Brain Natriuretic Peptide Levels Research Articles

Glyceraldehyde-derived advanced glycation end-products are associated with left ventricular ejection fraction and brain natriuretic peptide in patients with diabetic adverse cardiac remodeling

Objectives: Glyceraldehyde-derived advanced glycation end-products (Glycer-AGEs) have a strong binding affinity for their cognate receptor and elicit oxidative stress and inflammation. However, it remains unknown whether the levels of Glycer-AGEs correlate with the severity of cardiac function and heart failure in patients with diabetic adverse cardiac remodeling (DbCR). Fourteen heart failure patients with type 2 diabetes mellitus (DM) without other cardiac disorders (DbCR group) were enrolled. Another 14 patients with idiopathic dilated cardiomyopathy (DCM) without DM were served as a control (DCM group). All patients were assessed for serum Glycer-AGEs, nitrotyrosine (NT), and tumor necrosis factor alpha (TNFα) and for plasma brain natriuretic peptide (BNP). The left ventricular ejection fraction (LVEF) was evaluated by echocardiography. Results: The mean serum levels of Glycer-AGEs, NT, and TNFα in the DbCR group were significantly higher than those in the DCM group (for Glycer-AGEs, p = .0073; for NT, p = .005; for TNFα, p < .0001, respectively). In the patients with DbCR, the levels of serum Glycer-AGEs and TNFα were closely associated with LVEF and BNP values. Conclusions: Both Glycer-AGEs and TNFα showed close associations with LVEF and the levels of BNP in patients with DbCR. Glycer-AGEs and TNFα may play a pathological role in the development of DbCR.

Biomarkers of hemodynamic status in patients with moderate and severe COVID-19

Aim. To assess laboratory markers of hemodynamic status in patients with moderate to severe COVID-19.Materials and Methods. Here we examined 15 patients with moderate COVID-19 and 16 critically ill COVID-19 patients. The control group consisted of 20 healthy volunteers. The levels of endothelin-1, brain natriuretic peptide (BNP), and N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured by enzyme-linked immunosorbent assay. The amounts of nitrites (NO2) and nitrates (NO3) were measured by a Griess test (an enzymatic conversion of nitrates to nitrites) with a following colorimetric analysis.Results. Measurements of endothelin-1, nitrites, and nitrates showed high variability. The levels of NT-proBNP were reduced by 65% and 50% in patients with moderate and severe COVID-19, respectively (p &lt; 0.05). In contrast, the levels of BNP were elevated by 472% and 548% in these patient categories (p &lt; 0.05). These results indicated increased left ventricular load and suggested a heart failure.Conclusion. Progressive increase of BNP and concurrent reduction of NT-proBNP indicate affected hemodynamics in patients with moderate and severe COVID-19.

Long-Term Sleep Deprivation-Induced Myocardial Remodeling and Mitochondrial Dysfunction in Mice Were Attenuated by Lipoic Acid and N-Acetylcysteine.

The impact of long-term sleep deprivation on the heart and its underlying mechanisms are poorly understood. The present study aimed to investigate the impact of chronic sleep deprivation (CSD) on the heart and mitochondrial function and explore an effective drug for treating CSD-induced heart dysfunction. We used a modified method to induce CSD in mice; lipoic acid (LA) and N-acetylcysteine (NAC) were used to treat CSD mice. Echocardiography, hematoxylin-eosin (H&E) staining, Sirius red staining, and immunohistochemistry were used to determine heart function and cardiac fibrosis. The serum levels of brain natriuretic peptide (BNP), superoxide Dismutase (SOD), micro malondialdehyde (MDA), and glutathione (GSH) were measured to determine cardiovascular and oxidative stress-related damage. Transmission electron microscopy was used to investigate mitochondrial damage. RNA-seq and Western blotting were used to explore related pathways. We found that the left ventricular ejection fraction (LVEF) and fraction shortening (LVFS) values were significantly decreased and myocardial hypertrophy was induced, accompanied by damaged mitochondria, elevated reactive oxygen species (ROS), and reduced SOD levels. RNA-sequence analysis of the heart tissue showed that various differentially expressed genes in the metabolic pathway were enriched. Sirtuin 1 (Sirt1) and Glutathione S-transferase A3 (Gsta3) may be responsible for CSD-induced heart and mitochondrial dysfunction. Pharmacological inhibition of ROS by treating CSD mice with LA and NAC effectively reduced heart damage and mitochondrial dysfunction by regulating Sirt1 and Gsta3 expression. Our data contribute to understanding the pathways of CSD-induced heart dysfunction, and pharmacological targeting to ROS may represent a strategy to prevent CSD-induced heart damage.

Brain Natriuretic Peptide levels on hospital admission are a useful predictor of cardiac complications and mortality in geriatric patients with proximal femur fractures

PurposeProximal femur fractures in geriatric patients are associated with increased morbidity and mortality. This study investigates Brain Natriuretic Peptide immunoassay levels taken at the time of hospital admission in predicting cardiac complications and mortality in geriatric patients with a proximal femur fracture. MethodsA single-site prospective cohort study at a large tertiary care, level 1 trauma centre was conducted on all consecutive geriatric patients aged greater than 60 years who sustained a proximal femur fracture. Investigators collected Brain Natriuretic Peptide levels from venous blood samples on admission to the Emergency Department. The main outcome measurements were inpatient cardiovascular complications, and all-cause mortality at 30-day, 90-day, one-year, and nine-years. ResultsOver a one-year period, 112 patients were enrolled. The average age was 82.7 years, and the average follow up was 6 years and 6 months (range, 2 days to 9 years). No patients were lost to follow up. There were 44 new or exacerbations of pre-existing cardiac complications requiring management recorded in 30 (26.8%) patients. Mortality at 30 days was 9.8%, 90 days was 16.1%, and one year was 24.1%, with deceased patients having a statistically significant elevated Brain Natriuretic Peptide immunoassay on hospital admission. The Kaplan-Meier graph demonstrated a trend towards increasing Brain Natriuretic Peptide and adverse survivorship risk. The Charlson Comorbidity Index was statistically significant in predicting overall survival probability. ConclusionBrain Natriuretic Peptide immunoassay on hospital admission may be utilised to identify patients at risk of cardiac complications and mortality to guide further investigations, operative planning, the consent process, and post-operative monitoring.

Short-term effects of transcatheter aortic valve replacement on blood pressure and cardiac function in elderly patients with severe aortic stenosis.

Transcatheter aortic valve replacement (TAVR) is a standard treatment for elderly and high-risk patients with aortic valve stenosis (AS); however, its short-term effects on blood pressure (BP) and cardiac function are not clear. Therefore, we aimed to determine the short-term effects of TAVR in elderly patients (>75 years), who reflect the clinical situation in Japan. Twenty-eight consecutive elderly patients with severe AS and hypertension who underwent TAVR under general anesthesia were retrospectively investigated. All patients had hypertension that was well controlled with antihypertensive drugs. Serum brain natriuretic peptide level and peak velocity in the aortic valve were significantly reduced. TAVR induces an increase in BP that requires additional antihypertensive agents. There was no correlation between the change rate of SBP and stroke volume index (SVI), but there was a positive correlation between the rate of change in pulse pressure (PP) and SVI. This tendency was particularly observed in patients with low brachial-ankle pulse wave velocity (baPWV). We observed post-TAVR hypertension and required additional antihypertensive drugs. The increases in SVI and PP after TAVR resulted in post-TAVR hypertension. Moreover, post-TAVR hypertension is less likely to occur in elderly patients with a high baPWV, which indicates advanced arteriosclerosis.

The combination of nondipper pulse rate pattern and nighttime high pulse rate variability is associated with an increase of brain natriuretic peptide: the J-HOP study.

The association between pulse rate (PR) and short-term PR variability and hypertensive organ damage has not been clarified. We enrolled 1439 patients from the J-HOP study. We calculated the standard deviation (SD) of PR in the nighttime using nighttime PR measurements at 30-min intervals. The SDs of PR (PR-SD) at nighttime were divided into quartiles (Q1-Q4). Nondipper PR was defined as (awake PR-sleep PR) < 0.1. Brain natriuretic peptide (BNP) levels were higher in patients with nondipper PR status in Q4 of PR-SD (nondipper PR/PR-SD Q4) than those with nondipper PR/PR-SD Q1-Q3 (37.8 vs 21.9 pg/mL, p = 0.041). The percentage of BNP > 100 pg/mL for patients with dipper PR/PR-SD Q1-Q3 was 5.2%, that for dipper PR/PR-SD Q4 was 4.8%, that for nondipper PR/PR-SD Q1-Q3 was 13.0%, and that for nondipper PR/PR-SD Q4 was 20.0% (ANOVA p < 0.001). In conclusion, BNP was high in patients having nondipper PR and high nocturnal PR-SD. Conceptual figure of subclinical heart failure and nondipper PR, PR variability. PR: pulse rate.

Intervention of Compound Xueshuantong Capsule on the incidence of heart failure in patients with acute myocardial infarction after PCI based on the combination of disease and syndrome: A multi-center, randomized, double-blind, controlled trial.

Heart failure (HF), manifested as a severe or end stage of various cardiac diseases, is characterized by increased incidence, mortality, re-hospitalization, and economic burden. Myocardial infarction (MI) is one of the most common and important causes of HF. Since 2005, acute MI (AMI)-associated mortality in China has been on the rise, and MI accounts for 23.1% of the causes of HF. Traditional Chinese medicine (TCM) has the unique advantages of controlling angina pectoris and HF symptoms, and improving patients' quality of life. Compound Xueshuantong Capsule (CXSTC), also named as Fufang Xueshuantong Capsule, has the effect of increasing cardiac output and protecting myocardial function. In this trial, we aim to investigate the efficacy and safety of CXSTC in the prophylactic treatment of post-infarction HF and attempt to provide a clinical evidence-based basis for the prophylactic treatment of HF after AMI using TCM. This will be a multi-center, randomized, double-blind, placebo-parallel controlled trial. A total of 300 patients diagnosed with AMI and undergoing percutaneous coronary intervention within 12 hours of diagnosis will be randomized 1:1 into 2 groups: the control group that will be administered conventional Western medicine plus placebo and the trial group that will be administered XST along with the conventional Western medicine. The duration of treatment will be 3 months and the follow-up will be up to 6 months for both groups. The main efficacy indicator is the incidence of HF. The secondary efficacy indicators are cardiac function classification, 6-minute walk test score, TCM syndrome score, survival quality score, brain natriuretic peptide level, ultrasensitive C-reactive protein level, and cardiac ultrasound result. Data will be collected to analyze the underlying mechanisms by using IBM SPSS 23.0 software. By investigating the efficacy and safety of CXSTC, this study will provide a clinical evidence base for the use of TCM in the prophylactic treatment of post-infarction HF.

Assessment of brain natriuretic peptide and copeptin as correlates of blood pressure in chronic hypertensive pregnant women

BackgroundHypertensive disorders of pregnancy including preexisting (or chronic) hypertension are the most common complication encountered during pregnancy that contribute significantly to maternal and perinatal morbidity and mortality. Brain natriuretic peptide (BNP) and copeptin have been investigated as biomarkers in various hypertensive disorders, but studies of their clinical value in chronic hypertensive pregnant women are sparce. This study aimed to assess the levels of BNP and copeptin in chronic hypertensive pregnant women and investigate their correlation with blood pressure (BP) in chronic hypertensive pregnant women in South Western Nigeria.MethodsOne hundred and sixty consenting pregnant women in their third trimester of pregnancy, grouped into those with chronic hypertension (n = 80) and normotensive (n = 80), were recruited for this cross-sectional study. Age and clinical characteristics were obtained, and blood was aseptically drawn for BNP and copeptin measurement using enzyme-linked immunosorbent assay. Data was analyzed with IBM SPSS ver. 20.0. Data was analyzed using Student t-test, chi-square, and Pearson correlation test as appropriate. Statistical significance was set at P < 0.05.ResultsThe mean systolic BP (SBP) and diastolic BP (DBP) were significantly higher in pregnant women with chronic hypertension (158.30 ± 3.51 and 105.08 ± 2.47 mmHg, respectively) compared with normotensive pregnant women (100.72 ± 3.02 and 70.29 ± 1.96 mmHg, respectively). The mean levels of BNP and copeptin were higher in pregnant women with chronic hypertension (57.26 ± 3.65 pg/mL and 12.44 ± 1.02 pmol/L, respectively) compared with normotensive pregnant women (49.85 ± 2.44 pg/mL and 10.25 ± 1.50 pmol/L, respectively) though not statistically significant. Correlations observed between SBP and DBP with levels of BNP (r = 0.204, P = 0.200; r = 0.142, P = 0.478) and copeptin (r = − 0.058, P = 0.288; r = 0.045, P = 0.907) were not statistically significant.ConclusionsThere was no association between BP and the levels of BNP and copeptin in pregnant women with chronic hypertension who were already on antihypertensive treatment, with the implication that antihypertensive treatment may modulate BNP and copeptin release despite significantly elevated BP levels.

Correlation of NT-proBNP and Echocardiographic Parameters in Patients with Heart Failure with Preserved Left Ventricular Systolic Function

OBJECTIVE: Natriuretic peptides are increasingly used in clinical practice to diagnose myocardial dysfunction in heart failure (HF) with preserved ejection fraction (HFpEF). Recent studies indicate that plasma brain natriuretic peptide (BNP) may have a role in the diagnosis and management of HF. However, there is marked heterogeneity in BNP levels among subjects with HFpEF, which is only partially explained by differences in left ventricular (LV) dimensions or systolic function. This study aims to investigate if N-terminal proBNP (NT-proBNP) can be a useful tool to guide management in patients with HFpEF when echocardiography is not easily accessible. MATERIALS AND METHODS: N-terminal proBNP in patients admitted in Chong Hua Hospital from July 2019 to July 2020 was collected from the hospital laboratory. Data of patients with HF symptoms with preserved LV systolic function and other echocardiographic parameters were collected from the hospital records. The correlation between the different echocardiographic parameters and NT-proBNP was determined. RESULTS: The NT-proBNP levels increased significantly in HFpEF as the values of left atrial volume index (P &lt;0.001), E/A ratio (P = 0.042), E/e′ (P &lt;0.001), and tricuspid regurgitation velocity (P &lt;0.001) increased. The mean NT-proBNP level was 5588 pg/mL. Highest levels were seen predominantly in diastolic dysfunction grade II. CONCLUSION: Our findings indicate that NT-proBNP is positively correlated to echocardiographic parameters, namely, left atrial volume index, E/A ratio, E/e′, and tricuspid regurgitation velocity in patients with preserved LV systolic function.

638: COPEPTIN AND CARDIOVASCULAR FUNCTION CORRELATION IN CHILDREN WITH MULTISYSTEM INFLAMMATION SYNDROME

Introduction: Children exposed to COVID-19 can develop Multisystem Inflammation Syndrome in Children (MIS-C). Literature has shown that 80% of affected children have cardiovascular involvement. Copeptin, a provasopressin protein, has been shown to correlate with myocardial injury and failure. Copeptin is a stable biomarker with minimal variation in a healthy population. We hypothesize that copeptin levels will correlate with troponin and Brain Natriuretic Peptide (BNP) levels and echocardiogram findings of left ventricular dysfunction in MIS-C. Methods: We conducted a prospective study with subjects admitted to the Pediatric Intensive Care Unit who met WHO criteria for MIS-C between 2021-2022. Within 24 hours of initiating therapy, consent and a whole blood sample was obtained. The plasma was evaluated by enzyme-linked immunosorbent assay for a copeptin level. Troponin and BNP were drawn as standard of care. Echocardiograms obtained within 24 hours of the copeptin sample were evaluated for dysfunction. Comparisons between copeptin and troponin, BNP, and Ejection Fraction (EF) were evaluated using Wilcoxon Signed Rank Test. Comparisons of copeptin across echocardiogram markers of diastolic dysfunction (EE’ ratio, EA ratio) and diastolic dimensions (LV diastolic dimeter index (LVDd), septal diastolic diameter index (LVSDd), and posterior wall diastolic diameter index (LVPWDd)) were evaluated using Friedman’s Test. Kruskal-Wallis test was used to compare copeptin levels in patients on vasopressor support. Results: Ten patients with a clinical diagnosis of MIS-C were recruited. While copeptin levels (normal range 4-45pg/ml, subjects range 19.5-963pg/ml) were not significantly different between patients who received vasopressors (p=0.088), LVSDd (p=< 0.001) and LVPWDd (< 0.001) did differ. Significant differences were found between copeptin and EA ratio (p=0.006) but not with EE’ ratio (p=0.495). Differences between copeptin and EF were statistically significant (p=0.007). Comparisons of copeptin with troponin (p=0.007) and BNP (p=0.005) were also significant. Conclusions: Copeptin is a biomarker that has the potential to indicate cardiac dysfunction in the MIS-C population. Elevated copeptin levels correlated with echocardiogram findings of systolic dysfunction and diastolic dysfunction in children with MIS-C.

Brain natriuretic peptide levels and short physical performance battery scores independently influence short-term readmission rates in older patients with heart failure.

The Short Physical Performance Battery (SPPB) is a well-established tool to assess the lower extremity physical performance status. The purpose of this study is to examine the impact of brain natriuretic peptide (BNP) levels and SPPB scores on short-term readmission in older patients with heart failure (HF). This prospective cohort study enrolled 325 patients with HF who were hospitalized for acute decompensated HF between November 2017 and December 2021. Variables were analyzed using the Cox proportional hazards model, receiver operating characteristic (ROC) curve, and Kaplan-Meier analysis. The 107 patients who met the inclusion criteria were divided into readmission (within 90days of discharge; n = 25) and non-readmission (n = 82) groups. Multivariate analysis revealed that BNP level and SPPB score were independent risk factors for readmission within 90days after discharge. Patients were classified into three groups according to the BNP and SPPB cutoff values calculated using ROC curves. The risk of readmission was significantly higher in Group 3 (BNP ≥ 384pg/mL and SPPB ≤ 7 points) than in Group 1 (BNP < 384pg/mL and SPPB > 7 points; hazard ratio: 27.68, 95% confidence interval: 3.672 - 208.700, P = 0.0012). Our study showed that HF patients with high BNP levels and low SPPB scores have a dramatically increased risk of readmission within 90days of discharge.

Inhibition of JAK1,2 Prevents Fibrotic Remodeling of Pulmonary Vascular Bed and Improves Outcomes in the Rat Model of Chronic Thromboembolic Pulmonary Hypertension.

Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare complication of acute pulmonary embolism with poor clinical outcomes. Therapeutic approaches to prevention of fibrotic remodeling of the pulmonary vascular bed in CTEPH are limited. In this work, we tested the hypothesis that Janus kinase 1/2 (JAK1/2) inhibition with ruxolitinib might prevent and attenuate CTEPH in a rat model. CTEPH was induced by repeated embolization of the pulmonary artery with partially biodegradable 180 ± 30 μm alginate microspheres. Two weeks after the last injection of microspheres, ruxolitinib was administered orally at doses of 0.86, 2.58, and 4.28 mg/kg per day for 4 weeks. Prednisolone (1.475 mg/kg, i.m.) was used as a reference drug. Ruxolitinib in all doses as well as prednisolone reduced pulmonary vascular wall hypertrophy. Ruxolitinib at a dose of 2.58 mg/kg and prednisolone reduced vascular wall fibrosis. Prednisolone treatment resulted in decreased right ventricular systolic pressure. Pulmonary vascular resistance was lower in the prednisolone and ruxolitinib (4.28 mg/kg) groups in comparison with the placebo group. The plasma level of brain natriuretic peptide was lower in groups receiving ruxolitinib at doses of 2.58 and 4.28 mg/kg versus placebo. This study demonstrated that JAK1/2 inhibitor ruxolitinib dose-dependently reduced pulmonary vascular remodeling, thereby preventing CTEPH formation in rats.

The initial attempt at home hemodialysis in mainland China

BackgroundObservational studies have shown home hemodialysis (HHD) to be associated with better survival than facility hemodialysis (HD) and peritoneal dialysis (PD). Patients on HHD have reported higher quality of life and independence. HHD is considered to be an economical way to manage end-stage kidney disease (ESKD). The coronavirus disease 2019 pandemic has had a significant impact on patients with ESKD. Patients on HHD may have an advantage over in-center HD patients because of a lower risk of exposure to infection.Participants and methodsWe enrolled HD patients from our dialysis center. We first established the HHD training center. The training center was approved by the Chinese government. Doctors, nurses and engineers train and assess patients separately. There are three forms of patient monitoring: home visits, internet remote monitoring, and outpatient services. Demographic and medical data included age, sex, blood pressure, and dialysis-related data. Laboratory tests were conducted in our central testing laboratory, including hemoglobin (Hgb), serum creatinine (Cr), urea nitrogen (BUN), uric acid (UA), albumin (Alb), calcium (Ca), phosphorus (P), parathyroid hormone (PTH), and brain natriuretic peptide (BNP) levels.ResultsSix patients who underwent regular dialysis in the HD center of our hospital were selected for HHD training. We enrolled 6 patients, including 4 males and 2 females. The mean age of the patients was 47.5 (34.7-55.7) years, and the mean dialysis age was 33.5 (11.2-41.5) months. After an average of 16.0 (11.2-25.5) months of training, Alb, P and BNP levels were improved compared with the baseline values. After training, three patients returned home to begin independent HD. During the follow-up, there were no serious adverse events leading to hospitalization or death, but there were several adverse events. They were solved quickly by extra home visits of the technicians or online by remote monitoring. During the follow-up time, the laboratory indicators of all the patients, including Hgb, Alb, Ca, P, PTH, BNP, and β2-MG levels, remained stable before and after HHD treatment.ConclusionHHD is feasible and safe for ESKD in China, but larger-scale and longer-term studies are needed for further confirmation.

РОЛЬ ХРОНИЧЕСКОЙ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТИ В ПРОГНОЗИРОВАНИИ ТЯЖЕСТИ ТЕЧЕНИЯ НОВОЙ КОРОНАВИРУСНОЙ ИНФЕКЦИИ

The purpose of this study is to determine the specifics of the effect of CHF on the severity of the course of NCVI. The material of this study was the case histories of 814 patients who were on inpatient treatment in the pulmonology department of the Yakut Republic’s Clinical Hospital in connection with NCVI complicated by bilateral polysegmental viral pneumonia from May to December 2020. The research method is a retrospective analysis of the data obtained. The following results were obtained during the study: the frequency of initial CHF among the patients hospitalized with NCVI complicated by bilateral polysegmental, viral pneumonia made 9.7 %, which is higher than the average for the Russian Federation (7 %). A direct positive relationship was found between the level of brain natriuretic peptide (BNP) and the degree of lung damage according to computed tomography (CT), correlation coefficient (r) = 0.77, which confirms the effect of CHF on the severe course of COVID-19.

The mechanism of Renshen-Fuzi herb pair for treating heart failure-Integrating a cardiovascular pharmacological assessment with serum metabolomics.

Background: Renshen-Fuzi herb pair (RS-FZ) is often used in the clinical treatment of heart failure (HF) and has a remarkable therapeutic effect. However, the mechanism of RS-FZ for treating HF remains unclear. In our study, we explored the mechanism of RS-FZ for treating HF. Methods: Evaluation of RS-FZ efficacy by cardiovascular pharmacology. Moreover, Global metabolomics profiling of the serum was detected by UPLC-QTOF/MS. Multivariate statistics analyzed the specific serum metabolites and corresponding metabolic pathways. Combining serum metabolomics with network pharmacology, animal experiments screened and validated the critical targets of RS-FZ intervention in HF. Results: RS-FZ significantly ameliorated myocardial fibrosis, enhanced cardiac function, and reduced the serum HF marker (brain natriuretic peptide) level in rats with HF. Through topological analysis of the "Metabolite-Target-Component" interaction network, we found that 79 compounds of RS-FZ directly regulated the downstream specific serum metabolites by acting on four critical target proteins (CYP2D6, EPHX2, MAOB, and ENPP2). The immunohistochemistry results showed that RS-FZ observably improved the expression of CYP2D6 and ENPP2 proteins while decreasing the expression of EPHX2 and MAOB proteins dramatically. Conclusion: The integrated cardiovascular pharmacological assessment with serum metabolomics revealed that RS-FZ plays a crucial role in the treatment of HF by intervening in CYP2D6, EPHX2, MAOB, and ENPP2 target proteins. It provides a theoretical basis for RS-FZ for treating HF.

Cardio-Ankle Vascular Index Reflects the Efficacy of Waon Therapy in Heart Failure Patients.

Waon therapy is a form of thermal treatment in a dry sauna developed by Tei. Although Waon therapy is reportedly effective for chronic heart failure (CHF) patients, not all patients respond to the therapy. The reason for this ineffectiveness has not been fully clarified. The cardio-ankle vascular index (CAVI) is an index of arterial stiffness of the arterial tree from the origin of the aorta to the ankle, and it is thought to reflect some of the afterload of the left ventricle. We investigated the effects of Waon therapy on CAVI and plasma brain natriuretic peptide (BNP) level to clarify the usefulness of CAVI during Waon therapy.CHF patients (n = 21) treated with Waon therapy (2 weeks of 10 sessions) were divided into two groups: responders with an improved BNP level (n = 11) and nonresponders with no improvement in BNP (n = 10). CAVI was measured using Vasela 1500.A significant decrease in CAVI (median and interquartile range) was observed in the responder group (from 10.3 [9.6, 11.6] to 9.6 [8.6, 10.3], P = 0.021), whereas no change was observed in the nonresponder group (from 9.6 [8.6, 10.5] to 9.5 [9.1, 11.2], P = 0.919). The incidence of rehospitalization or cardiac death due to heart failure was significantly higher in patients in whom Waon therapy was ineffective at 12 months of follow-up (log-rank P = 0.001).The effectiveness of Waon therapy in CHF patients may be reflected by the improvement in CAVI.

Prognostic Value of the FAN Score, a Combination of the Fibrosis-4 Index, Albumin-Bilirubin Score and Neutrophil-Lymphocyte Ratio, in Patients Hospitalized with Heart Failure.

The fibrosis-4 index, albumin-bilirubin score and neutrophil-lymphocyte ratio are all prognostic markers in patients with heart failure. Recently, the FAN score, which includes all 3 of these markers, was developed as a useful risk stratification tool in patients with cancer. However, its cut-off values have not been validated for heart failure. We aimed to investigate the optimal cut-off and prognostic values of the FAN score in patients with heart failure. We analyzed 669 consecutive patients hospitalized with heart failure (age, 75.8 ± 11.3 years). Their median values of the fibrosis-4 index, albumin-bilirubin score, and neutrophil-lymphocyte ratio at discharge were 2.12, -2.25, and 2.41, respectively. The FAN score for heart failure (HF-FAN score) was calculated using these median values. The primary outcome was a composite of all-cause death and heart failure rehospitalization. Patients were divided into 4 groups according to HF-FAN scores of 0 (n = 112), 1 (n = 231), 2 (n = 242) and 3 (n = 84). Patients with HF-FAN scores of 3 were older, had higher brain natriuretic peptide levels, and larger inferior vena cava diameters. Kaplan-Meier analysis showed a direct correlation between higher HF-FAN scores and occurrence of the primary endpoint (log-rank P < 0.001). Cox proportional hazard analysis revealed a higher HF-FAN score was significantly associated with a worse prognosis even after adjustment for possible prognostic factors. Changing from the FAN score to HF-FAN score provided significant continuous net reclassification improvement. In conclusion, the HF-FAN score at discharge was useful for risk stratification in patients hospitalized with heart failure. The HF-FAN score might be more suitable for patients with heart failure than the FAN score.

Tight vs liberal control of mild postpartum hypertension: a randomized controlled trial

High-quality evidence to inform the management of postpartum hypertension, including the optimal blood pressure threshold to initiate therapy, is lacking. Randomized trials have been conducted in pregnancy, but there are no published trials to guide management in the postpartum period. This study aimed to test the hypothesis that initiating antihypertensive therapy in the postpartum period at a threshold of 140/90 mm Hg would result in less maternal morbidity than initiating therapy at a threshold of 150/95 mm Hg. We performed a pragmatic multicenter randomized controlled trial of patients aged 18 to 55 years with postpartum hypertension. Patients with chronic hypertension, gestational hypertension, and preeclampsia without severe features were randomized to 1 of 2 blood pressure thresholds to initiate treatment: persistent blood pressure of ≥150/95 mm Hg (institutional standard or "liberal control" group) or ≥140/90 mm Hg (intervention or "tight control" group). Our primary outcome was composite maternal morbidity defined as: severe hypertension (blood pressure ≥160/110 mm Hg) or preeclampsia with severe features, the need for a second antihypertensive agent, postpartum hospitalization >4 days, and maternal adverse outcome secondary to hypertension as evidenced by pulmonary edema, acute kidney injury (creatinine level ≥1.1 mg/dL), cardiac dysfunction (eg, elevated brain natriuretic peptide level) or cardiomyopathy, posterior reversible encephalopathy syndrome, cerebrovascular accident, or admission to an intensive care unit. Secondary outcomes included hospital readmission for hypertension, persistence of hypertension beyond 14 days, medication side effects, and time to blood pressure control. We calculated that 256 women would provide 90% power to detect a relative 50% reduction in the primary outcome from 36% in the standard blood pressure threshold group to 18%, with a 2-sided alpha set at 0.05 for significance. Data were analyzed using R statistical software. A total of 256 patients were randomized, including 128 to the "tight control" group (140/90 mm Hg) and 128 to the "liberal control" group (150/95 mm Hg). Patients in the "tight control" group had a higher body mass index at delivery (37.1±9.4 vs 34.9±8.1; P=.04); other demographic and obstetrical characteristics were similar between groups. The rate of the primary outcome was similar between groups (8.6% vs 11.7%; P=.41; relative risk, 0.73; 95% confidence interval, 0.35-1.53). The rates of all secondary outcomes and the individual components of the primary and secondary outcome measures were also similar between groups. In the postpartum period, initiation of antihypertensive therapy at a lower blood pressure threshold of 140/90 mm Hg did not decrease maternal morbidity or improve outcomes compared with a threshold of 150/95 mm Hg.

Development and Validation of a Prognostic Model Based on Clinical Biomarkers for Heart Failure in Adult Patients Following Allogeneic Hematopoietic Stem Cell Transplantation

Introduction: Heart failure (HF) is an uncommon but one of the most serious types of cardiovascular complications after allogeneic hematopoietic stem cell transplantation (allo-HSCT). However, the prognostic factors of HF after allo-HSCT remain unknown, and there is currently no prognostic model for HF after allo-HSCT. In this study, we investigated the clinical features and prognosis of patients with HF after allo-HSCT. A prognostic model based on clinical biomarkers, which combined variables that are readily available in clinical practice, that is capable of predicting 2-month mortality of HF patients after allo-HSCT was developed and validated. Methods: In our retrospective study, 154 patients with HF after allo-HSCT from 2008 to 2021 were identified. One hundred patients were assigned to the derivation cohort and the remaining 54 patients were assigned to the external validation cohort according to the time of transplantation. We first calculated the univariable association of each variable with 2-month mortality in the derivation cohort. Second, the variables with p values less than 0.1 in the univariate analysis were further included as candidate predictors in the multivariate analysis using a backward stepwise logistic regression model. The variables that remained in the final model based on the outcomes of the multivariate analysis in the derivation cohort were identified as independent prognostic factors. A scoring system to predict the prognosis of HF after allo-HSCT was also established, and scores were assigned to the prognostic factors based on the regression coefficient. Results: Using multivariable logistic regression methods with stepwise variable selection, four highly significant independent prognostic factors for the two-month mortality of HF were identified: pulmonary infection (p=0.005; odds ratio [OR], 6.89; 95% confidence interval [CI], 1.93-29.13), Grades III to IV acute graft-versus-host disease (severe aGVHD) (p=0.033; odds ratio [OR], 3.62; 95% confidence interval [CI], 1.15-12.69), lactate dehydrogenase (LDH)>426 U/L (p=0.049; odds ratio [OR], 3.02; 95% confidence interval [CI], 1.00-9.32) and brain natriuretic peptide (BNP)>1799 pg/ml (p=0.026; odds ratio [OR], 3.44; 95% confidence interval [CI], 1.16-10.56). We also included cardiac troponin I (cTNI) (p=0.069; odds ratio [OR], 2.93, 95% confidence interval [CI], 0.94-29.13) in our final 5-predictor prognostic model. A risk grading model termed the BLIPS score (BNP, LDH, cardiac troponin I, pulmonary infection, severe aGVHD) was constructed according to the regression coefficients. BNP level>1799 pg/mL, LDH level>426 U/L, cTNI level>100 pg/ml, and severe aGVHD were each assigned one point, and pulmonary infection was assigned two points. The points scored for each of these five factors were added to yield the overall risk score, which ranged from zero to six. Patients were stratified into a low-risk group (0-2 points), an intermediate-risk group (3-4 points) and a high-risk group (5-6 points). The validated internal c-statistic was 0.870 (95% CI, 0.798-0.942), and the external c-statistic was 0.882 (95% CI, 0.791-0.973). According to the calibration plots, the model-predicted probabilities showed a good correlation with the actual observed frequencies. Decision curve analysis indicated that the clinical implementation of the prognostic model could benefit HF patients. The Kaplan‒Meier estimations of overall survival revealed good separation between these risk groups. We generated a risk heatmap for the BLIPS model to visualize the risk estimates derived from the individual prognostic factor profile. Conclusions: Patients who develop HF after allo-HSCT have a poor prognosis. An integrated prognostic model based on clinical biomarkers (BLIPS) was developed and externally validated, and this is the first straightforward scoring model that incorporates clinical and laboratory risk factors to evaluate the 2-month mortality of patients with HF after receiving allo-HSCT to treat hematological malignancies. This model can be effectively utilized to help improve the survival and prognosis of HF patients by accelerating the early identification of patients at a high risk of mortality and contributing to the appropriate implementation of urgent medical support. Disclosures: No relevant conflicts of interest to declare.

Abstract 12381: Elevated Serum Carboxy-Terminal Telopeptide of Type I Collagen is Associated With Clinical Outcomes in Patients With Stable Angina Pectoris Undergoing Percutaneous Coronary Intervention

Background: Despite high risk of developing cardiovascular events, it was reported to be difficult to predict clinical outcomes in patients with stable angina pectoris (AP). Serum carboxy-terminal telopeptide of type I collagen (I-CTP), a marker of collagen degradation, was reportedly associated with clinical outcomes in patients with acute coronary syndrome. However, clinical usefulness of I-CTP has not yet been elucidated in patients with stable AP. The aim of this study was to examine whether I-CTP can predict clinical outcomes in patients with stable AP. Methods and Results: Serum I-CTP levels were measured in consecutive 360 patients with stable AP undergoing percutaneous coronary intervention. All patients were divided into three groups according to serum I-CTP tertiles: low I-CTP group (≤4.4 ng/ml, n=120), middle I-CTP group (4.5-6.2 ng/ml, n=118), and high I-CTP group (≥6.3 ng/ml, n=122). The high I-CTP group was older and showed higher levels of brain natriuretic peptide (BNP) and lower levels of estimated glomerular filtration rate (eGFR) and left ventricular ejection fraction (LVEF) compared with other groups. During the median follow up period of 1,347 days, there were 68 cardiovascular events including all-cause deaths. Kaplan-Meier analysis showed that the high I-CTP group had the greatest risk for cardiovascular events among 3 groups. Univariate Cox proportional hazard regression analysis showed that age, multivessel disease, BNP, eGFR, LVEF, and I-CTP were significantly associated with cardiovascular events. Multivariate Cox proportional hazard analysis demonstrated that I-CTP was an independent predictor for cardiac events after adjusting for confounding risk factors. Conclusion: I-CTP could be the feasible marker for predicting cardiovascular events in patients with stable AP.