Higher NT-proBNP Values Research Articles

Left atrial mechanics and left ventricular function in cardiac amyloidosis patients treated with tafamidis

Abstract Introduction and aims Patients with amyloid cardiomyopathy (ATTR-CM) present with a restrictive phenotype characterized by decreased ventricular compliance and increased filling pressures, with progressive loss of atrial function and increased stiffness, which are associated with poor clinical outcomes. Tafamidis improves clinical outcomes and slows disease progression but its effects in left ventricle (LV) and atrium (LA) mechanics are still unclear, with recent studies (reference 1.) suggesting improvement of LA function (as assesses by LA strain [LAS]) in patients with sinus rythm (SR). Our study aimed to characterize the 1-year evolution of LV function and LA mechanics in ATTR-CM patients treated with tafamidis. Methods We prospectively evaluated a cohort of patients with ATTR-CM treated with tafamidis in a single-centre. Results Out of 41 patients treated, 13 were excluded due to incomplete follow-up or poor quality of echocardiographic images that precluded LAS analysis. A total of 28 patients (75% male) were included, with a mean age of 80 ± 10 years at the start of treatment and a median follow up of 14 months. 11 pts (39%) were in sinus rhythm (SR group) and 17 (61%) were not (non-SR group). At the start of the treatment with tafamidis, mean LV ejection fraction (LVEF) was 55.5 ± 11.4%, GLS was -10.7 ± 4.3%, E/e’ 17.2 ± 5.4 and indexed LA volume (LAVi) 47.4 ± 15.3 mL/m2. Median NTproBNP was 2031 (3143) pg/mL and pts walked 313 ± 121m on the 6-minute walk test (6MWT). Regarding LAS, there was significant reduction in all atrial functional components in both SR (LAS reservoir 13.1 ± 12, LAS conduit -6.5 ± 4.2, LA contraction -6.6 ± 3.6) and non-SR groups (LAS reservoir 5.1 ± 3.6) as well as significantly increased LA stiffness (SR – 1.4 ± 0.9, non-SR – 6.1 ±6.0). Our analysis showed stabilization, with no statistically significant differences in LVEF, GLS, diastolic function parameters, LAS or LA stiffness, as well as NTproBNP and 6MWT after 1-year treatment with tafamidis (tables 1 and 2). We found a moderate correlation between LAS contraction and NTproBNP in the SR group (r=0.650, p=0.031) – meaning that worse (less negative) LAS contraction associated with higher NTproBNP values – despite there being no correlation between other echocardiographic variables ante NTproBNP or 6MWT. Conclusions In our cohort of patients, patients presented with significantly reduced atrial function and increased stiffness. 12-month treatment with tafamidis allowed stabilization of LA and LV performance, as well as of NTproBNP and 6MWT. We found a moderate correlation between LA contraction objectively evaluated by strain analysis and NTproBNP in SR patients, highlighting the importance of LA mechanical contraction preservation in patients with a restrictive cardiomyopathy phenotype.

Investigating the diagnostic accuracy of vertebral heart score, vertebral left atrium score and thoracic width measurement in cats with suspected cardiac problems

This study aimed to evaluate vertebral heart score (VHS) in terms of sensitivity and accuracy of radiographic heart examination for early diagnosis of cardiac diseases in cats and to compare vertebral left atrium score (VLAS), N-terminal pro-B-type natriuretic peptide (Nt-proBNP) with thoracic width measurement (TWM). Thirty cats were used. Ten of these cases were used as the control group. The remaining 20 cases formed the group with suspected heart problems. The VHS, VLAS and thoracic width were measured by radiographic examination. Blood was drawn and Nt-proBNP concentrations were assayed in all animals. As a result, VHS was above the reference range in 14 cases. For VLAS measurements, 7 cases had values above the reference range. TDM was above the normal reference range in 5 cases from the control group. There was no statistically significant correlation between VHS and VLAS (p=0.07), VHS and TWM (p=0.06), VHS and Nt-proBNP (p=0.05). However, in cases with high VHS, VLAS, TWM, and Nt-proBNP values, elevated levels were observed in 50% of the cases compared to the reference values. However, radiographically measured VHS, VLAS, and TWM may represent independent measurements. No statistically significant relationship was found between them. It would be beneficial to conduct mroe extensive studies by considering the breed, age and weight in cats with suspected heart problems.

Abstract 4140057: Defining Severe Heart Failure across the Ejection Fraction Spectrum in DAPA-HF and DELIVER

Background: Patients with severe heart failure (HF) experience debilitating clinical symptoms and worse cardiovascular (CV) outcomes with an excess mortality risk. Until recently, severe HF has largely been considered only in those with reduced ejection fraction. The ESC HFA has put forth a consensus definition for severe or advanced HF that may be applicable across the ejection fraction (EF) spectrum. Hypothesis: Patients with severe HF experience a higher rate of CV outcomes. The safety and efficacy of SGLT2i dapagliflozin is consistent regardless of the severe HF status. Aims: To assess the prevalence, CV outcome risk, and treatment response to the SGLT2i dapagliflozin among patients with severe HF. Methods: DAPA-HF and DELIVER were randomized, double-blind trials, testing dapagliflozin vs placebo in 11,007 patients with symptomatic HF across the full spectrum of EF. Severe HF was adapted from the ESC HFA definition: NYHA class III/IV, evidence of HF with reduced, mildly reduced or preserved EF, elevated natriuretic peptides, HF hospitalization within previous 12 months, and adverse patient-reported symptom burden (KCCQ-TSS<75). Outcomes were assessed and the treatment effect of dapagliflozin was measured for the primary endpoint of CV death or first worsening HF event (including HF hospitalization and urgent HF visit) by severe HF status. Results: Overall, 730 (6.6%) fulfilled the severe HF definition (296 [40.6%] with EF ≤40%, 192 [26.3%] with EF 41-49%, and 232 [33.2%] with EF ≥50%). Patients with severe HF had a higher comorbidity burden and higher NT-proBNP values. Over a median follow-up of 22.4 months, the primary endpoint occurred in 231 patients, at a rate of 20 (17-23) per 100py. Patients with severe HF experienced a higher rate of events compared to patients without severe HF (adjusted hazard ratio [HR] 1.44, 95% confidence interval [CI] 1.20-1.75), across the spectrum of LVEF (Pinteraction=0.85). Treatment with dapagliflozin was consistently beneficial in reducing the risk of the primary endpoint regardless of the severe HF status (Pinteraction=0.10, Figure 1). The safety profile of dapagliflozin was also consistent irrespective of the severe HF status (Figure 2). Conclusions: In a large, global contemporary HF trial population, “severe HF” was associated with excess risk of CV events across the spectrum of EF. Treatment with the SGLT2i dapagliflozin appears safe and effective in reducing the risk of CV death or worsening HF in this population.

Associação entre peptídeos natriuréticos e gravidade clínica em pacientes internados por insuficiência cardíaca descompensada

This study aims to associate the values of natriuretic peptides (NP), BNP, and NT-proBNP, with the severity of clinical presentation in patients hospitalized with decompensated heart failure (HF). METHODS: This is a historical cohort study where data was collected from the medical records of patients admitted to a private hospital with decompensated heart failure between 2016 and 2023. RESULTS: The most common comorbidities included systemic arterial hypertension in 79 out of 96 patients (82.2%), previous HF in 46 (47.9%), dyslipidemia in 41 (42.7%), and diabetes mellitus in 38 (39.5%). The data revealed that patients who died of cardiac causes during hospitalization had higher NP values compared to those who did not experience the same outcome. Among these deaths, 57.14% of patients exhibited hemodynamic instability on hospital admission (p=0.017). Additionally, two patients were readmitted within 6 months of discharge due to a new episode of decompensated HF, both presenting hemodynamic instability on admission (p=0.03), and eventually progressed to cardiac death. Cardiac and non-cardiac deaths were associated with higher NT-proBNP values (p=0.043). CONCLUSION: The findings indicate that higher NP levels in patients hospitalized with decompensated HF correlate with greater initial severity and long-term, including an increased likelihood of hemodynamic instability and a higher risk of readmission, respectively. Elevated NT-proBNP values are also linked to a higher mortality rate.

Prevalence of amyloidosis among patients with mild to severe aortic stenosis. Validation of screening parameters

Abstract Background Cardiac amyloidosis (CA) is an increasingly recognized cause of human heart failure. Up to 16% of patients with severe aortic stenosis (AS) undergoing transcatheter valve replacement have been reported to suffer concomitant transthyretin CA (ATTR). Since the diagnosis of CA implies distinct therapies with prognostic relevance, early diagnosis of CA is crucial. Different parameters have been described to improve screening accuracy for detection of CA, but it is unknown whether these parameters are valid, and the prevalence of CA is stable throughout the spectrum of AS. Purpose To validate screening parameters for the detection of CA in mild, moderate and severe AS. Methods Patient 65 years and above undergoing echocardiography with mild to severe AS, defined as calculated valve orifice area <2 cm2 by velocity-time-integral, and an intraventricular septum thickness > 11mm, fulfilling at least one of two additional criteria (Sokolow-Lyon-Index to left ventricular mass index ratio < 1.5 or stroke volume index < 35 ml/m2) were prospectively included and screened for CA using bone scintigraphy and immunofixation in blood and urine. Results 57 patients were included and completed the diagnostic work-up. Mean age was 83 ± 0.7 years and 71% were male. Overall, 15 (26%) of patients were diagnosed with CA (12 with ATTR and 3 with light-chain CA, Figure1A). 17 patients had mild, 21 had moderate and 19 patients were diagnosed with severe AS. Among patients with mild AS 41% were diagnosed with CA, whereas only 24% of patients with moderate and 16% of patients with severe AS suffered CA (Figure 1B), these results did not show statistically significant differences (p= 0.2, by Chi-Square Quadrat test). Patients with CA were less likely to have NYHA classes I or II (20 vs. 57%, p= 0.03), had higher values of NT-proBNP (4572 [2323; 6044] vs. 817 [589; 2571], p< 0.001) and high-sensitive troponin (66 [47; 103.5] vs. 22.5 [17; 33.6], p< 0.001) and were more likely to have an atrioventricular block of any degree (60 vs. 26%, p=0.04). Conclusion Prevalence of CA among patients fulfilling the criteria of this screening algorithm seems to be high independent of AS severity. Clinicians should not only focus on patients with severe AS to detect CA early. Further research is needed to estimate the prevalence of CA among all patients with AS. Figure 1 A: Among patients with an age >65 years, IVS >11mm, AS and SLI/LVMMI >1.5 or SVI <35 ml/m2 26% (red area) of patients were diagnosed with CA (n= 57). B: In patients with mild AS 41% were diagnosed with CA, whereas in patients with moderate AS only 24% and in patients with severe AS 16% had CA. These differences did not show statistical significance (p= 0.2). IVS: intraventricular septum, AS: aortic stenosis, SLI: Skolow-Lyon-Index, LVMM= left ventricular myocardial mass index, SVI: stroke volume index, CA: cardiac-amyloidosis. (Statistics performed by chi-square test using GraphPad Prism 9.0).

Prognostic value of hemodynamically significant secondary tricuspid regurgitation in patients hospitalised for heart failure with preserved ejection fraction

Abstract Introduction Heart Failure with preserved ejection fraction (HFpEF) is a significant clinical concern, characterized by a rising prevalence and substantial morbidity. Despite the frequent presence of secondary tricuspid regurgitation (TR) in this population, its prognostic implications remain unknown. Purpose The aim of this study is to assess the rate of the composite of mortality and heart failure readmissions by considering the presence of hemodynamically significant secondary TR in patients hospitalised for HFpEF. Methods Prospective observational cohort study. Patients admitted for acute HFpEF (ejection fraction > 50%) between September 2019 to December 2022 were included. Patients with primary TR, pacemaker, moderate-severe left valve disease, end-stage renal failure (creatinine clearance < 30 ml/min/BSA) and recent myocardial infarction were excluded. TR was considered significant if rated as moderate or higher, following established semi-quantitative and quantitative criteria in current guidelines. Patients were followed-up for one year to assess the incidence of the composite primary outcome of death and heart failure readmission. Results A total of 110 patients were included. Median age was 85 [78-89] years, 64% were female. The mean left ventricle ejection fraction was 57% (+/-5%). Significant TR was observed in 44.5% (n=49) of cases. Patients with significant TR had higher NT-ProBnp values (4555 [2620-7025] pg/mL vs 2400 [1300-5494] pg/mL; P = 0.01), and worse echocardiographic parameters of right heart size and function compared to those without significant TR (TABLE). The incidence of the composite outcome was higher in patients with significant TR compared to patients without significant TR (P = 0.01, LogRank test) (FIGURE). In a Cox regression multivariate analysis including age and sex, significant TR was independently associated with the incidence of the primary outcome (HR 1.86; CI 1.10 - 3.13; P = 0.006). Conclusion In patients hospitalised for HFpEF, significant TR was independently associated with a higher incidence of death and heart failure readmission at one year-follow-up. Further research is needed in this group, particularly to explore novel risk stratification and therapeutic approaches.Kaplan-Meier curveTable

A-020 Evaluation of the QuidelOrtho Diagnostics Vitros NT-proBNP II Assay

Abstract Background N-terminal-proBNP (NT-proBNP), a short peptide originating from the cleavage of proBNP by Corin, can be used as a diagnostic test in individuals presenting with signs and symptoms consistent with heart failure (HF). QuidelOrtho Diagnostics released its latest reformulation of its NT-proBNP assay, the Vitros NT-proBNP II assay. The analytical performance of this assay was evaluated. Methods Repeatability, reproducibility, and carryover were assessed using quality control material. The analytical measuring range and clinical reportable range (AMR and CRR) were assessed using commercially available material and diluted patient samples. Accuracy was assessed by comparing results from the Vitros NT-proBNP II assay and results from the Vitros NT-proBNP assay. Instrument-to-instrument comparison was performed by comparing results from the NT-proBNP II assay from two different Vitros 5600 chemistry analyzers. Paired heparin and EDTA plasma samples were assessed for specimen type comparison. Results Repeatability and reproducibility were <=10% CV and no carryover was observed. The AMR was 20 - 30,000 pg/mL and the CRR extended the range to 600,000 pg/mL. Passing-Bablok analysis showed a significant proportional bias with a slope of 1.34 for samples up to 12,000 pg/mL (Vitros NT-proBNP). Vendor-performed comparison studies showed no significant proportional bias with a slope of 1.06 using unweighted Deming analysis for samples up to 20,700 pg/mL (Vitros NT-proBNP). Instrument-to-instrument and heparin-to-EDTA plasma comparisons showed no significant biases. Conclusions The NTproBNP II assay showed acceptable repeatability, reproducibility, and no carryover. The AMR analysis verified the measuring range in the IFU of the assay and the CRR is extended to 600,000 pg/mL. Results were very comparable between two different Vitros 5600s and between paired heparin and EDTA plasma specimens. Comparison between the Vitros NT-proBNP and Vitros NT-proBNP II assays showed a very significant proportional bias (slope of 1.34) for specimens up to 12,000 pg/mL measured on the Vitros NT-proBNP assay, but the proportional bias is less significant at higher NT-proBNP values (>20,000 pg/mL, Vitros NT-proBNP) are included in the analysis. There may be a significant matrix effect or interference at lower NT-proBNP concentrations with the reformulated reagent, which may be less prominent when NT-proBNP is present at much higher concentrations.

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

PROGNOSTIC VALUE OF BIOMARKERS IN PATIENTS WITH ISCHEMIC HEART FAILURE

Modern clinical recommendations of medical associations attach great importance to the improvement of methods of early diagnosis, prevention and individualized treatment of heart failure (HF). It is assumed that biological markers that reflect different pathophysiological stages of HF retain their value as a powerful tool for diagnosing acute and chronic HF, stratifying patients into high-risk groups for the occurrence and progression of the specified pathology, and as a probable predictor of treatment effectiveness. Along with this, the levels and prognostic value of serum biomarkers in patients with HF of different etiologies at different stages of treatment remain unclear.The purpose. To study the prognostic value of biomarkers in patients with HF of ischemic origin.Material and methods. 398 were examined with HF aged 45-65 years (54.3±7.2 years. All 398 patients with HF were divided into two groups. The 1st group included 219 (55%) patients who did not have re-hospitalization (RG) due to HF decompensation during the year of observation. The II group consisted of 179 (45%) patients with PG. 226 (56.8%) patients had a permanent form of atrial fibrillation (AF), 102 (25.6%) had type 2 diabetes. Among the examined - 198 (49,7%) women and 200 (50,2%) men. A standardized echocardiographic study was performed to determine the left ventricular ejection fraction (LV EF) and LV dimensions during hospitalization. The levels of thyroid-stimulating hormone, free T3, free T4, blood glucose, glycated hemoglobin, galectin-3, ST-2, BNP, NT-proBNP were determined. The ratios: ST-2 / Galectin-3 (UO), NT-proBNP / BNP (UO), NT-proBNP / ST-2 (UO) and NT-proBNP / Galectin-3 (UO) were calculated. During 1 year, patients were observed, taking into account the presence of repeated hospitalization (RG) due to HF decompensation, mortality. Patients were divided into two groups. The 1st group included 219 (55%) of patients who did not have re-hospitalization (PG) due to HF decompensation. II group - 179 (45%) patients with PG.Results. Compared to patients with a favorable short-term course of the disease, patients with HF of ischemic genesis, who had PG during the year of observation, have HF III and IV PK according to NYHA, diabetes mellitus, and a permanent form of AF more often; higher heart rate, serum levels of galectin-3 (by 11.1%), NT-proBNP (by 31.8%), higher values of NT-proBNP / BNP (by 40.6%) and NT-proBNP / ST- 2 (by 21.1%), but a smaller value of the ST-2 / Galectin-3 ratio (by 9.3%), as well as a higher risk of death during the first year (OR = 3.81). The risk of PG increases when the level of NT-proBNP > 652.6 pg/ml is reached and the ratios: ST-2/Galectin-3 ≤ 17.95 IU, NT-proBNP / BNP > 10.17 IU and NT-proBNP / ST-2 > 13.79 UO. The level of ST-2 > 41.37 ng/ml is prognostically significant for the one-year death of patients within a year.Conclusions. In patients with HF of ischemic genesis, the ratio of NT-proBNP / BNP has a greater prognostic significance regarding the risk of re-hospitalization, compared to NT-proBNP and NT-proBNP / ST-2.

Significant tricuspid regurgitation is associated with adverse outcomes in patients with transthyretin amyloid cardiomyopathy.

Patients diagnosed with transthyretin amyloid cardiomyopathy (ATTR-CM) often experience poor outcomes due to the development of heart failure (HF). Tricuspid regurgitation (TR) has been found to be correlated with adverse outcomes in patients with HF. This study aims to assess whether the presence of significant TR is associated to adverse cardiac outcomes in patients diagnosed with ATTR-CM. Retrospective study of ATTR-CM patients enrolled in the Institutional Registry of Amyloidosis (NCT01347047). Patients were categorized based on the presence of significant TR (moderate or severe according to current guidelines criteria) or absence of significant TR. All patients were followed up for 2 years to assess the incidence of the composite outcome of death or HF hospitalization. A total of 93 ATTR-CM patients were included. The mean age at diagnosis was 82.5 [IQR 75 - 86] years, 86% were male, and the mean left ventricular ejection fraction was 52% [IQR 43 - 60]. Among them, 32.3% (n = 30) patients had significant TR. Patients with significant TR had higher NTpro-BNP values (5308 vs 2454, pg/mL, p = 0.004), and a lower left ventricular ejection fraction (44 vs. 56%, p = 0.0002) compared to patients without significant TR. The incidence of the primary outcome was higher in patients with significant TR (77% vs. 30%, p<0.001). In a multivariate Cox regression analysis, only NTpro-BNP, as a numerical variable (HR 1.00, 95% CI 1.00005-1.0002, p = 0.001), and significant TR (HR 2.23, 95% CI 1.12-4.42, p=0.021) were independently associated with the composite outcome of death or HF hospitalization. In patients diagnosed with ATTR-CM, the presence of significant TR was associated with worse outcomes.

Acute cardiorenal syndrome: baseline comorbidities, biomarkers and prognostic significance

Abstract Introduction Acute cardiorenal syndrome (ACRS) encompasses a spectrum of disorders that induce acute kidney injury in patients with acute heart failure (AHF). The occurrence of ACRS has been associated with a worse prognosis in the literature and its management often poses a therapeutic challenge. Purpose The purpose of this study is to record the most frequent comorbidities and other clinical, biochemical and imaging parameters of patients with ACRS and to assess the prognostic value associated with its occurrence. Materials-Methods: We recorded demographic characteristics, baseline comorbidities, left ventricular ejection fraction (LVEF), NT-proBNP, sodium (Na), albumin, troponin (hs-cTnI), glomerular filtration rate (GFR) and systolic blood pressure (SBP) values on admission, creatinine (Cr) values, the peak lateral tricuspid annular systolic velocity (S’ RV) and E/E’ ratio during hospitalization as well as total hospital days and number of deaths in hospitalized AHF patients from February to November 2023. ACRS was defined as an increase in Cr of &amp;gt; 0.3mg/dl or &amp;gt; 1.5 times the baseline value. The patients were separated into two groups based on ACRS occurrence and statistical analysis was performed using IBM-SPSS and values presentation with median and interquartile range. Results 106/204 hospitalized patients developed ACRS. A statistically significant difference was observed between the two groups in the number of patients with ACRS, chronic kidney disease (CKD), and ischemic cardiomyopathy (ICM). More specifically, patients with CKD had almost 6 times higher risk of developing ACRS during hospitalization compared to those without CKD, while at the same time, patients with ICM had a 2.5 times higher risk for ACRS occurrence. Patients with ACRS also tended to have higher NT-proBNP values (p=0.008) and lower GFR (p&amp;lt;0.001) and sodium values (p=0.016) upon admission. Factors such as sex, age, diastolic and systolic function, co-existence of comorbidities such as hypertension, atrial fibrillation, diabetes mellitus, elevated troponin and admission SBP had no significant effect on the occurrence of ACRS. Finally no statistical significant difference was found between the occurrence of ACRS and death during hospitalization, but patients with ACRS required more hospital days (p&amp;lt;0.001). Conclusions Occurrence of ACRS is common among hospitalized patients with AHF. Patients with CKD, ICM, lower values of sodium and GFR as well as increased values of NT-proBNP on admission seem to be the ones to develop more often ACRS. There was no significant association found between gender, admission SBP, and systolic and diastolic function and the incidence of renal function deterioration. Furthermore, no statistical significant difference was found between the occurrence of ACRS and death during hospitalization. However, these patients require more hospital days which increases the risk of hospital-acquired infections and other poor outcomes. Demographics and comorbidities Biochemical and other markers

Routine screening for HLA Antibodies in Heart Transplant patients-Does it affect clinical decision making?

We aimed to assess outcomes in patients with and without donor specific antibodies (DSA) and to evaluate the relationship between DSA presence and graft function, cardiac allograft vasculopathy (CAV), and mortality. The study population comprises 193 consecutive long-term heart transplanted (HTx) patients who underwent DSA surveillance between 2016 and 2022. The patients were prospectively screened for CAV through serial coronary angiograms, graft function impairment through serial echocardiograms, and cardiac biomarkers. The patients were followed from the first DSA measurement until death, 5 years follow-up or right censuring on the 30th of June 2023. DSAs were detected in 50 patients using a cut-off at MFI ≥1000 and 45 patients using a cut-off at ≥2000 MFI. The median time since HTx was 9.0 years [3.0-14.4]. DSA positive patients had poorer graft function and higher values of NT-proBNP and troponin T, and more prevalent CAV than DSA negative patients. In total, 25 patients underwent endomyocardial biopsies due to DSA presence while another eight patients underwent endomyocardial biopsies for other reasons. Histological antibody mediated rejection (AMR) signs were seen in three biopsies. During a median follow-up of five years [4.7-5], a total of 41 patients died. Mortality rates did not differ between DSA positive and DSA negative patients (HR 1.2, 95% CI.6-2.4). DSA positive patients were more likely to experience CAV progression than DSA negative patients (HR 2.7, 95% CI 1.5-4.8) CONCLUSIONS: Routine screening reveals DSA in approximately 25% of long-term HTx patients but is rarely related to histopathological AMR signs. DSA presence was associated with poorer graft function and more prevalent and progressive CAV. However, DSA positive patients had similar survival rates to DSA negative patients.

Prevalence and risk factors of left ventricular diastolic dysfunction in systemic sclerosis patients: insights from new echocardiographic parameters

Abstract Background Systemic sclerosis (SSc) is a rare autoimmune connective tissue disease characterized by excessive extracellular matrix deposition and fibrosis that can affect the skin, blood vessels, and internal organs, including the heart. Primary heart involvement in SSc refers to the presence of cardiac fibrosis, inflammation, and dysfunction in the absence of pulmonary hypertension (PH). Although PH is usually considered the major risk factor for death in SSc patients, diastolic dysfunction has been proposed as an independent predictor of mortality, which may be more robust than PH. Purpose Early identification and management of heart complications in SSc patients are crucial to prevent further deterioration and improve treatment outcomes. However, myocardial damage caused by SSc is often poorly understood, and the long-term effects and prognosis remain unknown. Methods We conducted a cross-sectional study of 69 patients (p) with SSc diagnosis evaluated between February 2022 and February 2023. We analyzed the prevalence of left ventricular diastolic dysfunction (LVDD) as recommended by the 2016 ASE/EACVI guidelines. We compared the presence of risk factors associated with LVDD and its association with other echocardiographic findings. Of the 69p, 24 (34.8%) had LVDD, 41 (59.4%) had normal diastolic function, and 4 (5.8%) had undetermined diastolic dysfunction. Older age (mean age 69.7 ± 11.2 vs 57 ± 12.8; p &amp;lt; 0.01), arterial hypertension (50% vs 22%; p = 0.02), higher body mass index (28.3 ± 8 vs 24.6 ± 4.5; p = 0.02), and higher NTproBNP levels (131 [64-403] vs 97 [45-163]; p = 0.047) were significantly associated with LVDD. The absence of antitopoisomerase (scl70 0% vs 22.2%; p = 0.021) and the presence of anticentromere (CENP-A 81% vs 55.6%; p = 0.05) and (CENP-B 85.7% vs 55.6%; p = 0.02) antibodies were also significantly associated with LVDD. Additionally, classical parameters of ventricular function, such as left ventricular ejection fraction (LVEF 63.5 ± 4.2 vs 63.4 ± 3.7; p = 0.9) or tricuspid annular plane systolic excursion (TAPSE 20.6 ± 2.3mm vs 21.2 ± 2.4mm; p = 0.32), were not associated with LVDD. However, impairment of the right ventricular free wall strain (-23.8 ± 4 vs -27 ± 2.8; p = 0.017), and lower left atrial strain reservoir function (27.7 ± 10 vs 38.4 ± 12.7; p = 0.05) were significantly associated with LVDD. Conclusion LVDD is highly prevalent in patients with systemic sclerosis, particularly in elderly patients with a higher body mass index and those affected by arterial hypertension. These patientes have higher values of NTproBNP. Futhermore, antitopoisomerases antibodies are less likely to be expressed and anticetromere antibodies are more likely to be expressed . These findings highlight the importance of regular cardiovascular monitoring in SSc patients and the potential value of using new echocardiographic parameters to identify those at risk for LVDD.

Abstract 13706: Determinants of Right Ventricular Dysfunction in Patients With Heart Failure With Preserved Ejection Fraction: The PARAGON-HF Trial Experience

Introduction: Right ventricular dysfunction (RVD) is a major prognostic factor in patients with heart failure with preserved ejection fraction (HFpEF), however determinants of RVD in HFpEF are not well described. Although sex-specific mechanisms have been incriminated in the development of HFpEF, it is unclear whether this is also true for RVD. Goals: (1) Assess the prevalence of RVD (defined as a tricuspid annular plane systolic excursion [TAPSE] &lt;1.7 cm, a fractional area change [FAC] &lt;35% or a RV free wall longitudinal strain [RVFWLS] &lt;20%, absolute value) in patients with HFpEF; (2) identify determinants of RVD, overall and according to sex, in patients with HFpEF. Methods: We used data from patients enrolled in the echocardiographic sub-study of the PARAGON-HF trial with adequate image quality (N=809, 53% women, mean age 74±8 years). Determinants of RVD, in the whole study population and according to sex, were identified using a multivariable logistic regression model. Results: There were 461 patients (57%) with RVD. After multivariable adjustment, RVD was cross-sectionally associated with a history of atrial fibrillation of flutter (AFF), older age, higher heart rate, greater LV mean wall thickness and higher NT-proBNP values. Systolic blood pressure and LV global longitudinal strain (absolute value) showed an inverse association ( Figure ). These results were consistent between men and women, except for AFF and LV mean wall thickness, which were associated with a greater likelihood of RVD in men (OR 2.46, 95%CI 1.33-4.56, OR 1.61, 95%CI 1.18-2.21 respectively) but not in women (OR 0.99, 95%CI 0.58-1.68, OR 0.90 95%CI 0.69-1.17 respectively, p-values for interaction=0.028 and 0.006). Conclusions: RVD was highly prevalent in our study population. Determinants of RVD included AFF, LV remodeling and systolic impairment, and increased NT-proBNP levels. Differences between men and women suggest gender-specific mechanisms in the development of RVD in HFpEF.

Dynamics of global longitudinal strain of the left ventricular myocardium and blood biomarker levels in patients with rheumatoid arthritis treated with biologic disease-modifying antirheumatic drugs or Janus kinase inhibitors

Objective: to study the dynamics of global longitudinal myocardial strain (GLS) using echocardiography (speckle tracking method) and blood biomarker levels (NT -proBNP, soluble ST2, sST2) in RA patients against a background of 12 months of therapy with biological disease-modifying antirheumatic drugs (bDMARDs) or Janus kinase inhibitors (JAKi). Material and methods. The study included 50 patients with RA (ACR/EULAR criteria, 2010): 84 % were women, median age 51.0 [40.0; 59.0] years, median duration of RA was 4.5 [3.0; 14.0] years, median DAS28 5.7 [5.2; 6.4] points. 78 % of patients were positive for IgM rheumatoid factor, 66 % for antibodies to cyclic citrullinated peptide. At the time of inclusion in the study, 38% of patients were receiving methotrexate, 38 % – leflunomide, 10 % – sulfasalazine, 12 % – hydroxychloroquine, 70 % – glucocorticoids, 82 % – nonsteroidal anti-inflammatory drugs. 60 % of patients with RA had a history of inadequate efficacy of two or more DMARDs. After examination, all patients were prescribed bDMARDs or JAKi. TNF-α inhibitors were given to 38% of patients, anti-B-cell therapy – to 50% of patients, IL-6 inhibitors – to 4%, T-lymphocyte costimulation blockers – to 2 %, JAKi – to 6 % of RA patients. All patients with RA were examined before administration of bDMARDs and in dynamics after 12 months of treatment. Echocardiography was performed – tissue Dopplerography and evaluation by speckle tracking method of left ventricular myocardium GLS (GLD LVM); in blood serum the levels of NT-proBNP, sST2 were determined. The normal range for NT-proBNP was less than 125 pg/ml, and for sST2 less than 17.65 ng/ml. The control group consisted of 20 healthy subjects who were comparable in sex and age. RA patients and subjects in the control group had no cardiovascular disease. Results and discussion. After 12 months of bDMARDs therapy, GLS LVM increased and the frequency of reduced GLS LVM decreased by 47 % (p &lt; 0.05). The indexed end-systolic volume of the left atrium also decreased. RA patients had higher values of NT-proBNP and sST2 compared to the control group (p &lt; 0.05). The variations of NT-proBNP level in blood serum of RA patients after 12 months of therapy were statistically insignificant (p = 0.5). The level of sST2 in the serum of patients with RA decreased significantly after 12 months of therapy compared to baseline (p &lt; 0.01). Direct correlations were found between the delta (Δ) of the level of sST2 and ΔDAS28, the level of ΔsST2 and ΔCRP, and ΔACCP. After 12 months of therapy, RA patients with persistent moderate/high disease activity had higher levels of systolic blood pressure and serum levels of NT-proBNP, lower left ventricular (LV) ejection fraction (LVEF) and GLS LVM than patients who had remission/low RA activity. There were no differences between groups in LVEF, LV size, LV myocardial mass index, and NT-proBNP levels. Negative correlations were observed between ΔGLD LVM and ΔESR and ΔsST2. Conclusion. In patients with RA, a decrease in disease activity on a background of therapy with bDMARDs and JAKi leads to an improvement in GLS LVM. Administration of bDMARDs in patients with active RA and established LV subclinical myocardial dysfunction may slow the progression of myocardial dysfunction. Serum sST2 and NT-proBNP levels were increased in patients with RA compared with the control group. After 12 months of therapy with bDMARDs, the level of sST2 in the serum of RA patients decreased significantly, and the level of NT-proBNP did not change in dynamics.

СРАВНЕНИЕ ИНФОРМАТИВНОСТИ ОПРЕДЕЛЕНИЯ NT-PROBNP ПОЛУКОЛИЧЕСТВЕННЫМ И КОЛИЧЕСТВЕННЫМ МЕТОДАМИ ДЛЯ РАННЕЙ ДИАГНОСТИКИ ХРОНИЧЕСКОЙ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТИ

Вackground. Heart failure (HF) is one of the main causes of morbidity and mortality worldwide. Since it is important to diagnose CH early and quickly, at the outpatient appointment, there is a need to create and introduce into practice a portable highly sensitive method for the determination of BNP, NT-proBNP. Purpose of the study. To determine the possibility of using reagents for semi-quantitative determination of N-terminal brain natriuretic peptide antigen for early detection of heart failure. Methods of statistical analysis. Microsoft Office Excel 2019 program was used. Patient Characterization and Research Methods. An open cross-sectional non-randomized cohort study included 50 patients (mean age 63.5 years) who applied on an outpatient basis for consultation to a cardiologist. In addition to standard clinical, biochemical and instrumental examinations, the concentration of N-terminal brain natriuretic peptide (NT-proBNP) was determined by quantitative and semi-quantitative immunochromatographic method (LLC NPO "BioTest", Novosibirsk). The diagnosis of chronic heart failure (CHF) was established in accordance with national and European recommendations. Methods of statistical analysis. Microsoft Office Excel 2019 program was used. Results and conclusion. In the course of the study, it was found that semi-quantitative method is highly sensitive for detection of small NT-proBNP elevations, which is important for early diagnosis of heart failure, including subclinical forms. Semi-quantitative method also allows to distinguish a group of patients with high NT-proBNP values. The relationship of NT-proBNP level with the course and prognosis of CHF requires further study.

The predictive value of complete blood count-derived indices for major adverse cardiovascular events in MINOCA patients at 5-year follow-up

Introduction: The authors analysed the potential of red blood cell and platelet indices such as red cell distribution width (RDW), mean corpuscular volume (MCV), and mean platelet volume (MPV) as predicting factors in myocardial infarction with non-obstructive coronary arteries (MINOCA) patients of 5-year outcomes. Material and methods: Between 2010–2015 were identified 112 patients who had final MINOCA diagnosis and available laboratory findings. The primary endpoint was the 5-year major adverse cardiovascular events rate, defined as cardiac death, myocardial infarction, or hospitalization due to angina. Results: Only RDW had a significant impact on long-term outcomes. 93 (83%) patients had RDW ≤ 14.5 (group 1), and 19 (17%) patients had RDW &gt; 14.5 (group 2). The mean RDW value was 13.58 ± 1.11%. In group 1 and group 2, mean RDW values were 13.18 ± 0.55%, and 15.54 ± 1.06% (p &lt; 0.001), respectively. Patients with abnormal RDW values (group 2) characterized lower value of left ventricular eject fraction (60 ± 8% vs. 53 ± 13%, p = 0.024), and higher NT-proBNP values (3,170 ± 5,285 pg/mL vs. 6,200 ± 4,223 pg/mL, p = 0.013) as well as troponin levels (501–2500 ng/mL: 31% vs. 53%, p = 0.02). A statistically significant difference was observed only for all-cause death. All-cause death rates for no RDW ≤ 14.5% vs. RDW &gt; 14.5% were 2.2% vs. 21.1% (HR 5.09, 95% CI 1.03–25.2, p = 0.046), respectively. Conclusions: RDW was significantly associated with the increased risk of all-cause mortality in MINOCA patients at 5 years.

Computed tomography-derived myocardial extracellular volume in patients with severe aortic stenosis: correlation with markers of ventricular dysfunction

Abstract Funding Acknowledgements Type of funding sources: None. Background Myocardial fibrosis is a potential adverse prognostic marker in patients with severe aortic stenosis (AS) and can be quantified using non-invasive imaging measures, such as the extracellular volume fraction (ECV). Although computed tomography (CT) for transcatheter aortic valve replacement (TAVR) planning was originally developed to assess the aortic valve complex and access routes, it has evolved to include the measurement of ECV for myocardial tissue characterization. Aim This study aimed to determine associations between CT-derived ECV (ECVCT) and clinical and echocardiographic markers of ventricular function in patients with severe AS referred for TAVR-planning CT. Methods Single-center prospective study enrolling all consecutive patients with severe symptomatic AS referred for TAVR-planning CT between April and November 2022. CT was performed on a 192-slice dual-source 3rd generation scanner (Siemens Somatom Force) and ECVCT was acquired during TAVR-planning using an additional 5-minute post-contrast low-radiation-dose prospective acquisition. ECVCT was calculated as the ratio of change in CT attenuation (Hounsfield units [HU]) of the septal myocardium and the left ventricle (LV) blood pool before and after contrast administration, according to the equation: ECVCT = (1 – hematocrit) x (DHUmyo/DHUblood) – Figure 1A. Results A total of 102 patients were included (mean age 81 ± 7 years; 46% male; mean valvular transaortic gradient 51 ± 14 mmHg; mean aortic valve area 0.7 ± 0.2 cm2; mean LV ejection fraction (EF) by 2D echocardiogram 57 ± 11%). No patient had a clinical diagnosis of cardiac amyloidosis. Overall, the mean ECVCT value was 33.4 ± 7.0%. Myocardial ECVCT values significantly differed between AS subtypes, with higher values in patients with low-gradient AS (n=13, 13%; ECVCT 40.3 ± 4.8% vs 32.4 ± 6.7%, p&amp;lt;0.001) - Figure 1B. Additionally, myocardial ECVCT values correlated with markers of LV and right ventricular (RV) dysfunction, including lower LV EF (r = -0.354, p&amp;lt;0.001), worse LV global longitudinal strain (r = 0.420, p = 0.002), reduced TAPSE (r = -0.230, p = 0.043) and RV S wave by tissue doppler imaging (r = -0.321, p = 0.010) and higher NT-proBNP values (r = 0.347, p = 0.002). Conclusions In patients with severe AS scheduled for TAVR-planning CT, ECVCT values are significantly higher in those with low-gradient AS and correlated with several measures of biventricular dysfunction. This CT parameter may be useful to identify a subgroup of patients with higher risk of adverse prognosis.

Obesity in HFpEF with and without diabetes - Risk factor or innocent bystander?

Heart failure with preserved ejection fraction (HFpEF) is a condition that commonly coexists with type 2 diabetes mellitus (T2DM) and obesity. Whether the obesity-related survival benefit generally observed in HFpEF extends to individuals with concomitant T2DM is unclear. This study sought to examine the prognostic role of overweight and obesity in a large cohort of HFpEF with and without T2DM. This large-scale cohort study included patients with HFpEF enrolled between 2010 and 2020. The relationship between body mass index (BMI), T2DM and survival was assessed. 6,744 individuals with HFpEF were included, of which 1,702 (25%) had T2DM. Patients with T2DM had higher BMI values (29.4kg/m2 vs. 27.1kg/m2, p<0.001), higher NT-proBNP values (864mg/dl vs. 724mg/dl, p<0.001) and a higher prevalence of numerous risk factors/comorbidities than those without T2DM. During a median follow-up time of 47 months (Q1-Q3: 20-80), 2014 (30%) patients died. Patients with T2DM had a higher incidence of fatal events compared to those without T2DM, with a mortality rate of 39.2% and 26.7% respectively (p<0.001). In the overall cohort, using the BMI category 22.5 to 24.9 kg/m2 as the reference group, the unadjusted hazard ratio (HR) for all-cause death was increased in patients with BMI <22.5kg/m2 (HR: 1.27 [CI 1.09-1.48], p=0.003) and decreased in BMI categories ≥25kg/m2. After multivariate adjustment, BMI remained significantly inversely associated with survival in non-T2DM, whereas survival was unaltered at a wide range of BMI in patients with T2DM. Among the various phenotypes of HFpEF, the T2DM phenotype is specifically associated with greater disease burden. Higher BMI is linked to improved survival in HFpEF overall, while this effect neutralises in patients with concomitant T2DM. Advising BMI-based weight targets and weight loss may be pursued with different intensity in the management of HFpEF, particularly in the presence of T2DM.

Wearable cardioverter defibrillator shortens the length of stay: a single center real-world experience

Abstract Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): ZOLL France supported with an unrestricted grant. Background The wearable cardioverter defibrillator (WCD) has been proven to have efficacy in treating sudden cardiac death (SCD) in patients soon after acute myocardial infarction (AMI) and left ventricular ejection fraction (LVEF) ≤35%. However, data regarding hospitalization rate and length of stay among these patients have not yet been evaluated. Purpose WCD can shorten hospital stays (total length, time in intensive care unit (ICU) and in cardiac intensive care unit (CICU)) of patients post-AMI, with severe reduced LVEF. Methods We performed a single center, retrospective observational study of patients prescribed WCD upon hospital discharge, from June 2016 to June 2022. We selected patients referred for management of SCD, post-AMI, with age over 18 years and LVEF ≤35%. Patients who already had ICD or CRT-D (or who had previously received it) were excluded from the analysis. Patients with the same characteristics, and who were discharged from the hospital without WCD or ICD served as a control group. Clinical characteristics were obtained from hospital electronic and WCD specific database. The clinical characteristics and length of index hospitalization of two groups were compared. An initial propensity score analysis was performed, then a weighted regression models for total hospitalization, days in ICU, and days in CICU were conducted. Results 101 patients in the WCD group and 29 in the control group were enrolled in the analysis (Figure 1). The two groups showed similar clinical characteristics (Table 1), even if patients in the WCD group had lower LVEF (p &amp;lt;0.001), more cardiogenic shocks (p = 0.045) and higher NT-proBNP values (p = 0.033). After a propensity score analysis and a weighted regression model, LVEF emerged as independent variable for WCD use (odds ratio (OR) 0.755, confidence interval (CI) 95% 0.654 – 0.872, p &amp;lt;0.001). Left ventricular thrombosis also affected the use of WCD (OR 5.574, CI 95% 1.139 – 27.267, p = 0.0339). In a weighted regression model, WCD significantly influenced the days spent in CICU (p&amp;lt;0.001), and those in ICU even without statistical significance (p = 0.251). Even after excluding all patients undergoing extracorporeal membrane oxygenation (ECMO) or heart transplantation, WCD reduced days spent in CICU (p&amp;lt;0.001). Furthermore, when excluding from the analysis all patients with very long hospitalizations (&amp;gt; 30 days), WCD patients showed significantly shorter total hospitalization (p=0.005) and days spent in CICU (p&amp;lt;0.001), compared with control group. Conclusions At the propensity score analysis, WCD reduce CICU length of stay for patients post-AMI with LVEF ≤35%. The association between WCD use and hospitalization is more relevant for days spent in CICU, but there is also a positive trend for the days spent in ICU. The study has the limitation of a retrospective analysis and can only serve as hypothesis-generating research, which will be verified with further randomized clinical trial.