Higher NT-proBNP Research Articles

Role of beta-blocker therapy on the sympathetic effects in stroke heart syndrome.

Sympathetic activation, inflammation, and neuro-endocrine response after an ischemic stroke contribute to the development of the stroke heart syndrome (SHS). One marker of SHS is a troponin "rise and fall pattern" > 30%. Among the beta-blocker drugs, the β1 antagonist class has a selective effect on the heart against sympathetic neurotransmitters. The aim of this study is to evaluate the possible role of pre-stroke chronic cardioselective β1 blocker treatment (B1B) in preventing SHS. We retrospectively analyzed data of 891 acute stroke patients admitted to the stroke unit at the University Hospital of Trieste (Italy) between 2018 and 2020. In total, 490 patients met the inclusion criteria. Clinical data, imaging characteristics and markers of cardiac injury (troponin I [TnI], N-terminal fragment ofB type natriuretic peptide (NT-proBNP), and "rise and fall pattern" > 30%) and the chronic pre-stroke use of B1B were collected. We compared SHS against lack of SHS (no-SHS), subsequently examining the data through a multivariable analysis to determine possible SHS predictive factors. No association between chronic B1B pre-stroke use and SHS (odds ratio [OR] 1.031; 95% confidence interval [CI] 0.636-1.672; p = 0.900) has been observed. The same result has been found in a sub-analysis on patients with chronic heart failure characterized by high NT-proBNP levels (> 900pg/mL; n = 212), in which no association between chronic pre-stroke use of B1B and SHS (OR 0.807; 95% CI 0.449-1.451; p = 0.474) was identified. In our single-center retrospective cohort, a pre-stroke chronic B1B treatment seems not to prevent the development of SHS, including in patients with NT-proBNP > 900pg/mL with chronic heart failure. These results should be confirmed by future randomized controlled trials to better understand the lack of effect of beta blockers on SHS.

The association between plasma levels of Sestrin2 and risk factors of cardiovascular diseases in healthy and diabetic adults: A study of Qatar Biobank data.

This study examines the association between serum Sestrin2 (SESN2) levels and cardiovascular disease (CVD) risk factors in healthy and diabetic adults, using data from the Qatar Biobank (QBB). A total of 844 participants were included, with 518 in the diabetic cohort and 326 in the healthy cohort. Clinical characteristics, cardiometabolic markers, and SESN2 levels were measured, and binomial logistic regression analyses were conducted to assess the associations between SESN2 and various health indices. Diabetic patients had significantly lower SESN2 levels compared to healthy controls (5.49 ± 5.94 vs 8.25 ± 7.57 ng/mL, P < 0.001). A significant negative correlation was observed between SESN2 and HbA1c (-0.19, P = 0.0006), insulin (-0.19, P = 0.0006), HOMA-IR (-0.17, P = 0.0024), C-peptide (-0.18, P = 0.0012), triglycerides (TG)/HDL ratio (-0.12, P = 0.0283), and the pulsatility index (PI) (-0.15, P = 0.006). In healthy individuals, higher SESN2 levels were associated with lower odds of elevated HbA1c (adjusted odds ratio [AOR] = 0.33, P = 0.00), insulin (AOR = 0.23, P = 0.00), HOMA-IR (AOR = 0.58, P = 0.06), C-peptide (AOR = 0.56, P = 0.04), and TG (AOR = 0.37, P = 0.03). In contrast, diabetic patients showed a positive correlation between SESN2 and insulin (0.15, P = 0.0005), HOMA-IR (0.11, P = 0.0106), and C-peptide (0.12, P = 0.0048). Participants in the highest SESN2 tertile had increased risks for high BMI (AOR = 1.96, P = 0.05), high TG (AOR = 1.57, P = 0.04), high NT-proBNP (AOR = 7.27, P = 0.01), and high fibrinogen (AOR = 1.92, P = 0.03). These findings suggest that while high SESN2 levels are cardioprotective in healthy individuals, they may indicate higher cellular stress in diabetics. Determining optimal SESN2 levels could help assess CVD risk, particularly in diabetic patients.

Clinical outcomes of pregnancy in patients with pulmonary hypertension: A single center observational study

BackgroundPulmonary hypertension (PH) is associated with right ventricular failure in pregnant women and increases maternal morbidity and mortality during parturition and postpartum periods. According to current guidelines, pregnancy is contraindicated in women with PH. However, in recent decades, favorable outcomes have been observed in cases where the disease is well controlled. However, several questions remain unanswered regarding this issue.ObjectiveThis study aimed to investigate the medium-term outcomes of pregnancy in women with PH and to identify predictors for poor pregnancy outcomes in this population.MethodsA retrospective review of the medical records at our hospital was conducted to identify pregnant women with PH between July 2017 and December 2021. We collected data on maternal age, gravidity, parity, PH category, New York Heart Association Function class, N-terminal-pro Brain natriuretic peptide (NT-ProBNP) levels, mode of delivery, type of anesthesia, use of advanced therapy, and fetal outcomes. Based on the severity of PH, patients were categorized into three groups: group A systolic pulmonary arterial pressure (SPAP) 40–50 mmHg, group B 50–70 mmHg, and group C SPAP ≥ 70 mmHg.ResultsThe study included 78 individuals in group A, 22 in group B, and 18 in group C. Of the 118 individuals, 80 were classified as having pulmonary arterial hypertension (PAH), including congenital heart disease-associated PAH, idiopathic PAH, and other PAH subtypes, while 38 were classified as having PH associated with left heart disease (PH-LHD). The mortality rate was higher in the PAH category (6.3%, 5/80) than in the PH-LHD category (2.6%, 1/38). The NT-proBNP value was highest in group C (1723.5 ± 738.0pg/ml), compared with group B (196.6 ± 79.6 pg/ml) and group A (128.7 ± 54.3 pg/ml). Overall maternal mortality was 5.1% (6/118), with significantly higher mortality rates observed in group C (27.8%, 5/18) compared to group B (4.6%, 1/22), and no deaths in group A. Compared to groups A and B, gestational duration was shorter (median 26 weeks), and abortion rates were higher (38.9%, 7/18) in group C. Cesarean section rates were high across all three groups. The overall maternal mortality rate was 5.1% (6/118). Of them, five individuals were in group C, only one woman had moderate PH with perinatal cardiomyopathy and a lower LVEF of 15%. There was no maternal mortality in Group A with mild PH. All maternal deaths occurred postpartum. Excluding 17 cases of miscarriage (gestation less than 28 weeks), the overall offspring mortality rate was 4.0% (4/101), with one fetal mortality in group B, three fetal deaths in group C, and no fetal mortality observed in group A.ConclusionSevere PH and high NT-proBNP levels are strongly correlated with increased maternal mortality rates in pregnant women. Conception should be contraindicated in cases of severe PAH with elevated NT-proBNP levels. In situations where unplanned pregnancy occurs in severe PAH patients with decompensated heart function, early pregnancy termination and multidisciplinary management are crucial to ensure maternal safety. However, pregnancy should be considered individually in women with moderate and mild PH and preserved right heart function.

Effects of exercise training on nitric oxide metabolites in heart failure with reduced or preserved ejection fraction: a secondary analysis of the SMARTEX-HF and OptimEx-Clin trials.

Exercise has been shown to affect the nitric oxide (NO) pathway, which is involved in the pathophysiology of endothelial dysfunction in heart failure (HF) with reduced (HFrEF) and preserved ejection fraction (HFpEF). However, the effects of different exercise modes on NO metabolites in patients with HF are uncertain. Blood samples from two randomized controlled HF trials evaluating 1.) high-intensity-interval-training (HIIT), 2.) moderate-continuous-training (MCT) or 3.) a control group (CG) in HFrEF (SMARTEX-HF) and HFpEF (OptimEx-Clin) were analysed for NO metabolites L-arginine, homoarginine (hArg), asymmetric and symmetric dimethylarginine (ADMA; SDMA). Metabolite plasma concentrations were compared between HFrEF and HFpEF at baseline and within each HF type after 3 months of supervised exercise training and 12 month-follow-up. Overall, 206 patients with HFrEF (61±12 years, 18.9% females) and 160 with HFpEF (70±8 years, 65.6% females) were investigated. Baseline hArg (1.74±0.78 vs. 1.31±0.69 µmol/l) and ADMA (0.68±0.15 vs. 0.62±0.09 µmol/l) were significantly higher in HFrEF (p<0.001). NO metabolites showed several significant associations with markers of HF severity like exercise capacity (VO2peak) and NT-proBNP, but not with measures of endothelial function (reactive hyperaemia index, flow-mediated dilation). After 3 months of exercise and 12-month-follow-up, changes in metabolite plasma levels were not significantly different between study groups (HIIT, MCT or CG) (pgroup*time >0.05), neither in HFrEF nor HFpEF. Baseline NO metabolite profile was unfavourable in patients with HF and lower VO2peak or higher NT-proBNP. We did not find a significant influence of HIIT or MCT on NO metabolites at 3 and 12 months.

Abstract P3009: Biomarkers and Risk of Cognitive Impairment in Atrial Fibrillation: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Cohort

Introduction: Atrial fibrillation (AF) is highly prevalent, and its health effects outside of stroke are under intense study. AF increases dementia risk, but underlying mechanisms are unknown. Stroke or cerebrovascular pathophysiology, possibly attenuated with anticoagulation, may be contributory. Hypotheses: We assessed two hypotheses: (1) that higher levels of 9 circulating biomarkers (see Figure) would be associated with greater risk of incident cognitive impairment (ICI) in REGARDS participants with AF, and (2) that associations would be attenuated after adjusting for oral anticoagulant use. Methods: REGARDS enrolled 30,239 persons &gt; 45 years old in 2003-07. AF was defined by self-report or ECG. ICI was defined during follow-up by robust cognitive norms based on the Montreal Cognitive Assessment and Six-Item Screener. Biomarkers were measured at baseline in participants with AF and no prior stroke. HRs of time to ICI by biomarkers were calculated by Cox proportional hazards models, with covariates shown in the Figure. Interaction testing by baseline oral anticoagulant use was also performed. Results: Among 2,261 participants with baseline AF, mean follow-up was 10.6 years (mean age 66.5 years, 51% women, 28.7% Black), and there were 149 ICI cases (7%). Higher NT-proBNP, FVIII, and GDF15 were each associated with ICI (Figure), with the largest association for FVIII (HR adj 2.41 per SD higher FVIII). Added adjustment for anticoagulant use did not attenuate associations, but the association of GDF15 was lower among those on anticoagulation (HR 1.0, 95% CI 0.4-2.6 compared to HR 1.8, 95% CI 1.1-3.0 without anticoagulation; p interaction 0.07). Conclusion: Higher NT-proBNP, FVIII, and GDF15 were associated with ICI in this biracial cohort with AF. Risk associated with GDF15, an inflammation marker, might be reduced with anticoagulation, but further study is needed.

Abstract P3011: Empirically derived biomarker patterns in the REasons for Geographic and Racial Differences in Stroke Study

Background: Contemporary molecular epidemiologic approaches often consider individual or small groups of biomarkers and their relationship to cardiovascular disease risk factors or events. Factor analysis can group many biomarkers that represent the physiology and dysfunction of multiple organ systems into a small number of distinct patterns. These patterns may better reflect the complexity of human physiology and advance understanding of cardiovascular disease onset. We sought to empirically identify such patterns using factor analysis, and hypothesized that biomarkers would cluster into distinct patterns. Methods: REGARDS recruited 30,239 Black and White adults aged ≥45 years from the continuous US in 2003-2007 with a second visit in 2013-2016. Specialized biomarkers were measured in specimens collected at baseline from 4,400 participants who attended both visits; lipids, C-reactive protein (CRP), cystatin C, urine albumin/creatinine ratio, complete blood count, blood urea nitrogen (BUN), and serum albumin were measured in all or most participants. Factor analysis was used to derive patterns in a random split sample. Scree plot guided selection of factors used an eigenvalue cut point of 1. Validity was confirmed across race, sex, and age groups (&lt;55, 55 to &lt;65, 65 to &lt;75, and ≥75 years) A congruence test coefficient &gt;0.5 was considered acceptable. Final factor patterns were derived in the entire analytical sample using a 3-factor solution and named based on biologically known pathways. Results: Of the 4,400 participants, 31% were excluded who were missing any biomarker leaving an analytical sample of 2,723. The congruence coefficient between the factors was &gt;0.78 for all subgroup comparisons. As is shown in the Figure , the “thrombo-inflammatory” pattern (pattern 1) had higher levels of inflammation, coagulation, and leptin; the “renal-inflammatory” pattern (pattern 2) had high levels of inflammation, renal dysfunction, and also high NT-proBNP and proenkephalin; the “dyslipidemic-inflammatory” pattern (pattern 3) had high levels of inflammation and triglycerides and low levels of HDL and adiponectin. Discussion: Three observed biomarker patterns had strong congruence across race, sex, and age groups. Future research will determine if these patterns are associated with cardiovascular risk factors and events.

Cardiovascular Manifestations of People Living with HIV/AIDS: A Report from a Tertiary Care Hospital

Abstract- BACKGROUND : To study the profile and characteristics of cardiovascular abnormalities among PLWHA (patients living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) at a tertiary care hospital in India. The association of cardiovascular abnormalities with the CD4 count and disease stages, according to the World Health Organization (WHO) classification, was also analyzed. METHODS : A total of 200 [diagnosed as per the NACO criteria] were compared with 50 healthy controls. The predominantly young cohort of our study represents the HIV/AIDS population of India patients with HIV/AIDS. All patients underwent blood investigations, chest X-ray, electrocardiography, echocardiography, High sensitive NT pro BNP RESULTS: The mean age of the patients was 38.66 ± 9.22 years, with a male-to-female ratio of 3.25:1. Echocardiographic abnormalities were found in 52% of the patients and 12% of the controls, with the most common abnormality being left ventricular diastolic dysfunction. Echocardiographic abnormalities were markedly more common in patients with a CD4 count of &lt;200/mL The advanced stage of the disease, according to the WHO classification, was also associated with an increased incidence of echocardiographic abnormalities. CONCLUSION : Cardiovascular abnormalities in the form of electrocardiogram and ECHO findings were present in 54.5% and 52% of patients, respectively. Echocardiographic findings showed significant correlation with CD4 count and WHO disease stage.

Bone morphogenetic protein 10 is increased in precapillary pulmonary hypertension patients.

Precapillary pulmonary hypertension (precPH) results in increased right atrial (RA) stretch and pressure. The right atrium is the major source of bone morphogenetic protein 10 (BMP10) in adults, primarily produced by RA cardiomyocytes. The aim of this study was to investigate BMP10 expression in the right heart and systemic circulation and to identify potential triggers for increased BMP10 secretion associated with precPH. We examined BMP10 mRNA and protein expressions in RA tissue. Circulating BMP10 plasma levels were determined using ELISA. BMP10 transcriptional activity was studied using a BRE-Luciferase assay. Correlation analyses were performed between circulating BMP10 and RA dilatation as well as right ventricular (RV) function. Finally, we determined the impact of pressure unloading on BMP10 activity in Chronic Thromboembolic Pulmonary Hypertension (CTEPH) patients before and after pulmonary endarterectomy (PEA).BMP10 mRNA, protein and activity were significantly increased in the precPH right atrium. While circulating BMP10 protein levels were elevated, no significant changes were observed in BMP10 transcriptional activity between precPH and controls. Interestingly, RA dilatation, increased RA pressure, high NTproBNP levels and reduced RV ejection fraction were associated with high BMP10 activity. Finally, pressure unloading after PEA in a cohort of CTEPH patients, resulted in reduced BMP10 activity. In conclusion, RA BMP10 expression and plasma levels are increased in precPH, likely triggered by excessive RA dilatation and pressure overload. Future studies are needed to determine whether increased BMP10 release is an adaptive mechanism or a potential therapeutic target.

Comprehensive study of various vitamin concentrations in the human postmortem blood with an autopsy case report of beriberi.

Comprehensive study of various vitamin concentrations in the human postmortem blood with an autopsy case report of beriberi.

Differential diagnosis of hypertrophic cardiomyopathy, fabry cardiomyopathy and transthyretin cardiac amyloidosis: insights from right ventricular strain imaging echocardiography

Abstract Introduction Timely differential diagnosis between hypertrophic cardiomyopathy (HCM), Fabry cardiomyopathy (FC) and wild-type transthyretin cardiac amyloidosis (ATTR-CA) is crucial for appropriate treatment and family screening. Right ventricle (RV) involvement is common in these diseases, making the systematic RV assessment essential. Two-dimensional speckle-tracking echocardiography (2D-STE) offers potential for precise RV myocardial mechanics evaluation, however its utility in distinguishing these conditions remains uncertain. Methods This study retrospectively compared matched controls (n=30) with three patient cohorts of nonobstructive HCM (n=30), ATTR-CA (n=30) and FC (n=30) referred to cardiomyopathy consultation between 2014 and 2021. Two blinded researchers independently performed morfofunctional echocardiographic evaluation of RV and 2D-STE analysis of RV myocardial strain. Receiver operating characteristic (ROC) analysis assessed the diagnostic performance of these parameters. Inter- and intra-observer reproducibility used Bland-Altman analysis and intraclass correlation coefficients. Results Male gender predominated in all groups (ATTR-CA 50%; FC 63%; HCM 63%). ATTR-CA patients were older when compared to FC and HCM (Median [IQR]: 84 [5] vs. 64.5 [18.75] vs. 57 [18.25] years, p&amp;lt;0.001) and had higher NT-proBNP (Median [IQR]: 5841 [11742] vs. 467 [1203] vs. 812 [857] pg/ml, p&amp;lt;0.001). ATTR-CA patients had the highest RV wall thickness (RVWT) in comparison to FC (9.0 vs. 7.4 mm, p=0.001) and HCM (9.0 vs. 5.5 mm, p&amp;lt;0.001). Patients with ATTR-CA had lower TAPSE (p=0.001), RV S’ (p=0.001), and RV-FAC values (p=0.003) compared to FC, with no significant differences compared to HCM. RV global longitudinal strain (RV-GLS) and RV free wall strain (RV-FWS) were significantly reduced in ATTR-CA (11.6% ± 4.7 and 15.5% ± 7.6) comparing to FC (19.3% ± 3.2 and 24.7% ± 3.9) and HCM (18.9% ± 3.1 and 25.6% ± 5.2) (p&amp;lt;0.001). RV systolic dysfunction according to RV strain analysis (RV-FWS &amp;lt;23%) led to substantial reclassification and increased prevalence in all groups (ATTR-CA: 37% to 87%; FA 0% to 20%; HCM: 3% to 27%). In ROC analysis, RV-GLS emerged as the most effective parameter for distinguishing ATTR-CA from FC (AUC 0.91; 95% CI 0.81-0.97, p&amp;lt;0.001) with an optimal cut-off of 15.0% yielding 83% sensitivity and 93% specificity. RVWT was the best discriminative parameter for distinguishing ATTR-CA from HCM (AUC 0.98; 95% CI 0.90-0.99, p&amp;lt;0.001; optimal cut-off of 6.5mm; 97% sensitivity, 90% specificity) and FC from HCM (AUC 0.91, 95% CI 0.81-0.97, p&amp;lt;0.001; optimal cut-off of 6.5mm; 83% sensitivity, 90% specificity). RVWT and strain parameters analyses were consistent Intra- and inter-observer with excellent agreement. Conclusion This study underscores the importance of RV thickness and RV-GLS for the differential diagnosis of HCM from phenocopies.

Associations Between Albumin/Neutrophil-to-Lymphocyte Ratio Score and New-Onset Atrial Fibrillation in Patients with Acute Myocardial Infarction Undergoing PCI.

Inflammation was associated with the increased risk of atrial fibrillation (AF). As a novel inflammatory indicator, albumin/neutrophil-to-lymphocyte ratio score (ANS) has been demonstrated to associate with coronary artery disease. However, the relationship between ANS and new onset atrial fibrillation (NOAF) in patients with acute myocardial infarction (AMI) underwent PCI was not determined. A total of 2410 AMI patients underwent PCI were consecutively included between March 2020 and December 2023. Patients were divided into NOAF group and control group according to the occurrence of NOAF during hospitalization. The ANS was calculated and analyzed, so as to determine its predictive value in the presence of NOAF in AMI patients after PCI. In total, 88 (3.7%) individuals developed NOAF during hospitalization. We found that NOAF was associated with older age, greater LA, higher NT-proBNP, ANS and Killip ≥ 2. The ANS exhibited an accurately predictive value for the NOAF (area under the curve [AUC], 0.695; 95% CI, 0.649-0.740, P < 0.001). Moreover, when divided into three groups according to the tertile of ANS, patients in tertile 1 (lowest in ANS) showed a 2.214-fold increased risk of NOAF in comparison to those in the tertile 3 (HR, 2.214; 95% CI 1.804-5.101; P = 0.029). ANS is a robust tool for the prediction of NOAF in AMI patients underwent PCI. Therefore ANS could be used for risk prediction and optimal management for NOAF in AMI patients after PCI.

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.

High NT pro-BNP levels in children with malignant disorder receiving intensive fluid treatment: a prospective comparative study.

Hematologic malignancies are a well-known risk factor for cardiovascular disease development. Chemotherapeutic protocols commonly include intensive fluid therapy (IFT), which may negatively influence the cardiovascular system and predispose to arterial hypertension. This study aims to evaluate atrial natriuretic peptide (NT-proBNP), high-sensitivity troponin T (hs-TnT), and changes in blood pressure in children with hematological malignancies undergoing intensive fluid therapy. This prospective cohort study comprised thirteen children. 24-h ambulatory blood pressure monitoring (ABPM) and concentrations of NT-proBNP and hs-TnT were performed on the first day of IFT and during follow-up. There were no statistically significant differences in 24-h, daytime, night-time systolic (SBP) and diastolic blood pressure (DBP), SBP and DBP dipping, and the number of non-dippers during intensive fluid therapy compared to the control points. The mean NT-proBNP concentration at 24 h was 321.27 ± 318.08 pg/mL and was significantly higher compared with baseline (79.13 ± 105.42 pg/mL) and follow-up (175.92 ± 241.48 pg/mL); p-values 0.005 and p = 0.006 respectively. Troponin T concentration at 24 h was not significantly different compared with baseline and follow-up. These results show no significant influence of intensive fluid therapy on blood pressure profile. In contrast, an increase in NT-proBNP values 24 h after the start of fluid therapy may reflect the impact of fluid overload on the cardiovascular system.

Abstract 4142209: Left Atrial Pressure at Time of Atrial Fibrillation Ablation: A Tool in The Diagnosis of Underlying CHF and Risk of Readmission

Background: Patients with CHF at time of AF ablation are more likely to have earlier (&lt;90 days) AF recurrence, more CHF exacerbations, and prolonged index hospitalization. The diagnosis of CHF in those with AF can be confounded by their overlapping symptoms leading to under-recognition and delays in care. This study aims to determine whether elevated left atrial mean pressure (LAP) at time of AF ablation, measured immediately after transseptal catheterization, allows for detection of previously undiagnosed and undertreated CHF, and whether this may serve as a marker for patients at higher risk of AF recurrence and rehospitalization. Methods: A retrospective chart review was performed of all patients ≥18 years old at an academic medical center with a diagnosis of AF and who underwent AF ablation between 5/2022 and 9/2023. The cohort was divided into those with LAP ≥15 mmHg and those with LAP &lt;15 mmHg at time of AF ablation. Baseline demographics, comorbidities, readmission rates, GDMT, and antiarrhythmic prescription rates were collected. Results: This analysis included 238 patients (31.5% female). At time of ablation, 77 (32.4%) had a LAP ≥ 15 mmHg, of which 34 (44.2%) did not have a pre-existing diagnosis of CHF. Those with LAP ≥15 were more likely to be on RAAS inhibition (57.1% vs 43.5%, p=0.048), MRA (23.4% vs 8.7%, p=0.002), and SGLT2i (23.4% vs 10.6% p=0.009) compared with those with a normal LAP. While not reaching statistical significance, elevated LAP was associated with higher NT-proBNP at time of ablation (1657 vs 930 p=0.129) despite higher BMIs (34.8 vs 30.1, p&lt;0.001), with a trend towards increased 90-day readmission (9.1% vs 3.7%, p= 0.088). Discussion: LAP measurement identified a significant number of patients undiagnosed with CHF (44.2%). Elevated LAP also trended toward higher NT-proBNP despite having a higher BMI. Although rates of GDMT were higher for those with LAP ≥15 mmHg, the group remained significantly undermedicated, particularly with SGLT2i (29.3%, p&lt;0.001) and MRA (26.3%, p&lt;0.001). This may indicate suboptimal GDMT for both HFrEF and HFpEF. While not reaching statistical significance, this lack of recognition of CHF and subsequent lapse in GDMT prescription likely influenced the trend towards increased 90-day readmissions post ablation (p=0.088). Further work is needed to determine if identification of patients with elevated LAP at time of AF ablation can be prospectively optimized on GDMT improve outcomes post ablation.

Abstract 4141419: Predictors of Mortality and Hospitalization in Heart Failure with Preserved Ejection Fraction with Low NT-proBNP Levels

Introduction: Many patients with heart failure with preserved ejection fraction (HFpEF) have relatively low natriuretic peptide (NP) levels, often related to obesity. The predictors of mortality and hospitalization (CV outcomes) within HFpEF patients with low NT-proBNP levels remain unclear. In this study, we examined these predictors, comparing HFpEF with low NT-proBNP (HFpEF-LoBNP) and high NT-proBNP (HFpEF-HiBNP) groups. Methods: Patients from the Johns Hopkins HFpEF Clinic (July 2014 - May 2024) were categorized into HFpEF-LoBNP (&lt;125 pg/mL) and HFpEF-HiBNP (≥125 pg/mL) groups. Diagnosis relied on clinical findings, standard echocardiography, and right heart catheterization when available. Group differences were analyzed using Chi-square or Mann-Whitney U tests. Cox models examined associations with CV outcomes, and Kaplan-Meier analysis assessed the combined factor impact on outcomes. Analyses compared within each BNP level category (HFpEF-LoBNP and HFpEF-HiBNP) those who experienced CV outcomes versus those who did not. Results: A total of 378 HFpEF patients were included, categorized as HFpEF-LoBNP (107 patients) and HFpEF-HiBNP (271 patients), with a median follow-up period of 36 months. Within the HFpEF-LoBNP group (mean age 59.5 years, 68% female), 26 (24.3%) experienced CV outcomes. HFpEF-LoBNP patients with CV outcomes had higher diabetes prevalence, HbA1c, RA pressure, PA systolic pressure, RV systolic pressure, PA diastolic pressure, PCWP, PVR, and lower albumin (Figure A) compared to HFpEF-LoBNP patients without CV outcomes. No significant differences were found in other characteristics. Within the HFpEF-HiBNP group (mean age 68.2 years, 59.4% female), 98 (36.2%) experienced CV outcomes. HFpEF-HiBNP patients with CV outcome were more likely to be on β-blocker therapy, had a higher E/e' ratio, NT-proBNP, cystatin C, uric acid, RV systolic pressure, PA systolic and diastolic pressures, PCWP, PVR, and lower albumin compared to those without CV outcomes (Figure B). There were no notable differences in other characteristics. Kaplan-Meier graphs showed poorer outcomes with an increasing number of factors in each subgroup (Figures C&amp;D). Conclusion: NT-proBNP is linked to HF prognosis but often low in HFpEF. HFpEF-LoBNP patients still face high CV outcomes. Predictors of CV outcomes in HFpEF-LoBNP, similar to HFpEF-HiBNP, include higher pulmonary pressures. Alternative prognosis markers, like hemodynamic testing, are needed for HFpEF-LoBNP patients.

Abstract 4140272: Prevalence, Clinical Correlates, and Outcomes of Tricuspid Regurgitation Among Older Adults: The Atherosclerosis Risk in Communities Study

Introduction: Tricuspid regurgitation (TR) prevalence increases with age and is associated with higher mortality. Limited data exist regarding the prognostic relevance of TR among older adults in the general population. Objective: To estimate the prevalence of TR in late life, identify cardiac structural and functional measures associated with TR severity, and determine the prognostic relevance of TR severity. Methods: In the community-based Atherosclerosis Risk in Communities (ARIC) study, 3,046 participants underwent protocol echocardiography at the 7th study visit (2018-2019). TR severity was assessed qualitatively as none/trace, mild, moderate, or severe by a board-certified cardiologist. Dyspnea was assessed using the modified Medical Research Council questionnaire and post-Visit 7 mortality was ascertained through the National Death Index. Cross-sectional associations of TR severity with clinical characteristics, echocardiographic measures, and dyspnea were assessed using multivariable linear and logistic regression models. Associations with death were assessed using Cox proportional hazard models adjusted for demographics. Results: Mean age was 81±4 years, 58% were women, 25% reported Black race, and mean LVEF was 63±8%. TR prevalence was 30% mild, 9% moderate, and 1% severe. Greater TR severity was associated with older age, female sex, higher HF prevalence, and loop diuretic use. Greater TR severity was also associated with lower LVEF, worse LV diastolic function (higher LAVi, E/A, E/e’ septal), higher NT-proBNP, higher prevalence of moderate-severe mitral regurgitation, greater pulmonary artery systolic pressure, and larger RV size. Severe TR was associated with higher odds of moderate-severe dyspnea (OR:2.3 [1.2-4.5], p=0.012). During follow-up (median 2.1 years [IQR 1.7-2.5]), 192 participants died. Higher TR severity was associated with greater mortality (Figure). Compared to participants with none/trace TR, even mild TR was associated with a 64% greater mortality risk. Conclusion: TR is common in late life and is associated with greater left heart disease despite generally preserved LVEF. Greater TR severity, even when mild, is a marker of increased mortality. Longer follow-up is needed to determine whether this risk is independent of concomitant left heart dysfunction.

Abstract 4147677: Exercise Pulmonary Vascular Resistance relates to impaired RV-PA coupling and effort intolerance in HFpEF

Introduction: Elevated pulmonary vascular resistance (PVR) during exercise is a proposed marker of negative prognosis in patients with heart failure with preserved ejection fraction (HFpEF), however its pathophysiology is incompletely characterised. We investigate here the relative contribution to exercise-induced PVR on right ventricular (RV) functional and structural remodelling and pulmonary artery (PA) coupling during exercise in HFpEF patients. Methods: We included 67 consecutive patients from the Johns Hopkins HFpEF Clinic where supine bicycle exercise right heart catheterisation (RHC) was available. In agreement with previous studies, we defined 2 distinct subgroups: patients with elevated exercise-induced PVR (HFpEF-highPVR), including patients with PVR ≥ 1.74 WU at maximal effort and those without exercise-induced PVR (HFpEF-normalPVR) patients with PVR &lt; 1.74 WU at maximal effort. Echocardiography and RV endomyocardial biopsy (EMB) data were analysed to assess cardiac structural and functional remodelling associated with HFpEF-highPVR. Results: From the total of 67 patients, 23 (34%) had elevated PVR at rest (PVR≥2 WU) of which 17 (74%) continued on to have exercise-induced PVR (PVR≥1.74 WU). From 44 (66%) patients without elevated PVR at rest, 4 (9.1%) further developed PVR at maximal exercise. (Figure1A). HFpEF-highPVR were older, had lower eGFR and higher NT-proBNP, than HFpEF-normalPVR. Maximal exercise tolerance was severely reduced in the HFpEF-highPVR group (14.0±13.7 vs 31.4±16.9 watts, P&lt;0.001; Figure 1B). HFpEF-highPVR was associated with lower PA compliance (2.7±1.0 vs 5.2±1.7 mL/mmHg, P&lt;0.001), higher PA elastance (840±320 vs 441±138 mmHg/mL, P&lt;0.001) and higher diastolic pulmonary gradient (4.71±4.23 vs 2.07±2.69 mmHg, P=0.014). Patients with HFpEF-highPVR had a higher frequency of RV dilatation (OR=5.42, 95%CI 1.36-21.70, P=0.012), LV restrictive diastolic filling (OR=3.80, 95%CI 1.08-13.37, P=0.031) by echocardiography, and, higher frequency of moderate and severe hypertrophy (OR=4.80, 95%CI 1.48-15.61, P=0.007) and presence of fibrosis (OR=4.71, 95%CI 1.18-18.80, P=0.021) on EMB. Conclusion: Patients with elevated PVR during exercise had more pronounced maladaptive RV remodelling and less compliant PA, which contributed to impaired hemodynamic and lower endurance. Assessing exercise PVR can offer an important distinct insight into HFpEF phenotype classification and further stratify clinical risk.

Abstract 4143538: A Predictive Tool and Diagnostic Screening Algorithm for the Identification of Transthyretin Amyloid Cardiomyopathy in High-Risk Patient Populations

Introduction: Transthyretin amyloid cardiomyopathy (ATTR-CM) is an underdiagnosed disease that may result in heart failure (HF), arrhythmias, and valvular disease. Our aim was to develop (1) screening criteria to identify high-risk patients for ATTR-CM and (2) our own predictive tool of ATTR-CM. Methods: This was a prospective observational registry at 2 academic sites in Canada. We designed screening criteria to identify high-risk patients in HF, atrial fibrillation, transcatheter valve clinics, and in cardiologist’s offices from January 2019-December 2022. Patients &gt;60 years were included if one of several screening criteria was met and they were referred for pyrophosphate scan by the cardiologist. Univariate and multivariate logistic regression were used to identify predictive clinical, imaging, and biochemical characteristics. Results: In total, 2500 patients were screened, and 200 patients were enrolled with a follow-up duration of 3 years. The mean age was 78 years and 65% were male. Forty-six (23%) had a diagnosis of ATTR-CM and 7 (4%) were diagnosed with AL-amyloidosis. ATTR-CM patients were older (83±7 vs. 77±8; p&lt;0.001), predominantly male (80 vs. 60%, p=0.01), symptomatic (NYHA III-IV) (46 vs. 19%; p&lt;0.001) and had higher NT-proBNP (3633 vs. 2018; p=0.01). Fewer were on beta-blocker (p&lt;0.001) and renin-angiotensin inhibitors (p=0.01), and more were on amiodarone (p=0.008). They had larger left ventricular posterior wall diameters (14±3 vs. 11±2; p&lt;0.001). On electrocardiogram, ATTR-CM patients had lower voltages (37 vs. 4%; p&lt;0.001) and more atrioventricular blocks (39 vs. 19%; p=0.02). Tissue doppler (E/e’) was higher in ATTR-CM patients (18±7 vs. 14±6; p=0.001). The positive predictive value (PPV) for our screening criteria ranged from 16-38%, with the highest PPV and negative predictive value (NPV) for age ≥70 years and new HF (PPV 38%, NPV 95%). We identified 5 key predictors of ATTR-CM to develop a practical tool for clinicians with a score of ≥7 meeting criteria for further testing (Figure 1). This tool had a sensitivity of 89%, specificity of 85%, PPV of 64%, NPV of 96%, and an area under receiver operating characteristic curve of 0.9. Conclusion: Broad screening criteria applied to high-risk patient populations yielded new ATTR-CM diagnoses in 23% of patients. Screening tools for ATTR-CM can be used to help clinicians identify patients who should undergo further testing. Further studies are needed to validate our predictive tool.

Clinical and Demographic Characteristics of Patients Hospitalized for Decompensated Heart Failure with Extremely High NT-proBNP Levels.

NT-proBNP levels with a wide range at admission play both a diagnostic and a prognostic role in patients with HF. The differences regarding the clinical profiles and demography in decompensated HF patients according to NT-proBNP levels at admission are not clear. This study aimed to analyze and compare clinical profiles and demographics in patients hospitalized for decompensated heart failure according to levels of NT-proBNP at admission. The study included 302 patients hospitalized for decompensated HF who were divided into three groups based on admission NT-proBNP levels: group A (n = 46, with NT-proBNP level < 3000 pg/mL), group B (n = 130, NT-proBNP level between 3000-10,000 pg/mL), and group C (n = 126, NT-proBNP level > 10,000 pg/mL). Patients hospitalized with decompensated HF and very high levels of NTproBNP, above 10,000 pg/mL at admission, are older, have a lower LVEF, higher NYHA class, more renal dysfunction, and longer hospital stay, resulting in a more severe clinical profile. The presence of very high levels of NT-proBNP may identify a category of patients with a more severe prognosis that requires more aggressive management and closer follow-up.

Obesity Paradox and the Effect of NT-proBNP on All-Cause and Cause-Specific Mortality.

In heart failure patients, obesity is associated with better outcomes as compared to normal weight, a phenomenon called the obesity paradox. To examine if obesity modifies the relationship between NT-proBNP and all-cause and cause-specific mortality in adults without coronary artery disease or heart failure history. We used the National Health and Nutrition Examination Survey (NHANES) data from 1999 to 2004 and linked it with mortality through December 31, 2019. Participants > 18 years were categorized into normal weight (BMI ≤ 25 kg/m2), overweight (BMI > 25-29.9 kg/m2) and obese (BMI > 29.9 kg/m2). NT-proBNP levels were categorized as low (< 126 pg/mL) or high (≥ 126 pg/mL). Using Cox proportional hazard models, we examined effect modification by obesity using interaction, without and with adjusting for potential confounders. Of the 12 621 participants, 2794 (22%) died during 202 859 person-years follow-up. In adjusted models, normal-weight participants with high NT-proBNP had 2 times higher all-cause mortality risk than those with low NT-proBNP (HR = 2.05; 95%CI = 1.74, 2.41; p < 0.001); however, this mortality risk was 27% lower in obese participants (HR interaction = 0.73; 95%CI = 0.59, 0.92; p = 0.008). Similarly, in normal-weight participants, the difference in other-cause mortality risk between high and low NT-proBNP participants was significant in adjusted models (HR = 2.27; 95%CI = 1.81, 2.85; p < 0.001) and obese participants had 48% lower other-cause mortality risk between those with high and low NT-proBNP (interaction HR = 0.52; 95%CI = 0.36, 0.77; p = 0.001). Conversely, obesity did not modify the relationship between NT-proBNP and cardiovascular or cancer mortality. In patients free of heart failure or coronary artery disease, obesity may be protective against mortality associated with high NT-proBNP.