Changes In NT-proBNP Research Articles

Association of Longitudinal Changes in NT-proBNP With Changes in Left Atrial Volume and Function: MESA.

The mechanism of left atrial (LA) remodeling is poorly understood. The aim of this longitudinal study was to investigate whether changes in NT-proBNP levels relate to alterations of LA structure and function over time in a multiethnic population. From the prospective cohort study, the Multi-Ethnic Study of Atherosclerosis, our analysis included 1,838 participants who underwent cardiac magnetic resonance imaging at the baseline and 10-year examinations, had NT-proBNP levels available at both time points, and did not develop heart failure, myocardial infarction, and/or atrial fibrillation. Multivariable linear regression was used to analyze the association between NT-proBNP level (log-transformed) at the 2 time points and change in LA volumes, LA emptying fractions (total, active, and passive), and LA longitudinal strain. Log NT-proBNP was categorized into Low-Low (N = 681), Low-High (N = 238), High-Low (N = 237), and High-High (N = 682) based on the median value at both time points. With the Low-Low group as the reference group, the High-High group experienced a greater increase in LA maximum and minimum indexed volumes: 3.1 ml/m2 (95% confidence interval 1.98, 4.20) and 2.7 ml/m2 (1.89, 3.51), respectively. The High-High group also experienced a greater decrease in LA total, passive, active emptying fraction, and longitudinal strain: -3.3% (-4.46, -2.11), -0.9% (-1.80, -0.02), -4.2% (-5.55, -2.76), and -2.3% (-3.80, -0.72), respectively. The Low-High group had similar associations, but the effect sizes were not as high. Adverse LA remodeling over 10 years of follow-up strongly correlates with prolonged elevated levels of intracardiac stress, as assessed by NT-proBNP levels.

Discussion on the Level Change of NT-proBNP in Patients with Chronic Heart Failure and Its Correlation with Cardiac Troponin I

Discussion on the Level Change of NT-proBNP in Patients with Chronic Heart Failure and Its Correlation with Cardiac Troponin I

Effect of Bariatric Surgery on Natriuretic Peptide Levels: A Systematic Review and Meta-Analysis.

The effect of bariatric surgery on natriuretic peptide levels in patients with obesity is unclear. The purpose of this study was to conduct a systematic review and meta-analysis to determine the effect of bariatric surgery on B-type natriuretic peptide (BNP) and aminoterminal BNP (NT-proBNP) levels. MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials were searched to February 2020. Primary outcomes included change in NT-proBNP or BNP levels following bariatric surgery and change in weight and body mass index. Secondary outcomes included change in blood pressure, echocardiographic findings, and heart failure symptoms. MINORS tool was used to assess quality of evidence. Twelve studies with 622 patients were included. Most patients underwent Roux-en-Y gastric bypass (RYGB) (70.5%). Mean absolute reduction in body mass index was 23%. NT-proBNP levels increased significantly from baseline at 6 months (mean difference [MD] 53.67 pg/mL; 95% confidence interval [CI], 28.72-78.61; P ≤ 0.001, I2 = 99%; 8 studies) and 12 months (MD 51.16 pg/mL; 95% CI, 20.46-81.86; P = 0.001, I2 = 99%; 8 studies) postbariatric surgery. BNP levels also increased significantly at 6 months (MD 17.57 pg/mL; 95% CI, 7.62-27.51; P < 0.001, I2 = 95%; 4 studies). Systolic and diastolic blood pressure decreased significantly 12 months after surgery. Studies measuring echocardiographic findings saw improvement in left ventricle mass and the E/A ratio, but no significant change in ejection fraction. Bariatric surgery is associated with increased natriuretic peptide levels in the absence of deteriorating cardiac function, and may be associated with improved cardiac and metabolic function after the procedure.

NT-Pro-BNP levels during spontaneous breathing test and its association with successful weaning in patients undergoing mechanical ventilation in the Intensive Care Unit: Original Article

Introduction: Weaning of the patient is one of the important medical challenges. One of the most important causes of failure in weaning is cardiovascular disorders. NT-Pro-BNP is a serum marker for cardiac dysfunction. This study conducted to evaluate the level of NT-Pro-BNP during the spontaneous breathing test (SBT) in patients undergoing mechanical ventilation in ICU and its association with successful weaning. Methods: In this cross-sectional study, we enrolled 42 intubated patients who were admitted to the ICU ward of Imam Reza Hospital and were clinically weaned. After obtaining informed consent, SBT was started for the patient. One and a half hours after SBT onset, a venous blood sample was obtained and the patients were followed for SBT test success and the results were recorded. Patients were extubated in stabilized condition or continued mechanical ventilation if needed. Then Data were analyzed. Results: SBT was successful in 45.2% of patients. 54.8% of patients were male. The most common cause of hospitalization was COPD (35.7%). The mean age of patients with successful SBT was 67.53±6.14 years and in patients with unsuccessful SBT was 68.70±5.44 years. There was a significant difference between NT-Pro-BNP levels half an hour after SBT between two groups of patients with successful (7.15±31.18) and unsuccessful (59.61±196.51) SBT. NT-ProBNP changes before and half an hour after SBT in both groups were statistically significant. Conclusion: NT-Pro-BNP is a predictor criteria of success in weaning in patients and as the level of NT-Pro-BNP increases, the rate of failure in weaning increases.

Delta NT-proBNP predicts cardiotoxicity in HER2-positive breast cancer patients treated with trastuzumab

Background Overall survival has improved significantly in patients with human epidermal growth receptor 2 (HER2)-positive breast cancer due to the use of the monoclonal antibody trastuzumab blocking HER2. However, patients may develop trastuzumab-induced cardiotoxicity (TIC) leading to congestive heart failure. Here we assessed whether analysing NT-proBNP and assessment of electrocardiography (ECG) could detect TIC during trastuzumab therapy. Methods One hundred thirty-six patients undergoing adjuvant, neoadjuvant or palliative chemotherapy and HER2 blockade for HER2-positive breast cancer were prospectively assessed with echocardiography, ECG and N-terminal – pro hormone B-type natriuretic peptide (NT-proBNP) testing at baseline and at 6 and 12 months of trastuzumab therapy. TIC was defined as a left ventricular ejection fraction (LVEF) of less than 50% and a decline from baseline of ≥10 units. Results Six patients developed TIC under 12 months of trastuzumab therapy (incidence 4.4%). NT-proBNP increased from 198.8 ± 64.0 pg/ml to 678.7 ± 132.4 pg/ml (p < .05) in TIC patients. With a cut-off point of 276.5 pg/ml for NTproBNP and increase in NT-proBNP by 75.8 pg/ml from baseline the sensitivity was 100% and the specificity 95% to detect TIC. Compared with controls, TIC patients were older (68.3 ± 1.1 years and 56.2 ± 1.4 years, respectively; p < .01), had more often diabetes mellitus (OR = 63.5, 95% CI: 5.63–915, p < .01) and atrial fibrillation (OR = 12.3; 95% CI: 1.89–74.62; p < .05) and had lower baseline LVEF (57.1 ± 1.4% and 61.4 ± 0.3%, respectively; p < .001). Abnormal ECGs were common in patients developing TIC. Conclusions Measuring changes in NTproBNP may be used to monitor patients for TIC under trastuzumab therapy. Patients with a cardiovascular risk profile are more at risk of developing TIC.

Efficacy and safety of dapagliflozin in acute heart failure: Rationale and design of the DICTATE-AHF trial

Dapagliflozin, a sodium-glucose cotransporter-2 inhibitor, reduces cardiovascular death and worsening heart failure in patients with chronic heart failure and reduced ejection fraction. Early initiation during an acute heart failure (AHF) hospitalization may facilitate decongestion, improve natriuresis, and facilitate safe transition to a beneficial outpatient therapy for both diabetes and heart failure. The objective is to assess the efficacy and safety of initiating dapagliflozin within the first 24 hours of hospitalization in patients with AHF compared to usual care. DICTATE-AHF is a prospective, multicenter, open-label, randomized trial enrolling a planned 240 patients in the United States. Patients with type 2 diabetes hospitalized with hypervolemic AHF and an estimated glomerular filtration rate of at least 30 mL/min/1.73m2 are eligible for participation. Patients are randomly assigned 1:1 to dapagliflozin 10 mg once daily or structured usual care until day 5 or hospital discharge. Both treatment arms receive protocolized diuretic and insulin therapies. The primary endpoint is diuretic response expressed as the cumulative change in weight per cumulative loop diuretic dose in 40 mg intravenous furosemide equivalents. Secondary and exploratory endpoints include inpatient worsening AHF, 30-day hospital readmission for AHF or diabetic reasons, change in NT-proBNP, and measures of natriuresis. Safety endpoints include the incidence of hyper/hypoglycemia, ketoacidosis, worsening kidney function, hypovolemic hypotension, and inpatient mortality. The DICTATE-AHF trial will establish the efficacy and safety of early initiation of dapagliflozin during AHF across both AHF and diabetic outcomes in patients with diabetes.

NT-proBNP (N-terminal prohorne of brain natriuretic peptide) as an early marker for detection of response to endothelin receptor antagonist in pulmonary arterial hypertension patients

Abstract Background Endothelin receptor antagonist (ERA) is well-established for targeted therapy of pulmonary arterial hypertension (PAH). According to the guidelines, comprehensive evaluation of responses to PAH-targeted therapy is recommended 3 to 6 months after treatment onset. Early detection of response to ERA after starting new treatment may be of clinical value to establish next therapeutic plan. Purpose We sought to investigate whether NT-proBNP plays a reliable role for early maker of responses to ERA in PAH patients. Methods Sixty four patients (age &amp;gt;19 years old) with a confirmatory diagnosis of PAH were enrolled who were treated with ERA (bosentan or macitentan) in two tertially PAH experts centers. NT-proBNP measurements were performed at baseline, 1 month and 6 months after ERA treatment. Clinical characteristics including WHO functional class, laboratory test, and echocardiographic results were systematically collected. Result Sixty four patients were finally analyzed who completed the 6 months of follow-up. Etiology of PAH was as follows: idiopathic PAH (n=25), connective tissue disease associated PAH (n=16) and congenital heart disease assocciated PAH (n=24). Mean age was 50±15 years-old and female were predominant (75%). NTproBNP level was changed from 703pg/ml [207–2748] at baseline, 301 pg/ml [126–1314] at 1 month and 297pg/ml [106–901] at 6 months after ERA treatment. Although, NT proBNP level in overall population was significantly decreased after ERA treatment, NT proBNP level before treatment showed poor correlation with those at 6 months (R2=0.32). However, change of NT proBNP at 1 month from baseline showed strongly correlated with change of NT proBNP at 6 months from baseline with linear regression model analysis (R2 =0.90, p&amp;lt;0.001). Conclusions Assessment of early change in nt-proBNP with only a month of treatment is associated with midterm response to ERA treatment in PAH. It can help to early decision making for early intensive therapy and rapid escalation of PAH medication in non-responsive PAH patients for initial therapy. The relationship of BNP Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Handok

Reverse remodelling, changes in diastolic function and their prognostic value compared to natriuretic peptides

Abstract Background Reverse remodelling (RR) is the recovery from left ventricular (LV) dilation and dysfunction in response to treatment for heart failure (HF). RR is usually associated with improved prognosis. The impact of RR on indices of diastolic function, and the relative prognostic value of RR, changes in diastolic function and natriuretic peptide levels are currently unknown. Methods We analysed data from patients with stable systolic HF (LV ejection fraction [LVEF] &amp;lt;50%) undergoing 2 transthoracic echocardiograms (TTE) within 12±2 months. RR was defined as a ≥15% reduction in LV end-systolic volume index (LVESVi). The follow-up started after the second TTE. Results 927 patients were evaluated (68±12 years; median LVEF 35% [interquartile interval 30–43%]; 27% women; 52% ischaemic aetiology). Patients experiencing RR (n=286, 31%) displayed more prominent positive changes in several parameters reflecting diastolic dysfunction, namely E/e' ratio, left atrial volume index (LAVi), and systolic pulmonary artery pressure (sPAP), as well as N-terminal fraction of pro-B-type natriuretic peptide (NT-proBNP; Figure). In the whole population, percent changes (Δ%) LVESVi displayed weak but significant correlations with Δ% E/e' (r=0.237, p&amp;lt;0.001), LAVi (r=0.316, p&amp;lt;0.001), and sPAP (r=0.158, p&amp;lt;0.001), and also with Δ% NT-proBNP (r=0.279, p&amp;lt;0.001). There were 123 cardiovascular deaths and 4 heart transplantations over 2.8 years (1.3–4.9). Δ% LVESVi, RR, Δ% sPAP and Δ% NT-proBNP were univariate predictors of this endpoint. In 2 multivariable models including Δ% sPAP and Δ% NT-proBNP and either RR or Δ% LVESVi, only Δ% NT-proBNP emerged as independent predictor of outcome (hazard ratio 1.01, 95% confidence interval 1.01–1.02; p&amp;lt;0.001). Conclusions A recovery of LV geometry is accompanied by positive modifications in several indices related to diastolic function, as well as a decrease in NT-proBNP levels. Percent changes in NT-proBNP over 12 months are stronger predictors of outcome than variations in LV geometry or sPAP. Funding Acknowledgement Type of funding source: None

Direct comparison of BNP and NT-proBNP for mortality prediction in patients with acute dyspnea

Abstract Background It is unclear whether BNP or NT-proBNP, their admission or discharge measurement or percentage change during hospitalization are preferable for mortality prediction in patients with acute dyspnea. Purpose To directly compare BNP and NT-proBNP regarding their potential in mortality prediction in patients with acute dyspnea and in patients with dyspnea due to AHF. Methods In a prospective multicenter diagnostic study the presence of AHF was centrally adjudicated by two independent cardiologists among patients presenting with acute dyspnea. The levels of BNP and NT-proBNP were measured at presentation and discharge. Patients were stratified according to their natriuretic peptide response (responders vs. non-responders: natriuretic peptide decrease ≥25% vs. &amp;lt;25% before discharge). Prognostic accuracy for 720-day mortality was quantified using the area under the receiver-operating-characteristic curve (AUC). Cox proportional hazard models were constructed to identify significant predictors for 720-day mortality. Results Among 1156 patients presenting with acute dyspnea, 353 (30.5%) died within 720 days of follow-up. Prognostic accuracy for death at 720 days was significantly higher for discharge compared to admission measurements for BNP (AUC 0.750 vs. 0.711, p&amp;lt;0.001) and NT-proBNP (AUC 0.769 vs. 0.720, p&amp;lt;0.001). When directly comparing discharge measurements, NT-proBNP levels exhibited a significantly higher accuracy (p=0.013). 632 (54.6%) and 600 (51.9%) patients were BNP and NT-proBNP non-responders, respectively. Among BNP and NT-proBNP non-responders 202 (32%) and 207 (34.5%) patients died within 720 days of follow-up. After adjusting for common covariates NTproBNP response was the strongest predictor for 720-day mortality in a Cox regression model (Hazard ratio for NT-proBNP non-responders: 2.096 (95% CI 1.550–2.835), p&amp;lt;0.001). Results were confirmed in a sensitivity analysis of 687 (59.4%) patients with adjudicated AHF. Conclusion Percentage change of NT-proBNP during hospitalization seems to be the strongest predictor for long-term mortality in patients with acute dyspnea in general and in those with dyspnea due to AHF in particular. ROC curve for direct comparison Funding Acknowledgement Type of funding source: None

The development of chronic diuretic resistance can be predicted during a heart-failure hospitalization. Results from the REDIHF registry.

IntroductionDiuretic resistance (DR) is a common condition during a heart failure (HF) hospitalization, and is related to worse prognosis. Although the risk factors for DR during a HF hospitalization are widely described, we do not know whether the risk of chronic DR could be predicted during admission.Material and methodsWe conducted a multicenter, prospective observational study between July 2017 and July 2019. All patients admitted for acute HF with intravenous diuretic treatment and at least one criterion of congestion on admission were invited to participate. Patients on renal replacement therapy, under intravenous diuretic treatment for >72 hours before screening and those who were unable to sign the informed consent were excluded. We monitored decongestion (physical exam, hemoconcentration, NTproBNP change and lung ultrasound) and DR (diuresis and weight loss per unit of 40mg furosemide and fractional excretion of sodium) on the fifth day of admission. Chronic DR was evaluate two months after hospitalization and was defined as persistent signs of congestion despite ≥80 mg furosemide per day. We compared variables from the hospitalization between patients with and without chronic DR. A multivariate logistic regression analysis was conducted to find predictors of chronic DR.ResultsA total of 105 patients were included in the study. Mean age was 74.5±12.0 years, 64.8% were male and mean LVEF was 46±17%. In the two months follow-up, five patients have died and one patient has had a heart transplant. Of the 99 remaining patients, 21 patients (21.2%) had chronic DR. The dose of furosemide before admission and the decrease in NT-proBNP ≤30% during admission were predictors of chronic DR in the multivariate analysis.ConclusionsWe can predict during a HF hospitalization which patients will develop chronic DR. The dose of furosemide before admission and the change in NT-proBNP are independent predictors of chronic DR.

Biochemical markers after the Norseman Extreme Triathlon.

Prolonged exercise is known to cause changes in common biomarkers. Occasionally, competition athletes need medical assistance and hospitalisation during prolonged exercise events. To aid clinicians treating patients and medical teams in such events we have studied common biomarkers after at The Norseman Xtreme Triathlon (Norseman), an Ironman distance triathlon with an accumulated climb of 5200 m, and an Olympic triathlon for comparison. Blood samples were collected before, immediately after, and the day following the Norseman Xtreme Triatlon (n = 98) and Oslo Olympic Triathlon (n = 15). Increased levels of clinical significance were seen at the finish line of the Norseman in white blood cells count (WBC) (14.2 [13.5-14.9] 109/L, p < 0.001), creatinine kinase (CK) (2450 [1620-3950] U/L, p < 0.001) and NT-proBNP (576 [331-856] ng/L, p < 0.001). The following day there were clinically significant changes in CRP (39 [27-56] mg/L, p < 0.001) and Aspartate Aminotransferase (AST) (142 [99-191] U/L, p < 0.001). In comparison, after the Olympic triathlon distance, there were statistically significant, but less clinically important, changes in WBC (7.8 [6.7-9.6] 109/L, p < 0.001), CK (303 [182-393] U/L, p < 0.001) and NT-proBNP (77 [49-88] ng/L, p < 0.01) immediately after the race, and in CRP (2 [1-3] mg/L, p < 0.001) and AST (31 [26-41] U/L, p < 0.01) the following day. Subclinical changes were also observed in Hemoglobin, Thrombocytes, K+, Ca2+, Mg2+, Creatinine, Alanine Aminotransferase and Thyroxine after the Norseman. In conclusion, there were significant changes in biomarkers used in a clinical setting after the Norseman. Of largest clinical importance were clinically significant increased WBC, CRP, AST, CK and NT-proBNP after the Norseman. This is important to be aware of when athletes engaging in prolonged exercise events receive medical assistance or are hospitalised.

How low is "low-flow" in aortic stenosis? A retrospective analysis of patients with true low-flow/low-gradient aortic stenosis undergoing TAVI.

Transcatheter aortic valve implantation (TAVI) is a valuable treatment option for patients with reduced left ventricular ejection fraction (LVEF) and low-flow/low-gradient (LF/LG) aortic stenosis (AS). According to current literature, the presence of severe AS is unlikely in case of severely reduced LVEF and mean pressure gradient (meanPG) below 30 mmHg. However, a considerable number of patients presenting with typical clinical symptoms of severe AS, show gradients below 30 mmHg. We hypothesized, that these patients undergoing TAVI do have a measurable clinical benefit and an improved LVEF. In this single center retrospective cohort study, data from 1199 patients undergoing TAVI between 2013 and 2017 was analyzed. A 6-month follow-up was performed to assess changes in NT-proBNP, NYHA-class, and LVEF. Thirty patients presented with LVEF<35%, an aortic valve area (AVA<1 cm2), and a meanPG below 30 mmHg. Mean logistic EuroSCORE II was 24.05±10.9. Most patients (56%) showed improved NYHA-class upon follow-up. NT-proBNP-levels decreased from 3.901 pg/mL IQR 10.880 to 1.491 pg/mL IQR 2.245 (P<0.001). LVEF increased from 30% IQR 6.25 to 40% IQR 15 (P<0.001). Based on our findings TAVI represents a valuable treatment option even in patients with LF/LG AS and PGmean below 30mmHg.

The predictive value of vascular endothelial growth factor-A gene polymorphism for clinical outcomes among acute ST-segment elevation myocardial infarction patients: A single center prospective study

Background: Vascular endothelial growth factor (VEGF) is an angiopoetic factor; its variability in circulating levels is mediated by expression of specific VEGF-A gene variants. The aim of this study was to investigate the predictive role of VEGF-A gene polymorphism in clinical outcomes of STelevation myocardial infarction (STEMI) patients.&#x0D; Methods: For the study, 135 patients with acute STEMI and 30 healthy volunteers were enrolled. The G634C polymorphism in VEGF-A gene was performed by real-time polymerase chain reaction at baseline. The 6-month combined clinical endpoint was then determined. Design: The study was an open prospective single-center cohort study.&#x0D; Results: The entire patient population was distributed into two groups based on the G634G-genotype (n = 70) and combination of G634C and C634C-genotypes (n = 65). Unadjusted multivariate regressive logistic analysis showed peak troponin I levels at admission, Killip class of heart failure &gt; 2, GC/CC polymorphisms in VEGF-A gene, and dynamic increase of NT-pro brain natriuretic peptide (BNP) and VEGF-A levels for 6 months, which were independent predictors for the combined clinical endpoint. After adjustment for dynamic changes of NT-proBNP and VEGF-A levels, we found that GC/CC polymorphisms in the VEGF-A gene was an independent predictor of clinical outcome. Kaplan-Meier curves demonstrated that STEMI patients with GG VEGF-A genotype had a lower frequency of clinical combined endpoint accumulation when compared to those who had GC/CC VEGF-A genotypes (Log-rank p = 0.02).&#x0D; Conclusion: The G634C polymorphism in the VEGF-A gene was found to be an independent predictor for 6-month clinical combined endpoint in STEMI patients.

Effects of Liraglutide on Worsening Renal Function Among Patients With Heart Failure With Reduced Ejection Fraction

The FIGHT (Functional Impact of GLP-1 [glucagon-like peptide-1] for Heart Failure Treatment) trial randomized 300 patients with heart failure with reduced ejection fraction (HFrEF) and a recent hospitalization for heart failure to liraglutide versus placebo. While there was no difference in the primary outcome (rank score of time to death, time to rehospitalization for heart failure, and change in NT-proBNP [N-terminal pro-B-type natriuretic peptide]), there was a significant increase in cystatin C among patients randomized to liraglutide raising concern of adverse renal outcomes. We performed a post hoc analysis of FIGHT to investigate whether liraglutide was associated with worsening renal function (WRF). The relationship between randomization to liraglutide and WRF was evaluated using logistic regression models. Two hundred seventy-four patients (91%) had complete data to assess for WRF defined as: increase in SCr ≥0.3 mg/dL, or ≥25% decrease in estimated glomerular filtration rate, or an increase in cystatin C ≥0.3 mg/L from baseline to 180-days. Patients with WRF (n=113, 41%), compared with those without, were older, had more comorbidities, and lower utilization of guideline-directed medical treatment. Logistic regression models showed that age and baseline cystatin C levels were associated with WRF. In adjusted models, liraglutide was not associated with excess risk of WRF compared with placebo (odds ratio, 1.02 [95% CI, 0.62-1.67]). There was also no difference in the rank score when WRF was added as a fourth-tier outcome. Liraglutide was not associated with WRF among patients with HFrEF and a recent hospitalization for heart failure. These data support the relative renal safety profile of liraglutide among patients with HFrEF. Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01800968.

Angiotensin Receptor Neprilysin Inhibition in Patients with Left Ventricular Assist Devices

Angiotensin receptor neprilysin inhibitors (ARNI) are now an established therapy for HF pts. While LVADs are a life-prolonging treatment for advanced HF, optimal management of hypertension and HF in this population is not known. We sought to evaluate the safety and efficacy of ARNI therapy in LVAD pts. We retrospectively reviewed all LVAD pts implanted between 8/2010 and 5/2019 who were subsequently treated with ARNI for at least 3 months. The primary outcome was change in NT-proBNP between the time of ARNI initiation (t0) and at 3- and 6-mo follow up. Safety endpoints included changes in mean arterial blood pressure (MAP), serum creatinine and potassium pre- and post-ARNI therapy. Data on concomitant drug therapy including diuretic dosing equivalents were also gathered. The above mentioned variables were log-transformed prior to analysis with repeated measures ANOVA. Pairwise comparisons were performed with Bonferroni's post hoc test. 30 pts met our inclusion criteria (age 54.7 ± 15.5 y; 90% M; HM3 17[57%], HMII 12[40%], HVAD 1 [3%]). ARNI was initiated at a median of 250 [67 - 601] days after LVAD implant. Prior to ARNI initiation, 47% were on ACE inhibitor, 13% on ARB, 40% on neither and 60% were treated with diuretics, with an average oral furosemide equivalent dose of 34 mg/day. At t0, 73% were started on 24/26 mg, and at 6 mos, 27% were on 49/51 mg and 32% on 97/103 mg of ARNI (Table). There was no statistically significant change in median MAP, serum creatinine or potassium (Table). A significant decrease in NT-proBNP was noted from t0 to follow-up (t0 = 1082 pg/mL, 3 mos = 724 pg/mL, 6 mos = 651 pg/mL) (Figure). The use of ARNI therapy was well tolerated among LVAD pts. There was a significant decrease in NT-proBNP levels, an effect previously reported in HF pts without LVADs in the PARADIGM-HF and PIONEER-HF trials. Randomized studies to determine the role of ARNI on the clinical course of LVAD patients are warranted.

Abstract MP32: Variation in NT-proBNP Levels After Bariatric Surgery and Its Association With Body Fat Percentage

Introduction: Natriuretic peptides are regulators of the cardiovascular system that are also related to adiposity and insulin resistance. NT-proBNP levels are inversely associated with adiposity and increase with weight loss, which may have hemodynamic implications in obesity. However, it is unclear if the changes in NT-proBNP with weight loss are independent of changes in insulin resistance and related metabolic risk factors. Hypothesis: NT-proBNP increases with surgical weight loss are partially independent of changes in other metabolic risk factors. Methods: We investigated 71 patients from the BARI-Heart Study, a prospective cohort with anthropometrics, metabolic risk factors and biomarkers before and after bariatric surgery. We compared data between pre- and post-surgical visits (1-2 weeks and 6 months, respectively) using t-tests, and performed regression analysis examining the association of changes adiposity measures with NT-proBNP before and after adjusting for metabolic risk factors. Results: After bariatric surgery, major reductions in weight, body-mass index (BMI) and body fat percentage (BFP) (mean change) were observed (Table 1), whereas NT-proBNP levels increased (mean change +61 pg/mL, SD 104). There were significant reductions post-surgery in HOMA-IR (from 9.9 to 2.6; p &lt;0.0001), as well as in triglycerides, total cholesterol, glucose, and blood pressure (all p&lt;0.05). A negative correlation between changes in ln-NT-proBNP and BFP was found ( r -0.27; p=0.03). In regression analysis, the inverse association remained statistically significant after adjustment for changes in the other metabolic risk factors (Table 2). Conclusions: Reductions in adiposity are linked to increases in NT-proBNP independent of changes in metabolic risk factors. The mechanisms and cardiovascular implications of this direct link between weight loss and NT-proBNP deserve further investigation.

Abstract P436: The Role of Free Fatty Acids in Patients With Obesity and Heart Failure With Preserved Ejection Fraction: A Post-hoc Analysis of the UFA-preserved Pilot Study

Background: Increased circulating free fatty acids (FFA) are associated with an increased risk for heart failure (HF). Interestingly, in the setting of established HF, the failing heart relies heavily on the use of FFA as energetic substrate, and therapeutics aimed at reducing FFA in HF have been found to worsen cardiac performance. A dietary intervention aimed at increasing unsaturated fatty acids (UFA) was associated with favorable changes in cardiorespiratory fitness (CRF) in patients with obesity and HF with preserved ejection fraction (HFpEF) in the UFA-Preserved Pilot Study, although the mechanism remains largely unknown. We hypothesized that dietary UFA supplementation is associated with an increase in circulating FFA and may improve determinants of CRF such as cardiac function and body composition. Methods: Eight subjects with obesity and HFpEF engaged in 12 weeks of UFA supplementation by increasing intake of foods rich in monounsaturated fatty acids (i.e., oleic acid) and polyunsaturated fatty acids (i.e., α-linolenic acid, linoleic acid) under instruction and monitoring of a research dietitian. Measures were performed at baseline and 12 weeks. Subjects underwent venipuncture to measure circulating FFA, plasma biomarkers of UFA consumption, and NT-proBNP.. Bioelectrical impedance analysis was used to estimate skeletal muscle mass (SMM). Maximal cardiopulmonary exercise testing was performed to measure CRF defined as peak oxygen consumption (VO 2 ). Data are presented as median and interquartile range. Within group changes were assessed using Wilcoxon rank test and correlations were performed using Spearman rank test. Results: Five subjects were female and median age was 53 [50-59] years. The dietary intervention resulted in a significant increase in FFA (from 0.29 [0.20-0.43] to 0.37 [0.32-0.73] μmol/L, p=0.012) and plasmatic UFA (from 1319 [1224-1477] to 1620 [1268-2110] μg/mL, p=0.05). Changes in FFA were positively associated with changes in plasmatic UFA (R=+0.74, p=0.035). Changes in FFA were associated with a trend toward improvement in peak VO 2 , although it did not reach statistical significance (R=+0.72, p=0.068). Changes in FFA were also positively and significantly associated with an increase in SMM expressed in kg (R=+0.99, p&lt;0.001) and % of body weight (R=+0.90, p=0.006) and inversely associated with changes in NT-proBNP (R=-0.85, p=0.007). Conclusion: In patients with obesity and HFpEF, dietary UFA supplementation increases FFA, which are associated with favorable changes in cardiac function and body composition. This supports a novel mechanism through which UFA may positively affect CRF. Ongoing randomized controlled trials (NCT03966755) are underway investigating UFA supplementation as a therapeutic strategy to improve CRF in obesity and HFpEF.

P1386 A change in left ventricular global longitudinal strain is a prognostic indicator in congestive heart failure patients with preserved ejection fraction

Abstract Purposes We examined how changes in left ventricular (LV) global longitudinal strain (GLS) were associated with prognosis in patients with preserved LV ejection fraction (LVEF) after congestive heart failure (HF) admission. Methods We studied 123 consecutive patients (age 70 ± 15 years, 55% male) who had been hospitalized due to congestive HF with preserved LVEF (&amp;gt; 50%). The exclusion criteria were atrial fibrillation and inadequate echo image quality for strain analyses. The patients underwent speckle-tracking echocardiography and measurement of plasma NT-ProBNP levels on the same day at the time of hospital admission as well as in the stable condition after discharge. Differences in GLS, LVEF and NT-ProBNP (delta GLS, LVEF and NT-ProBNP ; 2nd – 1st measurements) were calculated. The study end points were all-cause mortality and cardiac events. Results Mean periods of echo performance after hospitalization were 2 ±１days (1st echo) and 240 ± 289 days (2nd echo), respectively. During the follow-up (974 ± 626 days), 12 patients died and 25 patients were hospitalized because of HF worsening. In multivariate analysis, delta GLS and follow-up GLS were prognostic factors, whereas baseline and follow-up LVEF, NT-ProBNP, changes in LVEF and NT-ProBNP could not predict cardiac events. Delta GLS (p = 0.002) turned out to be the best independent prognosticator. Receiver operating characteristics analysis revealed that -0.6% of delta GLS was the optimal cut-off value to predict cardiac events and mortality (sensitivity 76%, specificity 67%, AUC 0.75). Kaplan-Meier analysis showed that patients with delta GLS more than -0.6% experienced significantly less cardiac events during the follow-up period (p &amp;lt; 0.0001, log-rank). Conclusion A change in LV GLS after congestive HF admission was a predictor of the prognosis in patients with preserved LVEF. It would be useful to check the changes in GLS in those with preserved LVEF after discharge.

411 Recompensation induces distinct changes in myocardial work in patients with acutely decompensated heart failure and reduced vs preserved left ventricular ejection fraction

Abstract Funding Acknowledgements German Research Foundation (BMBF 01EO1004 and 01EO1504) OnBehalf Acute Heart Failure Registry Background &amp; Aim A new, less load-dependent echocardiographic tool to determine left ventricular (LV) myocardial work (MyW) based on longitudinal strain and blood pressure has recently been introduced and validated against invasive measurements. We investigated the impact of change in N-terminal pro-B-natriuretic peptide (NT-proBNP; i.e. surrogate of recompensation) during the hospital phase on changes in MyW (global work efficiency [GWE]; global constructive work [GCW]; and global wasted work [GWW]), in patients admitted for acutely decompensated heart failure (AHF). Methods The AHF registry is a monocentric prospective follow-up study that comprehensively phenotypes consecutive patients hospitalized for AHF. Echocardiography was performed and NT-proBNP measured on the day of admission and within 72 hours prior to discharge. MyW assessment was performed off-line using EchoPAC (GE, version 202). In order to quantify changes in MyW and NT-proBNP, we used the respective discharge-to-admission ratio (DAR). Local polynomial regression was applied to model these associations in patients with LV ejection fraction (LVEF) &amp;lt;40% vs ≥40%. Results We analyzed 111 patients: mean age 73 ± 11 yrs; 32% female; 46 patients (41.4%) with LVEF &amp;lt; 40%. The median [Q1, Q3] NT-proBNP level at admission was 5883 pg/ml (2589, 10188). Median length of stay in hospital was 12.0 days (9.0, 16.5). The DAR for NT-proBNP was 0.55 (0.34; 0.80) indicating that the majority of patients experienced a marked lowering of NT-proBNP. The figure demonstrates that the association between DAR of MyW parameters and DAR of NT-proBNP showed distinct profiles depending on admission LVEF. E.g., in panel A, the arrows indicate that a NT-proBNP reduction by 50% was associated with a 45% increment in GCW if admission LVEF was &amp;lt;40%, but with an 8% increment only if LVEF was ≥40%. Conclusions Our preliminary analysis indicates that a decrease in NT-proBNP may be associated with an improvement in GCW and GWE in patients with reduced LVEF, while these parameters were non-responsive in the other patient group. Although these results require confirmation in a larger cohort, they encourage further research in to MyW as a less load-dependent measure of LV function, shedding new light on echocardiographically manifest alterations of myocardial texture and the timing of healing processes after an acute cardiac event. Figure Discharge-to-admission ratio (DAR) of A) global work efficiency (GWE, &amp;gt;1= improvement), B) global constructive work (GCW, &amp;gt;1= improvement), and C) global wasted work (GWW, &amp;lt;1 = improvement) as a function of discharge to admission NT-proBNP in acute heart failure patients with left ventricular ejection fraction ≥ and &amp;lt;40%. Abstract 411 Figure

The Determinants and Outcomes of Myocardial Injury After Transcatheter Aortic-Valve Implantation: SAPIEN 3 Study

BackgroundThe effect of myocardial injury (MI) post-transcatheter aortic valve implantation (TAVI) on clinical outcomes is controversial. This study aimed to evaluate the effect of MI severity on clinical outcome and left ventricle function 30 days post-TAVI and determine MI post-TAVI predictors. MethodsOverall, 138 consecutive patients who underwent successful transfemoral TAVI using SAPIEN3 and diagnosed using echocardiography and computed tomography were analyzed. High-sensitivity cardiac troponin T (TnT) was evaluated at baseline, immediately, and at 24, 48, and 72 h post-TAVI. Echocardiography findings and N-terminal pro-B-type natriuretic peptide (Nt-pro BNP) levels were evaluated 30 days post-TAVI. ResultsMean age and STS score were 84.4 ± 3.5 years and 6.4 ± 3.2%, respectively. All cases showed severe aortic valve stenosis. Peri-procedural MI was observed in 48 of 100 patients (48.0%). Patients were grouped into MI (n = 48) and non-MI (n = 52), without significant difference in characteristics. Pre-balloon aortic valvuloplasty rate and total pacing time were significantly higher in MI vs non-MI. Total rapid pacing time (TRPT) was an independent predictor for MI (OR 1.06; 95% CI 1.01–1.16; p = 0.04). Echocardiography and Nt-pro BNP changes 30 days post-TAVI were similar between groups. ConclusionPeri-procedural MI, assessed by TnT changes, was observed in 48% of patients. The MI was not associated with overt cardiac dysfunction, and the recovery of left ventricular function and Nt-pro BNP level occurred similarly by 30 day post-TAVI between both groups. In multivariate analysis, TRPT was associated with MI after SAPIEN3 implantation. Trial registration numberUMIN000036669.