Brain Natriuretic Peptide Research Articles

Development of cancer therapy-related cardiac dysfunction in anthracycline-treated breast cancer patients: a retrospective study

PurposeCardiac dysfunction as a result of anthracycline treatment is a major concern regarding the management of patient life after therapy. The aim of the present study was to determine the clinical characteristics of cancer patients at high risk of developing cancer therapy-related cardiac dysfunction (CTRCD), in order to improve the risk management for the appropriate treatment.MethodsThis is a single-center, retrospective study of patients with breast cancer who underwent anthracycline treatment and had regular consultations with cardiologists. To investigate the incidence of CTRCD and the risk factors related to its occurrence, left ventricular ejection fraction (LVEF), cardiac troponin I (TnI), and brain natriuretic peptide (BNP) were assessed in 177 patients at the start of anthracycline treatment, and again at 3, 6, 9, and 12 months.ResultsEight patients (4.5%) developed CTRCD (CTRCD group). The comparisons between the CTRCD group and those without CTRCD (non-CTRCD group) showed significant differences in pre-treatment cancer stage and neutrophil/lymphocyte ratio (NLR). Multivariate analysis showed a strong association between pre-treatment cancer stage, NLR, and type of anthracycline administered (epirubicin or doxorubicin).ConclusionHigh NLR, the more advanced stages of cancer, and doxorubicin administration were suggested as possible risk factors for the development of CTRCD. Special attention should be warranted for patients with any of these risk factors.

Clinical manifestations and misdiagnosis factors of pulmonary embolism patients seeking treatment in cardiology.

To explore the clinical manifestations and factors leading to misdiagnosis in pulmonary embolism (PE) patients in a cardiology department. We retrospectively analyzed 74 patients diagnosed with PE at our hospital from March 2018 to March 2022, comparing them to 136 patients suspected of PE but excluded by computed tomography pulmonary angiography during the same period. Both groups received the same basic care, including disease counseling, nutritional planning, and monitoring. We compared general information, clinical manifestations, risk factors, and auxiliary examinations to identify correlations between specific manifestations and misdiagnosis factors. The male-to-female ratio in the PE group was approximately 3:4, which was statistically significant compared to the control group (P < .05), though its impact on PE incidence was low. Common symptoms in the PE group included chest tightness, shortness of breath, sweating, and chest pain, with no significant difference from the control group (P > .05). Notable risk factors included deep vein thrombosis (DVT) (43.24%), prolonged bed rest (32.43%), lower limb varicose veins (18.92%), trauma (21.62%), pulmonary infections (62.16%), coronary heart disease (37.84%), respiratory failure (32.43%), and chronic obstructive pulmonary disease (13.51%). DVT was significantly associated with PE (P < .05). Multivariate logistic regression identified DVT (OR = 118.528, 95% CI: 6.959-2018.906, P = .001) and lower limb varicose veins (OR = 212.766, 95% CI: 6.584-6875.950, P = .003) as independent predictive factors for suspected PE. Clinical manifestations strongly correlated with PE included pulmonary rales, cyanosis, tachycardia, hypotension, elevated D-dimer, positive N-terminal pro-brain natriuretic peptide, and sinus tachycardia on echocardiogram. PE in cardiology patients may present with pulmonary rales, hypotension, shortness of breath, and abdominal symptoms, warranting reexamination for PE. Misdiagnosis factors typically involve chest pain, tightness, and shortness of breath. Lower limb varicose veins and DVT are reliable predictors of suspected PE.

Comparative Effectiveness of Therapies for Sleep-Disordered Breathing in Heart Failure Patients: A Comprehensive Systematic Review and Network Meta-Analysis.

The prevalence of sleep-disordered breathing (SDB) in patients with heart failure (HF) is a significant concern, leading to adverse outcomes. This network meta-analysis (NMA) is dedicated to evaluate the relative effectiveness of diverse therapeutic approaches for SDB treatments in the context of HF. An extensive search up to May 19, 2023, was implemented in PubMed, Cochrane, Embase, and Web of Science to identify randomized controlled trials (RCTs). These trials compared adaptive servo ventilation (ASV), automatic positive airway pressure (APAP), Bi-level positive pressure ventilation (Bi-level PPV), continuous positive airway pressure (CPAP), and oxygen therapy against placebo or standard treatment. Key outcomes included cardiac function indicators (left ventricular ejection fraction [LVEF], plasma B-type natriuretic peptide [BNP] levels), polysomnography data (apnea-hypopnea index [AHI], Mean and Minimum Oxygen Saturation), and patient-reported quality of life measures (Epworth sleepiness scale [ESS]). A random-effects Bayesian NMA was utilized to evaluate and compare the efficacy of these interventions. The study revealed significant therapeutic effects of different interventions in sleep apnea patients. For patients with obstructive sleep apnea (OSA), CPAP demonstrated superior efficacy in enhancing average oxygen saturation (mean difference (MD) = 0.98; 95% credible interval (CI) [0.07,2.09]), improving LVEF (MD= 5.66; 95% CI [0.71, 10.08]), and reducing AHI (MD= -20.61; 95% CI [-33.84, -9.9]). In the case of central sleep apnea (CSA), the therapeutic approaches showed varying degrees of effectiveness. CPAP proved most effective for enhancing average oxygen saturation(MD= 1.1; 95% CI [0.26,1.98]). ASV was the most effective in lowering AHI (MD = -32.11; 95% CI [-47.5, -17.16]), increasing lowest oxygen saturation (MD =8.14; 95% CI [1.72,14.92]), and enhancing LVEF (MD =6.58; 95% CI [0.06,12.49]). No single SDB treatment uniformly benefits all clinical indicators in SDB and HF patients.

Mitral valve transcatheter edge-to-edge repair in the elderly-A safe and effective therapy.

Prevalence of mitral regurgitation (MR) and comorbidity burden rise with age. Mitral valve transcatheter edge-to-edge repair (M-TEER) is increasingly performed in elderly patients, but only limited data are available for this specific subgroup. In this study, outcomes of octogenarians and nonagenarians undergoing M-TEER were analysed using a large real-world dataset. This retrospective study included consecutive patients undergoing M-TEER at the Ulm University Heart Center between January 2010 and December 2021. The cohort was divided into an elderly group and a younger group based on the cohorts' median age. Group differences regarding 1 and 3year mortality and heart failure hospitalization rates were assessed using Kaplan-Meier survival analysis and Cox proportional hazard models. A total of 1118 patients [median age 79 (inter-quartile range 74-83) years; 42% female] were included and divided into 513 elderly (≥80years) and 605 younger (<80years) patients. Primary MR was more frequent in the elderly group (56% vs. 27%, P<0.001). Pre-procedural and post-procedural MR grades were comparable between groups (pre-procedural MR grade 4: 69% in the elderly group vs. 71% in the younger group, P=0.67; post-procedural MR grade 1: 60% in the elderly group vs. 58% in the younger group, P=0.77) as well as in-hospital mortality rates (0.2% vs. 0.3%, P=0.66). Three-year heart failure hospitalization rates did not differ significantly between both groups (30.7% in the older age cohort vs. 36.0% in the younger cohort, P=0.191). While 1year all-cause mortality rates were comparable (18% vs. 16.4%, P=0.577), 3year all-cause mortality was significantly higher in the elderly [43.1% vs. 33.0%; hazard ratio (HR) 1.29 (95% confidence interval 1.02-1.65), P=0.035]. Pre-procedural N-terminal pro-brain natriuretic peptide (NT-proBNP) ≥3402pg/mL [HR 2.29 (95% CI 1.34-3.90), P=0.002], pre-interventional MR grade [HR 1.79 (95% CI 1.01-3.17), P=0.045] and European System for Cardiac Operative Risk Evaluation (EuroSCORE) II [HR 1.06 (95% CI 1.03-1.08), P<0.001] were identified as independent predictors of 3year mortality in the elderly. M-TEER displays a safe and effective treatment option for elderly patients with symptomatic MR, offering symptom relief and comparable 1year outcomes to younger patients. Elderly patients with elevated EuroSCORE II and advanced heart failure might benefit from additional care to further reduce 3year mortality.

Atypical presentation of Andersen-Tawil syndrome: heart failure with reduced ejection without periodic paralysis or dysmorphic features

Background: Andersen-Tawil syndrome (ATS) is a rare autosomal dominant disorder caused by variants in the KCNJ2 gene. It is associated with periodic paralysis, dysmorphic features and cardiac arrhythmias. The syndrome exhibits incomplete penetrance, leading to a broad spectrum of clinical manifestations, making diagnosis challenging. Case description: A male in his mid-20s with class 3 obesity presented to the emergency department with a week-long history of worsening chest pain, orthopnoea and fatigue. His family history was significant for sudden cardiac death affecting both his mother and brother, with his father having died from complications of Wolff-Parkinson-White syndrome. Cardiovascular examination revealed an S3 heart sound and elevated brain natriuretic peptide levels at 875 pg/ml, with undetectable troponins; potassium level on admission was 3.6 mEq/l. An electrocardiogram showed normal sinus rhythm, first-degree heart block, left atrial enlargement, left bundle branch block and a prolonged QTc of 486 ms. A transthoracic echocardiogram demonstrated a 15-20% reduction in ejection fraction with global left ventricular hypokinesis and left atrial enlargement. Ultimately, he was diagnosed with non-ischaemic dilated cardiomyopathy and referred for genetic testing, which revealed a KCNJ2 variant. Shortly after discharge, he experienced a 55-second run of ventricular tachycardia, necessitating the placement of a single-chamber ICD. Currently, the patient remains on guideline-directed medical therapy and is listed for a heart transplant. Conclusions: Dilated cardiomyopathy, although a rare manifestation in ATS, can profoundly increase the risk of fatal arrythmias, necessitating the need for a low threshold of suspicion, to ensure timely diagnosis and management.

The effect of trimetazidine on cardiac haemodynamics and mitochondrial function in wild-type transthyretin amyloidosis.

Wild-type transthyretin cardiac amyloidosis (ATTRwt) is a cardiomyopathy causing myocardial hypoperfusion and impaired cardiac mitochondrial function. Trimetazidine is an antianginal agent used in patients with stable angina pectoris, which improves cardiac contractility and mitochondrial function. The aim of the study was to investigate the effect of trimetazidine on invasive haemodynamics and cardiac mitochondrial function in ATTRwt. In a randomized, double-blind, placebo-controlled, crossover trial, 22 patients with ATTRwt received 4weeks of trimetazidine and placebo in randomized order. After each treatment period followed examinations with endomyocardial biopsies taken for high-resolution respirometry and right heart catheterization at rest and during a cardiopulmonary exercise test. The primary endpoint was mean pulmonary artery wedge pressure (mPAWP) during peak exercise. The secondary endpoint was cardiac mitochondrial oxidative phosphorylation capacity. Exploratory endpoints were echocardiographic parameters, cardiac biomarker levels and quality of life. Trimetazidine did not significantly reduce mPAWP during peak exercise (31±12 vs. 31±13mmHg, P=0.61) or improve the cardiac mitochondrial oxidative phosphorylation capacity (73.4±7.7 vs. 75.3±7.7pmol O2/(mg*s), P=0.81) compared with placebo, nor did treatment with trimetazidine improve ejection fraction (P=0.93), global longitudinal strain (P=0.23), N-terminal pro-brain natriuretic peptide (NT-proBNP) levels (P=0.92) or the patients' quality of life (P=0.98). In ATTRwt, treatment with trimetazidine did not improve mPAWP or cardiac mitochondrial oxidative phosphorylation capacity compared with placebo.

Clinical characteristics and in-hospital event rate of chronic obstructive pulmonary disease patients with concurrent acute myocardial infarction

This study was to investigate the clinical features of chronic obstructive pulmonary disease (COPD) patients with concurrent acute myocardial infarction (AMI) and analyze the occurrence of in-hospital adverse events. Patients with AMI who were admitted to Beijing Chaoyang Hospital from January 2019 to August 2023 were retrospectively collected. All patients were divided into COPD with concurrent AMI group and simple AMI group according to whether they were with concurrent COPD. All patients received interventional treatment for AMI. The clinical features and the occurrence of in-hospital adverse events were compared between the two groups. A total of 183 AMI patients aged (65.6±13.6) years were enrolled, including 142 males (77.6%). There were 94 patients (51.4%) in simple AMI group and 89 patients (48.6%) in COPD with concurrent AMI group, respectively. Patients in COPD with concurrent AMI group were older, had higher Killip grade, rate of smoking and previous percutaneous coronary intervention history, creatinine and B-type natriuretic peptide levels, and lower albumin, hemoglobin, low-density lipoprotein cholesterol, white blood cell count and cardiac troponin I than those of simple AMI group (all P<0.05). There were no significant differences in echocardiographic parameters between the two groups (all P>0.05). The proportion of β-blockers, angiotensin-converting enzyme inhibitors/angiotensin-blockers used in COPD with concurrent AMI group was lower (P<0.05). Patients in COPD with concurrent AMI group had longer length of hospital stay than those in simple AMI group (P=0.028). The incidence of primary endpoint events in COPD with concurrent AMI group was higher than that in simple AMI group (27.0% vs 18.0%, P=0.002). The current study indicates that COPD patients with concurrent AMI have longer length of hospital stay and higher incidence of in-hospital events, which are worthy of significant attention in clinical practice.

Evaluation of Pentraxin-3 levels in children with multisystem inflammatory syndrome.

Early recognition of cardiac involvement and prediction of disease prognosis are essential for the management of inflammatory diseases such as multisystem inflammatory syndrome. This study aimed to investigate the role of Pentraxin-3 levels in identifying cardiac involvement and evaluating disease severity in patients with multisystem inflammatory syndrome. The study included 56 multisystem inflammatory syndrome patients and 26 healthy children as a control group. The multisystem inflammatory syndrome group was divided into those with cardiac involvement (n = 34) and those without (n = 22), as well as those with clinically mild-moderate (n = 30) and severe (n = 26) multisystem inflammatory syndrome. Blood samples for measurement of Pentraxin-3 levels were obtained from all patients before treatment and from the healthy controls. In the patient group, the mean age was 8.2 ± 4 years (range: 2-17 years), and the male-to-female ratio was 1.8. In the control group, these values were 9.5 ± 3.7 years (range: 2-16 years) and 1.9, respectively (p > 0.05). Plasma Pentraxin-3 levels were significantly higher in multisystem inflammatory syndrome patients compared to controls (7.1 ± 5 ng/mL vs. 2.9 ± 2.1 ng/mL, p = 0.001). Patients with cardiac involvement had a significantly higher median Pentraxin-3 level than those without (5.8 ng/mL vs. 4.1 ng/mL, p = 0.004). Severe disease was also associated with a higher median Pentraxin-3 level compared to mild-moderate disease (6.1 ng/mL vs. 4.4 ng/mL, p = 0.001). Pentraxin-3 level was negatively correlated with left ventricular ejection fraction and positively correlated with B-type natriuretic peptide, troponin. Elevated Pentraxin-3 levels in multisystem inflammatory syndrome patients may help predict the clinical course of the disease and cardiac involvement. However, larger-scale prospective studies are needed to further elucidate this.

Short-term impact of kampo goreisan in patients with congestive heart failure refractory to tolvaptan-incorporated medical therapy.

We often encounter patients with congestive heart failure refractory to conventional diuretics therapy. Kampo goreisan (Tsumura &Co. Tokyo, Japan) is receiving great concern in mediating body water balance, particularly for such a cohort. However, its detailed biological mechanism remains uncertain. Patients who received goreisan to treat congestive heart failure refractory to tolvaptan-incorporated medical therapy were prospectively included and observed for one week during the therapeutic period. The change in urine biomarkers during the first 24h was assessed as a primary concern. Baseline factors associated with an increase in urine volume during the first 24h were investigated as a secondary concern. A total of 18 patients were included. Median age was 81 (77, 86) and 12 (67%) were men. During the first 24h after the initiation of goreisan, urine cyclic AMP tended to decrease, urine aquaporin-2 decreased significantly, urine osmolality decreased significantly, and urine volume tended to increase. Baseline higher common logarithm of plasma B-type natriuretic peptide was associated with any increases in urine volume during the first 24h with an odds ratio of 73.2 (95% confidence interval 1.04-5149, p = 0.048). Baseline plasma B-type natriuretic peptide level had a positive correlation with a change in urine volume between baseline and day 1 (r = 0.533, p = 0.026). Goreisan may increase urine volume even in patients with congestive heart failure refractory to tolvaptan-incorporated medical therapy by modulating aquaporin-2 systems in the collecting duct, particularly in individuals with advanced heart failure accompanying significant congestion. Goreisan may have a regulatory effect on body fluid, rather than just forcing aquaresis.

Prevalence of Neurogenic Stress Cardiomyopathy in Acute Ischemic Stroke and Relationship with Leukocytosis

Describe the prevalence and features of neurogenic stress cardiomyopathy in acute ischemic stroke. Describe leukocytosis as an inflammatory marker in neurogenic stress cardiomyopathy. Retrospective review of 688 adult ischemic stroke patients at a tertiary care center (1/2018 - 12/2021). Neurogenic stress cardiomyopathy was identified by one of: low left ventricular ejection fraction, ventricular wall motion abnormalities, elevated Troponin-I, or elevated brain natriuretic peptide. Leukocytosis defined as white blood cell count ≥12.0 × 10^9/L. Clinical and demographic data were collected. Neurogenic stress cardiomyopathy was observed in 147 (21%) patients. In this group, mean age was 68, 44% were female, mean National Institutes of Health Stroke Scale was 10 and mean hospital stay was 8 days. Low left ventricular ejection fraction (median 40%) was observed in 64% of these patients, elevated Troponin-I (median 0.252 ng/mL) in 40%, and ventricular wall motion abnormalities in 55%. Stroke mechanisms were cryptogenic (43%), cardioembolic (24%), small vessel disease (13%), large artery atherosclerosis (12%), and other (8%). Mean white blood cell count was 8.63 × 10^9/L. Leukocytosis occurred in 12% of patients with cardiomyopathy and 8% without, with no significant difference (p=0.9). We propose defining neurogenic stress cardiomyopathy by one of four cardiac biomarkers. The prevalence aligns with prior reports, most frequently identified by low left ventricular ejection fraction or ventricular wall motion abnormalities. Unlike Takotsubo Cardiomyopathy, abnormal wall motion patterns were predominantly diffuse. No significant difference in leukocytosis was found between groups. Further research is needed to identify neurogenic stress cardiomyopathy risk factors.

Features of indicators of macrohemodynamics and systemic inflammation in patients with community-acquired pneumonia combined with gastroesophageal reflux disease

Relevance. The clinical course, treatment approaches, and outcomes of community-acquired pneumonia (CAP) often depend on microcirculatory disorders. The significant prevalence of gastroesophageal reflux disease (GERD) in the population determines the frequency of CAP. Study of the pathogenetic basis of the combined course of CAP in individuals with GERD, incl. microcirculation systems, can target correction paths and increase the effectiveness of therapy.Objective. To identify indicators of systemic inflammation and macrohemodynamics in patients with CAP combined with GERD.Material and methods. A total of 123 patients were under observation, incl. with mild CAP without signs of GERD (group I) — 38, with CAP and GERD — 49 (group 2), and 36 patients with GERD without CAP — group 3. In all patients with CAP, along with traditional studies, the concentrations of C-reactive protein (CRP) and brain natriuretic peptide (BNP) were determined in the blood, and echocardioscopy (EchoCS) was performed to determine the end systolic (ES) and diastolic (ED) volumes of the left ventricle (LV) and right ventricles (RV), blood flow velocity at the level of the pulmonary artery (Vmax PA), pressure gradients ΔPmax at the level of the tricuspid valve (TV), PA, and LV isovolumic relaxation time (IVRT). Control values for indicators were obtained from 34 practically healthy donors.Results. In all patients with CAP, at the beginning of therapy, intoxication and respiratory syndromes were observed, and pneumonia was diagnosed on an X-ray. Patients in groups II and III had characteristic symptoms of GERD. Blood tests revealed leukocytosis in all patients with CAP. The initial CRP concentration in group 1 was 5.2, group 2 — 7.7, group 3 — 1.2 times higher than normal. The initial concentration of BNP in all groups did not differ from the control. By discharge, CRP levels in all patients had decreased: however, in group II, they remained higher than in healthy people (2.6 times (p &lt; 0.05) and higher than in group I, 1.3 times (p &lt; 0.05). Before discharge, the BNP level in group II increased by 1.2 times compared with baseline in group I, in healthy individuals, and in group III. When analyzing the EchoCS indicators in group II patients, a significant increase in the initial indicators of LV EDV and LV ESV and decrease in EF and IVRT were observed. After treatment, no significant dynamics of volume and velocity parameters were observed in patients in group II; in patients in group I, pressure gradients at the TC and PA levels remained slightly reduced.Conclusions. An increase in CRP levels in patients with GERD characterizes low-intensity inflammation, which potentiates systemic inflammation in patients with CAP combined with GERD and is accompanied by an increase in BNP.

Relationship of Iron Deficiency, Anemia and Combination of Iron Deficiency With Anemia With Severity of Manifestations of Chronic Heart Failure. Additional Analysis of the Study "Prevalence of Iron Deficiency in Patients With Chronic Heart Failure in the Russian Federation (J-CHF-RF)".

Aim To evaluate the role of iron deficiency (ID) identified by various criteria, anemia, and the combination of ID and anemia in determining the severity of the clinical course of chronic heart failure (CHF) in a retrospective analysis of data from 498 patients who participated in the ID-CHF-RF Russian multicenter program.Material and methods ID was diagnosed by the following three criteria established by the European Society of Cardiology (ESC) and the Russian Society of Cardiology (RSC): 1) ferritin concentration &lt;100 μg/l or ferritin concentration 100-299 μg/l in combination with a decreased transferrin saturation (TS) &lt;20%; 2) ID criteria that showed a high sensitivity and specificity when compared with bone marrow morphology (BMM): TS ≤19.8% or serum iron (SI) ≤13 μmol/l; and 3) a composite index including a ferritin concentration &lt;100 μg/l in combination with TS &lt;20% and SI ≤13 μmol/l. The presence of anemia was defined as a hemoglobin concentration of less than 12.0 g/dl in women and less than 13.0 g/dl in men according to the criteria of the World Health Organization.Results Concomitant anemia was detected in 40.3% of patients with CHF; in 85.1% of cases, anemia was combined with the SI concentration below normal. CHF patients with concomitant anemia were significantly older and had low levels of not only red blood cells and hemoglobin but also all parameters of iron metabolism, i.e., SI, ferritin concentration, and TS. The mean deviation of the red blood cell size, that characterizes the degree of anisocytosis, was significantly increased in patients with anemia, especially with a low SI. These patients had a higher CHF functional class, elevated levels of N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) and walked a shorter distance in the 6-minute walk test, which reflects significantly more severe manifestations of CHF with concomitant anemia, particularly in combination with a low SI. The incidence of ID was 83.1% (including 23.3% in combination with anemia) according to the ESC/RSC criteria; 74.5% (including 43.3% with anemia) according to the BMM criteria; and 51.6% (including 51.7% with anemia) according to the composite index, which seems to be stricter compared to the first two criteria. Regardless of the assessment method (by total weighted average data), in ID combined with anemia, not only the hemoglobin concentration was significantly reduced but all three analyzed parameters of iron metabolism were also significantly reduced (SI 9.0 μmol/l vs. 10.4 μmol/l; ferritin 41 μg/l vs. 59 μg/l; TS 8.5% vs. 12.9%) compared to ID without anemia, respectively. The CHF severity and the NT-proBNP concentration were also maximum for the combination of ID and anemia, in contrast to ID without anemia, regardless of the ID criterion used. A more accurate comparison of the methods for determining ID in CHF in the context of their prognostic value will be obtained by analyzing the data of a two-year follow-up of patients in this study, which will be the subject of the next article.Conclusion This analysis suggests that the presence of concomitant ID without anemia or anemia without ID moderately affects the severity of clinical manifestations of CHF and may be rather markers than factors determining the course of the disease, and in this case, does not require special correction with iron medications. And only ID anemia (a combination of ID with anemia) in patients with CHF can be considered a condition requiring special correction (for example, with intravenous medication) in addition to optimal therapy for CHF. This conclusion does not change depending on the used criteria for ID and requires verification in new RCTs.

Landscape of cardiorenal syndrome research: A bibliometric analysis.

To comprehensively review cardiorenal syndrome (CRS)-related research, this study analyzes its whole landscape and future trends from a bibliometric perspective. Using "cardiorenal syndrome" as the key word, a representative dataset of CRS was constructed in the Web of Science Core Collection (Science Citation Index Expanded) database up to November 2023. VOSviewer (version 1.6.18) and R-Studio (version 1.4) were used to visualize CRS-related author and national collaboration networks, hotspot distribution clustering and historical citation networks. The annual number of publications shows an upward trend, especially since 2009. The United States is the most active country and closely cooperates with European countries. Cardiorenal Medicine is the journal that publishes the most CRS-related research. Urology & Nephrology and Cardiovascular System & Cardiology are the most prominent areas of CRS literature output. The leaders in CRS-related research are Ronco C from Italy and Mccullough PA, from the United States. Combined with keyword co-occurrence, theme evolution, and strategic distribution analysis, it was found that centering on the mechanism of CRS (cardiovascular lesions, venous congestion, and fibrosis), prognosis (transplantation, dialysis, hospitalization, mortality) and cardiac function management (b-type natriuretic peptide, diastolic dysfunction, left ventricular hypertrophy) is a possible research direction for a long time to come. Although CRS has a relatively short history, it has received a lot of attention and is currently enjoying a high level of overall acceptance. In conclusion, this study explores the major research areas, frontiers and trends in CRS, which are important for future research.

Функція зовнішнього дихання та дифузійна здатність легень у пацієнтів із різними формами легеневої гіпертензії

The aim – to compare pulmonary function test (PFT) results and diffusion capacity of the lungs for carbon monoxide (DLCO) in patients with various forms of pulmonary arterial hypertension (PAH), chronic thromboembolic pulmonary hypertension (CTEPH) and healthy individuals; to establish correlations between PFT, DLCO and parameters used to stratify the risk of death in pulmonary hypertension (PH).Materials and methods. 74 patients were included: 18 with idiopathic PAH (IPAH), 15 with PAH associated with congenital heart defects (PAH-CHD), 21 with CTEPH and 20 healthy persons (control group). All participants underwent an assessment of PFT (vital capacity (VC), forced vital capacity (FVC), forced expiratory volume during one second (FEV1), peak expiratory velocity (PEV), maximum expiratory flow (MEF) 75, MEF-50, MEF-25) and measurement of DLCO. For all PH patients the standard examinations were provided, including N-terminal brain natriuretic peptide (NT-proBNP) assessment and right heart catheterization. Results. Patients of all PH groups had significantly lower parameters of PFT and DLCO, compared to the control group. The most pronounced and reliable decrease in PFT was observed among patients with PAH-CHD. The lowest DLCO was observed in CTEPH group. PH patients with DLCO &lt; 64 %, compared with DLCO ≥ 64 %, had significantly lower distance of the 6-minute walk test (6MWT) (p = 0.014), TAPSE (р = 0.015), SpO2 during pulse oximetry and direct measurement (p = 0.023 and 0.032, respectively), hemoglobin level (p = 0.031). They had a significantly higher level of NT-proBNP (p = 0.012) and they were somewhat older (p = 0.053). DLCO &lt; 64 % correlated with hemoglobin level (r = –0.31, p = 0.022), 6MWT distance (r = –0.35, p = 0.012), SpO2 (r = –0.29, p = 0.036), TAPSE (r = –0.34, p = 0.012) and NT-proBNP (r = 0.27, p = 0.048). Independent predictors of reduced DLCO were hemoglobin level (β = 0.95, CI 0.90-0.99), SpO2 (β = 0.75, CI 0.58-0.95) and TAPSE (β = 0.75, CI 0.63-0.91).Conclusions. Parameters of PFT and DLCO were significantly lower in patients of all PH groups compared to the healthy individuals. Patients with PAH-CHD had significantly worse PFT parameters. In the general population of patients with PH, PFT indicators, which characterize inspiratory capabilities, were independently correlated with the area of ​​the right atrium. The reduced DLCO (&lt; 64 %) correlated with the level of hemoglobin, SpO2 and indicators of the patient functional state. However, low levels of hemoglobin, SpO2, and TAPSE were independent predictors of low DLCO.

Real-life experience with disease-modifying drugs in hereditary transthyretin amyloid polyneuropathy: A clinical and electrophysiological appraisal.

New treatments have dramatically improved the prognosis for Hereditary Transthyretin Amyloid Polyneuropathy (ATTRv-PN). However, there is a lack of routine follow-up studies outside of therapeutic trials. Our aim was to report the long-term clinical and electrophysiological evolution of a cohort of ATTRv-PN patients and to determine which biomarkers are most sensitive to change. We retrospectively collected neuropathy impairment scale (NIS), polyneuropathy disability scale (PND), overall neuropathy limitation scale (ONLS), rash built overall disability scale (RODS), electrodiagnostic data, motor unit number index (MUNIX), troponin and N-terminal pro-brain natriuretic peptide levels. Electrophysiological worsening was defined as a 20% decrease in previous values. Thirty-five patients, with a median age of 58 (interquartile ranges 42-71) years, were followed for a median of 36 (24-48) months. All patients received a transthyretin stabiliser, gene silencer or liver transplant. Overall assessment of the cohort showed clinical, biological and electrophysiological stability. However, on an individual basis, NIS worsened in 45% of patients (14/31), ONLS in 46% (13/28), PND in 28% (9/32) and RODS in 39% (11/28) at the last follow-up. Motor amplitude sum score decreased in 33% (11/33), amplitude recorded on tibialis anterior muscle in 44% (12/27), sensory amplitude sum score in 39% (11/28) and MUNIX sum score in 27% (7/26). Overall effectiveness of ATTRv-PN treatments in routine care is good. However, individual assessments show up to 40% deterioration over time. Electrophysiological measures are valuable monitoring tools but are not more sensitive to change than clinical scores. Results must be confirmed in larger cohorts.

Analysis of the clinical characteristics of patients with Kawasaki disease complicated with cholestasis

BackgroundTo explore the clinical characteristics, related factors, and prognosis of Kawasaki disease (KD) combined with acute febrile cholestasis and improve the understanding of the liver complications of KD to avoid misdiagnosis and missed diagnosis.MethodsWe retrospectively analyzed the demographic, clinical, and laboratory data of 1803 patients with KD between January 2019 and July 2023 in our hospital. Based on the presence of cholestasis, patients were divided into the cholestatic and control groups. Logistic regression analysis was performed for the statistically significant indicators between the two groups to examine the risk factors for KD with coronary artery abnormalities (CAA) and intravenous immunoglobulin (IVIG) unresponsiveness. Additionally, patients with KD and cholestasis were compared with patients with acute febrile cholestasis due to other causes during the same period.ResultsCompared to the control group (n = 1720), patients in the cholestatic group (n = 83) were older, had higher levels of white blood cell count (WBC), C-reactive protein (CRP), D-dimer, N-terminal pro-brain natriuretic peptide (NT-proBNP), a shorter fever duration, and high incidences of IVIG unresponsiveness and CAA. KD was the leading cause of acute febrile cholestasis in children (72.6%). In the multivariate logistic regression analysis, younger age, cholestasis, hypoalbuminemia, and a high NT-proBNP level were risk factors for IVIG unresponsiveness, whereas male sex, longer fever duration before treatment, and high alanine aminotransferase (ALT), and CRP levels were risk factors for CAA.ConclusionKD with cholestasis was associated with a higher risk of IVIG unresponsiveness and coronary artery abnormalities. KD was the leading cause of acute febrile cholestasis in children. Attention to the possibility of KD is warranted in children with acute febrile cholestatic jaundice, especially if associated with elevated WBC, CRP, and D-dimer levels, or hypoalbuminemia.

The Implication of NT-proBNP in the Assessment of the Clinical Phenotype of Patients with Type 2 Diabetes Mellitus, Without Established Cardiovascular Disease

Background: Natriuretic peptide (NP) levels have been proposed for characterization and risk stratification of heart failure (HF) among patients with cardiovascular disease (CVD). However, their role in patients with diabetes mellitus type 2 (T2DM) has not been well studied and understood. The aim of this study was to assess phenotypical, functional characteristics and imaging parameters in relation to N-terminal pro b-type natriuretic peptide (NT-proBNP) values in T2DM patients without known CVD that may predispose to overt HF. Methods: This was a cross-sectional study of 100 consecutive T2DM patients (mean overall age of 67 ± 9 years, 40% women and 60% men) who were enrolled from the outpatient diabetic clinic. Patients underwent a cardiopulmonary exercise test (CPET), and echocardiographic and cardiac magnetic resonance imaging (CMR); serum NT-proBNP was also measured. Results: The mean (standard deviation) NT-proBNP was 149 (±186) pg/mL. Patients in the highest tertile of NT-proBNP values (&gt;107 pg/mL) had lower values of predicted maximum oxygen consumption compared to the lowest quartile (&lt;55 pg/mL) (84% vs. 92%, p = 0.018) in the CPET and higher ratio of early diastolic mitral inflow velocity to early diastolic mitral annulus velocity (E/e′) (9.0 vs. 7.2, p = 0.05) in echocardiography. Finally, there was a negative correlation between right ventricle end diastolic volume in CMR and predicted maximum oxygen consumption (b = −0.225 ± 0.11, p = 0.046). Conclusions: NT-proBNP levels seemed to be a useful marker in people with T2DM, as elevated levels reflected ongoing appearance of HF with preserved ejection fraction and were related to CPET and echocardiographic indices of impaired left ventricular diastolic and right ventricular systolic function.

Characterisation of patients who develop atrial fibrillation-induced cardiomyopathy

IntroductionAtrial fibrillation (AF)-induced cardiomyopathy (AIC) is retrospectively defined after normalisation of left ventricular ejection fraction (LVEF) in sinus rhythm. It is unclear why some patients develop AIC.HypothesisPatients with AIC have...

Laboratory and instrumental parameters associated with the risk of death in the long-term follow-up period in patients after myocardial infarction

BACKGROUND: In patients who successfully survived the 1st year after myocardial infarction, the risk of death remains elevated. AIM: To determine laboratory and instrumental parameters of myocardial remodeling associated with a lethal outcome in the long-term follow-up period in patients 1 year after myocardial infarction. MATERIAL AND METHODS: The study included 184 patients 12 months after myocardial infarction: the first group — living patients at the 5-year follow-up point (n=160), the second group — deceased patients at the 5-year follow-up point (n=24). A comparative analysis of inflammation and myocardial dysfunction biomarkers, as well as echocardiographic parameters reflecting the types of left ventricular remodeling, linear dimensions of the cavities and wall thickness of the heart, chamber volumes, and ventricular systolic function was retrospectively performed. After assessing the distribution of quantitative data, the Student's t-test or Mann–Whitney U-test and the χ2 criterion for categorical data were used. The model was built on the basis of logistic regression. The ROC curve, the Hosmer–Lemeshow test, and the bootstrap method were used to assess the model itself and its reliability. RESULTS: Patients in the second group were older (p=0.007), and more often had myocardial infarction with ST-segment elevation during hospitalization (p 0.001). Twelve months after myocardial infarction, a multidirectional pattern of changes in the level of N-terminal brain natriuretic propeptide was revealed: a decrease was registered in the first group, while an increase was registered in the second group. In the dynamics of the second group, the index of end-diastolic volume (p=0.014) and the size of left ventricular asynergy were higher (p=0.043), and the ejection fraction was lower (p=0.015) than in the first group. The model for predicting 4-year mortality in patients who survived myocardial infarction during the 1st year included such parameters as the index of the left ventricular end-diastolic volume, the content of the N-terminal fragment of the natriuretic peptide and the presence of concentric hypertrophy of the left ventricle. CONCLUSION: In patients who survived 1 year after myocardial infarction, the long-term risk of death is associated with a set of parameters reflecting left ventricular remodeling and the development of heart failure.

Observational Study of Trans-Septal Endocardial Left Ventricle Lead Implant for Effective Cardiac Resynchronization Therapy in Patients with Heart Failure and Challenging Coronary Sinus Anatomy

Background: When conventional trans-venous CS lead placement fails, trans-septal endocardial left ventricle lead placement is an alternative technique used to capture the left ventricle endocardially; however, its use is limited due to a lack of evidence, practice uptake, and clinical trials. Methods: In this single-center cohort study, we evaluated the efficiency of the procedure, post-procedural complication rate, rate of thromboembolic events, overall survival rate, and changes in the echocardiographic parameters, brain natriuretic peptide (BNP) level, and New York Heart Association (NYHA) class, both before and after TSLV lead implantation. Results: The TSLV lead implant is safe and improves EF, LVEDV, LVESV, and LVIDd. It significantly reduces the NTproBNP levels and the NYHA class; however, the rate of stroke incidence remains high, at 9%. Conclusions: We demonstrated a high success rate of trans-septal left ventricular endocardial lead implantation, LV reverse remodeling was noted, and patients had a favorable clinical response; however, there was an increased risk of systemic embolization after the trans-septal LV lead implant.