NT-proBNP and its correlation to left ventricular ejection fraction and heart failure - The DEMONSTRATE database.

Cardiac myosin-binding protein C as a candidate biomarker in heart failure: rational but not revolutionary.

Effect Of Saxagliptin On LV Structure And Function In Patients With Type 2 Diabetes And Heart Failure: Results Of Measure-HF

Factors influencing N-terminal pro-brain natriuretic peptide (NT-proBNP) level in heart failure patients with different cardiac functions were identified to explore the correlations with prognosis. Eighty heart failure patients with different cardiac functions treated in Yixing People's Hospital from January 2016 to June 2017 were selected, and divided into two groups (group with cardiac function in class II and below and group with cardiac function in class III and above), according to the cardiac function classification established by New York Heart Association (NYHA). Blood biochemical test and outcome analysis were conducted to measure serum NT-proBNP and matrix metalloproteinase-9 (MMP-9) levels in patients with different cardiac functions, and correlations between levels of NT-proBNP and MMP-9 and left ventricular ejection fraction (LVEF) level were analyzed in patients with different cardiac functions at the same time. In addition, risk factors for heart failure in patients with different cardiac functions were analyzed. Compared with the group with cardiac function in class III and above, the group with cardiac function in class II and below had significantly lower serum NT-proBNP and MMP-9 levels (p<0.05). For echocardiogram indexes, left ventricular end-diastolic diameter (LVEDD) and left ventricular end-systolic diameter (LVESD) in the group with cardiac function in class II and below were obviously lower than those in the group with cardiac function in class III and above (p<0.05), while LVEF was higher in group with cardiac function in class II and below than that in group with cardiac function in class III and above (p<0.05). NT-proBNP and MMP-9 levels were negatively correlated with LVEF level [r=−0.8517 and −0.8517, respectively, p<0.001 (<0.05)]. Cardiac function in class III and above, increased NT-proBNP, increased MMP-9 and decreased LVEF were relevant risk factors and independent risk factors for heart failure in patients with different cardiac functions. NT-proBNP and MMP-9 levels are negatively correlated with LVEF in patients regardless of the cardiac function class. Therefore, attention should be paid to patients who have cardiac function in class III and above, increased NT-proBNP and MMP-9 levels and decreased LVEF in clinical practices, so as to actively prevent and treat heart failure.

2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC.

Objective To investigate the correlation between red blood cell distribution width (RDW) and the cardiac function in children with acute heart failure, and to explore the clinical value in evaluating the degree of heart failure. Methods From July 2013 to October 2015, 75 cases of children with acute heart failure who were hospitalized in Chengdu Women and Children′s Central Hospital were collected and assigned as 3 groups.Heart function classification was done by using a modified Ross scoring system, and each group included 25 cases of class Ⅱ, Ⅲ, Ⅳ.Indices of red blood cell, haemoglobin, RDW, concentration of plasma N-terminal pro brain natriuretic peptide (NT-proBNP), and left ventricular ejection fraction (LVEF) were recorded.SPSS 17.0 software was statistically used for comparing each index among groups and correlation analysis. Results Red blood cells and haemoglobin were not statistically different among groups(F=0.802, 1.372, all P>0.05). RDW, NT-proBNP concentration and LVEF were significantly different among groups(F=31.388, 29.300, χ2=56.952, all P class Ⅲ group>class Ⅱ group[RDW: (16.6±1.3)%>(15.4±1.1)%>(13.9±1.3)%, NT-proBNP: (506.6±190.2) ng/L>(1 028.1±356.8) ng/L>(1 884.1±358.6) ng/L, all P<0.01]. According to LVEF=50% as the cut-off point, children with acute heart failure were divided into LVEF decreased group and LVEF retention group, former group′s RDW and NT-proBNP were significantly higher than the latter group[RDW: (16.7±1.3)% vs.(13.9±1.1)%, NT-proBNP: (1 787.4±368.6) ng/L vs.(657.4±291.1) ng/L, all P<0.01]. According to NT-proBNP levels, the children with acute heart failure were divided into low, medium, and high NT-proBNP group, and RDW in the high NT-proBNP group[(17.3±0.9)%] was significantly higher than that of medium[(15.4±0.7)%], and that of low level group[(13.7±1.2)%](all P<0.01). The correlation analysis between RDW, NT-proBNP as well as LVEF showed that RDW was significantly positive correlated with NT-proBNP (r=0.869, P<0.01), and negatively related with LVEF(r=- 0.962, P< 0.01). Conclusions RDW is closely related to the cardiac function in children with acute heart failure.RDW is increased with the aggravating of acute heart failure, which can indirectly reflect the NT-proBNP concentration and LVEF change and suggests that RDW can be used as a convenient and useful index monitoring the level of cardiac function in children with acute heart failure, and the assessment of the severity of acute heart failure. Key words: Red blood cell distribution width; Acute heart failure; N-terminal pro brain natriuretic peptide; Child

Background The contemporary conceptualization of heart failure (HF) encompasses four developmental stages (at risk for HF, pre-HF, symptomatic HF, and advanced HF) and three distinct HF phenotypes categorized by left ventricular ejection fraction (LVEF) (HFpEF, HFmrEF, HFrEF). However, there is a need for a more comprehensive understanding of echocardiographic similarities and differences among pre-HF stages and various HF phenotypes. Material and Methods Our national echocardiographic society conducted a multicenter HF screening initiative. General practitioners in 13 primary care centers utilized the original mobile phone app to determine referrals for transthoracic echocardiography and N-terminal pro-B-type natriuretic peptide (NT-proBNP) testing in individuals without a prior HF diagnosis. The 2021 ESC guidelines' algorithms were used to diagnose HF phenotypes and 2016 EACVI/ASA recommendation² to assess diastolic function. This study defined "heart stress" (elevated NT-proBNP in asymptomatic individuals with risk factors, regardless of structural heart disease or cardiac dysfunction) and "patients at risk for HF" (normal NTproBNP and at least one HF risk factor). All patients were categorized into six groups: (I) no HF, no risk, (II) at risk for HF, (III) heart stress, (IV) HFpEF, (V) HFmrEF, and (VI) HFrEF. Echocardiographic findings were compared among groups (II) to (VI), using ANOVA, Kruskal-Wallis and Chi-squared test, when needed. Results In a cohort of 930 outpatients (mean age 66±11 years, 61% female), 34.2% were diagnosed with HF, 22.3% experienced heart stress, 37.8% were at risk for HF, and 12.8% had neither HF nor risk factors (Figure). While NT pro BNP showed progressive increase, LVEF showed a progressive decline across the groups, reaching its lowest in HFrEF patients (Table). Simultaneously, left ventricular mass index (LVMi), left atrial volume index (LAVi), and maximal velocity of tricuspid regurgitation (TR Vmax) significantly increased in a stepwise manner. Variations in predominant LV geometry were significant across groups (p&amp;lt;0.001): normal LV geometry in those without HF (60.8%), concentric LV remodeling in at-risk patients (38.6%), normal LV geometry in heart stress (49%), concentric LV hypertrophy (LVH) in HFpEF (27.7%), eccentric LVH in HFmrEF (42.3%), and both concentric and eccentric LVH in HFrEF (43.3% each). Diastolic dysfunction increased prevalence across the groups (12.9% vs 24.7% vs 37.6% vs 19.6% vs 51.1%, p&amp;lt;0.001). Remarkably, HFmrEF group had the highest proportion of undetermined diastolic function (14.7% vs 23.1% vs 27.9% vs 50% vs 26.7%, p&amp;lt;0.001). Conclusions The mobile phone app used in primary care setting allowed identification of significant number of individuals in the pre-HF stages, warranting further investigation. Distinct echocardiographic differences in pre-HF stages and HF phenotypes provide valuable insights for early detection and tailored treatments.

Objective To assess the values of growth differentiation factor-15 (GDF-15) and N-terminal pro-brain natriuretic peptide (NT-proBNP) for the diagnosis of children with congenital heart disease(CHD) combined with heart failure. Methods Among the children under treatment at the First Affiliated Hospital of Xinjiang Medical University from Jan.2011 to Dec.2012, 206 children those suffered with CHD were selected as the case group.One hundred and five children without CHD or heart failure were selected as the control group.Improved Ross score≥3 grades was taken as reference standard for heart failure.The case group was divided into non-heart failure group (0-2 grades, 112 cases) and the heart failure group (3-12 grades, 94 cases). The heart failure group was divided into mild heart failure group (3-6 grades, 38 cases), moderate heart failure group (7-9 grades, 32 cases) and severe heart failure group (10-12 grades, 24 cases). Levels of plasma GDF-15 and NT-proBNP were tested.In the meanwhile, the left ventricular ejection fraction (LVEF) was tested with ultrasonic cardiogram.Linear correlation analysis was performed for evaluating levels of plasma GDF-15 and NT-proBNP against the cardiac function grading in Ross scores and the LVEF, respectively.ROC curve was made to determine critical point or threshold value of diagnosis and assess values of levels of plasma GDF-15 and NT-proBNP for diagnosis of congenital heart disease combined with heart failure. Results Comparison of age and gender differences between the case group and the control group showed no statistically significant(χ2=4.233, 4.360, P>0.05). Levels of plasma LogGDF-15 and LogNT-proBNP in the heart failure group were significantly higher than those values of the non-heart failure group and the control group(F=115.2, 63.2, all P<0.01). Levels of plasma GDF-15 and NT-proBNP increased with the severity of heart failure and were positively correlated with improved Ross scores (r=0.890, P<0.01) and negatively correlated with LVEF(r=-0.652, P<0.01). GDF-15 was considered in combination with NT-proBNP, the specificity(80.2%) and precision(77.9%) for diagnosis of heart failure could be enhanced when plasma GDF-15≥831.6 ng/L coexisted with NT-proBNP≥759.8 ng/L. Conclusions Plasma GDF-15 and NT-proBNP can help the diagnosis of heart failure caused by CHD in children.The increase of these two factors is closely related to the severity of clinical heart failure.Combination of these two factors for test can enhance specificity and precision for diagnosis of heart failure. Key words: Growth differentiation factor-15; N-terminal pro-brain natriuretic peptide; Congenital heart disease; Heart failure

Objective To investigate the value of serum carbohydrate antigen 125(CA125)in the diagnosis of acute heart failure and its clinical prognosis. Methods From August 2015 to August 2016, 173 patients with acute heart failure in the Department of Cardiology of Jintan Hospital Affiliated to Jiangsu University and Jiangsu Province Subei People′s Hospital were enrolled in this study.According to the New York Heart Association(NYHA)classification, they were divided into NYHA class Ⅲ or class Ⅳ group.Fifty healthy subjects were selected as the control group as well.The blood levels of N-terminal pro B-type natriuretic peptide(NT-proBNP), high-sensitivity C-reactive protein(hs-CRP)and CA125 in each group were measured and compared, correlation analysis with parameters of echocardiography and the mortality rate of patients in each group were observed. Results Compared with the control group, the levels of BNP, hs-CRP and CA125 were significantly increased in patients with acute heart failure, and gradually increased with the increase of NYHA heart function classification.The difference was statistically significant(P<0.01). CA125 and hs-CRP levels and left ventricular end diastolic diameter(LVEDD)were positively correlated with NT-proBNP(r=0.401, 0.316, 0.445, all P<0.01), left ventricular ejection fraction(LVEF)was negatively correlated with NT-proBNP(r=-0.642, P<0.01). Conclusions CA125 levels is elevated in patients with acute heart failure and can be used as an important index in the diagnosis of heart failure and for prediction of the clinical prognosis. Key words: Serum carbohydrate antigen 125; Acute heart failure; Left ventricular ejection fraction; Prognosis

Objective To observe and compare the value of B brain natriuretic peptide(BNP) and N-terminal pro-brain natriuretic peptide(NT-proBNP) in the diagnosis of heart failure after neonatal asphyxia, and to optimize early clinical diagnosis. Methods A retrospective analysis was conducted on 124 neonatal asphyxia cases from January 2013 to October 2015, who were divided into heart failure group(53 cases) and control group(71 cases) according to whether complicated with heart failure.Comparison was conducted on BNP, NT-proBNP, cardiac troponin T (cTnT), creatine kinase isoenzyme (CK-MB) through blood sampling from femoral vein puncture within 48 h. And Logistic regression analysis was introduced into explore effecting factors of heart failure, besides, correlations between BNP, NT-proBNP and left ventricular ejection fraction (LVEF) of asphyxia children were calculated, and receiver operating characteristic curve(ROC) was introduced into analyzing of BNP and NT-proBNP for diagnostic efficacy of heart failure after neonatal asphyxia. Results Heart failure group whose BNP[(835.8±154.7) pg/ml vs. (235.4±38.5) pg/ml], NT-proBNP(25 903.8 pg/ml vs. 6 974.5 pg/ml), cTnT[(0.21±0.06)ng/ml vs. (0.11±0.03) ng/ml], CK-MB[(61.3±11.7) U/L vs. (40.8±9.5) U/L] were significantly higher than those of control group (P<0.05). Logistic regression analysis indicated BNP and NT-proBNP were closely related with newborn heart failure(ORBNP=3.013, P<0.001; ORNT-proBNP=3.808, P=0.006). BNP and NT-proBNP were both significantly negatively correlated with LVEF(rBNP=-0.650, P=0.007; rNT-proBNP=-0.721, P<0.001). The ROC curve indicated the diagnostic efficacy of BNP and NT-proBNP for heart failure after neonatal asphyxia were 0.868, 0.911, with the highest diagnosis cut-off value were 268.8 pg/ml, 3 972.3 pg/ml, respectively. Conclusion BNP and NT proBNP are specific indicators reflecting heart failure after neonatal asphyxia, and NT-proBNP with higher auxiliary diagnostic efficacy comparatively. Key words: Neonatal asphyxia; Heart failure; Brain natriuretic peptide; N-terminal pro-brain natriuretic peptide; Diagnostic efficacy

Diabetes mellitus and heart failure: insights from a toxic relationship

BackgroundAcute kidney injury (AKI) is one of the most common postoperative complications in noncardiac surgical patients, has an important impact on prognosis and is difficult to predict. Whether preoperative N-terminal pro-brain natriuretic peptide (NT-proBNP) concentrations and left ventricular ejection fraction (LVEF) levels can predict postoperative AKI in noncardiac surgical patients is unclear.MethodsWe included 3,314 patients who underwent noncardiac surgery and had measurements of preoperative NT-proBNP concentrations and LVEF levels at a tertiary academic hospital in China between 2008 and 2018. Multiple logistic regression analysis was used to construct a postoperative AKI risk prediction model for this cohort. Then, NT-proBNP concentrations and LVEF levels were included in the abovementioned model as independent variables, and the predictive ability of these two models was compared.ResultsPostoperative AKI occurred in 223 (6.72%) patients within 1 week after surgery. Preoperative NT-proBNP concentrations and LVEF levels were independent predictors of AKI after adjustment for clinical variables. The area under the receiver operating characteristic curve (AUROC) of the AKI risk predictive model established with clinical baseline variables was 0.767 (95% CI: 0.732, 0.802). When NT-proBNP concentrations and LVEF levels were added to the base model, the AUROC was 0.811 (95% CI: 0.779, 0.843). The addition of NT-proBNP concentrations and LVEF levels improved reclassification by 22.9% (95% CI 10.5–34.4%) for patients who developed postoperative AKI and by 36.3% (95% CI 29.5–43.9%) for those who did not, resulting in a significant overall improvement in net reclassification (NRI: 0.591, 95% CI 0.437–0.752, P < 0.000). The integral discrimination improvement was 0.100 (95% CI: 0.075, 0.125, P < 0.000).The final postoperative AKI prediction model was constructed, and had a good discriminative ability and fitted to the dataset.ConclusionsPreoperative NT-proBNP concentrations and LVEF levels were independently associated with the risk of AKI after noncardiac surgery, and they could improve the predictive ability of logistic regression models based on conventional clinical risk factors.Trial registrationThe protocol was preregistered in the Chinese Clinical Trial Registry (ChiCTR1900024056).

Background: There are currently no robust clinical markers for assessing prognosis in patients with heart failure (HF) with recovered left ventricular ejection fraction (LVEF). Hypothesis: We hypothesized that N-terminal pro-B-type natriuretic peptide (NT-proBNP) measured at the time of LVEF recovery is an independent predictor of LVEF relapse and adverse clinical outcomes in patients with HF with recovered LVEF. Methods: This retrospective cohort study (2009–2024) included 3935 patients with HF with recovered LVEF (≥50%) and available NT-proBNP data at the time of LVEF recovery. Patients were categorized into seven NT-proBNP groups, which were compared using Kaplan-Meier analysis and multivariable Cox regression to evaluate the outcome of LVEF relapse (decrease by ≥10% to &lt;50%) and the composite outcome of HF hospitalization or all-cause death. NT-proBNP was also modeled as a continuous variable using natural cubic splines. Utilization of medications constituting guideline-directed medical therapy (GDMT) was compared across NT-proBNP groups at 6 months of follow-up. Results: The median value of baseline NT-proBNP was 1341 pg/mL (IQR, 400–4207). In general, the probability of remaining free from LVEF relapse and the composite outcome decreased across NT-proBNP groups. In the fully adjusted multivariable Cox regression model, NT-proBNP was an independent predictor of both LVEF relapse and the composite outcome, with higher NT-proBNP levels associated with higher risk of both outcomes in a dose-response manner. Notably, even near-normal NT-proBNP levels (125–299 pg/mL) were associated with poorer prognosis relative to normal levels (&lt;125 pg/mL), with a 46% higher risk of LVEF relapse and 82% higher risk of the composite outcome. This relationship was consistent across age, sex, atrial fibrillation status, and renal function, but was modified by body mass index (BMI), with higher BMI associated with higher risk. NT-proBNP was even predictive of the composite outcome when patients sustained LVEF recovery and did not experience LVEF relapse. Patients with higher baseline NT-proBNP levels did not have higher utilization of GDMT medications at 6 months of follow-up, and in some cases even had lower utilization. Conclusions: NT-proBNP is an independent and robust predictor of prognosis in patients with HF with recovered LVEF, warranting routine measurement of NT-proBNP in these patients for further GDMT optimization.

Lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) appears to be involved in atherosclerotic plaque vulnerability and rupture. In this study, we aimed to evaluate the utility of serum LOX-1 levels in the diagnosis and assessment of left ventricular systolic HF and LOX-1’s relationship with serum pro-brain natriuretic peptide (NT-proBNP). This was a cross-sectional study of all eligible patients admitted to the department of cardiology of the University Hospital between July 2011 and April 2012. Fifty-five patients with a diagnosis of systolic heart failure and 25 patients without systolic HF were enrolled in this study. Serum C-reactive protein, NT-proBNP, and LOX-1 were studied. Serum LOX-1 and NT-proBNP levels were significantly higher in the heart failure group and showed a positive correlation with NT-proBNP and negative correlations with left ventricular ejection fraction (EF). In addition, LOX-1 levels in patients with ischaemic cardiomyopathy were significantly higher, while they were similar in patients with dilated cardiomyopathy compared to control subjects. Our study demonstrates the utility of the serum LOX-1 levels in the diagnosis of left ventricular systolic heart failure. LOX-1 may have a place in the diagnosis of heart failure, in particular in patients with ischaemic cardiomyopathy.

Research Highlights

There are currently no robust clinical markers for assessing prognosis in patients with heart failure (HF) with recovered left ventricular ejection fraction (LVEF). This study sought to investigate whether NT-proBNP (N-terminal pro-B-type natriuretic peptide) measured at the time of LVEF recovery is an independent predictor of prognosis among patients with HF with recovered LVEF. This retrospective cohort study (2009-2024) included 3935 patients with HF with recovered LVEF (previous LVEF of ≤40% with subsequent improvement to ≥50%) and available NT-proBNP data at the time of LVEF recovery. Patients were categorized into 7 different NT-proBNP groups, which were compared using Kaplan-Meier analysis and multivariable Cox regression to evaluate the outcome of LVEF relapse (decrease in LVEF by ≥10% to <50%) and the composite outcome of HF hospitalization or all-cause death. The median value of NT-proBNP at the time of LVEF recovery was 1341 pg/mL (interquartile range, 400-4207). The probability of remaining free from LVEF relapse and the composite outcome decreased across NT-proBNP groups. After multivariable adjustment, NT-proBNP was an independent predictor of both LVEF relapse and the composite outcome, with higher NT-proBNP levels associated with higher risk of both outcomes in a dose-response manner. Even near-normal NT-proBNP levels (125-299 pg/mL) were associated with poorer prognosis relative to normal levels (<125 pg/mL), with a 46% higher risk of LVEF relapse and 82% higher risk of the composite outcome. This relationship was consistent and similar across age, sex, atrial fibrillation status, and renal function, but was modified by body mass index, with higher body mass index associated with higher risk. Notably, NT-proBNP was predictive of the composite outcome even when patients sustained LVEF recovery without experiencing LVEF relapse. NT-proBNP is an independent and robust predictor of prognosis in patients with HF with recovered LVEF and may therefore be used to guide further optimization of pharmacotherapy.