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Siebers P, Gembruch U, Merz WM, Recker F, Müller A, Strizek B, Geipel A, Berg C, Weber EC. Fetal NT-proBNP levels and their course in severe anemia during intrauterine treatment. Arch Gynecol Obstet 2024; 309:1341-1351. [PMID: 36966429 PMCID: PMC10894143 DOI: 10.1007/s00404-023-07006-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 03/07/2023] [Indexed: 03/27/2023]
Abstract
PURPOSE In adults and fetuses, N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a marker of cardiac failure and myocardial remodelling. We examined the effect of anemia and intrauterine transfusion (IUT) on NT-proBNP concentrations in fetuses with anemia and established gestational age-dependent reference values of a control group. METHODS We analyzed NT-proBNP levels in anemic fetuses that underwent serial intrauterine transfusions (IUT), focusing on different causes and severity of anemia and comparing the results to a non-anemic control group. RESULTS In the control group, the average NT-proBNP concentration was 1339 ± 639 pg/ml, decreasing significantly with increasing gestational age (R = - 74.04, T = - 3.65, p = 0.001). Subjects had significantly higher NT-proBNP concentrations before initiation of IUT therapy (p < 0.001), showing fetuses with parvovirus B19 (PVB19) infection having the highest concentrations. Hydropic fetuses also showed an increased NT-proBNP concentration compared to non-hydropic fetuses (p < 0.001). During the course of therapy, NT-proBNP concentration before subsequent IUT decreased significantly from pathologically high levels, while MoM-Hb and MoM-MCA-PSV remained pathological. CONCLUSION NT-pro BNP levels in non-anemic fetuses are higher than in postnatal life, decreasing with ongoing pregnancy. Anemia is a hyperdynamic state and its severity correlates with circulating NT-proBNP levels. Highest concentrations occur in fetuses with hydrops and with PVB19 infection, respectively. Treatment by IUT leads to a normalisation of NT-proBNP concentrations, so the measurement of its levels may be useful in therapy monitoring.
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Affiliation(s)
- Pauline Siebers
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Ulrich Gembruch
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Waltraut Maria Merz
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Florian Recker
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Andreas Müller
- Department of Neonatology and Pediatric Intensive Care, University Hospital Bonn, Bonn, Germany
| | - Brigitte Strizek
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Annegret Geipel
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Christoph Berg
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
- Division of Prenatal Medicine, Gynecological Ultrasound and Fetal Surgery, Department of Obstetrics and Gynecology, University Hospital Cologne, Cologne, Germany
| | - Eva Christin Weber
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany.
- Division of Prenatal Medicine, Gynecological Ultrasound and Fetal Surgery, Department of Obstetrics and Gynecology, University Hospital Cologne, Cologne, Germany.
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Stroda A, Mauermann E, Ionescu D, Szczeklik W, De Hert S, Filipovic M, Beck Schimmer B, Spadaro S, Matute P, Ganter MT, Ovezov A, Turhan SC, van Waes J, Lagarto F, Theodoraki K, Gupta A, Gillmann HJ, Guzzetti L, Kotfis K, Larmann J, Corneci D, Buggy DJ, Howell SJ, Lurati Buse G. Pathological findings associated with the updated European Society of Cardiology 2022 guidelines for preoperative cardiac testing: an observational cohort modelling study. Br J Anaesth 2024; 132:675-684. [PMID: 38336516 DOI: 10.1016/j.bja.2023.12.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 12/20/2023] [Accepted: 12/27/2023] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND In 2022, the European Society of Cardiology updated guidelines for preoperative evaluation. The aims of this study were to quantify: (1) the impact of the updated recommendations on the yield of pathological findings compared with the previous guidelines published in 2014; (2) the impact of preoperative B-type natriuretic peptide (NT-proBNP) use for risk estimation on the yield of pathological findings; and (3) the association between 2022 guideline adherence and outcomes. METHODS This was a secondary analysis of MET-REPAIR, an international, prospective observational cohort study (NCT03016936). Primary endpoints were reduced ejection fraction (EF<40%), stress-induced ischaemia, and major adverse cardiovascular events (MACE). The explanatory variables were class of recommendations for transthoracic echocardiography (TTE), stress imaging, and guideline adherence. We conducted second-order Monte Carlo simulations and multivariable regression. RESULTS In total, 15,529 patients (39% female, median age 72 [inter-quartile range: 67-78] yr) were included. The 2022 update changed the recommendation for preoperative TTE in 39.7% patients, and for preoperative stress imaging in 12.9% patients. The update resulted in missing 1 EF <40% every 3 fewer conducted TTE, and in 4 additional stress imaging per 1 additionally detected ischaemia events. For cardiac stress testing, four more investigations were performed for every 1 additionally detected ischaemia episodes. Use of NT-proBNP did not improve the yield of pathological findings. Multivariable regression analysis failed to find an association between adherence to the updated guidelines and MACE. CONCLUSIONS The 2022 update for preoperative cardiac testing resulted in a relevant increase in tests receiving a stronger recommendation. The updated recommendations for TTE did not improve the yield of pathological cardiac testing.
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Affiliation(s)
- Alexandra Stroda
- Department of Anaesthesiology, University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany.
| | - Eckhard Mauermann
- Clinic for Anaesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
| | - Daniela Ionescu
- Department of Anaesthesia and Intensive Care, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Stefan De Hert
- Department of Anaesthesiology and Peri-operative Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Miodrag Filipovic
- Division of Anaesthesiology, Intensive Care, Rescue and Pain Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Beatrice Beck Schimmer
- Institute of Anaesthesiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Savino Spadaro
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Purificación Matute
- Department of Anaesthesia, Hospital Clinic of Barcelona, Universidad de Barcelona, Barcelona, Spain
| | - Michael T Ganter
- Department of Anaesthesiology and Intensive Care Medicine, Klinik Hirslanden, Zurich, Switzerland
| | - Alexey Ovezov
- Department of Anaesthesiology, Moscow Regional Research Clinical Institute, Moscow, Russia
| | - Sanem C Turhan
- Department of Anaesthesiology and ICU, Ankara University Medical School, Ankara, Turkey
| | - Judith van Waes
- Department of Anaesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Filipa Lagarto
- Department of Anaesthesiology, Hospital Beatriz Ângelo, Loures, Portugal
| | - Kassiani Theodoraki
- Aretaieion University Hospital National and Kapodistrian University of Athens, Athens, Greece
| | - Anil Gupta
- Department of Perioperative Medicine and Intensive Care, Karolinska Hospital and Institution for Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Hans-Jörg Gillmann
- Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Luca Guzzetti
- Anesthesia and Intensive Care Department, University Hospital, Varese, Italy
| | - Katarzyna Kotfis
- Department of Anaesthesiology, Intensive Therapy and Pain Management, Pomeranian Medical University, Szczecin, Poland
| | - Jan Larmann
- Department of Anaesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Dan Corneci
- Anesthesia and Intensive Care Department III, Carol Davila University of Medicine and Pharmacy Bucharest, Central Military Emergency University Hospital "Dr. Carol Davila Bucharest", Bucharest, Romania
| | - Donal J Buggy
- Department of Anaesthesiology, Mater University Hospital, Dublin, Ireland
| | - Simon J Howell
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Giovanna Lurati Buse
- Department of Anaesthesiology, University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany; CARID, Cardiovascular Research Institute Düsseldorf, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
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3
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Sleem B, El Rassi C, Zareef R, Bitar F, Arabi M. NT-proBNP cardiac value in COVID-19: a focus on the paediatric population. Cardiol Young 2024:1-10. [PMID: 38528805 DOI: 10.1017/s1047951124000283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
NT-proBNP is a peptide related to brain natriuretic peptide, a cardiac biomarker and a member of the natriuretic family of peptides. NT-proBNP has demonstrated its clinical utility in the assessment of a wide spectrum of cardiac manifestations. It is also considered a more precise diagnostic and prognostic cardiac biomarker than brain natriuretic peptide. With the appearance of the Severe Acute Respiratory Syndrome Coronavirus 2 virus and the subsequent COVID-19 pandemic, diagnosis of heart implications began to pose an increasing struggle for the physician. Echocardiography is considered a central means of evaluating cardiac disorders like heart failure, and it is considered a reliable method. However, other diagnostic methods are currently being explored, one of which involves the assessment of NT-proBNP levels. In the literature that involves the adult population, significant positive correlations were drawn between the levels of NT-proBNP and COVID-19 outcomes such as high severity and fatality. In the paediatric population, however, the literature is scarce, and most of the investigations assess NT-proBNP in the context of Multiple Inflammatory Syndrome in Children, where studies have shown that cohorts with this syndrome had elevated levels of NT-proBNP when compared to non-syndromic cohorts. Thus, more large-scale studies on existing COVID-19 data should be carried out in the paediatric population to further understand the prognostic and diagnostic roles of NT-proBNP.
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Affiliation(s)
- Bshara Sleem
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Christophe El Rassi
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rana Zareef
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fadi Bitar
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Pediatric Department, Division of Pediatric Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mariam Arabi
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- Pediatric Department, Division of Pediatric Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
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Gruson D, Hammerer-Lercher A, Collinson P, Duff C, Baum H, Pulkki K, Suvisaari J, Stankovic S, Laitinen P, Bayes-Genis A. The multidimensional value of natriuretic peptides in heart failure, integrating laboratory and clinical aspects. Crit Rev Clin Lab Sci 2024:1-15. [PMID: 38523480 DOI: 10.1080/10408363.2024.2319578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/13/2024] [Indexed: 03/26/2024]
Abstract
Natriuretic peptides (NP) play an essential role in heart failure (HF) regulation, and their measurement has improved diagnostic and prognostic accuracy. Clinical symptoms and objective measurements, such as NP levels, should be included in the HF definition to render it more reliable and consistent among observers, hospitals, and healthcare systems. BNP and NT-proBNP are reasonable surrogates for cardiac disease, and their measurement is critical to early diagnosis and risk stratification of HF patients. NPs should be measured in all patients presenting with dyspnea or other symptoms suggestive of HF to facilitate early diagnosis and risk stratification. Both BNP and NT-proBNP are currently used for guided HF management and display comparable diagnostic and prognostic accuracy. Standardized cutoffs for each NP assay are essential for data comparison. The value of NP testing is recognized at various levels, including patient empowerment and education, analytical and operational issues, clinical HF management, and cost-effectiveness.
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Affiliation(s)
- Damien Gruson
- Pôle de recherche en Endocrinologie, Diabète et Nutrition, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires St-Luc and Université Catholique de Louvain, Brussels, Belgium
- Department of Clinical Biochemistry, Cliniques Universitaires St-Luc and Université Catholique de Louvain, Brussels, Belgium
| | | | - Paul Collinson
- Department of Clinical Blood Science Chemical Pathology and Cardiology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Christopher Duff
- Department of Clinical Biochemistry, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | - Hannsjörg Baum
- Department Laboratory Medicine, Regionale Kliniken Holding RKH, Ludwigsburg, Germany
| | - Kari Pulkki
- Clinical Chemistry and Hematology, Diagnostic Center, Helsinki University Hospital and the University of Helsinki, Helsinki, Finland
| | - Janne Suvisaari
- Clinical Chemistry and Hematology, Diagnostic Center, Helsinki University Hospital and the University of Helsinki, Helsinki, Finland
| | - Sanja Stankovic
- Center for Medical Biochemistry, University Clinical Center of Serbia, Belgrade, Serbia
- Department of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Paivi Laitinen
- Center for Medical Biochemistry, University Clinical Center of Serbia, Belgrade, Serbia
| | - Antoni Bayes-Genis
- Germans Trias Heart Institute (iCor), Pujol, Universitat Autònoma de Barcelona; CIBERCV, Barcelona, Spain
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Nattkemper LA, Kim BS, Yap QV, Hoon MA, Mishra SK, Yosipovitch G. Increased systemic levels of centrally acting B-type Natriuretic Peptide are associated with chronic Itch of different types. J Invest Dermatol 2024:S0022-202X(24)00197-0. [PMID: 38522572 DOI: 10.1016/j.jid.2024.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/05/2024] [Accepted: 02/14/2024] [Indexed: 03/26/2024]
Abstract
B-Type natriuretic peptide (BNP) is an itch-selective neuropeptide that was shown to play a role in both histaminergic and non-histaminergic itch in mice. It was also shown that elevated serum BNP is linked to increased pruritus in non-diabetic hemodialysis patients. This study examined plasma BNP levels of 77 patients and N-Terminal pro-BNP (NT-proBNP) levels of 33 patients with differing types of chronic itch to see if BNP and NT-proBNP levels can correlate with itch severity. Plasma BNP and NT-proBNP levels of all itch patients correlated to itch NRS, and in particular for patients with Chronic Pruritus of Unknown Origin (CPUO). Based on this clinical observation, this study further showed that increasing pathophysiological levels of BNP in mice by IV or osmotic pump induced significant scratching. Additionally, pharmacological and ablation strategies determined that BNP acts centrally by activating the natriuretic peptide receptor A (NPRA) in the dorsal horn of the spinal cord. These data support that BNP and NT-proBNP levels are associated with chronic itch and may be used in clinical setting.
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Affiliation(s)
- Leigh A Nattkemper
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Brian S Kim
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Qai Ven Yap
- Department of Biostatistics, Yong Loo Lin School of Medicine, Singapore, Singapore
| | - Mark A Hoon
- Molecular Genetics Section, National Institute of Dental and Craniofacial Research/NIH, Bethesda, MD, USA
| | - Santosh K Mishra
- Department of Biomedical Sciences, College of Veterinary Medicine, NC State University, Raleigh, North Carolina, USA.
| | - Gil Yosipovitch
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miami Itch Center, Miller School of Medicine, University of Miami, Miami, Florida, USA.
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Palm J, Ono M, Niedermaier C, Hörer J, Hoffmann G, Holdenrieder S, Klawonn F, Ewert P. Quantification of ventricular stress in univentricular hearts during early childhood using age-independent zlog- NT-proBNP. Int J Cardiol 2024:131983. [PMID: 38521506 DOI: 10.1016/j.ijcard.2024.131983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 03/13/2024] [Accepted: 03/17/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Children with univentricular hearts (UVH) undergo up to three palliative surgical procedures to achieve complete circulatory separation (Fontan circulation). As a marker of cardiac wall stress, NT-proBNP is a promising tool to assess systemic ventricular load in these patients. However, different reference intervals (RI) apply to each stage, as NT-proBNP is highly age-dependent. METHODS Children undergoing systemic-to-pulmonary (SP) shunt placement (stage 1), bidirectional cavopulmonary shunt (BCPS, stage 2) or total cavopulmonary connection (TCPC, stage 3) between 2011 and 2021 with NT-proBNP measurement within 7 days before surgery were included. Furthermore, outpatients after TCPC with NT-proBNP measurement were enrolled. Biomarker levels were evaluated using its age-adjusted z-score ("zlog-NT-proBNP"; age-independent RI, -1.96 to +1.96), allowing comparison between different stages and revealing changes in systemic ventricular load independent of the marked physiological decline in RI with age. RESULTS Overall, 289 children (227 before, 62 after TCPC) met the eligibility criteria. Median time between blood sampling and surgery (SP shunt/BCPS/TCPC) was 2 [1-3] days and 3.2 [2.0-4.5] years after TCPC. Age-adjusted zlog-NT-proBNP levels were 3.47 [2.79-3.93] in children with native UVH (before SP shunt), 3.10 [1.89-3.58] at stage 1 (before BCPS), 1.08 [0.51-1.88] at stage 2 (before TCPC), and 1.09 [0.72-1.75] at stage 3 (after TCPC/Fontan completion). Consequently, BCPS revealed the strongest decrease (median - 2.02 logarithmized standard deviations, p < 0.001). CONCLUSIONS In children with UVH undergoing staged Fontan palliation, zlog-NT-proBNP is a highly promising tool for course assessment of systemic ventricular load, independent of the age-related decline in physiological NT-proBNP concentration.
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Affiliation(s)
- Jonas Palm
- Department of Pediatric Cardiology and Congenital Heart Defects, German Heart Center of the Technical University Munich, Germany.
| | - Masamichi Ono
- Department for Congenital and Pediatric Heart Surgery, German Heart Center of the Technical University Munich, Division for Congenital and Pediatric Heart Surgery, University Hospital Großhadern, Ludwig-Maximilians University, Munich, Germany
| | - Carolin Niedermaier
- Department for Congenital and Pediatric Heart Surgery, German Heart Center of the Technical University Munich, Division for Congenital and Pediatric Heart Surgery, University Hospital Großhadern, Ludwig-Maximilians University, Munich, Germany
| | - Jürgen Hörer
- Department for Congenital and Pediatric Heart Surgery, German Heart Center of the Technical University Munich, Division for Congenital and Pediatric Heart Surgery, University Hospital Großhadern, Ludwig-Maximilians University, Munich, Germany
| | - Georg Hoffmann
- Institute of Laboratory Medicine, German Heart Center of the Technical University Munich, Germany
| | - Stefan Holdenrieder
- Institute of Laboratory Medicine, German Heart Center of the Technical University Munich, Germany
| | - Frank Klawonn
- Biostatistics, Helmholtz Center for Infection Research, Braunschweig, Germany; Institute for Information Engineering, Ostfalia University of Applied Sciences, Wolfenbuttel, Germany
| | - Peter Ewert
- Department of Pediatric Cardiology and Congenital Heart Defects, German Heart Center of the Technical University Munich, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Germany
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Prokopidis K, Morwani-Mangnani J, McDowell G, Lip GYH, Venturelli M, Sankaranarayanan R, Isanejad M. Sarcopenia is linked to higher levels of B-type natriuretic peptide and its N-terminal fragment in heart failure: a systematic review and meta-analysis. Eur Geriatr Med 2024:10.1007/s41999-024-00950-x. [PMID: 38457043 DOI: 10.1007/s41999-024-00950-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/21/2024] [Indexed: 03/09/2024]
Abstract
AIMS Sarcopenia is linked to impaired physical function and exercise tolerance. The aim of this systematic review and meta-analysis was to examine the association of sarcopenia and low appendicular skeletal muscle (ASM) with biomarkers of cardiac function, B-type natriuretic peptide (BNP) and its N-terminal fragment (NT-proBNP), in patients with heart failure (HF). METHODS AND RESULTS From inception until May 2023, a systematic literature search of observational studies was undertaken utilizing the PubMed, Web of Science, Scopus, and Cochrane Library databases. A meta-analysis employing a random-effects model was used to compute the pooled effects (CRD42023418465). Overall, 16 studies were included in this systematic review and meta-analysis. Our main analysis showed that sarcopenia in HF was linked to significantly higher levels of BNP (MD: 87.76, 95% CI 20.74-154.78, I2 = 61%, P = 0.01) and NT-proBNP (MD: 947.45, 95% CI 98.97-1795.93, I2 = 35%, P = 0.03). Similarly, low ASM was associated with significantly higher levels of BNP (MD: 118.95, 95% CI 46.91-191.00, I2 = 93%, P < 0.01) and NT-proBNP (MD: 672.01, 95% CI 383.72-960.30, I2 = 2%, P < 0.01). The quality of the included cohort studies was considered moderate, using the binary AXIS checklist and the Cochrane Tool to Assess the Risk of Bias in Cohort Studies. CONCLUSIONS In patients with HF, sarcopenia and reduced ASM are associated with considerably higher plasma levels of BNP and NT-proBNP. Future research is required to investigate whether sarcopenia may express dysregulated biomarkers of cardiac function.
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Affiliation(s)
- Konstantinos Prokopidis
- Department of Musculoskeletal Ageing and Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.
| | | | - Garry McDowell
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
- Research Lab, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Massimo Venturelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Rajiv Sankaranarayanan
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Masoud Isanejad
- Department of Musculoskeletal Ageing and Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
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Prokopidis K, Ishiguchi H, Jordan C, Irlik K, Nabrdalik K, Formiga F, Sankaranarayanan R, Lip GYH, Isanejad M. Association between natriuretic peptides and C-reactive protein with frailty in heart failure: a systematic review and meta-analysis. Aging Clin Exp Res 2024; 36:57. [PMID: 38446241 PMCID: PMC10917829 DOI: 10.1007/s40520-024-02713-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/24/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND Heart failure (HF) and frailty are accompanied by a bidirectional relationship, sharing common risk factors including elevated levels of natriuretic peptides and inflammation. The aim of this study was to compare biomarkers associated with poor clinical outcomes, that is, plasma brain natriuretic peptide (BNP), N-terminal-pro B-type natriuretic peptide (NT-proBNP), and C-reactive protein (CRP) in patients with HF and frailty vs. patients with HF without frailty. METHODS From inception until July 2023, PubMed, Scopus, Web of Science, and Cochrane Library a systematic literature search was conducted. To evaluate whether frailty is linked with greater levels of BNP, NT-proBNP, and CRP, a meta-analysis using a random-effects model was used to calculate the pooled effects (CRD42023446607). RESULTS Fifty-three studies were included in this systematic review and meta-analysis. Patients with HF and frailty displayed significantly higher levels of BNP (k = 11; SMD: 0.53, 95%CI 0.30-0.76, I2 = 86%, P < 0.01), NT-proBNP (k = 23; SMD: 0.33, 95%CI 0.25-0.40, I2 = 72%, P < 0.01), and CRP (k = 8; SMD: 0.30, 95%CI 0.12-0.48, I2 = 62%, P < 0.01) vs. patients with HF without frailty. Using meta-regression, body mass index (BMI) and age were deemed potential moderators of these findings. CONCLUSIONS Frailty in HF is linked to increased concentrations of BNP, NT-proBNP, and CRP, which have been epidemiologically associated with adverse outcomes. The increased risk of NYHA III/IV classification further emphasizes the clinical impact of frailty in this population.
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Affiliation(s)
- Konstantinos Prokopidis
- Department of Musculoskeletal Ageing and 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 and Chest Hospital, Liverpool, UK.
| | - Hironori Ishiguchi
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Cara Jordan
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Krzysztof Irlik
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
- Faculty of Medical Sciences in Zabrze, Students' Scientific Association By the Department of Internal Medicine, Diabetology and Nephrology in Zabrze, Medical University of Silesia, Katowice, Poland
- Doctoral School, Faculty of Medical Sciences in Zabrze, Department of Internal Medicine, Diabetology and Nephrology, Medical University of Silesia, Katowice, Poland
| | - Katarzyna Nabrdalik
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
- Faculty of Medical Sciences in Zabrze, Department of Internal Medicine, Diabetology and Nephrology, Medical University of Silesia, Katowice, Poland
| | - Francesc Formiga
- Servicio de Medicina Interna, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Rajiv Sankaranarayanan
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
- National Institute for Health and Care Research, Liverpool, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Masoud Isanejad
- Department of Musculoskeletal Ageing and Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
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9
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Alexander KM. Defining Disease Progression in ATTR Cardiac Amyloidosis: Keeping It Simple. J Am Coll Cardiol 2024:S0735-1097(24)00409-1. [PMID: 38530685 DOI: 10.1016/j.jacc.2024.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 03/28/2024]
Affiliation(s)
- Kevin M Alexander
- Stanford Amyloid Center, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California, USA.
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10
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Rossi R, Jabrah D, Douglas A, Prendergast J, Pandit A, Gilvarry M, McCarthy R, Redfors P, Nordanstig A, Tatlisumak T, Ceder E, Dunker D, Carlqvist J, Szikora I, Tsivgoulis G, Psychogios K, Thornton J, Rentzos A, Jood K, Juega J, Doyle KM. Investigating the Role of Brain Natriuretic Peptide (BNP) and N-Terminal-proBNP in Thrombosis and Acute Ischemic Stroke Etiology. Int J Mol Sci 2024; 25:2999. [PMID: 38474245 DOI: 10.3390/ijms25052999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/28/2024] [Accepted: 03/02/2024] [Indexed: 03/14/2024] Open
Abstract
The need for biomarkers for acute ischemic stroke (AIS) to understand the mechanisms implicated in pathological clot formation is critical. The levels of the brain natriuretic peptides known as brain natriuretic peptide (BNP) and NT-proBNP have been shown to be increased in patients suffering from heart failure and other heart conditions. We measured their expression in AIS clots of cardioembolic (CE) and large artery atherosclerosis (LAA) etiology, evaluating their location inside the clots, aiming to uncover their possible role in thrombosis. We analyzed 80 thrombi from 80 AIS patients in the RESTORE registry of AIS clots, 40 of which were of CE and 40 of LAA etiology. The localization of BNP and NT-BNP, quantified using immunohistochemistry and immunofluorescence, in AIS-associated white blood cell subtypes was also investigated. We found a statistically significant positive correlation between BNP and NT-proBNP expression levels (Spearman's rho = 0.668 p < 0.0001 *). We did not observe any statistically significant difference between LAA and CE clots in BNP expression (0.66 [0.13-3.54]% vs. 0.53 [0.14-3.07]%, p = 0.923) or in NT-proBNP expression (0.29 [0.11-0.58]% vs. 0.18 [0.05-0.51]%, p = 0.119), although there was a trend of higher NT-proBNP expression in the LAA clots. It was noticeable that BNP was distributed throughout the thrombus and especially within platelet-rich regions. However, NT-proBNP colocalized with neutrophils, macrophages, and T-lymphocytes, suggesting its association with the thrombo-inflammatory process.
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Affiliation(s)
- Rosanna Rossi
- Department of Physiology and Galway Neuroscience Centre, School of Medicine, University of Galway, University Road, H91 TK33 Galway, Ireland
- CÚRAM-SFI Research Centre in Medical Devices, University of Galway, H91 W2TY Galway, Ireland
- Institute of Biotechnology and Biomedicine, Universitat Autonoma de Barcelona (UAB), 08193 Bellaterra, Spain
| | - Duaa Jabrah
- Department of Physiology and Galway Neuroscience Centre, School of Medicine, University of Galway, University Road, H91 TK33 Galway, Ireland
| | - Andrew Douglas
- Department of Physiology and Galway Neuroscience Centre, School of Medicine, University of Galway, University Road, H91 TK33 Galway, Ireland
- CÚRAM-SFI Research Centre in Medical Devices, University of Galway, H91 W2TY Galway, Ireland
| | - James Prendergast
- Department of Physiology and Galway Neuroscience Centre, School of Medicine, University of Galway, University Road, H91 TK33 Galway, Ireland
| | - Abhay Pandit
- CÚRAM-SFI Research Centre in Medical Devices, University of Galway, H91 W2TY Galway, Ireland
| | - Michael Gilvarry
- Cerenovus, Block 3, Corporate House, Ballybrit Business Park, H91 K5YD Galway, Ireland
| | - Ray McCarthy
- Cerenovus, Block 3, Corporate House, Ballybrit Business Park, H91 K5YD Galway, Ireland
| | - Petra Redfors
- Department of Neurology, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, 41345 Gothenburg, Sweden
| | - Annika Nordanstig
- Department of Neurology, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, 41345 Gothenburg, Sweden
| | - Turgut Tatlisumak
- Department of Neurology, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, 41345 Gothenburg, Sweden
| | - Erik Ceder
- Department of Interventional and Diagnostic Neuroradiology, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
| | - Dennis Dunker
- Department of Interventional and Diagnostic Neuroradiology, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
| | - Jeanette Carlqvist
- Department of Interventional and Diagnostic Neuroradiology, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
| | - István Szikora
- Department of Neurointerventions, National Institute of Clinical Neurosciences, 1145 Budapest, Hungary
| | - Georgios Tsivgoulis
- Second Department of Neurology, "Attikon" University Hospital, National & Kapodistrian University of Athens, 157 72 Athens, Greece
| | | | - John Thornton
- Department of Radiology, Beaumont Hospital, Royal College of Surgeons in Ireland, D02 YN77 Dublin, Ireland
| | - Alexandros Rentzos
- Department of Interventional and Diagnostic Neuroradiology, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
| | - Katarina Jood
- Department of Neurology, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, 41345 Gothenburg, Sweden
| | - Jesus Juega
- Neurology Department, Val d'Hebron Hospital, 08035 Barcelona, Spain
| | - Karen M Doyle
- Department of Physiology and Galway Neuroscience Centre, School of Medicine, University of Galway, University Road, H91 TK33 Galway, Ireland
- CÚRAM-SFI Research Centre in Medical Devices, University of Galway, H91 W2TY Galway, Ireland
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11
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Khan MS, Greene SJ, DeVore AD. Serial NT-proBNP Measurements and Implementation of Guideline-Directed Medical Therapy. JACC Heart Fail 2024; 12:488-491. [PMID: 38448150 DOI: 10.1016/j.jchf.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 01/02/2024] [Indexed: 03/08/2024]
Affiliation(s)
- Muhammad Shahzeb Khan
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA.
| | - Stephen J Greene
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA; Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Adam D DeVore
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA; Duke Clinical Research Institute, Durham, North Carolina, USA
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12
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Ioannou A, Cappelli F, Emdin M, Nitsche C, Longhi S, Masri A, Cipriani A, Zampieri M, Colio F, Poledniczek M, Porcari A, Razvi Y, Aimo A, Vergaro G, De Michieli L, Rauf MU, Patel RK, Villanueva E, Lustig Y, Venneri L, Martinez-Naharro A, Lachmann H, Wechalekar A, Whelan C, Petrie A, Hawkins PN, Solomon S, Gillmore JD, Fontana M. Stratifying Disease Progression in Patients With Cardiac ATTR Amyloidosis. J Am Coll Cardiol 2024:S0735-1097(24)00251-1. [PMID: 38530684 DOI: 10.1016/j.jacc.2023.12.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 12/26/2023] [Accepted: 12/28/2023] [Indexed: 03/28/2024]
Abstract
BACKGROUND Transthyretin cardiac amyloidosis (ATTR-CA) is a progressive cardiomyopathy. The clinical course varies among individuals and there are no established measures to assess disease progression. OBJECTIVES The goal of this study was to assess the prognostic importance of an increase in N-terminal pro-B-type natriuretic peptide (NT-proBNP) and outpatient diuretic intensification (ODI) as markers of disease progression in a large cohort of patients with ATTR-CA. METHODS We evaluated landmark survival analysis based on worsening of NT-proBNP and requirement for ODI between time of diagnosis and a 1-year visit, and subsequent mortality in 2,275 patients with ATTR-CA from 7 specialist centers. The variables were developed in the National Amyloidosis Centre (NAC) cohort (n = 1,598) and validated in the external cohort from the remaining centers (n = 677). RESULTS Between baseline and 1-year visits, 551 (34.5%) NAC patients and 204 (30.1%) patients in the external validation cohort experienced NT-proBNP progression (NT-proBNP increase >700 ng/L and >30%), which was associated with mortality (NAC cohort: HR: 1.82; 95% CI: 1.57-2.10; P < 0.001; validation cohort: HR: 1.75; 95% CI: 1.32-2.33; P < 0.001). At 1 year, 451 (28.2%) NAC patients and 301 (44.5%) patients in the external validation cohort experienced ODI, which was associated with mortality (NAC cohort: HR: 1.88; 95% CI: 1.62-2.18; P < 0.001; validation cohort: HR: 2.05; 95% CI: 1.53-2.74; P < 0.001). When compared with patients with a stable NT-proBNP and stable diuretic dose, a higher risk of mortality was observed in those experiencing either NT-proBNP progression or ODI (NAC cohort: HR: 1.93; 95% CI: 1.65-2.27; P < 0.001; validation cohort: HR: 1.94; 95% CI: 1.36-2.77; P < 0.001), and those experiencing both NT-proBNP progression and ODI (NAC cohort: HR: 2.98; 95% CI: 2.42-3.67; P < 0.001; validation cohort: HR: 3.23; 95% CI: 2.17-4.79; P < 0.001). CONCLUSIONS NT-proBNP progression and ODI are frequent and consistently associated with an increased risk of mortality. Combining both variables produces a simple, universally applicable model that detects disease progression in ATTR-CA.
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Affiliation(s)
- Adam Ioannou
- National Amyloidosis Centre, University College London, London, United Kingdom
| | - Francesco Cappelli
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - Michele Emdin
- Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa, Italy; Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Christian Nitsche
- Division of Cardiology, Department of Internal Medicine, Medical University of Vienna, Vienna, Austria
| | - Simone Longhi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Ahmad Masri
- OHSU Center for Hypertrophic Cardiomyopathy and Amyloidosis, Portland, Oregon, USA
| | - Alberto Cipriani
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy; Cardiology Unit, University Hospital Padua, Padua, Italy
| | - Mattia Zampieri
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - Federica Colio
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - Michael Poledniczek
- Division of Cardiology, Department of Internal Medicine, Medical University of Vienna, Vienna, Austria
| | - Aldostefano Porcari
- National Amyloidosis Centre, University College London, London, United Kingdom; Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), University of Trieste, Trieste, Italy
| | - Yousuf Razvi
- National Amyloidosis Centre, University College London, London, United Kingdom
| | - Alberto Aimo
- Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa, Italy; Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Giuseppe Vergaro
- Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa, Italy; Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Laura De Michieli
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Muhammad U Rauf
- National Amyloidosis Centre, University College London, London, United Kingdom
| | - Rishi K Patel
- National Amyloidosis Centre, University College London, London, United Kingdom
| | - Eugenia Villanueva
- National Amyloidosis Centre, University College London, London, United Kingdom
| | - Yael Lustig
- National Amyloidosis Centre, University College London, London, United Kingdom
| | - Lucia Venneri
- National Amyloidosis Centre, University College London, London, United Kingdom
| | | | - Helen Lachmann
- National Amyloidosis Centre, University College London, London, United Kingdom
| | - Ashutosh Wechalekar
- National Amyloidosis Centre, University College London, London, United Kingdom
| | - Carol Whelan
- National Amyloidosis Centre, University College London, London, United Kingdom
| | - Aviva Petrie
- University College London, Biostatistics Unit, UCL Eastman Dental Institute, London, United Kingdom
| | - Philip N Hawkins
- National Amyloidosis Centre, University College London, London, United Kingdom
| | - Scott Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Julian D Gillmore
- National Amyloidosis Centre, University College London, London, United Kingdom
| | - Marianna Fontana
- National Amyloidosis Centre, University College London, London, United Kingdom.
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13
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Tristão Parra M, Sada I, Gold R, Vella CA, Price C, Miljkovic I, Eastman A, Allison M. Associations between muscle quality and N-terminal pro-B-type natriuretic peptide ( NT-proBNP): The multi-ethnic study of atherosclerosis. Am J Med Sci 2024; 367:160-170. [PMID: 38029852 DOI: 10.1016/j.amjms.2023.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 11/24/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION N-terminal pro-B-type natriuretic peptide (NT-proBNP) is widely used in clinical settings to identify cardiac stress, diagnose, and manage heart failure (HF). We explored the associations between NT-proBNP and both muscle area and density. METHODS A cross-sectional analysis including 1,489 participants from the MESA. Plasma NT-proBNP concentrations and inflammatory biomarkers and health history questionnaires were analyzed. Computed tomography quantified abdominal body composition. Separate multivariable linear regression models were used to assess the associations between both muscle (MA) area and density (MD) and NT-proBNP. RESULTS In models adjusted for sociodemographic characteristics, risk factors for cardiovascular disease, anthropometric variables, and subcutaneous and visceral adiposity, NT-proBNP was inversely associated with total abdominal and psoas MAs. Adjustment for inflammatory markers and MD attenuated these associations to the null. Stabilization MA and NT-proBNP were not significantly associated. Analyses per quartiles of MA confirmed lack of a consistent association between stabilization and total abdominal MAs and NT-proBNP. While the third and fourth quartiles of psoas MA were inversely associated with NT-proBNP, adding inflammation biomarkers and MD to the model attenuated the association to the null. Conversely, after full adjustment, NT-proBNP was inversely and significantly associated with total abdominal, stabilization and psoas MDs. For psoas MD, but not the other muscle density variables, the addition of MA to the model attenuated the association to the null. The quartiles of MD were consistently inversely associated with NT-proBNP, where higher MDs showed larger estimates of the association compared to the lowest quartiles, for all muscle groups investigated. CONCLUSION Muscle density is inversely associated with NT-proBNP, while muscle area is not after adjustment for inflammation and muscle density.
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Affiliation(s)
- Maíra Tristão Parra
- Hebert Wertheim School of Public Health and Longevity Science, University of California, San Diego, La Jolla, California, USA.
| | - Isaac Sada
- School of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Rebecca Gold
- University of Washington, Seattle, Washington, USA
| | - Chantal A Vella
- Department of Movement Sciences, University of Idaho, Moscow, Idaho, USA
| | - Candice Price
- Department of Molecular Biosciences, School of Veterinary Medicine, University of California, Davis, Davis, California, USA
| | - Iva Miljkovic
- School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Amelia Eastman
- School of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Matthew Allison
- School of Medicine, University of California, San Diego, La Jolla, California, USA.
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14
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Fuery MA, Leifer ES, Samsky MD, Sen S, O'Connor CM, Fiuzat M, Ezekowitz J, Piña I, Whellan D, Mark D, Felker GM, Desai NR, Januzzi JL, Ahmad T. Prognostic Impact of Repeated NT-proBNP Measurements in Patients With Heart Failure With Reduced Ejection Fraction. JACC Heart Fail 2024; 12:479-487. [PMID: 38127049 DOI: 10.1016/j.jchf.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 10/10/2023] [Accepted: 11/04/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Although clinical studies have demonstrated the association between a single N-terminal pro-B-type natriuretic peptide (NT-proBNP) measurement and clinical outcomes in chronic heart failure, the biomarker is frequently measured serially in clinical practice. OBJECTIVES The aim of this study was to determine the added prognostic value of repeated NT-proBNP measurements compared with single measurements alone for chronic heart failure patients. METHODS In the GUIDE-IT (Guiding Evidence Based Therapy Using Biomarker Intensified Treatment in Heart Failure) study, 894 study participants with chronic heart failure with reduced ejection fraction were enrolled at 45 outpatient sites in the United States and Canada. Repeated NT-proBNP levels were measured over a 2-year study period. Associations between repeated NT-proBNP measurements and trial endpoints were assessed using a joint longitudinal and survival model. RESULTS After adjustment for baseline covariates, each doubling of the baseline NT-proBNP level was associated with a HR of 1.17 (95% CI: 1.08-1.28; P = 0.0003) for the primary trial endpoint of cardiovascular death or heart failure hospitalization. Serial measurements increased the adjusted HR for the primary trial endpoint to 1.66 (95% CI: 1.50-1.84; P < 0.0001), and a similar increased risk was observed across secondary trial endpoints. In joint modeling, an increase in NT-proBNP occurred weeks before the onset of adjudicated events. CONCLUSIONS Repeated NT-proBNP measurements are a strong predictor of outcomes in heart failure with reduced ejection fraction with an increase in concentration occurring well before event onset. These results may support routine NT-proBNP monitoring to assist in clinical decision making. (Guiding Evidence Based Therapy Using Biomarker Intensified Treatment in Heart Failure [GUIDE-IT]; NCT01685840).
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Affiliation(s)
- Michael A Fuery
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Eric S Leifer
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Marc D Samsky
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Sounok Sen
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | | | - Mona Fiuzat
- Duke University School of Medicine and Duke Clinical Research Institute, Durham, North Carolina, USA
| | | | - Ileana Piña
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - David Whellan
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Daniel Mark
- Duke University School of Medicine and Duke Clinical Research Institute, Durham, North Carolina, USA
| | - G Michael Felker
- Duke University School of Medicine and Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Nihar R Desai
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut, USA; Center for Outcomes Research and Evaluation, Yale University School of Medicine, New Haven, Connecticut, USA
| | - James L Januzzi
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Heart Failure and Biomarker Trials, Baim Institute for Clinical Research, Boston, Massachusetts, USA
| | - Tariq Ahmad
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut, USA; Center for Outcomes Research and Evaluation, Yale University School of Medicine, New Haven, Connecticut, USA.
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15
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Kambara T, Shibata R, Sakamoto Y, Sakaguchi T, Osanai H, Nakashima Y, Asano H, Murohara T, Ajioka M. Impact of HIF prolyl hydroxylase inhibitors in heart failure patients with renal anemia. BMC Res Notes 2024; 17:60. [PMID: 38429779 PMCID: PMC10905796 DOI: 10.1186/s13104-024-06726-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 02/21/2024] [Indexed: 03/03/2024] Open
Abstract
OBJECTIVE Hypoxia-inducible factor prolyl hydroxylase (HIF-PH) inhibitors are a new class of anti-anemia agents. We retrospectively evaluated the safety and efficacy of HIF-PH inhibitors in patients with heart failure (HF) complicated by anemia associated with chronic kidney disase. HIF-PH inhibitor treatment was initiated in 32 patients with chronic HF complicated by renal anemia and were followed up for 3 months. RESULTS Hematocrit and hemoglobin levels markedly improved 3 months after HIF-PH inhibitor treatment. However, levels of NT-proBNP, which is an indicator of HF, did not decrease considerably. Based on the rate of change in NT-proBNP, we divided the patients into "responder" and "non-responder" groups. The results showed that considerably more patients had a ferritin level of less than 100 ng/mL in the non-responder group at baseline. There were substantially more patients with TSAT of less than 20% in the non-responder group at 1 month after HIF-PH inhibitor treatment. The cut-off values to maximize the predictive power of ferritin level at baseline and TSAT value at 1 month after treatment were 41.8 ng/ml and 20.75. HIF-PH inhibitor treatment can be expected to be effective for improving both anemia and HF if ferritin≥41.8 ng/ml at baseline or TSAT≥20.75 at 1 month after treatment.
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Affiliation(s)
- Takahiro Kambara
- Department of Cardiovascular Medicine, Tosei General Hospital, Seto, Japan.
| | - Rei Shibata
- Department of Advanced Cardiovascular Therapeutics, Nagoya University Graduate School of Medicine, 65 Tsurumai, Showa, Nagoya, 466-8550, Japan.
| | - Yuusuke Sakamoto
- Department of Cardiovascular Medicine, Tosei General Hospital, Seto, Japan
| | - Teruhiro Sakaguchi
- Department of Cardiovascular Medicine, Tosei General Hospital, Seto, Japan
| | - Hiroyuki Osanai
- Department of Cardiovascular Medicine, Tosei General Hospital, Seto, Japan
| | | | - Hiroshi Asano
- Department of Cardiovascular Medicine, Tosei General Hospital, Seto, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masayoshi Ajioka
- Department of Cardiovascular Medicine, Tosei General Hospital, Seto, Japan
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16
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Hadziselimovic E, Greve AM, Sajadieh A, Olsen MH, Nienaber CA, Ray SG, Rossebø AB, Wachtell K, Dominguez H, Valeur N, Carstensen HG, Nielsen OW. Development and validation of the ASGARD risk score for safe monitoring in asymptomatic nonsevere aortic stenosis. Eur J Prev Cardiol 2024:zwae086. [PMID: 38416125 DOI: 10.1093/eurjpc/zwae086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 02/21/2024] [Accepted: 02/24/2024] [Indexed: 02/29/2024]
Abstract
AIMS Current guidelines recommend serial echocardiography at minimum 1-2 year intervals for monitoring patients with nonsevere aortic valve stenosis (AS), which is costly and often clinically inconsequential.We aimed to develop and test whether the biomarker-based ASGARD risk score (Aortic Valve Stenosis Guarded by Amplified Risk Determination) can guide the timing of echocardiograms in asymptomatic patients with nonsevere AS. METHODS The development cohort comprised 1,093 of 1,589 (69%) asymptomatic patients with mild-to-moderate AS who remained event-free one year after inclusion into the SEAS trial. Cox regression landmark analyses with a 2-year follow-up identified the model (ASGARD) with the lowest Akaike information criterion for association to AS-related composite outcome (heart failure hospitalization, aortic valve replacement, or cardiovascular death). Fine-Gray analyses provided cumulative event rates by ASGARD score quartiles. The ASGARD score was internally validated in the remaining 496 patients (31%) from the SEAS-cohort and externally in 71 asymptomatic outpatients with nonsevere AS from six Copenhagen hospitals. RESULTS The ASGARD score comprises updated measurements of heart rate and age- and sex-adjusted N-terminal pro-brain natriuretic peptide upon transaortic maximal velocity (Vmax) from the previous year. The ASGARD score had high predictive accuracy across all cohorts (external validation: area under the curve: 0.74 [95% CI, 0.62-0.86]), and similar to an updated Vmax measurement. An ASGARD score ≤50% was associated with AS-related event rates ≤5% for a minimum of 15 months. CONCLUSION The ASGARD score could provide a personalized and safe surveillance alternative to routinely planned echocardiograms, so physicians can prioritize echocardiograms for high-risk patients.
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Affiliation(s)
| | - Anders M Greve
- Department of Clinical Biochemistry 3011, Rigshospitalet, Copenhagen, Denmark
| | - Ahmad Sajadieh
- Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Michael H Olsen
- Department of Internal Medicine 1, Holbæk Hospital, Denmark
- Department of Regional Health Research, University of Southern Denmark, Denmark
- Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Christoph A Nienaber
- Royal Brompton and Harefield NHS Foundation Trust, Imperial College, London, United Kingdom of Great Britain & Northern Ireland
| | - Simon G Ray
- Manchester University Hospitals, Manchester, United Kingdom of Great Britain & Northern Ireland
| | - Anne B Rossebø
- Department of Cardiology, Oslo University Hospital, Ullevål, Norway
| | - Kristian Wachtell
- Division of Cardiology, Weill Cornell Medicine, New York, United States of America
| | - Helena Dominguez
- Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Nana Valeur
- Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Helle G Carstensen
- Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Olav W Nielsen
- Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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17
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Jewad AM, Shwayel AJ. Evaluation of some nonroutine cardiac biomarkers among adults and children with beta-thalassemia major. Lab Med 2024:lmae007. [PMID: 38417033 DOI: 10.1093/labmed/lmae007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND Cardiac injury caused by iron overload is the leading cause of mortality and morbidity in patients with beta-thalassemia, owing to frequent blood transfusion, increased iron overload, and blood hemolysis. OBJECTIVE This research aimed to assess several novel cardiac biomarkers in the blood samples of children and adult patients with beta-thalassemia major (βTM), along with their respective control groups. These biomarkers included endothelin 1 (ET-1), N-terminal pro-brain natriuretic peptide (NT-proBNP), atrial natriuretic peptide (ANP), growth differentiation factor-15 (GDF-15), and renalase (RNLS). METHODS This case-control study was done on 46 patients with βTM (23 children <18 years, and 23 adults ≥18 years) from the Genetic Hematology Center in Thi-Qar province, Iraq, and 42 comparable controls in 2 groups (21 for each group) in the period from February to April 2023. RESULTS Levels of ET-1, NT-proBNP, ANP, GDF-15, RNLS, and ferritin were higher in the children and adults with βTM than in the control subjects. CONCLUSION Elevations of the novel cardiac biomarkers ET-1, NT-proBNP, ANP, GDF-15, and RNLS in the sera of children and adult patients with βTM when compared with comparable control subjects confirm that the majority of patients with βTM are at risk of cardiac and cardiovascular complications even when there are no obvious symptoms, especially in children, which gives suitable predictive biomarkers.
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Affiliation(s)
- Abdulkareem M Jewad
- Ministry of Higher Education and Scientific Research, Southern Technical University, College of Health and Medical Techniques, Basra, Iraq
| | - Ameer J Shwayel
- Ministry of Higher Education and Scientific Research, Southern Technical University, College of Health and Medical Techniques, Basra, Iraq
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18
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Du Q, Yu J, Chen Q, Chen X, Jiang Q, Deng L, Li A, Xiong Y. Clinical characteristics and influencing factors of severe fever with thrombocytopenia syndrome complicated by viral myocarditis: a retrospective study. BMC Infect Dis 2024; 24:240. [PMID: 38389047 PMCID: PMC10885462 DOI: 10.1186/s12879-024-09096-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 02/04/2024] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVE This study aimed to investigate the clinical characteristics of severe fever with thrombocytopenia syndrome complicated by viral myocarditis (SFTS-VM) and analyze relevant influencing factors. METHODS Retrospective analysis was conducted on clinical data from 79 SFTS-VM patients, categorized into common (SFTS-CVM, n = 40) and severe groups (SFTS-SVM, n = 39). Clinical manifestations, laboratory results, cardiac ultrasonography, and electrocardiogram features were analyzed. Univariate and multivariate analyses identified significant indicators, which were further assessed using ROC curves to predict SFTS-SVM. RESULTS SFTS-SVM group exhibited higher rates of hypotension, shock, abdominal pain, cough with sputum, and consciousness disorders compared to SFTS-CVM group. Laboratory findings showed elevated platelet count, ALT, AST, amylase, lipase, LDH, D-dimer, procalcitonin, TNI, and NT-proBNP in SFTS-SVM. Abnormal electrocardiograms, especially atrial fibrillation, were more prevalent in SFTS-SVM (P < 0.05). Multivariate analysis identified elevated LDH upon admission (OR = 1.004, 95% CI: 1-1.008, P = 0.050), elevated NT-proBNP (OR = 1.005, 95% CI: 1.001-1.008, P = 0.007), and consciousness disorders (OR = 112.852, 95% CI: 3.676 ~ 3464.292, P = 0.007) as independent risk factors for SFTS-SVM. LDH and NT-proBNP had AUCs of 0.728 and 0.744, respectively, in predicting SFTS-SVM. Critical values of LDH (> 978.5U/L) and NT-proBNP (> 857.5pg/ml)) indicated increased likelihood of SFTS progression into SVM. CONCLUSION Elevated LDH, NT-proBNP, and consciousness disorders independently correlate with SFTS-SVM. LDH and NT-proBNP can aid in early identification of SFTS-SVM development when above specified thresholds.
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Affiliation(s)
- Qian Du
- Department of Infectious Disease, Zhongnan Hospital of Wuhan University, 430071, Wuhan, China
| | - Jin Yu
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, 430071, Wuhan, China
| | - Qianhui Chen
- Department of Infectious Disease, Zhongnan Hospital of Wuhan University, 430071, Wuhan, China
| | - Xiaoping Chen
- Department of Infectious Disease, Zhongnan Hospital of Wuhan University, 430071, Wuhan, China
| | - Qunqun Jiang
- Department of Infectious Disease, Zhongnan Hospital of Wuhan University, 430071, Wuhan, China
| | - Liping Deng
- Department of Infectious Disease, Zhongnan Hospital of Wuhan University, 430071, Wuhan, China.
| | - Anling Li
- Department of Laboratory Medicine, Zhongnan Hospital of Wuhan University, 430071, Wuhan, China.
| | - Yong Xiong
- Department of Infectious Disease, Zhongnan Hospital of Wuhan University, 430071, Wuhan, China.
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Puch-Walczak A, Kunicka K, Jagiełło K, Puzio E, Jankowska H, Hoffman P, Dudziak M, Kuziemski K, Drygas W, Zdrojewski T. Is the 2016 ESC diagnostic algorithm useful for assessing the prevalence of chronic heart failure in population-based studies? Kardiol Pol 2024; 82:175-182. [PMID: 38374779 DOI: 10.33963/v.phj.98958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 01/16/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND Chronic heart failure (CHF) is a major healthcare problem. However, there are no epidemiological studies assessing the prevalence of CHF in the general population with diagnosis based on algorithms recommended for clinical practice. AIM The aim of the HF-Pomorskie survey was to assess the prevalence of three basic components of the 2016 ESC diagnostic algorithm for CHF (symptoms, N-terminal pro B-type natriuretic peptide [NT-proBNP], and abnormalities on echocardiography) and to determine whether this algorithm may be applicable to studies in general population samples. METHODS The study was performed in a representative sample of 313 adults (170 women and 143 men) aged between 20 and 90 years (mean 55.2 years [15.3]) in Northern Poland. A questionnaire to determine New York Heart Association [NYHA] class, laboratory tests including NT-proBNP, as well as transthoracic echocardiography and spirometry examinations were performed in all subjects. RESULTS Dyspnea (NYHA class II-IV) was reported by 13.7% of recruited participants. Dyspnea and elevated levels of NT-proBNP (>125 pg/ml) were found in 7.7% of all examined subjects, while dyspnea, elevated NT-proBNP levels accompanied by systolic or diastolic abnormalities on echocardiography occurred in 4.8%. In the group without dyspnea (86.3% of all examined subjects), every sixth subject had an elevated level of NT-proBNP. On the other hand, 5.8% of studied subjects reported a previous diagnosis of CHF, which was confirmed using the current ESC algorithm in 78% of them. CONCLUSIONS The prevalence of CHF assessed by the 2016 ESC diagnostic algorithm in the representative sample of adults was equal to 4.8%. The clinical algorithm for the diagnosis of CHF is fully applicable to the representative surveys in the general population. However, due to logistic and economic factors, echocardiography examination and NT-proBNP determination can be limited to patients reporting dyspnea or previous diagnosis of CHF.
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Affiliation(s)
- Aleksandra Puch-Walczak
- Department of Preventive Medicine and Education, Medical University of Gdansk, Gdańsk, Poland.
| | - Katarzyna Kunicka
- Department of Hypertension and Diabetology, Medical University of Gdansk, Gdańsk, Poland
| | - Kacper Jagiełło
- Department of Preventive Medicine and Education, Medical University of Gdansk, Gdańsk, Poland
| | - Ewa Puzio
- Department of Cardiac Diagnostics, Medical University of Gdansk, Gdańsk, Poland
| | - Hanna Jankowska
- Department of Cardiac Diagnostics, Medical University of Gdansk, Gdańsk, Poland
| | - Piotr Hoffman
- Department of Congenital Heart Diseases, National Institute of Cardiology, Warszawa, Poland
| | - Maria Dudziak
- Department of Cardiac Diagnostics, Medical University of Gdansk, Gdańsk, Poland
| | | | - Wojciech Drygas
- Department of Social and Preventive Medicine, Medical University of Lodz, Łódź, Poland
- Department of Epidemiology, Cardiovascular Disease Prevention and Health Promotion, Institute of Cardiology, Warszawa, Poland
| | - Tomasz Zdrojewski
- Department of Preventive Medicine and Education, Medical University of Gdansk, Gdańsk, Poland
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Ameh A, Brady JJ. Reference intervals for high sensitivity cardiac troponin I and N-terminal pro-B-type natriuretic peptide in children and adolescents on the Siemens Atellica. Clin Chem Lab Med 2024; 0:cclm-2023-0977. [PMID: 38373095 DOI: 10.1515/cclm-2023-0977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 02/07/2024] [Indexed: 02/21/2024]
Abstract
OBJECTIVES The cardiac biomarkers high sensitivity cardiac troponin I (hs-cTnI) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) are utilised in paediatric healthcare for the diagnosis and prognostic assessment of many conditions including myocarditis, congenital heart disease, multisystem inflammatory syndrome in children (MIS-C) and heart failure. However, the standardised age-related reference intervals, 99th percentile cut-offs and clinical guidelines are not available, making the interpretation of these biomarkers challenging. This study aimed to generate normative data in a paediatric cohort for the Siemens Atellica® IM 1300 analyser. METHODS Residual plasma samples were collected from children aged up to 17 years attending primary care and out-patient settings and with no apparent evidence of cardiac dysfunction, renal dysfunction or other confounders. Reference intervals were generated using the 2.5th-97.5th percentiles, and 99th percentile cut-offs determined according to CLSI EP28-A3c. RESULTS Statistical analysis revealed that partitioning was not required for gender for either biomarker. The reference interval for hs-cTnI for children aged one month to 16 years (n=292, 146 females and 146 males) was <14 ng/L with a 99th percentile cut-off of 19 ng/L. The reference interval for NT-proBNP for children aged one month up to one year was <714 ng/L (n=14) and for children aged 1-16 years (n=339) was <295 ng/L. CONCLUSIONS This is the first paediatric reference interval data generated on the Siemens Atellica® solution. These reference intervals and 99th percentiles will inform clinical decisions in the paediatric cardiology setting.
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Affiliation(s)
- Akoji Ameh
- Department of Biochemistry, Children's Health Ireland at Crumlin, Dublin, Republic of Ireland
| | - Jennifer J Brady
- Department of Biochemistry, Children's Health Ireland at Crumlin, Dublin, Republic of Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
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Catană A, Andrei CL, Guberna S, Ceban O, Sinescu CJ. Possible Correlations between Mean Platelet Volume and Biological, Electrocardiographic, and Echocardiographic Parameters in Patients with Heart Failure. Life (Basel) 2024; 14:260. [PMID: 38398768 PMCID: PMC10890115 DOI: 10.3390/life14020260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/07/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
(1) Background: Despite advancements in medical research and discoveries, heart failure (HF) still represents a significant and prevalent public health challenge. It is characterized by persistently high mortality and morbidity rates, along with increased rates of readmissions, particularly among the elderly population. (2) Methods: This study was conducted retrospectively on 260 patients with stable or decompensated chronic HF. The parameter of interest in the study population was the mean platelet volume (MPV), and the main objective of the research was to identify a possible relationship between MPV and several variables-biological (NT-proBNP, presepsin, red cell distribution width (RDW)), electrocardiographic (atrial fibrillation (AFib) rhythm, sinus rhythm (SR)), and echocardiographic (left ventricle ejection fraction (LVEF), left atrial (LA) diameter, left ventricle (LV) diameter, pulmonary hypertension (PH)). (3) Results: By applying logistic and linear regression models, we assessed whether there is a correlation between MPV and biological, electrocardiographic, and echocardiographic variables in patients with HF. The results revealed linear relationships between MPV and NT pro-BNP values and between MPV and RDW values, and an increased probability for the patients to have an AFib rhythm, reduced LVEF, dilated LA, dilated LV, and PH as their MPV value increases. The results were deemed statistically relevant based on a p-value below 0.05. (4) Conclusions: Through regression model analyses, our research revealed that certain negative variables in HF patients such as increased levels of NT-proBNP, increased levels of RDW, AFib rhythm, reduced LVEF, dilated LA, dilated LV, and PH, could be predicted based on MPV values.
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Affiliation(s)
- Andreea Catană
- Department of Cardiology, University of Medicine and Pharmacy “Carol Davila”, Emergency Hospital “Bagdasar-Arseni”, 020021 Bucharest, Romania; (S.G.); (C.J.S.)
| | - Cătălina Liliana Andrei
- Department of Cardiology, University of Medicine and Pharmacy “Carol Davila”, Emergency Hospital “Bagdasar-Arseni”, 020021 Bucharest, Romania; (S.G.); (C.J.S.)
| | - Suzana Guberna
- Department of Cardiology, University of Medicine and Pharmacy “Carol Davila”, Emergency Hospital “Bagdasar-Arseni”, 020021 Bucharest, Romania; (S.G.); (C.J.S.)
| | - Octavian Ceban
- Economic Cybernetics and Informatics Department, The Bucharest University of Economic Studies, 010552 Bucharest, Romania;
| | - Crina Julieta Sinescu
- Department of Cardiology, University of Medicine and Pharmacy “Carol Davila”, Emergency Hospital “Bagdasar-Arseni”, 020021 Bucharest, Romania; (S.G.); (C.J.S.)
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Del Moral LE, Lerma C, González-Pacheco H, Chávez-Lázaro AC, Massó F, Rodriguez E. Correlation of Plasmatic Amyloid Beta Peptides (Aβ-40, Aβ-42) with Myocardial Injury and Inflammatory Biomarkers in Acute Coronary Syndrome. J Clin Med 2024; 13:1117. [PMID: 38398429 PMCID: PMC10889335 DOI: 10.3390/jcm13041117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/10/2024] [Accepted: 02/13/2024] [Indexed: 02/25/2024] Open
Abstract
Background/Objective: Amyloid beta (β) -40 levels increase with age and inflammation states and appear to be associated with clinical manifestations of acute coronary syndrome (ACS). We investigated the correlation of Aβ peptides with myocardial injury and inflammation biomarkers in patients with or without ST elevation myocardial infarction (STEMI, NSTEMI). Methods: This singe-center, cross-sectional, observational, and correlation study included 65 patients with ACS (n = 34 STEMI, 29 males, age = 58 ± 12 years; n = 31 NSTEMI, 22 males, age = 60 ± 12 years) who were enrolled in the coronary care unit within 12 h after symptom onset from February 2022 to May 2023. Aβ peptide levels and biochemical parameters were assessed. Results: NSTEMI patients had a higher prevalence of hypertension (p = 0.039), diabetes (p = 0.043), smoking (p = 0.003), and prior myocardial infarction (p = 0.010) compared to STEMI patients. We observed a higher level of Aβ-42 in NSTEMI (p = 0.001) but no difference in Aβ-40 levels. We also found a correlation between age and NT-proBNP with both Aβ peptides (Aβ-40, Aβ-42) (p = 0.001, p = 0.002 respectively). Conclusions: Our results show that patients with NSTEMI had a higher prevalence of cardiovascular risk factors (hypertension, diabetes, smoking, and prior myocardial infarction). Considering these results, we propose that Aβ-42 can add value to risk stratification in NSTEMI patients.
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Affiliation(s)
- Luis Eduardo Del Moral
- Translacional Research Unit, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico; (L.E.D.M.); (A.C.C.-L.); (F.M.)
| | - Claudia Lerma
- Department of Molecular Biology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico;
| | - Héctor González-Pacheco
- Coronary Care Unit, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico;
| | - Alan Cristhian Chávez-Lázaro
- Translacional Research Unit, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico; (L.E.D.M.); (A.C.C.-L.); (F.M.)
| | - Felipe Massó
- Translacional Research Unit, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico; (L.E.D.M.); (A.C.C.-L.); (F.M.)
| | - Emma Rodriguez
- Translacional Research Unit, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico; (L.E.D.M.); (A.C.C.-L.); (F.M.)
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Menghoum N, Badii MC, Deltombe M, Lejeune S, Roy C, Vancraeynest D, Pasquet A, Gerber BL, Horman S, Gruson D, Beauloye C, Pouleur AC. Carbohydrate antigen 125: a useful marker of congestion, fibrosis, and prognosis in heart failure with preserved ejection fraction. ESC Heart Fail 2024. [PMID: 38339764 DOI: 10.1002/ehf2.14699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 12/27/2023] [Accepted: 01/08/2024] [Indexed: 02/12/2024] Open
Abstract
AIMS Heart failure (HF) with preserved ejection fraction (HFpEF) is a disease associated with high morbidity and mortality, for which it is difficult to identify patients with the poorest prognosis in routine clinical practice. Carbohydrate antigen 125 (CA 125) has been shown to be a potential marker of congestion and prognosis in HF. We sought to better characterize HFpEF patients with high CA 125 levels by using a multimodal approach. METHODS AND RESULTS We prospectively enrolled 139 HFpEF patients (78 ± 8 years; 60% females) and 25 controls matched for age and sex (77 ± 5 years; 60% females). They underwent two-dimensional echocardiography, cardiac magnetic resonance with late gadolinium enhancement [including extracellular volume (ECV) measurement], and serum measurements of CA 125 level. The primary endpoint of the study was a composite of all-cause mortality or first HF hospitalization. The prognostic impact of CA 125 was determined using Cox proportional hazard models. Median CA 125 levels were significantly higher in HFpEF patients compared with controls [CA 125: 23.5 (14.5-44.7) vs. 14.6 (10.3-21.0) U/mL, P = 0.004]. CA 125 levels were positively correlated with a congestion marker [N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, Pearson's r = 0.37, P < 0.001] and markers of cardiac fibrosis estimated by both ECV (Pearson's r = 0.26, P = 0.003) and fibroblast growth factor 23 levels (Pearson's r = 0.50, P < 0.001). Over a median follow-up of 49 (22-64) months, 97 HFpEF patients reached the composite endpoint. Even after adjustment for the Meta-Analysis Global Group in Chronic risk score, a CA 125 level ≥35 U/mL was still a significant predictor of the composite endpoint [hazard ratio (HR): 1.58 (1.04-2.41), P = 0.032] and more particularly of HF hospitalization [HR: 1.81 (1.13-2.92), P = 0.014]. In contrast, NT-proBNP levels were not an independent predictor. CONCLUSIONS CA 125 levels were significantly higher in HFpEF patients compared with controls matched for age and sex and were associated with markers of congestion and cardiac fibrosis. CA 125 levels were a strong and independent predictor of HF hospitalization in HFpEF patients. These data suggest a potential value of CA 125 as a biomarker for staging and risk prediction in HFpEF.
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Affiliation(s)
- Nassiba Menghoum
- Cardiovascular Department, Cliniques universitaires Saint-Luc, Brussels, Belgium
- Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Maria Chiara Badii
- Cardiovascular Department, Cliniques universitaires Saint-Luc, Brussels, Belgium
- Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Matthieu Deltombe
- Department of Laboratory Medicine, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Sibille Lejeune
- Cardiovascular Department, Cliniques universitaires Saint-Luc, Brussels, Belgium
- Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Clotilde Roy
- Cardiovascular Department, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - David Vancraeynest
- Cardiovascular Department, Cliniques universitaires Saint-Luc, Brussels, Belgium
- Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Agnes Pasquet
- Cardiovascular Department, Cliniques universitaires Saint-Luc, Brussels, Belgium
- Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Bernhard L Gerber
- Cardiovascular Department, Cliniques universitaires Saint-Luc, Brussels, Belgium
- Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Sandrine Horman
- Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Damien Gruson
- Department of Laboratory Medicine, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Christophe Beauloye
- Cardiovascular Department, Cliniques universitaires Saint-Luc, Brussels, Belgium
- Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Anne-Catherine Pouleur
- Cardiovascular Department, Cliniques universitaires Saint-Luc, Brussels, Belgium
- Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), Brussels, Belgium
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Siddiqui MH, Dixit R, Agarwal S, Jha SC, Khanna H, Agrawal SK. Determining the role of NT-proBNP levels in diabetic patients with heart failure: A study from North India. J Educ Health Promot 2024; 13:20. [PMID: 38532921 PMCID: PMC10965036 DOI: 10.4103/jehp.jehp_701_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 07/11/2023] [Indexed: 03/28/2024]
Abstract
BACKGROUND Diabetic patients are at higher risk of cardiovascular morbidity and mortality. NT-proBNP levels measurements are useful for the assessment of risk in heart failure patients in emergency condition and give the faster result. Further, it also offers lower cost and unnecessary hospitalization and follow-up cost. The studies have shown that NT-proBNP levels are a direct predictor of outcome risk in diabetic patients with heart failure. The objective of this research was to study the role of NT-proBNP levels to determine the severity of heart failure in diabetic patients. MATERIALS AND METHODS In this study 150 patients diagnosed with symptomatic heart failure admitted to the emergency department of a tertiary care center from January 2021 to January 2022 have been included in Saraswati Institute Of Medical Sciences, Hapur, India. N-terminal pro-B-type natriuretic peptide (NT-Pro-BNP) levels were measured using an automated analyzer ranging between 60 and 3000 pg/ml. According to the European society of cardiology (ESC) guidelines, it has been defined as NT-Pro-BNP level above 125 pg/ml indicates a high possibility of heart failure and NT-Pro-BNP level below 125 pg/ml excludes the high possibility of heart failure. All the patients underwent an echocardiographic study and ejection fraction was calculated and recorded. RESULTS In diabetic patients ejection fraction was significantly lower in diabetic patients: 47.15 ± 8.75% vs. 43.24 ± 9.54%, P = 0.002). We have observed statistically significant lower HDL values (40.10 ± vs. 35.94 mg/dL, P = 0.0004), however, significant higher triglycerides values were found (101.43 ± 41.7 mg/dL vs. 151.37 ± 78.85, P = 0.001). No significant difference was observed in LDL level (97.8 ± 31.23 vs. 92.35 ± 314.2, P ≥ 0.05) and total cholesterol level (161.49 ± 41.38 vs. 159.97 ± 41.12, P ≥ 0.05). CONCLUSION We concluded that the measurement of NT-proBNP in heart failure and diabetic patients could be an economic marker for the evaluation of morbidity and mortality, facilitating better management and follow-up.
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Affiliation(s)
- Merajul H. Siddiqui
- Department of Biochemistry, Saraswathi Medical Institute, Hapur, Uttar Pradesh, India
| | - Ritvija Dixit
- Department of Biochemistry, Saraswathi Medical Institute, Hapur, Uttar Pradesh, India
| | - Shikha Agarwal
- Department of Biochemistry, Saraswathi Medical Institute, Hapur, Uttar Pradesh, India
| | | | - Harshita Khanna
- Department of Biochemistry, Saraswathi Medical Institute, Hapur, Uttar Pradesh, India
| | - Sonu Kumari Agrawal
- Department of Biochemistry, Saraswathi Medical Institute, Hapur, Uttar Pradesh, India
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Inoue K, Yamamoto K, Higashi H, Takata Y, Inaba S, Miyazaki S, Higaki A, Saito M, Osawa H, Yamaguchi O. A prediction model for estimating NT-proBNP in a general Japanese population: the Toon Health Study. ESC Heart Fail 2024. [PMID: 38303572 DOI: 10.1002/ehf2.14691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/05/2024] [Accepted: 01/09/2024] [Indexed: 02/03/2024] Open
Abstract
AIMS As part of the Toon Health Study, which is an ongoing population-based cohort study, we aimed to develop a prediction model for N-terminal pro-brain natriuretic peptide (NT-proBNP) in a general Japanese population. We sought to explore the influence of various demographic and clinical factors on NT-proBNP levels and assess the model's performance. In addition, our objectives included internal validation and investigation of the diagnostic potential of the observed-to-predicted NT-proBNP ratio (OPR) at baseline for predicting the risk of heart failure with preserved ejection fraction (HFpEF). METHODS AND RESULTS In this prospective cohort study, participants were recruited from Toon City, Japan, as part of the larger Toon Health Study, focusing on cardiovascular risk factors. We measured the NT-proBNP levels and used linear regression with penalization (ridge regression) to develop the model. The model incorporated 10 prespecified predictors (age, gender, body mass index, diastolic blood pressure, heart rate, haemoglobin, albumin, total cholesterol, haemoglobin A1c, and estimated glomerular filtration rate) and underwent assessment using R2 and root mean squared error (RMSE). Internal validation was conducted through bootstrapping. In a post hoc analysis, we explored the OPR's diagnostic potential using 5 year follow-up data (n = 636) to predict the elevation of NT-proBNP > 125 pg/mL at the 5 year follow-up as the risk of HFpEF. A total of 2505 participants (age: 60.4 ± 12.9 years, men: 35%) were enrolled in this study. There was a linear relationship between the observed and predicted values of NT-proBNP in which the logarithm of observed NT-proBNP was <6, which corresponds to 403 pg/mL in NT-proBNP. The prediction model demonstrated satisfactory performance (R2 : 0.291, RMSE: 0.688), with age identified as a dominant predictor. The stability of the model was underscored by the internal validation. The OPR at baseline predicted NT-proBNP > 125 pg/mL at the 5 year follow-up with an area under the curve of 0.793. CONCLUSIONS This study introduces the first prediction model for NT-proBNP in a general Japanese population. Although the model has acceptable performance, ongoing refinement is essential. Our transparent approach to model development, alongside a web-based interactive tool, lays the groundwork for further improvements and external validation. The OPR holds potential for predicting the future risk of HFpEF. This research contributes to understanding the nuanced influence of patient backgrounds on levels of NT-proBNP in asymptomatic individuals within the context of a broader population-based cohort study.
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Affiliation(s)
- Katsuji Inoue
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
- Department of Community Emergency Medicine, Ehime University Graduate School of Medicine, Yawatahama, Ehime, Japan
| | | | - Haruhiko Higashi
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Yasunori Takata
- Department of Diabetes and Molecular Genetics, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Shinji Inaba
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Shigehiro Miyazaki
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Akinori Higaki
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Makoto Saito
- Department of Cardiology, Kitaishikai Hospital, Ozu, Ehime, Japan
| | - Haruhiko Osawa
- Department of Diabetes and Molecular Genetics, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Osamu Yamaguchi
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
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Schupp T, Abumayyaleh M, Weidner K, Lau F, Schmitt A, Reinhardt M, Abel N, Forner J, Akin M, Ayoub M, Mashayekhi K, Bertsch T, Akin I, Behnes M. Diagnostic and Prognostic Value of Aminoterminal Prohormone of Brain Natriuretic Peptide in Heart Failure with Mildly Reduced Ejection Fraction Stratified by the Degree of Renal Dysfunction. J Clin Med 2024; 13:489. [PMID: 38256622 PMCID: PMC10816452 DOI: 10.3390/jcm13020489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 12/31/2023] [Accepted: 01/07/2024] [Indexed: 01/24/2024] Open
Abstract
Limited data concerning the diagnostic and prognostic value of blood-derived biomarkers in heart failure with mildly reduced ejection fraction (HFmrEF) is available. This study investigates the diagnostic and prognostic value of aminoterminal prohormone of brain natriuretic peptide (NT-proBNP) in patients with HFmrEF, stratified by the estimated glomerular filtration rate (eGFR). Consecutive patients with HFmrEF were retrospectively included at one institution from 2016 to 2022. First, the diagnostic value of NT-proBNP for acute decompensated heart failure (ADHF) was tested. Thereafter, the prognostic value of NT-proBNP levels was tested for 30-months all-cause mortality in patients with ADHF. From a total of 755 patients hospitalized with HFmrEF, the rate of ADHF was 42%. Patients with ADHF revealed higher NT-proBNP levels compared to patients without (median 5394 pg/mL vs. 1655 pg/mL; p = 0.001). NT-proBNP was able to discriminate ADHF with an area under the curve (AUC) of 0.777 (p = 0.001), with the highest AUC in patients with eGFR ≥ 60 mL/min (AUC = 0.800; p = 0.001), and no diagnostic value was seen in eGFR < 30 mL/min (AUC = 0.576; p = 0.210). Patients with NT-proBNP levels > 3946 pg/mL were associated with higher rates of all-cause mortality at 30 months (57.7% vs. 34.4%; HR = 2.036; 95% CI 1.423-2.912; p = 0.001), even after multivariable adjustment (HR = 1.712; 95% CI 1.166-2.512; p = 0.006). In conclusion, increasing NT-proBNP levels predicted the risk of ADHF and all-cause mortality in patients with HFmrEF and preserved renal function; however, NT-proBNP levels were not predictive in patients with HFmrEF and eGFR < 30 mL/min.
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Affiliation(s)
- Tobias Schupp
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Mohammad Abumayyaleh
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Kathrin Weidner
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Felix Lau
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Alexander Schmitt
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Marielen Reinhardt
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Noah Abel
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Jan Forner
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Muharrem Akin
- Department of Cardiology, St. Josef-Hospital, Ruhr-Universität Bochum, 44791 Bochum, Germany
| | - Mohamed Ayoub
- Division of Cardiology and Angiology, Heart Center University of Bochum, 32545 Bad Oeynhausen, Germany
| | - Kambis Mashayekhi
- Department of Internal Medicine and Cardiology, Mediclin Heart Centre Lahr, 77933 Lahr, Germany
| | - Thomas Bertsch
- Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Nuremberg General Hospital, Paracelsus Medical University, 90419 Nuremberg, Germany
| | - Ibrahim Akin
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Michael Behnes
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
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Willinger L, Brudy L, Häcker AL, Meyer M, Hager A, Oberhoffer-Fritz R, Ewert P, Müller J. High-sensitive troponin T and N-terminal pro-B-type natriuretic peptide independently predict survival and cardiac-related events in adults with congenital heart disease. Eur J Cardiovasc Nurs 2024; 23:55-61. [PMID: 36883916 DOI: 10.1093/eurjcn/zvad032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/02/2023] [Accepted: 03/06/2023] [Indexed: 03/09/2023]
Abstract
AIMS High-sensitive troponin T (hs-TnT), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and C-reactive protein (CRP) are established prognostic biomarkers for cardiovascular (CV) morbidity and mortality and frequently used in symptomatic and/or hospitalized adults with congenital heart disease (ACHD). Their prognostic value in clinically stable ACHD has not yet been well established. This study investigates the predictive value of hs-TnT, NT-proBNP, and CRP for survival and CV events in stable ACHD. METHODS AND RESULTS In this prospective cohort study, 495 outpatient ACHD (43.9 ± 10.0 years, 49.1% female) underwent venous blood sampling including hs-TnT, NT-proBNP, and CRP. Patients were followed up for survival status and the occurrence of CV events. Survival analyses were performed with Cox proportional hazards regression analysis and Kaplan-Meier curves. During a mean follow-up of 2.8 ± 1.0 years, 53 patients (10.7%) died or reached a cardiac-related endpoint including sustained ventricular tachycardia, hospitalization with cardiac decompensation, ablation, interventional catheterization, pacer implantation, or cardiac surgery. Multivariable Cox regression revealed hs-TnT (P = 0.005) and NT-proBNP (P = 0.018) as independent predictors of death or cardiac-related events in stable ACHD, whilst the prognostic value of CRP vanished after multivariable adjustment (P = 0.057). Receiver-operator characteristic curve analysis identified cut-off values for event-free survival of hs-TnT ≤9 ng/L and NT-proBNP ≤200 ng/L. Patients with both increased biomarkers had a 7.7-fold (confidence interval 3.57-16.40, P < 0.001) higher risk for death and cardiac-related events compared with patients without elevated blood values. CONCLUSION Subclinical values of hs-TnT and NT-proBNP are a useful, simple, and independent prognostic tool for adverse cardiac events and survival in stable outpatient ACHD. REGISTRATION German Clinical Trial Registry DRKS00015248.
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Affiliation(s)
- Laura Willinger
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636 Munich, Germany
- Institute of Preventive Pediatrics, Technische Universität München, Georg-Brauchle-Ring 60/62, 80992 München, Germany
| | - Leon Brudy
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636 Munich, Germany
| | - Anna-Luisa Häcker
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636 Munich, Germany
| | - Michael Meyer
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636 Munich, Germany
| | - Alfred Hager
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636 Munich, Germany
| | - Renate Oberhoffer-Fritz
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636 Munich, Germany
- Institute of Preventive Pediatrics, Technische Universität München, Georg-Brauchle-Ring 60/62, 80992 München, Germany
| | - Peter Ewert
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636 Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Jan Müller
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636 Munich, Germany
- Institute of Preventive Pediatrics, Technische Universität München, Georg-Brauchle-Ring 60/62, 80992 München, Germany
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Mojón-Álvarez D, Giralt T, Carreras-Mora J, Calvo-Fernández A, Izquierdo A, Soler C, Cabero P, Pérez-Fernández S, Vaquerizo B, Ribas Barquet N. Baseline NT-proBNP levels as a predictor of short-and long-term prognosis in COVID-19 patients: a prospective observational study. BMC Infect Dis 2024; 24:58. [PMID: 38191350 PMCID: PMC10773093 DOI: 10.1186/s12879-024-08980-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 01/03/2024] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Up to 20% of COVID-19 patients can suffer COVID-19-related myocardial injury. Elevated cardiac biomarkers, such as hs-cTnT and NT-proBNP, have been related to worse short-term prognosis. However, data on NT-proBNP and long-term prognosis are scarce. We have evaluated the potential association of baseline age-adjusted NT-proBNP levels and outcomes at one-year follow-up in COVID-19 patients. METHODS This was a single-center prospective study of 499 COVID-19 patients in whom NT-proBNP was assessed at hospital admission. NT-proBNP levels were age-adjusted and patients were classified as high or low NT-proBNP. Clinical and demographic characteristics, comorbidities, laboratory results, and in-hospital complications and mortality were compared between the two groups. Survivors of the acute phase of COVID-19 were followed up for one year from admission to detect readmissions and mortality. RESULTS The 68 patients with high NT-proBNP levels at hospital admission were older, with more cardiovascular risk factors, cardiovascular disease, comorbidities, myocardial injury, and higher levels of inflammatory markers than patients with low NT-proBNP levels. They also had more in-hospital complications and a higher acute-phase mortality rate (60.3% vs. 10.2%, p < 0.001). High NT-proBNP levels were an independent marker of death during hospitalization (HR 1.95; CI 1.07-3.52). At one-year follow-up, high NT-proBNP levels were independently associated with mortality (HR 2.69; CI 1.47-4.89). Among survivors of the acute phase of COVID-19, there were no differences in hospital readmissions between those with high vs. low NT-proBNP levels, but survivors with high baseline NT-proBNP levels showed a higher 1-year mortality rate (7.4% vs. 1.3%, p = 0.018). CONCLUSIONS High age-adjusted NT-proBNP levels at the time of hospital admission for COVID-19 are associated with poor short and long-term prognosis. High NT-proBNP seems also to be related to worse prognosis in survivors of the acute phase of COVID-19. A closer follow-up on these patients may be crucial.
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Affiliation(s)
- Diana Mojón-Álvarez
- Cardiology Department, Hospital del Mar, Passeig Marítim de la Barceloneta 25-29, Barcelona, 08003, Spain
- Medicine Department, Autonomous University of Barcelona, Bellaterra, Barcelona, 08193, Spain
| | - Teresa Giralt
- Cardiology Department, Hospital del Mar, Passeig Marítim de la Barceloneta 25-29, Barcelona, 08003, Spain
- Medicine Department, Pompeu Fabra University, Barcelona, 08005, Spain
| | - José Carreras-Mora
- Cardiology Department, Hospital del Mar, Passeig Marítim de la Barceloneta 25-29, Barcelona, 08003, Spain
- Medicine Department, Pompeu Fabra University, Barcelona, 08005, Spain
| | - Alicia Calvo-Fernández
- Cardiology Department, Hospital del Mar, Passeig Marítim de la Barceloneta 25-29, Barcelona, 08003, Spain
- Medicine Department, Autonomous University of Barcelona, Bellaterra, Barcelona, 08193, Spain
- Medicine Department, Pompeu Fabra University, Barcelona, 08005, Spain
| | - Andrea Izquierdo
- Medicine Department, Autonomous University of Barcelona, Bellaterra, Barcelona, 08193, Spain
| | - Cristina Soler
- Cardiology Department, Hospital del Mar, Passeig Marítim de la Barceloneta 25-29, Barcelona, 08003, Spain
| | - Paula Cabero
- Cardiology Department, Hospital del Mar, Passeig Marítim de la Barceloneta 25-29, Barcelona, 08003, Spain
| | - Silvia Pérez-Fernández
- Scientific Coordination Facility, Biocruces Bizkaia Health Research Institute, Barakaldo, 48903, Spain
| | - Beatriz Vaquerizo
- Cardiology Department, Hospital del Mar, Passeig Marítim de la Barceloneta 25-29, Barcelona, 08003, Spain
- Medicine Department, Autonomous University of Barcelona, Bellaterra, Barcelona, 08193, Spain
- Medicine Department, Pompeu Fabra University, Barcelona, 08005, Spain
- Heart Disease Biomedical Research Group (GREC), IMIM (Hospital del Mar Medical Research Institute), Barcelona, 08003, Spain
- CIBER of Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III (ISCIII), Madrid, 28029, Spain
| | - Núria Ribas Barquet
- Cardiology Department, Hospital del Mar, Passeig Marítim de la Barceloneta 25-29, Barcelona, 08003, Spain.
- Medicine Department, Pompeu Fabra University, Barcelona, 08005, Spain.
- Heart Disease Biomedical Research Group (GREC), IMIM (Hospital del Mar Medical Research Institute), Barcelona, 08003, Spain.
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Young J, Seeberg KA, Aakre KM, Borgeraas H, Nordstrand N, Wisløff T, Hjelmesæth J, Omland T, Hertel JK. The liver-heart axis in patients with severe obesity: The association between liver fibrosis and chronic myocardial injury may be explained by shared risk factors of cardiovascular disease. Clin Biochem 2024; 123:110688. [PMID: 37995847 DOI: 10.1016/j.clinbiochem.2023.110688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 11/13/2023] [Accepted: 11/20/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Severe obesity is associated with increased risk of non-alcoholic fatty liver disease and cardiovascular disease. We hypothesized that liver fibrosis as quantified by the Enhanced Liver Fibrosis (ELF) test would be predictive of myocardial injury and fibrosis, expressed by higher concentrations of cardiac troponin T and I measured by high-sensitivity assays (hs-cTnT and hs-cTnI, respectively). MATERIAL AND METHODS We performed cross-sectional analyses of baseline data from 136 patients (mean age 45 years, 38 % male) with severe obesity participating in the non-randomized clinical trial Prevention of Coronary Heart Disease in Morbidly Obese Patients (ClinicalTrials.gov NCT00626964). Associations between ELF scores, hs-cTnT, and hs-cTnI concentrations were assessed using linear regression analysis. RESULTS ELF scores were associated with hs-cTnT in the unadjusted model (B 0.381, 95 % Confidence Interval [CI] 0.247, 0.514), but the association was attenuated upon adjustment for potential confounders (B -0.031, 95 % CI -0.155, 0.093). Similarly, for hs-cTnI, an observed association with ELF scores in the unadjusted model was attenuated upon adjustment for potential confounders ((B 0.432, 95 % CI 0.179, 0.685) and (B 0.069, 95 % CI -0.230, 0.367), respectively). Age, sex, hypertension, and estimated glomerular filtration rate were amongst the shared predictors of ELF score, hs-cTnT, and hs-cTnI that provided the univariable models with the highest R-squared and lowest Akaike Information Criterion values. CONCLUSIONS Contrary to our hypothesis, ELF score did not predict myocardial injury and fibrosis, but we rather demonstrated an association between liver fibrosis and myocardial injury and fibrosis may be explained by shared risk factors of cardiovascular disease.
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Affiliation(s)
- J Young
- K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - K A Seeberg
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Endocrinology, Obesity and Nutrition, Vestfold Hospital Trust, Tønsberg, Norway
| | - K M Aakre
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway; Department of Heart Disease, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway
| | - H Borgeraas
- Department of Endocrinology, Obesity and Nutrition, Vestfold Hospital Trust, Tønsberg, Norway
| | - N Nordstrand
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - T Wisløff
- K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - J Hjelmesæth
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Endocrinology, Obesity and Nutrition, Vestfold Hospital Trust, Tønsberg, Norway
| | - T Omland
- K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - J K Hertel
- Department of Endocrinology, Obesity and Nutrition, Vestfold Hospital Trust, Tønsberg, Norway
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Curtis KA, Waikar SS, Mc Causland FR. Higher NT-proBNP levels and the risk of intradialytic hypotension at hemodialysis initiation. Hemodial Int 2024; 28:77-84. [PMID: 37875429 DOI: 10.1111/hdi.13125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 10/26/2023]
Abstract
INTRODUCTION Elevated N-terminal pro B-type natriuretic peptide (NT-proBNP) is a potent predictor of adverse outcomes in hemodialysis initiation. These patients often experience intradialytic hypotension, which may partially reflect cardiac dysfunction, but the association of NT-proBNP with intradialytic hypotension is not clear. METHODS We performed a post hoc analysis of a randomized trial that tested mannitol versus placebo in 52 patients initiating hemodialysis (NCT01520207). NT-proBNP was measured prior to the first and third sessions (n = 87). Mixed-effects models (adjusting for randomized treatment, sex, race, age, diabetes, heart failure, catheter use, pre-dialysis systolic blood pressure, pre-dialysis weight, ultrafiltration volume, serum sodium, bicarbonate, urea nitrogen, phosphate, albumin, hemoglobin, and session length) were fit to examine the association of NT-proBNP with systolic blood pressure decline (pre-dialysis minus nadir systolic blood pressure). Additionally, mixed-effects Poisson models were fit to examine the association with intradialytic hypotension (≥20 mmHg decline in systolic blood pressure). FINDINGS Mean age was 55 ± 16 years; 33% had baseline heart failure. The median NT-proBNP was 5498 [25th-75th percentile 2011, 14,790] pg/mL; 26 sessions (30%) were complicated by intradialytic hypotension. In adjusted models, each unit higher log-NT-proBNP was associated with 6.0 mmHg less decline in systolic blood pressure (95%CI -9.2 to -2.8). Higher pre-dialysis NT-proBNP, per log-unit, was associated with a 52% lower risk of intradialytic hypotension (IRR 0.48, 95%CI 0.23-0.97), without evidence for effect modification by randomized treatment (P-interaction = 0.17). DISCUSSION In patients initiating hemodialysis, higher NT-proBNP is associated with less decline in intradialytic systolic blood pressure and lower risk of intradialytic hypotension. Future studies should investigate if higher pre-dialysis NT-proBNP levels may identify patients who might tolerate more aggressive ultrafiltration.
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Affiliation(s)
- Katherine A Curtis
- Division of Renal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Milken Institute School of Public Health, The George Washington University, Washington DC, USA
| | - Sushrut S Waikar
- Renal Section, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Finnian R Mc Causland
- Division of Renal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Shamsi A, Roghani SA, Soufivand P, Pournazari M, Khoobbakht F, Bahrehmand F, Taghadosi M. CXCL9 and NT-proBNP, a notable link between inflammatory mediator and cardiovascular disease biomarker in rheumatoid arthritis. Clin Rheumatol 2024; 43:137-145. [PMID: 38006573 DOI: 10.1007/s10067-023-06826-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 11/03/2023] [Accepted: 11/19/2023] [Indexed: 11/27/2023]
Abstract
INTRODUCTION Cardiovascular disease (CVD) is the most critical extra-articular manifestation of rheumatoid arthritis, and inflammatory molecules contribute to its pathogenesis. Recently, CXCL9 has been considered an inflammatory chemokine associated with the pathogenesis of CVD. Here, we evaluated the association of plasma CXCL9 with well-established cardiac biomarkers, including HS-CRP (High sensitivity C-reactive protein) and NT-ProBNP (N-terminal pro-B-type natriuretic peptide), in newly diagnosed and under-treatment RA patients. METHODS Thirty newly diagnosed patients, 30 under-treatment RA patients, and 30 healthy subjects were recruited. The plasma concentration of CXCL9 and NT-ProBNP was measured using the ELISA method. The HS-CRP levels was measured in plasma samples using latex-enhanced immunoturbidimetric test. RESULTS We found increased plasma levels of CXCL9, HS-CRP, and NT-proBNP in RA patients compared to healthy subjects, besides that the concentration of CXCL9, HS-CRP, and NT-ProBNP showed elevated levels in newly diagnosed RA patients compared to under-treatment group. The mean plasma concentration of CXCL9, NT-proBNP, and HS-CRP were statistically different among healthy subjects, newly diagnosed, and under-treatment RA patients (p < 0.001, p = 0.016, and p < 0.001, respectively). We also found a significant positive correlation between CXCL9 and DAS-28 (p = 0.0005, r = 0.436) in the patients' group (new-case + under-treatment). There was a significantly positive correlation between CXCL9 and NT-proBNP in newly diagnosed and under-treatment patients (p = 0.020, r = 0.424; p < 0.0001, r = 0.853, respectively). In the patient's group (new-case + under-treatment), there was a significantly positive correlation between CXCL9 with NT-proBNP (p < 0.001, r = 0.703) and CXCL9 with HS-CRP (p = 0.015, r = 0.313). CONCLUSION CXCL9 correlates significantly with well-established cardiovascular biomarkers, including HS-CRP and NT-ProBNP in RA patients. Key Points • CXCL9 is an inflammatory marker in RA. • CXCL9 has correlated with DAS-28. • There is a strong correlation between CXCL9 with NT-proBNP and HS-CRP.
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Affiliation(s)
- Afsaneh Shamsi
- Immunology Department, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Seyed Askar Roghani
- Immunology Department, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Medical Biology Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Parviz Soufivand
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mehran Pournazari
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Fatemeh Khoobbakht
- Immunology Department, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Fariborz Bahrehmand
- Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mahdi Taghadosi
- Immunology Department, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran.
- Cardiovascular Research Center, Health Institute, Imam-Ali Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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Thet MS, Hlwar KE, Thet KS, Han KPP, Oo AY. Preoperative B-Type Natriuretic Peptides to Predict Postoperative Atrial Fibrillation in Cardiac Surgery: A Systematic Review and Meta-Analysis. Heart Lung Circ 2024; 33:23-32. [PMID: 38143193 DOI: 10.1016/j.hlc.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/23/2023] [Accepted: 10/29/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Post-operative atrial fibrillation (AF) is the most common complication following cardiac surgery. There has been extensive exploration of clinical variables, imaging, and biomarkers to predict its occurrence after cardiac surgery. In this study, we examine the emerging biomarkers B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) to assess their pre-operative values and correlations with the occurrence of post-operative AF in patients undergoing cardiac surgery. METHODS A comprehensive literature search was conducted using PubMed, EMBASE, MEDLINE via Ovid, ClinicalTrials.Gov, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) to identify studies published until March 2023. The studies were included if they reported pre-operative BNP or NT-proBNP values and the development of post-operative AF in cardiac surgery patients. Subsequently, data were extracted, and a meta-analysis was performed using Review Manager 5.4 4 (The Cochrane Collaboration, 2020) and SPSS version 28 (IBM Corp, Armonk, NY, USA) to assess the difference between pre-operative BNP and NT-proBNP levels between patients with post-operative AF (AF group) and those without (No-AF group) using a random-effect model. Further analysis was performed in three subgroups: isolated coronary artery bypass grafting, isolated valve, and combined/mixed surgery group. RESULT A total of 20 studies, including 9,079 participants were identified and included in the systematic review and meta-analysis. Pre-operative BNP levels were reported in 11 studies, and NT-proBNP levels were reported in 10 studies, of which one study reported both BNP and NT-proBNP levels. There is an overall significant difference between pre-operative levels of BNP (p=0.03, I2=95%) and NT-proBNP (p<0.001, I2=65%) when compared between AF and No-AF groups. Nonetheless, subgroup analysis showed there is no significant difference in pre-operative BNP levels, except in isolated valve surgery (p<0.001), whereas all subgroups showed significantly different pre-operative levels of NT-proBNP. CONCLUSIONS Elevated levels of both BNP and NT-proBNP were observed in patients who developed post-operative AF after undergoing cardiac surgery. In particular, pre-operative NT-proBNP levels were elevated in all patients irrespective of the type of surgical procedure, but elevated pre-operative BNP was only seen in valve surgery patients. These findings suggest the potential usefulness of NT-proBNP as a promising biomarker for predicting the occurrence of post-operative AF following cardiac surgery.
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Affiliation(s)
- Myat Soe Thet
- Department of Surgery and Cancer, Imperial College London, United Kingdom.
| | - Khun Eaint Hlwar
- Department of Medicine, Mandalay General Hospital, University of Medicine, Mandalay, Myanmar
| | - Khaing Soe Thet
- Department of Medicine, Mandalay General Hospital, University of Medicine, Mandalay, Myanmar
| | - Khin Phue Phue Han
- Department of Medicine, Mandalay General Hospital, University of Medicine, Mandalay, Myanmar
| | - Aung Ye Oo
- Department of Cardiothoracic Surgery, St Bartholomew's Hospital, London, United Kingdom
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Li M, Pan W, Tian D, Chen D, Zhang X, Zhang Y, Chen S, Zhou D, Ge J. Diagnostic Value of Serum Galectin-3 Binding Protein Level in Patients with Pulmonary Arterial Hypertension. Curr Vasc Pharmacol 2024; 22:67-77. [PMID: 38038005 DOI: 10.2174/0115701611268078231010072521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/24/2023] [Accepted: 10/02/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) still lacks effective biomarkers to assist in its diagnosis and prognosis. Galectin-3 binding protein (Gal-3BP) plays a role in immune and inflammatory diseases. OBJECTIVE This study aimed to evaluate Gal-3BP as a prognostic and predictive factor in patients with PAH. METHODS From January 2017 to December 2019, we enrolled 167 consecutive PAH patients and 58 healthy controls. Right heart catheterization (RHC) was used to diagnose PAH. Serum Gal-3BP levels were measured by high-sensitivity human enzyme-linked immunosorbent assay (ELISA). RESULTS Serum Gal-3BP levels in the PAH group were significantly higher compared with the control group (4.87±2.09 vs 2.22±0.86 μg/mL, p<0.001). Gal-3BP level was correlated with several hemodynamic parameters obtained from RHC (p<0.001). Multivariate linear regression analysis showed that Gal-3BP was a risk factor for PAH (odds ratio (OR)=2.947, 95% CI: 1.821-4.767, p<0.001). The optimal cut-off value of serum Gal-3BP level for predicting PAH was 2.89 μg/mL (area under the curve (AUC)=0.860, 95 % CI: 0.811-0.910, p<0.001). Kaplan-Meier analysis showed that Gal-3BP levels above the median (4.87 μg/mL) were associated with an increased risk of death in patients with PAH (hazard ratio (HR)=8.868, 95 % CI: 3.631-21.65, p<0.0001). Cox multivariate risk regression analysis showed that Gal-3BP was a risk factor for death in PAH patients (HR=2.779, 95 % CI: 1.823-4.237, p<0.001). CONCLUSION Serum Gal-3BP levels were increased in patients with PAH, and levels of Gal-3BP were associated with the severity of PAH. Gal-3BP might have predictive value for the diagnosis and prognosis of PAH.
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Affiliation(s)
- Mingfei Li
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Wenzhi Pan
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Dan Tian
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Dandan Chen
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Xiaochun Zhang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Yuan Zhang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Shasha Chen
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Daxin Zhou
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, China National Clinical Research Center for Interventional Medicine, Shanghai, China
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Rader F, Oręziak A, Choudhury L, Saberi S, Fermin D, Wheeler MT, Abraham TP, Garcia-Pavia P, Zwas DR, Masri A, Owens A, Hegde SM, Seidler T, Fox S, Balaratnam G, Sehnert AJ, Olivotto I. Mavacamten Treatment for Symptomatic Obstructive Hypertrophic Cardiomyopathy: Interim Results From the MAVA-LTE Study, EXPLORER-LTE Cohort. JACC Heart Fail 2024; 12:164-177. [PMID: 38176782 DOI: 10.1016/j.jchf.2023.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 09/26/2023] [Accepted: 09/28/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Data assessing the long-term safety and efficacy of mavacamten treatment for symptomatic obstructive hypertrophic cardiomyopathy are needed. OBJECTIVES The authors sought to evaluate interim results from the EXPLORER-Long Term Extension (LTE) cohort of MAVA-LTE (A Long-Term Safety Extension Study of Mavacamten in Adults Who Have Completed EXPLORER-HCM; NCT03723655). METHODS After mavacamten or placebo withdrawal at the end of the parent EXPLORER-HCM (Clinical Study to Evaluate Mavacamten [MYK-461] in Adults With Symptomatic Obstructive Hypertrophic Cardiomyopathy; NCT03470545), patients could enroll in MAVA-LTE. Patients received mavacamten 5 mg once daily; adjustments were made based on site-read echocardiograms. RESULTS Between April 9, 2019, and March 5, 2021, 231 of 244 eligible patients (94.7%) enrolled in MAVA-LTE (mean age: 60 years; 39% female). At data cutoff (August 31, 2021) 217 (93.9%) remained on treatment (median time in study: 62.3 weeks; range: 0.3-123.9 weeks). At 48 weeks, patients showed improvements in left ventricular outflow tract (LVOT) gradients (mean change ± SD from baseline: resting: -35.6 ± 32.6 mm Hg; Valsalva: -45.3 ± 35.9 mm Hg), N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels (median: -480 ng/L; Q1-Q3: -1,104 to -179 ng/L), and NYHA functional class (67.5% improved by ≥1 class). LVOT gradients and NT-proBNP reductions were sustained through 84 weeks in patients who reached this timepoint. Over 315 patient-years of exposure, 8 patients experienced an adverse event of cardiac failure, and 21 patients had an adverse event of atrial fibrillation, including 11 with no prior history of atrial fibrillation. Twelve patients (5.2%) developed transient reductions in site-read echocardiogram left ventricular ejection fraction of <50%, resulting in temporary treatment interruption; all recovered. Ten patients discontinued treatment due to treatment-emergent adverse events. CONCLUSIONS Mavacamten treatment showed clinically important and durable improvements in LVOT gradients, NT-proBNP levels, and NYHA functional class, consistent with EXPLORER-HCM. Mavacamten treatment was well tolerated over a median 62-week follow-up.
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Affiliation(s)
- Florian Rader
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | - Lubna Choudhury
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sara Saberi
- University of Michigan, Ann Arbor, Michigan, USA
| | | | | | | | - Pablo Garcia-Pavia
- Hospital Universitario Puerta de Hierro Majadahonda, Centro de Investigación Biomédica En Red Enfermedades Cardiovasculares, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Donna R Zwas
- Hadassah University Medical Center, Jerusalem, Israel
| | - Ahmad Masri
- Oregon Health & Science University, Portland, Oregon, USA
| | - Anjali Owens
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Sheila M Hegde
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Tim Seidler
- University of Göttingen, Göttingen, Germany; Kerckhoff-Klinik, Department of Cardiology, Bad Nauheim, Germany
| | | | | | | | - Iacopo Olivotto
- Meyer University Children Hospital, University of Florence, Italy.
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Zhang X, Wan Y, Karunathilaka N, Chan W, Kostner K, Hartel G, Coats AJS, Atherton JJ, Punyadeera C. Prognostic utility of serum NT-proBNP (fragments 1-76aa and 13-71aa) and galectin-3 in predicting death and re-hospitalisation due to cardiovascular events in patients with heart failure. Heart Vessels 2024; 39:86-94. [PMID: 37537380 PMCID: PMC10764512 DOI: 10.1007/s00380-023-02296-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/20/2023] [Indexed: 08/05/2023]
Abstract
Patients with heart failure (HF) are at a higher risk of rehospitalisation. In this study, we investigated the prognostic utility of galectin-3 (Gal-3) and NT-proBNP fragments (1-76aa and 13-71aa) as biomarkers to predict outcomes for patients with HF. We collected blood samples from patients with HF (n = 101). Gal-3 and NT-proBNP fragments (1-76aa and 13-71aa) concentrations were measured by immunoassay. Survival analysis and Cox proportional regression models were used to determine the prognostic utility of Gal-3 and NT-proBNP fragments. In patients with increased baseline levels of NT-proBNP1-76 the time to primary endpoint (cardiovascular death or re-hospitalisation) was significantly shorter (p = 0.0058), but not in patient with increased baseline levels of Gal-3 or NTproBNP13-71. Patients with increased levels of NT-proBNP13-71aa at 1 month showed reduced time to the primary endpoint (p = 0.0123). Our findings demonstrated that Gal-3 and NT-proBNP can be used as prognostic biomarkers to stratify patients with HF.
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Affiliation(s)
- Xi Zhang
- Saliva and Liquid Biopsy Translational Laboratory, Griffith Institute for Drug Discovery, Griffith University, 46, Don Young Rd, Nathan, QLD, 4111, Australia
- Menzies Health Institute Queensland (MHIQ), Griffith University, Gold Coast, QLD, Australia
| | - Yunxia Wan
- Saliva and Liquid Biopsy Translational Laboratory, The School of Biomedical Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Nuwan Karunathilaka
- Saliva and Liquid Biopsy Translational Laboratory, Griffith Institute for Drug Discovery, Griffith University, 46, Don Young Rd, Nathan, QLD, 4111, Australia
- Menzies Health Institute Queensland (MHIQ), Griffith University, Gold Coast, QLD, Australia
| | - Wandy Chan
- The Prince Charles Hospital, Brisbane, QLD, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Karam Kostner
- Department of Cardiology, Mater Adult Hospital, Brisbane, QLD, Australia
| | - Gunter Hartel
- Statistics Unit, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Andrew J S Coats
- Faculty of Medicine, Monash University, Melbourne, VIC, Australia
- University of Warwick, Coventry, UK
- Monash University, Clayton, Australia
| | - John J Atherton
- Cardiology Department, Faculty of Medicine, Royal Brisbane and Women's Hospital and University of Queensland, Brisbane, QLD, Australia
| | - Chamindie Punyadeera
- Saliva and Liquid Biopsy Translational Laboratory, Griffith Institute for Drug Discovery, Griffith University, 46, Don Young Rd, Nathan, QLD, 4111, Australia.
- Saliva and Liquid Biopsy Translational Laboratory, The School of Biomedical Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia.
- Translational Research Institute, Woolloongabba, Australia.
- Menzies Health Institute Queensland (MHIQ), Griffith University, Gold Coast, QLD, Australia.
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Marta CI, Craina M, Nitu R, Maghiari AL, Abu-Awwad SA, Boscu L, Diaconu M, Dumitru C, Dahma G, Yasar II, Babes K. A Comparative Analysis of NT-proBNP Levels in Pregnant Women and the Impact of SARS-CoV-2 Infection: Influence on Birth Outcome. Diseases 2023; 12:10. [PMID: 38248361 PMCID: PMC10814387 DOI: 10.3390/diseases12010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/26/2023] [Accepted: 12/29/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND The cardiac biomarker NT-proBNP is released by the ventricles in response to increased cardiac wall tension, showing cardiac activity in heart failure. The primary objective of this comparative study was to analyze the variations of NT-proBNP levels among pregnant patients and to determine the potential influence of SARS-CoV-2 infection on these values. Secondly, the study focused on NT-proBNP levels and their influence on the type of birth. METHODS Blood samples were taken from 160 pregnant mothers in order to determine, through the solid-phase enzyme-linked immunosorbent assay (ELISA) method, the NT-proBNP concentrations from the plasma. The cohort was separated into two distinct groups based on SARS-CoV-2 diagnostic results: negative to the infection, and positive to the infection. RESULTS The SARS-CoV-2-positive group of patients presented with higher levels of NT-proBNP and had higher rates of cesarean sections. (4) Conclusions: Our research highlights the crucial relationship between elevated NT-proBNP values and the mode of giving birth, natural delivery or cesarean section, and also the influence of SARS-CoV-2 viral infection and this biomarker.
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Affiliation(s)
- Carmen-Ioana Marta
- Doctoral School, Faculty of Medicine and Pharmacy of Oradea, University of Oradea, 410087 Oradea, Romania;
- Clinic of Obstetrics and Gynecology, “Pius Brinzeu” County Clinical Emergency Hospital, 300723 Timisoara, Romania; (M.C.); (M.D.); (C.D.); (G.D.)
- Department of Obstetrics and Gynecology, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Marius Craina
- Clinic of Obstetrics and Gynecology, “Pius Brinzeu” County Clinical Emergency Hospital, 300723 Timisoara, Romania; (M.C.); (M.D.); (C.D.); (G.D.)
- Department of Obstetrics and Gynecology, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Razvan Nitu
- Clinic of Obstetrics and Gynecology, “Pius Brinzeu” County Clinical Emergency Hospital, 300723 Timisoara, Romania; (M.C.); (M.D.); (C.D.); (G.D.)
- Department of Obstetrics and Gynecology, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Anca Laura Maghiari
- Department I—Discipline of Anatomy and Embryology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
| | - Simona-Alina Abu-Awwad
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (S.-A.A.-A.); (L.B.); (I.-I.Y.)
| | - Lioara Boscu
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (S.-A.A.-A.); (L.B.); (I.-I.Y.)
| | - Mircea Diaconu
- Clinic of Obstetrics and Gynecology, “Pius Brinzeu” County Clinical Emergency Hospital, 300723 Timisoara, Romania; (M.C.); (M.D.); (C.D.); (G.D.)
- Department of Obstetrics and Gynecology, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Catalin Dumitru
- Clinic of Obstetrics and Gynecology, “Pius Brinzeu” County Clinical Emergency Hospital, 300723 Timisoara, Romania; (M.C.); (M.D.); (C.D.); (G.D.)
- Department of Obstetrics and Gynecology, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - George Dahma
- Clinic of Obstetrics and Gynecology, “Pius Brinzeu” County Clinical Emergency Hospital, 300723 Timisoara, Romania; (M.C.); (M.D.); (C.D.); (G.D.)
- Department of Obstetrics and Gynecology, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (S.-A.A.-A.); (L.B.); (I.-I.Y.)
| | - Ionela-Iasmina Yasar
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (S.-A.A.-A.); (L.B.); (I.-I.Y.)
- Department IX: Surgery I, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Katalin Babes
- Faculty of Medicine and Pharmacy of Oradea, University of Oradea, 410087 Oradea, Romania;
- Clinical County Emergency Hospital of Oradea, 410167 Oradea, Romania
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Raadsen R, Dijkshoorn B, van Boheemen L, Ten Boekel E, van Kuijk AWR, Nurmohamed MT. Lipid profile and NT-proBNP changes from pre-clinical to established rheumatoid arthritis: A 12 years follow-up explorative study. Joint Bone Spine 2023; 91:105683. [PMID: 38161051 DOI: 10.1016/j.jbspin.2023.105683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/11/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES The aim of the current study was to explore the changes in lipid and NT-proBNP levels in rheumatoid arthritis (RA) patients through different phases of the disease: from the pre-clinical stage and RA onset up to the treatment phase with biological disease-modifying anti-rheumatic drugs (bDMARDS). METHODS Thirty-eight consecutive patients, initially with arthralgia and rheumatoid factor and/or anti-citrullinated protein antibodies without arthritis, who later developed RA and eventually started treatment with bDMARDs, were included. Lipid spectrum and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels were measured longitudinally from several months before diagnosis through treatment with bDMARDs. RESULTS From baseline, C-reactive protein (CPR) initially increased sharply, decreasing with the start of biological treatment. Low-density lipoprotein-cholesterol (LDL-c) remained stable, high-density lipoprotein-cholesterol (HDL-c) increased, apolipoprotein A1 (ApoA1 and lipoprotein (a) (Lp(a)), and total cholesterol (TC)/HDL-c ratio and apolipoprotein B (ApoB) decreased during follow-up. NT-proBNP closely followed progression of CRP. TC, LDL-c, TC/HDL-c ratio, ApoA and ApoB inverse correlated with CRP, while Lp(a) positively correlated. HDL-c and triglycerides showed no correlation. CONCLUSION Changes in the lipid profile and NT-proBNP in RA patients seem to be related to inflammation, with changes reflecting an increase in CVD risk occurring along with rises in CRP levels. These changes seem to already be present at diagnosis, indicating the need for timely control of inflammation.
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Affiliation(s)
- Reinder Raadsen
- Amsterdam Rheumatology and Immunology Center, Location VUmc and Reade, Amsterdam, dr. Jan van Breemenstraat 2, 1056AB Noord-Holland, Netherlands.
| | - Bas Dijkshoorn
- Amsterdam Rheumatology and Immunology Center, Location VUmc and Reade, Amsterdam, dr. Jan van Breemenstraat 2, 1056AB Noord-Holland, Netherlands
| | - Laurette van Boheemen
- Amsterdam Rheumatology and Immunology Center, Location VUmc and Reade, Amsterdam, dr. Jan van Breemenstraat 2, 1056AB Noord-Holland, Netherlands
| | - Edwin Ten Boekel
- Northwest Clinics, location Alkmaar, Laboratory for Clinical Chemistry, Department of Hematology and Immunology, Alkmaar, Noord-Holland, Netherlands
| | - Arno W R van Kuijk
- Amsterdam Rheumatology and Immunology Center, Location VUmc and Reade, Amsterdam, dr. Jan van Breemenstraat 2, 1056AB Noord-Holland, Netherlands
| | - Michael T Nurmohamed
- Amsterdam Rheumatology and Immunology Center, Location VUmc and Reade, Amsterdam, dr. Jan van Breemenstraat 2, 1056AB Noord-Holland, Netherlands; Amsterdam UMC Location VUmc, Department of Rheumatology, Amsterdam, Noord-Holland, Netherlands
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Herrera-Martínez AD, Muñoz Jiménez C, López Aguilera J, Crespin MC, Manzano García G, Gálvez Moreno MÁ, Calañas Continente A, Molina Puerta MJ. Mediterranean Diet, Vitamin D, and Hypercaloric, Hyperproteic Oral Supplements for Treating Sarcopenia in Patients with Heart Failure-A Randomized Clinical Trial. Nutrients 2023; 16:110. [PMID: 38201939 PMCID: PMC10781070 DOI: 10.3390/nu16010110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/22/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Malnutrition and sarcopenia frequently affect patients with heart failure (HF), in which clinical outcomes and survival is decreased. Thus, appropriate nutritional screening and early nutrition support are highly recommended. Currently, nutritional support is not a standard of care in patients with HF, and the use of commercially available oral supplements (OSs) could provide an additional benefit to medical treatment in these patients. AIM To compare the effect of the Mediterranean diet in combination with hypercaloric, hyperproteic OS in patients with HF. PATIENTS AND METHODS An open label, controlled clinical study in which patients were randomly assigned to receive a Mediterranean diet (control group) vs. hypercaloric, hyperproteic OS (intervention group) for twenty-four weeks. Thirty-eight patients were included; epidemiological, clinical, anthropometric, ultrasound (muscle echography of the rectus femoris muscle of the quadriceps and abdominal adipose tissue), and biochemical evaluations were performed. All patients received additional supplementation with vitamin D. RESULTS Baseline malnutrition according to the GLIM criteria was observed in 30% of patients, while 65.8% presented with sarcopenia. Body cell mass, lean mass, and body mass increased in the intervention group (absolute increase of 0.5, p = 0.03, 1.2 kg, p = 0.03, and 0.1 kg, p = 0.03 respectively). In contrast, fat mass increased in the control group (4.5 kg, p = 0.05). According to the RF ultrasound, adipose tissue, muscle area, and circumference tended to decrease in the intervention group; it is probable that 24 weeks was too short a period of time for evaluating changes in muscle area or circumference, as previously observed in another group of patients. In contrast, functionality, determined by the up-and-go test, significantly improved in all patients (difference 12.6 s, p < 0.001), including the control (10 s improvement, p < 0.001) and the intervention group (improvement of 8.9 s, p < 0.001). Self-reported QoL significantly increased in all groups, from 68.7 ± 22.2 at baseline to 77.7 ± 18.7 (p = 0.01). When heart functionality was evaluated, LVEF increased in the whole cohort (38.7 ± 16.6 vs. 42.2 ± 8.9, p < 0.01); this increase was higher in the intervention group (34.2 ± 16.1 at baseline vs. 45.0% ± 17.0 after 24 weeks, p < 0.05). Serum values of NT-proBNP also significantly decreased in the whole cohort (p < 0.01), especially in the intervention group (p = 0.02). After adjusting by age and sex, nutritional support, baseline LVEF, NT-proBNP, and body composition parameters of functionality tests were not associated with mortality or new hospital admissions in this cohort. CONCLUSION Nutritional support with hypercaloric, hyperproteic OS, Mediterranean diet, and vitamin D supplementation were associated with decreased NT-proBNP and improvements in LVEF, functionality, and quality of life in patients with HF, despite a significant decrease in hospital admissions.
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Affiliation(s)
- Aura D. Herrera-Martínez
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), 14004 Córdoba, Spain; (C.M.J.); (J.L.A.); (G.M.G.); (M.Á.G.M.); (A.C.C.); (M.J.M.P.)
- Endocrinology and Nutrition Service, Reina Sofia University Hospital, 14004 Córdoba, Spain
| | - Concepción Muñoz Jiménez
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), 14004 Córdoba, Spain; (C.M.J.); (J.L.A.); (G.M.G.); (M.Á.G.M.); (A.C.C.); (M.J.M.P.)
- Endocrinology and Nutrition Service, Reina Sofia University Hospital, 14004 Córdoba, Spain
| | - José López Aguilera
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), 14004 Córdoba, Spain; (C.M.J.); (J.L.A.); (G.M.G.); (M.Á.G.M.); (A.C.C.); (M.J.M.P.)
- Cardiology Service, Reina Sofia University Hospital, 14004 Córdoba, Spain;
| | | | - Gregorio Manzano García
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), 14004 Córdoba, Spain; (C.M.J.); (J.L.A.); (G.M.G.); (M.Á.G.M.); (A.C.C.); (M.J.M.P.)
- Endocrinology and Nutrition Service, Reina Sofia University Hospital, 14004 Córdoba, Spain
| | - María Ángeles Gálvez Moreno
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), 14004 Córdoba, Spain; (C.M.J.); (J.L.A.); (G.M.G.); (M.Á.G.M.); (A.C.C.); (M.J.M.P.)
- Endocrinology and Nutrition Service, Reina Sofia University Hospital, 14004 Córdoba, Spain
| | - Alfonso Calañas Continente
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), 14004 Córdoba, Spain; (C.M.J.); (J.L.A.); (G.M.G.); (M.Á.G.M.); (A.C.C.); (M.J.M.P.)
- Endocrinology and Nutrition Service, Reina Sofia University Hospital, 14004 Córdoba, Spain
| | - María José Molina Puerta
- Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), 14004 Córdoba, Spain; (C.M.J.); (J.L.A.); (G.M.G.); (M.Á.G.M.); (A.C.C.); (M.J.M.P.)
- Endocrinology and Nutrition Service, Reina Sofia University Hospital, 14004 Córdoba, Spain
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Mosiewicz J, Brożyna-Tkaczyk K, Reichert E, Myśliński W, Panasiuk L, Jaroszyński A, Mosiewicz-Madejska B. Selected routine laboratory tests in the clinical assessment of patients with obstructive sleep apnea. Ann Agric Environ Med 2023; 30:737-742. [PMID: 38153079 DOI: 10.26444/aaem/177205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) is a chronic disease characterized by repetitive complete or partial occlusion of the upper airways during sleep with respiratory muscle effort, which leads to consecutive apneas and hypopneas. Obstruction of the upper airways during sleep leads to repetitive episodes of disrupted airflow and consequent changes in blood oxygenation, resulting in hypoxaemia and hypercapnia. Intermittent hypoxaemia induces the production of pro-inflammatory factors and promotes metabolic dysregulation and platelet aggregation. OBJECTIVE The main aim of this study was to determine differences, if any, in selected standard parameters in routine laboratory tests often used in GP practice between patients with obstructive sleep apnea, without comorbidities, and a well-defined control group with the absence of this syndrome proven in polygraphic examination. MATERIAL AND METHODS Of the 192 clinically assessed persons with suspected OSA and admitted to the Internal Medicine Department in Lublin, 85 were qualified for the study after application of exclusion criteria. Demographic and health behaviour-related data, medical history regarding sleep habits and cardiovascular disease, were collected from each patient. RESULTS Apart from significantly higher MCV and MCH among the cpontrol group, no significant differences were found between patients with obstructive sleep apnea and the control group. CONCLUSIONS The results can be useful for the holistic assessment of the health status of patients with newly-diagnosed OSA.
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Affiliation(s)
- Jerzy Mosiewicz
- Chair and Department of Internal Medicine, Medical University, Lublin, Poland
| | | | | | - Wojciech Myśliński
- Chair and Department of Internal Medicine, Medical University, Lublin, Poland
| | | | | | - Barbara Mosiewicz-Madejska
- I Chair and Department of Oncological Gynaecology and Gynaecology, Independent Public Hospital No 1, Lublin, Poland
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Emara AN, Wadie M, Mansour NO, Shams MEE. The clinical outcomes of dapagliflozin in patients with acute heart failure: A randomized controlled trial (DAPA-RESPONSE-AHF). Eur J Pharmacol 2023; 961:176179. [PMID: 37923161 DOI: 10.1016/j.ejphar.2023.176179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 11/07/2023]
Abstract
AIMS Dapagliflozin may confer additional decongestive and natriuretic benefits to patients with acute heart failure (AHF). Nonetheless, this hypothesis was not clinically examined. This study aimed primarily to investigate the effect of dapagliflozin on symptomatic relief in those patients. METHODS This was a randomized, double-blind study that included 87 patients with AHF presenting with dyspnea. Within 24 h of admission, patients were randomized to receive either dapagliflozin (10 mg/day, N = 45) or placebo (N = 42) for 30 days. The primary outcome was the difference between the two groups in the area under the curve (AUC) of visual analogue scale (VAS) dyspnea score over the first 4 days. Secondary endpoints included urinary sodium (Na) after 2 h of randomization, percent change in NT-proBNP, cumulative urine output (UOP), and differences in mortality and hospital readmission rates. RESULTS The results showed that dapagliflozin significantly reduced the AUC of VAS dyspnea score compared to placebo (3192.2 ± 1631.9 mm × h vs 4713.1 ± 1714.9 mm × h, P < 0.001). The relative change of NT-proBNP compared to its baseline was also larger with dapagliflozin (-34.89% vs -10.085%, P = 0.001). Additionally, higher cumulative UOP was found at day 4 (18600 ml in dapagliflozin vs 13700 in placebo, P = 0.031). Dapagliflozin decreased rehospitalization rates within 30 days after discharge, while it did not affect the spot urinary Na concentration, incidence of worsening of heart failure, or mortality rates. CONCLUSION Dapagliflozin may provide symptomatic relief and improve diuresis in patients with AHF. Further studies are needed to confirm these findings. https://clinicaltrials.gov/study/NCT05406505.
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Affiliation(s)
- Abdelrahman N Emara
- Clinical Pharmacy and Pharmacy Practice Department, Faculty of Pharmacy, Mansoura University, Mansoura, 35516, Egypt.
| | - Moheb Wadie
- Cardiology Department, Faculty of Medicine, Mansoura University, Mansoura, 35516, Egypt.
| | - Noha O Mansour
- Clinical Pharmacy and Pharmacy Practice Department, Faculty of Pharmacy, Mansoura University, Mansoura, 35516, Egypt; Clinical Pharmacy and Pharmacy Practice Department, Faculty of Pharmacy, Mansoura National University, Egypt.
| | - Mohamed E E Shams
- Clinical Pharmacy and Pharmacy Practice Department, Faculty of Pharmacy, Mansoura University, Mansoura, 35516, Egypt.
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Claudel SE, Waikar SS, Gopal DM, Verma A. Association of cardiac biomarkers, kidney function, and mortality among adults with chronic kidney disease. medRxiv 2023:2023.12.12.23299886. [PMID: 38168327 PMCID: PMC10760296 DOI: 10.1101/2023.12.12.23299886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Background and Aims The performance of high sensitivity troponin T (hs-cTnT), hs-cTnI, and N-terminal pro-hormone brain natriuretic peptide (NT-proBNP) in patients with chronic kidney disease (CKD) is poorly understood. Methods We included adults with CKD (eGFR<60 ml/min/1.73m2) in the 1999-2004 NHANES. We calculated the 99th percentile of hs-cTnT, hs-cTnI (Abbott, Ortho, and Siemens assays), and NT-proBNP, measured the association between eGFR and cardiac biomarker concentration, and used Cox regression models to assess the relationship between cardiac biomarkers and CVD mortality. Results Across 1,068 adults with CKD, the mean [SD] age was 71.9[12.7] years and 61.2% were female; 78.8% had elevated NT-proBNP and 42.6% had elevated hs-cTnT based on traditional clinical reference limits. The 99th percentile of hs-cTnT was 122 ng/L (95% confidence interval (CI) 101-143), hs-cTnIAbbott was 69 ng/L (95% CI 38-99), and NT-proBNP was 8952 pg/mL (95% CI 7506-10,399). A 10 ml/min decrease in eGFR was associated with greater increases in hs-cTnT and NT-proBNP than hs-cTnI (hs-cTnT: 27.5% increase (β=27.5, 95% CI 28.2-43.3)), NT-proBNP 46.0% increase (β=46.0, 95% CI 36.0-56.8), hs-cTnISiemens 17.9% (β=17.9, 95% CI 9.7-26.7). Each doubling of hs-cTnT, hs-cTnI, and NT-proBNP were associated with CVD mortality (hs-cTnT HR 1.62 [95% CI 1.32-1.98], p<0.0001; hs-cTnISiemens HR 1.40 [95% CI 1.26-1.55], p<0.0001; NT-proBNP HR 1.29 [95% CI 1.19-1.41], p<0.0001). Conclusions and Relevance Community dwelling adults with CKD have elevated concentrations of cardiac biomarkers, above established reference ranges. Of the troponin assays, hs-cTnI concentration appears to be most stable across eGFR categories and is associated with CVD mortality.
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Affiliation(s)
| | - Sushrut S. Waikar
- Department of Medicine, Section of Nephrology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Deepa M. Gopal
- Department of Medicine, Section of Cardiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Amyloidosis Center, Boston Medical Center, Boston, MA, USA
| | - Ashish Verma
- Department of Medicine, Section of Nephrology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Amyloidosis Center, Boston Medical Center, Boston, MA, USA
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Zhao Y, Zhao L, Wang Y, Zhang J, Ren H, Zhang R, Wu Y, Zou Y, Tong N, Liu F. The association of plasma NT-proBNP level and progression of diabetic kidney disease. Ren Fail 2023; 45:2158102. [PMID: 36820611 PMCID: PMC9970255 DOI: 10.1080/0886022x.2022.2158102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 12/05/2022] [Indexed: 02/24/2023] Open
Abstract
AIMS Diabetic kidney disease (DKD) is the most common cause of end-stage kidney disease (ESKD). The identification of risk factors involved in the progression of DKD to ESKD is expected to result in early detection and appropriate intervention and improve prognosis. This study aimed to explore whether plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) was associated with kidney outcomes in patients with type 2 diabetes mellitus (T2DM) and biopsy-proven DKD. METHODS Patients with biopsy-proven DKD who were followed up at West China Hospital over 12 months were enrolled. The kidney outcome was defined as progression to ESKD. The cutoff value of plasma NT-proBNP concentration was calculated by using receiver operating characteristic (ROC) curve analysis. The influence of NT-proBNP levels on kidney outcome in patients with DKD was assessed using Cox regression analysis. RESULTS A total of 30 (24.5%) patients reached ESKD during a median follow-up of 24.1 months. The baseline serum NT-proBNP level had a significant correlation with baseline proteinuria, kidney function, glomerular lesions, interstitial fibrosis tubular atrophy (IFTA), and arteriolar hyalinosis. Multivariate Cox regression analysis indicated that increased NT-proBNP level was significantly associated with a higher risk of progression to ESKD (HR 6.43; 95% CI (1.65-25.10, p = 0.007), and each 1 SD increase in LG (NT-proBNP) was also associated with a higher risk (HR 2.43; 95% CI 1.94-5.29, p = 0.047) of an adverse kidney outcome after adjusting for confounding factors. CONCLUSIONS A higher level of plasma NT-proBNP predicts kidney prognosis in patients with biopsy-proven DKD. This warrants further investigation into the potential mechanisms.
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Affiliation(s)
- Yuancheng Zhao
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu, SichuanChina
- Laboratory of Diabetic Kidney Disease, Centre of Diabetes and Metabolism Research, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Lijun Zhao
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu, SichuanChina
- Laboratory of Diabetic Kidney Disease, Centre of Diabetes and Metabolism Research, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yiting Wang
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu, SichuanChina
| | - Junlin Zhang
- Laboratory of Diabetic Kidney Disease, Centre of Diabetes and Metabolism Research, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Honghong Ren
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu, SichuanChina
| | - Rui Zhang
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu, SichuanChina
| | - Yucheng Wu
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu, SichuanChina
| | - Yutong Zou
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu, SichuanChina
| | - Nanwei Tong
- Division of Endocrinology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Fang Liu
- Division of Nephrology, West China Hospital of Sichuan University, Chengdu, SichuanChina
- Laboratory of Diabetic Kidney Disease, Centre of Diabetes and Metabolism Research, West China Hospital of Sichuan University, Chengdu, Sichuan, China
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de Bakker M, Petersen TB, Rueten-Budde AJ, Akkerhuis KM, Umans VA, Brugts JJ, Germans T, Reinders MJT, Katsikis PD, van der Spek PJ, Ostroff R, She R, Lanfear D, Asselbergs FW, Boersma E, Rizopoulos D, Kardys I. Machine learning-based biomarker profile derived from 4210 serially measured proteins predicts clinical outcome of patients with heart failure. Eur Heart J Digit Health 2023; 4:444-454. [PMID: 38045440 PMCID: PMC10689916 DOI: 10.1093/ehjdh/ztad056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/06/2023] [Accepted: 10/03/2023] [Indexed: 12/05/2023]
Abstract
Aims Risk assessment tools are needed for timely identification of patients with heart failure (HF) with reduced ejection fraction (HFrEF) who are at high risk of adverse events. In this study, we aim to derive a small set out of 4210 repeatedly measured proteins, which, along with clinical characteristics and established biomarkers, carry optimal prognostic capacity for adverse events, in patients with HFrEF. Methods and results In 382 patients, we performed repeated blood sampling (median follow-up: 2.1 years) and applied an aptamer-based multiplex proteomic approach. We used machine learning to select the optimal set of predictors for the primary endpoint (PEP: composite of cardiovascular death, heart transplantation, left ventricular assist device implantation, and HF hospitalization). The association between repeated measures of selected proteins and PEP was investigated by multivariable joint models. Internal validation (cross-validated c-index) and external validation (Henry Ford HF PharmacoGenomic Registry cohort) were performed. Nine proteins were selected in addition to the MAGGIC risk score, N-terminal pro-hormone B-type natriuretic peptide, and troponin T: suppression of tumourigenicity 2, tryptophanyl-tRNA synthetase cytoplasmic, histone H2A Type 3, angiotensinogen, deltex-1, thrombospondin-4, ADAMTS-like protein 2, anthrax toxin receptor 1, and cathepsin D. N-terminal pro-hormone B-type natriuretic peptide and angiotensinogen showed the strongest associations [hazard ratio (95% confidence interval): 1.96 (1.17-3.40) and 0.66 (0.49-0.88), respectively]. The multivariable model yielded a c-index of 0.85 upon internal validation and c-indices up to 0.80 upon external validation. The c-index was higher than that of a model containing established risk factors (P = 0.021). Conclusion Nine serially measured proteins captured the most essential prognostic information for the occurrence of adverse events in patients with HFrEF, and provided incremental value for HF prognostication beyond established risk factors. These proteins could be used for dynamic, individual risk assessment in a prospective setting. These findings also illustrate the potential value of relatively 'novel' biomarkers for prognostication. Clinical Trial Registration https://clinicaltrials.gov/ct2/show/NCT01851538?term=nCT01851538&draw=2&rank=1 24.
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Affiliation(s)
- Marie de Bakker
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molenwaterplein 40, 3015GD, Rotterdam, The Netherlands
| | - Teun B Petersen
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molenwaterplein 40, 3015GD, Rotterdam, The Netherlands
- Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, Dr. Molenwaterplein 40, 3015GD, Rotterdam, The Netherlands
| | - Anja J Rueten-Budde
- Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, Dr. Molenwaterplein 40, 3015GD, Rotterdam, The Netherlands
| | - K Martijn Akkerhuis
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molenwaterplein 40, 3015GD, Rotterdam, The Netherlands
| | - Victor A Umans
- Department of Cardiology, Northwest Clinics, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molenwaterplein 40, 3015GD, Rotterdam, The Netherlands
| | - Tjeerd Germans
- Department of Cardiology, Northwest Clinics, Wilhelminalaan 12, 1815 JD, Alkmaar, The Netherlands
| | - Marcel J T Reinders
- Delft Bioinformatics Lab, Delft University of Technology, Van Mourik Broekmanweg 6, 2628 XE, Delft, The Netherlands
| | - Peter D Katsikis
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Dr. Molenwaterplein 40, 3015GD, Rotterdam, The Netherlands
| | - Peter J van der Spek
- Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Dr. Molenwaterplein 40, 3015GD, Rotterdam, The Netherlands
| | - Rachel Ostroff
- SomaLogic, Inc., 2945 Wilderness Pl., Boulder, CO 80301, USA
| | - Ruicong She
- Department of Public Health Sciences, Henry Ford Health System, 1 Ford Pl, Detroit, MI 48202, USA
| | - David Lanfear
- Center for Individualized and Genomic Medicine Research (CIGMA), Henry Ford Hospital, 2799 W. Grand Boulevard, Detroit MI, 48202, USA
- Heart and Vascular Institute, Henry Ford Hospital, 2799 W. Grand Boulevard, Detroit, MI 48202, USA
| | - Folkert W Asselbergs
- Amsterdam University Medical Centers, Department of Cardiology, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Health Data Research UK and Institute of Health Informatics, University College London, Gower St, London, WC1E 6BT, UK
| | - Eric Boersma
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molenwaterplein 40, 3015GD, Rotterdam, The Netherlands
| | - Dimitris Rizopoulos
- Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, Dr. Molenwaterplein 40, 3015GD, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molenwaterplein 40, 3015GD, Rotterdam, The Netherlands
| | - Isabella Kardys
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molenwaterplein 40, 3015GD, Rotterdam, The Netherlands
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Chaminda Rathnayake BM, Illeperuma RP, Jayasinghe S, Fawcett TN, Maduwage K, Thilak Jayalath WA, Ralapanawa U. The Role of Serum NT-proBNP for Predicting Left Ventricular Systolic Dysfunction in Hospitalized Patients in Sri Lanka. EJIFCC 2023; 34:287-296. [PMID: 38303755 PMCID: PMC10828538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Background/aims Only a few studies have addressed the role of NT-proBNP in identifying Left Ventricular Systolic Dysfunction (LVSD) in South Asian populations. Therefore, the current study was aimed at assessing the use of serum NT-proBNP in predicting LVSD in a hospitalized population in Sri Lanka. Methods A random sample of 278 individuals referred for echocardiography at a major Teaching Hospital consented for venous blood samples to be collected for serum NT-proBNP assay by sandwich ELISA. Based on the ejection fraction (LVEF) and fractional shortening (FS), participants were differentiated as LVSD (LVEF<50%, FS≤ 29%) and non-LVSD individuals (LVEF>60%). According to inclusion/exclusion criteria, the final study sample consisted of 100 LVSD patients and 41 non-LVSD individuals. Results The mean ages of the LVSD and non-LVSD groups were 69.1 (±6.2 years) and 71.4 (±2.4 years) (p=0.066) respectively. The median NT-proBNP value (with IQR) among LVSD patients (528.2 pg/mL,355.2-924.2) was comparatively higher than that of non-LVSD individuals (207.3 pg/mL,177.5-343.0). Strong correlations of NT-proBNP level with LVEF (Spearman rho= -0.84, p<0.001) and FS (rho= -0.81, p<0.001) suggested that serum NT-proBNP concentration increases in parallel to deteriorating left ventricular functions. The AUROC of serum NT-proBNP for differentiating LVSD was 0.859 (95% CI:0.79 - 0.92) and the optimal cut-off level for predicting LVSD was 265pg/mL, with 90% sensitivity and 70% specificity. Conclusion Current Sri Lankan study revealed a considerable correlation of serum NT-proBNP level with LVSD and utilizing such an assay for screening will facilitate adequate evidence to rule-out LVSD among high-risk residents.
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Affiliation(s)
- B M Chaminda Rathnayake
- Department of Nursing, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Sri Lanka,
| | | | - Sakunthala Jayasinghe
- Department of Pathology, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka,
| | - Tonks N Fawcett
- Nursing Studies, The School of Health in Social Science, The Medical School, University of Edinburgh, Edinburgh, The United Kingdom,
| | - Kalana Maduwage
- Discipline of Biomedical Sciences, University of New England, New South Wales, Australia,
| | - W A Thilak Jayalath
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka,
| | - Udaya Ralapanawa
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka,
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Chowdhury RR, Kaur S, Gera R. N-Terminal Pro-B-Type Natriuretic Peptide as a Marker of Severity of Heart Failure in Children with Congenital Heart Diseases. Pediatr Cardiol 2023; 44:1716-1720. [PMID: 37563318 DOI: 10.1007/s00246-023-03259-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 07/29/2023] [Indexed: 08/12/2023]
Abstract
N-terminal pro-B-type natriuretic peptide (NT-proBNP) has been used as a tool for diagnosis, severity assessment and prognostication of congestive heart failure (CHF) in adults, with specific cut off values for diagnosis and denoting points of intervention. However, there is scarcity of paediatric literature regarding role of NT-proBNP as a marker of heart failure severity and prognostication. So, this study was done to assess the utility of NT-proBNP as a marker of severity of heart failure in children with congenital heart diseases. Single centre, prospective observational study. Children (1 month to 5 years), with congenital heart disease, admitted in the paediatric wards with varying severity of CHF were enrolled. Heart failure severity grading was done according to Laer modification of Ross Classification at the time of presentation to hospital and children were classified as having no/grade I CHF (score: 0-2); mild/grade II CHF (score 3-6); moderate/grade III CHF (score 7-9) or severe/grade IV CHF (score 10-12). NT-proBNP levels were measured within 24 h of admission. Eighty children with congenital heart disease were enrolled in this study. As per modified Ross Classification, 11 had grade I/No heart failure (13.7%), 32 children had grade II/mild heart failure (40%), 36 had grade III/moderate heart failure (45%) and only 1 had grade IV/severe heart failure (1.25%). The median NT-proBNP levels (IQR) in the above mentioned grades of heart failure were found to be 321.11 (211.1-411.78 pg/ml), 750.62 (474.62-995.2 pg/ml), 4159.61 (1440.59-11,857 pg/ml) and 11,320.34 pg/ml, respectively. Seven children (8.75%) expired. Median NT-proBNP value in seven children who died was significantly higher than those who survived [median (IQR): 11,681.01 pg/ml (10,092.72-14,754 pg/ml) vs 839.4 pg/ml (456.67-3288.09 pg/ml), p value < 0.001]. NT-proBNP level of 520.2 pg/ml predicted grade II (mild heart failure) or more severe grades of heart failure with Sensitivity, Specificity, Negative Predictive Value and Positive Predictive Value of 83%, 91%, 57.1% and 98%, respectively. NT-proBNP levels increase progressively with increasing severity of CHF and can be used as a marker of severity of heart failure in children with congenital heart disease presenting with CHF.
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Affiliation(s)
- Ritabrata Roy Chowdhury
- Department of Pediatrics, Vardhman Mahavir Medical College & Safdarjang Hospital, New Delhi, India
| | - Satnam Kaur
- Department of Pediatrics, Vardhman Mahavir Medical College & Safdarjang Hospital, New Delhi, India
| | - Rani Gera
- Department of Pediatrics, Vardhman Mahavir Medical College & Safdarjang Hospital, New Delhi, India.
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Walkley R, Allen AJ, Cowie MR, Maconachie R, Anderson L. The cost-effectiveness of NT-proBNP for assessment of suspected acute heart failure in the emergency department. ESC Heart Fail 2023; 10:3276-3286. [PMID: 37697738 PMCID: PMC10682884 DOI: 10.1002/ehf2.14471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 06/20/2023] [Accepted: 07/02/2023] [Indexed: 09/13/2023] Open
Abstract
AIMS When relying on clinical assessment alone, an estimated 22% of acute heart failure (AHF) patients are missed, so clinical guidelines recommend the use of N-terminal pro-B-type natriuretic peptide (NT-proBNP) for AHF diagnosis. Since publication of these guidelines, there has been poor uptake of NT-proBNP testing in part due to concerns over excessive false positive referrals resulting from the low specificity of a single 'rule-out' threshold of <300 pg/mL. Low specificity can be mitigated by the addition of age-specific 'rule-in' NT-proBNP thresholds. METHODS AND RESULTS A theoretical hybrid decision tree/semi-Markov model was developed, combining global trial and audit data to evaluate the cost-effectiveness of NT-proBNP testing using age-specific rule-in/rule-out (RI/RO) thresholds, compared with NT-proBNP RO only and with clinical decision alone (CDA). Cost-effectiveness was measured as the incremental cost per quality-adjusted life year (QALY) gained and incremental net health benefit. In the base case, using UK-specific inputs, NT-proBNP RI/RO was associated with both greater QALYs and lower costs than CDA. At a willingness-to-pay threshold of £20 000/QALY, NT-proBNP RO was also cost-effective compared with CDA [incremental cost-effectiveness ratio (ICER) of £8322/QALY], but not cost-effective vs. RI/RO (ICER of £64 518/QALY). Overall, NT-proBNP RI/RO was the most cost-effective strategy. Sensitivity and scenario analyses were undertaken; the conclusions were not impacted by plausible variations in parameters, and similar conclusions were obtained for the Netherlands and Spain. CONCLUSIONS An NT-proBNP strategy that combines an RO threshold with age-specific RI thresholds provides a cost-effective alternative to the currently recommended NT-proBNP RO only strategy, achieving greater diagnostic specificity with minimal reduction in sensitivity and thus reducing unnecessary echocardiograms and hospital admissions.
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Affiliation(s)
| | | | - Martin R. Cowie
- Royal Brompton Hospital, Guy's and St Thomas' NHS Foundation Trust and Faculty of Lifesciences and MedicineKing's College LondonLondonUK
| | - Ross Maconachie
- Value, Access and Devolved Nations, Merck Sharp and Dohme (UK) LtdLondonUK
| | - Lisa Anderson
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research InstituteSt George's, University of London, St George's HospitalLondonUK
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Apandi PR, Djer MM, Kuswiyanto RB, Wijaya EA, Artiko B, Rahayuningsih SE. NT-proBNP levels as a predictor of higher left ventricular end-diastolic pressure in children with small perimembranous ventricular septal defect. Cardiol Young 2023; 33:2604-2609. [PMID: 37078182 DOI: 10.1017/s1047951123000756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
INTRODUCTION The decision to close small ventricular septal defect is still controversial. Previous study showed that ventricular dysfunction in adulthood is correlated with small perimembranous ventricular septal defect. N terminal pro B-type natriuretic peptide (NT-proBNP) is a neurohormone secreted primarily from the ventricles in response to increased left and right ventricular pressure and volume load. The left ventricular end-diastolic pressure will reflect ventricular performance. This study aimed to evaluate the correlation between left ventricular end-diastolic pressure and the NT-proBNP in children with small perimembranous ventricular septal defect. MATERIALS AND METHODS Level of NT-proBNP in 41 patients with small perimembranous ventricular septal defect was measured before transcatheter closure procedure. We also measured the left ventricular end-diastolic pressure in each patients during catheterisation. We investigated the value of NT-proBNP in patients with small perimembranous ventricular septal defect and its correlation with the level of left ventricular end-diastolic pressure. RESULT We found positive correlation between NT-proBNP and left ventricular end-diastolic pressure (r = 0.278, p = 0.046). The median of NT-proBNP at left ventricular end-diastolic pressure < 10 was lower than at left ventricular end-diastolic pressure ≥ 10 (0.87 ng/ml versus 1.83 ng/ml, p = 0.023). The results of the NT-proBNP diagnostic test for predicting left ventricular end-diastolic pressure ≥ 10 using Receiver Operating Characteristic (ROC) analysis showed the area under the curve value of 0.715 (95% CI: 0.546-0.849). The cut-off value >0.99 ng/ml of NT-proBNP has 75.0% sensitivity and 72.2% specifity. CONCLUSION Level of NT-proBNP higher than 0.99 ng/ml was correlated significantly with left ventricular end-diastolic pressure ≥10 in children with small perimembranous ventricular septal defect.
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Affiliation(s)
- Putria R Apandi
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
- Department of Child Health, Faculty of Medicine, University of Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Mulyadi M Djer
- Department of Child Health, Faculty of Medicine, University of Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Rahmat B Kuswiyanto
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Elrika A Wijaya
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Bagus Artiko
- Department of Child Health, Faculty of Medicine, University of Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Sri E Rahayuningsih
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran, Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
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48
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Łapińska L, Krentowska A, Kondraciuk M, Chlabicz M, Waszkiewicz N, Kamiński K, Kowalska I. The association between plasma N-terminal pro-brain natriuretic peptide concentration and metabolic disturbances in women with depressive symptoms. Psychoneuroendocrinology 2023; 158:106409. [PMID: 37801752 DOI: 10.1016/j.psyneuen.2023.106409] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 08/25/2023] [Accepted: 09/29/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND The relationship between brain natriuretic peptides and depression was studied in patients with cardiovascular diseases (CVD), but the data in people without CVD are limited. Metabolic disturbances can be associated with natriuretic peptides' levels. The study aimed to assess serum N-terminal pro-brain natriuretic peptide (NT-proBNP) level in women with depressive symptoms and its relationship with metabolic disturbances. METHODS The analysis included 347 women (20-60 years old) from Bialystok PLUS cohort study: 98 with depressive symptoms and 249 controls. Clinical examination, oral glucose tolerance test (OGTT) and assessment of lipid, sex hormone binding globulin (SHBG) and NT-proBNP concentrations in the blood were performed. The participants completed Beck Depression Inventory questionnaire. RESULTS Metabolic syndrome was more frequent in the group of women with depressive symptoms compared to women without depressive symptoms. Women with depressive symptoms had lower NT-proBNP level than the control group - 45.88 (27.80-67.04) vs 56.49 (32.42-94.25) pg/mL, p = 0.027. Multiple linear regression analysis of all women showed that NT-proBNP level was reversely associated with the presence of depressive symptoms, waist circumference and heart rate and positively connected with age. In the group of women with depressive symptoms, we observed negative correlations between NT-proBNP level and insulin concentration at 60 min of OGTT, diastolic blood pressure and a positive correlation with SHBG. CONCLUSIONS NT-proBNP level is decreased in women with depressive symptoms, which might be connected with metabolic disturbances in this group.
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Affiliation(s)
- Lidia Łapińska
- Department of Internal Medicine and Metabolic Diseases, Medical University of Bialystok, Bialystok, Poland.
| | - Anna Krentowska
- Department of Internal Medicine and Metabolic Diseases, Medical University of Bialystok, Bialystok, Poland
| | - Marcin Kondraciuk
- Population Research Center, Medical University of Bialystok, Bialystok, Poland
| | - Małgorzata Chlabicz
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Bialystok, Bialystok, Poland
| | | | - Karol Kamiński
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Bialystok, Bialystok, Poland
| | - Irina Kowalska
- Department of Internal Medicine and Metabolic Diseases, Medical University of Bialystok, Bialystok, Poland
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49
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Saroha D, Panda S, Deora S, Mohammed S. Cardiac Abnormalities in Refractory Status Epilepticus-an Exploratory Study. J Epilepsy Res 2023; 13:42-50. [PMID: 38223358 PMCID: PMC10783967 DOI: 10.14581/jer.23007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/06/2023] [Accepted: 12/16/2023] [Indexed: 01/16/2024] Open
Abstract
Background and Purpose Cardiac abnormalities have been reported during ongoing seizures and refractory status epilepticus (RSE). Reduced heart rate variability (HRV) and cardiac arrhythmias may contribute to sudden unexpected death in epilepsy. We sought to explore the utility of electrocardiographic and echocardiographic changes in patients with RSE prognosis and functional outcome. Methods Patients of RSE underwent electrocardiogram (ECG), holter, troponin-I (Trop I), N-terminal prohormone of brain natriuretic peptide (NT-proBNP), and 2-dimensional echocardiogram (2D Echo) along with continuous electroencephalogram in first 24 hours and admission. Heart rate changes/arrhythmias, corrected QT interval (QTc) and HRV, ventricular dysfunction or regional motion wall abnormality were studied on 2D Echo. These parameters were also at baseline, at discharge or death and 30 days post discharge. Results This prospective observational study conducted over 18 months enrolled 20 patients with RSE, fulfilling the inclusion criteria. Mean age was 47.75±17.2 years with male: female ratio of 1:1. Mean time to presentation from seizure onset was 8.80±7.024 hours. Central nervous system infection (35.0%), autoimmune encephalitis (20.0%) and cerebrovascular disease (20.0%) were the common etiologies. Amongst cardiac injury markers, cardiac enzymes and QTc prolongation were the commonest abnormalities in RSE. Both reduced HRV and presence of cardiac injury markers had significant correlation with poor outcome along with poor Glasgow coma scale (GCS) and modified Rankin scale (mRS) at presentation, and presence of non convulsive status epilepticus (NCSE). Conclusions Presence of poor GCS, poor mRS, markers of cardiac injury, reduced HRV and occurrence of NCSE have a consistent correlation with mortality and poor clinical outcome. Therefore, routine assessment of cardiac abnormalities using affordable, easily accessible and non-invasive tools such as ECG, 2D Echo, holter NT-proBNP and Trop I is recommended in RSE patients.
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Affiliation(s)
- Deepika Saroha
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), Jodhpur,
India
| | - Samhita Panda
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), Jodhpur,
India
| | - Surender Deora
- Department of Cardiology, All India Institute of Medical Sciences (AIIMS), Jodhpur,
India
| | - Sadik Mohammed
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences (AIIMS), Jodhpur,
India
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50
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Cvetko Krajinović L, Bodulić K, Laškaj R, Žibrat B, Svoboda Karić P, Kurolt IC, Kordun M, Topić A, Čivljak R, Skuhala T, Markotić A. Hemorrhagic Fever with Renal Syndrome Patients Exhibit Increased Levels of Lipocalin-2, Endothelin-1 and NT-proBNP. Life (Basel) 2023; 13:2189. [PMID: 38004329 PMCID: PMC10672301 DOI: 10.3390/life13112189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
Hemorrhagic fever with renal syndrome (HFRS) is an acute zoonotic disease caused by viruses of the Orthohantavirus genus. This syndrome is characterized by renal and cardiopulmonary implications detectable with different biomarkers. Here, we explored the role of serum and urine levels of lipocalin-2, endothelin-1 and N-terminal pro-brain natriuretic peptide (NT-proBNP) in HFRS pathology. A total of twenty-eight patients hospitalized due to a Puumala orthohantavirus infection were included, with serum and urine samples collected on patient admission (acute phase) and discharge (convalescent phase). In comparison to healthy individuals, patients exhibited significantly higher acute-phase serum and urine levels of lipocalin-2, serum levels of endothelin-1 and serum and urine levels of NT-proBNP. Patients in the convalescent phase showed a significant decrease in urine lipocalin-2, serum endothelin-1 and serum and urine NT-proBNP levels. We recorded a strong correlation between serum levels of lipocalin-2 and endothelin-1 and urine levels of lipocalin-2 with several kidney injury markers, such as serum creatinine, urea, urine white blood cell count and proteinuria. We also demonstrated an independent correlation of serum and urine lipocalin-2 levels with acute kidney injury in HFRS. All in all, our results show an involvement of NT-proBNP, lipocalin-2 and endothelin-1 in the renal and cardiac pathology of HFRS.
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Affiliation(s)
| | - Kristian Bodulić
- University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10 000 Zagreb, Croatia
| | - Renata Laškaj
- University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10 000 Zagreb, Croatia
| | - Branka Žibrat
- University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10 000 Zagreb, Croatia
| | - Petra Svoboda Karić
- University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10 000 Zagreb, Croatia
| | - Ivan-Christian Kurolt
- University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10 000 Zagreb, Croatia
| | - Mihaela Kordun
- University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10 000 Zagreb, Croatia
| | - Antea Topić
- University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10 000 Zagreb, Croatia
| | - Rok Čivljak
- University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10 000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10 000 Zagreb, Croatia
| | - Tomislava Skuhala
- University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10 000 Zagreb, Croatia
- School of Dental Medicine, University of Zagreb, 10 000 Zagreb, Croatia
| | - Alemka Markotić
- University Hospital for Infectious Diseases “Dr. Fran Mihaljević”, 10 000 Zagreb, Croatia
- Faculty of Medicine, University of Rijeka, 51 000 Rijeka, Croatia
- Faculty of Medicine, Catholic University of Croatia, 10 000 Zagreb, Croatia
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