Brain Natriuretic Peptide Precursor Research Articles

Biomarkers of heart failure: current state of problem

There is constant increase in patients with heart failure every year worldwide. Early diagnosis and prediction of deterioration could upgrade management of patients and slow down the progression of heart failure.The brain natriuretic peptide precursor (NT-proBNP) is considered to be the universal biomarker, although it has several limitations. The search of ideal biomarker is directed into molecular biology and genetics. Microribonucleic acids (microRNAs) regulate different processes in human body, present myocardial specificity, and plasma stability. It has been proven in different trials that diagnostic and prognostic level of microRNAs is equal to NT-proBNP. Potential opportunities of the method are not only diagnosis but therapeutic targets for heart failure

Effect of Shenmai Injection on Long-Term Prognosis of Patients with Chronic Heart Failure: A Multicenter, Large Sample Capacity, Long-Term Follow-Up Retrospective Cohort Study.

To explore the effect of Shenmai Injection (SMI) on the long-term prognosis of patients with chronic heart failure (CHF). The Hospital Information System was used to extract data of CHF patients, and the retrospective cohort study was conducted for analysis. In non-exposed group, standardized Western medicine treatment and Chinese patent medicine or decoction were applied without combination of SMI while in the exposed group, SMI were applied for more than 7 days. Evaluation indicators are followed with New York Heart Association functional classification (NYHA classification), left ventricular ejection fraction (LVEF), N-terminal brain natriuretic peptide precursor (NT-ProBNP), cardiogenic death and heart failure (HF) readmission. Statistical analysis includes Kaplan-Meier analysis and Cox regression which are used to explore the relationship between SMI and outcome events. A total of 1,211 eligible CHF patients were involved and finally 1,047 patients were followed up successfully. After treatment, the cases of NYHA classification decline in the exposed and non-exposed groups accounted for 64.30% and 43.45%, respectively; the improvement values of LVEF were 8.89% and 7.91%, respectively; the improvement values of NT-ProBNP were 909 pg/mL and 735 pg/mL, respectively. After exposure on SMI, the rates of cardiogenic death and HF readmission reduced from 15.43% to 10.18% and 38.93% to 32.37%. According to Kaplan-Meier analysis, the log-rank P value of SMI and cardiogenic death was 0.014, while the counterpart of SMI and HF readmission was 0.025. Cox regression analysis indicated that for cardiogenic death, age, cardiomyopathy, diabetes, and NYHA classification were risk factors while β-blockers, aldosterone receptor antagonists, Chinese patent medicine/decoction and SMI were protective factors. Likewise, for HF readmission, age, cardiomyopathy, and NYHA classification were risk factors while SMI was a protective factor. Combination with SMI on the standardized Western medicine treatment can effectively reduce cardiogenic mortality and readmission rate in CHF patients, and thereby improve the long-term prognosis.

Prognostic Value of Myocardial Enzymes and Therapeutic Potential of Cardioprotective Agents in Chronic Lymphocytic Leukemia Patients with Cardiovascular Comorbidities

Introduction: Chronic lymphocytic leukemia (CLL) is the most common leukemia among adults in the western world. Cardiovascular disease (CVD), with a high incidence among comorbidities, is associated with significant morbidity and inferior quality of life in cancer patients. In CLL, comorbidities are associated with increased mortality from infections, second cancers and CVD. However, previous studies have not uncovered the relationships between cardiac biomarkers and the prognosis of CLL patients. In addition, whether cardioprotective drugs affect the effect of therapy in CLL patients remains undefined.Methods: Five hundred and ten CLL patients diagnosed in Shandong Provincial Hospital affiliated to Shandong University from October 2010 to July 2020 were enrolled in our study. The Kaplan-Meier curves were used to estimate survival rates, while the log-rank tests were used for comparison. Univariate and multivariate logistic regression analysis was used to verify prognostic independence. The available expression data and survival information of CLL samples and normal samples were extracted from 2 databases. The expression level of genes involved in the KEGG lipid and atherosclerosis pathway was analyzed to evaluate the prognosis of CLL patients. GSEA enrichment analysis was performed to explore the potential function of TNFRSF1A. Cell proliferation assay with the Cell Counting Kit-8 (CCK-8) was performed to detect the therapeutic potential of the common cardioprotective drugs atorvastatin, metoprolol and losartan in CLL.Results: Among the cohort, 30% CLL patients were complicated with CVD. Compared with those without CVD, CLL patients with CVD were of significantly advanced age (p<0.001), larger proportion with diabetes (p=0.003), as well as higher levels of N-terminal brain natriuretic peptide precursor (NTpro-BNP; p=0.016) and myohemoglobin (MYO; p=0.005). The Kaplan-Meier curves revealed that Binet stage (χ2=3.863, p=0.049), creatine kinase isoenzyme (CK-MB; χ2=4.335, p=0.037) and MYO (χ2=4.010, p=045) were related to the OS time of CLL patients with CVD (shown in Figure 1). The univariate logistic analysis showed that sex (p=0.031), Rai stage (p=0.036), Binet stage (p=0.017), β2-MG (p=0.004), creatine kinase (CK; p=0.017), α-hydroxybutyrate dehydrogenase (α-HBDH; p=0.017), MYO (p=0.025) and C-reactive protein (p=0.007) were associated with the outcomes of CLL patients with CVD. The multivariate logistic analysis confirmed that α-HBDH (p=0.046) and MYO (p=0.013) were independent prognostic biomarkers for the outcomes of CLL patients with CVD.To further evaluate the prognosis of CLL patients and CVD, the expression of genes involved in the KEGG lipid and atherosclerosis pathway were assessed. Most of them were dysregulated (shown in Figure 2A-B). The genes which were differential expression were performed with Kaplan-Meier analysis and univariate and multivariate Cox analysis subsequently. TNFRSF1A was upregulated among CLL cells and was independent prognostic biomarkers of both OS (shown in Figure 2C) and time to first treatment (TTFT) in CLL patients (shown in Figure 2D). GSEA enrichment illuminated that TNFRSF1A was related to the lipid catabolic and metabolic process, as well as other metabolic processes (shown in Figure 2E-F).To investigate the effect of cardioprotective drugs on chronic lymphocytic leukemia patients, cell proliferation assays were performed. Atorvastatin, metoprolol and losartan decreased the proliferation of CLL cell lines with IC50 values of 94.19 uM, 123.60 uM and 411.80 uM in EHEB cells, and 79.20 uM, 138.60 uM and 318.5 uM in MEC-1 cells, respectively (shown in Figure 3).Conclusions: In conclusion, we demonstrated CLL patients with CVD were of older age, larger proportion of patients with diabetes, higher levels of NTpro-BNP and MYO compared those without CVD for the first time. α-HBDH and MYO were independent prognostic biomarkers for survival in CLL patients with CVD. TNFRSF1A was an independent prognostic biomarker of OS and TTFT in CLL patients. Furthermore, atorvastatin, metoprolol and losartan exhibited inhibitory effects in CLL cell lines. The evaluation of cardiac biomarkers is beneficial to predict the clinical outcomes of CLL patients. CLL patients may benefit from the application of cardioprotective agents. Strengthening the evaluation of CVD risk and preventing CVD may improve the prognosis of CLL patients. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Milrinone is better choice for controlled low central venous pressure during hepatectomy: A randomized, controlled trial comparing with nitroglycerin

BackgroundTo explore the feasibility and effectiveness of controlled low central venous pressure(CLCVP)induced by milrinone during hepatectomy, and its influence on perioperative hemodynamics, blood loss and patients’ recovery, comparing with the traditional method by nitroglycerin. Methods52 patients who underwent elective open hepatectomy were enrolled in the study and randomly divided into two groups: milrinone (M) group and nitroglycerin (NG) group. Milrinone was infused with the rate of 0.5 μg/kg/min in group M, while nitroglycerin was given 0.2–0.5 μg/kg/min in group NG to maintain CVP≤ 5 mmHg during liver resection. The demographic variables, data of the operative procedure and intraoperative hemodynamics were recorded. The postoperative recovery profiles and pre- and post-operative haematological markers of vital organs were also collected and compared. Results1. The blood loss of group M, no matter during liver resection or in the whole procedure, was both less than that of group NG (P < 0.05), so did the hemoglobin detected by blood gas analysis (P < 0.05). Meanwhile, time of hepatectomy and hepatic hilum occlusion were shorter in group M (P < 0.05). 2. Compared with the NG group, cardiac index (CI) and stroke volume index (SVR) were higher in group M in the operation. The norepinephrine dosage necessary in the operation was of no difference in two groups (P > 0.05). 3. Drainage indwelling time and postoperative hospital stay of group M were shorter than that of group NG (P < 0.05). Most of the blood biomarkers increased on postoperative day (POD)-1, and returned to the preoperative level on POD-7 without inter-group difference (P > 0.05). Brain natriuretic peptide precursor (Pro-BNP) in group M was higher than NG group on POD-1 (P < 0.05), and the statistical difference disappeared on POD-7. ConclusionMilrinone can effectively maintain a controlled low central venous pressure during hepatectomy. Compared with nitroglycerin, milrinone can reduce the amount of blood loss, with the benefit of better manifestation of hemodynamics and enhanced postoperative recovery.

Predictors of an adverse course of heart failure with preserved left ventricular ejection fraction in patients with obstructive sleep apnea syndrome

Aim. To study the relationship of obstructive respiratory disorders during sleep with subclinical development of right ventricular dysfunction and pulmonary hypertension, as well as with the risk of an adverse course of chronic heart failure (CHF) with preserved left ventricular ejection fraction (LVEF). Materials and methods. The study included 86 men with moderate and severe forms of obstructive sleep apnea syndrome (OSAS) (with an apnea/hypopnea index (AHI) &gt; 15 per hour). All patients had abdominal obesity and hypertension. Upon inclusion in the study, all patients underwent polysomnography and echocardiography according to the standard protocol with an additional assessment of the fractional area change in the right ventricular myocardium (ΔSRV) and the right ventricular stroke work index (RVSWI). Also, the content of the N-terminal brain natriuretic peptide precursor (NT-proBNP) in the blood serum was determined by enzyme immunoassay analysis. A six-minute walk test (6MWT) was performed after inclusion in the study and after 12 months of follow-up. Depending on the course of CHF during the follow-up, retrospectively, the patients were divided into 2 groups: with an unfavorable ( n = 33) and favorable ( n = 53) prognosis. Results. A significant relationship between AHI and ΔSRV, RVSWI, NT-proBNP, and 6MWT was revealed. Based on the results of one-way correlation analysis, it was found that ΔSRV (odds ratio (OR) 2.51; 95% confidence interval (CI) 2.42–3.24; p = 0.0009), NT-proBNP (OR 1.92; 95% CI 1.32–2.78; p = 0.003), and AHI (OR 3.93; 95% CI 2.87–4.11; p = 0.018) were predictors of an adverse course of CHF. In a multivariate analysis, it was found that AHI was an independent predictor of an adverse course of CHF (OR 3.49; 95% CI 2.17–11.73; p = 0.0008), while the addition of NT-proBNP improved risk stratification of an adverse course of CHF (OR 4.66; 95% CI 3.87–13.11; p &lt; 0.0001). Conclusion . The fractional area change in the right ventricular myocardium (ΔSRV) can be considered as a non-invasive marker for determining the emerging right ventricular dysfunction and predicting adverse cardiovascular events in patients with preserved LVEF and OSAS. Moreover, the combined use of echocardiographic (ΔSRV) and laboratory (NT-proBNP) markers can improve risk stratification of CHF progression.

Chronic Heart Failure in Patients with Arterial Hypertension Associated with Obstructive Sleep Apnea Syndrome: Possible Options to Pathogenetic Therapy

Aim. To study approaches to the treatment of chronic heart failure (CHF) with reduced and mid-range left ventricular ejection fraction (LVEF) in patients with arterial hypertension (AH) against the background of obstructive sleep apnea (OSA).Material and methods. The study included 136 patients with CHF and AH. Inclusion criteria for the study: 1) moderate and severe OSA (with an apnea/hypopnea index of more than 15 per hour); 2) II-IV functional class of CHF according to NYHA; 3) the level of brain natriuretic peptide precursor (NT-proBNP) ≥125 pg/ml; 3) LVEF &lt;50%; 4) the duration of hypertension is at least 2 years. Patients received drug therapy, including beta-blockers, mineralocorticoid receptor antagonists, diuretics, ACE inhibitors or angiotensin receptor inhibitors or valsartan/sacubitrile. After 12 months of followup, the patients were divided into 2 groups depending on the medication being administered. Group 1 included patients (n = 50) receiving therapy with valsartan/sacubitril, group 2 included patients (n = 86) receiving therapy without this drug. Effective CPAP-therapy also was registered in each group.Results. In patients with CHF who received valsartan/sacubitril, disease progression was recorded in 28% of cases, while in patients who did not receive therapy with this drug, an unfavorable course of CHF was recorded in 42.8% (p = 0.001). In group 1, the NT-proBNP level significantly (p = 0.034) decreased by 34%, while in group 2, a significant (p = 0.002) increase in biomarker levels was revealed by 35.5%. In the group of patients receiving therapy with valsartan/sacubitril an increase in LVEF (p = 0.007) was revealed by 12.5%. In group 1, an increase in exercise tolerance was achieved in the form of a significant (p = 0.012) increase in the distance of the six-minute walk test by 18.2%, while in group 2, the six-minute walk distance decreased by 19.2% (p = 0.034). In the subgroup of patients receiving CPAP therapy in combination with valsartan/sacubitril therapy (n=8), LVEF increased by 11.6% (p = 0.043), the six-minute walk test distance increased by 29.7% (p = 0.046), and NT-proBNP decreased by 22.5% (p = 0.039), while in the group of patients who received only CPAP therapy (n=19).Conclusion. The most significant slowdown in the rate of progression of CHF in patients with AH associated with OSA, an increase in exercise tolerance, as well as the most pronounced tendency to the reverse development of pathological echocardiographic changes in the myocardium when using valsartan/sacubitrile in drug therapy in combination with effective hardware CPAP therapy.

Prognostic value of heart failure biomarkers in the assessment of cardiac dysfunction in the fetus and newborn

The assessment of the cardiac function of the fetus and hemodynamic stabilization of the newborn in the postnatal period is one of the most important tasks of modern perinatology. Understanding the pathophysiological mechanisms, the basis of the myocardial dysfunction in both the fetus and the newborn, can help to develop preventive measures and change the therapeutic approach to this category of children. This review highlights the problems of the disruption of the mechanisms of interregulation in the fetal heart and placenta, as well as the diagnostic possibilities of modern biomarkers of cardiovascular dysfunction – troponins, N-terminal precursor of brain natriuretic peptide and soluble type 2 tumor suppressor – in fetal and newborn.

Clinical value of NT-proBNP measurements in assessing patients in the pediatric intensive care unit.

BackgroundN-terminal brain natriuretic peptide precursor (NT-proBNP) and brain natriuretic peptide (BNP) are mainly produced and secreted in the heart. In 2008, the European Heart Association recommended that serum BNP/NT-proBNP levels should be included in one of the diagnostic criteria of heart failure. Serum NT-proBNP is more stable than BNP, and the detection results are less affected by objective factors, so it is widely used. At present, NT-proBNP has long been beyond the scope of heart failure markers, and has a wide range of clinical value in the evaluation and prediction of some serious diseases. This study prospectively studied the predictive value of serum NT-proBNP in pediatric intensive care unit (PICU).MethodsThis was a prospective study involving 375 children in the PICU. The patients were divided into three groups: non-risk, low-risk, and high-risk groups. Serum NT-proBNP levels and the 28-day mortality rate were analyzed.ResultsThe serum NT-proBNP levels and the mortality of the high-risk group was significantly higher than those of the low- and non-risk groups (P<0.01 in both cases). Receiver operating characteristic curve (ROC curve) analysis showed that the area under the curve was 0.705 (P<0.001, sensitivity =0.643, specificity =0.692). Death multivariate binary logistic regression analysis indicated that NT-proBNP was not an independent factor for 28-day mortality.ConclusionsSerum NT-proBNP was significantly correlated with the severity of illness for critically ill patients in PICU. Although high levels of NT-proBNP indicated greater severity, this was not an independent risk factor affecting the prognosis of patients.

A Novel Clinical Nomogram to Predict Transient Symptomatic Associated with Infarction: The ABCD3-SLOPE Score.

Background It is hard to differentiate transient symptoms associated with infarction (TSI) from transient ischemic stroke (TIA) without MRI in the early onset. However, they have distinct clinical outcomes and respond differently to therapeutics. Therefore, we aimed to develop a risk prediction model based on the clinical features to identify TSI. Methods We enrolled 230 consecutive patients with transient neurologic deficit in the Department of Neurology, Tongji University Affiliated Tenth People's Hospital from March 2014 to October 2019. All the patients were assigned into TIA group (DWI-negative) or TSI group (DWI-positive) based on MRI conducted within five days of onset. We summarized the clinical characteristics of TSI by univariate and multivariate analyses. And then, we developed and validated a nomogram to identify TSI by the logistic regression equation. Results Of the 230 patients, 41.3% were diagnosed with TSI. According to the multivariate analysis, four independent risk factors, including smoking history, low-density lipoprotein cholesterol, brain natriuretic peptide precursor, and ABCD3 score, were incorporated into a nomogram. We developed a predictive model named ABCD3-SLOPE. The calibration curve showed good agreement between nomogram prediction and observation. The concordance index (C-index) of the nomogram for TSI prediction was 0.77 (95% confidence interval, 0.70-0.83), and it was well-calibrated. Conclusions Smoking history, low-density lipoprotein cholesterol, brain natriuretic peptide precursor, and ABCD3 score were reliable risk factors for TSI. ABCD3-SLOPE was a potential tool to quantify the likelihood of TSI.

Assessment of the effect of nebivolol and сarvedilol on the functional state of patients with diastolic chronic heart failure

Aim. To determine the effect of combined therapy with nebivolol or carvedilol on the functional state of patients with diastolic chronic heart failure (CHF).&#x0D; Material and methods. The study involved 68 patients with CHF and preserved left ventricular ejection fraction, who were randomized into two groups for treatment with bisoprolol or carvedilol. As part of the combination therapy was prescribed quinapril, and if indicated atorvastatin, acetylsalicylic acid in the intestinal soluble shell. Initially and after 24 weeks of therapy were carried out: quantitative assessment of regulatory-adaptive status (RAS), echocardioscopy, treadmill test, six-minute walking test, subjective assessment of quality of life, determination of level of N-terminal fragment of the brain natriuretic peptide precursor in blood plasma.&#x0D; Results. Both schemes of combined therapy comparably improved the morpho-functional parameters of the heart and quality of life. In comparison with carvedilol, nebivolol more pronouncedly increased RAS and tolerance to physical activity.&#x0D; Conclusion. In patients with diastolic CHF in combination therapy, the use of nebivolol, in comparison with carvedilol, may be preferable due to the positive effect on the functional state.

Morphofunctional cardiac changes in singleton and twin pregnancies: a longitudinal cohort study

BackgroundThis study aimed to compare the echocardiographic changes and cardiac biomarkers between women with singleton and twin pregnancies.MethodsFrom April 2014 to March 2016, this longitudinal cohort study invited pregnant women who were scheduled to give birth at Hokkaido University Hospital. We analyzed prospectively collected data on simultaneously determined echocardiographic parameters and blood cardiac markers of 44 women with singleton and 22 women with twin pregnancies. Furthermore, we tested the mixed-effect models for echocardiographic parameters and cardiac biomarkers.ResultsDuring the third trimester and immediately postpartum (within 1 week after childbirth), the mean left atrial volume index and brain natriuretic peptide (BNP) level were significantly higher in women with twin pregnancies than in those with singleton pregnancies. Women with twin pregnancies also had significantly smaller second-trimester inferior vena cava diameters and significantly higher third−trimester creatinine levels than those with singleton pregnancies. BNP positively correlated with the left atrial volume index (β = 0.49, p < 0.01) and the ratio of early diastolic transmitral to mitral annular velocity (E/e’) (β = 0.41, p < 0.01). At 1 month after childbirth in women with singleton pregnancies, BNP and N-terminal precursor protein BNP (NT-proBNP) fragments immediately postpartum negatively correlated with the later E/e’ (r = − 0.33, p = 0.02 and r = − 0.36, p < 0.01, respectively).ConclusionsThe intravascular cardiac load reached maximum within 1 week after childbirth and was greater in women with twin pregnancies than in those with singleton pregnancies. BNP/NT-proBNP significantly positively correlated with LA volume index and E/e’. In women with singleton pregnancies, BNP secreted immediately after childbirth might improve the diastolic functions 1 month after childbirth.

T1 mapping and late gadolinium enhancement for the diagnosis of dilated cardiomyopathy

To explore the role of T1 mapping and late gadolinium enhancement (LGE) for detection of dilated cardiomyopathy (DCM). Thirty-two DCM patients detected by ultrasonic testing with unknown origin heart failure from April 2018 to November 2019 were involved. In addition, they were compared with 18 physical examiner under cardiac magnetic resonance imaging (CMRI) in the same period. Phillip's Ingenia 3.0T MRI was used to examine heart function, plain scan included cine, T2 weighted imaging (T2WI) and pre-contrast native T1 mapping. The enhancement scan included perfusion weighted imaging, LGE imaging and post-contrast post T1 mapping. Using gadolinium injection, a bolus of 0.1 mL/kg of gadolinium-based contrast followed by a 20 mL saline flush was administered. After a 7-minute later start scanning, delay enhance sequence was started, including 4 layers, 2 cavities and 4 cavities. LGE and T1 mapping results were observed, including cardiac function indexes [left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular ejection fraction (LVEF), valvular regurgitation], cardiac morphological indexes [left ventricular mass (LVM)], histological characteristics (T2WI myocardial signal, presence of perfusion defect and its position and scope, presence of delayed enhancement and its position, shape and scope, pre- and post-contrast T1 values), extracellular volume (ECV) and the accompanying signs (pericardial effusion and pleural effusion). The receiver-operating characteristic curve (ROC) was drawn, the diagnostic value of T1 value of pre-contrast T1 mapping for DCM was evaluated, and the occurrence of clinical endpoint events was observed. There were no statistically significant differences in DCM patients with gender, age, body mass index (BMI), blood pressure, heart rate (HR), hematocrit (HCT), creatinine (Cr), family history of hypertension or heart disease. In DCM group N-terminal brain natriuretic peptide precursor (NT-proBNP) level and proportion of patients with heart function level III, diabetes, smoking history, drinking history and medication history were significantly higher than those in control group. Compared with control group, LVEDV (mL/m2: 234.9±35.9 vs. 121.8±27.6), LVESV (mL/m2: 189.7±42.8 vs. 54.8±17.0), LVM (g: 197.6±56.3 vs. 110.5±22.9), pre-contrast T1 values (ms: 1 332.1±35.9 vs. 1 272.0±47.0), ECV [(45.7±4.9)% vs. (28.0±2.1)%] were significantly increased in the DCM group; LVEF (0.191±0.107 vs. 0.554±0.103), post-contrast T1 values (ms: 453.9±72.7 vs. 493.5±43.9) were significantly decreased (all P < 0.05). In DCM group, the proportions of valvular regurgitation, pericardial effusion and pleural effusion were 25.0%, 18.8% and 25.5%, respectively. ROC curve analysis showed that the cutoff value of pre-contrast T1 values was 1 220.22 ms, the area under ROC curve (AUC) was 0.84 (P = 0.015), the sensitivity and specificity were 77.8% and 88.9%, indicating that pre-contrast T1 values may be a certain prediction for diagnosis of DCM. In 32 patients with DCM, 22 cases (68.8%) had LGE in position wall, interventricular septum, inferior wall or under the epicardium, with local or multiple diffuse, 9 cases (28.1%) were both interventricular septum and inferior wall involved. During an average of 16 months follow-up, 3.1% patients appeared sudden cardiac death. One-stop CMRI can improve the diagnostic efficacy of DCM, and T1 mapping with LGE imaging can improve the diagnostic accuracy, which is very meaningful for diagnosis and follow-up of patients.

EFFECTIVENESS OF TREATMENT WITH MEBICAR IN PATIENTS WITH PERMANENT ATRIAL FIBRILLATION

Violation of the heart rhythm is widespread at present. Anxiety-depressive symptoms and a tendency to chronic stress leads to the depletion of the body, which contributes to arrhythmia. The aim of the study is to assess the severity of clinical and hemodynamic indices by using anxiolytic drug mebicar. Materials and methods. Assessment of psycho-emotional status was studied using the psychosocial scale of stress by L. Reader, PSS-10 PHQ-15 and questionnaire identification of social factors that can affect health. Determination of cortisol level in serum was carried out by immunoassay (ELISA) on the ER-500 Microplate Reader. The concentration of N-terminal fragment of the brain natriuretic peptide precursor (NTproBNP) in serum was determined by ELISA using a Biosan PST-60HL shaker. Results. The results of the survey showed a direct dependence of the manifestation of atrial fibrillation (AF) on the level of psychoemotional stress. We found that in group 1b (standard treatment+mebicar) there were complaints of increased excitability (p&lt;0.001), (p-reliability difference of indices before and after treatment), fatigue (p&lt;0.001), deterioration of memory (p&lt;0.01), appetite loss (p&lt;0.05), sleep disturbance (p&lt;0.001), signs of severe sweating (p&lt;0.001), indicating the appearance of astheno-vegetative syndrome. The reduction of manifestations of high stress (p&lt;0.01) in patients of group 1b (standard treatment+mebicar) was noted. A similar pattern was detected in the severity of anxiety in men (p&lt;0.01). Conclusions. Application in the complex therapy of patients with stable coronary heart disease (SIHD) in conjunction with AF anxiolytics of the benzodiazepine series (mebicar) has allowed stopping anxiety-depressive disorders. Analyzing the level of cortisol, we observed its increase depending on the degree of anxiety and depression; NT-proBNT metrics are respectively.

Features of remodeling of the right heart in comorbid patients with chronic heart failure

Objective: to identify the features of structural and functional remodeling of the right heart in patients with chronic heart failure (CHF) against the background of a combination of atrial fibrillation (AF) and chronic obstructive pulmonary disease (COPD), to assess the effect on the concentration of the heart failure marker NT-proBNP.Materials and methods: the study included 120 patients who were divided in to 4 groups depending on the presence of CHF, AF and COPD. Patients underwent an echocardiographic (EchoCG) study, and the concentration of the N-terminal fragment of the brain natriuretic peptide precursor (NT-proBNP) was determined.Results: comparison of EchoCG parameters of the right heart in patients with CHF of different groups was performed in pairs to determine the effect of diseases on the remodeling of the right atrium (RA) and right ventricle (RV) in comorbid conditions. In patients with CHF, AF and COPD, in comparison with patients with CHF and AF without COPD, lower volume parameters of RA (p=0.004), greater wall thickness of the RV (p&lt;0.001), lower values of the indexed end-diastolic area (EDA) of the RV (p=0.007) and its fractional area measurement (FAM) (p=0.011) were revealed, which allows us to judge the effect of chronic bronchoobstruction on heart remodeling in patients with CHF and AF. When compared with patients with CHF and COPD without AF in patients with CHF, AF and COPD have large size of RV (p=0.012), its indexed end-systolic area (ESA) (p&lt;0.001), lower ejection fraction (EF) of RV (p=0.002), FAM (p&lt;0.001), systolic excursion of the tricuspid valve plane (TAPSE) (p=0.012), indicating the influence of concomitant AF in EchoCG parameters in patients with CHF and COPD. A higher concentration of NT-proBNP was found in patients with CHF, AF and COPD compared to the marker level in both patients with CHF and AF without COPD (p=0.010) and in patients with CHF and COPD without AF (p&lt;0.001), due to more pronounced remodeling of the RV.Conclusions: In patients with CHF, AF and COPD were the features of the remodeling of the right heart, caused by influence of, on the one hand, AF, on the other, with COPD the structural and functional parameters of heart in patients with this combined pathology. Using the extended protocol EchoCG studies identify additional characteristics of structural-functional state of the right heart (ESA and EDA RV, RV EF, TAPSE and FAM) will optimize early diagnosis of CHF and cardiovascular and bronchopulmonary diseases.

Clinical characteristics and death risk factors of severe COVID-19

Objective: To analyze the clinical features and death-related risk factors of COVID-19. Methods: We enrolled 891 COVID-19 patients admitted to the Affiliated Hospital of Jianghan University from December 2019 to February 2020, including 427 men and 464 women. Of the 891 cases, 582 were severe or critical, including 423(73%)severe and 159 (27%) critical cases. We compared the demographics, laboratory findings, clinical characteristics, treatments and prognosis data of the 582 severe patients. Univariate and multivariate logistic regression analysis was conducted to explore the risk factors associated with death in COVID-19 patients. Results: The 582 severe patients included 293 males and 289 females, with a median age of 64(range 24 to 106). Sixty-three patients died, including 45 males and 18 females, with a median age of 71(range 37 to 90). The average onset time of the 582 patients was 8 days, of whom 461 (79%) had fever, 358 (62%) dry cough, 274 (47%) fatigue. There were 206 cases with shortness of breath (35%), 155 cases with expectoration (27%), 83 cases with muscle pain or joint pain (14%), 71 cases with diarrhea (12%), and 29 cases with headache (4%). Underlying diseases were present in 267 (46%) patients, most commonly hypertension (194, 33%), followed by diabetes (69, 12%), coronary atherosclerotic heart disease (37, 6%), tumor (18, 3%), and chronic obstructive pulmonary disease (5, 1%). Chest CT showed bilateral lung involvement in 505 patients (87%). Upon admission, the median lymphocyte count of the 582 patients was 0.8(IQR, 0.6-1.1)×10(9)/L, the median D-dimer was 0.5 (IQR, 0.4- 0.8) mg/L, the median N-terminal brain natriuretic peptide precursor (NT-proBNP) was 433 (IQR, 141- 806) pg/L, and the median creatinine was 70.3 (IQR, 56.9-87.9) μmol/L. The death group had a median lymphocyte count of 0.5 (0.4-0.8)×10(9)/L, D-dimer 1.1 (0.7-10.0)mg/L, N-terminal brain natriuretic peptide precursor 1479(893-5 087) pg/ml, and creatinine 89.9(67.1-125.3) μmol/L. Multivariate logistic analysis showed that increased D-dimer (OR: 1.095, 95% CI: 1.045-1.148, P<0.001), increased NT-proBNP (OR: 4.759, 95% CI: 2.437-9.291, P<0.001), and decreased lymphocyte count (OR: 0.180, 95% CI: 0.059-0.550, P=0.003) were the risk factors of death in COVID-19 patients. Conclusions: The average onset time of severe COVID-19 was 8 days, and the most common symptoms were fever, dry cough and fatigue. Comorbidities such as hypertension were common and mostly accompanied by impaired organ functions on admission. Higher D-dimer, higher NT-proBNP, and lower lymphocyte count were the independent risk factors of death in COVID-19 patients.

P1295OBSERVATION ON THE EFFECT OF DIGOXIN COMBINED WITH BENAZEPRIL HYDROCHLORIDE ON THE MAINTENANCE OF CHRONIC HEART FAILURE IN HEMODIALYSIS PATIENTS

Abstract Background and Aims To observe the effect of digoxin combined with benazepril hydrochloride on the heart structure and function of chronic heart failure in patients with maintenance hemodialysis. Method Choose 36 patients with maintenance hemodialysis, chronic heart failure (NYHA II - III) from 2016 to 2017 in our department. The patients were randomly divided into three groups: control group 1: digoxin (0.125mg/ day), control group 2: benapril hydrochloride (20mg/ day), and observation group: digoxin (0.125mg/ day) + benapril hydrochloride (20mg/ day), with 12 people in each group. There was no statistical difference in the clinical baseline data of the three groups of patients. The experiment mainly observed left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDV), serum troponin T, I (TnT, TnI), and serum n-terminal brain natriuretic peptide precursor (NT-proBNP), human component bioelectrical impedance analysis (BCM), the blood pressure. No other RAAS inhibitors were allowed for all patients. The observation period was 1 year. Results 1. According to the findings of cardiac ultrasound, LVEF value increased significantly and LVEDV decreased significantly in the observation group. There was a statistical difference between the observation group and the control group (P&amp;lt;0.05), while there was no statistical difference between the two control groups. 2. Serum examination showed that TnT, TnI, nt-probnp were significantly decreased in the observation group, there was a statistical difference between the observation group and the two control groups (P&amp;lt;0.05), there was no statistical difference between the two control groups. 3. During the observation period, there was no significant difference in the incidence of hyperkalemia among the three groups (P &amp;gt;0.05). Conclusion A large dose of benazepril hydrochloride combined with a small dose of digoxin, had significant effect on the cardiac structure and function of chronic heart failure in patients with maintenance hemodialysis.

Protective effect of low-dose hydrocortisone on myocardium in early septic shock

To investigate the effects and mechanisms of low-dose hydrocortisone on myocardial injury in early septic shock rats. Seventy-two healthy male Sprague-Dawley (SD) rats were divided into Sham group, lipopolysaccharide (LPS) model group (LPS group) and low dose hydrocortisone intervention group (LD group) according to the random number table method, with 24 rats in each group. The rat model of septic shock was produced by intravenous injection of LPS at 20 mg/kg. Sham group was injected with an equal amount of physiological saline. The LD group was injected 5 mg/kg of hydrocortisone via right femoral vein after model establishment. Sham group and LPS group were injected with an equal amount of physiological saline. Blood pressure and heart rate (HR) of rats in each group were continuously monitored. In each group, 8 rats were sacrificed for arterial blood gas analysis at 0, 3 and 6 hours after model establishment, and the level of plasma N-terminal B-type brain natriuretic peptide precursor (NT-proBNP) was detected by enzyme linked immunosorbent assay (ELISA). The expressions of cleaved-caspase-3 and nuclear factor-κB p65 (NF-κB p65) were detected by Western Blot. Myocardial tissue was harvested 6 hours after model establishment, the histopathological changes were observed by hematoxylin eosin (HE) staining, and the apoptosis rate of myocardial cells was detected by terminal-deoxynucleoitidyl transferase mediated nick end labeling (TUNEL). After LPS injection, mean arterial pressure (MAP) decreased significantly at 1 hour, then gradually increased, and was significantly higher than Sham group at 6 hours. There was no significant change in HR, and the difference was not statistically significant compared with Sham group. Blood lactic acid (Lac), base excess (BE), plasma NT-proBNP level, myocardial tissue caspase-3 and NF-κB p65 expression increased with the extension of time, all reach the peak in 6 hours, and significantly higher than Sham group. After early treatment with low-dose hydrocortisone in septic shock, MAP showed an increasing trend and Lac, BE decreased slowly. At 6 hours, MAP, Lac and BE were significantly lower than those in the LPS group [MAP (mmHg, 1 mmHg = 0.133 kPa): 98.6±7.5 vs. 106.1±8.5, Lac (mmol/L): 1.29±0.08 vs. 2.42±0.37, BE (mmol/L): 4.45±0.57 vs. 8.18±1.03, all P < 0.05]. The level of plasma NT-proBNP, and the expressions of caspase-3 and NF-κB p65 in myocardial tissue were significantly lower than those in LPS group at 3 hours and 6 hours after low-dose hydrocortisol treatment [NT-proBNP (ng/L): 2 740.56±97.31 vs. 4 425.60±743.32 at 3 hours, 2 638.81±205.12 vs. 4 993.01±373.78 at 6 hours; caspase-3/GAPDH: 0.567±0.045 vs. 0.841±0.162 at 3 hours, 0.496±0.071 vs. 1.116±0.172 at 6 hours; NF-κB p65/GAPDH: 0.852±0.734 vs. 1.232±0.115 at 3 hours, 0.783±0.047 vs. 1.383±0.215 at 6 hours, all P < 0.05]. HE staining results showed that myocardial cells in the LPS group were broken and inflammatory cells infiltrated. The myocardial histopathological changes in LD group were significantly less than those in LPS group. TUNEL staining showed that the apoptosis of myocardial cells in LPS group increased, and the apoptosis rate was significantly higher than that in Sham group [(82.41±1.57)% vs. (5.77±0.69)%, P < 0.05]. The apoptosis rate in LD group was significantly lower than that in LPS group [(27.82±1.77)% vs. (82.41±1.57)%, P < 0.05]. Low-dose hydrocortisone plays a protective role in the myocardial injury of early septic shock, and its mechanism may be related to the inhibition of caspase-3 and NF-κB p65 expression, the reduction of apoptosis rate and myocardial inhibition.

Improvement of cardiac function in CHF patients treated with acupuncture and moxibustion and western conventional medicine

Objective To investigate the effect of warm acupuncture combined with Western medicine on cardiac function in patients with CHF. Methods A total of 120 patients with CHF who met the inclusion criteria were randomly divided into two groups, 60 in each group. The control group was treated with conventional medicine, and the Chinese and western medicine group was combined with warm acupuncture on the basis of the control group. Both groups were treated for 4 weeks. The 6 min walking distance were compared. The LVEF%, LVEDd, and LVESd were measured by color Doppler ultrasound. The Plasma NT-proBNP was detected by ELISA. Results The total effective rate was 95.0% (57/60) in the Chinese and western medicine group and 90.0% (54/60) in the Western medicine group. The difference was statistically significant (Z=-2.218, P=0.027). After treatment, the LVEF% level of the Chinese and western medicine group (49.5% ± 4.7% vs. 47.0% ± 4.5 %, t=2.976), 6 min walking distance (348.9 ± 38.1 m vs. 319.7 ± 35.0 m, t= 5.107) were significantly higher than those of the Western medicine group (P<0.01); and the LVEDd (47.3 ± 4.0 mm vs. 50.0 ± 4.6 mm, t=-3.431), LVESd (38.5 ± 3.5 mm vs. 40.8 ± 3.9 mm, t=-3.400), NT-proBNP (750.2 ± 158.5 ng/L vs. 900.4 ± 183.7 ng/L, t=4.960) were significantly lower than those of the western medicine group (P<0.01). Conclusions Warm acupuncture combined with Western medicine can improve the heart function of CHF patients. Key words: Heart failure; Needle warming therapy; Acupuncture points; Amino terminal brain natriuretic peptide precursor; Integrated Chinese traditional and western medicine therapy

Pediatric Pulmonary Hypertension on the World Stage: Do We Need Separate Neonatal Guidelines?

Pediatric Pulmonary Hypertension on the World Stage: Do We Need Separate Neonatal Guidelines?

Effect of NIPPV in the treatment of AECOPD complicated with type II respiratory failure and its influence on blood gas index

Objective To investigate the effect of noninvasive positive pressure ventilation(NIPPV) in the treatment of patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD) complicated with type Ⅱ respiratory failure and its influence on blood gas index. Methods From August 2014 to December 2016, the clinical data of 79 patients with AECOPD complicated with type Ⅱ respiratory failure in the Central Hospital of Shanxi Coal were retrospectively analyzed.The patients were divided into two groups according to different treatment methods.Thirty-five patients in the control group were treated with conventional therapy, 44 patients in the observation group were treated with conventional NIPPV.The blood gas index, nutritional index, plasma N-terminal brain natriuretic peptide precursor(NT-proBNP), lactate(Lac) and the changes of procalcitonin (PCT), soluble myeloid cell trigger receptor-1(sTREM-1) level were compared between the two groups. Results There were no statistically significant differences in respiratory frequency, blood gas index and APACHE Ⅱ score between the two groups before treatment(P=0.282, 0.177, 0.485, 0.472, 0.485). The levels of pH (7.41±0.07) and PaO2[(82.30±6.99)mmHg]in the observation group were higher than those in the control group(t=9.357, 5.328, P=0.000, 0.000). The respiratory frequency[(20.02±2.15)times/min], PaCO2[(52.36±5.15)mmHg]and APACHE Ⅱ score[(18.20±1.01)points]in the observation group were lower than those in the control group(t=7.782, 10.608, 9.360, P=0.000, 0.000, 0.000). There were no statistically significant differences between the two groups in the levels of nutritional indicators before treatment(t=0.027, 0.039, 0.068, P=0.488, 0.485, 0.473). After treatment, the serum total protein level in the observation group was higher than that in the control group, but the levels of serum albumin and hemoglobin had no statistically significant differences compared with those in the control group(t=3.606, 1.659, 0.034, P=0.000, 0.051, 0.486). There were no statistically significant differences in the levels of Lac, NT-proBNP, inflammatory factors between the two groups before treatment(P=0.465, 0.477, 0.451, 0.493). The levels of Lac[(1.57±0.55)mmol/L], NT-proBNP[(130.25±42.36)ng/L], PCT[(0.16 ±0.09)g/L], sTREM-1[(66.36±12.87)ng/L]in the observation group were lower than those in the control group(t=7.662, 2.248, 4.030, 2.709, P=0.000, 0.014, 0.000, 0.004). After treatment, the respiratory rate, blood gas index and APACHE Ⅱ score of the two groups were improved compared with those of the control group(all P 0.05). Conclusion NIPPV in the treatment of AECOPD complicated with type Ⅱ respiratory failure can effectively improve the blood gas status and nutritional status of patients, and reduce the body Lac and NT-proBNP levels. Key words: Positive-pressure respiration; Ventilators, mechanical; Pulmonary disease, chronic Obstructive; Respiratory insufficiency; Blood gas analysis; Nutrition assessment; Natriuretic peptide, brain; Procalcitonin; Lactic acid