BNP Concentrations Research Articles

Association between BNP and all-cause mortality in critically ill children: a cohort study.

There is evidence that a high level of BNP is associated with poorer outcomes in patients with cardiac diseases, but few data are available concerning BNP and all-cause mortality in pediatric population. Using the 2010-2018 pediatric intensive care database, we conducted a retrospective study on patients aged 28 days to 18 years, analyzing post-admission BNP measurements. Through two-piecewise regression to identify inflection points, and multivariable logistic regression, we investigated BNP's association with all-cause mortality. We also developed a multivariable-adjusted restricted cubic spline model to explore BNP's non-linear correlation with mortality. In a study of 3220 patients, the overall all-cause mortality rate was 6.7%, with rates across BNP quartiles (Q1-Q4) significantly differing, highlighting a notable increase in mortality at higher BNP levels (P < 0.001). Specifically, patients with BNP ≥ 10,170 pg/ml had an adjusted mortality odds ratio (OR) of 2.017 (95% CI 1.265-3.217; P = 0.0032). Analysis confirmed a non-linear relationship between BNP levels and mortality, with log2 BNP associated with increased risk (OR1.28, 95% CI 1.19-1.38; P < 0.001). Subgroup analyses further revealed that very high BNP levels, especially in infants, with lactate ≥2.0 mmol/L, or CKMB ≥ 45 μ/L. BNP level was associated with all-cause mortality, especially for the patients with BNP ≥ 10,170 pg/ml. This study explored the non-linear association between BNP levels and all-cause mortality in the PICU, finding a significant association among patients with BNP levels above 10,170 pg/ml. The study revealed that higher BNP levels are associated with increased mortality in critically ill children, including those with non-cardiac diseases. This research provides new data on a Southern Chinese population, previously unstudied, enriching the existing body of knowledge. While most studies have focused on adult cardiac patients, this research highlights the importance of BNP as a prognostic tool in the PICU, including non-cardiac cases, adding to the literature. This study furnishes novel clinical evidence supporting the monitoring of BNP concentrations within the PICU, aiding in prognostic predictions and the development of tailored treatment plans for patients.

Heart failure biomarkers and prediction of early left ventricle remodeling after acute coronary syndromes

IntroductionSeveral biomarkers are characteristically elevated in patients with acute heart failure (AHF). Our hypothesis was they could predict early changes in left ventricular (LV) characteristics in acute coronary syndrome (ACS) patients. The objective of this study was two-fold: a) compare circulating concentrations of NT-pro BNP, CA-125, ST2, galectin-3 and pro-adrenomedullin among 4 groups of individuals (healthy controls; patients with ACS without AHF; patients with ACS and AHF and patients admitted for AHF); and b) evaluate whether these biomarkers predict adverse LV remodeling and ejection fraction changes in ACS. Methods6 biomarkers (NT-pro BNP, CA-125, ST2, galectin-3, pro-adrenomedullin and C-reactive) were measured within the first 48 h of admission. Echocardiograms were performed during admission and at 3 months. Variables associated with LV end-diastolic volume (EDV) and ejection fraction (LVEF) change were assessed by multivariate linear regression. ResultsWe analyzed 51 patients with ACS, 16 with AHF and, 20 healthy controls. NT-pro BNP and ST2 concentrations were elevated at similar values in patients admitted for AHF and ACS complicated with HF but CA-125 concentrations were higher in AHF patients. NT-pro BNP concentrations were positively correlated with CA-125 (rho = 0.58; p < 0.001), ST2 (rho = 0.58; p < 0.001) and galectin-3 (rho = 0.37; p < 0.001)Median change (median days was 83 days after) in EDV and LVEF was 5 %. CA-125 concentrations were positively associated to LV EDV change (β-coefficient 1.56) and negatively with LVEF trend (β-coefficient = −0.86). No other biomarker predicted changes in EDV or LVEF. ConclusionsCA-125 correlates with early LV remodeling and LVEF deterioration in ACS patients.

Plasma concentrations of peptide hormones: Unrealistic levels of vasopressin (AVP), oxytocin (OXT), and brain natriuretic peptide (BNP).

Hormones are specific molecules measured in biological fluids by elaborate analytical systems requiring meticulous attention. Variation between laboratories can be expected. However, recently published measurements of AVP, OXT, and BNP in human plasma under basal/control conditions include numbers which, between publications, vary by 100-10 000-fold. Generally, the methods descriptions are scant, at best, and provide no information about quality control measures. Clearly, two results describing the same basal hormone concentration by numbers three orders of magnitude apart are incongruent providing reason for concern. Basal concentrations of bioactive AVP, OXT, and BNP in human plasma are in the order of 1-10 pmol/L. Therefore, assay systems applied to plasma must be able to measure concentrations of less than 1 pmol/L with appropriate specificity and accuracy. Basal concentrations of AVP, OXT, and BNP above 100 pmol/L should be reconsidered, as such results do not reflect bioactive hormone levels in humans, rats, or mice. Any concentration above 1000 pmol/L is of concern because such levels of bioactive hormone may be seen only under extreme conditions, if at all.

The Effects of Different Blood Sample and Anticoagulant Types on Quantitative Tests of B-Type Natriuretic Peptide.

BNP is a sensitive and widely used biomarker for an early diagnosis of heart failure. Currently, most commercial BNP detection products use EDTA plasma samples. The aim of this study was to evaluate the clinical performance of the BNP test by using whole blood samples compared to plasma samples, and to evaluate the effect of the anticoagulant type on the BNP test result. In total, 106 patients with different BNP levels from the Dahua Hospital volunteered for this study. Clinically homogenous samples, including EDTA anticoagulant plasma, EDTA whole blood, and heparin anticoagulant plasma, were collected and analyzed by using i-Reader S automatic immuno-analyzer and its supporting reagent kits. Pearson's correlation and weighted least squares linear regression analysis, Bland-Altman plotting, and Kappa test were used for statistical analysis. Correlation analysis showed that BNP concentrations, measured from EDTA anticoagulated plasma samples, had a good linear regression relationship with BNP from whole blood samples, with a slope of 0.9477, r = 0.9978, p < 0.05. A similar correlation was observed between EDTA anticoagulated plasma samples and heparin anticoagulant plasma, with a slope of 0.8413, r = 0.9793, p < 0.05. The BNP concentration measured from the heparin plasma samples were lower than of the EDTA plasma samples. Bland-Altman analysis for assessing BNP concentration agreement showed there was no outlier ratio between EDTA whole blood and EDTA plasma within the range of the detection system, as well as no outlier between EDTA anticoagulated and heparin anticoagulant plasma. Kappa coefficient of BNP concentration between homologous EDTA anticoagulated and heparin anticoagulant plasma was 0.8553 (p < 0.001), and for EDTA anticoagulated plasma and homologous whole blood it was 0.8941 (p < 0.001). The diagnostic performance of EDTA anticoagulated whole blood samples did not differ significantly from EDTA anticoagulated plasma samples for the BNP test. This study showed no big significant difference between EDTA anticoagulated and heparin anticoagulated plasma measurements within 2 hours. The type of anticoagulant should be carefully chosen when performing the BNP test if BNP samples were in vitro for a long time.

Frequency, characteristics and risk assessment of pulmonary arterial hypertension with a left heart disease phenotype.

To obtain real-world evidence about the features and risk stratification of pulmonary arterial hypertension (PAH) with a left heart disease (LHD) phenotype (PAH-LHD). By reviewing the records of consecutive incident PAH patients at 7 tertiary centers from 2001 to 2021, we selected 286 subjects with all parameters needed to determine risk of death at baseline and at first follow-up with COMPERA and COMPERA 2.0 scores. Fifty seven (20%) had PAH-LHD according to the AMBITION definition. Compared with no-LHD ones, they were older, had higher BMI, more cardiovascular comorbidities, higher E/e' ratio and left atrial area, but lower BNP concentrations and better right ventricular function and pulmonary hemodynamics. Survival was comparable between PAH-LHD and no-LHD patients, although the former were less commonly treated with dual PAH therapy. Both COMPERA and COMPERA 2.0 discriminated all-cause mortality risk of PAH-LHD at follow-up, but not at baseline. Risk profile significantly improved during follow-up only when assessed by COMPERA 2.0. At multivariable analysis with low-risk status as reference, intermediate-high and high-risk, but not LHD phenotype, were associated with higher hazard of all-cause mortality. Results were comparable in secondary analyses including patients in the last 10years and atrial fibrillation and echocardiographic abnormalities as additional criteria for PAH-LHD. In real life, PAH-LHD patients are frequent, have less severe disease and are less likely treated with PAH drug combinations than no-LHD. TheCOMPERA 2.0 model may be more appropriate to evaluate their mortality risk during follow-up and how it is modulated by therapy.

Efficacy and safety of stem cell therapy in patients with dilated cardiomyopathy: An umbrella review of systematic reviews.

Stem cell therapy (SCT) has emerged as a potential therapeutic avenue, with various cell types being explored for their efficacy in treating DCM. However, the safety and efficacy of these therapies have been the subject of numerous systematic reviews. This umbrella review aims to consolidate the existing evidence on stem cell interventions for DCM, providing a comprehensive overview of the current research landscape. This review was conducted following the JBI and PRISMA guidelines. Systematic reviews and meta-analyses of randomized controlled trials (RCTs) evaluating the safety and efficacy of SCT for DCM were included. Outcomes such as 6MWT, LVEDD, LVEF, MACE, NYHA, and QoL, among others, were considered. A literature search was executed across databases like PubMed, Embase, Web of Science, and Cochrane Database up to October 07, 2023. The quality of the included reviews was assessed using the JBI Checklist for Systematic Reviews and Research Syntheses. Data synthesis was carried out in both narrative and tabular formats, with the GRADE criteria guiding the determination of evidence certainty. Nine systematic reviews met the inclusion criteria. LVEF found to be significantly improved with SCT. LVEDD and LVEDV assessments yielded mixed results, with some reviews observing significant changes. LVESV showed consistent reductions across multiple studies. BNP concentrations post-interventions were explored in several studies, with mixed findings. Health-related quality of life (HRQL) showed varied results, with some studies noting improvements and others finding no significant differences. NYHA classifications and 6-MWT results indicated potential benefits from stem cell treatments. SCT was observed to be generally safe. The certainty of evidence was low or very low for most of outcomes. SCT showed has shown promise in treating DCM, with many studies highlighting its safety and potential benefits. Nonetheless, the existing data has its limitations due to biases in the RCTs studies. To truly establish the benefits of SCT for DCM, future high quality RCTS, are crucial.

The Early Detection of Pulmonary Hypertension.

Up to 1% of the world population and 10% of all persons over age 65 suffer from pulmonary hypertension (PH). The latency from the first symptom to the diagnosis is more than one year on average, and more than three years in 20% of patients. 40% seek help from more than four different physicians until their condition is finally diagnosed. This review is based on publications retrieved by a selective literature search on pulmonary hypertension. The most common causes of pulmonary hypertension are left heart diseases and lung diseases. Its cardinal symptom is exertional dyspnea that worsens as the disease progresses. Additional symptoms of right heart failure are seen in advanced stages. Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) are rare, difficult to diagnose, and of particular clinical relevance because specific treatments are available. For this reason, strategies for the early detection of PAH and CTEPH have been developed. The clinical suspicion of PH arises in a patient who has nonspecific symptoms, electrocardiographic changes, and an abnormal (NT-pro-)BNP concentration. Once the suspicion of PH has been confirmed by echocardiography and, if necessary, differential-diagnostic evaluation with a cardiopulmonary stress test, and after the exclusion of a primary left heart disease or lung disease, the patient should be referred to a PH center for further diagnostic assessment, classification, and treatment. If both the (NT-pro-)BNP and the ECG are normal, PH is unlikely. Knowledge of the characteristic clinical manifestations and test results of PH is needed so that patients can be properly selected for referral to specialists and experts in PH.

A-003 Point of Care BNP Values Obtained by the Abbott i-STAT are not Interchangeable With Laboratory Determined Values Using Beckman DXI 800 Analyzer

Abstract Background B-type natriuretic peptide (BNP) is used as a biomarker of heart failure. In our hospital, point of care (POCT) BNP test is performed on whole blood using the i-STAT (Abbott, Abbott Park, IL) while in clinical laboratory, the DXI 800 analyzer is used (Beckman, Brea, CA) for determination of BNP in EDTA plasma. Sometimes clinicians interchangeably use POCT BNP with laboratory BNP test for monitoring heart failure patients, but values are sometimes significantly different causing diagnostic confusion. We compared POCT BNP values in 88 patients with laboratory-based BNP values analyzed between less than one hour to less than 12 h. In addition, 12 specimens were simultaneously analyzed for POCT BNP and lab-based BNP. No additional blood was drawn from patients and medical record was not accessed. The study had exempt status: by the IRB of University of Kansas Medical Center. Methods POCT BNP values were obtained using the i-STAT analyzer following manufacturer’s protocol. It is a two-site enzyme-linked immunosorbent assay (ELISA) with an analytical measurement range of 15–5000 pg/mL. In the laboratory BNP concentrations were obtained using the DXI 800 analyzer. It is also a sandwich immunoassay with the analytical measurement range of 5–5000 pg/mL. Results Overall comparison using lab-based BNP as x-axis and POCT BNP as y-axis produced the following regression equation; y = 1.48 x − 23.45 (n = 88, r = 0.96) indicating that although POCT BNP values correlated well with lab-based BNP values, POCT values showed an average 48% positive bias. When specimens analyzed within 4 h were compared, the regression equation was: y = 1.40 x + 74.12 (n = 20, r = 91) and when specimens analyzed within 1 h were compared, the regression equation was: y = 1.56 + 59.0 (n = 23, r = 0.97). In contrast, when 12 specimens were analyzed simultaneously using POCT and lab-based BNP, using x-axis as the lab-based BNP and y-axis as the POCT BNP, the following regression equation was observed: y = 1.83 x − 102.8 (n = 12, r = 0.99). Conclusion Higher positive bias in specimens analyzed simultaneously indicates true positive bias with POCT BNP compared to lab-based BNP because lab-based BNP in real patients were ordered later after POCT BNP. To our knowledge i-STAT BNP values were never compared with DXI 800 BNP values. We communicated with our clinicians not to use lab-based BNP test and POCT BNP in monitoring patients being treated for heart failure interchangeably. POCT BNP can be used for initial screening to identify potential patients with heart failure.

A new approach to the interpretation of B-type natriuretic peptide concentration in children with congenital heart disease

Abstract Objectives BNP is the unique cardiac marker that reflects not as much as the degree of heart muscle damage, but mostly the severity of hemodynamic disorder, which is important in congenital heart disease. The only disadvantage of this marker is the barely studied reference values for children. It is known that the younger the child is, the higher the BNP value will be. By shifting from interpreting the absolute values towards the application of zlog-transformed data in clinical practice, we can overcome the above problems. Methods We performed an age-adjusted zlog transformation of BNP concentration. The age dependence was accounted for by a piecewise linear interpolation of the logarithms of BNP concentration among healthy children in different age groups from the logarithms of age. Results The concentration of BNP was measured in 351 patients (under 1 year old) with various heart diseases. The median age at the time of testing was 52 days [10; 166]; the median weight was 4.1 kg [3.2; 6.2]. The conditions we investigated included almost all known congenital heart diseases, as well as primary cardiac tumors. After the zlog transformation, we eliminated age-dependence, which was proved by comparing BNP concentrations in two groups of patients with univentricular and biventricular hemodynamics. Conclusions BNP in patients with congenital heart disease reflects the severity of hemodynamic disorders, and zlogBNP is an objective, age-independent and clear mechanism that can be used to interpret this cardiac marker.

EDTA plasma in glass and PET tubes is suitable for measurement of B-type natriuretic peptide on the Mindray CL-6000i.

To explore differences in BNP concentration and stability and evaluate BNP accuracy in different collection tubes. BNP concentrations in heparin/glass, EDTA/glass, and EDTA/ PET tubes were measured on the Mindray CL-6000i at 0.5, 1, 2, and 4 h after collection. Differences were evaluated using Wilcoxon's paired tests and Bland-Altman plots. BNP stability and measurement accuracies were estimated using Kruskal-Wallis H tests and recovery tests. BNP concentrations in EDTA/glass tubes were 31.4% higher than those in heparin/glass tubes and 3.04% lower than those in EDTA/PET tubes. BNP stability significantly decreased in the heparin/glass tube. BNP remained stable in EDTA/glass and EDTA/PET tubes at room temperature for 4 h. BNP recovery rates in heparin/glass, EDTA/glass, and EDTA/PET tubes were 77.46, 86.04, and 88.23%, respectively. Plasma in EDTA/glass and EDTA/PET tubes is suitable for BNP measurement on the Mindray CL-6000i.

Biomarker Phenotypes in Heart Failure with Preserved Ejection Fraction Using Hierarchical Clustering: A Pilot Study

Objectives: We hypothesized the existence of distinct phenotype-based groups within the very heterogeneous population of patients of heart failure with preserved ejection fraction (HFpEF) and using an unsupervised hierarchical clustering applied to plasma concentration of various biomarkers. We sought to characterize them as “biomarker phenotypes” and to conclude differences in their overall characteristics. Subjects and Methods: A cross-sectional study was conducted on 75 patients with HFpEF. An agglomerative hierarchical clustering was performed using the concentrations of cardiac remodeling biomarkers, BNP, and cystatin C. Results: According to the obtained heat map of this analysis, we concluded two distinctive biomarker phenotypes within the HFpEF. The “remodeled phenotype” presented with significantly higher concentrations of cardiac remodeling biomarkers and cystatin C (p < 0.001), higher prevalence of myocardial infarction (p = 0.047), STEMI (p = 0.045), atrial fibrillation (p = 0.047), and anemia: lower erythrocytes count (p = 0.037), hemoglobin concentration (p = 0.034), and hematocrit (p = 0.046), compared to “non-remodeled phenotype.” Echocardiography showed that patients within “remodeled phenotype” had significantly increased parameters of left ventricular remodeling: left ventricular mass index (p < 0.001), left ventricular mass (p = 0.001), diameters of the interventricular septum (p = 0.027), posterior wall (p = 0.003), and function alterations, intermediate pauses duration >2.0 s (p < 0.006). Conclusion: Unsupervised hierarchical clustering applied to plasma concentration of various biomarkers in patients with HFpEF enables the identification of two biomarker phenotypes, significantly different in clinical characteristics and cardiac structure and function, whereas one phenotype particularly relates to patients with reduced ejection fraction. These findings imply distinct underlying pathophysiology within a unique cohort of HFpEF.

Abstract 13130: Impact of Midregional N-Terminal Pro-Atrial Natriuretic Peptide, Soluble Suppression of Tumorigenicity 2 and Brain Natriuretic Peptide Levels on Heart Rhythm in Persistent Atrial Fibrillation Treated by Electrical Cardioversion: The Biorhythm 2 Study

Introduction: We assessed the impact of plasma levels of MRproANP, sST2 and BNP on the maintenance of sinus rhythm at one year after a successful electrical cardioversion of atrial fibrillation. Methods: Prospective, multicenter, observational study including patients undergoing electrical cardioversion of persistent AF. MRproANP, sST2 and BNP were measured in peripheral venous blood before cardioversion. Primary endpoint was recurrent AF detected during the 12 month follow-up, defined as ECG showing AF, or any AF episode lasting &gt;30 seconds on 24 hour Holter monitoring. Results: We included 61 patients from 12/2017 to 03/2019. Average was 67.4±7.8 years, 46 were males (75.4%). Sinus rhythm was restored in 51 patients (83.6%). In these 51 patients, plasma concentrations of MRproANP were significantly higher among patients with recurrent AF at 12 months than among those in sinus rhythm (314.45 [210.90-342.50] vs 214.50 [138.97-264.72] pmol/L, p&lt;0.01). There was no difference between groups in terms of sST2 and BNP concentrations. ROC curve analysis identified an MRproANP threshold of 311.5pmol/L as having the best predictive value for recurrent AF at 12 months. By multivariable analysis, MRproANP &gt;311.5 pmol/L was found to be the sole predictor of AF recurrence (odds ratio 13.57; 95% CI, 2.01-91.54), and identified subjects at very high risk of recurrence (positive predictive value=83.3%). Conclusion: Elevated MRproANP level independently predicts recurrent AF, whereas sST2 and BNP levels do not appear to have any prognostic value in assessing the risk of recurrence of AF at one year after successful electrical cardioversion.

Different Protein Sources Enhance 18FDG-PET/MR Uptake of Brown Adipocytes in Male Subjects.

Background: The unique ability of brown adipocytes to increase metabolic rate suggests that they could be targeted as an obesity treatment. Objective: The objective of the study was to search for new dietary factors that may enhance brown adipose tissue (BAT) activity. Methods: The study group comprised 28 healthy non-smoking males, aged 21–42 years old. All volunteers underwent a physical examination and a 75 g oral glucose tolerance test (75g-OGTT). Serum atrial and brain natriuretic peptide (ANP, BNP), PRD1-BF1-RIZ1 homologous domain containing 16 (PRDM16) and eukaryotic translation initiation factor 4E (eIF4E) measurements were taken, and 3-day food intake diaries were completed. Body composition measurements were assessed using dual-energy X-ray absorptiometry (DXA) scanning and bioimpedance methods. An fluorodeoxyglucose-18 (FDG-18) uptake in BAT was assessed by positron emission tomography/magnetic resonance (PET/MR) in all participants after 2 h cold exposure. The results were adjusted for age, daily energy intake, and DXA lean mass. Results: Subjects with detectable BAT (BAT(+)) were characterized by a higher percentage of energy obtained from dietary protein and fat and higher muscle mass (p = 0.01, p = 0.02 and p = 0.04, respectively). In the BAT(+) group, animal protein intake was positively associated (p= 0.04), whereas the plant protein intake negatively correlated with BAT activity (p = 0.03). Additionally, the presence of BAT was inversely associated with BNP concentration in the 2 h of cold exposure (p = 0.002). Conclusion: The outcomes of our study suggest that different macronutrient consumption may be a new way to modulate BAT activity leading to weight reduction.

Abstract P2042: Down-regulation Of Microrna-16 Improved Selenium Deficiency-induced Cardiac Dysfunction In Rats Through Wnt/β-catenin Signaling

Objective: To investigate the mechanisms and effects of down-regulation of microRNA-16 in selenium deficiency-induced cardiac dysfunction in rats. Methods: Selenium deficiency was induced by low selenium diet. Injection of AAV9-carried microRNA-16 interference was used to down-regulate microRNA-16. Cardiac functions were evaluated by echocardiography and serum BNP concentrations. The expression of microRNA-16 was examined by RT-PCR. Expression levels of wnt, β-catenin, c-myc and caspase-3 were evaluated by Western blotting. Results: Down-regulation of microRNA-16 in rats with selenium deficiency significantly improved cardiac functions. Meanwhile, the down-regulation of microRNA-16 reduced the expression of wnt1, β-catenin and TCF in the Wnt/β-catenin signaling pathway, and the expression of c-myc and caspase-3 were also decreased. Conclusions: The down-regulation of microRNA-16 can improve the cardiac function of rats with selenium deficiency via the inactivation of Wnt/β-catenin signaling pathway.

Application of DSM–BIA in dry weight assessment in continuous ambulatory peritoneal dialysis

ObjectivesDry weight assessment (DWA) is an important part of dialysis and fluid management in patients receiving renal replacement therapy. With the development of bioimpedance analysis (BIA), the development of the direct segmental multi-frequency BIA (DSM–BIA) has provided a more convenient measure for DWA of dialysis patients, but its accuracy remains unclear. This study was designed to evaluate the application of DSM–BIA in DWA of continuous ambulatory peritoneal dialysis (CAPD) patients.DesignThis is a cross-sectional study. Using the conventional BIA as a reference, we examined the accuracy of the DSM–BIA technique for assessing dry weight in CAPD patients and analyzed the potential factors influencing their fluid volume status.Setting and participantsA total of 31 patients with end-stage renal disease receiving CAPD and 310 healthy volunteers were recruited for this study.MethodsThe intraclass correlation coefficients (ICC) and Bland–Altman plots were used to assess the consistency between DSM–BIA and the conventional BIA for DWA. Univariate and multivariate linear regression analyses were used to explore the influencing factors associated with the edema index.ResultsDSM–BIA and the conventional BIA technology were consistent in DWA in CAPD patients (ICC female 0.972, ICC male 0.882, ICC total 0.960). Similarly, Bland–Altman plots showed good agreements between the two methods in DWA for both genders. Univariate and multivariate linear regression analysis showed both eGFR level (P = 0.04) and serum NT-pro BNP concentration (P = 0.007) were positively correlated with the ratio of extracellular water to total body water (ECW/TCW).ConclusionsDSM–BIA in DWA has good accuracy in clinical applications and has potential application value for fluid volume management in CAPD patients.

Plasma Brain Natriuretic Peptide Levels in Children with Chronic Kidney Disease and Renal Transplant Recipients: A Single Center Study.

Pediatric chronic kidney disease (CKD) patients, as well as kidney transplant patients, are at an increased risk of developing cardiovascular disease. BNP measurement, as a biomarker of cardiovascular risk, has been recommended to this high-risk population. Plasma BNP levels were measured in 56 CKD children in either pre-dialysis stage, hemodialysis (HD) or renal transplant recipients (RTRs) and in 76 sex- and age-matched healthy controls. BNP levels were investigated in HD children, before and after the completion of their HD session. BNP levels in total CKD population, in pre-dialysis stage patients and on HD were significantly higher, compared to the respective controls. HD children had higher BNP levels compared to CKD patients in the pre-dialysis stage. Moreover, post-HD BNP concentration was slightly higher than pre-HD, with the difference being marginally statistically significant. BNP was positively correlated with eGFR, creatinine, cystatin-C and parathormone and negatively with albumin and 25-hydroxyvitamin D. A positive correlation between BNP concentration and the ratio of E/A in pulse-wave Doppler echocardiography was also observed. In conclusion, CKD pediatric patients, mainly those undergoing HD, have high plasma BNP levels which do not decrease after the HD session. This is indicative of a greater risk for future cardiovascular disease.

C - reactive protein is a promising indicator of ventricular arrhythmias in pacemaker patients

Abstract Funding Acknowledgements Type of funding sources: None. Background Ventricular tachyarrhythmias are the main reason for sudden cardiac death to date. Accordingly, tools for risk stratification for ventricular arrhythmias are paramount. Non-sustained ventricular tachycardia (nsVT) represents a predictor of malignant rhythm disorders. Recently, low grade chronic inflammation was shown to predict ventricular arrhythmic events in high risk patients. This study aims to investigate, if inflammatory markers may predict higher arrhythmia burden in a low risk population. Methods We prospectively analyzed ventricular arrhythmia burden in pacemaker records of 166 patients (age 79.2 9.3; male 60.2%, 38 with coronary artery disease (CAD)) with preserved ejection fraction (left ventricular ejection fraction≥50%) during a annually pacemaker follow up in a single center. To evaluate potential predictive factors, associations of laboratory values including inflammatory markers (CRP and interleukin 6) with occurrence of nsVT was evaluated using logistic regression. Sensitivity analysis in patients with and without established CAD was performed. Results The cumulative incidence of nsVT was 12.7%. Concentrations of BNP (OR 1.00 95%CI 0.99-1.01; p=0.46), troponin (OR 0.98 95%CI 0.95-1.02; p=0.43) or interleukin-6 (OR 1.03 95%CI 0.99-1.07; p=0.16) were not associated with the occurrence of nsVTs. However, the concentration of CRP was associated with increased odds of nsVT (OR 1.26 95%CI 0.97-1.64; p=0.09) in trend. In sensitivity analysis in CAD patients, CRP was associated with increased likelihood of nsVT (OR 3.89 95%CI 1.14-13.29; p=0.03), whereas in patients without CAD there was no association between CRP and rates of nsVTs (OR 1.16 95%CI 0.88-1.54; p=0.30). Conclusion Our study shows that inflammatory markers like CRP may be promising predictors of rhythm disorders CAD patients. While CRP was associated with increased odds for nsVTs in pacemaker patients with CAD, IL-6 did not show a significant correlation. This might be based on a more volatile expression of IL-6 while CRP represents a more stable parameter for inflammation.

Predictors of development and forecasting models in the diagnosis of chronic heart failure against hypertension

Annotation. Chronic heart failure (CHF) is a recognized public health problem with significant morbidity and mortality. Complementing and improving existing ones, as well as finding new methods for diagnosing and predicting the development of CHF is a promising and important area of research. The probable association between plasma concentrations of cerebral (BNP) and vascular (CNP) types of natriuretic peptides, features of clinical status and single nucleotide polymorphism of the BNP gene encoding was studied. The aim of the study was to improve the prognosis of CHF in women of Podolsk region of Ukraine aged 40-65 with hypertension by determining the range of the most important predictors of risk of CHF and creating a prognostic mathematical model for early personalized diagnosis of CHF based on carriers of polymorphic variants of the BNP gene. The survey involved 180 women aged 40-65 living in the Podolsk region of Ukraine: 67 women in the control group without signs of cardiovascular disease, 62 women with uncomplicated EH and 51 women with EH complicated by CHF. All patients were examined using general clinical, instrumental and laboratory methods. Genotyping of the BNP gene was performed by polymerase chain reaction. Plasma concentrations of BNP and CNP were determined by plate solid phase enzyme-linked immunosorbent assay. Mathematical processing was performed on a personal computer using the standard statistical package Statistica 10.0. It is established that among the predictors of the risk of heart failure in women 40-65 years with uncomplicated EH the most important role is played by: the level of plasma concentrations of BNP and CNP, overweight, burdened heredity of EH, the onset of EH up to 40 years, blood pressure, LV EF &lt;40% and the presence of left ventricular diastolic dysfunction type of relaxation disorders. The proposed prognostic mathematical model in the form of a scheme of equations in the future can be a convenient and fast method of early individualized diagnosis of CHF, available for use in online format.

The frequency of postoperative BNP measurement and intervention threshold of BNP concentration in pediatric cardiac intensive care unit: a prospective multicenter observational study.

The purpose of this study is to investigate the current status of postoperative BNP measurement in the pediatric cardiac intensive care unit (PCICU). This was a prospective multicenter observational study. Children under 15years old who underwent pediatric cardiac surgery were included. Postoperatively, all BNP measurement was collected in PCICU. We checked whether each BNP measurement was used for the decision-making of intervention or not. We divided the BNP measurements into 4 groups: group A 0-299pg/ml (reference), group B 300-999pg/ml, group C 1000-1999pg/ml, group D ≧ 2000pg/ml. We performed logistic regression analysis to compare the intervention ratio between group A and B, C, D. We also did multiple comparison analyses to compare the intervention ratio in each group. Thirty-nine (15.8%) measurements were used as a criterion to intervene in all BNP measurements. There was no protocol for the measurement of BNP in all institutions. The number of BNP measurements in each group is as follows: group A 113 (45.9%), group B 81 (32.9%), group C 45 (18.3%), group D 7 (2.8%). The intervention ratio in each group was 6.2% (group A), 8.6% (group B), 44.4% (group C), and 71.4% (group D). The intervention ratio of group C and D were significantly higher than group A: (Odds ratio (95%CI): 12.1(4.8-33.9), p < 0.0001, 25.2(5.2-146.2), p < 0.0001). The result of multiple comparisons is similar to logistic regression analysis. High BNP concentration, especially more than 1000pg/ml, was more often intervened upon compared to that of less than 1000pg/ml.

Kinetics of atrial and brain natriuretic peptides during hemodialysis are regulated in association with different cardiac functional changes.

The blood levels of atrial and brain natriuretic peptides (ANP and BNP) are both increased markedly in hemodialysis patients, but the kinetics of the two are not always parallel. The present study investigated the association of changes in ANP and BNP levels before and after dialysis with changes in cardiac function in hemodialysis patients. A total of 57 patients (mean age 64years, 47 males and 10 females) on maintenance hemodialysis with sinus rhythm were enrolled. Blood samples were taken at the beginning and end of dialysis, and plasma levels of ANP and BNP were measured. Changes in cardiac function during dialysis were examined by echocardiography performed just before and after dialysis. Both plasma ANP and BNP concentrations decreased significantly after hemodialysis, but the rate of decrease in BNP [mean ± SD, 555 ± 503 to 519 ± 477pg/mL (-6.4%), P = 0.011] was much smaller than that in ANP [233 ± 123 to 132 ± 83pg/mL (-43.4%), P < 0.001]. As for the relation to the changes in echocardiographic parameters before and after dialysis, the decrease in inferior vena cava diameter had a close correlation with the decrease in ANP (r = 0.528, P < 0.001), but not BNP. In contrast, the decrease in left ventricular end-diastolic volume index was correlated only with the decrease in BNP (r = 0.297, P = 0.035). The peak velocity ratio of early diastolic to atrial filling decreased with preload reduction by dialysis, and its decrease was more strongly correlated with the decrease in BNP (r = 0.407, P = 0.002) than that in ANP (r = 0.273, P = 0.040). These results demonstrated that in hemodialysis patients, the decrease in plasma ANP by a single dialysis was essentially caused by blood volume reduction, while BNP decrease was mainly induced by the reduction of left ventricular overload. Our findings indicate that the kinetics of both peptides during dialysis are regulated by different cardiac and hemodynamic factors.