NT-proBNP Determination Research Articles

THE EFFECT OF EMPAGLIFLOZIN AND RANOLAZINE ON THE DYNAMICS OF STRUCTURAL AND FUNCTIONAL PARAMETERS OF THE HEART AND LEVELS OF BIOMARKERS NT-proBNP AND SOLUBLE (s)ST-2 IN PATIENTS WITH ATRIAL FIBRILLATION AND HEART FAILURE

Atrial fibrillation (AF) is the most common long-term arrhythmia worldwide and has a strong association with heart failure (HF).Aim. To investigate the effect of empagliflozin and ranolazine in addition to standard therapy on the dynamics of structural and functional parameters of the heart and levels of biomarkers NT-proBNP and soluble (s)ST-2 in patients with atrial fibrillation and heart failure.Materials and Methods. We examined 300 patients aged 45-65 years. All patients were divided into groups: Group I - patients with HF without AF (n=150). Group II - patients with HF and AF (permanent form) (n=150). Group of 136 practically healthy individuals. All patients underwent clinical examination, echocardiography (Echo), determination of NT-proBNP and (s)ST-2 levels by enzyme-linked immunosorbent assay.Results. The dynamics of parameters of the LV in the main group was more significant compared to the control group (p<0.05). After treatment, the concentration of circulating NT-ProBNP in the control group decreased by an average of 26.2% (p<0.05), and in the main group of patients - by 15.9% (p<0.05). As for the blood levels of the (s)ST-2 biomarker, after treatment in the control group there was an average decrease of 13.1% (p<0.05) compared with the dynamics in the main group of patients - by 38.8% (p<0.05).Conclusions. The use of INSKTG-2 empagliflozin against the background of standard therapy of heart failure reduction of myocardial remodelling and increase ejection fraction. Complex treatment with empagliflozin and ranolazine as INZCTG-2 helps to reduce the level of NT-ProBNP and (s)ST-2 in the blood serum.

Comparative assessment of venous congestion severity and hospitalization outcomes in patients with acute decompensated heart failure with preserved ejection fraction

Aim. To characterize the potental of additional paraclinical research methods (ultrasound, determination of body composition) for assessing the congestion severity in patients with acute decompensated heart failure with preserved ejection fraction (ADHFpEF) in the intensive care unit.Material and methods. We examined 82 patients with ADHFpEF aged from 50 to 85 years, who were hospitalized in the intensive care unit of the Veresaev City Clinical Hospital (Moscow). All patients underwent a standard clinical and laboratory examination, including determination of NT-proBNP, as well as echocardiography, chest radiography, bioimpedance analysis, Venous Excess Ultrasound (VExUS), lung ultrasound. Depending on the congestion degree visualized by VExUS, patients were divided into three groups.Results. The median levels of NT-proBNP, E/A and E/e', number of B-lines in one lung segment, ECW and TBW, and the diuretics' dose used in the hospital in pa tients with ADHFpEF and severe congestion were significantly higher. Signs of congestion obtained as a result of X-ray examination did not differ significantly between groups. In-hospital death was associated with higher values of NT-proBNP, E/A ratio, IVC diameter, number of B-lines in one lung segment, ECW and TBW. The odds of death in patients with VExUS Grade 3 increased 20,9 times compared to Grade 1 (95% CI: 1,125-387,688).Conclusion. Higher levels of NT-proBNP, the dose of diuretics used in the hospital, and ECW and TBW were associated with congestion severity. The severity of congestion assessed by VExUS and ECW/TBW are positively associated with inhospital mortality

Estrogen and the estrogen receptor in ZSF1 rats with heart failure with preserved ejection fraction

Abstract Funding Acknowledgements None. Background Heart failure with preserved ejection fraction (HFpEF) is more prevalent in women, so declining estrogen levels after menopause may be involved in genesis of the disease. Estrogen is cardio-protective, affecting blood pressure and vasodilatation and endothelial dysfunction is discussed as HFpEF pathomechanism. However, the potential connection between HFpEF and estrogen levels remains poorly understood. The well-established HFpEF ZSF1 rat model was used to analyze endothelial dysfunction, and a pronounced imbalance of the NO synthase substrates arginine and homoarginine was observed. Of note, estrogen levels in woman are directly and positively associated to homoarginine levels. Purpose We characterized serum estrogen levels and the expression of the estrogen receptor alpha (ERα) in the hearts of female ZSF1 HFpEF rats to investigate a possible contribution of estrogen signaling in HFpEF manifestation and to evaluate the suitability of this animal model in the context of estrogen and HFpEF. Methods In total, 12 obese ZSF1 rats with HFpEF (O-ZSF1) and 12 lean healthy ZSF1 rats (L-ZSF1) at 20 weeks of age and 5 animals of either phenotype aged 32 weeks were analyzed. Further, six O-ZSF1 rats were supplemented with homoarginine (hArg) when HFpEF was manifest and were observed up to 32 weeks of age. The manifestation of HFpEF was confirmed by echocardiography and determination of NT-proBNP by ELISA. Circulating estradiol (E2) in serum was determined using ELISA. Expression of the estrogen receptor alpha was determined by Western Blot analysis in the left ventricle (LV), septum and right ventricle (RV). Results Serum estradiol levels were similar in age-matched L-ZSF1 and O-ZSF1, but were ~2-fold increased at an age of 32 weeks compared to 20 weeks (p=0.002). The canonical ERα-66kDa was very weakly expressed in all tissues. ERα-45kDa expression in the LV was lower in O-ZSF1 at an age of 20 weeks (-46%, p=0.008) and at 32 weeks (-46%, p=0.002). ERα-45kDa expression in LV was 2-fold higher than in septum and 5-fold higher than in RV in rats aged 20 weeks (p<0.001). In RV, no differences in ERα-45kDa expression were observed. Supplementation of O-ZSF1 with hArg reestablished the ERα-45kDa expression in the LV (p=0.005 vs. O-ZSF1 without supplementation). Conclusion The manifestation and progression of HFpEF in ZSF1 rats is accompanied by a decrease of the ERα-45kDa expression in the LV, whereas the RV is not affected. Supplementation with homoarginine normalizes ERα-45kDa expression. The ERα-45kDa isoform was found to suppress the transcriptional activity of the classical ERα-66kDa isoform and to be an acute regulator of endothelial NO synthase in response to estrogen. These results suggest that altered ERα expression in the LV may represent a novel pathomechanism in HFpEF. In combination with decreasing estrogen levels in woman, adverse consequences for NO production in the LV seem likely.

Rapid Homogeneous Fluorescent Enzyme-Linked Immunosorbent Assay (ELISA) for N-Terminal Brain Natriuretic Peptide (NT-proBNP) Combining Magnetic Probes and Ampliflu Red

Heart failure (HF) is the leading cause of death from cardiovascular disease, and early diagnosis using serum markers holds extraordinary significance for the treatment of patients. N-terminal brain natriuretic peptide (NT-proBNP) is the gold standard for HF diagnosis. Herein, a novel, rapid, sensitive, and immune-sensing strategy for NT-proBNP is reported employing an enzyme-linked immunosorbent assay (ELISA) that combines the use of magnetic biological probes and the fluorogenic substrate Ampliflu Red. Functionalized immunomagnetic nanoparticles with large surface areas provide an abundant reaction platform and reduce the analysis time due to their superparamagnetic properties. Ampliflu Red is catalyzed by horseradish peroxidase (HRP) using hydrogen peroxide (H2O2) to produce strong fluorescence and a low background. The reported method achieved a good detection limit of 2.73 ng mL−1 and a wide linear range from 3.13 to 100 ng mL−1. The analysis time was less than 1 h, which is superior to that of traditional ELISA (3–4 h). In addition, the recoveries of spiked human serum were satisfactory, indicating that the proposed strategy has potential applications for the rapid determination of NT-proBNP and other biomarkers in clinical settings.

Is the 2016 ESC diagnostic algorithm useful for assessing the prevalence of chronic heart failure in population-based studies?

Chronic heart failure (CHF) is a major healthcare problem. However, there are no epidemiological studies assessing the prevalence of CHF in the general population with diagnosis based on algorithms recommended for clinical practice. The aim of the HF-Pomorskie survey was to assess the prevalence of three basic components of the 2016 ESC diagnostic algorithm for CHF (symptoms, N-terminal pro B-type natriuretic peptide [NT-proBNP], and abnormalities on echocardiography) and to determine whether this algorithm may be applicable to studies in general population samples. The study was performed in a representative sample of 313 adults (170 women and 143 men) aged between 20 and 90 years (mean 55.2 years [15.3]) in Northern Poland. A questionnaire to determine New York Heart Association [NYHA] class, laboratory tests including NT-proBNP, as well as transthoracic echocardiography and spirometry examinations were performed in all subjects. Dyspnea (NYHA class II-IV) was reported by 13.7% of recruited participants. Dyspnea and elevated levels of NT-proBNP (>125 pg/ml) were found in 7.7% of all examined subjects, while dyspnea, elevated NT-proBNP levels accompanied by systolic or diastolic abnormalities on echocardiography occurred in 4.8%. In the group without dyspnea (86.3% of all examined subjects), every sixth subject had an elevated level of NT-proBNP. On the other hand, 5.8% of studied subjects reported a previous diagnosis of CHF, which was confirmed using the current ESC algorithm in 78% of them. The prevalence of CHF assessed by the 2016 ESC diagnostic algorithm in the representative sample of adults was equal to 4.8%. The clinical algorithm for the diagnosis of CHF is fully applicable to the representative surveys in the general population. However, due to logistic and economic factors, echocardiography examination and NT-proBNP determination can be limited to patients reporting dyspnea or previous diagnosis of CHF.

Relationship between free circulating DNA levels, ejection fraction and brain natriuretic peptide levels in patients with chronic heart failure: prospective observational study

BACKGROUND: Chronic heart failure (CHF) is one of the most serious problems in cardiovascular diseases, requiring accurate diagnosis and treatment. The search for new laboratory markers of CHF can improve the accuracy of diagnosis and identify the severity of the patients condition.
 AIM: Our aim was to study the relationship between the levels of free-circulating DNA (cfDNA) and brain natriuretic peptide (NT-proBNP) in the blood plasma of patients suffering from CHF with ejection fraction (EF), to investigate the relationship between these laboratory markers, and to evaluate the dynamics of changes in the studied parameters against the background of drug therapy.
 MATERIALS AND METHODS: The study involved 67 patients of both sexes with a diagnosis of CHF, verified by clinical and functional methods. 23 people without established chronic diseases formed the control group. At the stage of inclusion in the study, all patients underwent: physical examination, general blood test, biochemical blood test with determination of lipid profile, glucose, creatinine, NT-proBNP and cfDNA levels, as well as electrocardiography (ECG), electrocardiography (ECHO-CG), radiography of organs chest, ultrasound of the abdominal organs, 6-minute walk test. The level of cfDNA was determined using the method of P.P. Laktionov, S.N. Tamkovich, E.Yu. Rykova (2005). Repeated blood sampling with assessment of cfDNA and NT-proBNP levels was carried out in the group of patients with reduced ejection fraction 57 months from the start of treatment/correction of previous therapy.
 RESULTS: The study revealed significant differences in the levels of cfDNA in the blood plasma in patients with different EF (less than 40%, 4049%, 50% or more). At the same time, an inverse relationship was established between cfDNA indicators and EF, as well as between the level of NT-proBNP and EF, that is, a progressive decrease in myocardial contractility is accompanied by a combined increase in the levels of the studied markers in the blood, reflecting the severity of the patients condition. In addition, the positive effect of drug therapy on cfDNA and NT-proBNP levels in the group of patients with EF 40% has been proven.
 CONCLUSION: The identified patterns make it possible to consider the level of cfDNA in blood plasma as a potential biomarker of CHF, and also to use it for dynamic monitoring of patients.

SST2 and NT-proBNP biomarkers in prediction of COVID-19

Background. COVID-19 may cause or worsen cardiac dysfunction and patients with pre-existing cardiovascular disease, including heart failure (HF), who have an increased risk of severe and fatal outcomes of COVID-19. The study aimed to determine the role of soluble suppression of tumorigenesis-2 protein (sST2) and natriuretic peptide test (NT-proBNP) in predicting the severe course and in-hospital mortality of patients with COVID-19 and hypertension. Materials and methods. One hundred and fifteen patients with COVID-19 and hypertension were examined. The determination of sST2 and NT-proBNP in blood serum were done using the enzyme-linked immunosorbent assay. The clinical endpoint was assessed during the hospitalization period (death, hospitalization in the intensive care unit, prolonged hospitalization). The risk of the final event development was calculated for the patients who reached the threshold sST2 concentrations, and, separately, based on the diagnostic values of the NT-proBNP. Results. The cut-off values of sST2 recommended for the diagnosis of HF in our study were reached in 7 (28 %) cases. The risk of final clinical points development in these patients was as follows: OR = 10.67; 95% CI: 1.31–86.9; p = 0.0270. The level of NT-proBNP, which meets the criteria for the diagnosis of HF, was constant in only 10 (11.1 %) individuals (p = 0.0461) and the risk of clinical events developing was equal to OR = 7.0; 95% CI: 1.72–28.6; p = 0.0067. Conclusions. Stratification of patients based on sST2 values, in addition to NT-proBNP parameters, may provide further prognostic value compared to NT-proBNP levels in patients with COVID-19 and HF.

Prognostic value of myocardial flow reserve in patients with heart failure with preserved ejection fraction

Aim. To study the prognostic value of myocardial blood flow (MBF) and myocardial flow reserve (MFR) parameters in patients with heart failure with preserved ejection fraction (HFpEF) and non-obstructive coronary artery disease (CAD) in risk stratification of HFpEF progression during a 12-month follow-up.Materials and methods. The study included 58 patients with non-obstructive CAD and HFpEF (LVEF 62 [58; 66]%). Dynamic CZT-SRECT was used to evaluate MFR and MBF at rest (rest-MBF) and stress (stress-MBF). NT-proBNP levels were determined by the enzyme immunoassay. Diastolic dysfunction parameters were measured using 2D transthoracic echocardiography. Left ventricular systolic global longitudinal strain (GLS) was assessed using 2D speckle tracking.Results. After a 12-month follow-up, the patients were retrospectively divided into 2 groups: group 1 (n = 11) included patients with an unfavorable course of HFpEF, group 2 (n = 47) encompassed patients with a favorable course of the disease. In group 1, the level of NT-proBNP was 3.8 times higher than in group 2 (284.5 [183.42; 716.73] and 1,071.4 [272.4; 2,168.1] pg / ml, respectively). MFR values in group 1 were lower by 45.4%(p < 0.001) than in group 2 (1.19 [0.86; 1.55] vs. 2.18 [1.7; 2.55], respectively). In group 1, rest-MBF levels were higher by 23.6% (p = 0.046) and stress-MBF was lower by 28.2% (p = 0.046) than in group 2. The multivariate regression analysis revealed that NT-proBNP levels (odds ratio (OR) 3.23; p = 0.008), GLS (OR 2.27; p = 0.012), and MFR (OR 8.09; p < 0.001) were independent predictors of adverse outcomes in HFpEF. Based on the ROC analysis, MFR levels ≤ 1.62 (AUC = 0.827; p < 0.001), GLS ≤–18 (AUC = 0.756; p = 0.002), and NT-proBNP≥ 760.5 pg / ml (AUC = 0.708; p = 0.040) may be considered as markers of adverse outcomes. However, the combined determination of NT-proBNP and MFR had a greater significance (AUC 0.935; p < 0.001) in risk stratification compared with the monomarker model, while the addition of GLS did not increase the significance of the analysis.Conclusion. Levels of NT-proBNP, GLS, and MFR may be used as non-invasive markers of an adverse course of HFpEF in patients with non-obstructive CAD, while the combined determination of NT-proBNP and MBF increases the prognostic value of the analysis.

The Pre-Heart Failure in Hypertension

The objectives of this study were to detect pre-heart failure based on NT-proBNP in subjects with hypertension and to identify the risk factors for pre-heart failure. Research methods: We conducted a cross -sectional study between August and December 2022. This study was included 526 subjects with hypertension aged from 35- to 64 years, who had no clinical symptoms of heart failure. Cardiovascular risk factors were detected by clinical examinations and laboratory test. Hypertension was defined as systolic BP ≥ 130 mm Hg, diastolic BP ≥ 80 mm Hg, and/or receiving treatment with anti-hypertensive agents. NT-pro BNP determination was performed on an immunoassay analyzer (Getein 1100). An elevated NT-pro BNP was defined as a NT-pro BNP ≥ 125pg/ml. Pre-heart failure was based on elevated NT-pro BNPlevel. Ethical statement Research ethical permission was obtained from the Biomedical Ethics Committee of Mongolian National University of Medical Sciences. Research results: In total, 526 hypertensive subjects s aged 35-64 year enrolled in this study, of which, 243 (46.2%) were men and mean age was 52.5±7.7 years. The prevalence of pre-heart failure based on NT-pro BNP in women was non-significantly higher than in men(17.3% vs 14.0%, p= 0.297). The prevalence of pre-heart failure increased from 4.0% for men aged 35-44 years to 20.9% for men aged 55-64 years. Based on our logistic regression analysis, the likelihood of elevated NT-pro BNP in hypertensive subjects was independently associated with age(OR 2.18, 95%CI 1.51-3.14) and poor blood pressure control(OR 2.41, 95%CI 1.29-4.50). Conclusion: The present study showed that the overall prevalence of pre-heart failure in hypertensive subjects was 15.8% and increased with age. The poor blood pressure control and ageing were significant risk factors in the development pre-heart failure in subjects with hypertension.

Phenotyping of embolic cryptogenic stroke based on ultrasound diagnosis and determination of serum concentration NT-proBNP

Determining the potential mechanisms underlying cryptogenic ischemic stroke is essential to guide diagnostic discovery and personalize secondary prevention.Purpose is to study the phenotypes of embolic stroke of undetermined source (ESUS) based on ultrasound diagnosis and determination of the serum concentration of pro-natriuretic N-terminal peptide B-type (N-Terminal Pro-brain Natriuretic Peptide, NT-proBNP).Materials and methods. 141 patients with ESUS were examined. In addition to the standard examination aimed at fi nding the cause of stroke, the functional characteristics of the left atrium were assessed using the emptying fraction (left atrial emptying fraction, LAEF) and the functional index (left atrial function index, LAFI), and the concentration of NT-proBNP in blood serum was also measured.Results. The most common potential sources of embolism were atherosclerotic plaques in the stroke-associated carotid artery with stenosis in 30–49% (31.9% of patients) and atrial cardiopathy with a decrease in LAEF < 51.8% (24.8% of patients). An analysis of combinations of potential sources showed that 46.1% of patients had a negative phenotype, 21.3% of patients had a cardiac phenotype, 19.1% of patients had an atherosclerotic phenotype, and 13.5% of the examined patients had a mixed phenotype. Patients with a cardio-atherosclerotic phenotype diff ered from patients with a negative phenotype by higher disability on the Rankin scale at discharge from the hospital.Conclusion. The main potential embolic sources in patients with ESUS are non-stenosing carotid atherosclerosis and atrial cardiopathy with decreased LAEF. Cardiac and atherosclerotic phenotypes are determined in a quarter of patients, a mixed phenotype is found in every seventh patient, while in almost half of the patients no sources of embolism are found.

PS-C06-7: NT- PRO BNP IN ARTERIAL HYPERTENSION

Objectives of the present study were to evaluate the association of N-terminal pro-B-type natriuretic peptide to hypertension and to compare NT-pro BNP levels in groups with and without arterial hypertension. Design and method: The study included 253 participants with cardiovasular risk aged 35–64 years and who had no clinical symptoms of heart failure. All participants were divided into to two groups: hypertensive and normotensive. High risks for heart failure included arterial hypertension, diabetes, obesity, excessive drinking of alcohol, smoking and family history of cardiovascular disease were detected by clinical examinations. Hypertension was defined as systolic BP ≧ 140 mm Hg, diastolic BP ≧ 90 mm Hg, and/or receiving treatment with anti-hypertensive agents. The NT-pro BNP determination was performed using immunoassay analyzer which utilizes reagent strip to obtain quantitative NT- pro BNP results in plasma. The cut-off point for NT-pro BNP was 125 pg/ml. All statistical analyses were made with the SPSS version 25.0. Differences between the study groups were analyzed with the chi-square test for categorical variables. P value less than 0.05 is considered as statistically significant. Results: The study sample consisted of 100 men and 153 women. The mean age of participants was 51.1 ± 8.2 years. In all, 49% of participants were hypertensive. The mean age, body mass index and abdominal circumference in hypertensive group were significantly higher than in normotensive group. Elevated NT-pro BNP levels ≧ 125 pg/ml were detected in 12.6% of participants. Increased NT- pro BNP values were detected in 21.0% subjects with hypertension and in 4.6% subjects without hypertension. The mean N-terminal pro-B-type natriuretic peptide value among patients with and without hypertension were 145.0 ± 98.0 pg/ml and 112.6 ± 59.6 pg/ml. Multivariate linear regression analysis showed that age β; = 0.240, P = 0.021 and systolic blood pressure β; = 0.256, P = 0.008 were positively correlated with NT-pro BNP levels in hypertensive group. Conclusions: NT-pro BNP levels were significantly increased in participants with hypertension. The present study showed that age and systolic blood pressure were significantly positively associated with NT- pro BNP levels. In case of elevated NT- pro BNP we recommend using echocardiography

Evaluation of the Roche point of care system for determination of NT-proBNP in urine samples

IntroductionThe diagnostic potential of urine NT-pro-BNP has been studied recently and shows great promise, especially for children. Bedside serum-NT-proBNP determination with point of care testing (POCT) is established in adults. This study investigated the analytical capabilities of NT-proBNP POCT measurements for urine-samples. Furthermore, the stability of this biomarker in urine samples at room-temperature was explored. Methods104 urine samples were analysed, partly with double and triple determinations and compared to the established Elecsys system. To investigate the stability of NT-proBNP in urine, five samples were stored at room temperature and analysed 12-hourly over 96 h. Results34 % of samples lay outside the POCT range (60 pg/ml-9000 pg/ml). The 69 values within the range were correlated with those measured by Elecsys (correlation coefficient of 0.92; p < 0.001). Linear regression yields an r2 of 0.84. The stability of urine NT-proBNP was shown with correlation coefficients between 0.97 and 1 (p < 0.001). ConclusionAnalysing NT-ProBNP in urine with cobas h232 POC system is feasible, but the detection range needs to be adjusted. As urine NT-proBNP proved stable for at least 96 h even postal shipping would be possible. Adjusting this system‘s measuring range could help introduce a new, non-invasive, pain-free parameter.

Prevalence and clinical associations of iron deficiency in patients with decompensated heart failure, depending on the diagnostic criteria used for iron deficiency

To compare the frequency of iron deficiency (ID) in patients with decompensated heart failure (HF), defined by international guideline criterion ferritin 100 ng/ml or ferritin from 100 to 299 ng/ml with TSAT20% (criterion A) and by bone marrow biopsy criterion TSAT19.8% and serum iron 13 mol/l (criterion B); to evaluate the effect of ID, diagnosed on the basis of different ID criteria, on NT pro-BNP, sST2, CRP levels and New York Heart Association (NYHA) functional classes (FC) distribution between groups with ID and without ID. The study included 223 patients (median age 73 [65; 82] years, 58% males) who were hospitalized to V.V. Vinogradov Moscow City Clinical Hospital No. 64 with decompensated HF. All patients underwent a standard physiological examination, laboratory and instrumental studies, including determination of NT-proBNP, sST2, CRP, and ferrokinetic parameters (serum iron, transferrin, ferritin). TSAT was calculated as: serum iron / transferrin 3.98. NYHA FC was determined according to Heart Failure Severity Rating Scale score. All patients underwent echocardiography to assess the ejection fraction of the left ventricle. According to criterion A ID was detected in 89% (n=199) of patients. There were no significant differences between levels of CRP, NT-proBNP and sST2. According to criterion B ID was detected in 70% (n=156) of patients. In the ID group, higher levels of CRP (15.1 mg/l vs 6.2 mg/l, p0.001), NT-proBNP (5422 pg/ml vs 2380 pg/ml, p0.001) and sST2 (59.6 ng/ml vs 42 ng/ml, p=0.02) were detected. Intravenous FCM admission according to current international guidelines (diagnosis of ID according to criterion A) is recommended to 57% of patients included in this study. Both methods formed groups with ID, in which patients had higher NYHA FC compared to groups without ID. According to current clinical guidelines, iron deficiency should be assessed according to method 1. More than half of patients (57, n=127) have indications for intravenous FCM to reduce risk of HF hospitalizations. The frequency of ID in patients with decompensated heart failure varies from 70 to 89% depending on the criterion used to diagnose ID, but in any case, remains high. Intravenous FCM should be prescribed in 57% (n=127) of patients. Criterion B, validated against the gold standard of diagnostics, unlike criterion A, makes it possible to form groups of patients with ID and without ID, significantly differing in CRP, NT-proBNP, and sST2 levels.

MO115: Cardiorenal Units as Management Strategy to Improve Outcomes in Cardiorenal Syndrome

Abstract BACKGROUND AND AIMS Cardiorenal syndrome (CRS), defined as the spectrum of disorders that acutely or chronically affect both heart and kidney function, is often a challenging condition with paucity of evidence-based therapy. The increasing burden of this entity has prompted the creation of cardiorenal units (CRU) as integrating programs intended to provide a combined multidisciplinary approach to maximize all chances for organ and patient recovery. Here we describe the early results of the creation of one CRU in a high complexity university hospital. METHOD This observational study included all patients diagnosed with CRS, who have been seen in the cardiorenal day care unit, formed by specific trained nephrologist, cardiologist and nurses. Assessment of cardiorenal function and volume status was performed by conventional cardiac ultrasound plus V-Scan, GFR estimation by CKD EPI, NT-proBNP determination and bioelectrical impedance when indicated. RESULTS Cardiorenal Unit of Puerta de Hierro University Hospital was created in January 2021. A total of 68 patients have been evaluated with a mean follow-up of 4 months (SD 3.2). Most frequent cardiologic diagnoses were 63.9% heart fellow with reduced function (HFrF) and 37.1% heart failure with preserved ejection fraction (HFpEF) and the presence on pulmonary hypertension or tricuspid regurgitation were 29.4% and 50.9%. 51.6% patients showed diuretic resistance. Most frequent renal diagnosis were pure CRS 36.9%, and 27.7% and 24.6% CRS associated to diabetic kidney disease or nephroangioesclerosis, respectively. Mean FGe rate when patients were initially evaluated was 31.5 mL/min/1.73 m2 (SD 11.0) with demonstration of albuminuria in 48.5% of patients. The integrated cardiorenal management of these patients included initiation or adjustment of specific cardio-nephroprotective drugs [SGLT2 inhibitors (46.8%), ARNi (25.8%), aldosterone receptor antagonists (4.8%)] or diuretic regime adjustment including iv administration (54.8%). Peritoneal dialysis was indicated in three patients and haemodialysis in one patient. Approximately 13.2% patients suffer new episodes of heart failure that needed hospitalization or unexpected medical attention at the day-care clinic. One patient died during follow-up (1.5%). CONCLUSION We conclude that this coordinated cardionephro approach of CRS was useful to optimize drug therapy aimed to mid-long term goals of cardionephro protection and to implement advanced therapies for fluid management in patients with diuretic resistance.

Effects of curtailed sleep on cardiac stress biomarkers following high-intensity exercise

ObjectivePhysical exercise—especially at high intensity—is known to impose cardiac stress, as mirrored by, e.g., increased blood levels of cardiac stress biomarkers such as cardiac Troponin T (cTnT) and NT-proBNP. We examined healthy young participants to determine whether a few nights of short sleep duration alter the effects of acute exercise on these blood biomarkers. MethodsSixteen men participated in a randomized order in a crossover design, comprising three consecutive nights of a) normal sleep duration (NS, 8.5 h of sleep/night) and b) sleep restriction (SR, 4.25 h of sleep/night). Blood was repeatedly sampled for determination of NT-proBNP and cTnT serum levels before and after a high-intensity exercise protocol (i.e., 75% VO2maxReserve cycling on an ergometer). ResultsUnder pre-exercise sedentary conditions, blood levels of cTnT and NT-proBNP did not significantly differ between the sleep conditions (P > 0.10). However, in response to exercise, the surge of circulating cTnT was significantly greater following SR than NS (+37–38% at 120–240 min post-exercise, P ≤ 0.05). While blood levels of NT-proBNP rose significantly in response to exercise, they did not differ between the sleep conditions. ConclusionRecurrent sleep restriction may increase the cardiac stress response to acute high-intensity exercise in healthy young individuals. However, our findings must be further confirmed in women, older subjects and in patients with a history of heart disease.

Прогностическое значение N-концевого прогормона мозгового натрийуретического пептида при долгосрочном прогнозе желудочковой аритмии у больных сахарным диабетом с острым коронарным синдромом молодого и среднего возраста

The article investigates the prognostic value of pro-B-type N-terminal natriuretic peptide (NTproBNP) in connection with ventricular extrasystoles (VES) in a population of patients with diabetes mellitus with acute coronary syndrome (ACS) after successful coronary reperfusion by percutaneous coronary intervention (PCI). Patients with ACS were examined by defining biomarkers and performing echocardiography (EchoCG) on the first day of ACS after PCI with stenting of the infarction-related coronary artery, and Holter monitoring of electrocardiography (HM-ECG) on the second day after PCI; 12 months later, EchoCG, HM-ECG and NT-proBNP determination were repeated. It was found that the incidence of VES in the long-term prognosis among ACS patients with diabetes of young and middle age was more frequent than in patients without diabetes. A positive correlation was found between the NTproBNP level and ventricular arrhythmia in ACS patients with diabetes mellitus. It has been proven that a high level of NT-proBNP on the first day in patients with ACS after PCI as an independent indicator of risk to development of VES in long-term prognosis.

Clinical impact of the determination of natriuretic peptides on long-term follow-up of patients treated in the Heart Failure Unit

Abstract Introduction The use of natriuretic peptides has spread in recent years as a diagnostic tool in patients with heart failure (HF). However, its influence on the prognosis of these patients has not been clearly established. Thus, our main aim was to know the characteristics of patients with increased levels of NT-proBNP and to analyze its impact on long-term prognosis in terms of mortality and readmissions due to heart failure. Material and methods We selected cases from the heart failure unit at HURS which had a NT-proBNP determination at first consultation. Patients were divided into two groups: GROUP 1 (NT-ProBNP &amp;lt;10000) and GROUP 2 (NT-ProBNP &amp;gt;10000). Clinical, echocardiographic and treatment variables were collected and patients were followed up for readmissions due to heart failure and all-cause mortality. Results A total of 280 patients were selected. The mean age of the cohort was 66.74±13.88 years and was male-dominated (64%). In group 1, there was a higher initial left ventricular ejection fraction (LVEF) (43.19% vs 40.36%; p=0.057), lower basal creatinine (1.13 mg/dL vs 1.53 mg/dL; p=0.001), lower creatinine at the end of follow-up (1.27 mg/dL vs 1.79 mg/dL; p=0.001) and a lower NT-proBNP at the end of follow-up (4039 pg/mL vs 17140 pg/mL; p=0.000) than in group 2. In addition, group 2 showed a higher percentage of chronic kidney disease (55% vs 29%; p=0.000) than group 1, with no differences in their main variables. With 110 months of follow-up, patients with NT-proBNP levels&amp;gt;10000 had a similar hospital readmission rate compared to the group with lower NT-proBNP levels (81.2% vs 84.8% log rank p=0.133).With a mean of 130.01±9.11 months of follow-up, patients with NT-proBNP levels&amp;gt;10000 had a tendency to higher mortality from any cause than those with lower NT-proBNP levels (84.4% vs 48.4%, log rank p=0.000). Conclusion Patients with NT-proBNP levels&amp;gt;10000 are associated with a lower LVEF at baseline and a higher proportion of chronic kidney disease. In the long term, patients with NT-proBNP levels&amp;gt;10000 had the same rate of readmissions for heart failure but a higher rate of death from any cause. Kaplan-Meier analysis Funding Acknowledgement Type of funding source: None

Screening for asymptomatic heart failure with preserved ejection fraction in mongolian population at high risk.

Objective The goals of the present study were to assess the prevalence of asymptomatic heart failure with preserved ejection fraction (HFpEF) in subjects at high risk of developing HF and to define the diagnostic accuracy of NT-pro BNP assay compared with echocardiography in this setting.Material and methods This cross-sectional study included subjects aged from 35 to 64 years, with high risk of HF, who had no clinical symptoms of HF. Risk factors of HF were detected by clinical examinations. NT-pro BNP determination was performed using immunoassay analyzer (FIA8000, Getein Bio Medical Inc, China),. The cut-off point for NT-pro BNP was 125 pg/ml. Diagnosis of HFpEF was based on criteria recommended by 2016 ESC heart failure guidelines. Diastolic dysfunction was assessed according to the algorithm proposed in the joint recommendations of the ASE/EACVI.Results 602 patients with risk factors of HF were included in the study, of which 256 (42.5 %) were males and 346 (57.5 %) females. The mean age was 51.71±8.07 years. 83 patients (13.8 %) showed elevated NT-pro BNP levels of ≥125 pg / ml. Our study has shown that NT-pro BNP concentration was positively correlating with age, both systolic and diastolic blood pressure, left ventricular mass and E / e' ratio and negatively correlating with waist circumference, body mass index, left ventricular EF and E / A ratio in asymptomatic population. The likelihood of positive NT-pro BNP test was independently (p&lt;0.05) associated with age, hypertension and diabetes. The diagnosis of asymptomatic HFpEF was confirmed in 12.3 % of studied population. A cutoff value of 125 pg / ml for NT-proBNP concentration showed the following diagnostic re-abilities in identifying asymptomatic HFpEF: sensitivity 85.0 %, specificity 88.6 % and area under curve 0.92 (95 % CI 0.86-0.98).Conclusion Subjects with raised NT-pro BNP level (≥125 pg/ml) were more likely to have a confirmed diagnosis of asymptomatic HFpEF after screening. In summary, in at-risk population, natriuretic peptide based screening combined with echocardiography identifies high prevalence of asymptomatic HFpEF.

Prognostic value of NT-proBNP in Algerian patients with asymptomatic aortic stenosis

Aortic stenosis (AS) is the most common valve disease. Aortic-valve replacement (AVR) is the treatment of choice in symptomatic patients with severe AS. Our objective was to assess the prognostic value of NT-proBNP in Algerian patients with asymptomatic moderate/severe aortic. Prospective study of 225 patients with degenerative asymptomatic moderate/severe aortic stenosis. NT-proBNP was determined in all patients, who were then followed up clinically. A clinical event was defined as surgery, hospital admission due to angina, heart failure or syncope, or death. A total of 51% were women, and the mean age was 74 years. Mean (SD) echocardiographic values were as follows: peak velocity 4.14 (0.87) m/s; mean gradient, 43.2 (16.0) mmHg; aortic-valve area, 0.87 (0.72) cm 2 , and aortic-valve area index, 0.49 (0.14) cm 2 /m 2 . The median NT-pro-BNP value was 490.0 [198.0–1312.0] pg/mL. There were 139 events during follow-up (median 12 months). The optimum NT-proBNP cut-point was 515 pg/mL, giving event-free survival rates at 6 months and 1 years of 93% and 57%, respectively, in patients with NT-proBNP < 515 pg/mL compared with 50% and 31% in those with NT-proBNP > 515 pg/mL. NT-proBNP determination provides prognostic information in patients with asymptomatic moderate/severe aortic stenosis.

Uso de NT-proBNP como predictor de evolución en el posoperatorio de cirugía cardíaca

Introduccion: la fraccion amino-terminal del peptido natriuretico tipo B (NT-proBNP) es un biomarcador diagnostico y pronostico en insuficiencia cardiaca. Su uso como predictor pronostico en el posoperatorio de cirugia cardiaca (CC) noesta establecido.Objetivo: determinar si el valor del NT-proBNP en el preoperatorio de CC se asocia a parametros de evolucion posoperatoria.Objetivo primario: evaluar su asociacion con el tiempo de internacion prolongada en centro de tratamiento intensivo (CTI). Objetivos secundarios: evaluar su asociacion con el tiempo de asistencia respiratoria mecanica (ARM) y de requerimiento de inotropicos (RI). Determinar la evolucion de la concentracion del NT-proBNP luego de la circulacion extracorporea (CEC).Metodo: estudio multicentrico retrospectivo avalado por el Comite de Investigacion del Instituto Nacional de Cirugia Cardiaca y por el Comite de Etica de la Investigacion del Hospital de Clinicas. Se incluyeron pacientes operados con CEC desde marzo a agosto de 2018. Se midio el NT-proBNP durante la induccion anestesica y luego de CEC. Se estudio la posible asociacion del NTpro-BNP preoperatorio con factores de riesgo y tipo de procedimiento realizado. Mediante analisis de curvaROCse determino el area bajo la curva (AUC) y se establecio el mejor punto de corte del NT-proBNP para predecir internacion prolongada en CTI. Se definio como tiempo de internacion en CTI, deARMy de RI prolongado al mayor a 2 dias, 6 y 24 horas, respectivamente. Mediante logistica multivariada se determino el valor predictor del NT-proBNP para cada una de las variables anteriores. Se considero significativo un ? de 0,05.Resultados: se incluyeron 155 pacientes. La edad, creatininemia y fraccion de eyeccion del ventriculo izquierdo (FEVI) fueron de 65,8±11,4 anos, 1,15±1,10 mg/dl y 52,8±11,9%, respectivamente. La prevalencia de sexo femenino fue de 30,3%; hipertension arterial 77,4%; diabetes mellitus 25,2%, y dislipemia 50,3%. Enel 42,6% se realizo revascularizacion miocardica aislada, en 12,9% revascularizacion miocardica asociada a uno o mas procedimientos valvulares y en 44,5% procedimientos valvulares puros. En todos los casos hubo una disminucion significativa entre NT-proBNP preoperatorio (443 pg/ml, rango 143-1.193) y posoperatorio (362 pg/ml, rango 138-939). Edad, cretininemia, FEVI, clase funcional IV de la New Heart Association y dislipemia, se asociaron con el NT-proBNP preoperatorio. El NT-proBNP preoperatorio fue mayor en pacientes con internacion en CTI,ARM y RI prolongados, pero solo resulto ser predictor independiente para internacion prolongada (OR=1,62; IC95% 1,11-2,35, p=0,012). El mejor valor de corte para internacion prolongada en CTI fue de 409 pg/ml (AUC=0,68).Conclusion: la determinacion preoperatoria de NT-proBNP es de utilidad como una herramienta mas en predecir la evolucion posoperatoria. La CEC se asocia a un descenso significativo de dicho marcador.