Higher Brain Natriuretic Peptide Levels Research Articles

Factors Associated with Impaired Resistive Reserve Ratio and Microvascular Resistance Reserve

Coronary microvascular dysfunction (CMD) is described as an important subset of ischemia with no obstructive coronary artery disease. Resistive reserve ratio (RRR) and microvascular resistance reserve (MRR) have been proposed as novel physiological indices evaluating coronary microvascular dilation function. The aim of this study was to explore factors associated with impaired RRR and MRR. Coronary physiological indices were invasively evaluated in the left anterior descending coronary artery using the thermodilution method in patients suspected of CMD. CMD was defined as a coronary flow reserve <2.0 and/or index of microcirculatory resistance ≥25. Of 117 patients, 26 (24.1%) had CMD. RRR (3.1 ± 1.9 vs. 6.2 ± 3.2, p < 0.001) and MRR (3.4 ± 1.9 vs. 6.9 ± 3.5, p < 0.001) were lower in the CMD group. In the receiver operating characteristic curve analysis, RRR (area under the curve 0.84, p < 0.001) and MRR (area under the curve 0.85, p < 0.001) were both predictive of the presence of CMD. In the multivariable analysis, previous myocardial infarction, lower hemoglobin, higher brain natriuretic peptide levels, and intracoronary nicorandil were identified as factors associated with lower RRR and MRR. In conclusion, the presence of previous myocardial infarction, anemia, and heart failure was associated with impaired coronary microvascular dilation function. RRR and MRR may be useful to identify patients with CMD.

PS-R04-2: A CASE OF SUCCESSFUL PERCUTANEOUS TRANSLUMINAL RENAL ANGIOPLASTY (PTRA) FOR RENAL ARTERY STENOSIS ASSOCIATED WITH TAKAYASU'S ARTERITIS

Introduction: In Japan, renal vascular hypertension based on renal artery stenosis (RAS) accounts for 1% of all hypertensive patients, and RAS is present in approximately 10% of autopsy cases of coronary artery disease and cerebrovascular disease. As ischemic nephropathy and complications of cardiovascular disease (CVD) due to RAS are common, early diagnosis and treatment for RAS is important. However, results of several large clinical trials have not shown the efficacy of percutaneous transluminal renal angioplasty (PTRA) for atherosclerotic RAS. Case: 51-year-old woman who diagnosed as Takayasu's arteritis (TA) 35 years ago, had been treated with 5 mg daily of prednisone. She presented with hypertension and edema in both legs a year before admission. Her examination at that time revealed increased serum creatinine from 1.0 to 1.7 mg/dL, high proteinuria (7.3 g/gCr), high renin activity (47.0 ng/mL/hr) and right RAS. Eight months before admission, she had an operation for ruptured descending aorta. She had recurrent episodes of dyspnea on exertion, worsening leg edema and severe hypertension and was admitted to the hospital for the treatment. Clinical course: In addition to severe hypertension (190/80 mmHg) and progression of RAS, she had pulmonary congestion, high brain natriuretic peptide (BNP) level (1149.5 pg/mL), increasing creatinine levels (Cr 3.1 mg/dL), and left non-functioning kidney on admission. Despite taking 8 types of antihypertensive drugs and diuretics without renin-angiotensin system inhibitors, blood pressure and fluid retention were poorly controlled, and thus we decided to perform PTRA for the right RAS. After the PTRA, edema, hypertension and pleural effusion had been dramatically improved. In addition, we could observe decrease of serum creatinine (Cr 1.6 mg/dL), proteinuria (0.5 g/gCr) and plasma renin activity (1.9 ng/mL/hr). Therefore, we reduced the antihypertensive drugs from 8 to 2. Discussions: Although the benefit of PTRA for RAS associated with TA remains unclear, the clinical course suggests that the success of PTRA in this case may be related to the fact that the RAS was complicated by TA. It also suggests that we should consider PTRA in cases of hypertension and pulmonary congestion associated with RAS which are difficult to control like this case. Conclusion: We have experienced a case of RAS associated with TA that was successfully treated with PTRA.

Brain natriuretic peptide levels and short physical performance battery scores independently influence short-term readmission rates in older patients with heart failure.

The Short Physical Performance Battery (SPPB) is a well-established tool to assess the lower extremity physical performance status. The purpose of this study is to examine the impact of brain natriuretic peptide (BNP) levels and SPPB scores on short-term readmission in older patients with heart failure (HF). This prospective cohort study enrolled 325 patients with HF who were hospitalized for acute decompensated HF between November 2017 and December 2021. Variables were analyzed using the Cox proportional hazards model, receiver operating characteristic (ROC) curve, and Kaplan-Meier analysis. The 107 patients who met the inclusion criteria were divided into readmission (within 90days of discharge; n = 25) and non-readmission (n = 82) groups. Multivariate analysis revealed that BNP level and SPPB score were independent risk factors for readmission within 90days after discharge. Patients were classified into three groups according to the BNP and SPPB cutoff values calculated using ROC curves. The risk of readmission was significantly higher in Group 3 (BNP ≥ 384pg/mL and SPPB ≤ 7 points) than in Group 1 (BNP < 384pg/mL and SPPB > 7 points; hazard ratio: 27.68, 95% confidence interval: 3.672 - 208.700, P = 0.0012). Our study showed that HF patients with high BNP levels and low SPPB scores have a dramatically increased risk of readmission within 90days of discharge.

Prognostic Value of the FAN Score, a Combination of the Fibrosis-4 Index, Albumin-Bilirubin Score and Neutrophil-Lymphocyte Ratio, in Patients Hospitalized with Heart Failure.

The fibrosis-4 index, albumin-bilirubin score and neutrophil-lymphocyte ratio are all prognostic markers in patients with heart failure. Recently, the FAN score, which includes all 3 of these markers, was developed as a useful risk stratification tool in patients with cancer. However, its cut-off values have not been validated for heart failure. We aimed to investigate the optimal cut-off and prognostic values of the FAN score in patients with heart failure. We analyzed 669 consecutive patients hospitalized with heart failure (age, 75.8 ± 11.3 years). Their median values of the fibrosis-4 index, albumin-bilirubin score, and neutrophil-lymphocyte ratio at discharge were 2.12, -2.25, and 2.41, respectively. The FAN score for heart failure (HF-FAN score) was calculated using these median values. The primary outcome was a composite of all-cause death and heart failure rehospitalization. Patients were divided into 4 groups according to HF-FAN scores of 0 (n = 112), 1 (n = 231), 2 (n = 242) and 3 (n = 84). Patients with HF-FAN scores of 3 were older, had higher brain natriuretic peptide levels, and larger inferior vena cava diameters. Kaplan-Meier analysis showed a direct correlation between higher HF-FAN scores and occurrence of the primary endpoint (log-rank P < 0.001). Cox proportional hazard analysis revealed a higher HF-FAN score was significantly associated with a worse prognosis even after adjustment for possible prognostic factors. Changing from the FAN score to HF-FAN score provided significant continuous net reclassification improvement. In conclusion, the HF-FAN score at discharge was useful for risk stratification in patients hospitalized with heart failure. The HF-FAN score might be more suitable for patients with heart failure than the FAN score.

Abstract 14691: Sex Differences in the Prognostic Value of N-Terminal Brain Natriuretic Peptide in Pulmonary Arterial Hypertension

Introduction: Pulmonary arterial hypertension (PAH) causes right heart failure (HF) and mainly affects females, but males have worse survival. Atrial Natriuretic Peptide (ANP) and Brain Natriuretic Peptide (BNP), along with N-terminal BNP (NTproBNP), are secreted from cardiomyocytes upon stretch and are important biomarkers in HF. Sex differences are observed in NTproBNP levels and prognostic value in left HF, but unknown in right HF. The aim was to assess sex differences in NTproBNP levels and prognostic value in PAH from a translational perspective. Methods: We screened patients with baseline NTproBNP measurements and right heart catheterization between 2002 and 2020. Induced pluripotent stem cells (iPSCs) from 1 male and 1 female PAH-patients were differentiated into cardiomyocytes (iPSC-CMs), and stretched for 24h at 1Hz and 10% on the Flexcell FX-6000 system (N=2). Gene expression analyses were performed on static and stretched samples. Results: 266 patients (N=106 male, N=166 female) were included. Median baseline NTproBNP levels were similar in male and female patients (1118 vs 832 ng/ml, P=0.58). We risk stratified patients on NTproBNP according to the guidelines and assessed differences in 1-year survival. In males highest 1-year mortality was observed in low and low-intermediate risk groups (16,4% and 7.7%, respectively) vs females (4.7% and 4.2%, respectively) (Figure1 A,B). Preliminary results indicate ~2x higher BNP mRNA expressions on male vs female patients (0.80 vs 0.37, N=3 male and N=3 female, P=0.018), after mechanical stretch (Figure1 C). Conclusions: Although no sex differences were observed in NTproBNP plasma levels, it had different prognostic value in male and female patients. Furthermore, in vitro male iPSC-CMs had higher BNP levels after stretch compared to female iPSC-CMs.

The influence of atrial fibrillation on the prognostic value of brain natriuretic peptide (BNP) in risk assesment of paroxysmal ventricular tachycardia

Introduction. Brain natriuretic peptide (BNP) as marker of higher left ventricular myocardial mechanical stress has a strong prognostic value in patients with heart failure (HF). Elevated BNP levels are associated with the of malignant ventricular arrhythmias. Atrial fibrillation (AF) is known to futher elevate BNP levels and this can influence on BNP prognostic value. The aim of the study was to assess the predictive value of BNP in risk assessment of paroxysmal ventricular tachycardia (PVT) in patients with HF and AF. Materials and methods. Totally, 92 patients with sustained or persistent AF, HF with left ventricular ejection fraction &lt; 50 %. All patients underwent transthoratic echocardiography; 24-hour ECG monitoring to assess the ventricular arrhythmia burden. BNP determination by enzyme immunoassay in venous blood serum. Results. Patients with HF, AF and PVTcompared with patients with HF and AF without PVT have higher levels of BNP (298,8 [149; 500,6] pg/ml versus 152 [145,7; 335,4] pg/ml, р = 0,02). There is a significant positive correlation between the level of BNP and the amount of PVT per 24 hours (r = 0,26; р &lt; 0,05). Increased BNP levels are associated with an increased risk of VPT, OR = 3,71 [95 % CI 1,2 to 13,1]. Discussion. BNP is a novel biomarker to improve risk stratification of sudden cardiac death not only for patients in sinus rhythm but for patients with AF. Conclusions. BNP has a predictive value in risk assessment of PVT in patients with HF and AF.

Prognostic value of brain natriuretic peptide in COVID-19 with or without acute heart failure

Abstract Background Although Brain Natriuretic Peptide (BNP) provides strong prognostic information of an unfavorable outcome in patients with acute heart failure (AHF), there is little information of its relevance as a biomarker for outcomes in COVID-19 and its complications Purpose To evaluate the association of increased BNP levels with complications and in-hospital mortality in a cohort of hospitalized COVID-19 patients. Methods The study included COVID-19 patients with data on BNP levels included in the ISACS COVID-19 registry. The population was categorized according to the presence of peak BNP levels ≥100 pg/mL during hospitalization. Primary outcomes included in-hospital mortality, AHF or acute respiratory failure (ARF, defined as PiO2/FiO2&amp;lt;300 mmHg or need for mechanical ventilation). Calculations were conducted using age and sex-adjusted multivariable logistic regression analyses. Results were also stratified according to presence or absence of cardiovascular disease (CVD) history. Differences between subgroups were verified for statistical significance using test for interaction. Results Of the 1152 patients included in the study, 615 (53.4%) had elevated BNP levels. These subjects were older (69.9±13.8 vs 59.1±16.8, p-value&amp;lt;0.001), had higher rates of cardiovascular risk factors (82.9% vs 57.7%, p-value&amp;lt;0.001) and presented more frequently with a prior history of CVD (either ischemic heart disease, cerebrovascular disease, venous thromboembolism, atrial fibrillation or a history of revascularization) (50.1% vs 27.5%, p-value&amp;lt;0.001). No sex differences were observed. When considering outcomes, BNP levels ≥100 pg/mL were associated with increased rates of in-hospital mortality (32.9% vs 4.9%, p-value&amp;lt;0.001), even after adjustment for demographic characteristics (OR: 7.35; 95% CI: 4.75–11.40; p-value&amp;lt;0.001). High BNP levels were also strongly associated with an increased risk of AHF (OR 19.9; 95% CI 8.6–45.9; p-value&amp;lt;0.001), a correlation that persisted both in patients with and without a prior CVD history (p for interaction=0.29). Of note, patients with elevated BNP also had a higher likelihood of developing ARF (OR 2.7; 95% CI 2.1–3.6; p-value&amp;lt;0.001), even in absence of AHF (OR 3.00; 95% CI 2.20–4.1; p-value&amp;lt;0.001). Conclusions In COVID-19, blood BNP level not only appears to be predictor of in-hospital mortality and AHF but was also independently associated with an increased risk of ARF. This finding supports the routine use of BNP in all patients admitted to hospital for COVID-19, regardless of a prior history of CVD. Funding Acknowledgement Type of funding sources: None.

257 Exploring Brain Natriuretic Peptide and Subclinical Heart Disease in Emergency Patients With Asymptomatic Hypertension

257 Exploring Brain Natriuretic Peptide and Subclinical Heart Disease in Emergency Patients With Asymptomatic Hypertension

Redefinition of BNP as a prognostic biomarker in intensive care at COVID-19 infection

Aim&#x0D; Coronavirus disease 2019 (COVID-19) has caused a global pandemic and increased mortality has forced researchers to identify prognostic factors to identify patients at higher risk of mortality. In this study, we aimed to investigate the usability of Brain natriuretic peptide (BNP) as a predictor of mortality in critically ill patients hospitalized in the intensive care unit.&#x0D; Material and Method&#x0D; This retrospective study included 50 patients diagnosed with COVID-19 and followed in the intensive care unit. Patients with known heart failure who were found to have heart failure on echocardiography during follow-up were excluded from the study.&#x0D; Results &#x0D; The patients were divided into two groups based on their mortality status during hospitalization in the intensive care unit. These groups were found to be statistically similar in terms of chronic disease, gender and age (p&gt;0.05). Non-survivor group had higher levels of BNP at the admission to intensive care unit when compared to survivor group (93.2 pg/mL (43.5-357.3) vs. 62.9 (25.0-147.1), p=0.004, respectively). Regression analysis revealed that higher BNP levels and lower lymphocyte counts can be used as a predictor of mortality for these patients. ROC curve analysis indicated that best cut-off value for predicting in-hospital death for BNP was 85.6 pg/mL with a sensitivity of 73.1% and a specificity of 70.8%.&#x0D; Conclusions&#x0D; High BNP levels at admission to the intensive care unit can be used as an in-hospital mortality indicator in COVID-19 patients followed up in the intensive care unit.

Relation of hyperemic response during fractional flow reserve measurement to coronary flow reserve

BackgroundCoronary flow reserve (CFR) represents entire coronary compensatory capacity, while fractional flow reserve (FFR) is a standard to evaluate functional severity of epicardial coronary artery disease (CAD). ΔFFR, a decrease in a ratio of mean distal coronary pressure to aortic pressure (Pd/Pa) at rest to FFR, is conceptually associated with coronary microvascular function. This study aimed to evaluate the relation of ΔFFR to CFR in patients with stable CAD. MethodsWe performed resting Pd/Pa and FFR measurements in a total of 309 vessels with intermediate coronary artery stenosis in 242 patients. ΔFFR was defined as (resting Pd/Pa – FFR), and pressure bounded-CFR was calculated to estimate low CFR. Vessels were divided as the low CFR and non-low CFR groups. ResultsOf 309 vessels, low CFR was observed in 101 (32.7 %). While FFR values were similar (0.78 ± 0.11 vs. 0.78 ± 0.09, p = 0.84), resting Pd/Pa (0.85 ± 0.08 vs. 0.93 ± 0.04, p < 0.001) and ΔFFR (0.07 ± 0.06 vs. 0.15 ± 0.06, p < 0.001) were significantly lower in the low CFR group than in the non-low CFR group. The receiver operating characteristic curve analysis indicated that ΔFFR was predictive for low CFR (area under the curve 0.84, best cut-off value 0.08, p < 0.001). Multivariable analysis identified lower ΔFFR, the left anterior descending coronary artery, and lower hemoglobin and higher brain natriuretic peptide levels as factors associated with low CFR. ConclusionsIn patients with stable CAD, lower ΔFFR was significantly associated with low CFR in intermediate coronary stenosis in patients with stable CAD. ΔFFR may be a simple, practical, and useful surrogate to identify patients with impaired CFR.

Relation of a Filling Defect of Left Atrial Appendage by Contrast Computed Tomography Image With Subsequent Clinical Events in Patients With Atrial Fibrillation Receiving Catheter Ablation Procedures

Filling defect (FD) in left atrial appendage (LAA) is commonly observed in contrast computed tomography (CT) among patients with atrial fibrillation (AF), although its prognostic impact has not been well explored. We enrolled 1,019 consecutive patients who underwent AF ablation with baseline contrast CT images. FD in LAA was graded into 3 groups: grade 0 for complete filling (79.7%), grade 1 for incomplete filling (12.6%), and grade 2 for complete FD (7.8%). We evaluated the impact of the FD grade on the long-term clinical outcomes during the mean follow-up of 4.4 ± 2.0 years. Patients with grade 2 FD had higher prevalence of nonparoxysmal AF, higher brain natriuretic peptide level, and larger left atrial volume than those with grade 0 or 1 FD. The 5-year cumulative incidence of recurrent atrial tachyarrhythmias was higher in patients with grade 2 FD than those with grade 0 or 1 FD (74.0% vs 38.8% and 62.1%, log-rank p &lt;0.001). The 5-year cumulative incidence of major adverse cardiovascular events (MACEs), defined as a composite of all-cause death, heart failure hospitalization, and ischemic stroke, was also significantly higher in patients with grade 2 FD (19.4% vs 5.6% and 9.5%, log-rank p &lt;0.001). Follow-up CT images acquired in 87.1% of patients at median interval of 98 days showed significantly decreased FD (grade 1 in 4.5% and grade 2 in 2.1%, p &lt;0.001). The residual grade 2 FD at follow-up was associated with significantly higher risk for subsequent MACEs. In conclusion, among patients with AF receiving catheter ablation, severe FD in LAA in contrast CT was associated with higher incidence of arrhythmia recurrence and MACEs during follow-up.

Risk stratification of patients with cardiac sarcoidosis: the ILLUMINATE-CS registry

This study evaluated the prognosis and prognostic factors of patients with cardiac sarcoidosis (CS), an underdiagnosed disease. Patients from a retrospective multicentre registry, diagnosed with CS between 2001 and 2017 based on the 2016 Japanese Circulation Society or 2014 Heart Rhythm Society criteria, were included. The primary endpoint was a composite of all-cause death, hospitalization for heart failure, and documented fatal ventricular arrhythmia events (FVAE), each constituting exploratory endpoints. Among 512 registered patients, 148 combined events (56 heart failure hospitalizations, 99 documented FVAE, and 49 all-cause deaths) were observed during a median follow-up of 1042 (interquartile range: 518-1917) days. The 10-year estimated event rates for the primary endpoint, all-cause death, heart failure hospitalizations, and FVAE were 48.1, 18.0, 21.1, and 31.9%, respectively. On multivariable Cox regression, a history of ventricular tachycardia (VT) or fibrillation [hazard ratio (HR) 2.53, 95% confidence interval (CI) 1.59-4.00, P < 0.001], log-transformed brain natriuretic peptide (BNP) levels (HR 1.28, 95% CI 1.07-1.53, P = 0.008), left ventricular ejection fraction (LVEF) (HR 0.94 per 5% increase, 95% CI 0.88-1.00, P = 0.046), and post-diagnosis radiofrequency ablation for VT (HR 2.65, 95% CI 1.02-6.86, P = 0.045) independently predicted the primary endpoint. Although mortality is relatively low in CS, adverse events are common, mainly due to FVAE. Patients with low LVEF, with high BNP levels, with VT/fibrillation history, and requiring ablation to treat VT are at high risk.

The Utility of Brain Natriuretic Peptide in Patients Undergoing an Initial Evaluation for Pulmonary Hypertension.

IntroductionBrain natriuretic peptide (BNP) is a polypeptide released from the cardiac ventricles and has been used as a diagnostic marker in cardiovascular diseases. Some patients with pulmonary hypertension have significant increases in BNP levels. This study wanted to determine whether the BNP levels in patients referred for evaluation of possible pulmonary hypertension were associated with a particular functional class or diagnostic group.MethodsData were collected on patients from the Pulmonary Vascular Disease clinic undergoing right heart catheterization between 1/1/2019 and 5/20/2020. Clinical information, laboratory results including BNP, and hemodynamic parameters were recorded.ResultsThis study included 117 patients referred for evaluation for PH with measured BNP levels. The mean age was 63; the female to male ratio was 2:1, 25.4% of the patients were Hispanic. The average BNP level for the entire cohort was 4127.1 ± 11761.98 pg/ml. Patients in higher WHO functional classes tended to have higher levels of BNP, but statistical analysis BNP showed no differences between the functional classes. Patients in WHO Group 4 had significantly higher BNP levels than other WHO groups. Hemodynamic group classification demonstrated significant differences in BNP values between the low, intermediate, and high composite score patients.ConclusionsPatients undergoing evaluation for pulmonary hypertension had a wide range of BNP values. Patients with more abnormal composite hemodynamic scores higher BNP levels. Measurement of BNP provides an independent test to help interpret patients’ descriptions of their functional limitations and to identify patients with more abnormal hemodynamic parameters.

Abstract 56: Differences Between Chronic Thromboembolic Disease And Chronic Thromboembolic Pulmonary Hypertension Patients At Time Of Presentation

Background: Approximately 1/3 of acute pulmonary embolism (PE) patients develop chronic thromboembolic disease (CTED), a condition in which a patient’s PE does not resolve after standard anticoagulation therapy. Chronic thromboembolic pulmonary hypertension (CTEPH) can occur in about 3-4% of acute PE patients. Though CTED and CTEPH share an underlying cause, few studies have compared symptom severity, patient history, and other clinical indicators for the two diseases. Moreover, CTED is sometimes considered to be an asymptomatic condition. The symptomatology in CTEPH is thought to be primarily determined by pulmonary hypertension, a characteristic that CTED patients do not share. Methods: Data were collected at baseline diagnosis from 24 CTED and 65 CTEPH patients in the University of Michigan Pulmonary Hypertension Registry between 2016-2020. Demographic, 6-minute walk (6MW), echocardiography, past medical history, and brain natriuretic peptide (BNP) data were compared between groups. Results: CTED patients were: 1) less symptomatic (better WHO functional class [FC], better predicted 6MW), 2) had more preserved oxygenation during 6MW, 3) had less RV dilation/dysfunction and RA dilation on echo, and 4) lower BNP, than CTEPH patients. Despite this, 54% of CTED patients demonstrated significantly impaired FC (III/IV) without evidence of significant RV dysfunction, exercise hypoxia or volume overload. Conclusion: More than half of CTED patients in our study had significantly impaired FC. Further investigation into CTED symptomatology is warranted. CTEPH patients are more symptomatic and present with worse clinical metrics than CTED patients, which may be attributed to more advanced RV dysfunction and higher BNP level. These results may help distinguish CTED v. CTEPH diagnoses earlier, leading to earlier targeted treatment and better outcomes.

Factors associated with discordance between fractional flow reserve and resting full-cycle ratio

BackgroundResting full-cycle ratio (RFR), a non-hyperemic pressure ratio, is alternative to fractional flow reserve (FFR) for the evaluation of coronary artery stenoses. Although FFR and RFR results are often discordant using the cut-off values (0.80 and 0.89), factors associated with the discordance are unclear. The aim of this study was to explore factors related to the discordant results. MethodsWe performed FFR and RFR measurements in a total of 408 vessels with intermediate coronary artery stenosis in 277 patients. Positive FFR and RFR were defined based on the cut-off values of 0.80 and 0.89. The discordance was determined as positive FFR and negative RFR (FFR ≤0.80 and RFR >0.89) or negative FFR and positive RFR (FFR >0.80 and RFR ≤0.89). ResultsOverall, FFR and RFR were significantly correlated (r = 0.76, p < 0.001), while positive FFR and negative RFR and negative FFR and positive RFR were observed in 44 (10.8%) and 45 (11.0%) of 408 vessels, respectively. Smaller body surface area, diabetes, chronic kidney disease including hemodialysis, severe aortic stenosis, higher E/e', and lower left ventricular ejection fraction on echocardiography, and lower hemoglobin and higher brain natriuretic peptide levels were identified as factors associated with the negative FFR and positive RFR discordance. ConclusionsDiscordant results between FFR and RFR were often found in more than 20% of vessels with intermediate coronary stenosis. Clinical characteristics such as renal function, heart failure, and anemia may be considered in clinical decision-making when using FFR and RFR.

Prognostic value of the liver fibrosis marker fibrosis-5 index in patients with acute heart failure.

AimsRecently, liver fibrosis markers, such as the fibrosis‐4 index (FIB‐4), have been shown to be associated with prognosis in patients with heart failure. The fibrosis‐5 (FIB‐5) index, which assesses albumin, alkaline phosphatase, aspartate transaminase, alanine aminotransferase and platelet count, is a simple liver fibrosis marker that was reported to be superior to FIB‐4 for differentiation of liver fibrosis. This study aimed to compare the prognostic value of FIB‐4 and FIB‐5 in patients with heart failure.Methods and resultsThe FIB‐4 and FIB‐5 scores were calculated at discharge in 906 patients hospitalized with heart failure. The patients were stratified into three groups based on their FIB‐5 scores: low (n = 303), middle (n = 301), and high (n = 302) FIB‐5 groups. The primary endpoint was a composite of cardiac death or rehospitalization for heart failure. The low FIB‐5 group was older and had larger inferior vena cava diameters and higher brain natriuretic peptide levels than the other two groups. The primary endpoint occurred in 156 (51.5%), 110 (36.5%), and 54 patients (17.9%) in the low, middle, and high FIB‐5 groups, respectively (P < 0.001). On Cox proportional hazard analysis, the low FIB‐5 was independently associated with the primary endpoint after adjustment for confounding factors. The association was consistent in both patients with preserved and reduced left ventricular ejection fraction (LVEF), and there was no significant interaction between LVEF phenotypes in terms of the prognostic impact of FIB‐5 (P for interaction = 0.311). FIB‐5 was superior to FIB‐4 as a prognostic indicator of the primary endpoint (continuous net reclassification improvement, 0.530; 95% confidence interval [CI], 0.399–0.662; P < 0.001; integrated discrimination improvement, 0.072; 95% CI, 0.057–0.088; P < 0.001).ConclusionsThe FIB‐5 is a useful risk stratification marker with better prognostic value than FIB‐4 in patients hospitalized with heart failure.

Abstract TP221: Hyperacute Anterior Circulation Stroke Due To Atherosclerotic Occlusion Still Have Risks Of Cardioembolism

Background and Purpose: The difference among anterior and posterior circulation stroke regarding vascular risk factors is commonly known. Our aim is to verify the difference of clinical backgrounds between anterior and posterior circulation in hyperacute stroke with large vessel occlusion (LVO) caused by atherosclerotic occlusion (AO). Methods: This multicenter, retrospective study included LVO patients who were performed revascularization therapy (thrombectomy, intravenous thrombolysis, or both) between October 2017 and May 2021. The definition of AO was the fixed residual stenosis/occlusion at the initially occluded lesion confirmed in the second angiographic imaging performed 7 days later from symptom onset. The patients were dichotomized by LVO location, anterior or posterior. Traditional risk factors and laboratory data were compared. Results: Among the 1770 consecutive stroke patients admitted during the study period, 162 patients (104 men, median age 76 years old) were enrolled in our study. AO was diagnosed in 41 patients (25%; 27% of anterior circulation vs. 17% of posterior, P=0.291). In total cohort, patients with anterior circulation showed higher frequency of atrial fibrillation, lower glycosylated hemoglobin level, higher D dimer level, and higher brain natriuretic peptide level (Figure 1 black bar). The cohort of AO patients had a similar tendency (Figure 1 blue bar). Conclusion: One fourth of patients with LVO are AO. In anterior circulation stroke with AO, attention should be paid to stroke recurrence due to not only atherosclerosis but embolism.

Impact of sleep-disordered breathing on ventricular tachyarrhythmias after left ventricular assist device implantation.

Sleep-disordered breathing (SDB) is associated with an increased risk of adverse events in patients with heart failure (HF); however, its impact in patients implanted with a left ventricular assist device (LVAD) remains unclear. We aimed to investigate the prevalence of SDB in patients with LVAD and its impact on their clinical outcomes. Fifty consecutive patients with LVAD who underwent portable sleep monitoring between September 2017 and April 2018 were prospectively enrolled, and they were followed up for 170 ± 36days. According to their respiratory disturbance indexes (RDIs), they were categorized into the SDB group (RDI ≥ 15, n = 12) and the non-SDB group (RDI < 15, n = 38). The incidence of adverse events during the follow-up period was investigated after enrollment. Multivariate logistic regression analysis revealed significant differences in SDB in LVAD-implanted patients in terms of the logarithmic transformation brain natriuretic peptide (BNP) values (p = 0.005). The optimal BNP cut-off value for SDB prediction in LVAD-implanted patients was 300pg/mL (sensitivity: 58.3%, specificity: 94.7%). During follow-up, ventricular tachyarrhythmias (VTas) occurred significantly more frequently in the SDB group (4 [33%] vs. 2 [5%] patients,p = 0.02); Atrial tachyarrhythmia (ATa) also tended to occur more frequently in the SDB group (2 [25%] vs. 2 [2%] patients, p = 0.07). SBD was prevalent in 24% of the LVAD-implanted patients with advanced HF. Furthermore, SDB was significantly associated with high BNP levels and was also potentially associated with subsequent incidence of VTa in patients with LVAD.

High Brain Natriuretic Peptide Level Predicts The Prevalence of Low-Voltage Areas and Poor Rhythm Outcome in Patients Undergoing Atrial Fibrillation Ablation

High Brain Natriuretic Peptide Level Predicts The Prevalence of Low-Voltage Areas and Poor Rhythm Outcome in Patients Undergoing Atrial Fibrillation Ablation

High Brain Natriuretic Peptide Level Predicts The Prevalence of Low-Voltage Areas and Poor Rhythm Outcome in Patients Undergoing Atrial Fibrillation Ablation

High Brain Natriuretic Peptide Level Predicts The Prevalence of Low-Voltage Areas and Poor Rhythm Outcome in Patients Undergoing Atrial Fibrillation Ablation