33% had pseudonormal filling, 12% restrictive pattern, 6% indeterminate diastolic function, 4% were not classifiable due to missing data. During a follow-up of 2.1 ± 1.0 years, there were 233 HF/death. Compared to patients without pseudonormal/restrictive filling and with normal NP (23%), patients with pseudonormal/restrictive filling, alone (15%) or combined to elevated NP (30%), were at higher risk of events (respectively padj = 0.025 and padj < 0.001), as opposed to those with abnormal NP alone (22%; padj = 0.55). Adding DD to conventional markers of risk and NP improved prediction (C-statistic 0.733 versus 0.708, p = 0.024). DD was the first parameter to be considered to risk stratify MADIT-CRT population, according to Classification-And-Regression-Tree analysis. CONCLUSIONS Among HFrEF patients with mild symptoms, pseudonormal/restrictive filling, either alone or combined with elevated NP, was associated with high risk of events, as opposed to isolated elevation of NP. DD provided incremental risk prediction for death/HF beyond commonly used markers. These data might suggest to integrate DD into HF guidelines/risk scores.
Collapse
Affiliation(s)
- Mauro Gori
- Cardiovascular Department, Papa Giovanni XXIII Hospital, Piazza OMS, 1 - 24127, Bergamo, Italy; Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
| | - Brian Claggett
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Michele Senni
- Cardiovascular Department, Papa Giovanni XXIII Hospital, Piazza OMS, 1 - 24127, Bergamo, Italy
| | - Amil M Shah
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | | | | | - Dorit Knappe
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Ann-Catherine Pouleur
- Cardiovascular Department, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| |
Collapse
|
33
|
Application of Guideline-Based Echocardiographic Assessment of Left Atrial Pressure to Heart Failure with Preserved Ejection Fraction. J Am Soc Echocardiogr 2020; 34:455-464. [PMID: 33359021 DOI: 10.1016/j.echo.2020.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/16/2020] [Accepted: 12/14/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Early, noninvasive identification of patients with heart failure with preserved ejection fraction (HFpEF) with congestion may allow timely tailoring of decongestive therapies. The 2016 American Society of Echocardiography and European Association of Cardiovascular Imaging guidelines provide an algorithm to assess for elevated left atrial pressure (LAP); the associations of echocardiographic LAP with clinical status and disease progression in patients with HFpEF are unclear. METHODS Participants in the Phosphodiesterase-5 Inhibition to Improve Clinical Status and Exercise Capacity in HFpEF trial were categorized into one of four prespecified guideline-based echocardiographic LAP categories: (1) normal, (2) elevated, (3) atrial fibrillation (AF) at the time of echocardiography, or (4) indeterminate. Associations of echocardiographic LAP categories with baseline exercise capacity, change in exercise capacity, and change in N-terminal pro-B-type natriuretic peptide over 24 weeks were evaluated. RESULTS Of 216 participants, 199 underwent mitral inflow Doppler echocardiography for LAP categorization. Participants with elevated echocardiographic LAP (n = 81) or AF (n = 57) were older and had a higher prevalence of kidney dysfunction. Compared with the normal echocardiographic LAP group (n = 28), elevated echocardiographic LAP and AF were each independently associated with a greater reduction in peak oxygen consumption over 24 weeks after adjusting for baseline values and clinical covariates (β for elevated echocardiographic LAP = -1.55 [95% CI, -2.59 to -0.51], P = .004; β for AF = -1.33 [95% CI, -2.49 to -0.17], P = .03). Indeterminate echocardiographic LAP (n = 33) was also independently associated with a reduction in exercise capacity at 24 weeks compared with normal echocardiographic LAP (β = -1.35; 95% CI, -2.51 to -0.19; P = .02). Finally, elevated echocardiographic LAP and AF were significantly associated with increases in N-terminal pro-B-type natriuretic peptide over 24 weeks compared with normal echocardiographic LAP. CONCLUSIONS In patients with chronic HFpEF, elevated echocardiographic LAP and indeterminate echocardiographic LAP, as defined by contemporary guidelines, and AF were each independently associated with a reduction in exercise capacity compared with normal echocardiographic LAP. These findings suggest the potential utility of noninvasive LAP assessment in patients with HFpEF for tailoring treatments that decrease congestion.
Collapse
|
34
|
Differential Role of Circulating microRNAs to Track Progression and Pre-Symptomatic Stage of Chronic Heart Failure: A Pilot Study. Biomedicines 2020; 8:biomedicines8120597. [PMID: 33322648 PMCID: PMC7764340 DOI: 10.3390/biomedicines8120597] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 12/11/2022] Open
Abstract
(1)Background: Chronic heart failure (CHF) contributes to the overall burden of cardiovascular disease. Early identification of at-risk individuals may facilitate the targeting of precision therapies. Plasma microRNAs are promising circulating biomarkers for their implications with cardiac pathologies. In this pilot study, we investigate the possible exploitability of circulating micro-RNAs (miRNAs) to track chronic heart failure (CHF) occurrence, and progression from NYHA class I to IV. (2)Methods: We screened 367 microRNAs using TaqMan microRNA Arrays in plasma samples from healthy controls (HC) and CHF NYHA-class I-to-IV patients (5/group). Validation was performed by singleplex assays on 10 HC and 61 CHF subjects. Differences in the expression of validated microRNAs were evaluated through analysis of covariance (ANCOVA). Associations between N-terminal pro-BNP (NT-proBNP), left ventricular end-diastolic volume (LVEDV) or peak oxygen uptake (VO2 peak) and plasma microRNA were assessed by multivariable linear regression analysis. (3)Results: Twelve microRNAs showed higher expression in CHF patients vs. HC. Seven microRNAs were associated with NT-proBNP concentration; of these, miR-423-5p was also an independent predictor of LVEDV. Moreover, miR-499-5p was a predictor of the VO2 peak. Finally, a cluster of 5 miRNAs discriminated New York Heart Association (NYHA) class-I from HC subjects. (4)Conclusions: Our data suggest that circulating miRNAs have the potential to serve as pathophysiology-based markers of HF status and progression, and as indicators of pre-symptomatic individuals.
Collapse
|
35
|
Baines G, Da Silva AS, Cardozo L, Bach F, Parsons M, Robinson D, Toozs-Hobson P. Defining nocturnal polyuria in women. Neurourol Urodyn 2020; 40:265-271. [PMID: 33085813 DOI: 10.1002/nau.24546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/01/2020] [Accepted: 10/06/2020] [Indexed: 11/11/2022]
Abstract
AIMS Nocturnal polyuria (NP) is defined by the International Continence Society (ICS) as "excessive production of urine during the main sleep period" and is one of the main causes of nocturia. The ICS recognized that "excessive" is not clearly defined and that this needs to be highlighted in both clinical and research settings. The aim of this study was to identify different definitions of NP and apply them to a population of women attending the Urogynaecology clinic. METHODS This was a retrospective study of complete bladder diaries collected from women attending a tertiary Urogynaecology Unit. Six different definitions were identified and were divided into "absolute," "relative," and "functional definitions." Prevalence data were calculated and values generated for sensitivity, specificity, positive and negative predictive values when related to women voiding ≥ 2 times per night. RESULTS Complete bladder diaries were obtained from 1398 women, over 6 years, with a mean age of 57 years. Prevalence varied across the definitions from 21.5% (absolute definition) to 77% (relative definition). Sensitivity ranged from 43% (absolute) to 87% (relative). The definitions that showed the highest combined sensitivity and specificity were the functional definitions. CONCLUSION From this study it is clear that more work needs to be done to arrive at a consensus for defining NP to enable accurate diagnosis and development of treatment pathways. We propose that a relative definition may provide a more clinically relevant method of defining NP.
Collapse
Affiliation(s)
| | | | | | - Fiona Bach
- Birmingham Women's Hospital, Birmingham, England
| | | | | | | |
Collapse
|
36
|
Shimizu N, Kotani K. Point-of-care testing of (N-terminal pro) B-type natriuretic peptide for heart disease patients in home care and ambulatory care settings. Pract Lab Med 2020; 22:e00183. [PMID: 33134469 PMCID: PMC7585141 DOI: 10.1016/j.plabm.2020.e00183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 10/16/2020] [Indexed: 12/28/2022] Open
Abstract
Objectives The role of point-of-care testing (POCT) out of hospital, especially in home care and ambulatory care settings, is an issue meriting further research. We reviewed studies reporting cardiovascular events as a result of the implementation of B-type natriuretic peptide or N-terminal pro B-type natriuretic peptide POCT (BNP/NT-proBNP POCT) for heart disease patients in the settings. Design Articles were searched via a PubMed engine until May 30, 2020. Results In total, six studies were selected. Three studies involving ambulatory care used the POCT to refer patients with suspected heart diseases to a specialist. The other three used the tests in home care to monitor patients with heart failure. In ambulatory care, the randomized controlled trials, in which referrals were made to a specialist, showed that the group using POCT had significantly fewer cardiovascular outcomes, such as hospitalizations and deaths, than the non-use group. In home care, adverse outcomes were predicted from changes in BNP levels. Conclusions In most studies, the use of BNP/NT-proBNP POCT in home care and ambulatory care settings demonstrated favorable results regarding the cardiovascular outcomes. The utility of POCT in the settings is suggested, while more investigations are required. Point-of-care testing of BNP can be useful for referral of patients to specialists as demonstrated in two randomized control trials. Point-of-care testing of BNP couldpredict acute heart failure as demonstrated in three observational studies. The findings should be generalized with care because of the limitation of available data.
Collapse
Key Words
- ADHF, acute clinical HF decompensation
- AUC, area under the curve
- BNP
- BNP, B-type natriuretic peptide
- HF, heart failure
- HFpEF, HF with preserved ejection fraction
- HFrEF, HF with reduced ejection fraction
- HR, hazard ratio
- Heart failure
- Home care
- IRR, incidence rate ratio
- MACE, major adverse cardiac events
- NT-proBNP
- NT-proBNP, N-terminal pro B-type natriuretic peptide
- OR, odds ratio
- POCT, point-of-care testing
- Point-of-care testing
- Primary care
- RCT, randomized controlled trials
- Sn, sensitivity
- Sp, specificity
Collapse
Affiliation(s)
- Nayuta Shimizu
- Division of Community and Family Medicine, Center of Community Medicine, Jichi Medical University, Tochigi, Japan
| | - Kazuhiko Kotani
- Division of Community and Family Medicine, Center of Community Medicine, Jichi Medical University, Tochigi, Japan
| |
Collapse
|
37
|
Henkens MTHM, Remmelzwaal S, Robinson EL, van Ballegooijen AJ, Barandiarán Aizpurua A, Verdonschot JAJ, Raafs AG, Weerts J, Hazebroek MR, Sanders-van Wijk S, Handoko ML, den Ruijter HM, Lam CSP, de Boer RA, Paulus WJ, van Empel VPM, Vos R, Brunner-La Rocca HP, Beulens JWJ, Heymans SRB. Risk of bias in studies investigating novel diagnostic biomarkers for heart failure with preserved ejection fraction. A systematic review. Eur J Heart Fail 2020; 22:1586-1597. [PMID: 32592317 PMCID: PMC7689920 DOI: 10.1002/ejhf.1944] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 06/19/2020] [Accepted: 06/20/2020] [Indexed: 12/28/2022] Open
Abstract
Aim Diagnosing heart failure with preserved ejection fraction (HFpEF) in the non‐acute setting remains challenging. Natriuretic peptides have limited value for this purpose, and a multitude of studies investigating novel diagnostic circulating biomarkers have not resulted in their implementation. This review aims to provide an overview of studies investigating novel circulating biomarkers for the diagnosis of HFpEF and determine their risk of bias (ROB). Methods and results A systematic literature search for studies investigating novel diagnostic HFpEF circulating biomarkers in humans was performed up until 21 April 2020. Those without diagnostic performance measures reported, or performed in an acute heart failure population were excluded, leading to a total of 28 studies. For each study, four reviewers determined the ROB within the QUADAS‐2 domains: patient selection, index test, reference standard, and flow and timing. At least one domain with a high ROB was present in all studies. Use of case‐control/two‐gated designs, exclusion of difficult‐to‐diagnose patients, absence of a pre‐specified cut‐off value for the index test without the performance of external validation, the use of inappropriate reference standards and unclear timing of the index test and/or reference standard were the main bias determinants. Due to the high ROB and different patient populations, no meta‐analysis was performed. Conclusion The majority of current diagnostic HFpEF biomarker studies have a high ROB, reducing the reproducibility and the potential for clinical care. Methodological well‐designed studies with a uniform reference diagnosis are urgently needed to determine the incremental value of circulating biomarkers for the diagnosis of HFpEF.
Collapse
Affiliation(s)
- Michiel T H M Henkens
- Department of Cardiology, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
| | - Sharon Remmelzwaal
- Department of Epidemiology and Biostatistics, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Emma L Robinson
- Department of Cardiology, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
| | - Adriana J van Ballegooijen
- Department of Epidemiology and Biostatistics, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Arantxa Barandiarán Aizpurua
- Department of Cardiology, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
| | - Job A J Verdonschot
- Department of Cardiology, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands.,Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Anne G Raafs
- Department of Cardiology, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
| | - Jerremy Weerts
- Department of Cardiology, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
| | - Mark R Hazebroek
- Department of Cardiology, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
| | - Sandra Sanders-van Wijk
- Department of Cardiology, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
| | - M Louis Handoko
- Department of Cardiology, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Hester M den Ruijter
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Carolyn S P Lam
- National Heart Centre Singapore, Singapore, Singapore.,Duke-National University of Singapore, Singapore, Singapore.,Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rudolf A de Boer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Walter J Paulus
- Department of Physiology, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam UMC, Amsterdam, The Netherlands.,Netherlands Heart Institute (ICIN), Utrecht, The Netherlands
| | - Vanessa P M van Empel
- Department of Cardiology, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
| | - Rein Vos
- Department of Methodology and Statistics, Maastricht University, Maastricht, The Netherlands
| | - Hans-Peter Brunner-La Rocca
- Department of Cardiology, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
| | - Joline W J Beulens
- Department of Epidemiology and Biostatistics, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam UMC, Amsterdam, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Stephane R B Heymans
- Department of Cardiology, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands.,Netherlands Heart Institute (ICIN), Utrecht, The Netherlands.,Department of Cardiovascular Research, University of Leuven, Leuven, Belgium
| |
Collapse
|
38
|
NT-proBNP in Rheumatoid Arthritis Patients: Interaction of Immuno-inflammatory Process and Cardiovascular System. Fam Med 2020. [DOI: 10.30841/2307-5112.3.2020.211866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
39
|
Traxler D, Zimmermann M, Simader E, Veraar CM, Moser B, Mueller T, Mildner M, Dannenberg V, Lainscak M, Jug B, Ankersmit HJ. The inflammatory markers sST2, HSP27 and hsCRP as a prognostic biomarker panel in chronic heart failure patients. Clin Chim Acta 2020; 510:507-514. [PMID: 32735982 DOI: 10.1016/j.cca.2020.07.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/22/2020] [Accepted: 07/26/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND The inflammatory markers sST2, HSP27 and hsCRP have already been identified as prognostic markers in chronic heart failure (HF). Though individual biomarkers have proven their value in mortality risk prediction, the role of a multimarker strategy needs further evaluation. MATERIALS AND METHODS This is an exploratory reanalysis in chronic HF patients. Plasma HSP27, sST2 and hsCRP in outpatients with chronic HF were analysed. Patients were followed for a minimum of twelve months for the endpoint cardiovascular mortality and unplanned HF associated hospitalisation (=event). 15 year overall mortality was assessed retrospectively. The prognostic impact was assessed using a Cox proportional hazard model. RESULTS 113 chronic HF patients were included. Median follow up time was 614 days and 37 patients (32.7%) experienced an event. A Kaplan-Meier analysis revealed that patients with increased sST2, HSP27 and hsCRP levels have significantly worse prognosis (p < 0.001). The use of a three-biomarker combination was superior in an independent risk prediction of an event (one high vs. two high: HR = 4.5, 95% CI: 1.3-15.5, p = 0.018; and one high vs. all high: HR = 9.8, 95% CI: 2.8-34.3, p < 0.001) as shown in a multivariable cox proportional hazard model. However, the biomarker panel did not predict 15 year overall mortality, in contrast to elevated HSP27 levels (p = 0.012). CONCLUSIONS The combination of all three markers is an independent predictor of cardiovascular death and unplanned HF associated hospitalisation but not overall mortality. Our findings suggest that adding those markers in combination to well established risk assessment parameters may improve risk stratification.
Collapse
Affiliation(s)
- Denise Traxler
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; Laboratory for Cardiac and Thoracic Diagnosis, Regeneration and Applied Immunology, Waehringergürtel 18-20, 1090 Vienna, Austria; Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Matthias Zimmermann
- Department of Oral and Maxillofacial Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Elisabeth Simader
- Laboratory for Cardiac and Thoracic Diagnosis, Regeneration and Applied Immunology, Waehringergürtel 18-20, 1090 Vienna, Austria; Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Cecilia M Veraar
- Division of Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, Department of Anaesthesia, Intensive Care Medicine, and Pain Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Bernhard Moser
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Thomas Mueller
- Department of Clinical Pathology, Hospital of Bolzano, Lorenz Böhler Straße 5, 39100 Bolzano, Italy
| | - Michael Mildner
- Research Division of Biology and Pathobiology of the Skin, Department of Dermatology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Varius Dannenberg
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Mitja Lainscak
- Division of Cardiology, General Hospital Murska Sobota, Ulica dr. Vrbnjaka 6, 9000 Murska Sobota, Slovenia; Faculty of Medicine, University of Ljubljana, Korytkova ulica 2, 1000 Ljubljana, Slovenia
| | - Borut Jug
- Department of Vascular Diseases, Division of Internal Medicine, University Clinical Center, Zaloška 7/VI, SI-1000 Ljubljana, Slovenia
| | - Hendrik J Ankersmit
- Division of Thoracic Surgery, Department of Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| |
Collapse
|
40
|
Alem MM. Predictors of Mortality in Patients with Chronic Heart Failure: Is Hyponatremia a Useful Clinical Biomarker? Int J Gen Med 2020; 13:407-417. [PMID: 32765046 PMCID: PMC7381090 DOI: 10.2147/ijgm.s260256] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/18/2020] [Indexed: 01/07/2023] Open
Abstract
Background Chronic heart failure (CHF) is a global health burden. Despite advances in treatment, there remain well-recognised morbidity and mortality. Risk stratification requires the identification and validation of biomarkers, old and new. Hyponatremia has re-emerged as a prognostic marker in CHF patients. Methods This is a retrospective cohort study on 241 CHF patients recruited from King Fahd Hospital of the University, Al-Khobar, Saudi Arabia (January 2005–December 2016). Their serum sodium and biochemical parameters were measured at baseline, along with 2-D echocardiographic assessments of left ventricular mass and ejection fraction. The primary endpoint was the association between hyponatremia and all-cause mortality (ACM) after a follow-up period of 24 months. Results Mean age of patients was 60.61 ± 12.63 (SD) years; 65.1% were males, and type 2 diabetes mellitus (DM) was present in 71%. Baseline serum sodium was 138.00 (136, 140) (median and interquartile range). Hyponatremia (<135 meq/L) was present in 14.1%. After follow-up, 46 deaths had occurred. Multivariate Cox-proportional hazard model showed that type 2 DM, New York Heart Association (NYHA) class (III–IV vs I–II), age, and left ventricular mass index (LVMI) were significant and independent predictors of ACM, with HR 3.03 (95% CI; 1.13, 8.16) (P=0.028), HR 2.31 (95% CI; 1.11, 4.82) (P=0.026), HR 1.06 (95% CI; 1.03, 1.09) (P<0.001), and HR 1.01 (95% CI; 1.00, 1.02) (P=0.039), respectively. Estimated glomerular filtration rate (eGFR) was not a significant predictor. Kaplan–Meier survival analysis was used for the analysis of NYHA class and hyponatremia interactions and showed that hyponatremia had an association with poorer survival in patients with NYHA class III–IV rather than I–II (Log-rank test, P= 0.0009). Conclusion Hyponatremia was a feature in CHF patients, and ACM was predicted by type 2 DM, NYHA class, age, and LVMI. Hyponatremia impact on survival was in patients with more advanced disease.
Collapse
Affiliation(s)
- Manal M Alem
- Department of Pharmacology, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| |
Collapse
|
41
|
Chen JY, Lee SY, Tsai WC, Lin CY, Shieh MD, Ciou DS. Urine N-terminal pro b-type natriuretic peptide is predictive of heart failure-related emergency department visits. ESC Heart Fail 2020; 7:2672-2678. [PMID: 32613707 PMCID: PMC7524049 DOI: 10.1002/ehf2.12856] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 04/28/2020] [Accepted: 06/03/2020] [Indexed: 01/14/2023] Open
Abstract
AIMS Emergency department (ED) visits for decompensated heart failure (HF) are frequent and associated with poor long-term outcomes in patients with HF. Serum N-terminal pro b-type natriuretic peptide (NT-proBNP) is widely used to assist diagnosis and predict clinical outcomes in HF patients. Few studies have investigated the use of urine NT-proBNP as an HF biomarker. This study aims to assess the value of urine NT-proBNP for predicting ED visits for decompensated HF as compared with that of serum NT-proBNP. METHODS AND RESULTS This study included 122 HF patients with reduced left ventricular ejection fraction (<50%). Serum and urine NT-proBNP levels were measured. Baseline data included demographics, comorbidities, and co-medications. Medical records were used to determine the incidence of visits to the ED for decompensated HF during the 3 months following the last visit. We observed significantly higher levels of both serum and urine NT-proBNP in patients with subsequent ED visits than in those without. Multivariate logistic regression analysis showed that urine NT-proBNP/creatinine ratio (OR, 1.031; 95% CI, 1.001-1.061; P = 0.046) but not serum NT-proBNP was an independent factor associated with subsequent ED visits. According to receiver-operating characteristic-area under the curve analysis, the optimal cut-off value of urine NT-proBNP/creatinine ratio for predicting subsequent heart-failure related ED visits was 0.272 pg/μg Cr (area under the curve, 0.675; P = 0.011). CONCLUSIONS For HF patients with reduced left ventricular ejection fraction, a single measurement of urinary NT-proBNP/creatinine ratio is predictive of subsequent ED visits for decompensated HF. This non-invasive and easy measurement may be a clinically useful tool for monitoring clinical outcomes and identifying a subset of patients at higher risk of ED visits within a short time.
Collapse
Affiliation(s)
- Ju-Yi Chen
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shuenn-Yuh Lee
- Department of Electrical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Chuan Tsai
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chia-Yu Lin
- Department of Chemical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Meng-Dar Shieh
- Department of Industrial Design, National Cheng Kung University, Tainan, Taiwan
| | - Ding-Siang Ciou
- Department of Electrical Engineering, National Cheng Kung University, Tainan, Taiwan.,Department of Chemical Engineering, National Cheng Kung University, Tainan, Taiwan
| |
Collapse
|
42
|
Adverse Cardiac Remodelling after Acute Myocardial Infarction: Old and New Biomarkers. DISEASE MARKERS 2020; 2020:1215802. [PMID: 32626540 PMCID: PMC7306098 DOI: 10.1155/2020/1215802] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 01/06/2020] [Accepted: 05/22/2020] [Indexed: 12/15/2022]
Abstract
The prevalence of heart failure (HF) due to cardiac remodelling after acute myocardial infarction (AMI) does not decrease regardless of implementation of new technologies supporting opening culprit coronary artery and solving of ischemia-relating stenosis with primary percutaneous coronary intervention (PCI). Numerous studies have examined the diagnostic and prognostic potencies of circulating cardiac biomarkers in acute coronary syndrome/AMI and heart failure after AMI, and even fewer have depicted the utility of biomarkers in AMI patients undergoing primary PCI. Although complete revascularization at early period of acute coronary syndrome/AMI is an established factor for improved short-term and long-term prognosis and lowered risk of cardiovascular (CV) complications, late adverse cardiac remodelling may be a major risk factor for one-year mortality and postponded heart failure manifestation after PCI with subsequent blood flow resolving in culprit coronary artery. The aim of the review was to focus an attention on circulating biomarker as a promising tool to stratify AMI patients at high risk of poor cardiac recovery and developing HF after successful PCI. The main consideration affects biomarkers of inflammation, biomechanical myocardial stress, cardiac injury and necrosis, fibrosis, endothelial dysfunction, and vascular reparation. Clinical utilities and predictive modalities of natriuretic peptides, cardiac troponins, galectin 3, soluble suppressor tumorogenicity-2, high-sensitive C-reactive protein, growth differential factor-15, midregional proadrenomedullin, noncoding RNAs, and other biomarkers for adverse cardiac remodelling are discussed in the review.
Collapse
|
43
|
Pecherina T, Kutikhin A, Kashtalap V, Karetnikova V, Gruzdeva O, Hryachkova O, Barbarash O. Serum and Echocardiographic Markers May Synergistically Predict Adverse Cardiac Remodeling after ST-Segment Elevation Myocardial Infarction in Patients with Preserved Ejection Fraction. Diagnostics (Basel) 2020; 10:diagnostics10050301. [PMID: 32423119 PMCID: PMC7278008 DOI: 10.3390/diagnostics10050301] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 05/05/2020] [Accepted: 05/13/2020] [Indexed: 01/09/2023] Open
Abstract
Improvement of risk scoring is particularly important for patients with preserved left ventricular ejection fraction (LVEF) who generally lack efficient monitoring of progressing heart failure. Here, we evaluated whether the combination of serum biomarkers and echocardiographic parameters may be useful to predict the remodeling-related outcomes in patients with ST-segment elevation myocardial infarction (STEMI) and preserved LVEF (HFpEF) as compared to those with reduced LVEF (HFrEF). Echocardiographic assessment and measurement of the serum levels of NT-proBNP, sST2, galectin-3, matrix metalloproteinases, and their inhibitors (MMP-1, MMP-2, MMP-3, TIMP-1) was performed at the time of admission (1st day) and on the 10th–12th day upon STEMI onset. We found a reduction in NT-proBNP, sST2, galectin-3, and TIMP-1 in both patient categories from hospital admission to the discharge, as well as numerous correlations between the indicated biomarkers and echocardiographic parameters, testifying to the ongoing ventricular remodeling. In patients with HFpEF, NT-proBNP, sST2, galectin-3, and MMP-3 correlated with the parameters reflecting the diastolic dysfunction, while in patients with HFrEF, these markers were mainly associated with LVEF and left ventricular end-systolic volume/diameter. Therefore, the combination of the mentioned serum biomarkers and echocardiographic parameters might be useful for the prediction of adverse cardiac remodeling in patients with HFpEF.
Collapse
|
44
|
Brunner-La Rocca HP. What do we need to better understand the role of biomarkers in heart failure? Int J Cardiol 2020; 304:93-94. [PMID: 31955978 DOI: 10.1016/j.ijcard.2020.01.018] [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] [Received: 01/03/2020] [Accepted: 01/09/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Hans-Peter Brunner-La Rocca
- Department of Cardiology, Maastricht University Medical Centre, P.O. Box 5800, 6202AZ Maastricht, the Netherlands.
| |
Collapse
|
45
|
Araguas MA, Herrera A, Garrido I, Mateo J, Mayoral AP, Muñoz M. Risk factors for major adverse cardiovascular events after osteoporotic hip fracture repair surgery. Injury 2020; 51 Suppl 1:S30-S36. [PMID: 32360086 DOI: 10.1016/j.injury.2020.03.052] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/24/2020] [Accepted: 03/29/2020] [Indexed: 02/02/2023]
Abstract
Osteoporotic hip fracture (OHF) is an increasingly frequent age-related pathology, which results in high rates of functional loss and mortality within the first year after surgery. This study assessed whether preoperative levels of brain natriuretic peptide (NT-proBNP) and troponin I were related to early occurrence (30d) of major adverse cardio-vascular events (MACE) after OHF repair surgery. During a 6-month period, perioperative clinical and analytical data from consecutive patients, without known history of cardiovascular disease and undergoing surgery for OHF repair at a single centre, were prospectively collected. MACE was defined as acute myocardial ischaemia or infarction, acute heart failure or cardiovascular death. amongst the 140 patients included, 23 (16.4%) developed postoperative MACE (MACE group) and 117 did not (Control group). Compared to those from control group, patients from MACE group were older, had poorer physical status (ASA III-IV), received preoperative red blood cell transfusion (RBCT) more frequently, presented with lower haemoglobin concentrations and higher NT-proBNP, creatinine and troponin I concentrations. Overall, RBCT requirements and 30d mortality rate were also higher in MACE group. However, in multivariate analysis, only preoperative RBCT, creatinine >1 mg/dL and NT-proBNP >450 pg/mL remained as independent preoperative risks factors for postoperative MACE, while 95% confidence intervals of odds ratios were wide. Though our findings require confirmation in a larger multicentre cohort, identifying risk factors for early postoperative MACE after OHF repair surgery, might facilitate assessing patients' risk prior to and following surgery, and targeting them the appropriate preventive and/or therapeutic interventions.
Collapse
Affiliation(s)
- M A Araguas
- Department of Cardiology, Royo Villanova Hospital, Zaragoza, Spain
| | - A Herrera
- Department of Surgery, University of Zaragoza, Zaragoza, Spain; Aragón's Health Research Institute, Zaragoza, Spain.
| | - I Garrido
- Department of Orthopaedic Surgery and Traumatology, Miguel Servet University Hospital, Zaragoza, Spain
| | - J Mateo
- Department of Orthopaedic Surgery and Traumatology, Miguel Servet University Hospital, Zaragoza, Spain
| | - A P Mayoral
- Health Sciences School, University of Zaragoza, Zaragoza, Spain
| | - M Muñoz
- Department of Surgical Specialties, Biochemistry and Immunology, School of Medicine, University of Málaga, Málaga, Spain
| |
Collapse
|
46
|
cGMP signalling in cardiomyocyte microdomains. Biochem Soc Trans 2020; 47:1327-1339. [PMID: 31652306 DOI: 10.1042/bst20190225] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/20/2019] [Accepted: 09/24/2019] [Indexed: 02/07/2023]
Abstract
3',5'-Cyclic guanosine monophosphate (cGMP) is one of the major second messengers critically involved in the regulation of cardiac electrophysiology, hypertrophy, and contractility. Recent molecular and cellular studies have significantly advanced our understanding of the cGMP signalling cascade, its local microdomain-specific regulation and its role in protecting the heart from pathological stress. Here, we summarise recent findings on cardiac cGMP microdomain regulation and discuss their potential clinical significance.
Collapse
|
47
|
A MULTI-MARKER MODEL FOR PREDICTING DECOMPENSATED HEART FAILURE IN PATIENTS WITH PRIOR ACUTE MYOCARDIAL INFARCTION. EUREKA: HEALTH SCIENCES 2020. [DOI: 10.21303/2504-5679.2020.001049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The aim of the study was to assess the prognostic value of determining the plasma concentration of NT-proBNP and ST2 in the patients with decompensated HF and prior acute myocardial infarction and their combination in this category of patients.
Materials and methods. There were examined 120 patients with acute myocardial infarction and stage II A-B decompensated chronic HF according to the classification proposed by Vasylenko V. Kh. and Strazhesko M.D., NYHA functional class (FC) III-IV. The patients with Q-QS wave MI (60 individuals) and non Q MI (60 individuals) were divided into 4 groups depending on the treatment methods.
Study groups were homogenous by age, gender, disease severity, duration of the post-infarction period, clinical signs of decompensation, which served as a basis for inclusion of the patients in the study.
All the patients underwent the six-minute walk test in a quiet 30-50-m long hospital corridor in the morning. N-terminal pro-B-type brain natriuretic peptide (NT-proBNP) and ST-2 were analyzed in all patients.
Results. Promising biomarkers of HF decompensation in the post-infarction period were studied. In the patients with prior Q-QS MI and decompensated HF, NT-proBNP level was (950.38±3.15) pmol/l (p<0.05); in the patients with prior MI without signs of decompensated HF, it was (580.15±3.03) pmol/l (p˂0.05); in apparently healthy individuals, the level of NT-proBNP was found to be (111.20±3.47) pmol/l.
ST2 level was (14.80±1.61) ng/ml, (36.00±1.43) ng/ml and (49.22±1.40) ng/ml in the patients of Group 1, Group 2 and Group 3, respectively (p˂0.05).
Similar changes were found in patients with decompensated HF in postinfarction period after non Q MI.
Conclusions. The increase in plasma concentration of sST2 is associated with the activation of both neurohumoral and fibrous pathways and can help in detecting the patients with decompensated HF in the post-infarction period and predicting the risk of its development.
Our results confirmed the results of other multiple studies reporting ST2 in combination with NT-proBNP to be valuable tools for prognosing the development of decompensated HF in the patients with prior MI. ST2, alongside with NT-proBNP, is a promising biomarker to be included in the diagnostic panel for detecting acute HF and can provide additional information on risk stratification for such patients during hospitalization and at the time of discharge from the hospital.
Collapse
|
48
|
Aimo A, Januzzi JL, Vergaro G, Richards AM, Lam CS, Latini R, Anand IS, Cohn JN, Ueland T, Gullestad L, Aukrust P, Brunner‐La Rocca H, Bayes‐Genis A, Lupón J, Boer RA, Takeishi Y, Egstrup M, Gustafsson I, Gaggin HK, Eggers KM, Huber K, Gamble GD, Ling LH, Leong KTG, Yeo PSD, Ong HY, Jaufeerally F, Ng TP, Troughton R, Doughty RN, Passino C, Emdin M. Circulating levels and prognostic value of soluble ST2 in heart failure are less influenced by age than N‐terminal pro‐B‐type natriuretic peptide and high‐sensitivity troponin T. Eur J Heart Fail 2020; 22:2078-2088. [DOI: 10.1002/ejhf.1701] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/04/2019] [Accepted: 11/09/2019] [Indexed: 12/12/2022] Open
Affiliation(s)
| | - James L. Januzzi
- Massachusetts General Hospital and Baim Institute for Clinical Research Boston MA USA
| | - Giuseppe Vergaro
- Scuola Superiore Sant'Anna Pisa Italy
- Fondazione Toscana G. Monasterio Pisa Italy
| | | | | | - Roberto Latini
- IRCCS ‐ Istituto di Ricerche Farmacologiche ‘Mario Negri’ Milan Italy
| | - Inder S. Anand
- University of Minnesota Minneapolis MN USA
- VA Medical Centre Minneapolis MN USA
| | | | - Thor Ueland
- Oslo University Hospital Oslo Norway
- University of Oslo Oslo Norway
- University of Tromsø Tromsø Norway
| | | | | | | | - Antoni Bayes‐Genis
- Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona) and CIBER Cardiovascular, Instituto de Salud Carlos III Madrid Spain
| | - Josep Lupón
- Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona) and CIBER Cardiovascular, Instituto de Salud Carlos III Madrid Spain
| | - Rudolf A. Boer
- University Medical Centre Groningen Groningen The Netherlands
| | | | - Michael Egstrup
- Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Ida Gustafsson
- Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Hanna K. Gaggin
- Massachusetts General Hospital and Baim Institute for Clinical Research Boston MA USA
| | | | - Kurt Huber
- Wilhelminenspital and Sigmund Freud University Medical School Vienna Austria
| | | | | | | | | | | | | | - Tze P. Ng
- National University of Singapore Singapore
| | | | | | - Claudio Passino
- Fondazione Toscana G. Monasterio Pisa Italy
- University of Otago Dunedin New Zealand
| | - Michele Emdin
- Fondazione Toscana G. Monasterio Pisa Italy
- University of Otago Dunedin New Zealand
| |
Collapse
|
49
|
Simonavičius J, Sanders van-Wijk S, Rickenbacher P, Maeder MT, Pfister O, Kaufmann BA, Pfisterer M, Čelutkienė J, Puronaitė R, Knackstedt C, van Empel V, Brunner-La Rocca HP. Prognostic Significance of Longitudinal Clinical Congestion Pattern in Chronic Heart Failure: Insights From TIME-CHF Trial. Am J Med 2019; 132:e679-e692. [PMID: 31051151 DOI: 10.1016/j.amjmed.2019.04.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 04/06/2019] [Accepted: 04/08/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND The relationship between longitudinal clinical congestion pattern and heart failure outcome is uncertain. This study was designed to assess the prevalence of congestion over time and to investigate its impact on outcome in chronic heart failure. METHODS A total of 588 patients with chronic heart failure older than 60 years of age with New York Heart Association (NYHA) functional class ≥II from the TIME-CHF study were included. The endpoints for this study were survival and hospitalization-free heart failure survival. Orthopnea, NYHA ≥III, paroxysmal nocturnal dyspnea, hepatomegaly, peripheral pitting edema, jugular venous distension, and rales were repeatedly investigated and related to outcomes. These congestion-related signs and symptoms were used to design a 7-item Clinical Congestion Index. RESULTS Sixty-one percent of patients had a Clinical Congestion Index ≥3 at baseline, which decreased to 18% at month 18. During the median [interquartile range] follow-up of 27.2 [14.3-39.8] months, 17%, 27%, and 47% of patients with baseline Clinical Congestion Index of 0, 1-2, and ≥3 at inclusion, respectively, died (P <.001). Clinical Congestion Index was identified as an independent predictor of mortality at all visits (P <.05) except month 6 and reduced hospitalization-free heart failure survival (P <.05). Successful decongestion was related to better outcome as compared to persistent congestion or partial decongestion (log-rank P <0.001). CONCLUSIONS The extent of congestion as assessed by means of clinical signs and symptoms decreased over time with intensified treatment, but it remained present or relapsed in a substantial number of patients with heart failure and was associated with poor outcome. This highlights the importance of appropriate decongestion in chronic heart failure.
Collapse
Affiliation(s)
- Justas Simonavičius
- Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania; Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | | | - Peter Rickenbacher
- Department of Cardiology, University Hospital Bruderholz, Bruderholz, Switzerland
| | - Micha T Maeder
- Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Otmar Pfister
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Beat A Kaufmann
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | | | - Jelena Čelutkienė
- Institute of Clinical Medicine, Medical Faculty of Vilnius University, Vilnius, Lithuania
| | - Roma Puronaitė
- Department of Information Systems, Centre of Informatics and Development, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania; Clinic of Cardiac and Vascular diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; Institute of Data Science and Digital Technologies, Faculty of Mathematics and Informatics, Vilnius University, Vilnius, Lithuania
| | - Christian Knackstedt
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Vanessa van Empel
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Hans-Peter Brunner-La Rocca
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Cardiology, University Hospital Basel, Basel, Switzerland
| |
Collapse
|
50
|
Rubattu S, Volpe M. Natriuretic Peptides in the Cardiovascular System: Multifaceted Roles in Physiology, Pathology and Therapeutics. Int J Mol Sci 2019; 20:ijms20163991. [PMID: 31426320 PMCID: PMC6721730 DOI: 10.3390/ijms20163991] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 08/15/2019] [Indexed: 12/13/2022] Open
Abstract
The natriuretic peptides (NPs) family includes a class of hormones and their receptors needed for the physiological control of cardiovascular functions. The discovery of NPs provided a fundamental contribution into our understanding of the physiological regulation of blood pressure, and of heart and kidney functions. NPs have also been implicated in the pathogenesis of several cardiovascular diseases (CVDs), including hypertension, atherosclerosis, heart failure, and stroke. A fine comprehension of the molecular mechanisms dependent from NPs and underlying the promotion of cardiovascular damage has contributed to improve our understanding of the molecular basis of all major CVDs. Finally, the opportunity to target NPs in order to develop new therapeutic tools for a better treatment of CVDs has been developed over the years. The current Special Issue of the Journal covers all major aspects of the molecular implications of NPs in physiology and pathology of the cardiovascular system, including NP-based therapeutic approaches.
Collapse
Affiliation(s)
- Speranza Rubattu
- Department of Clinical and Molecular Medicine, School of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy.
- IRCCS Neuromed, 86077 Pozzilli (Isernia), Italy.
| | - Massimo Volpe
- Department of Clinical and Molecular Medicine, School of Medicine and Psychology, Sapienza University of Rome, 00189 Rome, Italy.
- IRCCS Neuromed, 86077 Pozzilli (Isernia), Italy.
| |
Collapse
|