Validation of NT-proBNP cutoff points for heart failure diagnosis in adults with CHD in the outpatient clinic and emergency department.

### A. Context of Biochemical Marker Testing in Heart Failure Biochemical marker testing has revolutionized the approach to diagnosis and management of heart failure over the past decade. There is an unsurpassed excitement in the heart failure community that significant advances in our understanding of currently available and future cardiac biomarkers will facilitate improved characterization of heart failure disease states and promote individualized therapy in heart failure and beyond. However, like most novel diagnostic tests, the promising findings from pivotal trials have met with ongoing challenges when applied in the clinical setting. The material discussed in this guidelines document addresses clinical use of BNP/NT-proBNP and cardiac troponin testing in the context of heart failure diagnosis, risk stratification and management, including therapeutic guidance in adult (>18 year-old) patients. Together with the associated document titled “ National Academy of Clinical Biochemistry and IFCC Committee for Standardization of Markers of Cardiac Damage Laboratory Medicine Practice Guidelines: Analytical Issues for Biomarkers of Heart Failure ”, …

Objective To study the effectiveness of carvedilol on serum high-sensitivity C-reactive protein (CRP),N-terminal pro-B-type brain natriuretic peptide (NT-proBNP),matrix metalloproteinases-9 (MMP-9) and cardiac function in patients with chronic heart failure.Methods Ninty patients with chronic heart failure were randomly divided into two groups,the observation group (45 cases) and the control group(45 cases).The patients in the observation group were treated with carvedilol based on the conventional treatment,while the patients in the control group were treated with metoprolol based on the conventional treatment.They were all treated for three months.LVEF,6 min walk test,serum hsCRP,NT-proBNP and MMP-9 were detected before and after treatment.Results LVEF and 6 min walk test results improved after treatment in both groups.There was significant difference between the two groups (P ＜ 0.05).Serum hs-CRP,NT-proBNP and MMP-9 decreased after treatment in both groups.There was significant difference between the two groups(P ＜0.05).Conclusions Carvedilol can improve the condition of patients with chronic heart failure through reducing the inflammatory response and extracellular matrix degradation. Key words: Chronic heart failure ; Carvedilol ; High-sensitivity C-reactive protein ; N-terminal pro-B-type brain natriuretic peptide; Matrix metalloproteinases-9

ObjectiveSoluble suppression of tumourigenicity-2 (sST2) is upregulated as response to myocardial stress and may be a potential biomarker for risk stratification in patients with adult congenital heart disease (ACHD). This...

The present research sets out to elucidate the clinical effectiveness and safety of olprinone combined with qiliqiangxin capsule in the treatment of severe pulmonary arterial hypertension complicated with right heart failure. 55 severe pulmonary arterial hypertension and right heart failure individuals admitted between April 2020 and April 2023 were selected and were assigned as control group (n=25) receiving olprinone treatment while the research group (n=30) received olprinone combined with qiliqiangxin capsules. The clinical effectiveness, safety (rash, chest pain, nausea, vomiting, dizziness, hypotension and tachycardia), echocardiography systolic pulmonary artery pressure, tricuspid annulus plane systolic excursion, right ventricular fractional area change, inferior vena cava collapse index, 6 min walking test and serum N-terminal pro-brain B-type natriuretic peptide were comparatively analyzed. The results showed an evidently higher overall effective rate and a comparable safety profile of the research group compared with the control group. The research group showed markedly reduced systolic pulmonary artery pressure and N-terminal pro-brain B-type natriuretic peptide levels, elevated tricuspid annulus plane systolic excursion, fractional area change, inferior vena cava collapse index and 6 min walking test after treatment, than the control group. Therefore, the combination of olprinone and qiliqiangxin capsule is effective and safe in the treatment of severe pulmonary arterial hypertension+right heart failure patients, which can significantly improve echocardiography results and patients’ exercise ability while exerting a significant inhibitory effect on serum N-terminal pro-brain B-type natriuretic peptide.

Assays for B-type natriuretic peptide (BNP) or N-terminal pro-brain BNP (NTproBNP) BNP are useful diagnostic method for evaluation of patients with dyspnea. And, natriuretic peptide levels have important prognostic value in heart failure. Therefore, measurements of BNP or NT-proBNP, taken together with conventional clinical assessment, may assist in the decision of treatment process. The following brief review summarizes available information concerning clinical significance of BNP or NT-proBNP.

N-terminal-pro-brain (B-type) natriuretic peptide (NT-pro-BNP) is a peptide hormone released from ventricles in response to myocyte stretch. The aim of the study was to investigate the influence of exercise training on plasma NT-pro-BNP to verify if this parameter could be used as a biological marker of left ventricular remodelling in myocardial infarction patients undergoing an exercise training programme. Forty-four patients after myocardial infarction were enrolled into a cardiac rehabilitation programme, and were randomized in two groups of 22 patients each. Group A patients followed a 3-month exercise training programme, while group B patients received only routine recommendations. All patients underwent NT-pro-BNP assay, and cardiopulmonary exercise test before hospital discharge and after 3 months. In Group A, exercise training reduced NT-pro-BNP levels (from 1498+/-438 to 470+/-375 pg/ml, P=0.0026), increased maximal (VO2peak+4.3+/-2.9 ml/kg per min, P<0.001; Powermax+38+/-7, P<0.001) exercise parameters and work efficiency (Powermax/VO2peak+1.3+/-0.4 Power/ml per kg per min, P<0.001); there was also an inverse correlation between changes in NT-pro-BNP levels and in VO2peak (r=-0.72, P<0.001), E-wave (r=-0.51, P<0.001) and E/A ratio (r=0.59, P<0.001). In group B, at 3 months, no changes were observed in NT-pro-BNP levels, exercise and echocardiographic parameters. Three months exercise training in patients with moderate left ventricular systolic dysfunction after myocardial infarction induced a reduction in NT-pro-BNP levels, an improvement of exercise capacity and early left ventricular diastolic filling, without negative left ventricular remodelling. Whether the reduction of NT-pro-BNP levels could be useful as a surrogate marker of favourable left ventricular remodelling at a later follow-up remains to be further explored.

Objective Experimental studies indicated a contribution of the essential amino acids kynurenine and quinolinic acid to cardiovascular disease. We therefore investigated the associations between their serum concentrations and surrogates of hypertensive target organ damage in a cohort of hypertensive patients. Design and method Cross-sectional data from 514 hypertensive participants of the Styrian Hypertension Study were analyzed who had been enrolled at a single tertiary care hospital. Serum concentrations of kynurenine and quinolinic acid were correlated with N-terminal pro-brain B-type natriuretic peptide (NT-proBNP) and 24-hours urinary protein-to-creatinine-ratio (PCR) in multivariate linear regression analyses. Results Mean age was 61.2 +/− 10.5 years (52.5% females) and mean 24-hours ambulatory blood pressure was 127.5/76.4 +/− 13.8/9.5 mmHg. Medians and interquartile ranges of NT-proBNP and PCR were 82 (42–152) pg/ml and 67.5 (52–93.4) mg/mmol creatinine, respectively. Both kynurenine and quinolinic acid were significanty related with NT-proBNP and PCR in univariate analyses. After adjustment for age, sex, systolic nighttime blood pressure, estimated glomerular filtration rate, body mass index, C-reactive protein, concomitant blood pressure and heart failure medication and other traditional cardiovascular risk factors, quinolinic acid was significantly related with NT-proBNP (adjusted beta-coefficient = 0.133, P = 0.003) and PCR (beta = 0.216, P < 0.001), while kynurenine was not. Restricting these analyses to patients with NT-proBNP > 125 pg/ml (n = 171), both amino acids were independently related with NT-proBNP (quinolinic acid: beta = 0.249, P = 0.027; kynurenine: beta = 0.207, P = 0.027). Conclusions Serum concentrations of quinolinic acid and, to a less extent, kynurenine determine hypertensive target organ damage independently of potentially confounding factors. These clinical data extend previous experimental studies indicating that quinolinic acid and kynurenine may mediate target organ damage in patients with arterial hypertension.

Objective To study the effectiveness of Shenmai injection combined with creatine phosphate injection on high sensitivity C-reactive protein(hs-CRP) and N-terminal pro-B-type brain natriuretic peptide(NT-proBNP) in children with viral myocarditis.Methods Sixty-two children with viral myocarditis were randomly divided into two groups,the control group(31 cases) and the observation group (31 cases).The children in the control group were treated by the conventional treatment,while the children in the observation group were treated with Shenmai injection combined with creatine phosphate injection on the basis of conventional treatment.They were treated for 14 days.Serum hs-CRP and NT-proBNP were detected before and after treatment.Results The total efficient rate was 96.8％ in the observation group and 83.9％ in the control group.There was significant difference between the two groups(P ＜0.05).Serum hs-CRP and NT-proBNP decreased after treatment,and in the observation group were lower than those in the control group(P ＜0.05).Conclusions Shenmai injection combined with creatine phosphate injection can decrease hs-CRP and NT-proBNP in children with viral myocarditis. Key words: Viral myocarditis; Shenmai injection plus; Creatine phosphate; High sensitivity C-reactive; N-terminal pro-B-type brain natriuretic peptide

Risk of Heart Failure in Congenital Heart Disease: A Nationwide Register-Based Cohort Study.

The aim of the study was to assess the prognostic value of determining the plasma concentration of NT-proBNP and ST2 in the patients with decompensated HF and prior acute myocardial infarction and their combination in this category of patients. Materials and methods. There were examined 120 patients with acute myocardial infarction and stage II A-B decompensated chronic HF according to the classification proposed by Vasylenko V. Kh. and Strazhesko M.D., NYHA functional class (FC) III-IV. The patients with Q-QS wave MI (60 individuals) and non Q MI (60 individuals) were divided into 4 groups depending on the treatment methods. Study groups were homogenous by age, gender, disease severity, duration of the post-infarction period, clinical signs of decompensation, which served as a basis for inclusion of the patients in the study. All the patients underwent the six-minute walk test in a quiet 30-50-m long hospital corridor in the morning. N-terminal pro-B-type brain natriuretic peptide (NT-proBNP) and ST-2 were analyzed in all patients. Results. Promising biomarkers of HF decompensation in the post-infarction period were studied. In the patients with prior Q-QS MI and decompensated HF, NT-proBNP level was (950.38±3.15) pmol/l (p&lt;0.05); in the patients with prior MI without signs of decompensated HF, it was (580.15±3.03) pmol/l (p˂0.05); in apparently healthy individuals, the level of NT-proBNP was found to be (111.20±3.47) pmol/l. ST2 level was (14.80±1.61) ng/ml, (36.00±1.43) ng/ml and (49.22±1.40) ng/ml in the patients of Group 1, Group 2 and Group 3, respectively (p˂0.05). Similar changes were found in patients with decompensated HF in postinfarction period after non Q MI. Conclusions. The increase in plasma concentration of sST2 is associated with the activation of both neurohumoral and fibrous pathways and can help in detecting the patients with decompensated HF in the post-infarction period and predicting the risk of its development. Our results confirmed the results of other multiple studies reporting ST2 in combination with NT-proBNP to be valuable tools for prognosing the development of decompensated HF in the patients with prior MI. ST2, alongside with NT-proBNP, is a promising biomarker to be included in the diagnostic panel for detecting acute HF and can provide additional information on risk stratification for such patients during hospitalization and at the time of discharge from the hospital.

The population of adults with congenital heart disease (ACHD) has increased dramatically over the past few decades, with many people who are now middle-aged and some in the geriatric age range. This improved longevity is leading to increased use of the medical system for both routine and episodic care, and caregivers need to be prepared to diagnose, follow up, and treat the older adult with congenital heart disease (CHD). The predictable natural progression of CHD entities and sequelae of previous interventions must now be treated in the setting of late complications, acquired cardiac disease, multiorgan effects of lifelong processes, and the unrelenting process of aging. Despite the advances in this field, death rates in the population from 20 to >70 years of age may be twice to 7 times higher for the ACHD population than for their peers.1 This American Heart Association (AHA) scientific statement will focus on the older adult (>40 years old) with CHD. It is meant to be complementary to the 2008 American College of Cardiology (ACC)/AHA guidelines for ACHD and orient the reader to the natural history, ramifications of childhood repair, and late initial diagnosis of CHD in the older adult. This population with CHD is unique and distinct from both the pediatric and young adult populations with CHD. Much of the information we provide is from scientific research combined with clinical experience from longitudinal care. We emphasize that this is the beginning of a discussion regarding this rapidly growing population, and continued research aimed at the progression of disease and complications reviewed here is necessary to advance the field of ACHD with the scientific rigor it deserves. ACHD encompass a broad range of presentations. There are people who are diagnosed for the first time in adulthood, as well as those with prior palliative repair …

Erratum

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.

N-Terminal Pro-Brain Natriuretic Peptide: A Powerful Biomarker of Cardiac Disease

There are limited data about the role of guideline-directed medical therapy (GDMT) in adults with congenital heart disease presenting with heart failure with reduced ejection fraction. This study aimed to assess the effect of GDMT on cardiac function, congestion, and mortality in adults with congenital heart disease presenting with heart failure with reduced ejection fraction. We hypothesized that GDMT uptitration was associated with improved cardiac function, less congestion, and lower mortality. GDMT score, left ventricular ejection fraction (LVEF), and N-terminal pro-b-type brain natriuretic peptide (NT-proBNP) levels were assessed at baseline encounter (baseline GDMT score) and 1-year follow-up. Delta (Δ) GDMT was calculated as GDMT at 1 year minus GDMT at baseline. GDMT uptitration was defined as ΔGDMT score > 0. Of 327 patients (age 46 ± 16 years; LVEF 31 ± 6%), the baseline GDMT score was 2 (1,3), and 135 (41%) had GDMT uptitration. Although patients with GDMT uptitration had similar LVEF and NT-proBNP levels at baseline encounter compared to patients without GDMT uptitration, the GDMT uptitration group had greater temporal improvement in LVEF (relative ΔLVEF 32 ± 12% vs 15 ± 7%; P < 0.001), reduction in NT-proBNP levels (relative ΔNT-proBNP -39 ± 15% vs -21 ± 19%; P < 0.001), and a lower 10-year incidence of death/transplant (38% vs 59%; P = 0.002). Higher ΔGDMT score (adjusted HR: 0.68 [95% CI: 0.54-0.83]; P < 0.001) and ΔLVEF (adjusted HR: 0.79 [95% CI: 0.65-0.96], P = 0.002) were associated with a lower risk of death/transplant. GDMT uptitration was associated with improved cardiac function, less congestion, and a lower incidence of death/transplant. Overall GDMT score was low, and only 41% of patients had GDMT uptitration, suggesting suboptimal therapy and need for optimization of heart failure therapy in this population.