Brain-type Natriuretic Peptide Levels Research Articles

Effect of Volume Removal by Hemodialysis on Elevated N-Terminal Pro Brain-Type Natriuretic Peptide (NT-ProBNP) Level

Effect of Volume Removal by Hemodialysis on Elevated N-Terminal Pro Brain-Type Natriuretic Peptide (NT-ProBNP) Level

Risk factors associated with atrial fibrillation following lung cancer surgery: A multi-center case-control study

BackgroundPostoperative atrial fibrillation (POAF) is a common complication after major thoracic operations. The objective of this case–control study was to identify the risk factors for POAF following lung cancer surgery. MethodsIn total, 216 patients with lung cancer who were selected from three different hospitals were followed up between May 2020 and May 2022. They were divided into two groups: case group, patients with POAF and control group, patients without POAF (case–control). Risk factors associated with POAF were investigated using univariate and multivariate logistic regression analyses. ResultsRisk factors that were significantly associated with POAF were preoperative brain-type natriuretic peptide (BNP) levels [odds ratio (OR): 4.46; 95% confidence interval (CI): 1.52–13.06; P = 0.0064], sex (OR: 0.07; 95%CI: 0.02–0.28; P = 0.0001), preoperative white blood cell (WBC) count (OR: 3.00; 95%CI: 1.89–4.77; P < 0.0001), lymph node dissection (OR: 11.49; 95%CI: 2.81–47.01; P = 0.0007), and cardiovascular disease (OR: 4.93; 95%CI: 1.14–21.31; P = 0.0326). ConclusionIn summary, data from the three hospitals suggested that preoperative BNP levels, sex, preoperative WBC count, lymph node dissection, and hypertension/coronary heart disease/myocardial infarction were associated with a significantly high risk of POAF following lung cancer surgery.

The Fontan Udenafil Exercise Longitudinal Trial: Subgroup Analysis.

The Pediatric Heart Network's Fontan Udenafil Exercise Longitudinal (FUEL) Trial (Mezzion Pharma Co. Ltd., NCT02741115) demonstrated improvements in some measures of exercise capacity and in the myocardial performance index following 6months of treatment with udenafil (87.5mg twice daily). In this post hoc analysis, we evaluate whether subgroups within the population experienced a differential effect on exercise performance in response to treatment. The effect of udenafil on exercise was evaluated within subgroups defined by baseline characteristics, including peak oxygen consumption (VO2), serum brain-type natriuretic peptide level, weight, race, gender, and ventricular morphology. Differences among subgroups were evaluated using ANCOVA modeling with fixed factors for treatment arm and subgroup and the interaction between treatment arm and subgroup. Within-subgroup analyses demonstrated trends toward quantitative improvements in peak VO2, work rate at the ventilatory anaerobic threshold (VAT), VO2 at VAT, and ventilatory efficiency (VE/VCO2) for those randomized to udenafil compared to placebo in nearly all subgroups. There was no identified differential response to udenafil based on baseline peak VO2, baseline BNP level, weight, race and ethnicity, gender, or ventricular morphology, although participants in the lowest tertile of baseline peak VO2 trended toward larger improvements. The absence of a differential response across subgroups in response to treatment with udenafil suggests that the treatment benefit may not be restricted to specific sub-populations. Further work is warranted to confirm the potential benefit of udenafil and to evaluate the long-term tolerability and safety of treatment and to determine the impact of udenafil on the development of other morbidities related to the Fontan circulation.Trial Registration NCT0274115.

Treprostinil in Neonates with Congenital Diaphragmatic Hernia-Related Pulmonary Hypertension

To describe our experience with treprostinil, evaluate correlations with cardiac function, and assess for adverse effects in neonates with congenital diaphragmatic hernia-related pulmonary hypertension (CDH-PH). A retrospective review of a single-center prospective registry at a quaternary care children's hospital. Patients included in the study had CDH-PH treated with treprostinil between April 2013 and September 2021. Assessed outcomes were brain-type natriuretic peptide levels and quantitative echocardiographic parameters collected at baseline, 1week, 2weeks, and 1month after treprostinil initiation. Right ventricular (RV) function was assessed by tricuspid annular plane systolic excursion Z-score and speckle tracking echocardiography (global longitudinal and free wall strain). Septal position and left ventricular (LV) compression were assessed by eccentricity index and M-mode Z-scores. Fifty-one patients were included, with an average expected/observed lung-to-head ratio of 28.4±9.0%. Most patients required extra-corporeal membrane oxygenation (n=45, 88%). Survival to hospital discharge was 31/49 (63%). Treprostinil was initiated at a median age of 19days with a median effective dose of 34ng/kg/minute. Median baseline brain-type natriuretic peptide level decreased from 416.9 pg/mL to 120.5 pg/mL after 1month. Treprostinil was associated with improved tricuspid annular plane systolic excursion Z-score, RV global longitudinal strain, RV free wall strain, LV eccentricity index, and LV diastolic and systolic dimensions, reflecting less compression by the RV, regardless of ultimate patient survival. No serious adverse effects were recorded. In neonates with CDH-PH, treprostinil administration is well tolerated and is associated with improved RV size and function.

Prognostic implications of post-discharge hemodynamic congestion assessed by peripheral venous pressure among patients discharged from acute heart failure

BackgroundCongestion is a major cause of hospitalization for heart failure (HF). Peripheral venous pressure (PVP) strongly correlates with right atrial pressure. We recently reported that high PVP at discharge portends a poor prognosis in patients hospitalized for HF. In the same population, we aimed to analyze changes in PVP after discharge and to evaluate prognostic implications of post-discharge PVP. MethodsPVP was measured at the forearm vein of 163 patients in the 1-month post-discharge follow-up visit. The primary outcome was a composite of cardiovascular death or re-hospitalization for HF after the 1-month follow-up visit up to 1 year after discharge. ResultsPost-discharge PVP correlated with jugular venous pressure, the inferior vena cava diameter, and brain-type natriuretic peptide levels. The cumulative incidence of the primary outcome event was significantly higher in patients with PVP above the median (6 mmHg) than in those with median PVP or lower (39.8% versus 16.9%, Log-rank P = 0.04). Age- and sex-adjusted risk of PVP per 1 mmHg for the primary outcome measure was significant (hazard ratio: 1.12 [95% confidence interval 1.03–1.21]). 35% of patients who had PVP ≤6 mmHg at discharge had PVP >6 mmHg at the 1-month follow-up. PVP significantly decreased from discharge to 1-month follow-up in patients without the primary outcome event (from 6 [4–10] to 6 [4–8] mmHg, P=0.01), but remained high in those with the primary outcome event (from 8 [5–11] to 7 [5–10.5] mmHg, P = 0.9). ConclusionsPVP measurements during the early post-discharge period may be useful to identify high risk patients.Trial registration number: UMIN000034279.

Vanillic Acid Alleviates Right Ventricular Function in Rats With MCT-Induced Pulmonary Arterial Hypertension

This study examined the molecular processes behind the effects of vanillic acid (VA) on right ventricular (RV) hypertrophy and function in rats with monocrotaline (MCT)-induced pulmonary arterial hypertension (PAH). There were 40 male Sprague‒Dawley (SD) rats that were separated into 4 groups: Control, PAH, MCT + VA (50 mg/kg/d), and MCT + VA (100 mg/kg/d). Male SD rats were injected with MCT once under the skin to create the PAH model (40 mg/kg). RV morphological properties were evaluated using Masson and hematoxylin and eosin (H&amp;E) staining. Echocardiography was used to evaluate RV functioning and right ventricle–pulmonary artery (RV-PA) coupling. In addition, Rho-associated protein kinase (ROCK) pathway-related factors were evaluated using Western blotting. Enzyme-linked immunosorbent assay (ELISA) was used to detect inflammatory markers as well as atrial natriuretic peptide (ANP) and brain-type natriuretic peptide (BNP) in the blood of PAH rats. As a result, VA effectively reduced the development of RV cardiomyocyte hypertrophy and fibrosis in PAH rats; levels of ANP, BNP, and inflammatory markers in the blood of PAH rats were also significantly decreased by VA intervention. Additionally, VA enhanced RV functioning and RV-PA coupling in PAH rats. In response to VA, the expression of proteins related to the ROCK pathway (ROCK1, ROCK2, NFATc3, P-STAT3, and Bax) was downregulated, whereas Bcl-2 expression was elevated. This study found that VA could attenuate RV remodeling and improve RV-PA coupling in PAH rats. RV remodeling and dysfunction may be linked to the dysregulation of the ROCK pathway, and the protective action of VA on RV function may be due to a block in the ROCK signaling pathway or its downstream signaling molecules.

Assessment of Relationship between Serum NT-proBNP Levels with Clinical Features and Prognosis in Acute Ischemic Stroke Patients.

We aimed to assess N-terminal pro brain-type natriuretic peptide (NT-proBNP) levels in acute ischemic stroke (AIS) patients according to clinical and radiological features and to investigate its relationship with short term clinical outcomes. In our study, 107 patients with AIS were evaluated prospectively. Of all, 56 patients had no evidence of atrial fibrillation (AF) (sinus rhythm [SR] group) (52.3%), 24 patients had paroxysmal AF (pAF group) (22.4%), and the other 27 patients had chronic AF (cAF group) (25.3%). Demographic datas, clinical characteristics, laboratory and radiological findings, CHA2DS2 -VASc scores, NIHSS (National Institute of Health Stroke Scale) and modified Rankin Scale (mRS) scores on admission and at the third month evaluations were recorded. Good functional outcome at 3 months was defined as modified Rankin score (mRS) 2 or less. According to the TOAST (Trial of Org 10172 in Acute StrokeTreatment) and OCSP (Oxfordshire Community Stroke Project) study, ischemic stroke subtyping was performed. Serum NT-proBNP levels were estimated in 107 stroke patients and 24 age- and sex-matched control subjects. Venous blood samples were obtained for serum NT-proBNP measurement within the first 48 hours of the patient group. Mean age of the 107 AIS patients was 68 ± 15.22 years and 58.9% of them were women. Compared to controls, the SR, pAF and cAF groups had higher plasma NT-proBNP levels (P < 0.001) and also NT-proBNP values were significantly higher in the pAF and cAF group than SR groups (P < 0.001). NT-proBNP values were significantly higher in cardioembolic (CE) (n = 57) group than in large artery atherosclerosis (LAA) (n = 20) and small vessel disease (SVD) (n = 30) groups (P < 0.001). NT-proBNP levels of noncardioembolic SR (n = 49) (P = 0.080), LAA and SVD groups (P = 0.103) were higher than the control group but the difference was not statistically significant. There was a positive correlation between NT-proBNP level and third month mRS scores in CE group (r = 0.491). NT-proBNP will contribute to predict cardioembolic and pAF groups and estimate the prognosis.

Impact of levosimendan on efficacy and renal function in acute heart failure according to renal function: A perspective, multi-center, real-world registry

Acute heart failure (AHF) is associated with high mortality. Levosimendan, an inodilator, has proved to increase cardiac output and exert renoprotective effect in AHF. Our aim was to investigate the efficacy and renoprotective effects of levosimendan in patients with AHF and different renal function. This is a prospective, observational, multi-center registry. Patients admitted with AHF between June 2020 and May 2022 and treated with levosimendan during the hospital stay were included. Baseline characteristics, laboratory tests, electrocardiogram (ECG), chest X-ray, echocardiography, and treatment were collected. A 5-point Likert scale was used to document patients' baseline dyspnea. The estimated glomerular filtration rate (eGFR) was calculated by means of the Modification of Diet in Renal Disease equation. After levosimendan infusion, patients underwent assessment of degree of dyspnea, and levels of brain-type natriuretic peptide (BNP) /N-terminal pro-BNP (NT-pro BNP), and eGFR repeatedly. Among 789 AHF patients who received levosimendan treatment in this study, 33.0 % were female, mean age was 64.9 ± 16.8 years, and mean eGFR was 72.6 ± 32.5 ml/min/m2. The mean score of dyspnea was 3.0 ± 1.0 using 5-point Likert scale before levosimendan infusion. Dyspnea improved in 68.7% patients at 6h after infusion of levosimendan, and in 79.5% at 24 h. Lower eGFR was associated with lower efficacy rate after 6h infusion (71.7, 70.7, 65.2, and 66.0%, respectively) and after 24 h infusion (80.5, 81.4, 76.2, and 77.8%, respectively). The levels of BNP or NT-pro BNP were also decreased after levosimendan treatment, and in each eGFR category. Levels of eGFR increased from baseline (72.6 ± 32.5 ml/min/m2) to 12-24h (73.8 ± 33.5 ml/min/m2) and 24-72h (75.0 ± 33.4 ml/min/m2) after starting treatment (p < 0.001). However, the eGFR levels increased only in patients with eGFR lower than 90.0 ml/min/m2. In AHF patients who received levosimendan, degree of dyspnea and levels of BNP or NT-pro BNP were significantly improved, especially in patients with higher eGFR levels. However, levosimendan infusion increase eGFR only in AHF patients with renal dysfunction.

Effects of Sildenafil on spirometric pulmonary function parameters, pulmonary artery systolic pressure and BNP levels in patients with chronic obstructive pulmonary disease and erectile dysfunction

We aimed to investigate the effects of Sildenafil on pulmonary artery systolic pressure (PASP) as well as forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) and serum brain-type natriuretic peptide (BNP) levels in stable chronic obstructive pulmonary disease (COPD) patients with erectile dysfunction (ED). This was a prospective non-controlled interventional study that recruited COPD patients with ED between the ages of 49 and 79. International Index of Erectile Dysfunction Form (IIEF-5) was used for the evaluation of ED. Patients who had pulmonary artery systolic pressure &amp;#62;50 mmHg were included in the study. Single-dose Sildenafil 100 mg was administered orally to the patients. Before and after the drug ingestion, spirometry and echocardiographic measurements were performed, and serum BNP levels were measured as well. Forty-five male COPD patients with ED were included. Both percent predicted, and absolute FEV1 values increased significantly after the Sildenafil administration compared with baseline values (p&amp;#60;0.01). Similarly, the FEV1/FVC ratio also increased significantly with the Sildenafil administration compared to baseline values (p&amp;#60;0.01). Pulmonary artery systolic pressure significantly decreased from its baseline value with Sildenafil administration (p&amp;#60;0.01). Serum BNP values significantly reduced with Sildenafil administration compared to the pre-treatment values (p&amp;#60;0.01). This is the first study conducted in COPD patients with erectile dysfunction who had also pulmonary hypertension. The single-dose Sildenafil administration reduced PASP and serum BNP levels significantly. For the first time in the literature, we showed that the spirometric pulmonary function tests, namely FEV1 and FEV1/FVC ratio, improved significantly with the Sildenafil administration.

Preparation of Nanographene and Its Effect on the Correlation Between N-Terminal Pro Brain-Type Natriuretic Peptide, Peripheral Blood Copeptin Level and Cardiac Function Grading of Patients with Heart Failure

At present, biosensors based on nanomaterials are increasingly adopted in clinical detection of heart failure (HF) patients. This work aimed to analyze the correlation between N-terminal pro brain-type natriuretic peptide (NT-proBNP) and copeptin (CPT) levels in order to study the grading of heart function in patients with HF under the fluorescence platform built on nanographene. The and detection principle of of nanographene solution was prepared, and After its physical and chemical properties were tested, the nanographene solution was then used to detect the expression levels of NT-proBNP and CPT in patients with heart failure. Seventy-two patients with heart failure who came to hospital were selected as the observation group, and another 50 healthy people with physical examination were selected as the control group. The results showed that the constructed nanographene solution mixed with NT-proBNP didn’t exhibit fluorescence quenching. Therefore, it was feasible to detect NT-proBNP with nanographene solution. The test results obtained after the detection of different concentrations of nanographene showed that 20 μg/mL nanographene had the best fluorescence quenching effect. The ROC curve of the constructed nanographene had improved specificity in judging heart failure and had better diagnostic performance. The levels of pro-brain natriuretic peptide and copeptin in patients with heart failure were obviously higher than those in the observation group, and there was considerable difference between the two (P &lt; 0.05). After correlation analysis, it was found that the levels of terminal pro-brain natriuretic peptide and copeptin in patients with heart failure were positively correlated with the grade of heart function in patients with heart failure. In summary, the nanographene solution used in this study can accurately detect the expression level of NT-proBNP in patients with heart failure, and the accuracy and efficiency of diagnosis were improved in patients with heart failure. Moreover, the higher the grade of cardiac function in HF patients, the higher NT-proBNP and CPT levels, and there was positive correlation between cardiac function grade and NT-proBNP and CPT levels.

Cardiac Complications in Pregnancy: A Systematic Review and Meta-Analysis of Diagnostic Accuracy of BNP and N-Terminal Pro-BNP.

IntroductionSerum brain-type natriuretic peptide (BNP) levels may be involved in detecting the breakdown of defense mechanisms in pregnant women. BNP and N-terminal pro-BNP (NT-proBNP) levels can be used in emergency settings as a biomarker to rule out or confirm cardiac complications. The present study was conducted as an attempt to evaluate the performance of BNP and NT-proBNP as diagnostic tools for cardiac complications, including heart failure and pre-eclampsia, in pregnant and recently-delivered women.MethodsThis meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. To extract the data, articles meeting the inclusion criteria were directly reviewed by two of the authors. Disputes were resolved through discussion with all authors before data mining. In cases of unresolved disagreement, a third reviewer was consulted to achieve consensus. A quantitative analysis of the total bias of publications was performed using Stata software version 14.0, using funnel plots and Deek’s test.ResultsOverall, 13 unique studies were included in this review. The pooled sensitivity, specificity and positive and negative predictive values for diagnosing cardiac complications in pregnant women when BNP level was ≤ 100 ng/L, were determined to be 95, 62, 71 and 91%, respectively. The corresponding measures when the BNP levels were 100–500 ng/L were calculated to be 98, 92, 97 and 92%, respectively. The pooled sensitivity, specificity and positive and negative predictive values for diagnosing cardiac complications in pregnant women using NT-proBNP were 78, 74, 20.5 and 97%, respectively.ConclusionOur results suggest that both BNP and NT-proBNP levels can be used as diagnostic tools among pregnant and newly-delivered women to diagnose cardiac complications, including heart failure and pre-eclampsia. While BNP showed a relatively better diagnostic accuracy compared to NT-proBNP, it must be noted that the number of studies evaluating NT-proBNP included in this meta-analysis was low and the studies were inconsistent in terms of cutoff value. Further studies are required to confirm the prospective use of BNP and NT-pro BNP in assessing common symptoms that indicate cardiac complications during labor. Moreover, the clinical use of the NT-proBNP test in this field requires further study.

Preoperative laboratory testing in elderly patients.

Purpose of reviewPreoperative testing in elderly patients is performed to examine the patient's current medical condition in the context of evaluating vulnerabilities and predicting postoperative complications to ensure that all functions recover before surgery. This review focused on preoperative laboratory tests in geriatric patients.Recent findingsPreoperative complete blood count, electrolyte testing, and blood chemistry can predict postoperative complications. Preoperative elevated morning/evening salivary cortisol secretion ratio, C-reactive protein/albumin ratio (CAR), neutrophil/lymphocyte ratios, and preoperative decreased serum albumin level or 25-hydroxyvitamin D levels can predict postoperative cognitive dysfunction. Elevated brain-type natriuretic peptide or serum alkaline phosphatase levels can be biomarkers of major postoperative adverse cardiac events. Decreased preoperative estimated glomerular filtration rates and serum albumin levels can predict acute kidney injury. Hyponatremia, hypocalcemia, and low albumin/fibrinogen ratio predict postoperative complications. Hypoalbuminemia can predict surgical site infection or postoperative mortality after hip fracture surgery. A high CAR can predict anastomotic site leakage and is a risk factor for one-year mortality after hip surgery.SummaryPreoperative laboratory testing helps predict postoperative adverse complications; thus, a plan of care can be initiated.

Evaluation of Circulating Cardiovascular Biomarker Levels for Early Detection of Congenital Heart Disease in Newborns in Sweden

Congenital heart disease (CHD) is the most common congenital malformation in humans worldwide. Circulating cardiovascular biomarkers could potentially improve the early detection of CHD, even in asymptomatic newborns. To assess the performance of a dried blood spot (DBS) test to measure the cardiovascular biomarker amino terminal fragment of the prohormone brain-type natriuretic peptide (NT-proBNP) levels in newborns and to compare DBS with standard EDTA analysis in control newborns during the first week of life. This diagnostic study was conducted in a single regional pediatric service in southern Sweden. Healthy, term neonates born between July 1, 2018, and May 31, 2019, were prospectively enrolled and compared against retrospectively identified newborns with CHD born between September 1, 2003, and September 30, 2019. Neonates who required inpatient treatment beyond the standard postnatal care were excluded. New DBS test for NT-proBNP quantification in newborns that used 3 μL of blood vs the current screening standard. Performance of the new test and when combined with pulse oximetry screening was measured by receiver operating characteristic curve analysis. Performance of the new test and EDTA screening was compared using Pearson linear correlation analysis. The DBS samples of 115 neonates (81 control newborns and 34 newborns with CHD, of whom 63 were boys [55%] and the mean [SD] gestational age was 39.6 [1.4] weeks) were analyzed. The new NT-proBNP test alone identified 71% (n = 24 of 34) of all CHD cases and 68% (n = 13 of 19) of critical CHD cases as soon as 2 days after birth. Detection of any CHD type improved to 82% (n = 28 of 34 newborns) and detection of critical CHD improved to 89% (n = 17 of 19 newborns) when combined pulse oximetry screening and NT-proBNP test results were used. Performance of the NT-proBNP test was excellent when control newborns were matched to newborns with CHD born between July 1, 2018, and May 31, 2019 (area under the curve, 0.96; SE, 0.027; 95% CI, 0.908-1.0; asymptotic P < .05). This study found that NT-proBNP assay using minimal DBS samples appears to be timely and accurate in detecting CHD in newborns and to discriminate well between healthy newborns and newborns with various types of CHD. This finding warrants further studies in larger cohorts and highlights the potential of NT-proBNP to improve neonatal CHD screening.

Abstract 14550: Sex Differences on Time-dependent Changes in Brain-type Natriuretic Peptide Among Patients With Hypertrophic Cardiomyopathy

Introduction: Sex differences in biomarkers such as brain-type natriuretic peptide (BNP) have not been fully elucidated among patients with hypertrophic cardiomyopathy (HCM). Hypothesis: Sex affects transition of BNP concentration among patients with HCM. Methods: This retrospective cohort study analyzed clinical personal record of HCM, a national database of Japanese Ministry of Health, Labor and Welfare, between 2009 and 2014. This record annually collected HCM patient data. Patients with HCM who were assessed with BNP concentration both at baseline and 2-year follow-up were included. Patients were excluded if they received ventricular assist device or heart transplantation during follow-up period. Outcomes were assessed according to sex. The primary endpoint was BNP concentration at 2-year follow-up. The log-transformed BNP concentration at 2-year was analyzed by analysis of covariance adjusted for baseline characteristics including baseline BNP. The cubic spline analysis of BNP concentration at 2-year for sex by BNP concentration was performed. Results: Out of 3,570 patients enrolled in the clinical personal record of HCM, 611 patients were included in the present analysis. Mean age was 60.4 years and female and male were 254 (41.6%) and 357 (58.4%), respectively. Left ventricular (LV) ejection fraction was higher in female (64.7 ± 14.5 vs. 61.4 ± 16.0%, P =.012), LV diastolic diameter (43.4 ± 7.8 vs. 48.0 ± 8.0 mm, P &lt;.001), LV systolic diameter (27.3 ± 8.9 vs. 31.2 ± 9.0 mm, P &lt;.001), posterior wall thickness (11.2 ± 3.0 vs. 11.9 ± 3.8 mm, P =.011), and left atrial diameter (41.8 ± 8.8 vs. 45.8 ± 10.1 mm, P &lt;.001) were smaller in female. Baseline BNP concentration was higher in female (320.3 [159.0-583.1] vs. 182.8 [86.1-363.9], P &amp;lt;.001). Female sex was associated with higher log-transformed BNP at 2-year in both complete case analysis (coefficient 0.31; 95% confidence interval [CI] 0.13-0.48; P &lt;.001) and multiple imputation analysis (coefficient 0.63: 95% CI 0.44-0.82; P &lt;.001). Cubic spline analysis showed that female sex was associated with higher BNP concentration at 2-year irrespective of baseline BNP concentration. Conclusions: Female sex was associated with higher BNP levels at 2-year follow-up compared with male sex in HCM.

Right Ventricular Strain, Brain Natriuretic Peptide, and Mortality in Congenital Diaphragmatic Hernia.

Rationale: Brain-type natriuretic peptide (BNP) correlates with pulmonary hypertension as demonstrated by echocardiogram in congenital diaphragmatic hernia (CDH); however, its association with right ventricular (RV) function and mortality is unknown.Objectives: To characterize the relationships between echocardiogram-derived RV strain, BNP, and mortality in diaphragmatic hernia.Methods: We performed a single-center retrospective cohort study of infants with CDH and at least one BNP-echocardiogram pair within a 24-hour period. RV global longitudinal strain (GLS) and free-wall strain (FWS) were measured on existing echocardiograms. Associations among strain, BNP, and mortality were tested using mixed-effect linear and logistic regression models. Survival analysis was stratified by BNP and strain abnormalities.Results: There were 220 infants with 460 BNP-echocardiogram pairs obtained preoperatively (n = 237), ≤1 week postoperatively (n = 35), and >1 week postoperatively ("recovery"; n = 188). Strain improved after repair (P < 0.0001 for all periods). Higher BNP level was associated with worse strain in recovery but not before or immediately after operation (estimate [95% confidence interval] for recovery: GLS, 1.03 [0.50-1.57]; P = 0.0003; FWS, 0.62 [0.01-1.22]; P = 0.047). BNP and strain abnormalities were associated with an extracorporeal-membrane oxygenation requirement. Higher BNP level in recovery was associated with greater mortality (odds ratio, 11.2 [1.2-571.3]; P = 0.02). Abnormal strain in recovery had high sensitivity for detection of mortality (100% for GLS; 100% for FWS) but had low specificity for detection of mortality (28% for GLS; 48% for FWS).Conclusions: Persistent RV dysfunction after CDH repair may be detected by a high BNP level and abnormal RV strain.

Prognostic and Predictive Value of Serum b-Type Natriuretic Peptide in Early Mortality and Morbidity of Children with Congenital Heart Disease after Open Heart Surgery

Epilepsy is a common neurodegenerative disease with an increasing morbidity. Clinical treatment of epilepsy includes symptomatic treatment, etiological treatment, surgery and prevention. The aim of the present study was to determine the effects of antiepileptic drugs (AEDs) on serum folate and vitamin B12 in various epileptic patients. Brain type natriuretic peptide (BNP) is a cardiac hormone that is secreted mainly by the ventricles in response to volume expansion and pressure load. It can predict post-operative complications after open cardiac surgery in children. We sought to evaluate the prognostic and predictive values of proBNP in children after heart surgery.This study was a prospective observational study conducted on patients with congenital heart diseases admitted to the pediatric cardiology department in Cairo University Children Hospital and Atfal Maser Hospital during 2 years interval from February 2016 to March 2018.The study was conducted on 45 cases age range from 0 up to 12 years, who are previously listed and prepared for open heart surgery. Brain natriuretic peptides determinations might be a useful tool for clinicians caring for infants and children after surgical intervention for congenital heart disease. The aim of this study is to compare perioperative changes in plasma brain natriuretic peptides in children undergoing open heart surgery and to evaluate effect of cardiopulmonary bypass on proBNP levels.The results in the present study revealed preoperative BNP assay of the 45 cases with a mean 239.6 +/- 829.7 pg/ml (median =32.0 pg/ml) and postoperative BNP assay with a mean 1412.2 +/-1279.1 pg/ml.In the current study, a comparison between preoperative and postoperative BNP values was done and revealed the total mean difference between pre and postoperative BNP was with a mean 1,172.5838 pg/ml +/- 936.6379 pg/ml with a significant p-value (0.00). We have found many studies in agreement with the results in the current study which have showed increase in BNP levels after surgery. ProBrain natriuretic peptides determinations might be a useful tool for clinicians caring for infants and children after surgical intervention for congenital heart disease. Mechanical ventilation duration, inotropic score calculation as well as Core-peripheral temperature difference are of value when correlated to postoperative BNP measurements. ProBNP cut off values in predicting poor outcome are of paramount importance.

Correlation between Lung Ultrasound B-lines and Overhydration by Spectroscopy Bioimpedance in Hemodialysis Patients

Abstract Introduction: Overhydration (OH) is a frequent on Hemodialysis (HD). OH is evidenced by Lung Ultrasound (LUS) as B-lines. We aimed to find if a correlation existed between the presence of B-lines and OH as measured by Bioimpedance (BIA) and Brain-Type Natriuretic Peptide (BNP), in patients on HD. Methodology: A single-center, cross-sectional study. OH was assessed by BIA and LUS in 17 HD patients. We correlated the number of pre-dialysis B-lines with BIA, BNP levels and systolic blood pressure. Results: Seventeen patients met the inclusion criteria; mean age was 44.1 ± 20.75 years, 76% were hypertensive, and 41% were diabetics; twenty-three percent presented edema, and 35% jugular engorgement. Body mass index was normal in 7 (41%). The patients received an average of 2.82 HD/week, with similar sodium conductivity (13.6 mS/cm), and ultrafiltration of 1.94 ± 0.85 kg. Serum Na was 134 ± 2.5 mEq/L, albumin was 3.6 ± 0.3 g/dL. A positive correlation was found between the number of B-lines and OH by BIA (r= 0.62, r2 0.38, p = 0.008), BNP levels (r= 0.7, r2 0.52, p = 0.001) and SBP (r= 0.71, r2 0.21, p = 0.001). No correlation was found between dry weight and the presence of B-lines. Conclusions: We found a positive correlation between the presence of B-lines and OH as measured by BIA, BNP, and SBP. LUS could be a useful tool to estimate OH in HD patients, with the advantage of being an accessible method that can be performed at the patient’s bedside.

Brain-type natriuretic peptide level in pregnant women with congenital heart disease predicts SGA offspring.

Women with congenital heart disease (CHD) commonly experience complications related to CHD during pregnancy. The clinical features of neonates born to mothers with CHD, however, have not been fully investigated. The frequency of small for gestational age (SGA) is high in infants born to mothers with CHD, but the risk factors have not been examined sufficiently. Therefore, we analyzed the maternal features associated with SGA infants. We enrolled pregnant women with repaired CHD and infants born to them at Tokyo Women's Medical University Hospital between April 2007 and March 2015. Eleven SGA (11%) and 91 non-SGA infants (89%) were included. On multivariate logistic regression, SGA infants were significantly more likely to be associated with a high maternal brain-type natriuretic peptide (BNP) level (OR, 6.7; 95%CI: 1.3-34.5; P = 0.02) and maternal single ventricle disease (OR, 8.4; 95%CI:1.4-51.8; P = 0.02) than were non-SGA infants. The incidence of SGA infants born to mothers with CHD was not high in this study. High BNP and maternal single ventricle disease, however, are independent predictors of SGA in infants.

Cyclophilin A as a biomarker for the therapeutic effect of balloon angioplasty in chronic thromboembolic pulmonary hypertension

BackgroundAlthough cardiac troponin and natriuretic peptide have been shown to decrease after balloon pulmonary angioplasty (BPA) with improved right ventricular afterload in chronic thromboembolic pulmonary hypertension (CTEPH), biomarkers to evaluate the effects of BPA independently of heart failure status remain to be developed. MethodsIn 39 consecutive CTEPH patients including 31 who underwent BPA, we measured plasma levels of cyclophilin A (CyPA), which we demonstrated is secreted from pulmonary vascular smooth muscle cells in response to mechanical stretch and hypoxia. ResultsCyPA levels were elevated in CTEPH patients (12.7, IQR: 7.6-16.0) compared with 8 thromboembolic controls with a history of venous thromboembolism (4.9, IQR: 2.4-11.2) or 18 healthy controls (4.1, IQR: 2.4-6.8) (both p< 0.05) and were linearly correlated with mean pulmonary arterial pressure (r=0.50, p = 0.0003) and pulmonary vascular resistance (r=0.32, p= 0.026). BPA reduced CyPA levels and tended to lower brain-type natriuretic peptide (BNP) levels (p< 0.01 and p = 0.07). When comparing the changes in CyPA before and after BPA in the two subgroups with higher (≥35pg/mL) and normal (<35pg/mL) BNP at baseline, CyPA decreased both in patients with higher BNP and those with normal BNP (both p< 0.05). In contrast, BNP decreased only in patients with higher BNP (p< 0.05). Also, CyPA decreased both in patients with lower (<25 kg/m2) and higher (≥25kg/m2) body mass index (BMI) at baseline (both p<0.05), whereas BPA tended to reduce BNP in patients with lower BMI (p = 0.12) but not in those with higher BMI (p = 0.55). ConclusionsCyPA could be a useful biomarker to evaluate the effects of BPA even in patients with normal BNP or high BMI.

P2634Prognostic value of admission left ventricular outflow tract velocity time integral in hospitalized heart failure patients with preserved ejection fraction: a report from the JASPER registry

Abstract Background There are little effective treatment strategies for heart failure with preserved ejection fraction (HFpEF) to achieve a reduction of morbidity and mortality. Thus, accurate prognostication of patients with HFpEF could help improve their outcomes by identifying high-risk patients who might potentially benefit from intensive inpatient and outpatient monitoring and early referral for advanced HFpEF therapy. The left ventricular outflow tract velocity time integral (LVOT-VTI) is a representative non-invasive parameter for evaluating stroke volume, which can be a determinant of adverse outcomes in hospitalized patients with heart failure. However, the prognostic implication of admission LVOT-VTI for hospitalized HFpEF patients is undetermined. Purpose The aim of the present study was to investigate whether admission LVOT-VTI could predict poor clinical outcomes in hospitalized patients with HFpEF. Methods We examined consecutive 535 hospitalized HFpEF patients (left ventricular ejection fraction ≥50%) due to acute decompensated heart failure from the JASPER (JApanese heart failure Syndrome with Preserved Ejection fRaction) multicenter registry, obtained between November 2012 and March 2015. Patients without accessible LVOT-VTI data on admission were excluded. Finally, 214 patients were examined. The primary outcome of interest was composite of all-cause death and rehospitalization due to heart failure. Results Mean age was 78±11 years, 100 were male, and median plasma brain-type natriuretic peptide level was 400 (interquartile range [IQR] 223–711) pg/ml. During a median follow-up period of 688 (IQR 162–810) days, adverse events occurred in 83 patients (39%), including 47 (22%) all-cause death, 51 (24%) rehospitalization due to heart failure. The c-index of LVOT-VTI for predicting the composite of adverse events was 0.59 (95% CI 0.51 to 0.67), and the optimal cut-off value of LVOT-VTI was 15.8 cm. Low LVOT-VTI (≤15.8 cm) was significantly associated with higher adverse events compared to high LVOT-VTI (&gt;15.8 cm) (Figure). Multivariable Cox regression analysis revealed that lower LVOT-VTI was an independent determinant of adverse events (HR 0.94, 95% CI 0.91 to 0.98, P=0.005) even after adjustment for pre-specified confounders including age, sex, systolic blood pressure, serum sodium, albumin, plasma brain-type natriuretic peptide and renal function. Figure 1 Conclusions Lower admission LVOT-VTI was an independent determinant of worse clinical outcomes in hospitalized HFpEF patients, indicating that LVOT-VTI on admission could be a useful marker for risk stratification in these patients.